Wide Branch Research Articles

Assessing the Physiologic Relevance of Red Blood Cell Deformability in Iron Deficiency Anemia

Background: Iron deficiency anemia (IDA), which affects individuals of all ages worldwide, is an often overlooked and undertreated component of chronic disease, despite data correlating its association with adverse outcomes in patients with cardiovascular disease (von Haehling, Nat Rev Cardiol, 2015). While red blood cells (RBCs) in IDA are known to be smaller and contain less hemoglobin than healthy RBCs, how RBC deformability is altered in IDA remains poorly understood; some ektacytometry studies have observed impaired deformability in iron deficient RBCs (idRBCs), while others described either unchanged or increased deformability (Brandão, Clin Hemorheol Microcirc, 2009). Here we ask: can single cell biophysical techniques definitively determine whether idRBCs are less deformable than healthy RBCs and how heterogenous that phenomena may be? Recent investigations into IDA's role in cardiovascular disease have generally focused on the myocardium and coronary vasculature, yet much regarding other physiologic implications remains unknown, including whether idRBCs cause microvascular obstruction or vasculopathy. To address such questions, we leveraged a suite of microvascular models we developed.Methods: We first coupled our microfluidic capillary model with μEXACT, our customized automated particle tracking program for hematologic cell-based assays, to collect high-throughput velocity tracking of single RBCs from a healthy control and 2 IDA patients (anemic for age, ferritin <10 ng/mL) to create a single cell deformability index (sDI) for each RBC (Fig 1). Next, whole blood samples collected in EDTA tubes from the control and IDA patients were perfused into both straight 100μm wide channels (mimicking large venules) and branching 30μm wide microfluidic devices (mimicking smaller venules) at a constant shear rate for 30 minutes to observe if any occlusions or obvious alterations in flow were observed (Fig 2). Finally, using the straight 100μm channel microfluidic devices, human umbilical vein endothelial cells (HUVECs) were cultured throughout each microchannel and RBCs from a healthy control and 3 IDA patients were perfused in parallel microchannels for 4 hours. The endothelialized models were then fixed, permeabilized, and immunostained with antibodies against VCAM-1 and E-selectin, known markers of endothelial inflammation. Mean fluorescence intensity was measured to quantify endothelial inflammation (Fig 3).Results: sDI distribution histograms were obtained for healthy and IDA patient RBCs. The mean sDIs for IDA patient RBCs were decreased in comparison to the healthy RBCs. Additionally, both IDA patient's RBCs lacked a subpopulation of highly deformable RBCs, likely reticulocytes, seen in the healthy RBCs (Fig 1C). There was no evidence of microchannel occlusion for the healthy control or IDA patient whole blood samples in either the straight 100μm microchannels or branching 30μm microfluidic devices (Fig 2D). Finally, in our endothelialized microfluidic model, endothelium exposed to IDA patient RBCs exhibited increased VCAM-1 and E-selectin expression over endothelium exposed to healthy RBCs (Fig 3B).Conclusions: By utilizing an array of microfluidic models we can develop a more comprehensive understanding of the role idRBCs play systemically on microvasculature. Our combined microfluidic and image analysis system demonstrated decreased deformability in idRBCs and can offer detection of subpopulation differences that cannot be fully characterized with bulk techniques such as ektacytometry. So far, our data demonstrates that while no microvascular occlusion occurs, idRBCs contribute to endothelial inflammation. Additionally, the observation that physical interactions between endothelial cells and idRBCs are sufficient to cause endothelial inflammation warrants further investigation, as generally idRBCs had not been viewed as pro-inflammatory. Ongoing studies will couple unique sDI distribution curves with the degree of endothelial inflammation, as well as elucidate how these changes are associated with the degree of IDA or clinical events such as the initiation of iron supplementation. Utilizing atomic force microscopy to better understand how the idRBC membrane impacts deformability and developing biophysical computer simulations to determine if increased idRBC-endothelium interactions are observed in silico are also planned. [Display omitted] DisclosuresLam: Sanguina, Inc.: Current holder of individual stocks in a privately-held company.

