Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis.

PubMed

Lenke, L G; Engsberg, J R; Ross, S A; Reitenbach, A; Blanke, K; Bridwell, K H

2001-07-15

Prospective evaluation of gait and spinal-pelvic balance parameters in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. To evaluate changes in gait and three-dimensional alignment and balance of the spine relative to the pelvis as a consequence of spinal fusion. Preoperative and postoperative spinal radiographs have been the major forms of outcome analysis of adolescent idiopathic scoliosis fusions. The use of optoelectronic analysis for posture and gait has gained acceptance recently. However, there is a paucity of data quantifying, comparing, and correlating structural and functional changes in patients undergoing scoliosis fusion surgery including upright posture and gait. Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion were prospectively evaluated. Coronal and sagittal vertical alignment was evaluated on radiographs (CVA-R, SVA-R), during upright posture (CVA-P and SVA-P), and during gait (CVA-G, SVA-G). Transverse plane alignment was evaluated by the acromion-pelvis angle during gait. Gait speed was significantly decreased (P < 0.05) between preoperative (129 +/- 16 cm/sec) and 2-year postoperative (119 +/- 16 cm/sec) testing sessions. Decreasing gait speed was the result of significantly reduced cadence and decreased stride length. There were no significant differences for lower extremity kinematics over the entire gait cycle. Spinal-pelvic balance parameters showed significant improvement in mean CVA-R, CVA-G (P < 0.05), then unchanged CVA-P at 2 years postoperation. CVA-P was relatively unchanged while the mean CVA-G also showed significant improvement from preoperation (2.2 +/- 2.4 cm) to 2 years postoperation (1.3 +/- 1.3 cm)(P < 0.05). The mean SVA-R, SVA-P, and SVA-G were unchanged at 2 years postoperation (P > 0.05). The acromion-pelvis angle during gait at maximum shoulder rotation was statistically improved at 1 year (P = 0.002) and 2 years (P = 0.001) after surgery. Importantly, CVA-P correlated with CVA-G, and SVA-P correlated with SVA-G to the P < 0.05 level. Patients with adolescent idiopathic scoliosis undergoing spinal fusion show slightly decreased gait speed at 2 years postoperation without any change in lower extremity kinematics. Spinal-pelvic balance parameters are improved in the coronal plane and unchanged in the sagittal plane radiographically and during standing posture and gait. Transverse plane parameters also are improved at maximum shoulder rotation during gait.

Factors favoring regain of the lost vertical spinal height through posterior spinal fusion in adolescent idiopathic scoliosis.

PubMed

Shi, Benlong; Mao, Saihu; Xu, Leilei; Sun, Xu; Liu, Zhen; Zhu, Zezhang; Lam, Tsz Ping; Cheng, Jack Cy; Ng, Bobby; Qiu, Yong

2016-07-04

Height gain is a common beneficial consequence following correction surgery in adolescent idiopathic scoliosis (AIS), yet little is known concerning factors favoring regain of the lost vertical spinal height (SH) through posterior spinal fusion. A consecutive series of AIS patients from February 2013 to August 2015 were reviewed. Surgical changes in SH (ΔSH), as well as the multiple coronal and sagittal deformity parameters were measured and correlated. Factors associated with ΔSH were identified through Pearson correlation analysis and multivariate regression analysis. A total of 172 single curve and 104 double curve patients were reviewed. The ΔSH averaged 2.5 ± 0.9 cm in single curve group and 2.9 ± 1.0 cm in double curve group. The multivariate regression analysis revealed the following pre-operative variables contributed significantly to ΔSH: pre-op Cobb angle, pre-op TK (single curve group only), pre-op GK (double curve group only) and pre-op LL (double curve group only) (p < 0.05). Thus change in height (in cm) = 0.044 × (pre-op Cobb angle) + 0.012 × (pre-op TK) (Single curve, adjusted R(2) = 0.549) or 0.923 + 0.021 × (pre-op Cobb angle1) + 0.028 × (pre-op Cobb angle2) + 0.015 × (pre-op GK)-0.012 × (pre-op LL) (Double curve, adjusted R(2) = 0.563). Severer pre-operative coronal Cobb angle and greater sagittal curves were beneficial factors favoring more contribution to the surgical lengthening effect in vertical spinal height in AIS.

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

PubMed

Chen, Zhonghui; Li, Song; Qiu, Yong; Zhu, Zezhang; Chen, Xi; Xu, Liang; Sun, Xu

2017-12-01

OBJECTIVE Although the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI. METHODS The data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years' follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded. RESULTS Patients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1-S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%). CONCLUSIONS The VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.

The impact of direct vertebral rotation (DVR) on radiographic outcome in surgical correction of idiopathic scoliosis.

PubMed

Urbanski, Wiktor; Wolanczyk, Michal J; Jurasz, Wojciech; Kulej, Miroslaw; Morasiewicz, Piotr; Dragan, Szymon Lukasz; Sasiadek, Marek; Dragan, Szymon Feliks

2017-07-01

Recent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment. Thirty-six consecutive patients who underwent posterior spinal fusion with pedicle screws only constructs for idiopathic scoliosis. Fifteen patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and postoperatively-coronal curves, kyphosis (T2-T12, T5-T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn. We observed reduction of RAsag in all patients; however, in DVR group, decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p = 0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p = 0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2-T12 kyphosis has increased in 28 (65%) patients whereas in non-DVR group in 31 (69%) cases. Mean value of T2-T12 kyphosis growth was 16.7% in DVR and 22.1% in non-DVR group. These differences however did not occur statistically significant. Direct vertebral rotation (DVR) maneuver reduces significantly apical rotation of the spine, enhances ability of coronal correction, and it does not reduce thoracic kyphosis.

Progression of spinal deformity in wheelchair-dependent patients with Duchenne muscular dystrophy who are not treated with steroids: coronal plane (scoliosis) and sagittal plane (kyphosis, lordosis) deformity.

PubMed

Shapiro, F; Zurakowski, D; Bui, T; Darras, B T

2014-01-01

We determined the frequency, rate and extent of development of scoliosis (coronal plane deformity) in wheelchair-dependent patients with Duchenne muscular dystrophy (DMD) who were not receiving steroid treatment. We also assessed kyphosis and lordosis (sagittal plane deformity). The extent of scoliosis was assessed on sitting anteroposterior (AP) spinal radiographs in 88 consecutive non-ambulatory patients with DMD. Radiographs were studied from the time the patients became wheelchair-dependent until the time of spinal fusion, or the latest assessment if surgery was not undertaken. Progression was estimated using a longitudinal mixed-model regression analysis to handle repeated measurements. Scoliosis ≥ 10° occurred in 85 of 88 patients (97%), ≥ 20° in 78 of 88 (89%) and ≥ 30° in 66 of 88 patients (75%). The fitted longitudinal model revealed that time in a wheelchair was a highly significant predictor of the magnitude of the curve, independent of the age of the patient (p < 0.001). Scoliosis developed in virtually all DMD patients not receiving steroids once they became wheelchair-dependent, and the degree of deformity deteriorated over time. In general, scoliosis increased at a constant rate, beginning at the time of wheelchair-dependency (p < 0.001). In some there was no scoliosis for as long as three years after dependency, but scoliosis then developed and increased at a constant rate. Some patients showed a rapid increase in the rate of progression of the curve after a few years - the clinical phenomenon of a rapidly collapsing curve over a few months. A sagittal plane kyphotic deformity was seen in 37 of 60 patients (62%) with appropriate radiographs, with 23 (38%) showing lumbar lordosis (16 (27%) abnormal and seven (11%) normal). This study provides a baseline to assess the effects of steroids and other forms of treatment on the natural history of scoliosis in patients with DMD, and an approach to assessing spinal deformity in the coronal and sagittal planes in wheelchair-dependent patients with other neuromuscular disorders.

Extended Asymmetrical Pedicle Subtraction Osteotomy for Adult Spinal Deformity: 2-Dimensional Operative Video.

PubMed

Buell, Thomas J; Buchholz, Avery L; Quinn, John C; Mullin, Jeffrey P; Garces, Juanita; Mazur, Marcus D; Shaffrey, Mark E; Yen, Chun-Po; Shaffrey, Christopher I; Smith, Justin S

2018-06-16

Pedicle subtraction osteotomy (PSO) is an effective technique to correct fixed sagittal malalignment. A variation of this technique, the "trans-discal" or "extended" PSO (Schwab grade IV osteotomy), involves extending the posterior wedge resection of the index vertebra to include the superior adjacent disc for radical discectomy. The posterior wedge may be resected in asymmetric fashion to correct concurrent global coronal malalignment.This video illustrates the technical nuances of an extended asymmetrical lumbar PSO for adult spinal deformity. A 62-yr-old female with multiple prior lumbar fusions presented with worsening back pain and posture. Preoperative scoliosis X-rays demonstrated severe global sagittal and coronal malalignment (sagittal vertical axis [SVA, C7-plumbline] of 13.5 cm, pelvic incidence [PI] of 60°, lumbar lordosis [LL] of 14° [in kyphosis], pelvic tilt [PT] of 61°, thoracic kyphosis [TK] of 18°, and rightward coronal shift of 9.3 cm). The patient gave informed consent to surgery and for use of her imaging for medical publication. Briefly, surgery first involved transpedicular instrumentation from T10 to S1 with bilateral iliac screw fixation, and then T11-12 and T12-L1 Smith-Petersen osteotomies were performed. Next, an extended asymmetrical L4 PSO was performed and a 12° lordotic cage (9 × 14 × 40 mm) was placed at the PSO defect. Rods were placed from T10 to iliac bilaterally, and accessory supplemental rods spanning the PSO were attached. Postoperative scoliosis X-rays demonstrated improved alignment: SVA 5.5 cm, PI 60°, LL 55°, PT 36°, TK 37°, and 3.7 cm of rightward coronal shift. The patient had uneventful recovery.

Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system.

PubMed

Somoskeöy, Szabolcs; Tunyogi-Csapó, Miklós; Bogyó, Csaba; Illés, Tamás

2012-11-01

Three-dimensional (3D) deformations of the spine are predominantly characterized by two-dimensional (2D) angulation measurements in coronal and sagittal planes, using anteroposterior and lateral X-ray images. For coronal curves, a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice, and these methods have been shown to exhibit good-to-excellent reliability and reproducibility, carried out either manually or by computer-based tools. Recently, an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column. Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting. Retrospective nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009. In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4° and 117.5°. Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation: 0° to 10° (Group 1, n=36), 10° to 25° (Group 2, n=25), 25° to 50° (Group 3, n=69), 50° to 75° (Group 4, n=49), and more than 75° (Group 5, n=22). Coronal and sagittal curvature measurements were determined by three experienced examiners, using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions. Manual measurements were performed three times, and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software (IBM Corp., Armonk, NY, USA). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. In comparison with manual 2D methods, only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations. This is the first clinical report on EOS 2D/3D system (EOS Imaging, Paris, France) and its sterEOS 3D software, documenting an excellent capability for accurate, reliable, and reproducible spinal curvature measurements. Copyright © 2012 Elsevier Inc. All rights reserved.

More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study.

PubMed

Zhou, Zhenhai; Zhang, Hongqi; Guo, Chaofeng; Yu, Honggui; Wang, Longjie; Guo, Qiang

2017-06-15

Tethered spinal cord is frequently associated with scoliosis. It is still controversial whether a prophylactic untethering is necessary before correction procedure in scoliosis patients with tethered spinal cord. In this study we determined the clinical outcome of a one-stage posterior scoliosis correction without a prophylactic untethering for treating scoliosis with an asymptomatic tethered spinal cord. Seventeen (5 males and 12 females) scoliosis patients with tethered spinal cords were retrospectively reviewed. All patients underwent a one-stage posterior scoliosis correction without preventive untethering. Parameters of radiograph were used to assess correction result. The Scoliosis Research Society (SRS)-22 questionnaire was analyzed pre- and post-operatively to evaluate the clinical outcomes. The modified Japanese Orthopaedic Association (mJOA) score was used to assess the pre- and post-operative spinal cord function. The post-operative coronal Cobb angle was significantly decreased compared with preoperative. (23.8 ± 6.4° vs. 58.4 ± 12.6°, P < 0.01). The coronal Cobb angle was 22.4 ± 6.8° at the final follow-up evaluation. The apical vertebral translation (AVT) was also decreased significantly. (27.5 mm vs. 60.9 mm, P < 0.01). The SRS-22 total score was improved at the 1-year follow-up evaluation compared with the pre-operative SRS-22 total score (87 ± 4 vs. 70 ± 5, p < 0.05). The functional activities, pain, self-image, mental health, and surgery satisfactory scores at the final follow-up evaluation were all improved compared with the corresponding pre-operative scores, especially the self-image and mental health scores (p < 0.05). The spinal cord function was stable and there was no new neurological symptoms after scoliosis correction. No difference existed between the pre- and post-operative total mJOA score (26 ± 2 vs. 27 ± 2, p = 0.39), which including subjective symptom (p = 0.07), clinical symptom (p = 0.33), daily activities (p = 0.44) and bladder function (p = 0.67). One-stage posterior scoliosis correction is a safe and effective surgical procedure for scoliosis patients combined with asymptomatic tethered spinal cord who have adequate spinal cord function reserve.

Prevalence of thoracic scoliosis in adults 25 to 64 years of age detected during routine chest radiographs.

PubMed

Chen, James B; Kim, Abraham D; Allan-Blitz, Lao; Shamie, Arya Nick

2016-10-01

To investigate the prevalence of thoracic scoliosis and determine the effect of both age and gender on coronal curve magnitude among asymptomatic adults aged 25-64 years old, using standing posterior-anterior chest radiographs. This was a retrospective, cross-sectional study evaluating 500 randomly selected digital posterior-anterior chest radiographs taken at a single institution on an outpatient basis between January 2010 and December 2011. Males (n = 184) and females (n = 316) ranged in age from 25 to 64 years. Patients with symptoms of back pain; including a history of back pain, spinal instrumentation, or known pre-existing spinal disease were excluded. Radiographs were evaluated using Centricity PACS Web Diagnostic 2.1 system (General Electric Co. Fairfield, CT). Coronal Cobb angle measurements of the thoracic spine were quantified by the authors, with scoliosis defined as coronal curves greater than 10°. Curvatures were subdivided into groups: a control group with coronal curves less than 10°, curves measuring 10° to 19°, 20° to 29°, and greater than 30°. The effect of age and gender on curve magnitude was examined using Pearson correlation analysis and linear regression analysis. There was a 13.4 % (67 patients) prevalence of thoracic scoliosis. The prevalence among asymptomatic males was 10.9 %, while the prevalence among asymptomatic females was 14.9 %. 11.6 % demonstrated a coronal curvature between 10° and 19° (58 patients), 1.6 % between 20° and 29° (8 patients), and 0.2 % greater than 30° (1 patient). Age and gender were not found to be significant independent predictors of curve severity. We found a 13.4 % prevalence of thoracic scoliosis among asymptomatic adults aged 25-64 years on routine outpatient chest radiographs. 11.6 % of patients demonstrated a coronal curvature between 10° and 19°. Unlike prior studies evaluating asymptomatic thoracic curves in elderly patients, age and gender did not significantly affect curve magnitude in our younger cohort. These data may provide a reference point to help clinicians counsel asymptomatic patients diagnosed with thoracic scoliosis on routine chest radiographs.

Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis.

PubMed

Yilmaz, Guney; Borkhuu, Battugs; Dhawale, Arjun A; Oto, Murat; Littleton, Aaron G; Mason, Dan E; Gabos, Peter G; Shah, Suken A

2012-01-01

Spinal instrumentation in adolescent idiopathic scoliosis (AIS) aims to correct spinal deformity and maintain long-term spinal stability until bony healing is ensured. The purpose of this study was to compare the minimum 2-year postoperative radiographic and clinical results of posterior spine correction and fusion with all-hook instrumentation versus hybrid segmental instrumentation versus pedicle screw instrumentation for AIS from a single institution. A total of 105 patients with AIS who underwent a posterior spinal fusion with segmental pedicle screw (35), hook (35), or hybrid (35) instrumentation were sorted and matched according to the following criteria: similar age at surgery, identical Lenke curve types, curve magnitude, and Risser grade. Patients were evaluated before, immediately after, and at 2 years after surgery for radiographic parameters, complications, and outcome, as well as on the basis of the Scoliosis Research Society (SRS) questionnaire. The age and Risser grade, major curve Cobb angle, apical vertebral rotation (AVR), apical vertebral translation (AVT), lowest instrumented vertebral tilt, global coronal and sagittal balance, lumbar lordosis, and thoracic kyphosis were determined as part of preoperative evaluation. All 3 groups showed significant differences between the preoperative and postoperative major curve Cobb angle, lowest instrumented vertebral tilt, AVT, and AVR. At the latest follow-up, lumbar lordosis, thoracic kyphosis, and global coronal and sagittal balance remained similar among the 3 groups. Major curve Cobb angle, AVT, and AVR were significantly different--the hook group's measurements were significantly higher than the other groups, but there was no difference between the pedicle screw and hybrid groups. Major curve correction rate was significantly different among all groups (screw=71.9%±13.8%, hybrid=61.4%±16.6%, hook=48.1%±19.7%) (P<0.001). The pedicle screw group had the least amount of correction loss but there was no statistically significant difference between groups (screw=2.6±6.7 degrees, hybrid=4.5±7.4 degrees, hook=4.4±6.2 degrees) (P=0.35). The hook group had the least amount of AVT correction, but the screw group and the hybrid groups were similar (pedicle=67.3%±15.5%, hybrid=57.5%±22.4%, hook=39.9%±32.5%) (P<0.001). Surgery time and blood loss were higher in the screw group. No differences in global SRS-22 scores were demonstrated between the patients treated with pedicle screw, hybrid, and hook constructs; however, the satisfaction domain was higher in the screw group at the latest follow-up. Pedicle screw and hybrid instrumentations offer significantly better spinal deformity correction than hook constructs in major curve coronal correction, AVT, and AVR. Patients with pedicle screw instrumentation had the greatest curve correction percentage, maintenance of this correction in the coronal and sagittal planes, and higher patient satisfaction by the SRS outcome scores. Global SRS-22 scores were similar at 2-year follow-up in all groups. Therapeutic level III retrospective comparative study.

Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity: 25 consecutive cases

PubMed Central

McAfee, Paul C.; Shucosky, Erin; Chotikul, Liana; Salari, Ben; Chen, Lun; Jerrems, Dan

2013-01-01

Background This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. Methods A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ≥2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. Results In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental pedicle screw instrumentation were required at follow up. No patients were out of sagittal balance (sagittal vertical line <3 cm from S1) postoperatively. Segmental instrumentation with osteotomies was also more effective for restoration of physiologic lumbar lordosis compared with anterior stand-alone procedures. Conclusions This retrospective study supports the finding that clinical outcomes (coronal/sagittal alignment) improve postoperatively after minimally invasive surgery with multilevel XLIF procedures and are improved compared with larger extensile thoracoabdominal anterior scoliosis procedures. PMID:25694908

Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy.

PubMed

Bao, H; Yan, P; Qiu, Y; Liu, Z; Zhu, F

2016-09-01

There is a paucity of information on the pre-operative coronal imbalance in patients with degenerative lumbar scoliosis (DLS) and its influence on surgical outcomes. A total of 284 DLS patients were recruited into this study, among whom 69 patients were treated surgically and the remaining 215 patients conservatively Patients were classified based on the coronal balance distance (CBD): Type A, CBD < 3 cm; Type B, CBD > 3 cm and C7 Plumb Line (C7PL) shifted to the concave side of the curve; Type C, CBD > 3 cm and C7PL shifted to the convex side. A total of 99 of the 284 (34.8%) patient presented with a pre-operative coronal imbalance (mean CBD: 48.5, standard deviation 18.7 mm). More patients with a Type B malalignment were observed than with a Type C malalignment (62 versus 37). A total of 21 pf the 69 (30.4%) surgically treated patients had a post-operative coronal imbalance, which was found to be more prevalent in Type C patients (p < 0.001). At follow-up, less improvement was observed in terms of Short Form-36 Physical Component Score and visual analogue score for back pain (p = 0.034 and 0.025, respectively) in Type C patients. This study shows that patients with Type C coronal malalignment may be at greater risk of post-operative coronal imbalance following posterior osteotomy. Cite this article: Bone Joint J 2016;98-B:1227-33. ©2016 The British Editorial Society of Bone & Joint Surgery.

Adult spinal deformity treated with minimally invasive surgery. Description of surgical technique, radiological results and literature review.

PubMed

Domínguez, I; Luque, R; Noriega, M; Rey, J; Alía, J; Urda, A; Marco, F

The prevalence of adult spinal deformity has been increasing exponentially over time. Surgery has been credited with good radiological and clinical results. The incidence of complications is high. MIS techniques provide good results with fewer complications. This is a retrospective study of 25 patients with an adult spinal deformity treated by MIS surgery, with a minimum follow-up of 6 months. Radiological improvement was SVA from 5 to 2cm, coronal Cobb angle from 31° to 6°, and lumbar lordosis from 18° to 38°. All of these parameters remained stable over time. We also present the complications that appeared in 4 patients (16%). Only one patient needed reoperation. We describe the technique used and review the references on the subject. We conclude that the MIS technique for treating adult spinal deformity has comparable results to those of the conventional techniques but with fewer complications. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Five major controversial issues about fusion level selection in corrective surgery for adolescent idiopathic scoliosis: a narrative review.

PubMed

Lee, Choon Sung; Hwang, Chang Ju; Lee, Dong-Ho; Cho, Jae Hwan

2017-07-01

Shoulder imbalance, coronal decompensation, and adding-on phenomenon following corrective surgery in patients with adolescent idiopathic scoliosis are known to be related to the fusion level selected. Although many studies have assessed the appropriate selection of the proximal and distal fusion level, no definite conclusions have been drawn thus far. We aimed to assess the problems with fusion level selection for corrective surgery in patients with adolescent idiopathic scoliosis, and to enhance understanding about these problems. This study is a narrative review. We conducted a literature search of fusion level selection in corrective surgery for adolescent idiopathic scoliosis. Accordingly, we selected and reviewed five debatable topics related to fusion level selection: (1) selective thoracic fusion; (2) selective thoracolumbar-lumbar (TL-L) fusion; (3) adding-on phenomenon; (4) distal fusion level selection for major TL-L curves; and (5) proximal fusion level selection and shoulder imbalance. Selective fusion can be chosen in specific curve types, although there is a risk of coronal decompensation or adding-on phenomenon. Generally, wider indications for selective fusions are usually associated with more frequent complications. Despite the determination of several indications for selective fusion to avoid such complications, no clear guidelines have been established. Although authors have suggested various criteria to prevent the adding-on phenomenon, no consensus has been reached on the appropriate selection of lower instrumented vertebra. The fusion level selection for major TL-L curves primarily focuses on whether distal fusion can terminate at L3, a topic that remains unclear. Furthermore, because of the presence of several related factors and complications, proximal level selection and shoulder imbalance has been constantly debated and remains controversial from its etiology to its prevention. Although several difficult problems in the diagnosis and treatment of adolescent idiopathic scoliosis have been resolved by understanding its mechanism and via technical advancement, no definite guideline for fusion level selection has been established. A review of five major controversial issues about fusion level selection could provide better understanding of adolescent idiopathic scoliosis. We believe that a thorough validation study of the abovementioned controversial issues can help address them. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical validation of coronal and sagittal spinal curve measurements based on three-dimensional vertebra vector parameters.

PubMed

Somoskeöy, Szabolcs; Tunyogi-Csapó, Miklós; Bogyó, Csaba; Illés, Tamás

2012-10-01

For many decades, visualization and evaluation of three-dimensional (3D) spinal deformities have only been possible by two-dimensional (2D) radiodiagnostic methods, and as a result, characterization and classification were based on 2D terminologies. Recent developments in medical digital imaging and 3D visualization techniques including surface 3D reconstructions opened a chance for a long-sought change in this field. Supported by a 3D Terminology on Spinal Deformities of the Scoliosis Research Society, an approach for 3D measurements and a new 3D classification of scoliosis yielded several compelling concepts on 3D visualization and new proposals for 3D classification in recent years. More recently, a new proposal for visualization and complete 3D evaluation of the spine by 3D vertebra vectors has been introduced by our workgroup, a concept, based on EOS 2D/3D, a groundbreaking new ultralow radiation dose integrated orthopedic imaging device with sterEOS 3D spine reconstruction software. Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and vertebra vector-based 3D measurements in a routine clinical setting. Retrospective, nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009. In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4 and 117.5°. Analysis of accuracy and reliability of measurements was carried out on a group of all patients and in subgroups based on coronal plane deviation: 0 to 10° (Group 1; n=36), 10 to 25° (Group 2; n=25), 25 to 50° (Group 3; n=69), 50 to 75° (Group 4; n=49), and above 75° (Group 5; n=22). All study subjects were examined by EOS 2D imaging, resulting in anteroposterior (AP) and lateral (LAT) full spine, orthogonal digital X-ray images, in standing position. Conventional coronal and sagittal curvature measurements including sagittal L5 vertebra wedges were determined by 3 experienced examiners, using traditional Cobb methods on EOS 2D AP and LAT images. Vertebra vector-based measurements were performed as published earlier, based on computer-assisted calculations of corresponding spinal curvature. Vertebra vectors were generated by dedicated software from sterEOS 3D spine models reconstructed from EOS 2D images by the same three examiners. Manual measurements were performed by each examiner, thrice for sterEOS 3D reconstructions and twice for vertebra vector-based measurements. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software. In comparison with manual 2D methods, only small and nonsignificant differences were detectable in vertebra vector-based curvature data for coronal curves and thoracic kyphosis, whereas the found difference in L1-L5 lordosis values was shown to be strongly related to the magnitude of corresponding L5 wedge. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for vertebra vector-based methods that was also found to be unaffected by the magnitude of coronal curves or sagittal plane deviations. Vertebra vector-based angulation measurements could fully substitute conventional manual 2D measurements, with similar accuracy and higher intraobserver reliability and interrater reproducibility. Vertebra vectors represent a truly 3D solution for clear and comprehensible 3D visualization of spinal deformities while preserving crucial parametric information for vertebral size, 3D position, orientation, and rotation. The concept of vertebra vectors may serve as a starting point to a valid and clinically useful alternative for a new 3D classification of scoliosis. Copyright © 2012 Elsevier Inc. All rights reserved.

[MR myelography: analysis of 126 cases].

PubMed

Wang, W; Zhang, X; Lu, Y

2000-03-01

To investigate the value and limitation of MR myelography (MRM) in depicting the spinal canal obstruction. Heavily T2-weighted coronal MR myelography was performed with 3D fast-spin-echo (FSE) and fat-suppression sequence in 126 cases, including 6 cerebellomedullary cistern, 18 cervical, 19 thoracic and 83 lumbar cases. The resulting slice were then projected into a composite image using a standard maxium intensity projection (MIP) algorithm. 90.5% (114/126) of MRM yielded reproducible high-quality image of the spinal thecal sac. 106 lesions (extradural, intradural, intramedullary) were detected in 101 cases (80.2%). The level and degree of spinal canal obstruction were visualized and confirmed by operation in 66 cases with a high sensitivity of 100%, and a diagnostic accuracy of 91.3%. Heavily T2 FSE MR myelography is a noninvasive and reliable method. MRM surpasses conventional and CT myelography and could replace them in some degree.

Asymmetric C7 pedicle subtraction osteotomy for correction of rigid cervical coronal imbalance secondary to post-traumatic heterotopic ossification: a case report, description of a novel surgical technique, and literature review.

PubMed

Theologis, Alexander A; Bellevue, Kate D; Qamirani, Erion; Ames, Christopher P; Deviren, Vedat

2017-05-01

Deformities of the cervical spine are uncommon in the coronal plane. In this report, a unique case of a 31-year-old male with a fixed, 30° left coronal deformity due to heterotopic ossification 3 years status post poly-trauma was treated with an asymmetric C7 pedicle subtraction osteotomy (PSO). Case report. Pre-operatively, the patient had a fixed 45-degree left tilt of his neck and radiographs demonstrated a rigid 30° scoliosis, 7 cm coronal imbalance, and 4 cm negative sagittal balance, diffuse bridging bone between the spinous processes and the facet joints of C5 to T1 bilaterally. An asymmetric C7 PSO with C2-T3 posterior spinal fusion was completed without complication. There was residual 9° coronal deformity, 2.9 cm left coronal imbalance, and 2.3 cm sagittal imbalance. He had a marked improvement in his function, as assessed by the SF-36 physical component score (pre-op 31.1; post-op 44.7) and mental component score (pre-op 46.0; post-op 66.8). Post-operatively, neck disability index scores also improved (pre-op 38; post-op 16). Although the patient passed away from a drug overdose 14 months post-operatively, he did not report neck pain, he had not sought evaluation from another physician for his neck, and he had not undergone a subsequent neck operation before his passing. In this one patient, an asymmetric C7 PSO was performed safely. While it was effective in addressing a fixed cervical coronal imbalance, its efficacy and safety profile should be confirmed in larger cohorts.

Deformity Angular Ratio Describes the Severity of Spinal Deformity and Predicts the Risk of Neurologic Deficit in Posterior Vertebral Column Resection Surgery.

PubMed

Wang, Xiao-Bin; Lenke, Lawrence G; Thuet, Earl; Blanke, Kathy; Koester, Linda A; Roth, Michael

2016-09-15

Retrospective review of prospectively collected data. To assess the value of the deformity angular ratio (DAR, maximum Cobb measurement divided by number of vertebrae involved) in evaluating the severity of spinal deformity, and predicting the risk of neurologic deficit in posterior vertebral column resection (PVCR). Although the literature has demonstrated that PVCR in spinal deformity patients has achieved excellent outcomes, it is still high risk neurologically. This study, to our knowledge, is the largest series of PVCR patients from a single center, evaluating deformity severity, and potential neurologic deficit risk. A total of 202 consecutive pediatric and adult patients undergoing PVCRs from November 2002 to September 2014 were reviewed. The DAR (coronal DAR, sagittal DAR, and total DAR) was used to evaluate the complexity of the deformity. The incidence of spinal cord monitoring (SCM) events was 20.5%. Eight patients (4.0%) had new neurologic deficits. Patients with a high total DAR (≥25) were significantly younger (20.3 vs. 29.0 yr, P = 0.001), had more severe coronal and sagittal deformities, were more myelopathic (33.3% vs. 11.7%, P = 0.000), needed larger vertebral resections (1.8 vs. 1.3, P = 0.000), and had a significantly higher rate of SCM events than seen in the low total DAR (<25) patients (41.1% vs. 10.8%; P = 0.000). Patients with a high sagittal DAR (≥15) also had a significantly higher rate of SCM events (34.0% vs. 15.1%, P = 0.005) and a greater chance of neurologic deficits postoperatively (12.5% vs. 0, P = 0.000). For patients undergoing a PVCR, the DAR can be used to quantify the angularity of the spinal deformity, which is strongly correlated to the risk of neurologic deficits. Patients with a total DAR greater than or equal to 25 or sagittal DAR greater than or equal to 15 are at much higher risk for intraoperative SCM events and new neurologic deficits. 3.

Hybrid fixation with sublaminar polyester bands in the treatment of neuromuscular scoliosis: a comparative analysis.

PubMed

Albert, Michael C; LaFleur, Brett C

2015-03-01

Segmental spinal instrumentation with Luque wire fixation has been the standard treatment of neuromuscular scoliosis for >30 years. More recently, pedicle screw constructs have become the most widely utilized method of posterior spinal fixation; however, they are associated with complications such as implant malposition. We report the use of polyester bands and clamps utilized with pedicle screws in a hybrid fixation construct in the treatment of neuromuscular scoliosis. A retrospective review was conducted of 115 pediatric spinal deformity cases between 2008 and 2010 at a single center performed by a single surgeon. Intraoperative and postoperative complications were recorded. Radiographs were reviewed preoperatively and at the latest follow-up. A systematic review of the literature was conducted. Data from case series reporting outcomes of sublaminar wires and all-pedicle screw constructs in the treatment of neuromuscular scoliosis were compared with outcomes of the present study. Twenty-nine patients with neuromuscular scoliosis who underwent segmental spinal instrumentation with a hybrid construct including sublaminar bands and pedicle screws were included. There was an average follow-up of 29 months (range, 12 to 40 mo). The average postoperative correction of coronal balance was 69% (range, 24 to 71 degrees). Sagittal balance was corrected to within 2 cm of the C7 plumbline in 97% of patients. The loss of coronal and sagittal correction at latest follow-up was 0% and 2%, respectively. There were 2 intraoperative clamp failures of the 398 implants (0.5%). There were 2 major (6.9%) and 7 minor (24%) complications in 7 patients (24% overall). These results compared favorably to previous case series of sublaminar wire and all-pedicle screw fixation techniques. The polyester band technique is an excellent adjunct in the correction of spinal deformity in patients with neuromuscular scoliosis. Sublaminar bands utilized in a hybrid construct appear to be safe, can achieve corrections equivalent to all-pedicle screw constructs, and may decrease the potential complications associated with every level transpedicular fixation in the patient with a highly dysmorphic and osteoporotic spine. Level IV: cohort study.

MRI of the lumbar spine: comparison of 3D isotropic turbo spin-echo SPACE sequence versus conventional 2D sequences at 3.0 T.

