De Winter Research Articles

De Winter T-wave Pattern in Proximal Left Anterior Descending Artery Occlusion.

Case PresentationWe describe a case of an acute myocardial infarction with an atypical electrocardiogram showing a de Winter T-wave pattern suggesting the 100% proximal left anterior descending artery occlusion seen on emergent cardiac catheterization.DiscussionTimely recognition of acute myocardial ischemia is paramount for emergency providers. As highlighted in this case, It is important to be mindful of atypical electrocardiogram findings, such as de Winter T-waves, which suggest acute myocardial ischemia.

Evolutionary de Winter pattern: from de Winter ECG to STEMI-A case report

BackgroundDe Winter pattern is associated with acute occlusion in the left anterior descending coronary artery combined with upsloping ST-segment depression at the J point in leads V1 through V6 without ST-segment elevation. The ECG changes in this case were illustrated by an up-sloping ST-segment depression in the V1 to V6 leads, followed by tall and symmetrical T waves. Changes from de Winter to ST-segment elevation myocardial infarction (STEMI) are rare.Case presentationOur case illustrated an evolutionary de Winter sign that changed to STEMI; the patient underwent cardiac catheterization in time.ConclusionsPatients who have an electrocardiogram showing de Winter changes may require primary percutaneous coronary intervention. Emergency physicians and cardiologists should not ignore these changes.

Total Occlusion of the Left Descending and circumflex Coronary Artery without ST Elevation: the De Winter electrocardiographic pattern

de Winter syndrome, or anterior ST segment elevation myocardial infarction (STEMI), constitutes 2% of acute myocardial infarctions. In contrast to classic ST segment elevation as seen with STEMI, it involves ST depression with precordial derivations and sharp waves. de Winter syndrome indicates critical narrowing of the left ascending coronary artery (LAD). Recognizing this presentation is important in terms of both mortality and morbidity. We present the case of a 71-year old patient presenting at the Emergency Department with chest pain, who had findings of de Winter syndrome on their ECG. Coronary angiography confirmed occlusions in the LAD and circumflex (CX) coronary arteries.

The de Winter ECG pattern: Distribution and morphology of ST depression.

BackgroundThe reported positive predictive value (PPV) for the “de Winter ECG pattern” to predict an acute left anterior descending artery (LAD) lesion is inconsistent. Besides, the morphology of upsloping or nonupsloping ST depression (STD) may have different significance of severity and prognostication.MethodsWe searched the MEDLINE database using “de Winter” or “junctional ST‐depression with tall symmetrical T‐waves” or “tall T wave” or “STEMI equivalent” as the item up to March 2020. We compared the ECG differences between the different culprit arteries and various morphological STD.ResultsA total of 70 patients with analyzable ECGs were included. In 60 patients (LAD group), the LAD was the culprit artery, while in 10 patients (non‐LAD group), there were other etiologies. Maximal STD in V2 or V3 had a PPV of 89% of all patients and 98% of patients without ST elevation in V2 to detect an acute LAD lesion. The presence of q/Q‐wave or poor R‐wave progression in the precordial leads was significantly more often found in patients with upsloping STD than in patients with nonupsloping STD in the LAD group (84% vs. 27%, p < .01). In 18 patients, the ECG showed a change from upsloping to nonupsloping STD from the leads with maximal STD to the surrounding leads with less STD.ConclusionsThe location of the maximal STD in the precordial leads differs between patients with LAD as the culprit artery and other etiologies of the de Winter ECG pattern. Upsloping STD signifies more severe signs of ischemia than nonupsloping STD.