Numerical study of droplet breakup in an asymmetric T-junction microchannel with different cross-section ratios

In this study, numerical simulations are conducted to investigate droplet breakup in an asymmetric [Formula: see text]-junction microchannel with different cross-section ratios. To this approach, a two-phase model based on the volume of fluid (VOF) method is adopted to study the three-dimensional feature of droplet motion inside [Formula: see text]-junctions. The comparison reveals that the present results are in good agreement with previous studies. The effects of the capillary number (Ca), the non-dimensional droplet length ([Formula: see text]), and the non-dimensional width ratio ([Formula: see text]) on the breakup time and splitting ratio of daughter droplets are studied. Five distinct regimes are observed involving the non-breakup, breakup with tunnel, breakup without tunnel, asymmetric breakup, and sorting. Achieved results indicate that the time of breakup ([Formula: see text]) increases about 15% when the Ca is increased from 0.0134 to 0.0268 (about 100%). It is also found that the mass center of the mother droplet in the primary channel is shifted to a larger wide branch, which facilitates the asymmetric breakup of the droplet in a [Formula: see text]-junction microchannel.

Improving prediction of COVID-19 evolution by fusing epidemiological and mobility data

We are witnessing the dramatic consequences of the COVID-19 pandemic which, unfortunately, go beyond the impact on the health system. Until herd immunity is achieved with vaccines, the only available mechanisms for controlling the pandemic are quarantines, perimeter closures and social distancing with the aim of reducing mobility. Governments only apply these measures for a reduced period, since they involve the closure of economic activities such as tourism, cultural activities, or nightlife. The main criterion for establishing these measures and planning socioeconomic subsidies is the evolution of infections. However, the collapse of the health system and the unpredictability of human behavior, among others, make it difficult to predict this evolution in the short to medium term. This article evaluates different models for the early prediction of the evolution of the COVID-19 pandemic to create a decision support system for policy-makers. We consider a wide branch of models including artificial neural networks such as LSTM and GRU and statistically based models such as autoregressive (AR) or ARIMA. Moreover, several consensus strategies to ensemble all models into one system are proposed to obtain better results in this uncertain environment. Finally, a multivariate model that includes mobility data provided by Google is proposed to better forecast trend changes in the 14-day CI. A real case study in Spain is evaluated, providing very accurate results for the prediction of 14-day CI in scenarios with and without trend changes, reaching 0.93 R^2, 4.16 RMSE and 1.08 MAE.

Modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional virtual reconstruction models.

BackgroundPrevious classification of renal pelvicalyceal anatomical structure may be difficult to intuitively understand and unpractical for endourological surgery. We aim to put forward a modified Takazawa anatomical classification of renal pelvicalyceal system based on three-dimensional (3D) virtual reconstruction models for endourological surgery.MethodsWe retrospectively collected data on 225 patients (320 kidneys) in total between Apr. 2017 and Dec. 2020, spatial anatomical structure of renal pelvis and calyces were modeled and corresponding morphological parameters were measured after 3D virtual reconstruction of computed tomography urography (CTU). The modified Takazawa renal pelvicalyceal anatomical classification was advanced based on the renal pelvicalyceal morphological parameters [bifurcated branches of renal pelvis, cross sectional area of renal pelvis and ureteropelvic junction (UPJ), infundibuloureteral angle (IUA), lower pole infundibular calyceal length (IL)] by 3D virtual reconstruction models, and comparison of renal pelvicalyceal system morphological parameters were performed to evaluate the differences in various classification types of renal pelvis and calyces.ResultsAnatomical structure of renal pelvis and calyces were divided into two main types (Type A and Type B) according to renal pelvic branch patterns. A single pelvis without bifurcated branch was regarded as Type A (62%) and subclassified into three subtypes: Type A1 (22%), Type A2 (27%) and Type A3 (13%), the slimline pelvis was classified as Type A1, the typical pelvis as Type A2 and the broad pelvis as Type A3. A divided pelvis with bifurcated branches was seen as Type B (38%) and subclassified into two subtypes: Type B1 (15%) with the wide and flat lower calyx branch, Type B2 (23%) with the narrow and steep lower calyx branch.ConclusionsPrevious studies have reported that the visualization and classification of renal pelvicalyceal anatomical structure by endocast, autopsy, ultrasonography and excretory urography, the modified Takazawa classification system based on 3D virtual reconstruction models enables to standardized different anatomical morphology of renal pelvicalyceal system and provide intuitive and concise information on anatomy, thus leading to the improvement in treatment modality.