PubMed

Lee, Sungwon; Jee, Won-Hee; Jung, Joon-Yong; Lee, So-Yeon; Ryu, Kyeung-Sik; Ha, Kee-Yong

2015-02-01

Three-dimensional (3D) fast spin-echo sequence with variable flip-angle refocusing pulse allows retrospective alignments of magnetic resonance imaging (MRI) in any desired plane. To compare isotropic 3D T2-weighted (T2W) turbo spin-echo sequence (TSE-SPACE) with standard two-dimensional (2D) T2W TSE imaging for evaluating lumbar spine pathology at 3.0 T MRI. Forty-two patients who had spine surgery for disk herniation and had 3.0 T spine MRI were included in this study. In addition to standard 2D T2W TSE imaging, sagittal 3D T2W TSE-SPACE was obtained to produce multiplanar (MPR) images. Each set of MR images from 3D T2W TSE and 2D TSE-SPACE were independently scored for the degree of lumbar neural foraminal stenosis, central spinal stenosis, and nerve compression by two reviewers. These scores were compared with operative findings and the sensitivities were evaluated by McNemar test. Inter-observer agreements and the correlation with symptoms laterality were assessed with kappa statistics. The 3D T2W TSE and 2D TSE-SPACE had similar sensitivity in detecting foraminal stenosis (78.9% versus 78.9% in 32 foramen levels), spinal stenosis (100% versus 100% in 42 spinal levels), and nerve compression (92.9% versus 81.8% in 59 spinal nerves). The inter-observer agreements (κ = 0.849 vs. 0.451 for foraminal stenosis, κ = 0.809 vs. 0.503 for spinal stenosis, and κ = 0.681 vs. 0.429 for nerve compression) and symptoms correlation (κ = 0.449 vs. κ = 0.242) were better in 3D TSE-SPACE compared to 2D TSE. 3D TSE-SPACE with oblique coronal MPR images demonstrated better inter-observer agreements compared to 3D TSE-SPACE without oblique coronal MPR images (κ = 0.930 vs. κ = 0.681). Isotropic 3D T2W TSE-SPACE at 3.0 T was comparable to 2D T2W TSE for detecting foraminal stenosis, central spinal stenosis, and nerve compression with better inter-observer agreements and symptom correlation. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults.

PubMed

Granacher, Urs; Lacroix, Andre; Muehlbauer, Thomas; Roettger, Katrin; Gollhofer, Albert

2013-01-01

Age-related postural misalignment, balance deficits and strength/power losses are associated with impaired functional mobility and an increased risk of falling in seniors. Core instability strength training (CIT) involves exercises that are challenging for both trunk muscles and postural control and may thus have the potential to induce benefits in trunk muscle strength, spinal mobility and balance performance. The objective was to investigate the effects of CIT on measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility in seniors. Thirty-two older adults were randomly assigned to an intervention group (INT; n = 16, aged 70.8 ± 4.1 years) that conducted a 9-week progressive CIT or to a control group (n = 16, aged 70.2 ± 4.5 years). Maximal isometric strength of the trunk flexors/extensors/lateral flexors (right, left)/rotators (right, left) as well as of spinal mobility in the sagittal and the coronal plane was measured before and after the intervention program. Dynamic balance (i.e. walking 10 m on an optoelectric walkway, the Functional Reach test) and functional mobility (Timed Up and Go test) were additionally tested. Program compliance was excellent with participants of the INT group completing 92% of the training sessions. Significant group × test interactions were found for the maximal isometric strength of the trunk flexors (34%, p < 0.001), extensors (21%, p < 0.001), lateral flexors (right: 48%, p < 0.001; left: 53%, p < 0.001) and left rotators (42%, p < 0.001) in favor of the INT group. Further, training-related improvements were found for spinal mobility in the sagittal (11%, p < 0.001) and coronal plane (11%, p = 0.06) directions, for stride velocity (9%, p < 0.05), the coefficient of variation in stride velocity (31%, p < 0.05), the Functional Reach test (20%, p < 0.05) and the Timed Up and Go test (4%, p < 0.05) in favor of the INT group. CIT proved to be a feasible exercise program for seniors with a high adherence rate. Age-related deficits in measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility can be mitigated by CIT. This training regimen could be used as an adjunct or even alternative to traditional balance and/or resistance training. Copyright © 2012 S. Karger AG, Basel.

Serial elongation-derotation-flexion casting for children with early-onset scoliosis.

PubMed

Canavese, Federico; Samba, Antoine; Dimeglio, Alain; Mansour, Mounira; Rousset, Marie

2015-12-18

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis (JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion (EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and - in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois.

Serial elongation-derotation-flexion casting for children with early-onset scoliosis

PubMed Central

Canavese, Federico; Samba, Antoine; Dimeglio, Alain; Mansour, Mounira; Rousset, Marie

2015-01-01

Various early-onset spinal deformities, particularly infantile and juvenile scoliosis (JS), still pose challenges to pediatric orthopedic surgeons. The ideal treatment of these deformities has yet to emerge, as both clinicians and surgeons still face multiple challenges including preservation of thoracic motion, spine and cage, and protection of cardiac and lung growth and function. Elongation-derotation-flexion (EDF) casting is a technique that uses a custom-made thoracolumbar cast based on a three-dimensional correction concept. EDF can control progression of the deformity and - in some cases-coax the initially-curved spine to grow straighter by acting simultaneously in the frontal, sagittal and coronal planes. Here we provide a comprehensive review of how infantile and JS can affect normal spine and thorax and how serial EDF casting can be used to manage these spinal deformities. A fresh review of the literature helps fully understand the principles of the serial EDF casting technique and the effectiveness of conservative treatment in patients with early-onset spinal deformities, particularly infantile and juvenile scolisois. PMID:26716089

Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up.

PubMed

Liu, Congcong; Lin, Li; Wang, Weixing; Lv, Guohua; Deng, Youwen

2016-05-01

OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.

How much incisor decompensation is achieved prior to orthognathic surgery?

PubMed

McNeil, Calum; McIntyre, Grant T; Laverick, Sean

2014-07-01

To quantify incisor decompensation in preparation for orthognathic surgery. Pre-treatment and pre-surgery lateral cephalograms for 86 patients who had combined orthodontic and orthognathic treatment were digitised using OPAL 2.1 [http://www.opalimage.co.uk]. To assess intra-observer reproducibility, 25 images were re-digitised one month later. Random and systematic error were assessed using the Dahlberg formula and a two-sample t-test, respectively. Differences in the proportions of cases where the maxillary (1100 +/- 60) or mandibular (900 +/- 60) incisors were fully decomensated were assessed using a Chi-square test (p<0.05). Mann-Whitney U tests were used to identify if there were any differences in the amount of net decompensation for maxillary and mandibular incisors between the Class II combined and Class III groups (p<0.05). Random and systematic error were less than 0.5 degrees and p<0.05, respectively. A greater proportion of cases had decompensated mandibular incisors (80%) than maxillary incisors (62%) and this difference was statistically significant (p=0.029). The amount of maxillary incisor decompensation in the Class II and Class III groups did not statistically differ (p=0.45) whereas the mandibular incisors in the Class III group underwent statistically significantly greater decompensation (p=0.02). Mandibular incisors were decompensated for a greater proportion of cases than maxillary incisors in preparation for orthognathic surgery. There was no difference in the amount of maxillary incisor decompensation between Class II and Class III cases. There was a greater net decompensation for mandibular incisors in Class III cases when compared to Class II cases. Key words:Decompensation, orthognathic, pre-surgical orthodontics, surgical-orthodontic.

Impact of portal hemodynamics on Doppler ultrasonography for predicting decompensation and long-term outcomes in patients with cirrhosis.

PubMed

Kondo, Takayuki; Maruyama, Hitoshi; Sekimoto, Tadashi; Shimada, Taro; Takahashi, Masanori; Okugawa, Hidehiro; Yokosuka, Osamu

2016-01-01

Significance of portal hemodynamics for non-invasive marker of cirrhosis remains unclear. The aim was to determine the value of portal hemodynamics on Doppler ultrasound for predicting decompensation and prognosis in cirrhosis. This retrospective study comprised 236 cirrhotic patients (132 males, 104 females; age 63.7 ± 11.3 years; 110 compensated, 126 decompensated). Clinical data, including Doppler findings, were analyzed with respect to decompensation and prognosis. The median follow-up period was 33.2 months (0.1-95.4). Fifty-three patients developed clinical decompensation, 13 patients received liver transplantation, and 71 died. Higher model for end-stage liver disease score (p < 0.001) at baseline was the significant factor for the presence of decompensation. Higher alanine transaminase (p = 0.020), lower albumin (p = 0.002) and lower mean velocity in the portal trunk (p = 0.038) were significant factors for developing decompensation (best cut-off value: Alanine transaminase > 31 IU/L, albumin < 3.6 g/dL, and portal trunk < 12.8 cm/s). The cumulative incidence of decompensation was higher in patients with portal trunk < 12.8 cm/s (22.5% at 1 year, 71.2% at 5 years) than those without (6.9% at 1 year, 35.4% at 5 years; p < 0.001). The significant prognostic factors were hepatocellular carcinoma (p = 0.036) and lower albumin (p = 0.008) for compensated patients, and reversed portal flow (p = 0.028), overt ascites (p < 0.001), and higher bilirubin (p < 0.001) for decompensated patients. Portal hemodynamics offer a non-invasive marker for decompensation and prognosis of cirrhosis, suggesting a future direction for practical management.

[Usefulness of curved coronal MPR imaging for the diagnosis of cervical radiculopathy].

PubMed

Inukai, Chikage; Inukai, Takashi; Matsuo, Naoki; Shimizu, Ikuo; Goto, Hisaharu; Takagi, Teruhide; Takayasu, Masakazu

2010-03-01

In surgical treatment of cervical radiculopathy, localization of the responsible lesions by various imaging modalities is essential. Among them, MRI is non-invasive and plays a primary role in the assessment of spinal radicular symptoms. However, demonstration of nerve root compression is sometimes difficult by the conventional methods of MRI, such as T1 weighted (T1W) and T2 weighted (T2W) sagittal or axial images. We have applied a new technique of curved coronal multiplanar reconstruction (MPR) imaging for the diagnosis of cervical radiculopathy. Ten patients (4 male, 6 female) with ages between 31 and 79 year-old, who had clinical diagnosis of cervical radiculopathy, were included in this study. Seven patients underwent anterior key-hole foraminotomy to decompress the nerve root with successful results. All the patients had 3D MRI studies, such as true fast imaging with steady-state precession (FISP), 3DT2W sampling perfection with application optimized contrasts using different fillip angle evolution (SPACE), and 3D multi-echo data image combination (MEDIC) imagings in addition to the routine MRI (1.5 T Avanto, Siemens, Germany) with a phased array coil. The curved coronal MPR images were produced from these MRI data using a workstation. The nerve root compression was diagnosed by curved coronal MPR images in all the patients. The compression sites were compatible with those of the operative findings in 7 patients, who underwent surgical treatment. The MEDIC imagings were the most demonstrable to visualize the nerve root, while the 3D-space imagings were the next. The curved coronal MPR imaging is useful for the diagnosis of accurate localization of the compressing lesions in patients with cervical radiculopathy.

Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5-S1 interbody fusion: a case-matched evaluation of 32 patients.

PubMed

Theologis, Alexander A; Mundis, Gregory M; Nguyen, Stacie; Okonkwo, David O; Mummaneni, Praveen V; Smith, Justin S; Shaffrey, Christopher I; Fessler, Richard; Bess, Shay; Schwab, Frank; Diebo, Bassel G; Burton, Douglas; Hart, Robert; Deviren, Vedat; Ames, Christopher

2017-02-01

OBJECTIVE The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar/thoracolumbar coronal curve apex in adult spinal deformity (ASD). METHODS Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5-S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5-S1 interbody fusion without LIF (LS-Only group). All patients had at least 2 years of follow-up. Percutaneous PSF and 3-column osteotomy (3CO) were excluded. Demographics, perioperative details, radiographic spinal deformity measurements, and HRQoL data were analyzed. RESULTS Thirty-two patients were matched (LS+Apex: 16; LS: 16) (6 men, 26 women; mean age 63 ± 10 years). Overall, the average values for measures of deformity were as follows: Cobb angle > 40°, sagittal vertical axis (SVA) > 6 cm, pelvic tilt (PT) > 25°, and mismatch between pelvic incidence (PI) and lumbar lordosis (LL) > 15°. There were no significant intergroup differences in preoperative radiographic parameters, although patients in the LS+Apex group had greater Cobb angles and less LL. Patients in the LS+Apex group had significantly more anterior levels fused (4.6 vs 1), longer operative times (859 vs 379 minutes), and longer length of stay (12 vs 7.5 days) (all p < 0.01). For patients in the LS+Apex group, Cobb angle, pelvic tilt (PT), lumbar lordosis (LL), PI-LL (lumbopelvic mismatch), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores for back and leg pain improved significantly (p < 0.05). For patients in the LS-Only group, there were significant improvements in Cobb angle, ODI score, and VAS scores for back and leg pain. The LS+Apex group had better correction of Cobb angles (56% vs 33%, p = 0.02), SVA (43% vs 5%, p = 0.46), LL (62% vs 13%, p = 0.35), and PI-LL (68% vs 33%, p = 0.32). Despite more LS+Apex patients having major complications (56% vs 13%; p = 0.02) and postoperative leg weakness (31% vs 6%, p = 0.07), there were no intergroup differences in 2-year outcomes. CONCLUSIONS Long open posterior instrumented fusion with or without multilevel LIF is used to treat a variety of coronal and sagittal adult thoracolumbar deformities. The addition of multilevel LIF to open PSF with L5-S1 interbody support in this small cohort was often used in more severe coronal and/or lumbopelvic sagittal deformities and offered better correction of major Cobb angles, lumbopelvic parameters, and SVA than posterior-only operations. As these advantages came at the expense of more major complications, more leg weakness, greater blood loss, and longer operative times and hospital stays without an improvement in 2-year outcomes, future investigations should aim to more clearly define deformities that warrant the addition of multilevel LIF to open PSF and L5-S1 interbody fusion.

Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis.

PubMed

Yang, Changsheng; Wang, Huafeng; Zheng, Zhaomin; Zhang, Zhongmin; Wang, Jianru; Liu, Hui; Kim, Yongjung Jay; Cho, Samuel

2017-07-01

Halo-gravity traction has been reported to successfully assist in managing severe spinal deformity. This is a systematic review of all studies on halo-gravity traction in the treatment of spinal deformity to provide information for clinical practice. A comprehensive search was conducted for articles on halo-gravity traction in the treatment of spinal deformity according to the PRISMA guidelines. Appropriate studies would be included and analyzed. Preoperative correction rate of spinal deformity, change of pulmonary function and prevalence of complications were the main measurements. Sixteen studies, a total of 351 patients, were included in this review. Generally, the initial Cobb angle was 101.1° in the coronal plane and 80.5° in the sagittal plane, and it was corrected to 49.4° and 56.0° after final spinal fusion. The preoperative correction due to traction alone was 24.1 and 19.3%, respectively. With traction, the flexibility improved 6.1% but postoperatively the patients did not have better correction. Less aggressive procedures and improved pulmonary function were observed in patients with traction. The prevalence of traction-related complications was 22% and three cases of neurologic complication related to traction were noted. The prevalence of total complications related to surgery was 32% and that of neurologic complications was 1%. Partial correction could be achieved preoperatively with halo-gravity traction, and it may help decrease aggressive procedures, improve preoperative pulmonary function, and reduce neurologic complications. However, traction could not increase preoperative flexibility or final correction. Traction-related complications, although usually not severe, were not rare.

Interferon-free treatment for HCV-infected patients with decompensated cirrhosis.

PubMed

Kanda, Tatsuo

2017-01-01

Progress in interferon-free treatment against hepatitis C virus (HCV) has remained a challenge in patients with decompensated cirrhosis due to a paucity of information on efficacy and safety profiles. This review illustrates that interferon-free treatment could result in greater than 85 % sustained virological response (SVR) rates in patients with HCV genotype 1 and decompensated cirrhosis. The combination of pangenotypic HCV NS5A inhibitor velpatasvir and HCV NS5B inhibitor sofosbuvir has demonstrated high SVR rates in patients with HCV genotypes 1, 2, 3, 4 or 6 and decompensated cirrhosis. Certain patients discontinued treatment due to adverse events, death or having liver transplantation. Taken together, interferon-free treatment could produce higher SVR rates in decompensated hepatic cirrhosis. However, as adverse events were occasionally observed, liver transplantation should always be considered as well. Further improvements in treatment are called for in patients with decompensated cirrhosis.

Decreased accommodation during decompensation of distance exotropia.

PubMed

Horwood, Anna M; Riddell, Patricia M

2012-04-01

Disparity cues can be a major drive to accommodation via the convergence accommodation to convergence (CA/C) linkage, but, on decompensation of exotropia, disparity cues are extinguished by suppression so this drive is lost. This study investigated accommodation and vergence responses to disparity, blur and proximal cues in a group of distance exotropes aged between 4 and 11 years both during decompensation and when exotropic. 19 participants with distance exotropia were tested using a PlusoptiXSO4 photo refractor set in a remote haploscopic device that assessed simultaneous vergence and accommodation to a range of targets incorporating different combinations of blur, disparity and proximal cues at four fixation distances between 2 m and 33 cm. Responses on decompensation were compared with those from the same children when their deviation was controlled. Manifest exotropia was more common in the more impoverished cue conditions. When decompensated for near, mean accommodation gain for the all-cue (naturalistic) target was significantly reduced (p<0.0001), with resultant mean under-accommodation of 2.33 D at 33 cm. The profile of near cues usage changed after decompensation, with blur and proximity driving residual responses, but these remaining cues did not compensate for loss of accommodation caused by the removal of disparity. Accommodation often reduces on decompensation of distance exotropia as the drive from convergence is extinguished, providing a further reason to try to prevent decompensation for near.

Decreased accommodation during decompensation of distance exotropia

PubMed Central

Horwood, Anna M; Riddell, Patricia M

2015-01-01

Objective Disparity cues can be a major drive to accommodation via the CA/C (convergence accommodation to convergence) linkage but, on decompensation of exotropia, disparity cues are extinguished by suppression, so this drive is lost. This study investigated accommodation and vergence responses to disparity, blur and proximal cues in a group of distance exotropes aged between 4-11 years both during decompensation and when exotropic. Methods 19 participants with distance exotropia were tested using a PlusoptiXSO4 photorefractor set in a remote haploscopic device which assessed simultaneous vergence and accommodation to a range of targets incorporating different combinations of blur, disparity and proximal cues at four fixation distances between 2m and 33cm. Responses on decompensation were compared to those from the same children when their deviation was controlled. Results Manifest exotropia was more common in the more impoverished cue conditions. When decompensated for near, mean accommodation gain for the all-cue (naturalistic) target reduced significantly (p<0.0001), with resultant mean under-accommodation of 2.33D at 33cm. The profile of near cues usage changed after decompensation, with blur and proximity driving residual responses, but these remaining cues did not compensate for loss of accommodation caused by the removal of disparity. Conclusions Accommodation often reduces on decompensation of distance exotropia as the drive from convergence is extinguished, providing a further reason to try to prevent decompensation for near. PMID:21873311

Relative effects of heavy alcohol use and hepatitis C in decompensated chronic liver disease in a hospital inpatient population.

PubMed

Mankal, Pavan Kumar; Abed, Jean; Aristy, Jose David; Munot, Khushboo; Suneja, Upma; Engelson, Ellen S; Kotler, Donald P

2015-03-01

Heavy alcohol use has been hypothesized to accelerate disease progression to end-stage liver disease in patients with hepatitis C virus (HCV) infection. In this study, we estimated the relative influences of heavy alcohol use and HCV in decompensated chronic liver disease (CLD). Retrospectively, 904 patients with cirrhotic disease admitted to our hospitals during January 2010-December 2012 were identified based on ICD9 codes. A thorough chart review captured information on demographics, viral hepatitis status, alcohol use and progression of liver disease (i.e. decompensation). Decompensation was defined as the presence of ascites due to portal hypertension, bleeding esophageal varices, hepatic encephalopathy or hepatorenal syndrome. Heavy alcohol use was defined as a chart entry of greater than six daily units of alcohol or its equivalent. 347 patients were included based on our selection criteria of documented heavy alcohol use (n = 215; 62.0%), hepatitis titers (HCV: n = 182; 52.5%) and radiological evidence of CLD with or without decompensation (decompensation: n = 225; 64.8%). Independent of HCV infection, heavy alcohol use significantly increased the risk of decompensation (OR = 1.75, 95% CI 1.11-2.75, p < 0.02) relative to no heavy alcohol use. No significance was seen with age, sex, race, HIV, viral hepatitis and moderate alcohol use for risk for decompensation. Additionally, dose-relationship regression analysis revealed that heavy, but not moderate alcohol use, resulted in a three-fold increase (p = 0.013) in the risk of decompensation relative to abstinence. While both heavy alcohol use and HCV infection are associated with risk of developing CLD, our data suggest that heavy, but not moderate, alcohol consumption is associated with a greater risk for hepatic decompensation in patients with cirrhosis than does HCV infection.

Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity.

PubMed

Bridwell, Keith H

2006-09-01

Author experience and literature review. To investigate and discuss decision-making on when to perform a Smith-Petersen osteotomy as opposed to a pedicle subtraction procedure and/or a vertebral column resection. Articles have been published regarding Smith-Petersen osteotomies, pedicle subtraction procedures, and vertebral column resections. Expectations and complications have been reviewed. However, decision-making regarding which of the 3 procedures is most useful for a particular spinal deformity case is not clearly investigated. Discussed in this manuscript is the author's experience and the literature regarding the operative options for a fixed coronal or sagittal deformity. There are roles for Smith-Petersen osteotomy, pedicle subtraction, and vertebral column resection. Each has specific applications and potential complications. As the magnitude of resection increases, the ability to correct deformity improves, but also the risk of complication increases. Therein, an understanding of potential applications and complications is helpful.

CT of facet distraction in flexion injuries of the thoracolumbar spine: the "naked" facet.

PubMed

O'Callaghan, J P; Ullrich, C G; Yuan, H A; Kieffer, S A

1980-03-01

Vertical distraction of the articular processes is an important sign of ligamentous disruption due to flexion injuries of the thoracolumbar spine. In addition to illustrating this finding in cross section (the "naked" facet), computed tomography in the transaxial plane allows assessment of the presence and position of fracture fragments that may encroach on the spinal canal. Image reconstruction in sagittal and coronal planes provides a clear demonstration of the degree of bony compression, facet distraction, and kyphosis associated with flexion injuries without additional patient manipulation or radiation exposure.

The effect of spinal curvature on the photogrammetric assessment on static balance in elderly women.

PubMed

Drzał-Grabiec, Justyna; Rachwał, Maciej; Podgórska-Bednarz, Justyna; Rykała, Justyna; Snela, Sławomir; Truszczyńska, Aleksandra; Trzaskoma, Zbigniew

2014-05-29

Involutional changes to the body in elderly patients affect the shape of the spine and the activity of postural muscles. The purpose of this study was to assess the influence of age-related changes in spinal curvature on postural balance in elderly women. The study population consisted of 90 women, with a mean age of 70 ± 8.01 years. Static balance assessments were conducted on a tensometric platform, and posturographic assessments of body posture were performed using a photogrammetric method based on the Projection Moiré method. The results obtained were analysed using the Spearman's rank correlation coefficient test. We found a statistically significant correlation between body posture and the quality of the balance system response based on the corrective function of the visual system. The shape of the spinal curvature influenced postural stability, as measured by static posturography. Improvement in the quality of the balance system response depended on corrective information from the visual system and proprioceptive information from the paraspinal muscles. The sensitivity of the balance system to the change of centre of pressure location was influenced by the direction of the change in rotation of the shoulder girdle and spine. Development of spinal curvature in the sagittal plane and maintenance of symmetry in the coronal and transverse planes are essential for correct balance control, which in turn is essential for the development of a properly proportioned locomotor system.

Utility of an allograft tendon for scoliosis correction via the costo-transverse foreman.

PubMed

Sun, Dong; McCarthy, Michael; Dooley, Adam C; Ramakrishnaiah, Raghu H; Shelton, R Shane; McLaren, Sandra G; Skinner, Robert A; Suva, Larry J; McCarthy, Richard E

2017-01-01

Current convex tethering techniques for treatment of scoliosis have centered on anterior convex staples or polypropylene tethers. We hypothesized that an allograft tendon tether inserted via the costo-transverse foramen would correct an established spinal deformity. In the pilot study, six 8-week-old pigs underwent allograft tendon tethering via the costo-transverse foreman or sham to test the strength of the transplanted tendon to retard spine growth. After 4 months, spinal deformity in three planes was induced in all animals with allograft tendons. In the treatment study, the allograft tendon tether was used to treat established scoliosis in 11 8-week-old pigs (spinal deformity > 50°). Once the deformity was observed (4 months) animals were assigned to either no treatment group or allograft tendon tether group and progression assessed by monthly radiographs. At final follow-up, coronal Cobb angle and maximum vertebral axial rotation of the treatment group was significantly smaller than the non-treatment group, whereas sagittal kyphosis of the treatment group was significantly larger than the non-treatment group. In sum, a significant correction was achieved using a unilateral allograft tendon spinal tether, suggesting that an allograft tendon tethering approach may represent a novel fusion-less procedure to correct idiopathic scoliosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:183-192, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Objective quantification of the tinnitus decompensation by synchronization measures of auditory evoked single sweeps.

PubMed

Strauss, Daniel J; Delb, Wolfgang; D'Amelio, Roberto; Low, Yin Fen; Falkai, Peter

2008-02-01

Large-scale neural correlates of the tinnitus decompensation might be used for an objective evaluation of therapies and neurofeedback based therapeutic approaches. In this study, we try to identify large-scale neural correlates of the tinnitus decompensation using wavelet phase stability criteria of single sweep sequences of late auditory evoked potentials as synchronization stability measure. The extracted measure provided an objective quantification of the tinnitus decompensation and allowed for a reliable discrimination between a group of compensated and decompensated tinnitus patients. We provide an interpretation for our results by a neural model of top-down projections based on the Jastreboff tinnitus model combined with the adaptive resonance theory which has not been applied to model tinnitus so far. Using this model, our stability measure of evoked potentials can be linked to the focus of attention on the tinnitus signal. It is concluded that the wavelet phase stability of late auditory evoked potential single sweeps might be used as objective tinnitus decompensation measure and can be interpreted in the framework of the Jastreboff tinnitus model and adaptive resonance theory.

Paraplegic patients: how to measure balance and what is normal or functional?

PubMed

Barkoh, Kaku; Lucas, Joshua W; Lee, Larry; Hsieh, Patrick C; Wang, Jeffrey C; Rolfe, Kevin

2018-02-01

To review the current understanding and data of sagittal balance and alignment considerations in paraplegic patients. A PubMed literature search was conducted to identify all relevant articles relating to sagittal alignment and sagittal balance considerations in paraplegic and spinal cord injury patients. While there are numerous studies and publications on sagittal balance in the ambulatory patient with spinal deformity or complex spine disorders, there is paucity of the literature on "normal" sagittal balance in the paraplegic patients. Studies have reported significantly alterations of the sagittal alignment parameters in the non-ambulatory paraplegic patients compared to ambulatory patients. The variability of the alignment changes is related to the differences in the level of the spinal cord injury and their differences in the activations of truncal muscles to allow functional movements in those patients, particularly in optimizing sitting and transferring. Surgical goal in treating paraplegic patients with complex pathologies should not be solely directed to achieve the "normal" radiographic parameters of sagittal alignment in the ambulatory patients. The goal should be to maintain good coronal balance to allow ideal sitting position and to preserve motion segment to optimize functions of paraplegia patients. Current available literature data have not defined normal sagittal parameters for paraplegic patients. There are significant differences in postural sagittal parameters and muscle activations in paraplegic and non-spinal cord injury patients that can lead to differences in sagittal alignment and balance. Treatment goal in spine surgery for paraplegic patients should address their global function, sitting balance, and ability to perform self-care rather than the accepted radiographic parameters for adult spinal deformity in ambulatory patients.

The role of attention in the tinnitus decompensation: reinforcement of a large-scale neural decompensation measure.

PubMed

Low, Yin Fen; Trenado, Carlos; Delb, Wolfgang; Corona-Strauss, Farah I; Strauss, Daniel J

2007-01-01

Large-scale neural correlates of the tinnitus decompensation have been identified by using wavelet phase stability criteria of single sweep sequences of auditory late responses (ALRs). The suggested measure provided an objective quantification of the tinnitus decompensation and allowed for a reliable discrimination between a group of compensated and decompensated tinnitus patients. By interpreting our results with an oscillatory tinnitus model, our synchronization stability measure of ALRs can be linked to the focus of attention on the tinnitus signal. In the following study, we examined in detail the correlates of this attentional mechanism in healthy subjects. The results support our previous findings of the phase synchronization stability measure that reflected neural correlates of the fixation of attention to the tinnitus signal. In this case, enabling the differentiation between the attended and unattended conditions. It is concluded that the wavelet phase synchronization stability of ALRs single sweeps can be used as objective tinnitus decompensation measure and can be interpreted in the framework of the Jastreboff tinnitus model and adaptive resonance theory. Our studies confirm that the synchronization stability in ALR sequences is linked to attention. This measure is not only able to serve as objective quantification of the tinnitus decompensation, but also can be applied in all online and real time neurofeedback therapeutic approach where a direct stimulus locked attention monitoring is compulsory as if it based on a single sweeps processing.

Biomarkers in acute heart failure.

PubMed

Mallick, Aditi; Januzzi, James L

2015-06-01

The care of patients with acutely decompensated heart failure is being reshaped by the availability and understanding of several novel and emerging heart failure biomarkers. The gold standard biomarkers in heart failure are B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, which play an important role in the diagnosis, prognosis, and management of acute decompensated heart failure. Novel biomarkers that are increasingly involved in the processes of myocardial injury, neurohormonal activation, and ventricular remodeling are showing promise in improving diagnosis and prognosis among patients with acute decompensated heart failure. These include midregional proatrial natriuretic peptide, soluble ST2, galectin-3, highly-sensitive troponin, and midregional proadrenomedullin. There has also been an emergence of biomarkers for evaluation of acute decompensated heart failure that assist in the differential diagnosis of dyspnea, such as procalcitonin (for identification of acute pneumonia), as well as markers that predict complications of acute decompensated heart failure, such as renal injury markers. In this article, we will review the pathophysiology and usefulness of established and emerging biomarkers for the clinical diagnosis, prognosis, and management of acute decompensated heart failure. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Sensory-motor polyneuropathy occurring in variant maple syrup urine disease.

PubMed

Harty, S; King, M D; McCoy, B; Costigan, D; Treacy, E P

2008-12-01

Maple syrup urine disease (MSUD; OMIM 248600) results from an inherited deficiency of the branched-chain ketoacid dehydrogenase (BCKD) complex. Approximately 20% of patients with BCKD deficiency are non-classic variants of MSUD with differing clinical severity. Outcomes for this cohort are generally favourable; episodes of metabolic decompensation do not appear to correlate with adverse events if acute management is promptly provided. A case of predominantly axonal sensory-motor neuropathy following metabolic decompensation which persisted for a number of months is presented in an adolescent girl with variant (intermediate type) MSUD. EMG and nerve conduction studies suggested a pre-existent asymptomatic chronic neuropathy, exacerbated by the acute decompensation. Peak leucine concentration at decompensation was 1083 μmol/L. The patient had laboratory signs of secondary mitochondrial respiratory chain dysfunction at presentation. She had been on a moderate dose of thiamine prior to decompensation; thiamine and pyridoxine blood concentrations were normal. This, to our knowledge, is the first report of a neuropathy presenting in a patient with a decompensation of variant MSUD. We propose that this presentation resembles the intermittent neuropathy observed in pyruvate dehydrogenase deficiency and may reflect secondary inhibition of pyruvate dehydrogenase activity by MSUD metabolites.

Segmental Pedicle Screw Instrumentation and Fusion Only to L5 in the Surgical Treatment of Flaccid Neuromuscular Scoliosis.

PubMed

Takaso, Masashi; Nakazawa, Toshiyuki; Imura, Takayuki; Fukuda, Michinari; Takahashi, Kazuhisa; Ohtori, Seiji

2018-03-01

A retrospective cohort study was performed. The purpose of this study was to determine the efficacy and safety of stopping segmental pedicle screw instrumentation constructs at L5 in the treatment of neuromuscular scoliosis. Duchenne muscular dystrophy and spinal muscular atrophy are flaccid neuromuscular disorders in which gradual deterioration is the hallmark and have a lot of characteristics in common despite differences in etiology. Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of flaccid neuromuscular scoliosis and recommended to correct pelvic obliquity. However, the caudal extent of instrumentation and fusion in the surgical treatment of flaccid neuromuscular scoliosis has remained a matter of considerable debate and there have been few studies on the use of segmental pedicle screw instrumentation for flaccid neuromuscular scoliosis. From 2005 to 2007, a total of 27 consecutive patients with neuromuscular disorders (20 Duchenne muscular dystrophy and 7 spinal muscular atrophy), aged 11 to 17 years, underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. Minimum 2-year follow-up was required for inclusion in this study. Twenty patients were enrolled in this study. No patient was lost to follow-up. All patients had L5 tilt of less than 15° and a coronal curve with apex L2 or higher preoperatively. Preoperative coronal curve averaged 70° (range: 51°-88°), with a postoperative mean of 15° (range: 5°-25°) and 17° (range: 6°-27°) at the last follow-up. The pelvic obliquity improved from 15° (range: 9°-25°) preoperatively to 5° (range: 3°-8°) postoperatively and 6° (range: 3°-8°) at the last follow-up. The L5 tilt improved from 9° (range: 2°-14°) preoperatively to 2° (range: 0°-4°) postoperatively and 2° (range: 0°-5°) at the last follow-up. Physiologic sagittal plane alignment was recreated after surgery and maintained long-term. There was no significant loss of correction of coronal curve and pelvic obliquity. There was no major complication. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with flaccid neuromuscular scoliosis with apex L2 or higher and minimal L5 tilt of less than 15°. Segmental pedicle screw instrumentation ending at L5 offered the ability to correct spinal deformity and pelvic obliquity initially, intermediate and even long-term, with no major complications. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of flaccid neuromuscular scoliosis. N/A.

Computer-assisted design and finite element simulation of braces for the treatment of adolescent idiopathic scoliosis using a coronal plane radiograph and surface topography.