A lateral lead variant of the de Winter pattern due to left main stenosis and left anterior descending artery occlusion

Early recognition of ST-segment elevation myocardial infarction equivalent electrocardiogram patterns is of paramount importance. Successful identification of these ischemic patterns helps ensure proper triage of patients needing urgent restoration of coronary perfusion. The so-called de Winter sign has become increasingly recognized as a ST-segment elevation myocardial infarction equivalent pattern due to proximal left anterior descending artery occlusion. Yet, despite the de Winter pattern's well-defined electrocardiographic-angiographic relationship, the electrophysiologic explanation for its characteristic electrocardiographic manifestations remains unclear. Herein, we report a case in which an ischemic lateral lead variant of the de Winter pattern emerged from a patient inflicted by an abrupt thrombotic occlusion of the ostial left anterior descending artery, which developed in series with a high-grade stenosis of the distal left main coronary artery. We examine the patient's presenting electrocardiographic findings and clinical course to (i) establish causal inferences that align with the distribution of myocardial ischemia supported by coronary angiography and (ii) provide an accompanying analysis of the relevant scientific literature.

PROMOTING PATRIARCHAL POLITICS IN DAPHNE DU MAURIER’S REBECCA

Abstract: This paper aims to analyze a patriarchal politics performed by the male antagonist named Maxim de Winter in his life of domestic partnership with a female protagonist, Rebecca, elucidated in Daphne du Maurier’s novel entitled Rebecca. The concept of promotion of patriarchal domination is done through deconstructive narration. At first, the novel constructs a narration by putting the woman in a privileged position. However, this position is later dismantled by male domination. This paper employs some methods consisting of close reading, qualitative analysis, and deconstructive analysis. The result shows that woman’s privileged position is only used as a medium for a man to prove his domination and promote patriarchal politics in the form of power struggle. Key words: patriarchal politics, power, Rebecca

The Female Version in Daphne Du Maurier�s Rebecca

Rebecca is a novel which is created by Daphne Du Maurier. That novel is retold by Margaret Tarner in 1991. The main character of this novel is the narrator. This study uses A Freudian Psychological Analysis. The purpose of this study is to trace the Electra Complex (the female version of the Oedipus Complex) in Rebecca. So, the steps of this study are identify the symbolic father figure and the symbolic mother figure and trace how the main character tries to displace the symbolic mother figures in that novel. There are two results of this study. The first, Mr. De Winter is the symbolic figure father, while Mrs. Van Hooper, Rebecca, and Mrs. Danvers are the symbolic of mother figures. The second, the main character tries to displace the mother figures. The main character is marrying Mr. De Winter before Mrs. Van Hooper realizes her plan to make Mr. De Winter as the next victim. Then, the main character is trying to displace Rebecca by doing: (1) make social call with Beatrice and Giles, (2) prepare the best appearance for the Ball, and (3) cover her husband as murderer. Then, the main character is trying to displace Mrs. Danvers by convincing Mrs. Danvers to be her friend, but Mrs. Danvers decides to burn Manderley and go away from that place. Therefore, the narrator suffers Electra Complex and becomes the female version of the Oedipus Complex.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

Supplementary Information for: "Absolute seasonal temperature estimates for a greenhouse climate state" by de Winter et al.

The Obsession of Women Characters in Daphne du Maurier's 'Rebecca'

The objectives of this study are to analyze how is the obsession of the women characters and to explain how the obsession of the women characters influences their behavior described in Daphne du Maurier’s Rebecca. The object of the study is a novel entitled Rebecca, written by Daphne du Maurier. This study is a descriptive qualitative study by applying Freudian psychoanalytic theory. The data of the study were collected by reading, identifying, inventorying, classifying, selecting, and reporting. By using Freudian psychoanalytic theory, the analysis focused on the women's character's obsession. The results show (1) Rebecca’s obsession in gaining power through fake appearances to get wealth and honor. Then, Mrs de Winter obsession in getting her husband’s love influenced by her father’s figure so that she has an electra complex. Further, Danvers obsession in loving Rebecca makes her have selfishness. (2) The influence of Rebecca’s obsession makes her have a narcissistic personality disorder. Then, the influence of Mrs de Winter obsession makes her envy, and finally she imitates Rebecca to increase her confidence in getting her husband’s love. Further, the influence of Danvers obsession makes her a Rebecca worshiper.&#x0D; Keywords: Characters, Obsession, Psychoanalytic, Rebecca, Women&#x0D;

Plant traits and phenotypic variability effect on the phytomass production ofStipagrostis ciliata (Desf.) De Winter.