Wide Weighted Attention Multi-Scale Network for Accurate MR Image Super-Resolution

High-quality magnetic resonance (MR) images afford more detailed information for reliable diagnoses and quantitative image analyses. Given low-resolution (LR) images, the deep convolutional neural network (CNN) has shown its promising ability for image super-resolution (SR). The LR MR images usually share some visual characteristics: structural textures of different sizes, edges with high correlation, and less informative background. However, multi-scale structural features are informative for image reconstruction, while the background is more smooth. Most previous CNN-based SR methods use a single receptive field and equally treat the spatial pixels (including the background). It neglects to sense the entire space and get diversified features from the input, which is critical for high-quality MR image SR. We propose a wide weighted attention multi-scale network ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{W}^{2}$ </tex-math></inline-formula> AMSN) for accurate MR image SR to address these problems. On the one hand, the features of varying sizes can be extracted by the wide multi-scale branches. On the other hand, we design a non-reduction attention mechanism to recalibrate feature responses adaptively. Such attention preserves continuous cross-channel interaction and focuses on more informative regions. Meanwhile, the learnable weighted factors fuse extracted features selectively. The encapsulated wide weighted attention multi-scale block ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{W}^{2}$ </tex-math></inline-formula> AMSB) is integrated through a recurrent framework and global attention mechanism. Extensive experiments and diversified ablation studies show the effectiveness of our proposed <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{W}^{2}$ </tex-math></inline-formula> AMSN, which surpasses state-of-the-art methods on most popular MR image SR benchmarks quantitatively and qualitatively. And our method still offers superior accuracy and adaptability on real MR images.

Two-Dimensional SPH Analysis of Seepage with Water Injection Process for Different Crack Morphologies

Crack seepage in nature involves natural and water injection flow, causing crack morphology in nature to be varied. Using the numerical simulation method of smoothed particle hydrodynamics (SPH), the natural free flow process in a crack was analyzed. With the interference of the initial velocity of the x = 0 particles, the other terminal particles were shifted, and the particles with initial velocities were reversed. For water injection simulations, ghost particles were set to block particles from overflowing, as particles subjected to injection water were mobilized more quickly than under free flow conditions. For rough cracks, particle magnitude was affected by the boundary shape, but overall particle velocity was influenced little, and the distribution of particles was sparse and densely spaced. For the branch crack simulation, overall particle seepage velocity decreased, but particles moved faster through the wider branch than through the narrower branch. SPH can simulate the seepage through crack networks and be used to analyze the effects of different crack geometries and physical properties.

In-situ green synthesis of fluorescent silica-silver conjugate nanodendrites using nanoporous frustules of diatoms: an unprecedented approach.