PubMed

Pea, Rany; Dansereau, Jean; Caouette, Christiane; Cobetto, Nikita; Aubin, Carl-Éric

2018-05-01

Orthopedic braces made by Computer-Aided Design and Manufacturing and numerical simulation were shown to improve spinal deformities correction in adolescent idiopathic scoliosis while using less material. Simulations with BraceSim (Rodin4D, Groupe Lagarrigue, Bordeaux, France) require a sagittal radiograph, not always available. The objective was to develop an innovative modeling method based on a single coronal radiograph and surface topography, and assess the effectiveness of braces designed with this approach. With a patient coronal radiograph and a surface topography, the developed method allowed the 3D reconstruction of the spine, rib cage and pelvis using geometric models from a database and a free form deformation technique. The resulting 3D reconstruction converted into a finite element model was used to design and simulate the correction of a brace. The developed method was tested with data from ten scoliosis cases. The simulated correction was compared to analogous simulations performed with a 3D reconstruction built using two radiographs and surface topography (validated gold standard reference). There was an average difference of 1.4°/1.7° for the thoracic/lumbar Cobb angle, and 2.6°/5.5° for the kyphosis/lordosis between the developed reconstruction method and the reference. The average difference of the simulated correction was 2.8°/2.4° for the thoracic/lumbar Cobb angles and 3.5°/5.4° the kyphosis/lordosis. This study showed the feasibility to design and simulate brace corrections based on a new modeling method with a single coronal radiograph and surface topography. This innovative method could be used to improve brace designs, at a lesser radiation dose for the patient. Copyright © 2018 Elsevier Ltd. All rights reserved.

Liver Surface Nodularity Score Allows Prediction of Cirrhosis Decompensation and Death.

PubMed

Smith, Andrew D; Zand, Kevin A; Florez, Edward; Sirous, Reza; Shlapak, Darya; Souza, Frederico; Roda, Manohar; Bryan, Jason; Vasanji, Amit; Griswold, Michael; Lirette, Seth T

2017-06-01

Purpose To determine whether use of the liver surface nodularity (LSN) score, a quantitative biomarker derived from routine computed tomographic (CT) images, allows prediction of cirrhosis decompensation and death. Materials and Methods For this institutional review board-approved HIPAA-compliant retrospective study, adult patients with cirrhosis and Model for End-Stage Liver Disease (MELD) score within 3 months of initial liver CT imaging between January 3, 2006, and May 30, 2012, were identified from electronic medical records (n = 830). The LSN score was measured by using CT images and quantitative software. Competing risk regression was used to determine the association of the LSN score with hepatic decompensation and overall survival. A risk model combining LSN scores (<3 or ≥3) and MELD scores (<10 or ≥10) was created for predicting liver-related events. Results In patients with compensated cirrhosis, 40% (129 of 326) experienced decompensation during a median follow-up period of 4.22 years. After adjustment for competing risks including MELD score, LSN score (hazard ratio, 1.38; 95% confidence interval: 1.06, 1.79) was found to be independently predictive of hepatic decompensation. Median times to decompensation of patients at high (1.76 years, n = 48), intermediate (3.79 years, n = 126), and low (6.14 years, n = 152) risk of hepatic decompensation were significantly different (P < .001). Among the full cohort with compensated or decompensated cirrhosis, 61% (504 of 830) died during the median follow-up period of 2.26 years. After adjustment for competing risks, LSN score (hazard ratio, 1.22; 95% confidence interval: 1.11, 1.33) and MELD score (hazard ratio, 1.08; 95% confidence interval: 1.06, 1.11) were found to be independent predictors of death. Median times to death of patients at high (0.94 years, n = 315), intermediate (2.79 years, n = 312), and low (4.69 years, n = 203) risk were significantly different (P < .001). Conclusion The LSN score derived from routine CT images allows prediction of cirrhosis decompensation and death. © RSNA, 2016 Online supplemental material is available for this article.

Do postoperative radiographically verified technical success, improved cosmesis, and trunk shift corroborate with patient-reported outcomes in Lenke 1C adolescent idiopathic scoliosis?

PubMed

Sharma, Shallu; Bünger, Cody Eric; Andersen, Thomas; Sun, Haolin; Wu, Chunsen; Hansen, Ebbe Stender

2015-07-01

To examine correlation between postoperative radiographic and cosmetic improvements in Lenke 1C adolescent idiopathic scoliosis (AIS) with patients' self-rated outcomes of health and disability at follow-up as determined by the Scoliosis Research Society questionnaire (SRS-30), Oswestry Disability Index score (ODI) and measure of overall health quality Euroqol-5d (EQ-5D). 24 Lenke 1C scoliosis patients, mean age 16.5 (12.8-38.1) years, treated with posterior pedicle screw-only construct, were included. The coronal profile indices (radiographic and cosmetic) regarding magnitude of spinal deformity and truncal balance were measured preoperatively, postoperatively and at final follow-up. A comprehensive index of overall back symmetry was also measured by means of the Posterior Trunk Symmetry Index (POTSI). Pearson's correlation analysis determined the association between the radiographic-cosmetic indices and patient-rated outcomes. Mean follow-up for the cohort was 4.4 (±1.86) years. The thoracic apical vertebra-first thoracic vertebra horizontal distance (AV-TI) correction had significant correlation with function, self-image, and mental health SRS-30 scores (0.55, 0.54, 0.66). Similarly, thoracic apical vertebra horizontal translation from central sacral vertical line (AV-CSVL) correction at follow-up had significant correlation with self-image and management domains (0.57, 0.50). Follow-up POTSI correlated well with SRS-30 and EQ-5D scores (r = -0.64, -0.54). Postoperative leftward trunk shift/spinal imbalance did not influence overall cosmesis and outcomes; significant spinal realignment was evident in follow-up resulting in physiological balance and acceptable cosmesis and outcomes. Significant, but less than "perfect" correlations were observed between the radiographic, cosmetic measures and patient-rated outcomes. Thoracic AV-CSVL, AV-T1 correction and POTSI associated significantly with SRS-30 scores. Whereas, thoracic Cobb angle, Cobb correction, and coronal balance did not correlate with any patient-rated outcome measure. It is, therefore, inferred that the patients-rated subjective outcomes are only poorly reflected by the objectively measured radiographic and cosmetic measures of deformity correction.

The Decompensated Monofixation Syndrome (An American Ophthalmological Society Thesis)

PubMed Central

Siatkowski, R. Michael

2011-01-01

Purpose To describe the clinical features and response to treatment of patients with decompensated monofixation syndrome (MFS) and to propose a hypothesis for a decompensation mechanism in such patients. Methods Fourteen adults with MFS who had been symptomatically stable for a mean duration of 25 years developed diplopia in the absence of neurologic or orbital disease. After retrospective chart review, they underwent detailed orthoptic testing. Results from this cross-sectional analysis were compared with similar data from 16 control subjects with stable MFS. Results Compared to stable MFS patients, decompensated subjects had significantly poorer horizontal fusional amplitudes but greater torsional fusional amplitudes; they were also more likely to have a small vertical strabismus and to have received initial treatment later. Stable subjects, however, also had subnormal horizontal as well as torsional fusional amplitudes. There was no difference between groups with respect to refractive error, amblyopia, type or prior treatment of strabismus, stereoacuity, or angle of deviation. After treatment, all patients regained monofixational alignment, but up to one-third had continued diplopia. Symptoms recurred in two patients whose treatment was initially successful. Conclusions Patients with MFS lose fusional amplitudes over time. In some cases this results in development of sensory torsion with secondary decompensation and diplopia. The rate of decompensation averages 7% per year from ages 20 to 70. Treatment for decompensation offers excellent motor results, but sensory symptoms may persist and recurrent symptoms may develop. Monitoring and maintenance of fusional vergence amplitudes should be part of the routine care for patients with MFS. PMID:22253490

Unstable upper and middle thoracic fractures. Preliminary experience with a posterior transpedicular correction-fixation technique.

PubMed

Payer, M

2005-06-01

A number of conservative and operative approaches have been described for the treatment of unstable traumatic upper and middle thoracic fractures. The advantage of surgical correction and fixation/fusion lies in its potential to restore sagittal and coronal alignment, thereby indirectly decompressing the spinal cord. A consecutive series of 8 patients with unstable traumatic upper and middle thoracic fractures is reviewed. In all patients, polyaxial pedicle screws were inserted bilaterally into the two levels above and below the fracture. Rods that were less contoured ("undercontoured") than the regional hyperkyphosis at the injured level, were anchored to the caudal four screws. The cranial four screws, with the vertebrae to which they were inserted, were then progressively pulled posteriorly onto the undercontoured rods with rod reducers, thus correcting the hyperkyphosis and anterolisthesis. The mean follow-up was 15 months. The mean regional kyphosis was 23 degrees preoperatively, 17 degrees postoperatively and 18 degrees at follow-up. The mean anterolisthesis was 8 mm preoperatively, 1 mm postoperatively and 1 mm at follow-up. No hardware failure occurred. Five patients with complete spinal cord injury at presentation made no neurological recovery, two patients with incomplete spinal cord injury initially (ASIA B), recovered substantially (to ASIA D), and the patients who were neurologically intact at presentation remained so.

Functional anatomy of the spine.

PubMed

Bogduk, Nikolai

2016-01-01

Among other important features of the functional anatomy of the spine, described in this chapter, is the remarkable difference between the design and function of the cervical spine and that of the lumbar spine. In the cervical spine, the atlas serves to transmit the load of the head to the typical cervical vertebrae. The axis adapts the suboccipital region to the typical cervical spine. In cervical intervertebrtal discs the anulus fibrosus is not circumferential but is crescentic, and serves as an interosseous ligament in the saddle joint between vertebral bodies. Cervical vertebrae rotate and translate in the sagittal plane, and rotate in the manner of an inverted cone, across an oblique coronal plane. The cervical zygapophysial joints are the most common source of chronic neck pain. By contrast, lumbar discs are well designed to sustain compression loads, but rely on posterior elements to limit axial rotation. Internal disc disruption is the most common basis for chronic low-back pain. Spinal muscles are arranged systematically in prevertebral and postvertebral groups. The intrinsic elements of the spine are innervated by the dorsal rami of the spinal nerves, and by the sinuvertebral nerves. Little modern research has been conducted into the structure of the thoracic spine, or the causes of thoracic spinal pain. © 2016 Elsevier B.V. All rights reserved.

Spatial variability and changes of metabolite concentrations in the cortico-spinal tract in multiple sclerosis using coronal CSI

PubMed Central

Tur, Carmen; Wheeler-Kingshott, Claudia AM; Altmann, Daniel R; Miller, David H; Thompson, Alan J; Ciccarelli, Olga

2014-01-01

We characterized metabolic changes along the cortico-spinal tract (CST) in multiple sclerosis (MS) patients using a novel application of chemical shift imaging (CSI) and considering the spatial variation of metabolite levels. Thirteen relapsing-remitting (RR) and 13 primary-progressive (PP) MS patients and 16 controls underwent 1H-MR CSI, which was applied to coronal-oblique scans to sample the entire CST. The concentrations of the main metabolites, i.e., N-acetyl-aspartate, myo-Inositol (Ins), choline containing compounds (Cho) and creatine and phosphocreatine (Cr), were calculated within voxels placed in regions where the CST is located, from cerebral peduncle to corona radiata. Differences in metabolite concentrations between groups and associations between metabolite concentrations and disability were investigated, allowing for the spatial variability of metabolite concentrations in the statistical model. RRMS patients showed higher CST Cho concentration than controls, and higher CST Ins concentration than PPMS, suggesting greater inflammation and glial proliferation in the RR than in the PP course. In RRMS, a significant, albeit modest, association between greater Ins concentration and greater disability suggested that gliosis may be relevant to disability. In PPMS, lower CST Cho and Cr concentrations correlated with greater disability, suggesting that in the progressive stage of the disease, inflammation declines and energy metabolism reduces. Attention to the spatial variation of metabolite concentrations made it possible to detect in patients a greater increase in Cr concentration towards the superior voxels as compared to controls and a stronger association between Cho and disability, suggesting that this step improves our ability to identify clinically relevant metabolic changes. PMID:23281189

Natural History of Cirrhosis of Liver after First Decompensation: A Prospective Study in India.

PubMed

Shah, Apurva S; Amarapurkar, Deepak N

2018-03-01

As liver cirrhosis is a dynamic condition, it is possible to improve survival in decompensated cirrhosis. Hence, we planned a prospective study to determine the natural history of cirrhosis after first decompensation. We enrolled all patients of liver cirrhosis who presented with first episode of decompensation defined by the presence of ascites, either overt or detected by Ultrasonography (UD), Gastroesophageal Variceal Bleeding (GEVB), and Hepatic Encephalopathy (HE). All patients were followed up to death/liver transplant or at least for the period of 1 year. Multivariable Cox proportional hazards regression was used to analyze the risk of failure (death or Orthotopic Liver Transplantation (OLT)). In total of 110 cirrhotic patients (93 males, mean age 50 ± 11 years), the most frequent etiology was alcohol (48%), followed by nonalcoholic steatohepatitis/cryptogenic (26%), hepatitis B (10%), autoimmune hepatitis (7%), and hepatitis C (6%). The distribution of CTP classes was: 4%, 56%, and 41% in class A, B, and C, respectively. Ascites was the most common decompensation found in 88 patients (80%) followed by HE (14%) and GEVB (6%). At 1-year follow up, transplant free survival was 78%, 2 underwent OLT, 4 developed hepatocellular carcinoma, and 24 died. Cumulative incidence of failure (death or OLT) by type of decompensation after 1 year was: 22% overt ascites, 50% GEVB, 28% UD ascites, 20% HE, and 33% ascites and GEVB concomitant. Patients with UD ascites do not have a negligible mortality rate as compared to overt ascites. Patients with cirrhosis after first decompensation have better transplant free survival with treatment of etiology and complications than previously mentioned in literature.

Diabetes Mellitus is Associated With Higher Risk of Developing Decompensated Cirrhosis in Chronic Hepatitis C Patients.

PubMed

Saeed, Mohammed J; Olsen, Margaret A; Powderly, William G; Presti, Rachel M

2017-01-01

To investigate the association of diabetes with risk of decompensated cirrhosis in patients with chronic hepatitis C (CHC). Direct-acting antivirals are highly effective in treating CHC but very expensive. CHC patients at high risk of progression to symptomatic liver disease may benefit most from early treatment. We conducted a retrospective cohort study using the 2006 to 2013 Truven Health Analytics MarketScan Commercial Claims and Encounters database including inpatient, outpatient, and pharmacy claims from private insurers. CHC and cirrhosis were identified using ICD-9-CM diagnosis codes; baseline diabetes was identified by diagnosis codes or antidiabetic medications. CHC patients were followed to identify decompensated cirrhosis. Multivariable Cox proportional hazards regression was used to model the risk of decompensated cirrhosis by baseline cirrhosis. There were 75,805 CHC patients with median 1.9 years follow-up. A total of 10,317 (13.6%) of the CHC population had diabetes. The rates of decompensated cirrhosis per 1000 person-years were: 185.5 for persons with baseline cirrhosis and diabetes, 119.8 for persons with cirrhosis and no diabetes, 35.3 for persons with no cirrhosis and diabetes, and 17.1 for persons with no cirrhosis and no diabetes. Diabetes was associated with increased risk of decompensated cirrhosis in persons with baseline cirrhosis (adjusted hazard ratio=1.4; 95% confidence interval, 1.3-1.6) and in persons without baseline cirrhosis (adjusted hazard ratio=1.9; 95% confidence interval, 1.7-2.1). In a privately insured US population with CHC, the adjusted risk of decompensated cirrhosis was higher in diabetic compared with nondiabetic patients. Diabetes status should be included in prioritization of antiviral treatment.

Preclinical Evaluation of a Decision Support Medical Monitoring System for Early Detection of Potential Hemodynamic Decompensation During Blood Loss in Humans

DTIC Science & Technology

2013-09-01

Hemodynamic Decompensation During Blood Loss in Humans PRINCIPAL INVESTIGATOR: Michael J. Joyner, M.D. CONTRACTING ORGANIZATION: Mayo Clinic...Medical Monitoring System for Early Detection of Potential Hemodynamic Decompensation During Blood Loss in Humans 5c. PROGRAM ELEMENT NUMBER 6...loss and hemorrhage in humans. The aim Is to be able to detect subtle changes in hemodynamic variables that provide prodromal clues to Impending

Curve Modulation and Apex Migration Using Shilla Growth Guidance Rods for Early-onset Scoliosis at 5-Year Follow-up.

PubMed

Wilkinson, John T; Songy, Chad E; Bumpass, David B; McCullough, Francis L; McCarthy, Richard E

2017-04-03

The Shilla procedure was designed to correct and control early-onset spinal deformity while harnessing a child's remaining spinal growth. It allows for controlled axial skeletal growth within the construct, avoiding the need for frequent surgeries to lengthen implants. We hypothesized that curve characteristics evolve over time after initial apex fusion and placement of the Shilla implants. The purpose of this study was to identify trends in curve evolution after Shilla implantation and understand how these changes influence ultimate outcome. A single-center, retrospective review of all patients with Shilla implants in place for ≥5 years yielded 21 patients. Charts and radiographs were reviewed to compare coronal curve characteristics preoperatively, postoperatively, and at last follow-up to note changes in the apex of the primary curve. Also noted were the development of adjacent compensatory curves, the overall vertical spinal growth, and the need for definitive spinal fusion once skeletal maturity was reached. Of the 21 patients, the curve apex migrated caudally in 12 patients (57%) and cephalad in 1 patient (5%), with a mean migration of 2.7 vertebral levels. Two patients (10%) developed new, significant compensatory curves (1 caudal and 1 cephalad). All patients demonstrated spinal growth in T1-S1 length following index surgery (mean, 45 mm). At skeletal maturity, 10 patients underwent definitive posterior spinal fusion and instrumentation, and 3 underwent implant removal alone. This study constitutes the longest follow-up of Shilla patients evaluating curve and implant behavior. Results of this review suggest that the apex of the fused primary curve shifts in approximately 62% of patients, with nearly all of these (92%) involving a distal migration. Compensatory curves did develop after Shilla placement as well. Overall, these findings represent adding-on distal to the apex after Shilla instrumentation rather than a crankshaft phenomenon about the apex. A better understanding of spinal growth mechanics and outcomes after Shilla placement may improve our ability to appropriately select patients and instrumentation levels. Level III.

Effect of Progressive Heart Failure on Cerebral Hemodynamics and Monoamine Metabolism in CNS.

PubMed

Mamalyga, M L; Mamalyga, L M

2017-07-01

Compensated and decompensated heart failure are characterized by different associations of disorders in the brain and heart. In compensated heart failure, the blood flow in the common carotid and basilar arteries does not change. Exacerbation of heart failure leads to severe decompensation and is accompanied by a decrease in blood flow in the carotid and basilar arteries. Changes in monoamine content occurring in the brain at different stages of heart failure are determined by various factors. The functional exercise test showed unequal monoamine-synthesizing capacities of the brain in compensated and decompensated heart failure. Reduced capacity of the monoaminergic systems in decompensated heart failure probably leads to overstrain of the central regulatory mechanisms, their gradual exhaustion, and failure of the compensatory mechanisms, which contributes to progression of heart failure.

Evidence of psychosomatic influences in compensated and decompensated tinnitus.

PubMed

Stobik, Corinna; Weber, Rainer K; Münte, Thomas F; Walter, Marc; Frommer, Jörg

2005-06-01

The purpose of this study was to evaluate the role and interaction of individual factors on decompensated tinnitus. Subjects consisted of 53 adult patients with chronic tinnitus. They were selected and assigned to two groups, compensated (n = 28) and decompensated (n = 25), according to the results of an established tinnitus questionnaire. Both groups were evaluated and compared. The patients with decompensated tinnitus suffered from more pronounced social disabilities, were more prone to depression, and used less effective techniques to cope with their illness. They showed a higher degree of somatic multimorbidity, with particularly strong correlations between tinnitus and the incidence of cardiovascular diseases and hypoacusis. As a consequence, in the psychosomatic tinnitus therapy, greater attention should be given to the treatment of the somatic complaints in addition to psychological and psychosocial aspects.

Acute Decompensated Heart Failure: New Strategies for Improving Outcomes.

PubMed

Singer Fisher, Emily; Burns, Boyd

2017-05-01

Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients.

Comparison of portable and conventional ultrasound imaging in spinal curvature measurement

NASA Astrophysics Data System (ADS)

Yan, Christina; Tabanfar, Reza; Kempston, Michael; Borschneck, Daniel; Ungi, Tamas; Fichtinger, Gabor

2016-03-01

PURPOSE: In scoliosis monitoring, tracked ultrasound has been explored as a safer imaging alternative to traditional radiography. The use of ultrasound in spinal curvature measurement requires identification of vertebral landmarks, but bones have reduced visibility in ultrasound imaging and high quality ultrasound machines are often expensive and not portable. In this work, we investigate the image quality and measurement accuracy of a low cost and portable ultrasound machine in comparison to a standard ultrasound machine in scoliosis monitoring. METHODS: Two different kinds of ultrasound machines were tested on three human subjects, using the same position tracker and software. Spinal curves were measured in the same reference coordinate system using both ultrasound machines. Lines were defined by connecting two symmetric landmarks identified on the left and right transverse process of the same vertebrae, and spinal curvature was defined as the transverse process angle between two such lines, projected on the coronal plane. RESULTS: Three healthy volunteers were scanned by both ultrasound configurations. Three experienced observers localized transverse processes as skeletal landmarks and obtained transverse process angles in images obtained from both ultrasounds. The mean difference per transverse process angle measured was 3.00 +/-2.1°. 94% of transverse processes visualized in the Sonix Touch were also visible in the Telemed. Inter-observer error in the Telemed was 4.5° and 4.3° in the Sonix Touch. CONCLUSION: Price, convenience and accessibility suggest the Telemed to be a viable alternative in scoliosis monitoring, however further improvements in measurement protocol and image noise reduction must be completed before implementing the Telemed in the clinical setting.

Clinically orientated classification incorporating shoulder balance for the surgical treatment of adolescent idiopathic scoliosis.

PubMed

Elsebaie, H B; Dannawi, Z; Altaf, F; Zaidan, A; Al Mukhtar, M; Shaw, M J; Gibson, A; Noordeen, H

2016-02-01

The achievement of shoulder balance is an important measure of successful scoliosis surgery. No previously described classification system has taken shoulder balance into account. We propose a simple classification system for AIS based on two components which include the curve type and shoulder level. Altogether, three curve types have been defined according to the size and location of the curves, each curve pattern is subdivided into type A or B depending on the shoulder level. This classification was tested for interobserver reproducibility and intraobserver reliability. A retrospective analysis of the radiographs of 232 consecutive cases of AIS patients treated surgically between 2005 and 2009 was also performed. Three major types and six subtypes were identified. Type I accounted for 30 %, type II 28 % and type III 42 %. The retrospective analysis showed three patients developed a decompensation that required extension of the fusion. One case developed worsening of shoulder balance requiring further surgery. This classification was tested for interobserver and intraobserver reliability. The mean kappa coefficients for interobserver reproducibility ranged from 0.89 to 0.952, while the mean kappa value for intraobserver reliability was 0.964 indicating a good-to-excellent reliability. The treatment algorithm guides the spinal surgeon to achieve optimal curve correction and postoperative shoulder balance whilst fusing the smallest number of spinal segments. The high interobserver reproducibility and intraobserver reliability makes it an invaluable tool to describe scoliosis curves in everyday clinical practice.

Early postnatal response of the spinal nucleus of the bulbocavernosus and target muscles to testosterone in male gerbils.

PubMed

Hadi Mansouri, S; Siegford, Janice M; Ulibarri, Catherine

2003-05-14

This study examined the response of the spinal nucleus of the bulbocavernosus (SNB) and the bulbocavernosus (BC) muscle, to testosterone in male Mongolian gerbils (Meriones unguiculatus) during the early postnatal period. Male gerbil pups were given testosterone propionate (TP) or vehicle for 2 days, then perfused on postnatal day (PND) 3, 5, 10 or 15. The BC and levator ani (LA) muscles were removed, weighed, and sectioned. Cross-sections of BC muscle fibers were measured and muscle fiber morphology examined. Spinal cords were removed and coronally sectioned in order to count and measure the SNB motoneurons. Following TP treatment, male pups of all ages had significantly heavier BC-LA muscles and larger fibers in the BC muscle compared to age-matched controls. The increase in muscle weight following TP treatment was greatest at PND10, while fiber size increased to a similar degree at all ages suggesting that hyperplasia as well as hypertrophy was responsible for the increase in muscle mass at this time. SNB motoneurons increased significantly in number and size with age and TP treatment. We hypothesize that the increase in SNB motoneuron number during normal ontogeny that can be augmented by TP treatment and represents an unusual means of establishing sexual dimorphism in the nervous system of a mammal through cell recruitment to the motor pool of a postnatal animal.

Lumbar spinal loading during bowling in cricket: a kinetic analysis using a musculoskeletal modelling approach.

PubMed

Zhang, Yanxin; Ma, Ye; Liu, Guangyu

2016-01-01

The objective of the study was to evaluate two types of cricket bowling techniques by comparing the lumbar spinal loading using a musculoskeletal modelling approach. Three-dimensional kinematic data were recorded by a Vicon motion capture system under two cricket bowling conditions: (1) participants bowled at their absolute maximal speeds (max condition), and (2) participants bowled at their absolute maximal speeds while simultaneously forcing their navel down towards their thighs starting just prior to ball release (max-trunk condition). A three-dimensional musculoskeletal model comprised of the pelvis, sacrum, lumbar vertebrae and torso segments, which enabled the motion of the individual lumbar vertebrae in the sagittal, frontal and coronal planes to be actuated by 210 muscle-tendon units, was used to simulate spinal loading based on the recorded kinematic data. The maximal lumbar spine compressive force is 4.89 ± 0.88BW for the max condition and 4.58 ± 0.54BW for the max-trunk condition. Results showed that there was no significant difference between the two techniques in trunk moments and lumbar spine forces. This indicates that the max-trunk technique may not increase lower back injury risks. The method proposed in this study could be served as a tool to evaluate lower back injury risks for cricket bowling as well as other throwing activities.

Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy.

PubMed

Liang, Chen; Sun, Jianmin; Cui, Xingang; Jiang, Zhensong; Zhang, Wen; Li, Tao

2016-07-22

Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index 'the largest recruitment order' were recorded and compared. All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (-0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P < 0.05). The preoperative mean TK and PT (24.7° ± 11.3° and 20.7° ± 7.8°) decreased to (22.0° ± 9.8° and 15.8 ± 5.5°) postoperatively (P < 0.05). The largest recruitment order on the level of T7-T8, T12-L1 and the herniated level all improved compared with before and after surgery (P < 0.05). All patients have been followed up for more than 2 years. The mean ODI was 77.8 % before surgery to 4.2 % at the final follow-up. Spinal sagittal imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.

Automated segmentation of three-dimensional MR brain images

NASA Astrophysics Data System (ADS)

Park, Jonggeun; Baek, Byungjun; Ahn, Choong-Il; Ku, Kyo Bum; Jeong, Dong Kyun; Lee, Chulhee

2006-03-01

Brain segmentation is a challenging problem due to the complexity of the brain. In this paper, we propose an automated brain segmentation method for 3D magnetic resonance (MR) brain images which are represented as a sequence of 2D brain images. The proposed method consists of three steps: pre-processing, removal of non-brain regions (e.g., the skull, meninges, other organs, etc), and spinal cord restoration. In pre-processing, we perform adaptive thresholding which takes into account variable intensities of MR brain images corresponding to various image acquisition conditions. In segmentation process, we iteratively apply 2D morphological operations and masking for the sequences of 2D sagittal, coronal, and axial planes in order to remove non-brain tissues. Next, final 3D brain regions are obtained by applying OR operation for segmentation results of three planes. Finally we reconstruct the spinal cord truncated during the previous processes. Experiments are performed with fifteen 3D MR brain image sets with 8-bit gray-scale. Experiment results show the proposed algorithm is fast, and provides robust and satisfactory results.

Acute decompensated heart failure: new strategies for improving outcomes [digest].

PubMed

Singer Fisher, Emily; Burns, Boyd; Kim, Jeremy

2017-05-22

Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. Heart failure accounts for more than 1 million hospitalizations annually, with a steadily increasing incidence as our population ages. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options. Emergency department management and appropriate interventions are discussed, along with critical decision-making points in resuscitation for both hypertensive and hypotensive patients. [Points & Pearls is a digest of Emergency Medicine Practice].

Trunk posture monitoring with inertial sensors

PubMed Central

Wong, Man Sang

2008-01-01

Measurement of human posture and movement is an important area of research in the bioengineering and rehabilitation fields. Various attempts have been initiated for different clinical application goals, such as diagnosis of pathological posture and movements, assessment of pre- and post-treatment efficacy and comparison of different treatment protocols. Image-based methods for measurements of human posture and movements have been developed, such as the radiography, photogrammetry, optoelectric technique and video analysis. However, it is found that these methods are complicated to set up, time-consuming to operate and could only be applied in laboratory environments. This study introduced a method of using a posture monitoring system in estimating the spinal curvature changes during trunk movements on the sagittal and coronal planes and providing trunk posture monitoring during daily activities. The system consisted of three sensor modules, each with one tri-axial accelerometer and three uni-axial gyroscopes orthogonally aligned, and a digital data acquisition and feedback system. The accuracy of this system was tested with a motion analysis system (Vicon 370) in calibration with experimental setup and in trunk posture measurement with nine human subjects, and the performance of the posture monitoring system during daily activities with two human subjects was reported. The averaged root mean squared differences between the measurements of the system and motion analysis system were found to be <1.5° in dynamic calibration, and <3.1° for the sagittal plane and ≤2.1° for the coronal plane in estimation of the trunk posture change during trunk movements. The measurements of the system and the motion analysis system was highly correlated (>0.999 for dynamic calibration and >0.829 for estimation of spinal curvature change in domain planes of movement during flexion and lateral bending). With the sensing modules located on the upper trunk, mid-trunk and the pelvic levels, the inclination of trunk segment and the change of spinal curvature in trunk movements could be estimated. The posture information of five subjects was recorded at 30 s intervals during daily activity over a period of 3 days and 2 h a day. The preliminary results demonstrated that the subjects could improve their posture when feedback signals were provided. The posture monitoring system could be used for the purpose of posture monitoring during daily activity. PMID:18196296

Trunk posture monitoring with inertial sensors.

PubMed

Wong, Wai Yin; Wong, Man Sang

2008-05-01

Measurement of human posture and movement is an important area of research in the bioengineering and rehabilitation fields. Various attempts have been initiated for different clinical application goals, such as diagnosis of pathological posture and movements, assessment of pre- and post-treatment efficacy and comparison of different treatment protocols. Image-based methods for measurements of human posture and movements have been developed, such as the radiography, photogrammetry, optoelectric technique and video analysis. However, it is found that these methods are complicated to set up, time-consuming to operate and could only be applied in laboratory environments. This study introduced a method of using a posture monitoring system in estimating the spinal curvature changes during trunk movements on the sagittal and coronal planes and providing trunk posture monitoring during daily activities. The system consisted of three sensor modules, each with one tri-axial accelerometer and three uni-axial gyroscopes orthogonally aligned, and a digital data acquisition and feedback system. The accuracy of this system was tested with a motion analysis system (Vicon 370) in calibration with experimental setup and in trunk posture measurement with nine human subjects, and the performance of the posture monitoring system during daily activities with two human subjects was reported. The averaged root mean squared differences between the measurements of the system and motion analysis system were found to be < 1.5 degrees in dynamic calibration, and < 3.1 degrees for the sagittal plane and < or = 2.1 degrees for the coronal plane in estimation of the trunk posture change during trunk movements. The measurements of the system and the motion analysis system was highly correlated (> 0.999 for dynamic calibration and > 0.829 for estimation of spinal curvature change in domain planes of movement during flexion and lateral bending). With the sensing modules located on the upper trunk, mid-trunk and the pelvic levels, the inclination of trunk segment and the change of spinal curvature in trunk movements could be estimated. The posture information of five subjects was recorded at 30 s intervals during daily activity over a period of 3 days and 2 h a day. The preliminary results demonstrated that the subjects could improve their posture when feedback signals were provided. The posture monitoring system could be used for the purpose of posture monitoring during daily activity.

Computational modeling to predict nitrogen balance during acute metabolic decompensation in patients with urea cycle disorders

PubMed Central

MacLeod, Erin L.; Hall, Kevin D.; McGuire, Peter J.

2015-01-01

SUMMARY Nutritional management of acute metabolic decompensation in amino acid inborn errors of metabolism (AA IEM) aims to restore nitrogen balance. While nutritional recommendations have been published, they have never been rigorously evaluated. Furthermore, despite these recommendations, there is a wide variation in the nutritional strategies employed amongst providers, particularly regarding the inclusion of parenteral lipids for protein-free caloric support. Since randomized clinical trials during acute metabolic decompensation are difficult and potentially dangerous, mathematical modeling of metabolism can serve as a surrogate for the preclinical evaluation of nutritional interventions aimed at restoring nitrogen balance during acute decompensation in AA IEM. A validated computational model of human macronutrient metabolism was adapted to predict nitrogen balance in response to various nutritional interventions in a simulated patient with a urea cycle disorder (UCD) during acute metabolic decompensation due to dietary non-adherence or infection. The nutritional interventions were constructed from published recommendations as well as clinical anecdotes. Overall, dextrose alone (DEX) was predicted to be better at restoring nitrogen balance and limiting nitrogen excretion during dietary non-adherence and infection scenarios, suggesting that the published recommended nutritional strategy involving dextrose and parenteral lipids (ISO) may be suboptimal. The implications for patients with AA IEM are that the medical course during acute metabolic decompensation may be influenced by the choice of protein-free caloric support. These results are also applicable to intensive care patients undergoing catabolism (postoperative phase or sepsis), where parenteral nutritional support aimed at restoring nitrogen balance may be more tailored regarding metabolic fuel selection. PMID:26260782

Computational modeling to predict nitrogen balance during acute metabolic decompensation in patients with urea cycle disorders.