A process of continuous degradation of plant communities, due mainly to long-term overgrazing has been revealed by most ecological studies in North African arid climate. Notably, this degradation appeared across the depletion of perennial grass species exhibiting low density in the majority of range ecosystems. This study aimed to examine the phenology and the aboveground phytomass production of Stipagrostis ciliata (Desf.) De Winter accessions, a perennial grass, growing under the same environment but coming from different climates of Tunisia. Additionally, the extent of genetic variation in phenological parameters, root and shoot phytomass productivity and the correlations among these parameters were also analyzed. Significant differences in all morphological parameters of S. ciliata accessions were revealed by ANOVA test and were corroborated with significant and positive correlation indicated by Pearson’s correlation analysis. Plant diameter, biovolume, root biomass with protective sleeve and spike number exhibited significant differences and high distinctiveness between S. ciliata accessions. Tukey’s HDS tests indicated the presence of three groups of accessions. Principal component analysis (PCA) applied on a table with eight observations and 13 variables, and dispersion of S. ciliata accessions on the first two axes of PCA confirmed the presence of three groups of accessions. Trait variability in the field for the five accessions is more likely to be the result of phenotypic plasticity rather than of genetic differentiation between accessions. Overall, the characterization of S. ciliata accessions exhibited significant differences in terms of morphological and biomass productivity.

‘An invention…that bottled up a memory, like scent’: phantom fragrances in Daphne du Maurier’s Rebecca

ABSTRACT In the opening chapters of Rebecca, du Maurier’s unnamed narrator makes a poignant remark about her desire to re-experience certain memories: ‘If only there could be an invention … that bottled up a memory, like scent. And it never faded, and it never got stale’. Although her suitor curtly dismisses this comment, readers should not be as quick to forget the tie that the narrator draws between memory and scent. In this article, I argue that fragrance is not an insignificant detail of du Maurier’s story but rather an emotively charged presence that can help readers better understand the relationship between the narrator and the first Mrs. de Winter. After discussing neurological and anthropological studies that have emerged around smell’s connection to memory and liminality, I explore moments in du Maurier’s text where fragrances reanimate Rebecca and create a visceral connection between the protagonist and this deceased yet very much present character. By examining the way Rebecca rises to the surface through smell, I ultimately show that odours play a pivotal role in allowing readers to recognize how her forceful and resilient personality continues to dismantle the boundaries of patriarchal control from beyond the grave.

Vertical Fibrous Morphology and Structure-Function Relationship in Natural and Biomimetic Suction-Based Adhesion Discs

Summary Recent years have seen rapid development in bio-inspired materials for adhesion. However, it remains challenging to realize robust adhesion on rough aquatic surfaces. An inspiring natural model is the remora fish, which has evolved to retain powerful adhesion to hosts using a dorsal suction disc. We find that the remora suction disc has a unique fibrous architecture of vertically oriented collagen fibers that enable anisotropic mechanical properties and enhanced adhesion performance. In the engineered prototype, vertically oriented nylon fibers are embedded into the soft silicone matrix using electrostatic flocking. The anisotropic mechanical properties are validated in both natural and biomimetic suction discs. Furthermore, the biomimetic suction disc demonstrates an enhanced adhesion function with a maximum 62.5% increase in pull-off force and a 340% increase in attachment time compared with the silicone control. This work can shed light on natural adhesion mechanisms and inspire novel designs for aquatic soft adhesives and actuators.