Generally, nanodendrite synthesis is chemical mediated and expensive. The biogenesis of such hierarchical structures is still in its nascent stage. The present study aimed at exploiting the nanoporous frustules of Halamphora subturgida, as a source of biosilica for the biosynthesis and stabilization of conjugate nanodendrites of silica and silver. These minute diatom frustules when exposed to 9mM of silver nitrate solution, a highly crystalline nanohybride dendrites were synthesized. The nanohybrid dendrite synthesis was initially confirmed by the formation of greyish-brown frustules after 72h of exposure. The composite dendrites were thoroughly characterized by standard techniques. Electron microscopic images illustrated that the process began with the formation of isotropic hybrid nanospheres with an internal diameter of 20nm and continued to develop anisotropic nanocrystals with time. The nanodendrites externally formed on the siliceous frustules, acting as a template for the former. They were characterized by distinct 100nm wide and 1-2µm long trunks and 70-100nm wide and 220-220nm long branches on either side of the trunk. The optical measurement revealed the fluorescence property of the nanostructures owing to the photoluminescent efficiency of the frustules. Both the externally derived hybrid nanodendrites and internally synthesized nanospheres possessed superior stability in the suspension with a zeta potential value of -35.7mV and -24.8mV, respectively. Thus, this method is eco-friendly and provides a new dimension for nanodendrite synthesis with minimal cost and maximal yield compared to its non-biologically synthesized counterparts that involve several other drawbacks like chemical hazards and high energy consumption.

APLIKASI KAIDAH "AL-'ADAH MUHAKKAMAH" DALAM KASUS PENETAPAN JUMLAH MAHAR

Al-'adah muhakkamah, literally ‘customary usage is the determining factor’,is one of the five universal maxims of Islamic jurisprudencewhich have a wide branch coverage agreed upon by the scholars.This maxim is built on the basis of custom and local wisdom that exists in every community, where this custom is continuously carried out by the community without any denial from them; it is precisely individuals who violate these customs will be considered "freaks". Therefore, Islam makes the customs of a community a legal basis as long as they fulfill the requirements stipulated by Sharia.The formulation of the problem in this study is about: (1) the definition of the al-'adah muhakkamah maxim, (2) the conditions for applying it, and (3) its application in determining the amount and type of dowry. This paper tries to study a jurisprudence principle and apply it to a jurisprudence problem so as to form a complete understanding of the rules as well as how to apply them in the branch of jurisprudence. The conclusions of this study are: (1) that 'adah is something that happens repeatedly which is accepted by common sense and human nature, (2) an 'adah can become a legal basis if it does not contradict the arguments of the Sharia, it is more often done than abandoned, there is no words of the' adah doer who excludes, and the 'adah must exist at the time the covenant occurs,(3) the rule of al-'adah muhakkamah can be applied to determine the number and types ofmis^ldowries, as well as musamma dowries which are absolutely stated.

Characteristics of hybrid chitosan/phospholipid-sterol, peptide coatings on plasma activated PEEK polymer

In this paper, we propose a method of obtaining multi-component surface coatings on PEEK polymer, which is becoming increasingly interested in a very wide branch of medicine - orthopedics. Thanks to the plasma techniques used and due to the presence of chitosan, the materials obtained are characterized by sterility, antisepticity, can accelerate wound healing, and serve as a drug delivery system directly to the tissues in need. In addition, the use of ternary Langmuir-Blodgett (lipid-sterol, peptide) films has resulted in significant change of surfaces polarity. The physico-chemical properties of the ternary Langmuir films obtained on the water subphase were tested exploiting Langmuir trough and a Brewster angle microscope. Then they were transferred to the modified surfaces of the solid PEEK polymer, where changes in wettability as well as surface free energy were determined by the type of substrate/coating and the hybrid composition. Additionally, surface chemistry was studied applying time of flight secondary ion mass spectrometry.

The Concept of “New Life” as a Powerful Psycholinguistic Element in the Inaugural Addresses of the U.S. Presidents