PubMed

MacLeod, Erin L; Hall, Kevin D; McGuire, Peter J

2016-01-01

Nutritional management of acute metabolic decompensation in amino acid inborn errors of metabolism (AA IEM) aims to restore nitrogen balance. While nutritional recommendations have been published, they have never been rigorously evaluated. Furthermore, despite these recommendations, there is a wide variation in the nutritional strategies employed amongst providers, particularly regarding the inclusion of parenteral lipids for protein-free caloric support. Since randomized clinical trials during acute metabolic decompensation are difficult and potentially dangerous, mathematical modeling of metabolism can serve as a surrogate for the preclinical evaluation of nutritional interventions aimed at restoring nitrogen balance during acute decompensation in AA IEM. A validated computational model of human macronutrient metabolism was adapted to predict nitrogen balance in response to various nutritional interventions in a simulated patient with a urea cycle disorder (UCD) during acute metabolic decompensation due to dietary non-adherence or infection. The nutritional interventions were constructed from published recommendations as well as clinical anecdotes. Overall, dextrose alone (DEX) was predicted to be better at restoring nitrogen balance and limiting nitrogen excretion during dietary non-adherence and infection scenarios, suggesting that the published recommended nutritional strategy involving dextrose and parenteral lipids (ISO) may be suboptimal. The implications for patients with AA IEM are that the medical course during acute metabolic decompensation may be influenced by the choice of protein-free caloric support. These results are also applicable to intensive care patients undergoing catabolism (postoperative phase or sepsis), where parenteral nutritional support aimed at restoring nitrogen balance may be more tailored regarding metabolic fuel selection.

Dietary protein in urea cycle defects: How much? Which? How?

PubMed

Boneh, Avihu

2014-01-01

Dietary recommendations for patients with urea cycle disorders (UCDs) are designed to prevent metabolic decompensation (primarily hyperammonaemia), and to enable normal growth. They are based on the 'recommended daily intake' guidelines, on theoretical considerations and on local experience. A retrospective dietary review of 28 patients with UCDs in good metabolic control, at different ages, indicates that most patients can tolerate a natural protein intake that is compatible with metabolic stability and good growth. However, protein aversion presents a problem in many patients, leading to poor compliance with the prescribed daily protein intake. These patients are at risk of chronic protein deficiency. Failing to recognise this risk, and further restricting protein intake because of persistent hyperammonaemia may aggravate the deficiency and potentially lead to episodes of metabolic decompensation for which no clear cause is found. These patients may need on-going supplementation with essential amino acids (EAA) to prevent protein malnutrition. Current recommendations for the management of acute metabolic decompensation include cessation of protein intake whilst increasing energy (calorie) intake in the first 24h. We have found that plasma concentrations of all EAA are low at the time of admission to hospital for metabolic decompensation, with correlation between low EAA concentrations, particularly branched-chain amino acids, and hyperammonaemia. Thus, supplementation with EAA should be considered at times of metabolic decompensation. Finally, it would be advantageous to treat patients in metabolic decompensation through enteral supplementation, whenever possible, because of the contribution of the splanchnic (portal-drained viscera) system to protein retention and metabolism. Copyright © 2014 Elsevier Inc. All rights reserved.

Autologous Peripheral Blood Stem Cell Transplantation Improves Portal Hemodynamics in Patients with Hepatitis B Virus-related Decompensated Cirrhosis.

PubMed

Deng, Qinzhi; Cai, Ting; Zhang, Shun; Hu, Airong; Zhang, Xingfen; Wang, Yinyin; Huang, Jianrong

2015-12-01

Chronic hepatitis B virus (HBV) infection may eventually lead to decompensated liver cirrhosis, which is a terminal illness. The aim of this study was to investigate the therapeutic efficacy of autologous peripheral blood stem cell (APBSC) transplantation to improve portal vein hemodynamics in patients with HBV-related decompensated cirrhosis. This prospective study included 68 hospitalized patients who were diagnosed with HBV-related decompensated cirrhosis. These patients were divided into two groups: the transplantation group included 33 patients, while the control group included 35. Both groups received conventional medical treatment simultaneously, and APBSC transplantation was performed on the patients in the transplantation group. We evaluated the effects of APBSC transplantation on postoperative liver function using the following indices: total bilirubin, serum prothrombin and albumin, spleen size, and portal vein hemodynamics. Postoperatively, all of the patients were followed up at 24, 36, and 48 weeks. The transplantation group had no serious reactions. Compared with the control group, albumin and prothrombin activity in the transplantation group was significantly improved at 24, 36, and 48 weeks after the procedure, and spleen length and portal vein diameter were substantially reduced at 48 weeks. The velocity of peak portal vein blood flow and mean maximum portal vein blood flow were greatly increased in the APBSC transplantation group at 36 and 48 weeks, respectively; however, there was also decreased portal vein diameter, which reduced portal vein pressure in patients with HBV-related decompensated cirrhosis. APBSC transplantation greatly benefits HBV-linked decompensated cirrhosis patients and should be recommended in clinical practice.

Three-dimensional analysis of scoliosis surgery using stereophotogrammetry

NASA Astrophysics Data System (ADS)

Jang, Stanley B.; Booth, Kellogg S.; Reilly, Chris W.; Sawatzky, Bonita J.; Tredwell, Stephen J.

1994-04-01

A new stereophotogrammetric analysis and 3D visualization allow accurate assessment of the scoliotic spine during instrumentation. Stereophoto pairs taken at each stage of the operation and robust statistical techniques are used to compute 3D transformations of the vertebrae between stages. These determine rotation, translation, goodness of fit, and overall spinal contour. A polygonal model of the spine using commercial 3D modeling package is used to produce an animation sequence of the transformation. The visualization have provided some important observation. Correction of the scoliosis is achieved largely through vertebral translation and coronal plane rotation, contrary to claims that large axial rotations are required. The animations provide valuable qualitative information for surgeons assessing the results of scoliotic correction.

Pessimistic mood in decompensated narcissistic patient.

PubMed

Yang, Ping-Suen; Huang, Tiao-Lai

2004-04-01

We report the negative emotional state as pessimistic mood of a case with narcissistic personality disorder during the period of narcissistic decompensation. In addition, we identified the clinical differences between pessimistic mood and depressive disorder. An 28-year-old unmarried woman experienced herself, her life and the external object as futile and disappointing after repeated failure to satisfy her grandiose fantasies about the search for ideal love. The patient then gave up her formerly gratifying activities, and fell into a prolonged state of negative emotions and passivity dominated by pessimistic mood characterized by an overwhelming sense of futility. The patient did not respond to medical treatment with antidepressants firstly. However after a 2-year course of intensive psychotherapy, the patient was able to restore her zest to find a new boyfriend with a more rational and realistic attitude. Clinically, decompensated narcissistic patients do not exhibit the typical attitude of worthlessness or guilty feelings, and are devoid of certain specific depressive emotions (e.g., sadness, sorrow, etc.). In contrast, decompensated narcissistic patients with pessimistic mood exhibit a dominant sense of futility and other negative emotions presented as outrage and disappointment. The purpose of this case report was to emphasize the importance to recognize clinical features of pessimistic mood for the differential diagnosis and management of the decompensated narcissistic patient.

Novel Wearable Seismocardiography and Machine Learning Algorithms Can Assess Clinical Status of Heart Failure Patients.

PubMed

Inan, Omer T; Baran Pouyan, Maziyar; Javaid, Abdul Q; Dowling, Sean; Etemadi, Mozziyar; Dorier, Alexis; Heller, J Alex; Bicen, A Ozan; Roy, Shuvo; De Marco, Teresa; Klein, Liviu

2018-01-01

Remote monitoring of patients with heart failure (HF) using wearable devices can allow patient-specific adjustments to treatments and thereby potentially reduce hospitalizations. We aimed to assess HF state using wearable measurements of electrical and mechanical aspects of cardiac function in the context of exercise. Patients with compensated (outpatient) and decompensated (hospitalized) HF were fitted with a wearable ECG and seismocardiogram sensing patch. Patients stood at rest for an initial recording, performed a 6-minute walk test, and then stood at rest for 5 minutes of recovery. The protocol was performed at the time of outpatient visit or at 2 time points (admission and discharge) during an HF hospitalization. To assess patient state, we devised a method based on comparing the similarity of the structure of seismocardiogram signals after exercise compared with rest using graph mining (graph similarity score). We found that graph similarity score can assess HF patient state and correlates to clinical improvement in 45 patients (13 decompensated, 32 compensated). A significant difference was found between the groups in the graph similarity score metric (44.4±4.9 [decompensated HF] versus 35.2±10.5 [compensated HF]; P <0.001). In the 6 decompensated patients with longitudinal data, we found a significant change in graph similarity score from admission (decompensated) to discharge (compensated; 44±4.1 [admitted] versus 35±3.9 [discharged]; P <0.05). Wearable technologies recording cardiac function and machine learning algorithms can assess compensated and decompensated HF states by analyzing cardiac response to submaximal exercise. These techniques can be tested in the future to track the clinical status of outpatients with HF and their response to pharmacological interventions. © 2018 American Heart Association, Inc.

[Psychosomatic stress factors in compensated and decompensated tinnitus].

PubMed

Stobik, Corinna; Weber, Rainer K; Münte, Thomas F; Frommer, Jörg

2003-08-01

In modern medical practice, chronic decompensated tinnitus is defined as a complex psychosomatic process in which mental and social factors are considered to have a determining effect on the patient's subjective response to the impairment of otological or other somatic functions attributed to tinnitus. What is still largely unknown is the interaction of the individual factors and their impact on the patient's ability to cope with tinnitus. The impact of psycho-social and somatic factors on the subjective experience of patients with compensated and decompensated tinnitus is evaluated. 53 patients with chronic tinnitus were divided into two groups, compensated and decompensated, on the basis of their subjective experience of the disorder, established according to the tinnitus questionnaire published by Goebel and Hiller. Self-assessment instruments and a survey of symptoms of somatic stress disorders were used to compare the two groups in terms of differences in the patients' mental and psycho-social behaviour, in their strategies for coping with tinnitus and in the incidence of co-morbidity. The patients with decompensated tinnitus suffered from more pronounced mental and social disabilities, were more prone to depression and used less effective techniques to cope with their illness. The principal difference between the two groups, however, appeared to lie in a significantly higher degree of somatic multi-morbidity, where a particularly strong correlation was found between tinnitus and the incidence of cardiovascular diseases and hypacusis. 81 percent of the total sample of patients suffered from impaired hearing. Patients with decompensated tinnitus experienced greater communication difficulties as a result of their auditory impairment. In the diagnosis and therapy of tinnitus, in addition to psychic and psycho-social aspects greater attention ought to be paid to somatic factors, influencing the patient's ability to cope with the disorder.

Impact of intravenous nitroglycerin in the management of acute decompensated heart failure.

PubMed

den Uil, Corstiaan A; Brugts, Jasper J

2015-02-01

Intravenous nitroglycerin is a well-known, but underused, treatment for acute decompensated heart failure. Nitroglycerin has a rapid onset of action and short half-life and there is a clear dose-response curve on both global hemodynamics and peripheral circulation. IV nitroglycerin reduces LV and RV filling pressures and afterload. In the case of acute decompensated heart failure, there is a typical decreased bioavailability of nitric oxide (NO), which needs to be supplemented by exogenous nitrates. Additionally, there is benefit on clinical endpoints, such as fast optimization of arterial oxygenation, lower rates of mechanical ventilation, and improved survival. Drawbacks of therapy include not only side effects such as headache, resistance, and development of tolerability to nitrates but also free radical production. However, nitrates in combination with diuretics remain the cornerstone of acute decompensated heart failure treatment. We propose a more aggressive use of nitrates and a more limited use of inotropes (due to ischemic demand and pro-arrhythmogenic characteristics) in normo- or hypertensive patients with acute heart failure.

Management of corneal decompensation 4 decades after Sputnik intraocular lens implantation.

PubMed

Hirji, Nashila; Nanavaty, Mayank A

2015-01-01

We report an unusual case of corneal decompensation occurring four decades after complicated cataract extraction with implantation of a Sputnik intraocular lens (IOL) and highlight the clinical and practical issues faced in managing corneal decompensation with a Sputnik IOL. A 72-year-old woman presented with deterioration of the vision in her left eye, four decades after intracapsular cataract extraction with Sputnik IOL implantation. Ocular examination revealed diffuse corneal edema and thickened vitreous strands in the anterior chamber. Her best-corrected visual acuity (BCVA) worsened to 6/60 within 3 months. Anterior vitrectomy and inferior iridectomy combined with Desçemet-stripping automated endothelial keratoplasty was performed. The procedure was successful, with the patient achieving best-corrected visual acuity of 6/6 at 8 months postoperatively. Corneal decompensation after Sputnik IOL implantation can occur four decades later. When the historical preoperative visual acuity is good in such cases, careful anterior vitrectomy with Desçemet-stripping automated endothelial keratoplasty provides good visual rehabilitation.

Successful treatment of hepatitis C, genotype 3, with sofosbuvir/ledipasvir in decompensated cirrhosis complicated by mixed cryoglobulinaemia

PubMed Central

Flemming, Jennifer A; Lowe, Catherine E

2016-01-01

Advances in the treatment of chronic hepatitis C (HCV) have given HCV providers access to treatment regimens able to achieve sustained virological response (SVR or ‘cure’) in the majority of patients. There are, however, groups of patients in whom HCV treatment outcomes with direct acting antivirals (DAAs) are suboptimal (genotype (GT) 3 patients, decompensated cirrhosis, renal failure) or have not been studied in large cohorts (patients with cryoglobulinaemia (CG)). This case outlines the successful eradication of GT-3 hepatitis C (HCV) in a patient with decompensated cirrhosis and renal failure secondary to mixed CG with DAA failure, using a 12-week course of sofosbuvir, ledipasvir and ribavirin. The achievement of SVR in this patient resulted in significant improvement in hepatic and renal function. Patients with decompensated cirrhosis and GT-3 disease remain a difficult to treat population, and the safety and efficacy of sofosbuvir, ledipasvir and ribavirin in this cohort require further study. PMID:27284099

Successful treatment of hepatitis C, genotype 3, with sofosbuvir/ledipasvir in decompensated cirrhosis complicated by mixed cryoglobulinaemia.

PubMed

Flemming, Jennifer A; Lowe, Catherine E

2016-06-09

Advances in the treatment of chronic hepatitis C (HCV) have given HCV providers access to treatment regimens able to achieve sustained virological response (SVR or 'cure') in the majority of patients. There are, however, groups of patients in whom HCV treatment outcomes with direct acting antivirals (DAAs) are suboptimal (genotype (GT) 3 patients, decompensated cirrhosis, renal failure) or have not been studied in large cohorts (patients with cryoglobulinaemia (CG)). This case outlines the successful eradication of GT-3 hepatitis C (HCV) in a patient with decompensated cirrhosis and renal failure secondary to mixed CG with DAA failure, using a 12-week course of sofosbuvir, ledipasvir and ribavirin. The achievement of SVR in this patient resulted in significant improvement in hepatic and renal function. Patients with decompensated cirrhosis and GT-3 disease remain a difficult to treat population, and the safety and efficacy of sofosbuvir, ledipasvir and ribavirin in this cohort require further study. 2016 BMJ Publishing Group Ltd.

Isostatic and Decompensative Gravity Anomalies of the Arabian Plate and Surrounding Regions: a Key for the Crustal Structure

NASA Astrophysics Data System (ADS)

Kaban, M. K.; El Khrepy, S.; Al-Arifi, N. S.

2016-12-01

The isostatic anomalies are often considered as one of the most useful correction of the gravity field for investigation of the upper crust structure in many practical applications. By applying this correction, a substantial part of the effect of deep density heterogeneity, which dominates in the Bouguer gravity anomaly, can be removed. With this approach, it is not even necessary to know the deep density structure of the crust and upper mantle in details; it is sufficient to prescribe some type of compensation (regional vs. local) and a compensation depth. However, even when all the parameters are chosen correctly, this reduction of the gravity field does not show the full gravity effect of unknown anomalies in the crust. The last ones should be also compensated to some extent; therefore their impact is substantially reduced by the isostatic compensation. Long ago (Cordell et al., 1991), it was suggested a so-called decompensative correction of the isostatic anomalies, which provides a possibility to separate these effects. However, the decompensative correction is very sensitive to the parameters of the compensation scheme. In the present study we analyse the ways to choose these parameters and extend this approach by assuming a possibility for the regional compensation via elastic deformations of the lithosphere. Based on this technique, we estimate the isostatic and decompensative anomalies for the Arabian plate and surrounding regions. The parameters of the isostatic model are chosen based on previous studies. It was demonstrated that the decompensative correction is very significant at the mid-range wavelengths and may exceed 100 mGal, therefore ignoring this effect would lead to wrong conclusions about the upper crust structure. The total amplitude of the decompensative anomalies reaches ±250 mGal, evidencing for both, large density anomalies of the upper crust (including sediments) and strong isostatic disturbances of the lithosphere. These results improve the knowledge about the crustal structure in the Middle East. Cordell, L., Zorin, Y. A., & Keller, G. R. (1991). The decompensative gravity anomaly and deep structure of the region of the Rio Grande rift. Journal of Geophysical Research: Solid Earth (1978-2012), 96(B4), 6557-6568.

Liver stiffness measurement by transient elastography predicts late posthepatectomy outcomes in patients undergoing resection for hepatocellular carcinoma.

PubMed

Rajakannu, Muthukumarassamy; Cherqui, Daniel; Ciacio, Oriana; Golse, Nicolas; Pittau, Gabriella; Allard, Marc Antoine; Antonini, Teresa Maria; Coilly, Audrey; Sa Cunha, Antonio; Castaing, Denis; Samuel, Didier; Guettier, Catherine; Adam, René; Vibert, Eric

2017-10-01

Postoperative hepatic decompensation is a serious complication of liver resection in patients undergoing hepatectomy for hepatocellular carcinoma. Liver fibrosis and clinical significant portal hypertension are well-known risk factors for hepatic decompensation. Liver stiffness measurement is a noninvasive method of evaluating hepatic venous pressure gradient and functional hepatic reserve by estimating hepatic fibrosis. Effectiveness of liver stiffness measurement in predicting persistent postoperative hepatic decompensation has not been investigated. Consecutive patients with resectable hepatocellular carcinoma were recruited prospectively and liver stiffness measurement of nontumoral liver was measured using FibroScan. Hepatic venous pressure gradient was measured intraoperatively by direct puncture of portal vein and inferior vena cava. Hepatic venous pressure gradient ≥10 mm Hg was defined as clinically significant portal hypertension. Primary outcome was persistent hepatic decompensation defined as the presence of at least one of the following: unresolved ascites, jaundice, and/or encephalopathy >3 months after hepatectomy. One hundred and six hepatectomies, including 22 right hepatectomy (20.8%), 3 central hepatectomy (2.8%), 12 left hepatectomy (11.3%), 11 bisegmentectomy (10.4%), 30 unisegmentectomy (28.3%), and 28 partial hepatectomy (26.4%) were performed in patients for hepatocellular carcinoma (84 men and 22 women with median age of 67.5 years; median model for end-stage liver disease score of 8). Ninety-day mortality was 4.7%. Nine patients (8.5%) developed postoperative hepatic decompensation. Multivariate logistic regression bootstrapped at 1,000 identified liver stiffness measurement (P = .001) as the only preoperative predictor of postoperative hepatic decompensation. Area under receiver operating characteristic curve for liver stiffness measurement and hepatic venous pressure gradient was 0.81 (95% confidence interval, 0.506-0.907) and 0.71 (95% confidence interval, 0.646-0.917), respectively. Liver stiffness measurement ≥22 kPa had 42.9% sensitivity and 92.6% specificity and hepatic venous pressure gradient ≥10 mm Hg had 28.6% sensitivity and 96.3% specificity. In selected patients undergoing liver resection for hepatocellular carcinoma, transient elastography is an easy and effective test to predict persistent hepatic decompensation preoperatively. Copyright © 2017 Elsevier Inc. All rights reserved.

Beta-blocker use in decompensated heart failure.

PubMed

Alharethi, Rami; Hershberger, Ray E

2006-06-01

Despite the current advances in treatment, acute decompensated heart failure accounts for more than 1 million hospital admissions annually. Many of the patients hospitalized are already receiving long-term treatment with beta-blockers. For patients who receive full dose beta-blocker therapy and suffer acute decompensated heart failure, clinicians face two key questions: what to do, if anything, with the dosage of beta-blocker and what is the best way to integrate inotropic and beta-blocker therapies for patients who require inotropes. This article discusses these issues and reviews the available literature. Because these topics have received little systematic evaluation, we also present our clinical approaches to these problems.

Decision Making of Graduation in Patients With Early-Onset Scoliosis at the End of Distraction-Based Programs: Risks and Benefits of Definitive Fusion.

PubMed

Pizones, Javier; Martín-Buitrago, Mar Pérez; Sánchez Márquez, José Miguel; Fernández-Baíllo, Nicomedes; Baldan-Martin, Montserrat; Sánchez Pérez-Grueso, Francisco Javier

Retrospective comparative analysis. Study early-onset scoliosis (EOS) graduated patients to establish founded criteria for graduation decision making and determine the risks and benefits of definitive fusion. EOS is treated by growth-friendly techniques until skeletal maturity. Afterwards, patients can be "graduated," either by definitive fusion (posterior spinal fusion [PSF]) or by retaining the previous implants (Observation) with no additional surgery. Criteria for this decision making and the outcomes of definitive fusion are still underexplored. We analyzed a consecutive cohort of "graduated" patients after a distraction-based lengthening program. We gathered demographic, radiographic, and surgical data. The results of the two final treatment options were compared after 2 years' follow-up. A total of 32 patients were included. Four patients had incomplete records. Thirteen underwent PSF, and 15 were observed. The mean age at initial treatment was 8 ± 3 years, with a mean follow-up of 8.3 ± 2.9 years. Both groups had similar preoperative and final radiographic parameters (p > .05). The criteria for undergoing PSF were as follows: implant-related complications, main curve magnitude (PSF = 63.2° ± 9° vs. OBS = 47.9° ± 15°; p = .008), curve progression >10°, and sagittal misalignment (SVA). During PSF 12/13 patients underwent multiple osteotomies, one vertebrectomy, and 3 costoplasties. Surgical time was 291.5 ± 58 minutes; blood loss was 946 ± 375 mL; and the number of levels fused was 13.7. Coronal deformity was corrected 31%, T1-S1 length gained was 31 ± 19.6 mm and T1-T12 length gained was 9.3 ± 39 mm; kyphosis was reduced by 22%. However, coronal balance worsened by 2.3 ± 30.8 mm. No major complications were encountered in these patients. Graduation by PSF depended on unacceptable or progressive major curve deformity, sagittal misalignment, or complications with previous implants. Observation depended on curve stabilization, Cobb <50°, and coronal misalignment <20 mm. Definitive fusion effectively corrected coronal and sagittal deformity and increased trunk height. However, it exposed patients to a very demanding surgery without improvement in coronal balance. Level III, therapeutic. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Effect of posterior multilevel vertebral osteotomies on coronal and sagittal balance in fused scoliosis deformity caused by previous surgery: preliminary results.

PubMed

Yang, Jae Hyuk; Suh, Seung Woo; Cho, Won Tae; Hwang, Jin Ho; Hong, Jae Young; Modi, Hitesh N

2014-10-15

Prospective case series study. To study the effect of posterior multilevel vertebral osteotomy (posterior crack osteotomy) on coronal and sagittal balance in patients with the fusion mass over the spine caused by previous surgery. Few studies have investigated revisional scoliosis surgery with the fusion mass using osteotomy. Among patients who had a history of prior surgery for scoliosis correction and posterior fusion, those showing progression of the curve postoperatively due to nonunion, implant failure, or adding-on phenomenon were enrolled. All patients were treated using posterior crack osteotomy. For clinical evaluation, the pre- and postoperative Gross Motor Function Classification System score for walking status and the Berg balanced scale were used. For radiological evaluation, pre- and postoperative Cobb angle, and coronal and sagittal balance factors were used. Ten patients (5 males and 5 females) were enrolled. The preoperative diagnosis was neuromuscular scoliosis (3 cases), syndromic scoliosis (1 case), congenital scoliosis (5 cases), and neurofibromatosis (1 case). Osteotomies were performed at 3.3±1.3 levels on average. Pre- and postoperative Cobb angles were 70.8°±30.0° and 28.1°±20.0° (P=0.002 (0.97)), respectively. In pre- and postoperative evaluation of coronal balance, the coronal balance, clavicle angle, and T1-tilt angle were 36.8±27.1 mm and 10.4±8.5 mm, 6.7°±8.0° and 3.3°±1.5°, and 7.8°±19.0° and 4.7°±2.1°, respectively (P=0.002, 0.002, 0.002). In pre- and postoperative evaluation of sagittal balance, the spinal vertical axis, thoracic kyphosis, and lumbar alignments were 25.1±37.8 mm and 14.1±21.8 mm, 33.5°±51.1° and 29.7°±27.4°, and 45.7°±34.8° and 48.9°±23.1° (P=0.002, 0.169, 0.169). The walking and functional statuses did not change (P=0.317, 0.932). Although pulmonary and gastrointestinal complications were noted, the patients were discharged without complications. Posterior crack osteotomy can be used effectively in revisional scoliosis surgery and the clinical and radiological results seem to be acceptable. 4.

Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty.

PubMed

Lass, Jonathan H; Sugar, Alan; Benetz, Beth Ann; Beck, Roy W; Dontchev, Mariya; Gal, Robin L; Kollman, Craig; Gross, Robert; Heck, Ellen; Holland, Edward J; Mannis, Mark J; Raber, Irving; Stark, Walter; Stulting, R Doyle

2010-01-01

To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema. In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail. Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (+/-95% confidence interval) of failure was 13% (+/-12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm(2) vs 2% (+/-3%) for the 137 participants with a 6-month ECD of 2500 cells/mm(2) or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm(2). Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm(2).

Importance of the Decompensative Correction of the Gravity Field for Study of the Upper Crust: Application to the Arabian Plate and Surroundings

NASA Astrophysics Data System (ADS)

Kaban, Mikhail K.; El Khrepy, Sami; Al-Arifi, Nassir

2017-01-01

The isostatic correction represents one of the most useful "geological" reduction methods of the gravity field. With this correction it is possible to remove a significant part of the effect of deep density heterogeneity, which dominates in the Bouguer gravity anomalies. However, even this reduction does not show the full gravity effect of unknown anomalies in the upper crust since their impact is substantially reduced by the isostatic compensation. We analyze a so-called decompensative correction of the isostatic anomalies, which provides a possibility to separate these effects. It was demonstrated that this correction is very significant at the mid-range wavelengths and may exceed 100 m/s2 (mGal), therefore ignoring this effect would lead to wrong conclusions about the upper crust structure. At the same time, the decompensative correction is very sensitive to the compensation depth and effective elastic thickness of the lithosphere. Therefore, these parameters should be properly determined based on other studies. Based on this technique, we estimate the decompensative correction for the Arabian plate and surrounding regions. The amplitude of the decompensative anomalies reaches ±250 m/s2 10-5 (mGal), evidencing for both, large density anomalies of the upper crust (including sediments) and strong isostatic disturbances of the lithosphere. These results improve the knowledge about the crustal structure in the Middle East.

Pediatric pulmonary arterial hypertension and hyperthyroidism: a potentially fatal combination.

PubMed

Trapp, Christine M; Elder, Robert W; Gerken, Adrienne T; Sopher, Aviva B; Lerner, Shulamit; Aranoff, Gaya S; Rosenzweig, Erika B

2012-07-01

Patients with pulmonary arterial hypertension (PAH) who develop hyperthyroidism are at risk for acute cardiopulmonary decompensation and death. We present a series of eight idiopathic PAH/heritable PAH pediatric patients who developed hyperthyroidism between 1999 and 2011. Institutional Review Board approval was obtained; informed consent was waived due to the retrospective nature of the series. All eight patients were receiving iv epoprostenol; five of the eight patients presented with acute cardiopulmonary decompensation in the setting of hyperthyroidism. In the remaining three patients, hyperthyroidism was detected during routine screening of thyroid function tests. The one patient who underwent emergency thyroidectomy was the only survivor of those who presented in cardiopulmonary decline. Aggressive treatment of the hyperthyroid state, including emergency total thyroidectomy and escalation of targeted PAH therapy and β-blockade when warranted, may prove lifesaving in these patients. Prompt thyroidectomy or radioactive iodine ablation should be considered for clinically stable PAH patients with early and/or mild hyperthyroidism to avoid potentially life-threatening cardiopulmonary decompensation. Although the association between hyperthyroidism and PAH remains poorly understood, the potential impact of hyperthyroidism on the cardiopulmonary status of PAH patients must not be ignored. Hyperthyroidism must be identified early in this patient population to optimize intervention before acute decompensation. Thyroid function tests should be checked routinely in patients with PAH, particularly those on iv epoprostenol, and urgently in patients with acute decompensation or symptoms of hyperthyroidism.

[Pressure sensors to prevent cardiac decompensation].

PubMed

Klug, Didier

2017-11-01

Most cases of hospitalisation for heart failure are preceded by episodes of cardiac decompensation. Preventing these episodes would improve quality of life and reduce mortality and treatment costs. The monitoring of intracardiac pressures, using innovative sensors, coupled with telemedicine, offers interesting perspectives. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

[Self-neglect as a sign of decompensation].

PubMed

Jean-Louis, Eric

2015-01-01

A lack of hygiene to which the patient appears indifferent, self-neglect can be a sign of the decompensation of a mental pathology. This article presents the case of a patient who, after several months of stabilisation and a return home to a relatively clean environment, reactivates a delusion of persecution.

Anterior only fusion for scoliosis in patients with myelomeningocele.

PubMed

Sponseller, P D; Young, A T; Sarwark, J F; Lim, R

1999-07-01

A series of patients with single major scoliosis curvatures attributable to spina bifida treated by anterior only spinal fusion was studied for 2 years to determine whether the infection rate could be decreased, adequate correction and pelvic balance could be provided, and posterior surgery could be avoided in these patients. Anterior surgery alone was performed for thoracolumbar scoliosis greater than 45 degrees if the compensatory thoracic curve was less than 40 degrees and there was no significant junctional kyphosis. Fourteen patients were treated at a mean age of 11.9 years (range, 7-16 years), with a mean curve of 64 degrees (range, 51 degrees-85 degrees), and motor levels distributed from T10-L4. Thirteen patients had prior neurosurgery for tether, syrinx, or Arnold-Chiari malformation. The spine was fused over a mean of seven vertebrae. A 3/16 inch Texas Scottish Rite Hospital rod was used most commonly (10 patients). Blood loss averaged 1100 cc. The mean curve correction was 57% at 40 months after surgery. Loss of correction occurred primarily by adding on outside the instrumented area. Mean pelvic obliquity was improved from 16 degrees to 9 degrees. There was one superficial infection. Results were good in five patients, fair in four, and poor in five. Failures were attributable to proximal decompensation in two patients who required revision surgery (two), neurologic deterioration in two, and screw pullout in one. Both patients with decompensation had syringomyelia. Both patients with neurologic deterioration had large curves (> 75 degrees). Both patients recovered after rod removal. Retrospectively, by eliminating patients with syrinx or with a curve greater than 75 degrees, all poor results would be eliminated. Anterior only fusion and instrumentation may have significant advantages, but only for selected patients with thoracolumbar curves less than 75 degrees, compensatory curves less than 40 degrees, no increased kyphosis, and no syrinx. Quadriceps function should be monitored. On the basis of this preliminary experience, continued use of this approach using stricter selection seems warranted.

Current status of adult spinal deformity.

PubMed

Youssef, J A; Orndorff, D O; Patty, C A; Scott, M A; Price, H L; Hamlin, L F; Williams, T L; Uribe, J S; Deviren, V

2013-03-01

Purpose To review the current literature for the nonoperative and operative treatment for adult spinal deformity. Recent Findings With more than 11 million baby boomers joining the population of over 60 years of age in the United States, the incidence of lumbar deformity is greatly increasing. Recent literature suggests that a lack of evidence exists to support the effectiveness of nonoperative treatment for adult scoliosis. In regards to operative treatment, current literature reports a varying range of improved clinical outcomes, curve correction, and complication rates. The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic among literature. Summary Most adult deformity patients never seek nonoperative or operative treatment. Of the few that seek treatment, many can benefit from nonoperative treatment. However, in selected patients who have failed nonoperative treatment and who are candidates for surgical intervention, the literature reflects positive outcomes related to surgical intervention as compared with nonoperative treatment despite varying associated ranges in morbidity and mortality rates. If nonoperative therapy fails in addressing a patient's complaints, then an appropriate surgical procedure that relieves neural compression, corrects excessive sagittal or coronal imbalance, and results in a solidly fused, pain-free spine is warranted.

Switching Therapy from Intravenous Landiolol to Transdermal Bisoprolol in a Patient with Thyroid Storm Complicated by Decompensated Heart Failure and Gastrointestinal Dysfunction.

PubMed

Godo, Shigeo; Kawazoe, Yu; Ozaki, Hiroshi; Fujita, Motoo; Kudo, Daisuke; Nomura, Ryosuke; Shimokawa, Hiroaki; Kushimoto, Shigeki

2017-10-01

Thyroid storm is a life-threatening disorder that remains a therapeutic challenge. Although β-blockers are the mainstay for treatment, their use can be challenging in cases complicated by rapid atrial fibrillation and decompensated heart failure. We present a case of thyroid storm-associated atrial fibrillation and decompensated heart failure complicated by gastrointestinal dysfunction secondary to diffuse peritonitis that was successfully managed by a switching therapy, in which the continuous intravenous administration of landiolol was changed to bisoprolol via transdermal patch, in the acute phase treatment. This switching therapy may offer a promising therapeutic option for this potentially lethal disorder.

Pediatric Pulmonary Arterial Hypertension and Hyperthyroidism: A Potentially Fatal Combination

PubMed Central

Trapp, Christine M.; Elder, Robert W.; Gerken, Adrienne T.; Sopher, Aviva B.; Lerner, Shulamit; Rosenzweig, Erika B.