Figurative comparisons and eponims in functional diagnostics

The article presents a summary of figurative comparisons and eponyms that are used in modern cardiology and functional diagnostics. Links are given to the sources in which these names were first used.There are a lot of great scientists leaving their names in the name of the medical terms they discovered. The contribution of this scientists is reflected: Einthoven, Wilson, Pardee, Cabrera, Chapman, de Winter, Prinzmetal, Bazett and others. Syndromes of Wellens, Brugada, Romano-Ward, Wolff-Parkinson-White, Clerc-Levy-Critesco, Chatterjee and others, and figurative comparisons are briefly described: “cat back”, “death wing”, “bull terrier muzzle”, “torsades de pointes”, “epsilon-wave”, “Salvador Dali’s mustache”, “saw teeth”, “shield and sword”, etc. All the terms given in the article have not only scientific, but also, most important, applied meaning. The article will be useful not only for students of medical universities, residents and graduate students, but also to practical doctors, whom it will help test her knowledge.

KBTBD13 and the ever-expanding sarcomeric universe.

KBTBD13 is a protein expressed in striated muscle whose precise function is unknown. Work by de Winter et al. in this issue of the JCI provides evidence that KBTBD13 localizes to the sarcomere and can directly bind actin. A mutation in KBTBD13 that is associated with nemaline myopathy alters the protein's effects on actin, apparently increasing thin-filament stiffness and ultimately depressing contractile force and relaxation rate. We discuss here the implications of this new sarcomeric protein, some alternate explanations for the effects of KBTBD13R408C, and the advantages of using computational models to interpret functional data from muscle.

An electrocardiogram case of de Winter's T-waves evolving into Wellens' waves

de Winter综合征和Wellens综合征属于高危非ST段抬高型急性冠状动脉综合征范畴，其心电图特征性ST-T改变提示冠状动脉前降支近段严重狭窄，该类患者极易进展为急性ST段抬高型广泛前壁心肌梗死，应及早行介入治疗。本文报道1例de Winter心电图快速演变为Wellens心电图，心电图记录到急性心肌缺血和缺血后T波倒置的完整演变过程。.

Safety of Caplacizumab in Patients Without Documented Severe ADAMTS13 Deficiency During the HERCULES Study

Safety of Caplacizumab in Patients Without Documented Severe ADAMTS13 Deficiency During the HERCULES Study

Efficacy of Caplacizumab in Patients with aTTP in the HERCULES Study According to Initial Immunosuppression Regimen