The article deals with the concept of “new life” in the inaugural addresses of the U.S. presidents. A political language, as a reflection of people’s behavior in a certain ethnocultural community, is under the consideration. The investigation of political language caused the special approach to the analysis of lexical units that comprise the semantic group “novelty”. Based on this analysis a group of words that have the common sema “new” was singled out. The means of expressions and stylistic devices that presidents used to express the idea of “new life” were determined. The presidents make people believe in their ability to take new actions and change the situation, lead the nation to new, better life. Adjective “new” is often used by the presidents in context of the necessity to revitalize old values, to renew the nation spiritually. Analysis of inaugural address of American presidents showed that ideas of “new life” run through the entire speech of every president. In this article the role of the idea of “new life” in inaugural addresses of American presidents and means of its conveying has been studied. Model of a “new life” can be rather complex, needs more or less strong argumentation. The very word-combination the “better life” predetermines that this life should be different from the existing one, i.e. new. Thus concept of “new life” plays important role in political discourse. Consequently, our research may be understood not only as belonging to a narrow sphere of analysis of political discourse but to wider branch of science – linguistic political science.

The back-approach technique of endoscopic saphenous vein harvesting in coronary artery bypass grafting.

One of the concerns during endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting (CABG) is injury to the vein or its branches. The cutting edge of bipolar electrocautery scissors, used to divide the side branches of the saphenous vein, can cause vascular injury leading to reduced graft patency. We have developed a novel back-approach technique using a C-ring to divide the wide side branches of the saphenous vein during EVH. The aim of the study was to describe the technique and assess early outcomes of EVH using this technique. The back-approach technique is as follows: (a) insert the C-ring near the target branch, (b) push the C-ring over the proximal aspect of the target branch, (c) twist the C-ring forward to capture the target branch, and (d) cut the target branch by bipolar electrocautery. We investigated 169 patients, including 35 women (mean age 70.1 ± 8.9years), who underwent CABG at our hospital, using a novel EVH technique. The patients were categorized as those who underwent EVH (EVH group, n = 44) or open vein harvesting (OVH) (OVH group, n = 125). This method involves the creation of a small incision (2cm), sufficient saphenous vein dissection near the skin incision, adequate dissection to separate the vein from the surrounding tissues, and the back-approach technique with C-ring to divide the side branch of the saphenous vein. The primary endpoint was the graft patency rate, and the secondary endpoints were leg wound complications and length of hospitalization. No significant intergroup difference was observed in early patency of saphenous vein graft patency (OVH vs. EVH = 94.7 vs. 95.6%, p = 0.763). The incidence of lower extremity wound lymphorrhea was significantly lesser (OVH: EVH = 16.0: 0.0%, p = 0.005) and the length of hospitalization was also significantly shorter in the EVH group (OVH vs. EVH = 24.2 ± 9.8 vs. 19.0 ± 5.3days, p = 0.001). EVH, using the back-approach technique, showed satisfactory short-term results; therefore, this technique performed with C-ring might be effective for vein harvesting during EVH.

Novel Noncrossing Y-Stent Technique Using Tapered Proximal End of a Solitaire AB Stent for Coil Embolization of Wide-Neck Bifurcation Aneurysms.

The crossing Y-stent method is one of the indispensable techniques to achieve sufficient neck coverage during coil embolization of bifurcation aneurysms with a wide neck and/or branch incorporation. However, the inevitable hourglass-like expansion of the second stent at the crossing point can result in insufficient vessel wall apposition, reduced aneurysm neck coverage, delayed endothelialization, and subsequent higher risks of acute or delayed thrombosis. It also interferes with engagement of the microcatheter into the aneurysm after stent installation. We expected to be able to reduce these disadvantages by installing a noncrossing type Y-stent using the Solitaire AB stent, which is fully retrievable with a tapered proximal end. Here we report the techniques and two successful cases.

METADOCK 2: a high-throughput parallel metaheuristic scheme for molecular docking.