2012-01-01

Context: Patients with pulmonary arterial hypertension (PAH) who develop hyperthyroidism are at risk for acute cardiopulmonary decompensation and death. Cases and Setting: We present a series of eight idiopathic PAH/heritable PAH pediatric patients who developed hyperthyroidism between 1999 and 2011. Institutional Review Board approval was obtained; informed consent was waived due to the retrospective nature of the series. All eight patients were receiving iv epoprostenol; five of the eight patients presented with acute cardiopulmonary decompensation in the setting of hyperthyroidism. In the remaining three patients, hyperthyroidism was detected during routine screening of thyroid function tests. The one patient who underwent emergency thyroidectomy was the only survivor of those who presented in cardiopulmonary decline. Evidence Synthesis: Aggressive treatment of the hyperthyroid state, including emergency total thyroidectomy and escalation of targeted PAH therapy and β-blockade when warranted, may prove lifesaving in these patients. Prompt thyroidectomy or radioactive iodine ablation should be considered for clinically stable PAH patients with early and/or mild hyperthyroidism to avoid potentially life-threatening cardiopulmonary decompensation. Conclusions: Although the association between hyperthyroidism and PAH remains poorly understood, the potential impact of hyperthyroidism on the cardiopulmonary status of PAH patients must not be ignored. Hyperthyroidism must be identified early in this patient population to optimize intervention before acute decompensation. Thyroid function tests should be checked routinely in patients with PAH, particularly those on iv epoprostenol, and urgently in patients with acute decompensation or symptoms of hyperthyroidism. PMID:22622024

Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine-zinc): a case of decompensated liver cirrhosis in Wilson's disease.

PubMed

Ping, C C; Hassan, Y; Aziz, N A; Ghazali, R; Awaisu, A

2007-02-01

To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease. A 33-year-old Chinese female patient was diagnosed with Wilson's disease, for which penicillamine 250 mg p.o. once daily was prescribed. However, the patient developed intolerance and penicillamine was discontinued without alternative treatment. Five months later, she developed decompensated liver cirrhosis with hepatic encephalopathy. Eventually, the patient died because of the complications of sepsis and decompensated liver failure. Chelating agent is the mainstay of treatment in Wilson's disease, which is an inherited disorder of hepatic copper metabolism. Therapy must be instituted and continued for life once diagnosis is confirmed. Interruption of therapy can be fatal or cause irreversible relapse. Penicillamine given orally is the chelating agent of first choice. However, its unfavourable side-effects profile leads to discontinuation of therapy in 20-30% of patients. In most case reports, cessation of penicillamine without replacement treatment causes rapid progression to fulminant hepatitis, which is fatal unless liver transplantation is performed. In this, we highlight a case of discontinuation of penicillamine in a patient with Wilson's disease without substitution with alternative regimen. This was caused by unavailability of the alternative agents such as trientine in our country. Consequently, the patient progressed to decompensated liver cirrhosis with encephalopathy and eventually passed-away within 5 months. One recent study supports a combination of trientine and zinc in treating patient with decompensated liver cirrhosis. This combination is capable of reversing liver failure and prevents the need of liver transplantation. Both trientine and zinc are not registered in Malaysia. Therefore, liver transplantation was probably the only treatment option for this patient. Hence, non-availability of orphan drugs in clinical practice is certainly a subject of serious concern. Systems for better management of patients with rare diseases need to be instituted by all the institutions concerned.

Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF).

PubMed

Lala, Anuradha; McNulty, Steven E; Mentz, Robert J; Dunlay, Shannon M; Vader, Justin M; AbouEzzeddine, Omar F; DeVore, Adam D; Khazanie, Prateeti; Redfield, Margaret M; Goldsmith, Steven R; Bart, Bradley A; Anstrom, Kevin J; Felker, G Michael; Hernandez, Adrian F; Stevenson, Lynne W

2015-07-01

Congestion is the most frequent cause for hospitalization in acute decompensated heart failure. Although decongestion is a major goal of acute therapy, it is unclear how the clinical components of congestion (eg, peripheral edema, orthopnea) contribute to outcomes after discharge or how well decongestion is maintained. A post hoc analysis was performed of 496 patients enrolled in the Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trials during hospitalization with acute decompensated heart failure and clinical congestion. A simple orthodema congestion score was generated based on symptoms of orthopnea (≥2 pillows=2 points, <2 pillows=0 points) and peripheral edema (trace=0 points, moderate=1 point, severe=2 points) at baseline, discharge, and 60-day follow-up. Orthodema scores were classified as absent (score of 0), low-grade (score of 1-2), and high-grade (score of 3-4), and the association with death, rehospitalization, or unscheduled medical visits through 60 days was assessed. At baseline, 65% of patients had high-grade orthodema and 35% had low-grade orthodema. At discharge, 52% patients were free from orthodema at discharge (score=0) and these patients had lower 60-day rates of death, rehospitalization, or unscheduled visits (50%) compared with those with low-grade or high-grade orthodema (52% and 68%, respectively; P=0.038). Of the patients without orthodema at discharge, 27% relapsed to low-grade orthodema and 38% to high-grade orthodema at 60-day follow-up. Increased severity of congestion by a simple orthodema assessment is associated with increased morbidity and mortality. Despite intent to relieve congestion, current therapy often fails to relieve orthodema during hospitalization or to prevent recurrence after discharge. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00608491, NCT00577135. © 2015 American Heart Association, Inc.

Cell-Free and Concentrated Ascites Reinfusion Therapy for Decompensated Liver Cirrhosis.

PubMed

Kozaki, Koichi; IInuma, Masahiro; Takagi, Tomoyuki; Fukuda, Takanori; Sanpei, Takaya; Terunuma, Yusuke; Yatabe, Yoshiharu; Akano, Kazuhiro

2016-08-01

Cell-free and concentrated ascites reinfusion therapy (CART) is expected to improve symptoms associated with refractory ascites of the decompensated liver cirrhosis patients. The aim of this study was to evaluate the safety and efficacy of the CART system performed on the decompensated liver cirrhosis patients. In this retrospective observational study, we evaluated 24 CART processes performed on 11 patients with decompensated liver cirrhosis. We evaluated the effectiveness and adverse events during CART procedures. The amounts of collected and concentrated ascites were 4491.7 ± 2222.8 mL (mean ± SD), respectively, and the concentration ratio was 22.4 ± 15.3 times, respectively. The amount of collected protein in ascites was 2.3 ± 0.5 g/dL, and concentration ratio of protein was 8.2 ± 9.4 times. Serum protein level was not significantly different between before and after CART sessions. Thus, CART allowed for the reduction of doses of albumin preparations (Alb) to be administered. CART has been reported to cause two adverse reactions: elevation of body temperature and decrease in blood pressure. In our study, decreased blood pressure was not observed even in patients with > 5 L of ascites drained. Although a transient elevation in body temperature was seen in only one patient, this febrile patient immediately returned to normal body temperature with the use of NSAIDs. In patients with refractory ascites of decompensated liver cirrhosis in whom complete cure cannot be expected, CART improves their QOL and, in terms of medical economy, allows for the reduction of doses of Alb. CART can be effectively applied as a palliative procedure for refractory ascites of decompensated liver cirrhosis patients. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

Differences in baseline factors and survival between normocapnia, compensated respiratory acidosis and decompensated respiratory acidosis in COPD exacerbation: A pilot study.

PubMed

Lun, Chung-Tat; Tsui, Miranda S N; Cheng, Suet-Lai; Chan, Veronica L; Leung, Wah-Shing; Cheung, Alice P S; Chu, Chung-Ming

2016-01-01

Patients with chronic obstructive pulmonary disease (COPD) experiencing acute exacerbation (AE-COPD) with decompensated respiratory acidosis are known to have poor outcomes in terms of recurrent respiratory failure and death. However, the outcomes of AE-COPD patients with compensated respiratory acidosis are not known. We performed a 1-year prospective, single-centre, cohort study in patients surviving the index admission for AE-COPD to compare baseline factors between groups with normocapnia, compensated respiratory acidosis and decompensated respiratory acidosis. Survival analysis was done to examine time to readmissions, life-threatening events and death. A total of 250 patients fulfilling the inclusion and exclusion criteria were recruited and 245 patients were analysed. Compared with normocapnia, both compensated and decompensated respiratory acidosis are associated with lower FEV1 % (P < 0.001), higher GOLD stage (P = 0.003, <0.001) and higher BODE index (P = 0.038, 0.001) and a shorter time to life-threatening events (P < 0.001). Comparing compensated and decompensated respiratory acidosis, there was no difference in FEV1 (% predicted) (P = 0.15), GOLD stage (P = 0.091), BODE index (P = 0.158) or time to life-threatening events (P = 0.301). High PaCO2 level (P = 0.002) and previous use of non-invasive ventilation (NIV) in acute setting (P < 0.001) are predictive factors of future life-threatening events by multivariate analysis. Compared with normocapnia, both compensated and decompensated respiratory acidosis are associated with poorer lung function and higher risk of future life-threatening events. High PaCO2 level and past history of NIV use in acute settings were predictive factors for future life-threatening events. Compensated respiratory acidosis warrants special attention and optimization of medical therapy as it poses risk of life-threatening events. © 2015 Asian Pacific Society of Respirology.

Skeletal anteroposterior discrepancy and vertical type effects on lower incisor preoperative decompensation and postoperative compensation in skeletal Class III patients.

PubMed

Ahn, Hyo-Won; Baek, Seung-Hak

2011-01-01

To determine the initial compensation, preoperative decompensation, and postoperative compensation of the lower incisors according to the skeletal anteroposterior discrepancy and vertical type in skeletal Class III patients. The samples consisted of 68 skeletal Class III patients treated with two-jaw surgery and orthodontic treatment. Lateral cephalograms were taken before preoperative orthodontic treatment (T0) and before surgery (T1) and after debonding (T2). According to skeletal anteroposterior discrepancy/vertical type (ANB, criteria  =  -4°; SN-GoMe, criteria  =  35°) at the T0 stage, the samples were allocated into group 1 (severe anteroposterior discrepancy/hypodivergent vertical type, N  =  17), group 2 (moderate anteroposterior discrepancy/hypodivergent vertical type, N  =  17), group 3 (severe anteroposterior discrepancy/hyperdivergent vertical type, N  =  17), or group 4 (moderate anteroposterior discrepancy/hyperdivergent vertical type, N  =  17). After measurement of variables, one-way analysis of variance with Duncan's multiple comparison test, crosstab analysis, and Pearson correlation analysis were performed. At T0, groups 3 and 2 exhibited the most and least compensated lower incisors. In group 2, good preoperative decompensation and considerable postoperative compensation resulted in different values for T0, T1, and T2 (IMPA, T0 < T2 < T1; P < .001). However, group 3 did not show significant changes in IMPA between stages. Therefore, groups 2 and 3 showed different decompensation achievement ratios (P < .05). Group 3 exhibited the worst ratios of decompensation and stability (24% and 6%, respectively, P < .001). Anteroposterior discrepancy/vertical type (ANB: P < .01 at T0 and T1, P < .001 at T2; SN-GoMe: P < .01, all stages) were strongly correlated with relative percentage ratio of IMPA to norm value. Skeletal anteroposterior discrepancy/vertical type results in differences in the amount and pattern of initial compensation, preoperative decompensation, and postoperative compensation of lower incisors in Class III patients.

[The Effect of Intraoperative Screw Monitoring (Root Monitoring) with the INS-1 System (NUVASIVE) on the Radiological Outcome of Dorsal Instrumentation of the Lumbar Spine].

PubMed

Bernhardt, G; Awiszus, F; Meister, U; Heyde, C E; Böhm, H

2016-06-01

Transpedicular screw fixation of spinal segments has been described for a variety of surgical indications and is a key element in spinal surgery. The aim of transpedicular screw fixation is to achieve maximal stability. Screw malposition should be obviated to avoid neurological complications. There are published methods of applying evoked EMG to control screw position in relation to neural structures. These studies demonstrated that an intact bony pedicle wall acts as an electrical isolator between the screw and spinal nerve root. The aim of our study was to evaluate the impact of intraoperative pedicle screw monitoring on screw positioning. We enrolled 22 patients in this prospective randomised study, who underwent spinal instrumentation after being split into two equal groups. In the first group, dorsal instrumentation was supplemented with intraoperative nerve root monitoring using the INS-1-System (NuVasive, San Diego USA). In the second group, screws were inserted without additional pedicle monitoring. All patients underwent monosegmental instrumentation with "free hand implanted" pedicle screws. 44 screws were inserted in each group. The screw position was evaluated postoperatively using CT scans. The position of the screws in relation to the pedicle was measured in three different planes: sagittal, axial and coronal. The accuracy of the screw position was described using the Berlemann classification system. Screw position is classified in three groups: type 1 correct screw position, type 2 encroachment on the inner cortical wall, type 3 pedicle cortical perforation. Screw angulation and secondary operative criteria were also evaluated. The use of neuromonitoring did not influence the distance between the centre of the screws and the pedicle wall. Distances only depended on the implantation side (right and left) and the height of implantation (caudal or cranial screw). Because of the low number of cases, no conclusion could be reached about the influence of root monitoring on the correct positioning of the screws. There was at least a non-significant trend towards more frequent perforation of the pedicle in the monitor group. In the present study, we showed that root monitoring had a significant effect on the scattering of transversal angles. These were increased compared to the control group. Otherwise, the implantation angle was not shown to depend on the use of neuromonitoring. Neuromonitoring did not influence blood loss or operative time. The data did not permit any conclusion as to whether this technique can minimise the frequency of pedicle screw malposition. The four coronal plane distances did not depend on the use of neuromonitoring. The inclination angle was also unaffected by neuromonitoring. The only parameter for which we found any effect was the transverse angle. The mean values were similar in both groups, but the variances were not equal. The effect of monitoring on the only parameter which could not be evaluated by fluoroscopy is thus rather unfavourable. Georg Thieme Verlag KG Stuttgart · New York.

Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results.

PubMed

Illés, Tamás; Somoskeöy, Szabolcs

2013-06-01

A new concept of vertebra vectors based on spinal three-dimensional (3D) reconstructions of images from the EOS system, a new low-dose X-ray imaging device, was recently proposed to facilitate interpretation of EOS 3D data, especially with regard to horizontal plane images. This retrospective study was aimed at the evaluation of the spinal layout visualized by EOS 3D and vertebra vectors before and after surgical correction, the comparison of scoliotic spine measurement values based on 3D vertebra vectors with measurements using conventional two-dimensional (2D) methods, and an evaluation of horizontal plane vector parameters for their relationship with the magnitude of scoliotic deformity. 95 patients with adolescent idiopathic scoliosis operated according to the Cotrel-Dubousset principle were subjected to EOS X-ray examinations pre- and postoperatively, followed by 3D reconstructions and generation of vertebra vectors in a calibrated coordinate system to calculate vector coordinates and parameters, as published earlier. Differences in values of conventional 2D Cobb methods and methods based on vertebra vectors were evaluated by means comparison T test and relationship of corresponding parameters was analysed by bivariate correlation. Relationship of horizontal plane vector parameters with the magnitude of scoliotic deformities and results of surgical correction were analysed by Pearson correlation and linear regression. In comparison to manual 2D methods, a very close relationship was detectable in vertebra vector-based curvature data for coronal curves (preop r 0.950, postop r 0.935) and thoracic kyphosis (preop r 0.893, postop r 0.896), while the found small difference in L1-L5 lordosis values (preop r 0.763, postop r 0.809) was shown to be strongly related to the magnitude of corresponding L5 wedge. The correlation analysis results revealed strong correlation between the magnitude of scoliosis and the lateral translation of apical vertebra in horizontal plane. The horizontal plane coordinates of the terminal and initial points of apical vertebra vectors represent this (r 0.701; r 0.667). Less strong correlation was detected in the axial rotation of apical vertebras and the magnitudes of the frontal curves (r 0.459). Vertebra vectors provide a key opportunity to visualize spinal deformities in all three planes simultaneously. Measurement methods based on vertebral vectors proved to be just as accurate and reliable as conventional measurement methods for coronal and sagittal plane parameters. In addition, the horizontal plane display of the curves can be studied using the same vertebra vectors. Based on the vertebra vectors data, during the surgical treatment of spinal deformities, the diminution of the lateral translation of the vertebras seems to be more important in the results of the surgical correction than the correction of the axial rotation.

Remote patient monitoring in chronic heart failure.

PubMed

Palaniswamy, Chandrasekar; Mishkin, Aaron; Aronow, Wilbert S; Kalra, Ankur; Frishman, William H

2013-01-01

Heart failure (HF) poses a significant economic burden on our health-care resources with very high readmission rates. Remote monitoring has a substantial potential to improve the management and outcome of patients with HF. Readmission for decompensated HF is often preceded by a stage of subclinical hemodynamic decompensation, where therapeutic interventions would prevent subsequent clinical decompensation and hospitalization. Various methods of remote patient monitoring include structured telephone support, advanced telemonitoring technologies, remote monitoring of patients with implanted cardiac devices such as pacemakers and defibrillators, and implantable hemodynamic monitors. Current data examining the efficacy of remote monitoring technologies in improving outcomes have shown inconsistent results. Various medicolegal and financial issues need to be addressed before widespread implementation of this exciting technology can take place.

[Case-control study on spinal leveraging manipulation and medicine for the treatment of degenerative scoliosis].

PubMed

Tian, Gang; Shen, Mao-rong; Jiang, Wei-guo; Xie, Fu-rong; Wei, Wen-wu

2015-06-01

To compare clinical effects of spinal leveraging manipulation and medicine for the treatment of degenerative scoliosis in pain and function. From July 2010 to June 2013, 38 patients with degenerative scoliosis were randomly divided into spinal leveraging manipulation group and medicine group by coin tossing. In manipulation group, there were 9 males and 11 females aged from 58 to 74 years old with an average of (66.63±7.73), the courses of diseases ranged from 3 to 8 months with an average of (5.65±2.58), spinal leveraging manipulation(following meridian to straighten tendon,relieving spasm, osteopathy and massage, clearing and activating the channels and collaterals) were performed for 30 min, once a day, 4 days for a period treatment, totally 9 courses. In medicine group, there were 8 males and 10 females aged from 57 to 70 years old with an average of (63.51±6.61) the courses of diseases ranged from 3 to 5 months with an average of (4.82±1.43), celecoxib with eperisone hydrochloride were orally taken, 4 days for a period treatment, totally 9 courses. VAS score, Cobb angle and ODI score were measured. After treatment, VAS score in manipulation group was (5.38±0.99), (6.36±1.31) in medicine group,and had significant meaning (t=2.618, P<0.05); there was significant differences in Cobb angle between manipulation group (16.51±4.89)° and medicine group (19.85±5.03) °(t=2.074,P<0.05); and had obviously meaning in ODI score between manipulation group (20.20±2.93) and medicine group (26.01±3.11) (t=5.592, P<0.05). Spinal leveraging manipulation for degenerative scoliosis could regulate muscle balance on both side of spine, correct coronal imbalances in spine, recover normal sequence of spine, reduce and remove opperssion and stimulation of nerve root, relieve pain in leg and waist and further improve quality of life.

Muscular MRI-based algorithm to differentiate inherited myopathies presenting with spinal rigidity.

PubMed

Tordjman, Mickael; Dabaj, Ivana; Laforet, Pascal; Felter, Adrien; Ferreiro, Ana; Biyoukar, Moustafa; Law-Ye, Bruno; Zanoteli, Edmar; Castiglioni, Claudia; Rendu, John; Beroud, Christophe; Chamouni, Alexandre; Richard, Pascale; Mompoint, Dominique; Quijano-Roy, Susana; Carlier, Robert-Yves

2018-05-25

Inherited myopathies are major causes of muscle atrophy and are often characterized by rigid spine syndrome, a clinical feature designating patients with early spinal contractures. We aim to present a decision algorithm based on muscular whole body magnetic resonance imaging (mWB-MRI) as a unique tool to orientate the diagnosis of each inherited myopathy long before the genetically confirmed diagnosis. This multicentre retrospective study enrolled 79 patients from referral centres in France, Brazil and Chile. The patients underwent 1.5-T or 3-T mWB-MRI. The protocol comprised STIR and T1 sequences in axial and coronal planes, from head to toe. All images were analyzed manually by multiple raters. Fatty muscle replacement was evaluated on mWB-MRI using both the Mercuri scale and statistical comparison based on the percentage of affected muscle. Between February 2005 and December 2015, 76 patients with genetically confirmed inherited myopathy were included. They were affected by Pompe disease or harbored mutations in RYR1, Collagen VI, LMNA, SEPN1, LAMA2 and MYH7 genes. Each myopathy had a specific pattern of affected muscles recognizable on mWB-MRI. This allowed us to create a novel decision algorithm for patients with rigid spine syndrome by segregating these signs. This algorithm was validated by five external evaluators on a cohort of seven patients with a diagnostic accuracy of 94.3% compared with the genetic diagnosis. We provide a novel decision algorithm based on muscle fat replacement graded on mWB-MRI that allows diagnosis and differentiation of inherited myopathies presenting with spinal rigidity. • Inherited myopathies are rare, diagnosis is challenging and genetic tests require specialized centres and often take years. • Inherited myopathies are often characterized by spinal rigidity. • Whole body magnetic resonance imaging is a unique tool to orientate the diagnosis of each inherited myopathy presenting with spinal rigidity. • Each inherited myopathy in this study has a specific pattern of affected muscles that orientate diagnosis. • A novel MRI-based algorithm, usable by every radiologist, can help the early diagnosis of these myopathies.

Endoscopic Ultrasound (EUS) Guided Fine Needle Aspiration: A New Modality to Diagnose Peritoneal Tuberculosis in Presence of Decompensated Cirrhosis-A Case Series and Review of Literature.

PubMed

Daswani, Ravi; Kumar, Ashish; Singla, Vikas; Kaur, Gagandeep; Sharma, Praveen; Bansal, Naresh; Arora, Anil

2018-06-01

The gold-standard for diagnosis is growth of Mycobacterium tuberculosis on ascitic fluid or peritoneal culture. Due to the non-specific signs and symptoms of disease, its early diagnosis is difficult, especially in patients with decompensated cirrhosis. The reported sensitivity of ascitic fluid is low and to obtain tissue for peritoneal biopsy in patients with cirrhosis is difficult. Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is a good alternative to obtain peritoneal tissue for establishing the diagnosis of peritoneal TB. To assess the role of EUS-FNA in the diagnosis of peritoneal tuberculosis in patients with decompensated cirrhosis. Consecutive patients with peritoneal thickening, ascites and decompensated cirrhosis underwent EUS-FNA from the thickened omentum. Presence of granuloma or demonstration of acid fast bacilli was diagnostic of peritoneal tuberculosis. A total of 5 patients with CLD underwent EUS-FNA from omentum. FNA cytology revealed granuloma with multinucleated cells in all patients (100%) and AFB stain was positive in 2 of them (40%). We hereby report the use of EUS guided fine needle aspiration (FNA) of peritoneum as a newer, safe and unexplored technique for diagnosis of peritoneal TB.

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry

PubMed Central

Kim, Kyung-A; Lee, Ji-Won; Park, Jeong-Ho; Kim, Byoung-Ho; Ahn, Hyo-Won

2017-01-01

Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries. PMID:28523246

Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry.

PubMed

Kim, Kyung-A; Lee, Ji-Won; Park, Jeong-Ho; Kim, Byoung-Ho; Ahn, Hyo-Won; Kim, Su-Jung

2017-05-01

Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.

Large-scale inverse and forward modeling of adaptive resonance in the tinnitus decompensation.

PubMed

Low, Yin Fen; Trenado, Carlos; Delb, Wolfgang; D'Amelio, Roberto; Falkai, Peter; Strauss, Daniel J

2006-01-01

Neural correlates of psychophysiological tinnitus models in humans may be used for their neurophysiological validation as well as for their refinement and improvement to better understand the pathogenesis of the tinnitus decompensation and to develop new therapeutic approaches. In this paper we make use of neural correlates of top-down projections, particularly, a recently introduced synchronization stability measure, together with a multiscale evoked response potential (ERP) model in order to study and evaluate the tinnitus decompensation by using a hybrid inverse-forward mathematical methodology. The neural synchronization stability, which according to the underlying model is linked to the focus of attention on the tinnitus signal, follows the experimental and inverse way and allows to discriminate between a group of compensated and decompensated tinnitus patients. The multiscale ERP model, which works in the forward direction, is used to consolidate hypotheses which are derived from the experiments for a known neural source dynamics related to attention. It is concluded that both methodologies agree and support each other in the description of the discriminatory character of the neural correlate proposed, but also help to fill the gap between the top-down adaptive resonance theory and the Jastreboff model of tinnitus.

Lumbar Disc Replacement for Junctional Decompensation After Fusion Surgery: Clinical and Radiological Outcome at an Average Follow-Up of 33 Months

PubMed Central

Sliwa, Karen; Weinberg, Ian R.; Sweet, Barry MBE; de Villiers, Malan; Candy, Geoffrey P.

2007-01-01

Background Failed fusion surgery remains difficult to treat. Few published data on disc replacement surgery after failed fusion procedures exist. Our objective was to evaluate outcomes of junctional lumbar disc replacement after previous fusion surgery and to correlate outcome with radiological changes to parameters of sagittal balance. Methods Out of a single-center prospective registry of 290 patients with 404 lumbar disc replacements, 27 patients had had a previous lumbar fusion operation on 1 to 4 lumbar segments and had completed a mean follow- up of 33 months (range: 18–56). We correlated the clinical outcome measures (patient satisfaction, 10-point pain score, and Oswestry Disability Index [ODI] score) to parameters of spinal sagittal alignment (sacral tilt, pelvic tilt, pelvic incidence, and lumbar lordosis). Results Postoperative hospital stay averaged 3.3 days (range: 2–8). Previously-employed patients went back to their jobs with a mean of 32 days (range: 21–42) after the procedure. At the latest follow-up, 1 of the patients considered the outcome to be poor, 3 fair, 8 good, and 15 excellent. Twenty-four patients “would undergo the operation again.” Average pain score decreased from 9.1 ± 1.0 (SD) to 3.2 ± 2.1 (P < .01). Average ODI decreased from 50.2 ± 9.9 preoperatively to 21.7 ± 14.2 (P ≤ .01). We found the change in pelvic tilt to be an independent predictor of better clinical outcome by multivariate analysis (P < .05). Conclusions In patients with junctional failure adjacent to a previous posterolateral fusion, disc replacement at the junctional level(s), compared with osteotomy and fusion surgery, offers the advantage of maintaining segmental mobility and correcting the flat-back deformity through a single approach with less operative time and blood loss. Early- to intermediate-term results are promising. The influence of changes in spinal sagittal alignment on clinical outcome needs to be addressed in future research. Clinical Relevance This is the first study on “junctional disc replacement patients” correlating clinical outcome to changes in spinal/pelvic alignment. PMID:25802584

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation.

PubMed

Di Silvestre, Mario; Bakaloudis, Georgios; Lolli, Francesco; Vommaro, Francesco; Martikos, Konstantinos; Parisini, Patrizio

2008-10-01

The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80 degrees traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80 degrees) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80 degrees (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92 degrees vs. PSF-S: 88 degrees), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9 degrees versus -11.3 degrees (P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19 degrees vs. -10 degrees; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and stable correction of severe scoliosis. However, severe curves may be amenable to hybrid instrumentation that produced analogous results to the screws-only constructs concerning patient satisfaction; at the latest follow-up, SRS-30 and SF-36 scores did not show any statistical differences between the two groups.

Does the size of the rod affect the surgical results in adolescent idiopathic scoliosis? 5.5-mm versus 6.35-mm rod.

PubMed

Huang, Tsung-Hsi; Ma, Hsiao-Li; Wang, Shih-Tien; Chou, Po-Hsin; Ying, Szu-Han; Liu, Chien-Lin; Yu, Wing-Kwong; Chang, Ming-Chau

2014-08-01

Favorable clinical outcomes of surgical treatment with Cotrel-Dubousset instrumentation (CDI) or instrumentations that follow the principles of CDI, for adolescent idiopathic scoliosis (AIS) have been reported. However, there are few studies concerning the results with rods of different sizes. To find out whether the rod size affects the surgical results for AIS. A retrospective cohort study based on the same spinal system with different sizes of rod. A consecutive series of 93 patients, who underwent posterior correction with posterior instrumentation and fusion for AIS, were included and retrospectively analyzed. Postoperative radiologic outcomes were evaluated using coronal curves, percentage of curve correction, and coronal global balance. Ninety-three patients treated during the period January 2000 to December 2008 were included in this study; 48 patients were treated with the Cotrel-Dubousset Horizon (CDH) M10 system with a 6.35-mm rod from January 2000 through December 2004, and a CDH M8 was used with a 5.5-mm rod in another 45 patients from January 2005 through December 2008. The Cobb angle, Risser grade, coronal curves, flexibility of curve, percentage of curve correction, coronal global balance, operative time, and estimated blood loss were measured and analyzed. The same parameters were used when the patient was followed at the OPD. All of the patients underwent regular follow-up for at least 2 years. No statistical significance was observed in the demographic data, including age, sex, BMI, and Risser grade, between these 2 groups. The overall average percentage of correction was 60.0%±12.7%: 60.7%±12.5% for the CDH M10 group, and 59%±13.1% for the CDH M8 group. At the final follow-up, the overall average loss of correction was 4.8±3.9° for the CDH M10 group, and 4.3±4.0° for the CDH M8 group. The average percentage of correction at the final follow-up was 50.9%±15.1% for the CDH M10 group, and 51.1%±16.1% for the M8 group. No statistical significance could be observed in the radiologic parameters between these 2 groups. The radiologic results for the 5.5-mm rod and the 6.35-mm rod were comparable in terms of correction, loss of correction, and coronal global balance. Copyright © 2014 Elsevier Inc. All rights reserved.

Class III obesity is a risk factor for the development of acute-on-chronic liver failure in patients with decompensated cirrhosis.

PubMed

Sundaram, Vinay; Jalan, Rajiv; Ahn, Joseph C; Charlton, Michael R; Goldberg, David S; Karvellas, Constantine J; Noureddin, Mazen; Wong, Robert J

2018-04-28

Acute-on-chronic liver failure (ACLF) is a syndrome of systemic inflammation and organ failures. Obesity, also characterized by chronic inflammation, is a risk factor among patients with cirrhosis for decompensation, infection, and mortality. Our aim was to test the hypothesis that obesity predisposes patients with decompensated cirrhosis to the development of ACLF. We examined the United Network for Organ Sharing (UNOS) database, from 2005-2016, characterizing patients at wait-listing as non-obese (body mass index [BMI] <30), obese class I-II (BMI 30-39.9) and obese class III (BMI ≥40). ACLF was determined based on the CANONIC study definition. We used Cox proportional hazards regression to assess the association between obesity and ACLF development at liver transplantation (LT). We confirmed our findings using the Nationwide Inpatient Sample (NIS), years 2009-2013, using validated diagnostic coding algorithms to identify obesity, hepatic decompensation and ACLF. Logistic regression evaluated the association between obesity and ACLF occurrence. Among 387,884 patient records with decompensated cirrhosis, 116,704 (30.1%) were identified as having ACLF in both databases. Multivariable modeling from the UNOS database revealed class III obesity to be an independent risk factor for ACLF at LT (hazard ratio 1.24; 95% CI 1.09-1.41; p <0.001). This finding was confirmed using the NIS (odds ratio 1.30; 95% CI 1.25-1.35; p <0.001). Regarding specific organ failures, analysis of both registries demonstrated patients with class I-II and class III obesity had a greater prevalence of renal failure. Class III obesity is a newly identified risk factor for ACLF development in patients with decompensated cirrhosis. Obese patients have a particularly high prevalence of renal failure as a component of ACLF. These findings have important implications regarding stratifying risk and preventing the occurrence of ACLF. In this study, we identify that among patients with decompensated cirrhosis, class III obesity (severe/morbid obesity) is a modifiable risk factor for the development of acute-on-chronic liver failure (ACLF). We further demonstrate that regarding the specific organ failures associated with ACLF, renal failure is significantly more prevalent in obese patients, particularly those with class III obesity. These findings underscore the importance of weight management in cirrhosis, to reduce the risk of ACLF. Patients with class III obesity should be monitored closely for the development of renal failure. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance.

PubMed

Hikata, Tomohiro; Watanabe, Kota; Fujita, Nobuyuki; Iwanami, Akio; Hosogane, Naobumi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

2015-10-01

The object of this study was to investigate correlations between sagittal spinopelvic alignment and improvements in clinical and quality-of-life (QOL) outcomes after lumbar decompression surgery for lumbar spinal canal stenosis (LCS) without coronal imbalance. The authors retrospectively reviewed data from consecutive patients treated for LCS with decompression surgery in the period from 2009 through 2011. They examined correlations between preoperative or postoperative sagittal vertical axis (SVA) and radiological parameters, clinical outcomes, and health-related (HR)QOL scores in patients divided according to SVA. Clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores. Health-related QOL was evaluated using the Roland-Morris Disability Questionnaire (RMDQ) and the JOA Back Pain Evaluation Questionnaire (JOABPEQ). One hundred nine patients were eligible for inclusion in the study. Compared to patients with normal sagittal alignment prior to surgery (Group A: SVA < 50 mm), those with preoperative sagittal imbalance (Group B: SVA ≥ 50 mm) had significantly smaller lumbar lordosis and thoracic kyphosis angles and larger pelvic tilt. In Group B, there was a significant decrease in postoperative SVA compared with the preoperative SVA (76.3 ± 29.7 mm vs. 54.3 ± 39.8 mm, p = 0.004). The patients in Group B with severe preoperative sagittal imbalance (SVA > 80 mm) had residual sagittal imbalance after surgery (82.8 ± 41.6 mm). There were no significant differences in clinical and HRQOL outcomes between Groups A and B. Compared to patients with normal postoperative SVA (Group C: SVA < 50 mm), patients with a postoperative SVA ≥ 50 mm (Group D) had significantly lower JOABPEQ scores, both preoperative and postoperative, for walking ability (preop: 36.6 ± 26.3 vs. 22.7 ± 26.0, p = 0.038, respectively; postop: 71.1 ± 30.4 vs. 42.5 ± 29.6, p < 0.001) and social functioning (preop: 38.7 ± 18.5 vs. 30.2 ± 16.7, p = 0.045; postop: 67.0 ± 25.8 vs. 49.6 ± 20.0, p = 0.001), as well as significantly higher postoperative RMDQ (4.9 ± 5.2 vs. 7.9 ± 5.7, p = 0.015) and VAS scores for low-back pain (2.68 ± 2.69 vs. 3.94 ± 2.59, p = 0.039). Preoperative sagittal balance was not significantly correlated with clinical or HRQOL outcomes after decompression surgery in LCS patients without coronal imbalance. Decompression surgery improved the SVA value in patients with preoperative sagittal imbalance; however, the patients with severe preoperative sagittal imbalance (SVA > 80 mm) had residual imbalance after decompression surgery. Both clinical and HRQOL outcomes were negatively affected by postoperative residual sagittal imbalance.