Background: Acquired thrombotic thrombocytopenic purpura (aTTP) is an acute, life-threatening thrombotic microangiopathy that requires urgent and specialized treatment. Prior to the introduction of caplacizumab, the treatment for aTTP was based on daily therapeutic plasma exchange (TPE; to replenish functional ADAMTS13 enzyme) plus immunosuppression (mainly corticosteroids and rituximab; to suppress anti-ADAMTS13 autoantibody production). TPE combined with immunosuppressive therapy improved outcomes in patients; however, episodes of aTTP are still associated with an acute mortality of up to 20% as these therapies do not have an immediate effect on the pathologic microvascular thrombosis. The primary results of the randomized, double-blind, placebo-controlled phase 3 HERCULES study showed that, in combination with TPE and corticosteroids, caplacizumab shortened the time to platelet count response and reduced the incidence of a composite outcome of TTP-related death, exacerbation, or major thromboembolic events, by inhibiting vWF-platelet interaction and, thereby, stopping the formation of microthrombi. As additional immunosuppression per local practice was permitted in HERCULES, the present analysis aimed to determine whether there was any difference in the efficacy of caplacizumab according to the initial immunosuppression regimen. Methods: Data of patients participating in HERCULES were stratified based on the type of first-line immunosuppression regimen (i.e. therapy started up to Day 3 of the treatment period) and analyzed descriptively. The main 2 groups analyzed were those receiving corticosteroids only and those receiving a combined regimen of corticosteroids and rituximab. Differences in dose or dosing frequency were not taken into consideration in this descriptive analysis. Results: Of the 145 randomized patients in the HERCULES study, 112 (77.2%) patients received only corticosteroids as first-line immunosuppressive therapy, while 24 (16.6%) patients received corticosteroids and rituximab (initiated within the first 3 days of the study). Three patients (2.1%) received another type of initial immunosuppression (cyclophosphamide + corticosteroids [n=1], hydroxychloroquine [n=1], and mycophenolate mofetil + corticosteroids [n=1]), 1 patient (0.7%) started immunosuppression later in the study (cyclophosphamide + corticosteroids), while 5 patients (3.4%) did not receive any immunosuppressive treatment during the study. Baseline characteristics between the main 2 subgroups were well balanced (Table 1). Immunosuppressive therapy intensification occurred in 38 patients (33.9%) initiated on corticosteroids alone (most often addition of rituximab [n=37], others included splenectomy [n=2], bortezomib [n=1], mycophenolate mofetil [n=1]), and in 3 patients (12.5%) initiated on corticosteroids with rituximab (bortezomib [n=1] and mycophenolate mofetil [n=3]). Caplacizumab treatment improved outcomes in patients with aTTP irrespective of the type of initial immunosuppression. Data on time to platelet count response and clinical outcomes are summarized in Table 2. Caplacizumab reduced the rate of the composite endpoint of TTP-related death, exacerbation, and major thromboembolic events during the double-blind treatment period irrespective of baseline immunosuppression regimen. Notably, in the placebo arm, exacerbations occurred in both subgroups to a similar extent, indicating that corticosteroids, with or without rituximab, are not immediately effective. Overall, recurrences (exacerbations or relapses) during the study were also reduced by caplacizumab in both subgroups (Table 2). Two placebo patients died during the treatment period in the corticosteroid only subgroup versus none in the corticosteroid plus rituximab subgroup (one other placebo patient died during the study drug treatment period while receiving another type of immunosuppression). Conclusion: Immunosuppressive therapy in aTTP aims to control the underlying autoimmune disease, but requires time to take effect; this exposes patients to thrombotic complications and death. Caplacizumab treatment prevents disease exacerbations and death, irrespective of the type of initial immunosuppression used, allowing time for immunosuppressive therapy to take effect. Disclosures Pavenski: Ablynx: Honoraria, Research Funding; Shire: Honoraria; Alexion: Honoraria, Research Funding; Octapharma: Research Funding; Bioverativ: Research Funding. Knoebl:Novo-Nordisk: Consultancy, Research Funding; Ablynx/Sanofi: Consultancy; CSL-Behring: Consultancy; Shire/Takeda: Consultancy; Roche: Consultancy. Scully:Shire: Research Funding; Alexion: Consultancy; Ablynx/Sanofi: Consultancy; Shire/Takeda: Consultancy; Novartis: Consultancy. Kremer Hovinga:Siemens: Honoraria, Other: Honoraria go to employer (Insel Gruppe AG, Department of Hematology); Shire: Consultancy, Other: Honoraria go to employer (Insel Gruppe AG, Department of Hematology), Research Funding; CSL-Behring: Honoraria, Other: Honoraria go to employer (Insel Gruppe AG, Department of Hematology); Ablynx/Sanofi: Consultancy, Honoraria, Other: Honoraria go to employer (Insel Gruppe AG, Department of Hematology); Roche: Honoraria, Other: Honoraria go to employer (Insel Gruppe AG, Department of Hematology). Coppo:Shire: Consultancy; Ablynx/Sanofi: Consultancy; Alexion: Consultancy. Peyvandi:Sanofi: Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees; Grifols: Honoraria; Kedrion: Honoraria; Bioverativ: Membership on an entity's Board of Directors or advisory committees; Alnylam: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Octapharma: Research Funding. Cataland:Ablynx/Sanofi: Consultancy, Research Funding; Alexion: Consultancy, Research Funding. Metjian:Genentech: Consultancy, Research Funding; AblynxNV/Sanofi: Consultancy, Research Funding. De La Rubia:Celgene Corporation: Consultancy; AbbVie: Consultancy; Takeda: Consultancy; AMGEN: Consultancy; Janssen: Consultancy. De Winter:Ablynx, a Sanofi company: Employment. de Passos Sousa:Sanofi: Employment. Callewaert:Sanofi (formerly employed by Ablynx, a Sanofi company): Employment.