Molecular docking methods are extensively used to predict the interaction between protein-ligand systems in terms of structure and binding affinity, through the optimization of a physics-based scoring function. However, the computational requirements of these simulations grow exponentially with: (i) the global optimization procedure, (ii) the number and degrees of freedom of molecular conformations generated and (iii) the mathematical complexity of the scoring function. In this work, we introduce a novel molecular docking method named METADOCK 2, which incorporates several novel features, such as (i) a ligand-dependent blind docking approach that exhaustively scans the whole protein surface to detect novel allosteric sites, (ii) an optimization method to enable the use of a wide branch of metaheuristics and (iii) a heterogeneous implementation based on multicore CPUs and multiple graphics processing units. Two representative scoring functions implemented in METADOCK 2 are extensively evaluated in terms of computational performance and accuracy using several benchmarks (such as the well-known DUD) against AutoDock 4.2 and AutoDock Vina. Results place METADOCK 2 as an efficient and accurate docking methodology able to deal with complex systems where computational demands are staggering and which outperforms both AutoDock Vina and AutoDock 4. https://Baldoimbernon@bitbucket.org/Baldoimbernon/metadock_2.git. Supplementary data are available at Bioinformatics online.

Factors Affecting Choice of Commercial Banks in Kosovo

This research investigates the factors that influence customers choice of commercial banks in Kosovo and also the factors that influence their continued patronage. A survey research was carried out that involved interviews with bank customers and staffs to explore how customers choose their banks. The input from this group was used to develop the research questionnaire which was responded to by 192 bank customers in Kosovo region. The research revealed that customer service quality, reputation/image of banks and availability of a wide branch network were the most important influences on customers choice of commercial banks in Kosovo It was also observed that the most important factors that encouraged continued patronage of commercial banks in Kosovo were customer service quality, proximity of banks to office or home and reputation/image of the bank.

The Inheritance of Branch Position, Plant Height and Rosette Habit in Safflower

Safflower is a rare culture adapted for growing in arid regions. It has wide usage as decorative, feeding plant and in medicine but mainly it is used in oil production nowadays. In rain insufficient areas in summer months it can be used as alternative to sunflower. Because of climate changes the study of the culture becomes even more important. The safflower plant (Carthamus tinctorius L) of the family of Asteraceae is one of the oilseeds growing in Asia, America, on the territory of Ukraine. Safflower is used as a forage plant for animals and birds, for technical, decorative purposes, in medicine. Safflower is a rough, herbaceous, annual plant with a pronounced appearance of an inhabitant of dry steppes. It is believed that the habitat of this species is confined to steppes and semi-deserts. The root of safflower is pivotal, it gives the plant the opportunity to feel good in arid climates. The stem is hard, branching, whitish in color, up to 100 cm tall, sometimes more. The leaves are alternate, sessile, oblong-lanceolate, leathery, with sharp edges, which usually end with spines, although there are varieties without spines, with a sharply protruding network of veins from below. According to available data, one recessive gene causes erectoid location of branches. Researchers Fernandez-Martinez and Knowles point to the existence of two genes that have the opposite effect on the location of branches. The ap gene in the homozygous state causes the branches to tilt at an angle of 20 degrees or less relative to the stem, and the dec gene from 80 to 90 degrees. The combination of these genes gives the slope of the branches to the stem in 40-70 degrees. The Institute of Oilseed Crops NAAS of Ukraine has been engaged in cultivation of safflower since 2001. The aim of this work was to study the inheritance of branch position on the stem and the association of plant height and rosette habit of samples in our collection. For realization of the work were used the methods of field experiment, genetic analysis and mathematical statistics. For determining the type of inheritance the results of free and artificial pollination were used. Chi-square test was used as a statistical method. Four samples from our collection heterogeneous by height, branch position and rosette habit were involved in crosses: Belotsvetkovy nekoluchy, Salut, Medovy, Kurchavy. Characteristics of crossed collection samples: Belotsvetkovy nekoluchy — normal branch position, medium height, average rosette habit; Salut — erectoid branch position, high, late rosette habit; Medovy — normal branch position, medium height, average rosette habit; Kurchavy — normal branch position, medium height, average rosette habit. The first generation from the free pollination of the plant with normal branch position in 2011 also had normal branch position, the second generation demonstrated splitting by 3:1 scheme into normal and wide branch position accordingly. In crossing plants with normal and erectoid branch position the first generation hybrids also had normal branch position, the second generation demonstrated splitting by 3:1 scheme into plants with normal and erectoid branch position. When crossing the sample Salut (high, late rosette habit) with Kurchavy sample (medium height, average rosette habit) the first generation hybrids were of medium height and average rosette habit. The second generation splitting scheme validly differed from the expected one 9:3:3:1. Genes encoding these traits are not fully linked. Using the formula r = n/N, where n is the number of recombinants and N is the total number of specimen, we calculated the crossover frequency. Thus, the sing of the normal branch position dominates wide and erectoid branch position sings in safflower. The sing of the rosette habit is linked with plant height sing. The distance between genes is 6,13 morganite.