Current Status of Adult Spinal Deformity

PubMed Central

Youssef, J. A.; Orndorff, D. O.; Patty, C. A.; Scott, M. A.; Price, H. L.; Hamlin, L. F.; Williams, T. L.; Uribe, J. S.; Deviren, V.

2012-01-01

Purpose To review the current literature for the nonoperative and operative treatment for adult spinal deformity. Recent Findings With more than 11 million baby boomers joining the population of over 60 years of age in the United States, the incidence of lumbar deformity is greatly increasing. Recent literature suggests that a lack of evidence exists to support the effectiveness of nonoperative treatment for adult scoliosis. In regards to operative treatment, current literature reports a varying range of improved clinical outcomes, curve correction, and complication rates. The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic among literature. Summary Most adult deformity patients never seek nonoperative or operative treatment. Of the few that seek treatment, many can benefit from nonoperative treatment. However, in selected patients who have failed nonoperative treatment and who are candidates for surgical intervention, the literature reflects positive outcomes related to surgical intervention as compared with nonoperative treatment despite varying associated ranges in morbidity and mortality rates. If nonoperative therapy fails in addressing a patient's complaints, then an appropriate surgical procedure that relieves neural compression, corrects excessive sagittal or coronal imbalance, and results in a solidly fused, pain-free spine is warranted. PMID:24436852

Rationale and Design of the "Safety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) Trial:" A Double-Blind, Randomized, Placebo-Controlled Study to Determine the Effect of Combined Diuretic Therapy (Loop Diuretics With Thiazide-Type Diuretics) Among Patients With Decompensated Heart Failure.

PubMed

Trullàs, Joan Carles; Morales-Rull, José Luís; Casado, Jesús; Freitas Ramírez, Adriana; Manzano, Luís; Formiga, Francesc

2016-07-01

Fluid overload refractory to loop diuretic therapy can complicate acute or chronic heart failure (HF) management. The Safety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) trial (Clinicaltrials.gov identifier NCT01647932) will test the hypothesis that blocking distal tubule sodium reabsorption with hydrochlorothiazide can antagonize the renal adaptation to chronic loop diuretic therapy and improve diuretic resistance. CLOROTIC is a randomized, placebo-controlled, double-blind, multicenter study. Three hundred and four patients with decompensated HF will be randomly assigned to receive hydrochlorothiazide or placebo in addition to a furosemide regimen. The main inclusion criteria are: age ≥18 years, history of chronic HF (irrespective of etiology and/or ejection fraction), admission for acute decompensation, and previous treatment with an oral loop diuretic for at least 1 month before randomization. The 2 coprimary endpoints are changes in body weight and changes in patient-reported dyspnea during hospital admission. Morbidity, mortality, and safety aspects will also be addressed. CLOROTIC is the first large-scale trial to evaluate whether the addition of a thiazide diuretic (hydrochlorothiazide) to a loop diuretic (furosemide) is a safe and effective strategy for improving congestive symptoms resulting from HF. This trial will provide important information and will therefore have a major impact on treatment strategies and future trials in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure.

PubMed

Tabit, Corey E; Coplan, Mitchell J; Spencer, Kirk T; Alcain, Charina F; Spiegel, Thomas; Vohra, Adam S; Adelman, Daniel; Liao, James K; Sanghani, Rupa Mehta

2017-09-01

Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure. There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded. Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery. Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure. Copyright © 2017 Elsevier Inc. All rights reserved.

Intra-Aortic Balloon Counterpulsation in Patients with Chronic Heart Failure and Cardiogenic Shock: Clinical Response and Predictors of Stabilization

PubMed Central

Sintek, Marc A.; Gdowski, Mark; Lindman, Brian R.; Nassif, Michael; Lavine, Kory J.; Novak, Eric; Bach, Richard G.; Silvestry, Scott C.; Mann, Douglas L.; Joseph, Susan M.

2015-01-01

Objective To characterize the clinical response and identify predictors of clinical stabilization after intra-aortic balloon counterpulsation (IABP) support in patients with chronic systolic heart failure in cardiogenic shock prior to implantation of a left ventricular assist device (LVAD). Background Limited data exist regarding the clinical response to IABP in patients with chronic heart failure in cardiogenic shock. Methods We identified 54 patients supported with IABP prior to LVAD implantation. Criteria for clinical decompensation after IABP insertion and before LVAD included the need for more advanced temporary support, initiation of mechanical ventilation or dialysis, increase in vasopressors/inotropes, refractory ventricular arrhythmias, or worsening acidosis. The absence of these indicated stabilization. Results Clinical decompensation after IABP occurred in 23 (43%) patients. Both patients who decompensated and those who stabilized had similar hemodynamic improvements after IABP support but patients who decompensated required more vasopressors/inotropes. Clinical decompensation after IABP was associated with worse outcomes after LVAD implantation, including a 3-fold longer intensive care unit stay and 5-fold longer time on mechanical ventilation (p<0.01 for both). While baseline characteristics were similar between groups, right and left ventricular cardiac power indices (Cardiac power Index= Cardiac Index × Mean arterial pressure / 451)identified patients who were likely to stabilize (AUC=0.82). Conclusions Among patients with chronic systolic heart failure who develop cardiogenic shock, more than half of patients stabilized with IABP support as a bridge to LVAD. Baseline measures of right and left ventricular cardiac power, both measures of work performed for a given flow and pressure, may allow clinicians to identify patients with sufficient contractile reserve who will be likely to stabilize with an IABP versus those who may need more aggressive ventricular support. PMID:26164215

TSOC-HFrEF Registry: A Registry of Hospitalized Patients with Decompensated Systolic Heart Failure: Description of Population and Management

PubMed Central

Wang, Chun-Chieh; Chang, Hung-Yu; Yin, Wei-Hsian; Wu, Yen-Wen; Chu, Pao-Hsien; Wu, Chih-Cheng; Hsu, Chih-Hsin; Wen, Ming-Shien; Voon, Wen-Chol; Lin, Wei-Shiang; Huang, Jin-Long; Chen, Shyh-Ming; Yang, Ning-I; Chang, Heng-Chia; Chang, Kuan-Cheng; Sung, Shih-Hsien; Shyu, Kou-Gi; Lin, Jiunn-Lee; Mar, Guang-Yuan; Chan, Kuei-Chuan; Kuo, Jen-Yuan; Wang, Ji-Hung; Chen, Zhih-Cherng; Tseng, Wei-Kung; Cherng, Wen-Jin

2016-01-01

Introduction Heart failure (HF) is a medical condition with a rapidly increasing incidence both in Taiwan and worldwide. The objective of the TSOC-HFrEF registry was to assess epidemiology, etiology, clinical management, and outcomes in a large sample of hospitalized patients presenting with acute decompensated systolic HF. Methods The TSOC-HFrEF registry was a prospective, multicenter, observational survey of patients presenting to 21 medical centers or teaching hospitals in Taiwan. Hospitalized patients with either acute new-onset HF or acute decompensation of chronic HFrEF were enrolled. Data including demographic characteristics, medical history, primary etiology of HF, precipitating factors for HF hospitalization, presenting symptoms and signs, diagnostic and treatment procedures, in-hospital mortality, length of stay, and discharge medications, were collected and analyzed. Results A total of 1509 patients were enrolled into the registry by the end of October 2014, with a mean age of 64 years (72% were male). Ischemic cardiomyopathy and dilated cardiomyopathy were diagnosed in 44% and 33% of patients, respectively. Coronary artery disease, hypertension, diabetes, and chronic renal insufficiency were the common comorbid conditions. Acute coronary syndrome, non-compliant to treatment, and concurrent infection were the major precipitating factors for acute decompensation. The median length of hospital stay was 8 days, and the in-hospital mortality rate was 2.4%. At discharge, 62% of patients were prescribed either angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers, 60% were prescribed beta-blockers, and 49% were prescribed mineralocorticoid receptor antagonists. Conclusions The TSOC-HFrEF registry provided important insights into the current clinical characteristics and management of hospitalized decompensated systolic HF patients in Taiwan. One important observation was that adherence to guideline-directed medical therapy was suboptimal. PMID:27471353

Retrospective application of Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure criteria for the remote management of patients with cardiac resynchronisation therapy.

PubMed

Brasca, Francesco Ma; Franzetti, Jessica; Rella, Valeria; Malfatto, Gabriella; Brambilla, Roberto; Facchini, Mario; Parati, Gianfranco; Perego, Giovanni B

2017-05-01

Aim The Program to Access and Review Trending iNformation and Evaluate coRrelation to Symptoms in patients with Heart Failure (PARTNERS HF) trial elaborated a multiparametric model for prediction of acute decompensation in advanced heart failure patients, based on periodical in office data download from cardiac resynchronisation devices. In this study, we evaluated the ability of the PARTNERS HF criteria to detect initial decompensation in a population of moderate heart failure patients under remote monitoring. Methods We retrospectively applied the PARTNERS HF criteria to 1860 transmissions from 104 patients (median follow up 21 months; range 1-67 months), who were enrolled in our programme of telemedicine after cardiac resynchronisation therapy. We tested the ability of a score based on these criteria to predict any acute clinical decompensation occurring in the 15 days following a transmission. Results In 441 cases, acute heart failure was diagnosed after the index transmission. The area under the curve (AUC) of the score for the diagnosis of acute decompensation was 0.752 (confidence interval (CI) 95% 0.728-0.777). The best score cut-off was consistent with the results of PARTNERS HF: with a score ≥2, sensitivity was 75% and specificity 68%. The odds ratio for events was 6.24 (CI 95% 4.90-7.95; p < 0.001). Conclusions When retrospectively applied to remote monitoring transmissions and arranged in a score, PARTNERS HF criteria could identify HF patients who subsequently developed acute decompensation. These results warrant prospective studies applying PARTNERS HF criteria to remote monitoring.

Serum sodium concentration, blood urea nitrogen, and outcomes in patients hospitalized for acute decompensated heart failure.

PubMed

Kajimoto, Katsuya; Minami, Yuichiro; Sato, Naoki; Takano, Teruo

2016-11-01

This study investigated the association of a low serum sodium and elevated blood urea nitrogen (BUN) with outcomes in acute decompensated heart failure (HF) patients. Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4438 patients discharged after hospitalization for acute decompensated HF were investigated to assess the association of a low serum sodium and/or elevated BUN at discharge with all-cause mortality. The patients were divided into four groups based on serum sodium (>136 or ≤136mEq/l) and BUN (<25 or ≥25mg/dl) at discharge. The median follow-up period after discharge was 517 (381-776) days. According to multivariate analysis, a low serum sodium (≤136mEq/l) or an elevated BUN (≥25mg/dl) was significantly associated with a higher risk of all-cause death compared with patients who had neither (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.22 to 1.94; P<0.001 and HR, 1.44; 95% CI, 1.19 to 1.73; P<0.001, respectively). Patients with both low serum sodium and elevated BUN had a higher risk of all-cause death relative to patients with neither (HR, 2.64; 95% CI, 2.17 to 3.20; P<0.001) and also relative to patients with either low serum sodium alone or elevated BUN alone (HR, 1.72; 95% CI, 1.36 to 2.18; P<0.001 and HR, 1.84; 95% CI, 1.53 to 2.21; P<0.001, respectively). These findings demonstrated that a low serum sodium and an elevated BUN may be additive risk factors for postdischarge mortality in acute decompensated HF patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Progressive early-onset scoliosis in Conradi disease: a 34-year follow-up of surgical management.

PubMed

Kabirian, Nima; Hunt, Leonel A; Ganjavian, Mohammad S; Akbarnia, Behrooz A

2013-03-01

Conradi-Hunermann syndrome (CHS) is a rare metabolic syndrome with several orthopaedic problems. Early-onset scoliosis is of great importance because of often rapidly progressive nature and high risk of postoperative complications. To report the 34-year follow-up and outcome of a patient with CHS treated with combined anterior and posterior fusion without instrumentation. All available clinical and radiographs of a female patient with CHS retrospectively reviewed. Overall health status, sagittal and coronal deformity, pulmonary function test, and outcome questionnaires were evaluated. Initial films at the age of 4 months showed a curve of 37 degrees from T6-T11 and a curve of 17 degrees from T11-L2. Thoracic kyphosis was measured at 43 degrees. Standing films at the age of 2 years and 2 months showed progression of both the curves to 50 and 66 degrees, respectively, and a significant spinal imbalance. The kyphosis also progressed to 57 degrees. She underwent a staged anterior inlay graft spinal fusion with autograft and allograft ribs from T8-L1 and posterior in situ fusion from T6-L1 with corticocancellous allograft. Solid radiographic fusion was observed 18 months after surgery. She was 36 years old at her latest follow-up, 34 years after surgery, with neutral clinical coronal and sagittal balance. No significant pain and respiratory complaint at moderate sports and normal daily life activity. "Vital capacity" and "total lung capacity" were 65% and 75%, respectively, of the normal. Thoracic curve of 35 degrees (T6-T11) and right thoracolumbar curve of 53 degrees from T11-L2 with a solid fusion fromT6-L1 with kyphosis measured over the fused area of 40 degrees were observed. Her overall mean Scoliosis Research Society-22 score was 3.68. She is an MBA graduate from a competitive school and currently works full-time. Although the treatment of early-onset scoliosis has significantly evolved over the past 3 decades, the traditional method of anterior release and fusion and staged in-situ posterior fusion posterior fusion with postoperative immobilization showed acceptable deformity correction and maintenance of the pulmonary function over the 34 years.

[Cervical disc hernia decompensation complicated by postoperative transitory tetraparesia about long-term haemodialysis patient].

PubMed

Caltot, E; Hélaine, L; Cadic, A; Muller, C; Arvieux, C-C

2011-01-01

We report a case of a 51-year-old man who underwent a third kidney transplantation that was complicated by tetraparesia due to a C5-C6 cervical disc hernia decompensation in the immediate postoperative period. Preoperative consultation for long-term haemodialysis patients could be perfected by further neurological investigation and additional imagery. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Wernicke-like encephalopathy during classic maple syrup urine disease decompensation.

PubMed

Manara, R; Del Rizzo, M; Burlina, A P; Bordugo, A; Citton, V; Rodriguez-Pombo, P; Ugarte, M; Burlina, A B

2012-05-01

We describe a new neuroradiologic picture observed during metabolic decompensation in two maple syrup urine disease (MSUD) patients that resembles Wernicke encephalopathy (WE). Clinical observations and the review of the literature regarding WE and MSUD pathophysiology prompted us to hypothesize a pathogenic link between these two disorders. Based on these findings, clinicians and neuroradiologists should be aware of MSUD as a possible predisposing factor of WE in children.

Treatment of acute decompensation of maple syrup urine disease in adult patients with a new parenteral amino-acid mixture.

PubMed

Servais, A; Arnoux, J B; Lamy, C; Hummel, A; Vittoz, N; Katerinis, I; Bazzaoui, V; Dubois, S; Broissand, C; Husson, M C; Berleur, M P; Rabier, D; Ottolenghi, C; Valayannopoulos, V; de Lonlay, P

2013-11-01

Acute decompensation of maple syrup urine disease (MSUD) is usually treated by enteral feeding with an amino-acid mixture without leucine (Leu), valine or isoleucine. However, its administration is ineffective in cases of gastric intolerance and some adult patients refuse enteral feeding via a nasogastric tube. We developed a new parenteral amino-acid mixture for patients with MSUD. Seventeen decompensation episodes in four adult patients with MSUD treated with a parenteral amino-acid mixture (group P) were compared to 18 previous episodes in the same patients treated by enteral feeding (group E). The mean Leu concentration at presentation was similar in the groups P and E (1196.9 μmol/L and 1212.2 μmol/L, respectively). The mean decrease in the Leu concentration during the first 3 days of hospitalisation was significantly higher in group P than group E (p = 0.0026); there were no side effects. The mean duration of hospitalisation was similar (4 vs. 4.5 days, p = NS). No patient in group P deteriorated whereas one patient in group E required dialysis. This new parenteral amino-acid mixture is safe and allows efficient Leu concentration decrease during acute MSUD decompensation episodes in adults. Its use avoids the need for nasogastric tube insertion.

Albumin Homodimers in Patients with Cirrhosis: Clinical and Prognostic Relevance of a Novel Identified Structural Alteration of the Molecule

PubMed Central

Baldassarre, Maurizio; Domenicali, Marco; Naldi, Marina; Laggetta, Maristella; Giannone, Ferdinando A.; Biselli, Maurizio; Patrono, Daniela; Bertucci, Carlo; Bernardi, Mauro; Caraceni, Paolo

2016-01-01

Decompensated cirrhosis is associated to extensive post-transcriptional changes of human albumin (HA). This study aims to characterize the occurrence of HA homodimerization in a large cohort of patients with decompensated cirrhosis and to evaluate its association with clinical features and prognosis. HA monomeric and dimeric isoforms were identified in peripheral blood by using a HPLC-ESI-MS technique in 123 cirrhotic patients hospitalized for acute decompensation and 50 age- and sex-comparable healthy controls. Clinical and biochemical parameters were recorded and patients followed up to one year. Among the monomeric isoforms identified, the N- and C-terminal truncated and the native HA underwent homodimerization. All three homodimers were significantly more abundant in patients with cirrhosis, acute-on-chronic liver failure and correlate with the prognostic scores. The homodimeric N-terminal truncated isoform was independently associated to disease complications and was able to stratify 1-year survival. As a result of all these changes, the monomeric native HA was significantly decreased in patients with cirrhosis, being also associated with a poorer prognosis. In conclusion homodimerization is a novel described structural alteration of the HA molecule in decompensated cirrhosis and contributes to the progressive reduction of the monomeric native HA, the only isoform provided of structural and functional integrity. PMID:27782157

Albumin Homodimers in Patients with Cirrhosis: Clinical and Prognostic Relevance of a Novel Identified Structural Alteration of the Molecule.

PubMed

Baldassarre, Maurizio; Domenicali, Marco; Naldi, Marina; Laggetta, Maristella; Giannone, Ferdinando A; Biselli, Maurizio; Patrono, Daniela; Bertucci, Carlo; Bernardi, Mauro; Caraceni, Paolo

2016-10-26

Decompensated cirrhosis is associated to extensive post-transcriptional changes of human albumin (HA). This study aims to characterize the occurrence of HA homodimerization in a large cohort of patients with decompensated cirrhosis and to evaluate its association with clinical features and prognosis. HA monomeric and dimeric isoforms were identified in peripheral blood by using a HPLC-ESI-MS technique in 123 cirrhotic patients hospitalized for acute decompensation and 50 age- and sex-comparable healthy controls. Clinical and biochemical parameters were recorded and patients followed up to one year. Among the monomeric isoforms identified, the N- and C-terminal truncated and the native HA underwent homodimerization. All three homodimers were significantly more abundant in patients with cirrhosis, acute-on-chronic liver failure and correlate with the prognostic scores. The homodimeric N-terminal truncated isoform was independently associated to disease complications and was able to stratify 1-year survival. As a result of all these changes, the monomeric native HA was significantly decreased in patients with cirrhosis, being also associated with a poorer prognosis. In conclusion homodimerization is a novel described structural alteration of the HA molecule in decompensated cirrhosis and contributes to the progressive reduction of the monomeric native HA, the only isoform provided of structural and functional integrity.

Patient-specific 3D models created by 3D imaging system or bi-planar imaging coupled with Moiré-Fringe projections: a comparative study of accuracy and reliability on spinal curvatures and vertebral rotation data.

PubMed

Hocquelet, Arnaud; Cornelis, François; Jirot, Anna; Castaings, Laurent; de Sèze, Mathieu; Hauger, Olivier

2016-10-01

The aim of this study is to compare the accuracy and reliability of spinal curvatures and vertebral rotation data based on patient-specific 3D models created by 3D imaging system or by bi-planar imaging coupled with Moiré-Fringe projections. Sixty-two consecutive patients from a single institution were prospectively included. For each patient, frontal and sagittal calibrated low-dose bi-planar X-rays were performed and coupled simultaneously with an optical Moiré back surface-based technology. The 3D reconstructions of spine and pelvis were performed independently by one radiologist and one technician in radiology using two different semi-automatic methods using 3D radio-imaging system (method 1) or bi-planar imaging coupled with Moiré projections (method 2). Both methods were compared using Bland-Altman analysis, and reliability using intraclass correlation coefficient (ICC). ICC showed good to very good agreement. Between the two techniques, the maximum 95 % prediction limits was -4.9° degrees for the measurements of spinal coronal curves and less than 5° for other parameters. Inter-rater reliability was excellent for all parameters across both methods, except for axial rotation with method 2 for which ICC was fair. Method 1 was faster for reconstruction time than method 2 for both readers (13.4 vs. 20.7 min and 10.6 vs. 13.9 min; p = 0.0001). While a lower accuracy was observed for the evaluation of the axial rotation, bi-planar imaging coupled with Moiré-Fringe projections may be an accurate and reliable tool to perform 3D reconstructions of the spine and pelvis.

New diagnostic modalities in the diagnosis of heart failure.

PubMed Central

Mitchell, Judith E.; Palta, Sanjeev

2004-01-01

Heart failure (HF) is the one cardiovascular disease that is increasing in prevalence in the United States. As the population continues to age, the incidence will certainly be amplified. However, some studies have shown that HF is correctly diagnosed initially in only 50% of affected patients. Despite the use of history, physical examination, echocardiogram, and chest x-ray, the percentage of correct initial diagnosis of HF is low. Recognizing the symptoms of HF decompensations is often problematic because other diagnoses can mimic them. There are two new diagnostic modalities that offer promise in improving HF diagnostic accuracy and identifying early HF decompensations. These diagnostic modalities include tests utilizing impedance cardiography and the B-type natriuretic peptide assay. They have the potential of increasing the accuracy of HF diagnosis and guide pharmacological treatment in the inpatient and outpatient settings. They may also assist in the recognition (or prediction) of acute HF decompensations. Images Figure 2 PMID:15586645

Myxoedema coma in the setting of hyperglycaemic hyperosmolar state

PubMed Central

Spyridoulias, Alexander; Riaz, Muhammad Shakeel

2016-01-01

Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. We wanted to highlight this case of myxoedema coma occurring in the context of a hyperglycaemic hyperosmolar state (HHS), as the former condition is normally associated with hypoglycaemia, hyponatraemia and hypo-osmolality. Decompensated hypothyroidism should be considered in presentations of HHS as well as with other metabolic derangements, as delays in thyroid hormone replacement are associated with poorer outcomes. It has multisystem effects challenging its recognition and we discuss potential complications and their management. PMID:26759401

Change of Exhaled Acetone Concentration in a Diabetic Patient with Acute Decompensated Heart Failure.

PubMed

Yokokawa, Tetsuro; Ichijo, Yasuhiro; Houtsuki, Yu; Matsumoto, Yoshiyuki; Oikawa, Masayoshi; Yoshihisa, Akiomi; Sugimoto, Koichi; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-Ichi; Shimouchi, Akito; Takeishi, Yasuchika

2017-10-21

In heart failure patients, exhaled acetone concentration, a noninvasive biomarker, is increased according to heart failure severity. Moreover, exhaled acetone concentration is also known to be affected by diabetes mellitus. However, there have been no reports on exhaled acetone concentration in heart failure patients with diabetes mellitus. A 77-year old man was admitted to our hospital with acute decompensated heart failure and atrioventricular block. He had controlled diabetes mellitus under insulin treatment with hemoglobin A1c of 6.5%. He underwent treatment of diuretics and permanent pacemaker implantation. His condition improved and he was discharged at Day 12. Due to the heart failure improvement, his levels of exhaled acetone concentration decreased from 1.623 ppm at admission to 0.664 ppm at discharge. This is the first report to reveal a change of exhaled acetone concentration in a diabetic patient with acute decompensated heart failure.

Decompensation of a congenital retinal macrovessel with arteriovenous communications induced by repetitive rollercoaster rides.

PubMed

Beatty, S; Goodall, K; Radford, R; Lavin, M J

2000-10-01

To describe a congenital retinal venous macrovessel that communicates with a cilioretinal artery and a retinal artery, and to report how this vascular anomaly decompensated as a result of repetitive rollercoaster rides. Case report with serial fundus photography and fluorescein angiography. After a short period of intensive rollercoaster rides, a 19-year-old woman complained of reduced vision in one eye. Funduscopy and fluorescein angiography revealed a venous congenital retinal macrovessel with arteriovenous communications, and retinal exudation was visible at the termination of the anomalous vessel. Exudation resolved, and acuity recovered after a period of avoidance of rollercoaster rides. This case represents the first report of a retinal artery and a cilioretinal artery communicating with a congenital retinal macrovessel, and it suggests that such patients are at increased risk of retinal vascular decompensation if involved in activities associated with changes in g-forces, such as bungee jumping or rollercoaster rides.

[Organization and methodology of early rehabilitation of the patients with cardioembolic stroke complicated by cardiac insufficiency].

PubMed

Isaeva, T V

2013-01-01

The present work was focused on the safety and effectiveness of the combined rehabilitative treatment in the case of pre-acute and acute cardioembolic stroke in 45 patients with varying degree of cardiac decompensation. The study showed that the use of "passive" remediation, such as the postural treatment, breathing exercises, selective massage, neuromuscular electrical stimulation, is safe and can be recommended to the patients with stroke and cardiac decompensation of different severity (II and III FC of chronic cardiac insufficiency). The introduction of such active measures as verticalization into the program of comprehensive rehabilitation may cause decompensation of cardiac insufficiency. The rehabilitation strategy used in the present study improved performance and exercise tolerance in the majority of the patients. Moreover, it resulted in the significant reduction of the severity of stroke, improved the motor function, and increased functional independence of the patients.

[Dialysis and ultrafiltration therapy in patients with cardio-renal syndrome: recommendations of the working group "heart-kidney" of the German Cardiac Society and the German Society of Nephrology].

PubMed

Schwenger, V; Remppis, B A; Westenfeld, R; Weinreich, T; Brunkhorst, R; Schieren, G; Krumme, B; Haller, H; Schmieder, R; Schlieper, G; Frye, B; Hoppe, U C; Hoyer, J; Keller, T; Blumenstein, M; Schunkert, H; Mahfoud, F; Rump, L C

2014-02-01

Renal failure is common in patients with severe heart failure. This complex pathophysiological interaction has been classified as cardio-renal syndrome. In these patients hydropic decompensation is the main cause of hospitalization. In patients with refractory heart failure, characterized by diuretic resistance and congestion due to volume overload, ultrafiltration has to be considered. In acute decompensated heart failure with worsening of renal function, extracorporeal ultrafiltration is the preferred treatment modality. On the other hand, patients suffering from chronic decompensated heart failure, particularly patients with ascites, will profit from the treatment specific advantages of peritoneal ultrafiltration. Prerequisite for an optimized care of patients with cardio-renal syndrome is the close collaboration among intensive care doctors, cardiologists and nephrologists. © Georg Thieme Verlag KG Stuttgart · New York.

Evaluation of a compact tinnitus therapy by electrophysiological tinnitus decompensation measures.

PubMed

Low, Yin Fen; Argstatter, Heike; Bolay, Hans Volker; Strauss, Daniel J

2008-01-01

Large-scale neural correlates of the tinnitus decompensation have been identified by using wavelet phase stability criteria of single sweep sequences of auditory late responses (ALRs). Our previous work showed that the synchronization stability in ALR sequences might be used for objective quantification of the tinnitus decompensation and attention which link to Jastreboff tinnitus model. In this study, we intend to provide an objective evaluation for quantifying the effect of music therapy in tinnitus patients. We examined neural correlates of the attentional mechanism in single sweep sequences of ALRs in chronic tinnitus patients who underwent compact therapy course by using the maximum entropy auditory paradigm. Results by our measure showed that the extent of differentiation between attended and unattended conditions improved significantly after the therapy. It is concluded that the wavelet phase synchronization stability of ALRs single sweeps can be used for the objective evaluation of tinnitus therapies, in this case the compact tinnitus music therapy.

Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

PubMed

Samartzis, Dino; Leung, Yee; Shigematsu, Hideki; Natarajan, Deepa; Stokes, Oliver; Mak, Kin-Cheung; Yao, Guanfeng; Luk, Keith D K; Cheung, Kenneth M C

2015-01-01

Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques. In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion. This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels.

Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment.

PubMed

Hayashi, Kazunori; Toyoda, Hiromitsu; Terai, Hidetomi; Suzuki, Akinobu; Hoshino, Masatoshi; Tamai, Koji; Ohyama, Shoichiro; Nakamura, Hiroaki

2017-04-01

OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than -10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24-90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (-5.4° ± 14°) to the 2-year follow-up measurement (-1.7° ± 11°) (p = 0.019). Twelve of the 51 patients had postoperative cervical hyperkyphosis. This group exhibited significantly smaller preoperative CLA and TK measurements (p = 0.001 and 0.004, respectively) than the others. After adjusting for confounding factors, preoperative CLA less than -5° and preoperative TK less than 10° were significantly associated with postoperative cervical hyperkyphosis (p < 0.05; OR 12.5 and 8.59, respectively). However, no differences were found in the clinical results regardless of cervical hyperkyphosis. CONCLUSIONS The CLA increased significantly from preoperatively to 2 years after surgery. Preoperative small CLA and TK measurements were independent risk factors of postoperative cervical hyperkyphosis. However, there was no difference in the clinical outcomes regardless of cervical hyperkyphosis.

Modification in CSF specific gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy, evidences for an early blood-CSF barrier dysfunction in cirrhosis.

PubMed

Weiss, Nicolas; Rosselli, Matteo; Mouri, Sarah; Galanaud, Damien; Puybasset, Louis; Agarwal, Banwari; Thabut, Dominique; Jalan, Rajiv

2017-04-01

Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific gravity of cerebrospinal fluid measured by CT is able to estimate blood-cerebrospinal fluid-barrier permeability. This study aimed to assess cerebrospinal fluid specific gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy. We identified all the patients admitted for acute decompensation of cirrhosis who underwent a brain CT-scan. Those patients could present acute decompensation with or without ACLF. The presence of hepatic encephalopathy was noted. They were compared to a group of stable cirrhotic patients and healthy controls. Quantitative brain CT analysis used the Brainview software that gives the weight, the volume and the specific gravity of each determined brain regions. Results are given as median and interquartile ranges and as relative variation compared to the control/baseline group. 36 patients presented an acute decompensation of cirrhosis. Among them, 25 presented with ACLF and 11 without ACLF; 20 presented with hepatic encephalopathy grade ≥ 2. They were compared to 31 stable cirrhosis patients and 61 healthy controls. Cirrhotic patients had increased cerebrospinal fluid specific gravity (CSF-SG) compared to healthy controls (+0.4 %, p < 0.0001). Cirrhotic patients with ACLF have decreased CSF-SG as compared to cirrhotic patients without ACLF (-0.2 %, p = 0.0030) that remained higher than in healthy controls. The presence of hepatic encephalopathy did not modify CSF-SG (-0.09 %, p = 0.1757). Specific gravity did not differ between different brain regions according to the presence or absence of either ACLF or HE. In patients with acute decompensation of cirrhosis, and those with ACLF, CSF specific gravity is modified compared to both stable cirrhotic patients and healthy controls. This pattern is observed even in the absence of hepatic encephalopathy suggesting that blood-CSF barrier impairment is manifest even in absence of overt hepatic encephalopathy.

Observation unit management of acute decompensated heart failure.

PubMed

Schrock, Jon W; Emerman, Charles L

2009-01-01

Acute decompensated heart failure (ADHF) is a common illness presenting to the emergency department (ED) that is amenable to observation unit (OU) treatment. As the number of baby boomers continues to grow and the incidence of heart failure increases, the financial implications of ADHF treatment will become more prominent. Obtaining institutional support and developing a good working relationship with cardiology colleagues is vital to creating workable ADHF protocols for whichever type of OU an institution decides to use.

Haemodialysis is an effective treatment in acute metabolic decompensation of maple syrup urine disease.

PubMed

Atwal, P S; Macmurdo, C; Grimm, P C

2015-09-01

Acute metabolic decompensation in maple syrup urine disease can occur during intercurrent illness and is a medical emergency. A handful of reports in the medical literature describe the use of peritoneal dialysis and haemodialysis as therapeutic inventions. We report the only patient from our centre to have haemodialysis performed in this setting. Combined with dietary BCAA restriction and calorific support, haemodialysis allows rapid reduction in plasma leucine concentrations considerably faster than conservative methods.

Body temperature circadian rhythm variability corresponds to left ventricular systolic dysfunction in decompensated cardiomyopathic hamsters.

PubMed

Ahmed, Amany; Gondi, Sreedevi; Cox, Casey; Zheng, Minjuan; Mohammed, Anwarullah; Stupin, Igor V; Wang, Suwei; Vela, Deborah; Brewer, Alan; Elayda, Macarthur A; Buja, L Maximilian; Ward Casscells, S; Wilson, James M

2011-11-01

A declining amplitude of body temperature circadian rhythm (BTCR) predicts decompensation or death in cardiomyopathic hamsters. We tested the hypothesis that changes in BTCR amplitude accompany significant changes in left ventricular (LV) size and function. Using intraperitoneal transmitters, we continuously monitored the temperature of 30 male BIO TO-2 Syrian dilated cardiomyopathic hamsters. Cosinor analysis was used to detect significant changes--defined as changes >1 standard deviation from the baseline amplitude for 3 consecutive days--in BTCR amplitude over each hamster's lifespan. The Student t-test was used to compare BTCR variability and LV size and function (as assessed by 2D echocardiography) between baseline and the time that BTCR amplitude declined. All hamsters received 10 mg/kg furosemide daily. At the time of BTCR amplitude decline, functional parameters had changed significantly (P < .0001) from baseline: ejection fraction (0.31 ± 0.09% vs. 0.52 ± 0.08%), LV end-systolic volume (0.11 ± 0.03 vs. 0.05 ± 0.02 cm(3)), and LV end-diastolic volume (0.16 ± 0.04 vs. 0.10 ± 0.03 cm(3)). In decompensated cardiomyopathic hamsters, a decline in BTCR amplitude was associated with progression of heart failure and cardiac decompensation. Variation in BTCR warrants further investigation because of its potential implications for the diagnosis and treatment of cardiovascular disorders. Published by Elsevier Inc.

Plasma Serotonin in Heart Failure: Possible Marker and Potential Treatment Target.

PubMed

Selim, Ahmed M; Sarswat, Nitasha; Kelesidis, Iosif; Iqbal, Muhammad; Chandra, Ramesh; Zolty, Ronald

2017-05-01

The relationship between heart failure (HF) and the serotonergic system has been established in animal studies. However, data on human plasma serotonin level in HF and its significance over the course of the disease is lacking. Serotonin levels were measured in 173 patients (108 males, 65 females), 116 were stable HF and 40 were acute decompensated HF patients. The normal control group included 17 healthy volunteers with no known medical or psychiatric conditions. Patients receiving medications affecting serotonin receptors and those with pulmonary hypertension were excluded. All patients, except for those in the decompensated group, were on stable doses of HF medications. Plasma serotonin levels were significantly elevated in decompensated HF patients compared with stable patients (P=0.002). Higher plasma serotonin levels were associated with worse HF symptoms (NYHA class) and the presence of systolic dysfunction, and was borderline associated with low peak oxygen consumption during cardiopulmonary exercise testing (P=0.055). These results were independent of age, gender, race, hypertension, diabetes, renal failure, weight, coronary artery disease (CAD), atrial fibrillation and medication use. Serotonin is a marker for decompensation in patients with chronic heart failure. Higher serotonin levels were associated with worse HF symptoms and systolic dysfunction. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

The Italian compassionate use of sofosbuvir in HCV patients waitlisted for liver transplantation: A national real-life experience.

PubMed

Martini, Silvia; Donato, Maria Francesca; Mazzarelli, Chiara; Rendina, Maria; Visco-Comandini, Ubaldo; Filì, Daniela; Gianstefani, Alice; Fagiuoli, Stefano; Melazzini, Mario; Montilla, Simona; Pani, Luca; Petraglia, Sandra; Russo, Pierluigi; Trotta, Maria Paola; Carrai, Paola; Caraceni, Paolo

2018-04-01

This study aimed to assess the real-life clinical and virological outcomes of HCV waitlisted patients for liver transplantation (LT) who received sofosbuvir/ribavirin (SOF/R) within the Italian compassionate use program. Clinical and virological data were collected in 224 patients with decompensated cirrhosis and/or hepatocellular carcinoma (HCC) receiving daily SOF/R until LT or up a maximum of 48 weeks. Of 100 transplanted patients, 51 were HCV-RNA negative for >4 weeks before LT (SVR12: 88%) and 49 negative for <4 weeks or still viraemic at transplant: 34 patients continued treatment after LT (bridging therapy) (SVR12: 88%), while 15 stopped treatment (SVR12: 53%). 98 patients completed SOF/R without LT (SVR12: 73%). In patients with advanced decompensated cirrhosis (basal MELD ≥15 and/or C-P ≥B8), a marked improvement of the scores occurred in about 50% of cases and almost 20% of decompensated patients without HCC reached a condition suitable for inactivation and delisting. These real-life data indicate that in waitlisted patients: (i) bridging antiviral therapy can be an option for patients still viraemic or negative <4 weeks at LT; and (ii) clinical improvement to a condition suitable for delisting can occur even in patients with advanced decompensated cirrhosis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Disease progression in Chinese chronic hepatitis C patients with persistently normal alanine aminotransaminase levels.

PubMed

Hui, C-K; Zhang, H-Y; Shek, T; Yao, H; Yueng, Y-H; Leung, K-W; Lai, S-T; Lai, J-Y; Leung, N; Lau, G K

2007-06-01

Although chronic hepatitis C virus-infected patients with persistently normal alanine aminotransaminase levels usually have mild liver disease, disease progression can still occur. However, it is uncertain which group of patients is at risk of disease progression. To examine the severity of liver disease on liver biopsy in Chinese patients with persistently normal alanine aminotransaminase levels, and their disease progression over time. Eighty-two patients with persistently normal alanine aminotransaminase levels were followed up longitudinally. The median time of follow-up was 8.1 years. Forty-seven of the 82 patients (57.3%) had a second liver biopsy. At the time of analysis, six of the 82 patients (7.3%) developed decompensated liver cirrhosis. Patients with an initial fibrosis stage F2 or F3 [6/23 (26.1%) vs. 0/59 (0%), P < 0.0001] or inflammatory grade A2 or A3 [5/40 (12.5%) vs. 1/42 (2.4%), P = 0.04] were more likely to develop decompensated liver cirrhosis. On multivariate analysis, initial fibrosis stage F2 or F3 was independently associated with progression to decompensated liver cirrhosis (relative risk 2.3, 95% confidence interval 0.03-2.5, P = 0.02). Chinese chronic hepatitis C virus patients with persistently normal alanine aminotransaminase levels with moderate to severe fibrosis at initial evaluation are more likely to develop decompensated liver cirrhosis.

Prognostic Value of Urinary Neutrophil Gelatinase-Associated Lipocalin on the First Day of Admission for Adverse Events in Patients With Acute Decompensated Heart Failure.

PubMed

Nakada, Yasuki; Kawakami, Rika; Matsui, Masaru; Ueda, Tomoya; Nakano, Tomoya; Takitsume, Akihiro; Nakagawa, Hitoshi; Nishida, Taku; Onoue, Kenji; Soeda, Tsunenari; Okayama, Satoshi; Watanabe, Makoto; Kawata, Hiroyuki; Okura, Hiroyuki; Saito, Yoshihiko

2017-05-18

Urinary neutrophil gelatinase-associated lipocalin (U-NGAL) is an early predictor of acute kidney injury and adverse events in various diseases; however, in acute decompensated heart failure patients, its significance remains poorly understood. This study aimed to investigate the prognostic value of U-NGAL on the first day of admission for the occurrence of acute kidney injury and long-term outcomes in acute decompensated heart failure patients. We studied 260 acute decompensated heart failure patients admitted to our department between 2011 and 2014 by measuring U-NGAL in 24-hour urine samples collected on the first day of admission. Primary end points were all-cause death, cardiovascular death, and heart failure admission. Patients were divided into 2 groups according to their median U-NGAL levels (32.5 μg/gCr). The high-U-NGAL group had a significantly higher occurrence of acute kidney injury during hospitalization than the low-U-NGAL group ( P =0.0012). Kaplan-Meier analysis revealed that the high-U-NGAL group exhibited a worse prognosis than the low-U-NGAL group in all-cause death (hazard ratio 2.07; 95%CI 1.38-3.12, P =0.0004), cardiovascular death (hazard ratio 2.29; 95%CI 1.28-4.24, P =0.0052), and heart failure admission (hazard ratio 1.77; 95%CI 1.13-2.77, P =0.0119). The addition of U-NGAL to the estimated glomerular filtration rate significantly improved the predictive accuracy of all-cause mortality ( P =0.0083). In acute decompensated heart failure patients, an elevated U-NGAL level on the first day of admission was related to the development of clinical acute kidney injury and independently associated with poor prognosis. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Hepatocellular Carcinoma: An Unusual Complication of Longstanding Wilson Disease.

PubMed

Gunjan, Deepak; Shalimar; Nadda, Neeti; Kedia, Saurabh; Nayak, Baibaswata; Paul, Shashi B; Gamanagatti, Shivanand Ramachandra; Acharya, Subrat K

2017-06-01

Wilson disease is caused by the accumulation of copper in the liver, brain or other organs, due to the mutation in ATP7B gene, which encodes protein that helps in excretion of copper in the bile canaliculus. Clinical presentation varies from asymptomatic elevation of transaminases to cirrhosis with decompensation. Hepatocellular carcinoma is a known complication of cirrhosis, but a rare occurrence in Wilson disease. We present a case of neurological Wilson disease, who later developed decompensated cirrhosis and hepatocellular carcinoma.

Rare Cardiopulmonary Complications of Chronically Decompensated Myasthenia Gravis

PubMed Central

Chisholm, Joseph C.; Gilson, Alan

1980-01-01

Although myasthenia gravis (MG) is frequently mentioned in standard textbooks and journal articles as a rare cause for pulmonary hypertension and right heart failure, no case can actually be found in the literature. The case described in this report is the first documented case of chronically decompensated MG manifesting itself as pulmonary hypertension, severe right heart failure, and functional prolapse of both the mitral and tricuspid valves. Interestingly, no hepatic biochemical abnormalities were present in spite of significant congestive hepatomegaly. PMID:7420443

Haemodialysis is an effective treatment in acute metabolic decompensation of maple syrup urine disease

PubMed Central

Atwal, P.S.; Macmurdo, C.; Grimm, P.C.

2015-01-01

Acute metabolic decompensation in maple syrup urine disease can occur during intercurrent illness and is a medical emergency. A handful of reports in the medical literature describe the use of peritoneal dialysis and haemodialysis as therapeutic inventions. We report the only patient from our centre to have haemodialysis performed in this setting. Combined with dietary BCAA restriction and calorific support, haemodialysis allows rapid reduction in plasma leucine concentrations considerably faster than conservative methods. PMID:26937409

Minimally invasive decompression surgery for lumbar spinal stenosis with degenerative scoliosis: Predictive factors of radiographic and clinical outcomes.

PubMed

Minamide, Akihito; Yoshida, Munehito; Iwahashi, Hiroki; Simpson, Andrew K; Yamada, Hiroshi; Hashizume, Hiroshi; Nakagawa, Yukihiro; Iwasaki, Hiroshi; Tsutsui, Shunji; Kagotani, Ryohei; Sonekatsu, Mayumi; Sasaki, Takahide; Shinto, Kazunori; Deguchi, Tsuyoshi

2017-05-01

There is ongoing controversy regarding the most appropriate surgical treatment for lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS): decompression alone, decompression with limited spinal fusion, or long spinal fusion for deformity correction. The coexistence of degenerative stenosis and deformity is a common scenario; Nonetheless, selecting the appropriate surgical intervention requires thorough understanding of the patients clinical symptomatology as well as radiographic parameters. Minimally invasive (MIS) decompression surgery was performed for LSS patients with DLS. The aims of this study were (1) to investigate the clinical outcomes of MIS decompression surgery in LSS patients with DLS, and (2) to identify the predictive factors for both radiographic and clinical outcomes after MIS surgery. 438 consecutive patients were enrolled in this study. Inclusion criteria was evidence of LSS and DLS with coronal curvature measuring greater than 10°. The Japanese Orthopaedic Association (JOA) score, JOA recovery rate, low back pain (LBP), and radiographic features were evaluated preoperatively and at over 2 years postoperatively. Of the 438 patients, 122 were included in final analysis, with a mean follow-up of 2.4 years. The JOA recovery rate was 47.6%. LBP was significantly improved at final follow-up. Cobb angle was maintained for 2 years postoperatively (p = 0.159). Clinical outcomes in foraminal stenosis patients were significantly related to sex, preoperative high Cobb angle and progression of scoliosis (p = 0.008). In the severe scoliosis patients, the JOA recovery was 44%, and was significantly depended on progression of scoliosis (Cobb angle: preoperation 29.6°, 2-years follow-up 36.9°) and mismatch between the pelvic incidence (PI) and the lumbar lordosis (LL) (preoperative PI-LL 35.5 ± 21.2°) (p = 0.028). This study investigated clinical outcomes of MIS decompression surgery in LSS patients with DLS. The predictive risk factors of clinical outcomes were severe scoliosis, foramina stenosis, progressive scoliosis and large mismatch of PI-LL. Copyright © 2016 The Japanese Orthopaedic Association. All rights reserved.

Sofosbuvir and Velpatasvir Combination Improves Patient-reported Outcomes for Patients With HCV Infection, Without or With Compensated or Decompensated Cirrhosis.

PubMed

Younossi, Zobair M; Stepanova, Maria; Feld, Jordan; Zeuzem, Stefan; Sulkowski, Mark; Foster, Graham R; Mangia, Alessandra; Charlton, Michael; O'Leary, Jacqueline G; Curry, Michael P; Nader, Fatema; Henry, Linda; Hunt, Sharon

2017-03-01

The combination of sofosbuvir and velpatasvir is used to treat patients with hepatitis C virus (HCV) infection of different genotypes. We compared the effects of this treatment regimen, with and without ribavirin, on outcomes reported by patients (patient-reported outcomes [PROs]) with HCV infection, with or without cirrhosis. We performed a post hoc analysis of data collected from phase 3 clinical trials (ASTRAL-1, -2, -3, and -4) of 1701 patients infected with HCV of different genotypes treated with sofosbuvir and velpatasvir with ribavirin for 12 weeks (n = 87), sofosbuvir with ribavirin for 12 or 24 weeks (n = 401), and ribavirin-free sofosbuvir and velpatasvir for 12 or 24 weeks (n = 1213). In all trials, participants completed 4 PRO questionnaires (while blinded to their HCV RNA levels): the Short Form-36, the Functional Assessment of Chronic Illness Therapy-Fatigue, the Chronic Liver Disease Questionnaire-HCV Version, and the Work Productivity and Activity Impairment: Specific Health Problem, at multiple time points. We compared baseline PROs and changes in PROs following treatment in patients without cirrhosis (n = 1112), with compensated cirrhosis (n = 338), and with decompensated cirrhosis (n = 251). Baseline PRO scores were as much as 33.5% lower in patients with decompensated cirrhosis than in patients without cirrhosis (P < .05). Following treatment with ribavirin-containing regimens, changes in PRO scores were similar among patients with compensated and decompensated cirrhosis (all P > .01). Treatment with these regimens increased some PRO scores by as much as 11.8% from baseline (P < .05) and reduced others, by as much as 7.1% (P < .05). Despite this, by 12 weeks after cessation of treatment with ribavirin-containing regimens, all PRO decrements resolved; PRO scores increased by as much as 14.2%, and as much as 17.1% at 24 weeks after treatment, regardless of cirrhosis status (all P > .01 between cirrhosis groups). In contrast, treatment with ribavirin-free sofosbuvir and velpatasvir increased PRO scores for patients with compensated cirrhosis, and even more so in patients with decompensated cirrhosis starting at treatment Week 4; no statistically significant decrement was observed at any time point (all 1-sided P values > .05). In multivariate analysis, compensated cirrhosis was associated with a 2.3% to 5.0% greater increase in PRO scores following treatment with sofosbuvir and velpatasvir (P < .05); decompensated cirrhosis was associated with a 5.5%-9.1% greater increase (P < .002). Clinicaltrials.gov number, NCT02201940, NCT02220998, NCT02201953, NCT02201901. In an analysis of data from 4 phase 3 clinical trials, we found that patients with HCV infection (especially those with decompensated cirrhosis) have significant increases in their PRO scores during treatment with sofosbuvir and velpatasvir and after achieving a sustained virologic response. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Decompensation: A Novel Approach to Accounting for Stress Arising From the Effects of Ideology and Social Norms.

PubMed

Riggs, Damien W; Treharne, Gareth J

2017-01-01

To date, research that has drawn on Meyer's (2003) minority stress model has largely taken for granted the premises underpinning it. In this article we provide a close reading of how "stress" is conceptualized in the model and suggest that aspects of the model do not attend to the institutionalized nature of stressors experienced by people with marginalized identities, particularly lesbian, gay, bisexual, and transgender individuals. As a counter to this, we highlight the importance of a focus on the effects of ideology and social norms in terms of stress, and we argue why an intersectional approach is necessary to ensure recognition of multiple axes of marginalization and privilege. The article then outlines the concept of decompensation and suggests that it may offer one way to reconsider the effects of ideology and social norms. The decompensation approach centers on the need for social change rather than solely relying on individuals to be resilient.

P-LUM-08: Endoscopic ultrasound-guided fine needle aspiration: A new modality to diagnose peritoneal tuberculosis in the presence of decompensated cirrhosis – a case series

PubMed Central

Daswani, Ravi; Singla, Vikas; Arora, Anil; Sharma, Praveen; Bansal, Naresh; Kumar, Ashish

2017-01-01

The gold standard for diagnosis of peritoneal tuberculosis is growth of Mycobacterium tuberculosis on ascitic fluid or peritoneal culture. Due to the nonspecific signs and symptoms of disease, its early diagnosis is difficult, especially in patients with decompensated cirrhosis. The reported sensitivity of ascitic fluid is low, and to obtain tissue for peritoneal biopsy in patients with cirrhosis is difficult. Thus, there is an urgent need to explore newer diagnostic modalities, especially those that can provide perioneal tissue by less invasive means. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is a good alternative to obtain peritoneal tissue for establishing the diagnosis of peritoneal tuberculosis (TB). We hereby report the use of EUS- FNA of the peritoneum in five patients with decompensated cirrhosis, in whom the diagnosis could not be confirmed by other means; thus, we propose EUS-FNA of the peritoneum as a new, safe, and unexplored technique for diagnosis of peritoneal TB.

Myxoedema coma in the setting of hyperglycaemic hyperosmolar state.

PubMed

Spyridoulias, Alexander; Riaz, Muhammad Shakeel

2016-01-11

Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. We wanted to highlight this case of myxoedema coma occurring in the context of a hyperglycaemic hyperosmolar state (HHS), as the former condition is normally associated with hypoglycaemia, hyponatraemia and hypo-osmolality. Decompensated hypothyroidism should be considered in presentations of HHS as well as with other metabolic derangements, as delays in thyroid hormone replacement are associated with poorer outcomes. It has multisystem effects challenging its recognition and we discuss potential complications and their management. 2016 BMJ Publishing Group Ltd.

Glaucoma tube shunt implantation through the ciliary sulcus in pseudophakic eyes with high risk of corneal decompensation.

PubMed

Weiner, Asher; Cohn, Aaron D; Balasubramaniam, Mamtha; Weiner, Adam J

2010-08-01

To summarize our clinical experience with implanting Baerveldt glaucoma tube shunts through the ciliary sulcus in eyes with a posterior chamber intraocular lens and shallow anterior chambers, corneal transplants, guttata or edema. A retrospective interventional nonrandomized noncomparative case series. Main outcome measure was postoperative corneal status. Secondary outcome measures included postoperative intraocular pressure (IOP), visual acuity and complications. Thirty-six eyes of 32 patients were identified through chart review. Follow-up period was 21.8+/-16.6 months (mean+/-standard deviation, range: 4.0 to 58.5 mo). At final visit, all 23 preoperative clear native corneas and 6 of 7 corneal transplants remained clear. Thus, of the 30 preoperative clear corneas, only 1 decompensated. Preoperative IOP was 27.9+/-11.8 mm Hg (range: 12 to 59 mm Hg), reduced postoperatively to 10.1+/-3.9 mm Hg (range: 2 to 21 mm Hg, P=0.0001), a reduction of 58.2%+/-19.3% (range: 5.0% to 95.4%). Final IOP was >or=5 and

Comparison of the effect of BCAA granules on between decompensated and compensated cirrhosis.

PubMed

Habu, Daiki; Nishiguchi, Shuhei; Nakatani, Shinji; Lee, Chulyoo; Enomoto, Masaru; Tamori, Akihiro; Takeda, Tadashi; Ohfuji, Satoko; Fukushima, Wakaba; Tanaka, Takashi; Kawamura, Etsuji; Shiomi, Susumu

2009-01-01

We designed a randomized trial to examine whether increase or preservation of serum albumin levels was attained with administration of branched-chain amino acid (BCAA) granules for compensated cirrhosis, compared with decompensated cirrhosis. Sixty-five patients with HCV-related cirrhosis with serum albumin level less than 4.0 g/dl were enrolled in this study. Half of the patients were randomly assigned to receive 14.22 g/day of BCAA granules orally, and half were assigned to a control group. Patients were evaluated at entry and at 1-year intervals for at least 2 years. The parameters were divided into 3 categories. Class 1 was decompensated cirrhosis with serum albumin level less than 3.5 mg/dl. Class 2 was compensated cirrhosis with serum albumin level over 3.6 mg/dl and molar ratio of BCAA to tyrosine (BTR) less than 4. Class 3 was compensated cirrhosis with serum albumin level over 3.6 mg/dl and BTR over 4. In class 1 and class 2, the BCAA group exhibited significantly higher rates of maintaining serum albumin level than the control group for 2 years. In contrast, there was no significant difference between the BCAA group and control group in rate of maintaining serum albumin levels in class 3. Those results suggested that if cirrhotic patients were in the compensated stage at the entry but with lower BTR, as for decompensated cirrhosis, oral BCAA supplementation might be effective in maintaining serum albumin level for 2 years.

Changes in corneal endothelial cell density and the cumulative risk of corneal decompensation after Ahmed glaucoma valve implantation.

PubMed

Kim, Kyoung Nam; Lee, Sung Bok; Lee, Yeon Hee; Lee, Jong Joo; Lim, Hyung Bin; Kim, Chang-Sik

2016-07-01

To evaluate changes in the corneal endothelial cell density (ECD) and corneal decompensation following Ahmed glaucoma valve (AGV) implantation. This study was retrospective and observational case series. Patients with refractory glaucoma who underwent AGV implantation and were followed >5 years were consecutively enrolled. We reviewed the medical records, including the results of central corneal specular microscopy. Of the 127 enrolled patients, the annual change in ECD (%) was determined using linear regression for 72 eyes evaluated at least four times using serial specular microscopic examination and compared with 31 control eyes (fellow glaucomatous eyes under medical treatment). The main outcome measures were cumulative risk of corneal decompensation and differences in the ECD loss rates between subjects and controls. The mean follow-up after AGV implantation was 43.1 months. There were no cases of postoperative tube-corneal touch. The cumulative risk of corneal decompensation was 3.3%, 5 years after AGV implantation. There was a more rapid loss of ECD in the 72 subject eyes compared with the 31 controls (-7.0% and -0.1%/year, respectively; p<0.001). However, the rate of loss decreased over time and statistical significance compared with control eyes disappeared after 2 years postoperatively: -10.7% from baseline to 1 year (p<0.01), -7.0% from 1 year to 2 years (p=0.037), -4.2% from 2 years to 3 years (p=0.230) and -2.7% from 3 years to the final follow-up (p=0.111). In case of uncomplicated AGV implantation, the cumulative risk of corneal decompensation was 3.3%, 5 years after the operation. The ECD loss was statistically greater in eyes with AGV than in control eyes without AGV, but the difference was significant only up to 2 years post surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Circadian body temperature variability is an indicator of poor prognosis in cardiomyopathic hamsters.

PubMed

Ahmed, Amany; Gondi, Sreedevi; Cox, Casey; Wang, Suwei; Stupin, Igor V; Shankar, K J; Munir, Shahzeb M; Sobash, Ed; Brewer, Alan; Ferguson, James J; Elayda, Macarthur A; Casscells, S Ward; Wilson, James M

2010-03-01

Low body temperature is an independent predictor of poor prognosis in patients with congestive heart failure. The cardiomyopathic hamster develops progressive biventricular dysfunction, resulting in heart failure death at 9 months to 1 year of life. Our goal was to use cardiomyopathic hamsters to examine the relationship between body temperature and heart failure decompensation and death. To this end, we implanted temperature and activity transducers with telemetry into the peritoneal space of 46 male Bio-TO-2 Syrian cardiomyopathic hamsters. Multiple techniques, including computing mean temperature, frequency domain analysis, and nonlinear analysis, were used to determine the most useful method for predicting poor prognosis. Data from 44 hamsters were included in our final analysis. We detected a decline in core body temperature in 98% of the hamsters 8+/-4 days before death (P < .001). We examined the dominant frequency of temperature variation (ie, the circadian rhythm) by using cosinor analysis, which revealed a significant decrease in the amplitude of the body temperature circadian rhythm 8 weeks before death (0.28 degrees C; 95% CI, 0.26-0.31) compared to baseline (0.36 degrees C; 95% CI, 0.34-0.39; P=.005). The decline in the circadian temperature variation preceded all other evidence of decompensation. We conclude that a decrease in the amplitude of the body temperature circadian rhythm precedes fatal decompensation in cardiomyopathic hamsters. Continuous temperature monitoring may be useful in predicting preclinical decompensation in patients with heart failure and in identifying opportunities for therapeutic intervention. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Efficacy and safety of electroacupuncture in acute decompensated heart failure: a study protocol for a randomized, patient- and assessor-blinded, sham controlled trial.

PubMed

Leem, Jungtae; Lee, Seung Min Kathy; Park, Jun Hyeong; Lee, Suji; Chung, Hyemoon; Lee, Jung Myung; Kim, Weon; Lee, Sanghoon; Woo, Jong Shin

2017-07-11

The purpose of this trial is to evaluate the effectiveness and safety of electroacupuncture in the treatment of acute decompensated heart failure compared with sham electroacupuncture. This protocol is for a randomized, sham controlled, patient- and assessor-blinded, parallel group, single center clinical trial that can overcome the limitations of previous trials examining acupuncture and heart failure. Forty-four acute decompensated heart failure patients admitted to the cardiology ward will be randomly assigned into the electroacupuncture treatment group (n = 22) or the sham electroacupuncture control group (n = 22). Participants will receive electroacupuncture treatment for 5 days of their hospital stay. The primary outcome of this study is the difference in total diuretic dose between the two groups during hospitalization. On the day of discharge, follow-up heart rate variability, routine blood tests, cardiac biomarkers, high-sensitivity C-reactive protein (hs-CRP) level, and N-terminal pro b-type natriuretic peptide (NT-pro BNP) level will be assessed. Four weeks after discharge, hs-CRP, NT-pro BNP, heart failure symptoms, quality of life, and a pattern identification questionnaire will be used for follow-up analysis. Six months after discharge, major cardiac adverse events and cardiac function measured by echocardiography will be assessed. Adverse events will be recorded during every visit. The result of this clinical trial will offer evidence of the effectiveness and safety of electroacupuncture for acute decompensated heart failure. Clinical Research Information Service: KCT0002249 .

Assessment of the hepatic microvascular changes in liver cirrhosis by perfusion computed tomography

PubMed Central

Chen, Mai-Lin; Zeng, Qing-Yu; Huo, Jian-Wei; Yin, Xiao-Ming; Li, Bao-Ping; Liu, Jian-Xin

2009-01-01

AIM: To assess the hepatic microvascular parameters in patients with liver cirrhosis by perfusion computed tomography (CT). METHODS: Perfusion CT was performed in 29 patients without liver disease (control subjects) and 39 patients with liver cirrhosis, including 22 patients with compensated cirrhosis and 17 patients with decompensated cirrhosis, proved by clinical and laboratory parameters. CT cine-scans were obtained over 50 s beginning with the injection of 50 mL of contrast agent. Hepatic microvascular parameters, mean transit time (MTT) and permeability surface area product (PS) were obtained with the Perfusion 3 software (General Electric, ADW 4.2). RESULTS: The overall differences of MTT and PS between control subjects, patients with compensated cirrhosis and those with decompensated cirrhosis were statistically significant (P = 0.010 and P = 0.002, respectively). MTT values were 15.613 ± 4.1746 s, 12.592 ± 4.7518 s, and 11.721 ± 4.5681 s for the three groups, respectively, while PS were 18.945 ± 7.2347 mL/min per 100 mL, 22.767 ± 8.3936 mL/min per 100 mL, and 28.735 ± 13.0654 mL/min per 100 mL. MTT in decompensated cirrhotic patients were significantly decreased compared to controls (P = 0.017), whereas PS values were remarkably increased (P = 0.001). CONCLUSION: The hepatic microvascular changes in patients with liver cirrhosis can be quantitatively assessed by perfusion CT. Hepatic microvascular parameters (MTT and PS), as measured by perfusion CT, were significantly altered in decompensated cirrhosis. PMID:19630110

Six minute walk test predicts long-term all-cause mortality and heart failure rehospitalization in African-American patients hospitalized with acute decompensated heart failure.

PubMed

Alahdab, M Tarek; Mansour, Ibrahim N; Napan, Sirikarn; Stamos, Thomas D

2009-03-01

The prognostic value of the 6-minute walk test (6MWT) has been described in patients with heart failure (HF); however, limited data are available in an African-American (AA) population. We prospectively evaluated the usefulness of the 6MWT in predicting mortality and HF rehospitalization in AA patients with acute decompensated HF. Two hundred AA patients (63.1% men, mean age 55.7 +/- 12.9 years) with acute decompensated HF were prospectively studied. Patients were followed to assess 40-month all-cause mortality and 18-month HF rehospitalization. The median distance walked on the 6MWT was 213 m. Of the 198 patients with available mortality data, 59 patients (29.8%) died. Of the 191 patients with available rehospitalization data, 114 (59.7%) were rehospitalized for worsening HF. For patients who walked 200 m (P = .001). For patients who walked 200 m (P = .027). Multivariate Cox regression analysis showed that 6MWT distance

Echocardiographic predictors of change in renal function with intravenous diuresis for decompensated heart failure.

PubMed

Gannon, Stephen A; Mukamal, Kenneth J; Chang, James D

2018-06-14

The aim of this study was to identify echocardiographic predictors of improved or worsening renal function during intravenous diuresis for decompensated heart failure. Secondary aim included defining the incidence and clinical risk factors for acute changes in renal function with decongestion. A retrospective review of 363 patients admitted to a single centre for decompensated heart failure who underwent intravenous diuresis and transthoracic echocardiography was conducted. Clinical, echocardiographic, and renal function data were retrospectively collected. A multinomial logistic regression model was created to determine relative risk ratios for improved renal function (IRF) or worsening renal function (WRF). Within this cohort, 36% of patients experienced WRF, 35% had stable renal function, and 29% had IRF. Patients with WRF were more likely to have a preserved left ventricular ejection fraction compared with those with stable renal function or IRF (P = 0.02). Patients with IRF were more likely to have a dilated, hypokinetic right ventricle compared with those with stable renal function or WRF (P ≤ 0.01), although this was not significant after adjustment for baseline characteristics. Left atrial size, left ventricular linear dimensions, and diastolic function did not significantly predict change in renal function. An acute change in renal function occurred in 65% of patients admitted with decompensated heart failure. WRF was statistically more likely in patients with a preserved left ventricular ejection fraction. A trend towards IRF was noted in patients with global right ventricular dysfunction. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

[Decompensated valvular disease and coarctation. One-stage repair using a median approach with an ascending aorta-abdominal aorta shunt].

PubMed

Baille, Y; Sigwalt, M; Vaillant, A; Sicard Desnuelle, M P; Varnet, B

1981-11-01

The tactical decision in patients with decompensated valvular disease associated with a severe stenosis of the aortic isthmus is always difficult. One stage surgical repair using two separate approaches is a long and high risk procedure. It would seem more logical and safer to treat the lesions in two stages a few weeks apart, the severest lesion being managed first. In the two cases reported. The isthmic stenoses and valvular lesions were of the same severity and made both classical techniques impracticable. Therefore the patients underwent a single stage procedure by a median approach associating valve replacement under cardiopulmonary bypass (mitral and tricuspid in one and aortic in the other case) and an ascending aorta-abdominal aorta dacron conduit. The present postoperative survival periods are 30 and 9 months. The functional result was good (Class 1 and 0) and postoperative angiography has shown the montage to be working satisfactorily. This technique is exceptional but may be useful in borderline cases with decompensated valvular disease and severe isthmic stenosis.

Higher-speed coronal mass ejections and their geoeffectiveness

NASA Astrophysics Data System (ADS)

Singh, A. K.; Bhargawa, Asheesh; Tonk, Apeksha

2018-06-01

We have attempted to examine the ability of coronal mass ejections to cause geoeffectiveness. To that end, we have investigated total 571 cases of higher-speed (> 1000 km/s) coronal mass ejection events observed during the years 1996-2012. On the basis of angular width (W) of observance, events of coronal mass ejection were further classified as front-side or halo coronal mass ejections (W = 360°); back-side halo coronal mass ejections (W = 360°); partial halo (120°< W < 360°) and non-halo (W < 120°). From further analysis, we found that front halo coronal mass ejections were much faster and more geoeffective in comparison of partial halo and non-halo coronal mass ejections. We also inferred that the front-sided halo coronal mass ejections were 67.1% geoeffective while geoeffectiveness of partial halo coronal mass ejections and non-halo coronal mass ejections were found to be 44.2% and 56.6% respectively. During the same period of observation, 43% of back-sided CMEs showed geoeffectiveness. We have also investigated some events of coronal mass ejections having speed > 2500 km/s as a case study. We have concluded that mere speed of coronal mass ejection and their association with solar flares or solar activity were not mere criterion for producing geoeffectiveness but angular width of coronal mass ejections and their originating position also played a key role.