Design and results of aCRT MID-Q study: Adoption of adaptive CRT in patients with normal AV conduction and moderately wide left bundle branch block

BackgroundSub-analysis of the adaptive CRT (aCRT) trial demonstrated the potential benefits of the aCRT algorithm over conventional echo-guided bi-ventricular (BiV) pacing in patients with left bundle branch block (LBBB) with moderately wide QRS (120–149 ms) and normal atrioventricular (AV) conduction. MethodsAdoption of Adaptive CRT in Patients with Left Bundle Branch Block and Moderately Wide QRS (aCRT MID-Q, UMIN Clinical Trials Registry Number: 000022452) was a multicenter, prospective, randomized, double-blind study designed to investigate the superiority of the aCRT pacing algorithm compared to echo-guided BiV pacing in patients with moderately wide LBBB and normal AV conduction. The primary endpoint was the improvement in clinical composite score (CCS) at 6 months; the secondary endpoints were changes in left ventricular (LV) end-systolic volume, LV ejection fraction, New York Heart Association classification, 6-min walk distance, and quality of life from baseline to 6 months post-randomization; heart failure administration; all-cause mortality; and cardiac mortality within 12 months. ResultsThe trial was terminated prematurely after enrollment of 39 patients (aCRT arm; n = 17, echo-guided BiV arm; n = 22) because of lower than expected enrollment. In the intention-to-treat analysis, the improvement of CCS was achieved in 10 patients (59%) in the aCRT arm (n = 17) and 16 patients (73%) in the echo-guided BiV arm (n = 22, p = 0.36). For the secondary endpoint, only 6-min walk distance was significantly greater in the aCRT arm than in the echo-guided BiV arm, and no difference was observed in the echocardiographic parameters. Heart failure hospitalization-free survival was also not significantly different (p = 0.91). There was no death during the follow-up. ConclusionsImprovement of CCS was similarly observed after aCRT and echo-guided BiV in CRT recipients with moderately wide LBBB and normal AV conduction. A prospective study is needed to explore the impact of CRT and pacing algorithm on Japanese patients with moderately wide LBBB.

Induction of aneurysmogenic high positive wall shear stress gradient by wide angle at cerebral bifurcations, independent of flow rate.

Endothelium adapts to wall shear stress (WSS) and is functionally sensitive to positive (aneurysmogenic) and negative (protective) spatial WSS gradients (WSSG) in regions of accelerating and decelerating flow, respectively. Positive WSSG causes endothelial migration, apoptosis, and aneurysmal extracellular remodeling. Given the association of wide branching angles with aneurysm presence, the authors evaluated the effect of bifurcation geometry on local apical hemodynamics. Computational fluid dynamics simulations were performed on parametric bifurcation models with increasing angles having: 1) symmetrical geometry (bifurcation angle 60°-180°), 2) asymmetrical geometry (daughter angles 30°/60° and 30°/90°), and 3) curved parent vessel (bifurcation angles 60°-120°), all at baseline and double flow rate. Time-dependent and time-averaged apical WSS and WSSG were analyzed. Results were validated on patient-derived models. Narrow symmetrical bifurcations are characterized by protective negative apical WSSG, with a switch to aneurysmogenic WSSG occurring at angles ≥ 85°. Asymmetrical bifurcations develop positive WSSG on the more obtuse daughter branch. A curved parent vessel leads to positive apical WSSG on the side corresponding to the outer curve. All simulations revealed wider apical area coverage by higher WSS and positive WSSG magnitudes, with increased bifurcation angle and higher flow rate. Flow rate did not affect the angle threshold of 85°, past which positive WSSG occurs. In curved models, high flow displaced the impingement area away from the apex, in a dynamic fashion and in an angle-dependent manner. Apical shear forces and spatial gradients are highly dependent on bifurcation and inflow vessel geometry. The development of aneurysmogenic positive WSSG as a function of angular geometry provides a mechanotransductive link for the association of wide bifurcations and aneurysm development. These results suggest therapeutic strategies aimed at altering underlying unfavorable geometry and deciphering the molecular endothelial response to shear gradients in a bid to disrupt the associated aneurysmal degeneration.

Mapping the Interstellar Reddening and Extinction toward Baade’s Window Using Minimum Light Colors of ab-type RR Lyrae Stars: Revelations from the De-reddened Color–Magnitude Diagrams

Abstract We have obtained repeated images of six fields toward the Galactic bulge in five passbands (u, g, r, i, z) with the DECam imager on the Blanco 4 m telescope at CTIO. From more than 1.6 billion individual photometric measurements in the field centered on Baade’s window, we have detected 4877 putative variable stars. A total of 474 of these have been confirmed as fundamental mode RR Lyrae stars, whose colors at minimum light yield line-of-sight reddening determinations, as well as a reddenning law toward the Galactic Bulge, which differs significantly from the standard R V = 3.1 formulation. Assuming that the stellar mix is invariant over the 3 square-degree field, we are able to derive a line-of-sight reddening map with sub-arcminute resolution, enabling us to obtain de-reddened and extinction corrected color–magnitude diagrams (CMDs) of this bulge field using up to 2.5 million well-measured stars. The corrected CMDs show unprecedented detail and expose sparsely populated sequences: for example, delineation of the very wide red giant branch, structure within the red giant clump, the full extent of the horizontal branch, and a surprising bright feature that is likely due to stars with ages younger than 1 Gyr. We use the RR Lyrae stars to trace the spatial structure of the ancient stars and find an exponential decline in density with Galactocentric distance. We discuss ways in which our data products can be used to explore the age and metallicity properties of the bulge, and how our larger list of all variables is useful for learning to interpret future LSST alerts.

Validated numerics for period-tupling and touch-and-go bifurcations of symmetric periodic orbits in reversible systems

We propose a general framework for computer-assisted verification of the presence of symmetry breaking, period-tupling and touch-and-go bifurcations of symmetric periodic orbits for reversible maps. The framework is then adopted to Poincaré maps in reversible autonomous Hamiltonian systems.In order to justify the applicability of the method, we study bifurcations of halo orbits in the Circular Restricted Three Body Problem. We give a computer-assisted proof of the existence of wide branches of halo orbits bifurcating from L1,2,3-Lyapunov families and for wide range of mass parameter. For two physically relevant mass parameters we prove, that halo orbits undergo multiple period doubling, quadrupling and third-order touch-and-go bifurcations.

Different aspects of laboratory analog of tropical cyclone

Localized heating in the rotating layer of fluid leads to the formation of intense cyclonic vortex. Cyclonic vortex becomes unstable at low values of viscosity and fast rotation of the experimental model. The instability of the vortex is tightly connected with a structure of the radial inflow. For moderate values of rotational Reynolds number Re the radial flows consist of several branches which transport angular momentum to the center of the model. When Re exceeds critical value (about 23) radial inflow changes its structure and appears as one wide branch which does not reach the center. As a result of strong anisotropy of radial inflow the cyclonic vortex is formed at some distance from the center. Further increase of Re leads to chaotic state with several vortices which appear at different locations near the periphery of the heating area. The map of regimes with stable and unstable vortices is presented.