Biomechanical study of anterior spinal instrumentation configurations

PubMed Central

Cloutier, Luc P.; Grimard, Guy

2007-01-01

The biomechanical impact of the surgical instrumentation configuration for spine surgery is hard to evaluate by the surgeons in pre-operative situation. This study was performed to evaluate different configurations of the anterior instrumentation of the spine, with simulated post-operative conditions, to recommend configurations to the surgeons. Four biomechanical parameters of the anterior instrumentation with simulated post-operative conditions have been studied. They were the screw diameter (5.5–7.5 mm) and its angle (0°–22.5°), the bone grip of the screw (mono–bi cortical) and the amount of instrumented levels (5–8). Eight configurations were tested using an experimental plan with instrumented synthetic spinal models. A follower load was applied and the models were loaded in flexion, torsion and lateral bending. At 5 Nm, average final stiffness was greater in flexion (0.92 Nm/°) than in lateral bending (0.56 Nm/°) and than in torsion (0.26 Nm/°). The screw angle was the parameter influencing the most the final stiffness and the coupling behaviors. It has a significant effect (p ≤ 0.05) on increasing the final stiffness for a 22.5° screw angle in flexion and for a coronal screw angle (0°) in lateral bending. The bi-cortical bone grip of the screw significantly increased the initial stiffness in flexion and lateral bending. Mathematical models representing the behavior of an instrumented spinal model have been used to identify optimal instrumentation configurations. A variation of the angle of the screw from 22.5° to 0° gave a global final stiffness diminution of 13% and a global coupling diminution of 40%. The screw angle was the most important parameter affecting the stiffness and the coupling of the instrumented spine with simulated post-operative conditions. Information about the effect of four different biomechanical parameters will be helpful in preoperative situations to guide surgeons in their clinical choices. PMID:17205240

Posterior Surgery for Adolescent Idiopathic Scoliosis With Pedicle Screws and Ultrahigh-Molecular Weight Polyethylene Tape: Achieving the Ideal Thoracic Kyphosis.

PubMed

Imagama, Shiro; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsui, Hiroki; Matsumoto, Tomohiro; Sakai, Yoshihito; Katayama, Yoshito; Matsuyama, Yukihiro; Ishiguro, Naoki

2016-10-01

Prospective clinical case series. To describe our surgical procedure and results for posterior correction and fusion with a hybrid approach using pedicle screws, hooks, and ultrahigh-molecular weight polyethylene tape with direct vertebral rotation (DVR) (the PSTH-DVR procedure) for treatment of adolescent idiopathic scoliosis (AIS) with satisfactory correction in the coronal and sagittal planes. Introduction of segmental pedicle screws in posterior surgery for AIS has facilitated good correction and fusion. However, procedures using only pedicle screws have risks during screw insertion, higher costs, and decreased postoperative thoracic kyphosis. We have obtained good outcomes compared with segmental pedicle screw fixation in surgery for AIS using a relatively simple operative procedure (PSTH-DVR) that uses fewer pedicle screws. The subjects were 30 consecutive patients with AIS who underwent the PSTH-DVR procedure and were followed for a minimum of 2 years. Preoperative flexibility, preoperative and postoperative Cobb angles, correction rates, loss of correction, thoracic kyphotic angles (T5-T12), coronal balance, sagittal balance, and shoulder balance were measured on plain radiographs. Rib hump, operation time, estimated blood loss, spinal cord monitoring findings, complications, and scoliosis research society (SRS)-22 scores were also examined. The mean preoperative curve of 58.0 degrees (range, 40-96 degrees) was corrected to a mean of 9.9 degrees postoperatively, and the correction rate was 83.6%. Fusion was obtained in all patients without loss of correction. In 10 cases with preoperative kyphosis angles (T5-T12) <10 degrees, the preoperative mean of 5.8 degrees improved to 20.2 degrees at the final follow-up. Rib hump and coronal, sagittal and shoulder balances were also improved, and good SRS-22 scores were achieved at final follow-up. The correction of deformity with PSTH-DVR is equivalent to that of all-pedicle screw constructs. The procedure gives favorable correction, is advantageous for kyphosis compared with segmental screw fixation, and uses the minimum number of pedicle screws. Therefore, the PSTH-DVR procedure may be useful for treatment of idiopathic scoliosis.

Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the Treatment of Congenital Scoliosis Without Fused Ribs.

PubMed

Murphy, Robert F; Moisan, Alice; Kelly, Derek M; Warner, William C; Jones, Tamekia L; Sawyer, Jeffrey R

2016-06-01

Although the vertical expandable prosthetic titanium rib (VEPTR) has been shown to be useful in treating congenital scoliosis (CS) with fused ribs, no studies to date have specifically evaluated the efficacy of VEPTR in the treatment of CS without fused ribs. The purpose of this study was to determine the effectiveness of VEPTR in sagittal/coronal curve correction and spine growth and compare its complication rate to the use of VEPTR in other conditions and to other treatment methods used for CS. A multicenter database was queried for patients with CS without fused ribs treated with VEPTR. Anteroposterior (AP) and lateral radiographs were used to measure parameters at 3 timepoints (preoperative, immediate postoperative, and latest follow-up): coronal Cobb angle, sagittal kyphosis, and thoracic and lumbar spine heights. Clinical data included age, time to follow-up, and complications. Twenty-five patients (13 females, 12 males) were identified. The average age at implantation was 5.7 years, with an average follow-up of 50 months. Several parameters improved from preoperative to latest follow-up: coronal Cobb angle (69 to 54 degrees, P<0.0001), thoracic spine height (T1-T12) in the AP (13.3 to 15.9 cm, P<0.0001) and lateral (14.8 to 17.4 cm, P=0.0024) planes, and lumbar spine height (L1-S1) in the AP (8.8 to 11.4 cm, P<0.0001) and lateral (9.9 to 11.9 cm, P=0.0002) planes. Kyphosis increased over the study period (36 to 41 degrees, P=0.6). Fifteen patients (60%) had 41 complications (average 2.75; range, 1 to 12). Twenty-eight complications (68%) were device-related, and 13 (32%) were disease-related. The most common complications were infection, wound dehiscence, and device migration. Six complications (15%) altered the course of treatment. Thoracic spine height increased 79% of expected growth. VEPTR is an effective treatment for patients with CS without fused ribs, as evidenced by improved radiographic parameters and increased spinal height, with a complication rate which is high but similar to other methods of treatment. Level IV-case series.

Surgical Correction of Scoliosis in Patients With Duchenne Muscular Dystrophy: 30-Year Experience.

PubMed

Scannell, Brian P; Yaszay, Burt; Bartley, Carrie E; Newton, Peter O; Mubarak, Scott J

2017-12-01

The natural history of scoliosis in Duchenne muscular dystrophy (DMD) is progressive and debilitating if neglected. The purpose of this study was to evaluate outcomes related to spinal deformity surgery in patients with DMD over a 30-year period. This was a single center retrospective study of all operatively treated scoliosis in DMD patients over 30 years. Minimum follow-up was 2 years. Owing to changes in instrumentation over time, patients were divided into 2 groups: Luque or pedicle screws (PS) constructs. Radiographic, perioperative variables, pulmonary function test (preoperatively and postoperatively), and complication data were evaluated. There were 60 subjects (Luque: 47, PS: 13). The Luque group was on average 13 years old, 53 kg, and had 7 years of follow-up. Coronal Cobb was 31±12 degrees preoperatively, 16±11 degrees at first postoperatively, and 21±15 degrees at final follow-up (P≤0.001). Pelvic obliquity was 7±6 degrees preoperatively, 5±5 degrees at first postoperatively (P=0.43), and 5±4 degrees at final follow-up (P=0.77). The majority of this group was fused to L5 (45%) or the sacrum (49%). The PS group was on average 14 years old, 65 kg, and had 4 years of follow-up. Coronal Cobb was 43±19 degrees preoperatively, 12±9 degrees at first postoperatively (P≤0.001), and 12±8 degrees at final follow-up. Pelvic obliquity was 6±5 degrees preoperatively, 3±3 degrees at first postoperatively (P=0.06), and 2±2 degrees at final follow-up (P=0.053). The majority were fused to the pelvis (92%). Both groups' pulmonary function declined with time. Both groups had high complication rates (Luque 68%; PS group 54%). The Luque group had more implant-related complications (26%); the PS group had a higher rate of early postoperative infections (23%). Over a 30-year period of operative treatment of scoliosis in DMD, both PS constructs and Luque instrumentation improved coronal Cobb. The PS group had improved and maintained pelvic obliquity. Both groups had high complication rates. Level IV-therapeutic.

Coronal and Prominence Plasmas

NASA Technical Reports Server (NTRS)

Poland, Arthur I. (Editor)

1986-01-01

Various aspects of solar prominences and the solar corona are discussed. The formation of prominences, prominence diagnostics and structure, prominence dissappearance, large scale coronal structure, coronal diagnostics, small scale coronal structure, and non-equilibrium/coronal heating are among the topics covered.

Determinants of Iliac Blade Orientation in Anthropoid Primates.

PubMed

Middleton, Emily R; Winkler, Zachariah J; Hammond, Ashley S; Plavcan, J Michael; Ward, Carol V

2017-05-01

Orientation of the iliac blades is a key feature that appears to distinguish extant apes from monkeys. Iliac morphology is hypothesized to reflect variation in thoracic shape that, in turn, reflects adaptations for shoulder and forearm function in anthropoids. Iliac orientation is traditionally measured relative to the acetabulum, whereas functional explanations pertain to its orientation relative to the cardinal anatomical planes. We investigated iliac orientation relative to a median plane using digital models of hipbones registered to landmark data from articulated pelves. We fit planes to the iliac surfaces, midline, and acetabulum, and investigated linear metrics that characterize geometric relationships of the iliac margins. Our results demonstrate that extant hominoid ilia are not rotated into a coronal plane from a more sagittal position in basal apes and monkeys but that the apparent rotation is the result of geometric changes within the ilia. The whole ilium and its gluteal surface are more coronally oriented in apes, but apes and monkeys do not differ in orientation of the iliac fossa. The angular differences in the whole blade and gluteal surface primarily reflect a narrower iliac tuberosity set closer to the midline in extant apes, reflecting a decrease in erector spinae muscle mass associated with stiffening of the lumbar spine. Mediolateral breadth across the ventral dorsal iliac spines is only slightly greater in extant apes than in monkeys. These results demonstrate that spinal musculature and mobility have a more significant effect on pelvic morphology than does shoulder orientation, as had been previously hypothesized. Anat Rec, 300:810-827, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Photospheric magnetic field of an eroded-by-solar-wind coronal mass ejection

NASA Astrophysics Data System (ADS)

Palacios, J.; Cid, C.; Saiz, E.; Guerrero, A.

2017-10-01

We have investigated the case of a coronal mass ejection that was eroded by the fast wind of a coronal hole in the interplanetary medium. When a solar ejection takes place close to a coronal hole, the flux rope magnetic topology of the coronal mass ejection (CME) may become misshapen at 1 AU as a result of the interaction. Detailed analysis of this event reveals erosion of the interplanetary coronal mass ejection (ICME) magnetic field. In this communication, we study the photospheric magnetic roots of the coronal hole and the coronal mass ejection area with HMI/SDO magnetograms to define their magnetic characteristics.

Prevalence of minimal hepatic encephalopathy and quality of life in patients with decompensated cirrhosis.

PubMed

Mina, Aline; Moran, Segundo; Ortiz-Olvera, Nayeli; Mera, Robertino; Uribe, Misael

2014-10-01

Minimal hepatic encephalopathy (MHE) affects more than 30% of patients with cirrhosis, and it has been suggested that despite no recognizable clinical symptoms of neurological abnormalities, it may affect health-related quality of life (HRQL); however, this fact remains controversial. The aim of our study was to evaluate the prevalence of MHE and HRQL in patients diagnosed with decompensated cirrhosis. Patients with liver cirrhosis were selected independent of the etiology of the disease. All patients underwent a complete clinical history, and only patients with decompensated hepatic cirrhosis were included. Psychometric tests were applied to evaluate the presence of MHE along with the Chronic Liver Disease Questionnaire. Appetite was measured by verbal and visual analog scales. One hundred and twenty-five patients were included with a median age of 56.0 years. They were classified according to the Child-Pugh index as A, (n = 56), B, (n = 51) and C (n = 18). Prevalence of MHE was 44.0% (n = 55). In patients with MHE, a significant reduction was observed in domains of activity (3.3 [2.0] vs 4.8 [2.8]), fatigue (3.2 [2.0] vs 3.9 [2.3]), systemic symptoms (3.8 [2.0] vs 4.8 [1.7]), emotional function (3.6 [1.9] vs 4.0 [1.9]) and global scoring (3.7 [1.7] vs 4.3 [1.8]) when compared with non-MHE patients (n = 70). Twenty-two percent of the patients with MHE reported little appetite compared with 11% in the non-MHE group. The results suggest that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis. © 2013 The Japan Society of Hepatology.

Is the aligning prism measured with the Mallett unit correlated with fusional vergence reserves?

PubMed

Conway, Miriam L; Thomas, Jennifer; Subramanian, Ahalya

2012-01-01

The Mallett Unit is a clinical test designed to detect the fixation disparity that is most likely to occur in the presence of a decompensated heterophoria. It measures the associated phoria, which is the "aligning prism" needed to nullify the subjective disparity. The technique has gained widespread acceptance within professions such as optometry, for investigating suspected cases of decompensating heterophoria; it is, however, rarely used by orthoptists and ophthalmologists. The aim of this study was to investigate whether fusional vergence reserves, measured routinely by both orthoptists and ophthalmologists to detect heterophoria decompensation, were correlated with aligning prism (associated phoria) in a normal clinical population. Aligning prism (using the Mallett Unit) and fusional vergence reserves (using a prism bar) were measured in 500 participants (mean 41.63 years; standard deviation 11.86 years) at 40 cm and 6 m. At 40 cm a strong correlation (p<0.001) between base in aligning prism (Exo FD) and positive fusional reserves was found. Of the participants with zero aligning prism 30% had reduced fusional reserves. At 6 m a weak correlation between base out aligning prism (Eso FD) and negative fusional reserves was found to break (p = 0.01) and to recovery (p = 0.048). Of the participants with zero aligning prism 12% reported reduced fusional reserves. For near vision testing, the strong inverse correlation between base in aligning prism (Exo FD) and fusional vergence reserves supports the notion that both measures are indicators of decompensation of heterophoria. For distance vision testing and for those patients reporting zero aligning prism further research is required to determine why the relationship appears to be weak/non-existent?

Effect and clinical prediction of worsening renal function in acute decompensated heart failure.

PubMed

Breidthardt, Tobias; Socrates, Thenral; Noveanu, Markus; Klima, Theresia; Heinisch, Corinna; Reichlin, Tobias; Potocki, Mihael; Nowak, Albina; Tschung, Christopher; Arenja, Nisha; Bingisser, Roland; Mueller, Christian

2011-03-01

We aimed to establish the prevalence and effect of worsening renal function (WRF) on survival among patients with acute decompensated heart failure. Furthermore, we sought to establish a risk score for the prediction of WRF and externally validate the previously established Forman risk score. A total of 657 consecutive patients with acute decompensated heart failure presenting to the emergency department and undergoing serial creatinine measurements were enrolled. The potential of the clinical parameters at admission to predict WRF was assessed as the primary end point. The secondary end point was all-cause mortality at 360 days. Of the 657 patients, 136 (21%) developed WRF, and 220 patients had died during the first year. WRF was more common in the nonsurvivors (30% vs 41%, p = 0.03). Multivariate regression analysis found WRF to independently predict mortality (hazard ratio 1.92, p <0.01). In a single parameter model, previously diagnosed chronic kidney disease was the only independent predictor of WRF and achieved an area under the receiver operating characteristic curve of 0.60. After the inclusion of the blood gas analysis parameters into the model history of chronic kidney disease (hazard ratio 2.13, p = 0.03), outpatient diuretics (hazard ratio 5.75, p <0.01), and bicarbonate (hazard ratio 0.91, p <0.01) were all predictive of WRF. A risk score was developed using these predictors. On receiver operating characteristic curve analysis, the Forman and Basel prediction rules achieved an area under the curve of 0.65 and 0.71, respectively. In conclusion, WRF was common in patients with acute decompensated heart failure and was linked to significantly worse outcomes. However, the clinical parameters failed to adequately predict its occurrence, making a tailored therapy approach impossible. Copyright © 2011 Elsevier Inc. All rights reserved.

Predicting short-term mortality in advanced decompensated heart failure - role of the updated acute decompensated heart failure/N-terminal pro-B-type natriuretic Peptide risk score.

PubMed

Scrutinio, Domenico; Ammirati, Enrico; Passantino, Andrea; Guida, Pietro; D'Angelo, Luciana; Oliva, Fabrizio; Ciccone, Marco Matteo; Iacoviello, Massimo; Dentamaro, Ilaria; Santoro, Daniela; Lagioia, Rocco; Sarzi Braga, Simona; Guzzetti, Daniela; Frigerio, Maria

2015-01-01

The first few months after admission are the most vulnerable period in patients with acute decompensated heart failure (ADHF). We assessed the association of the updated ADHF/N-terminal pro-B-type natriuretic peptide (NT-proBNP) risk score with 90-day and in-hospital mortality in 701 patients admitted with advanced ADHF, defined as severe symptoms of worsening HF, severely depressed left ventricular ejection fraction, and the need for i.v. diuretic and/or inotropic drugs. A total of 15.7% of the patients died within 90 days of admission and 5.2% underwent ventricular assist device (VAD) implantation or urgent heart transplantation (UHT). The C-statistic of the ADHF/NT-proBNP risk score for 90-day mortality was 0.810 (95% CI: 0.769-0.852). Predicted and observed mortality rates were in close agreement. When the composite outcome of death/VAD/UHT at 90 days was considered, the C-statistic decreased to 0.741. During hospitalization, 7.6% of the patients died. The C-statistic for in-hospital mortality was 0.815 (95% CI: 0.761-0.868) and Hosmer-Lemeshow χ(2)=3.71 (P=0.716). The updated ADHF/NT-proBNP risk score outperformed the Acute Decompensated Heart Failure National Registry, the Organized Program to Initiate Lifesaving Treatment in Patients Hospitalized for Heart Failure, and the American Heart Association Get with the Guidelines Program predictive models. Updated ADHF/NT-proBNP risk score is a valuable tool for predicting short-term mortality in severe ADHF, outperforming existing inpatient predictive models.

Use of botulinum toxin in small-angle heterotropia and decompensating heterophoria: a review of the literature.

PubMed

Ripley, L; Rowe, F J

2007-01-01

Botulinum toxin has been used extensively in strabismus management. However, less is published regarding its use in small-angled manifest deviations or decompensating heterophorias, where an alternative to surgery is required. The aim of this review is to look at the use and effectiveness of botulinum toxin in managing small-angled manifest deviations, both constant and intermittent, and decompensating heterophorias. These types of strabismus can prove difficult to manage, as the angle present is often too small for surgery to be advised, but it may still cause a cosmetic or symptom-producing problem. A search of the English speaking literature was undertaken using Medline facilities as well as a limited manual search of non-Medline journals and transactions. A brief overview is provided for mechanisms of action, complications and dose effects, and diagnostic and therapeutic uses of botulinum toxin. The main reported complications are those of ptosis, induced vertical deviation and subconjunctival haemorrhage. The higher the dose, the greater the risk of complications. In small-angle strabismus, botulinum toxin is reported as particularly useful in cases of acquired and acute-onset esotropia in aiding maintenance of binocular vision. It is useful for additional management of surgically under- or over-corrected esotropia, particularly for those with potential for binocular vision. Less effect is reported in primary exotropia versus primary esotropia. It is the management of choice for consecutive exotropia, particularly when patients have had previous multiple surgery and where there is a risk for postoperative diplopia. Botulinum toxin has a specific role in decompensated heterophoria, allowing the visual axes a chance to 'lock on' and subsequently maintain binocular vision. Successful outcomes are reported after 1-2 injections only but the results are best in cases of heterophoria with little near-distance angle disparity.

Downregulation of MicroRNA-126 Contributes to the Failing Right Ventricle in Pulmonary Arterial Hypertension.

PubMed

Potus, François; Ruffenach, Grégoire; Dahou, Abdellaziz; Thebault, Christophe; Breuils-Bonnet, Sandra; Tremblay, Ève; Nadeau, Valérie; Paradis, Renée; Graydon, Colin; Wong, Ryan; Johnson, Ian; Paulin, Roxane; Lajoie, Annie C; Perron, Jean; Charbonneau, Eric; Joubert, Philippe; Pibarot, Philippe; Michelakis, Evangelos D; Provencher, Steeve; Bonnet, Sébastien

2015-09-08

Right ventricular (RV) failure is the most important factor of both morbidity and mortality in pulmonary arterial hypertension (PAH). However, the underlying mechanisms resulting in the failed RV in PAH remain unknown. There is growing evidence that angiogenesis and microRNAs are involved in PAH-associated RV failure. We hypothesized that microRNA-126 (miR-126) downregulation decreases microvessel density and promotes the transition from a compensated to a decompensated RV in PAH. We studied RV free wall tissues from humans with normal RV (n=17), those with compensated RV hypertrophy (n=8), and patients with PAH with decompensated RV failure (n=14). Compared with RV tissues from patients with compensated RV hypertrophy, patients with decompensated RV failure had decreased miR-126 expression (quantitative reverse transcription-polymerase chain reaction; P<0.01) and capillary density (CD31(+) immunofluorescence; P<0.001), whereas left ventricular tissues were not affected. miR-126 downregulation was associated with increased Sprouty-related EVH1 domain-containing protein 1 (SPRED-1), leading to decreased activation of RAF (phosphorylated RAF/RAF) and mitogen-activated protein kinase (MAPK); (phosphorylated MAPK/MAPK), thus inhibiting the vascular endothelial growth factor pathway. In vitro, Matrigel assay showed that miR-126 upregulation increased angiogenesis of primary cultured endothelial cells from patients with decompensated RV failure. Furthermore, in vivo miR-126 upregulation (mimic intravenous injection) improved cardiac vascular density and function of monocrotaline-induced PAH animals. RV failure in PAH is associated with a specific molecular signature within the RV, contributing to a decrease in RV vascular density and promoting the progression to RV failure. More importantly, miR-126 upregulation in the RV improves microvessel density and RV function in experimental PAH. © 2015 American Heart Association, Inc.

Proton pump inhibitors are associated with accelerated development of cirrhosis, hepatic decompensation and hepatocellular carcinoma in noncirrhotic patients with chronic hepatitis C infection: results from ERCHIVES.

PubMed

Li, D K; Yan, P; Abou-Samra, A-B; Chung, R T; Butt, A A

2018-01-01

Proton pump inhibitors are among the most commonly prescribed medications in the United States. Their safety in cirrhosis has recently been questioned, but their overall effect on disease progression in noncirrhotic patients with chronic liver disease remains unclear. To determine the impact of proton pump inhibitors on the progression of liver disease in noncirrhotic patients with hepatitis C virus (HCV) infection. Using the electronically retrieved cohort of HCV-infected veterans (ERCHIVES) database, we identified all subjects who received HCV treatment and all incident cases of cirrhosis, hepatic decompensation and hepatocellular carcinoma. Proton pump inhibitor use was measured using cumulative defined daily dose. Multivariate Cox regression analysis was performed after adjusting univariate predictors of cirrhosis and various indications for proton pump inhibitor use. Among 11 526 eligible individuals, we found that exposure to proton pump inhibitors was independently associated with an increased risk of developing cirrhosis (hazard ratio [HR]: 1.32; 95% confidence interval: [1.17, 1.49]). This association remained robust to sensitivity analysis in which only patients who achieved sustained virologic response were analysed as well as analysis excluding those with alcohol abuse/dependence. Proton pump inhibitor exposure was also independently associated with an increased risk of hepatic decompensation (HR: 3.79 [2.58, 5.57]) and hepatocellular carcinoma (HR: 2.01 [1.50, 2.70]). In patients with chronic HCV infection, increasing proton pump inhibitor use is associated with a dose-dependent risk of progression of chronic liver disease to cirrhosis, as well as an increased risk of hepatic decompensation and hepatocellular carcinoma. © 2017 John Wiley & Sons Ltd.

Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury.

PubMed

Garcia-Martinez, Rita; Noiret, Lorette; Sen, Sambit; Mookerjee, Rajeshwar; Jalan, Rajiv

2015-02-01

In cirrhotic patients with renal failure, renal blood flow autoregulation curve is shifted to the right, which is consequent upon sympathetic nervous system activation and endothelial dysfunction. Albumin infusion improves renal function in cirrhosis by mechanisms that are incompletely understood. We aimed to determine the effect of albumin infusion on systemic haemodynamics, renal blood flow, renal function and endothelial function in patients with acute decompensation of cirrhosis and acute kidney injury. Twelve patients with refractory ascites and 10 patients with acute decompensation of cirrhosis and acute kidney injury were studied. Both groups were treated with intravenous albumin infusion, 40-60 g/days over 3-4 days. Cardiac and renal haemodynamics were measured. Endothelial activation/dysfunction was assessed using von Willebrand factor and serum nitrite levels. F2α Isoprostanes, resting neutrophil burst and noradrenaline levels were quantified as markers of oxidative stress, endotoxemia and sympathetic activation respectively. Albumin infusion leads to a shift in the renal blood flow autoregulation curve towards normalization, which resulted in a significant increase in renal blood flow. Accordingly, improvement of renal function was observed. In parallel, a significant decrease in sympathetic activation, inflammation/oxidative stress and endothelial activation/dysfunction was documented. Improvement of renal blood flow correlated with improvement in endothelial activation (r = 0.741, P < 0.001). The data suggest that albumin infusion improves renal function in acutely decompensated cirrhotic patients with acute kidney injury by impacting on renal blood flow autoregulation. This is possibly achieved through endothelial stabilization and a reduction in the sympathetic tone, endotoxemia and oxidative stress. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Observation of combined/optimized therapy of Lamivudine and Adefovir Dipivoxyl for hepatitis B-induced decompensated cirrhosis with baseline HBV DNA>1,000 IU/mL.

PubMed

Zhang, D; Zhao, G; Li, L; Li, Z

2017-01-01

This study aimed to observe and compare the efficacy and safety of the combined therapy and two different optimized therapies of lamivudine (LAM) and adefovir dipivoxil (ADV), as well as entecavir (ETV) monotherapy in patients with hepatitis B-induced decompensated cirrhosis. Method : A total of 127 patients with decompensated cirrhosis were divided into four groups, and each group received different doses of regimens: initial combination of LAM and ADV, ADV add-on therapies with previous 12-week LAM, ADV add-on therapies with previous 24-week LAM, and ETV monotherapy. At the end of the treatment, the level of alanine amino-transferase (ALT), albumin (ALB) and total bilirubin (TBIL) in the combination therapy group and 12-week optimized therapy group were significantly improved. For the 24-week optimized therapy group, only ALT levels revealed a significant improvement. There were no obvious differences in the normalization rate of ALT, negative conversion rate of HBV DNA and HBeAg, as well as improvement in Child-Pugh scores among the combination therapy group, 12-week optimized therapy group, and ETV monotherapy group. However, the difference among these three groups and the 24-week optimized therapy group were significant. Differences were not observed in the HBeAg seroconversion between each group. Differences in blood urea nitrogen, serum creatinine, creatine kinase, or other serious adverse effects were not observed in each group at the end of the 96-week treatment. Combination therapy and early ADV addition were the preferred approaches in the antiviral strategy for the treatment of hepatitis B-induced decompensated cirrhosis.

The impact of depression and antidepressant usage on primary biliary cholangitis clinical outcomes

PubMed Central

Kaplan, Gilaad G.; Almishri, Wagdi; Vallerand, Isabelle; Frolkis, Alexandra D.; Patten, Scott; Swain, Mark G.

2018-01-01

Background Depression is prevalent in primary biliary cholangitis (PBC) patients. Our aims were to examine the effects of depression and antidepressants on hepatic outcomes of PBC patients. Methods We used the UK Health Improvement Network database to identify PBC patients between 1974 and 2007. Our primary outcome was one of three clinical events: decompensated cirrhosis, liver transplantation and death. We assessed depression and each class of antidepressant medication in adjusted multivariate Cox proportional hazards models to identify independent predictors of outcomes. In a sensitivity analysis, the study population was restricted to PBC patients using ursodeoxycholic acid (UDCA). Results We identified 1,177 PBC patients during our study period. In our cohort, 86 patients (7.3%) had a depression diagnosis prior to PBC diagnosis, while 79 patients (6.7%) had a depression diagnosis after PBC diagnosis. Ten-year incidence of mortality, decompensated cirrhosis, and liver transplantation were 13.4%, 6.6%, and 2.0%, respectively. In our adjusted models, depression status was not a predictor of poor outcomes. After studying all classes of antidepressants, using the atypical antidepressant mirtazapine after PBC diagnosis was significantly protective (Adjusted HR 0.23: 95% CI 0.07–0.72) against poor liver outcomes (decompensation, liver transplant, mortality), which remained statistically significant in patients using UCDA (HR 0.21: 95% CI 0.05–0.83). Conclusions In our study, depression was not associated with poor clinical outcomes. However, using the antidepressant mirtazapine was associated with decreased mortality, decompensated cirrhosis and liver transplantation in PBC patients. These findings support further assessment of mirtazapine as a potential treatment for PBC patients. PMID:29617396

Long-term metabolic follow-up and clinical outcome of 35 patients with maple syrup urine disease.

PubMed

Abi-Wardé, Marie-Thérèse; Roda, Célina; Arnoux, Jean-Baptiste; Servais, Aude; Habarou, Florence; Brassier, Anais; Pontoizeau, Clément; Barbier, Valérie; Bayart, Manuella; Leboeuf, Virginie; Chadefaux-Vekemans, Bernadette; Dubois, Sandrine; Assoun, Murielle; Belloche, Claire; Alili, Jean-Meidi; Husson, Marie-Caroline; Lesage, Fabrice; Dupic, Laurent; Theuil, Benoit; Ottolenghi, Chris; de Lonlay, Pascale

2017-11-01

Maple syrup urine disease (MSUD) is a rare disease that requires a protein-restricted diet for successful management. Little is known, however, about the psychosocial outcome of MSUD patients. This study investigates the relationship between metabolic and clinical parameters and psychosocial outcomes in a cohort of patients with neonatal-onset MSUD. Data on academic achievement, psychological care, family involvement, and biochemical parameters were collected from the medical records of neonatal MSUD patients treated at Necker Hospital (Paris) between 1964 and 2013. Thirty-five MSUD patients with a mean age of 16.3 (2.1-49.0) years participated. Metabolic decompensations (plasma leucine >380 μmol/L) were more frequent during the first year of life and after 15 years, mainly due to infection and dietary noncompliance, respectively. Leucine levels increased significantly in adulthood: 61.5% of adults were independent and achieved adequate social and professional integration; 56% needed occasional or sustained psychological or psychiatric care (8/19, with externalizing, mood, emotional, and anxiety disorders being the most common). Patients needing psychiatric care were significantly older [mean and standard deviation (SD) 22.6 (7.7) years] than patients needing only psychological follow-up [mean (SD) 14.3 (8.9) years]. Patients with psychological follow-up experienced the highest lifetime number of decompensations; 45% of families had difficulty coping with the chronic disease. Parental involvement was negatively associated with the number of lifetime decompensations. Adults had increased levels of plasma leucine, consistent with greater chronic toxicity. Psychological care was associated with age and number of decompensations. In addition, parental involvement appeared to be crucial in the management of MSUD patients.

Chemohypersensitivity and autonomic modulation of venous capacitance in the pathophysiology of acute decompensated heart failure.

PubMed

Burchell, Amy E; Sobotka, Paul A; Hart, Emma C; Nightingale, Angus K; Dunlap, Mark E

2013-06-01

Heart failure is increasing in prevalence around the world, with hospitalization and re-hospitalization as a result of acute decompensated heart failure (ADHF) presenting a huge social and economic burden. The mechanism for this decompensation is not clear. Whilst in some cases it is due to volume expansion, over half of patients with an acute admission for ADHF did not experience an increase in total body weight. This calls into question the current treatment strategy of targeting salt and water retention in ADHF. An alternative hypothesis proposed by Fallick et al. is that an endogenous fluid shift from the splanchnic bed is implicated in ADHF, rather than an exogenous fluid gain. The hypothesis states further that this shift is triggered by an increase in sympathetic tone causing vasoconstriction in the splanchnic bed, a mechanism that can translocate blood rapidly into the effective circulating volume, generating the raised venous pressure and congestion seen in ADHF. This hypothesis encourages a new clinical paradigm which focuses on the underlying mechanisms of congestion, and highlights the importance of fluid redistribution and neurohormonal activation in its pathophysiology. In this article, we consider the concept that ADHF is attributable to episodic sympathetic hyperactivity, resulting in fluid shifts from the splanchnic bed. Chemosensitivity is a pathologic autonomic mechanism associated with mortality in patients with systolic heart failure. Tonic and episodic activity of the peripheral chemoreceptors may underlie the syndrome of acute decompensation without total body salt and water expansion. We suggest in this manuscript that chemosensitivity in response to intermittent hypoxia, such as experienced in sleep disordered breathing, may explain the intermittent sympathetic hyperactivity underlying renal sodium retention and acute volume redistribution from venous storage sites. This hypothesis provides an alternative structure to guide novel diagnostic and treatment strategies for ADHF.

Is the Aligning Prism Measured with the Mallett Unit Correlated with Fusional Vergence Reserves?

PubMed Central

Conway, Miriam L.; Thomas, Jennifer; Subramanian, Ahalya

2012-01-01

Background The Mallett Unit is a clinical test designed to detect the fixation disparity that is most likely to occur in the presence of a decompensated heterophoria. It measures the associated phoria, which is the “aligning prism” needed to nullify the subjective disparity. The technique has gained widespread acceptance within professions such as optometry, for investigating suspected cases of decompensating heterophoria; it is, however, rarely used by orthoptists and ophthalmologists. The aim of this study was to investigate whether fusional vergence reserves, measured routinely by both orthoptists and ophthalmologists to detect heterophoria decompensation, were correlated with aligning prism (associated phoria) in a normal clinical population. Methodology/Principal Findings Aligning prism (using the Mallett Unit) and fusional vergence reserves (using a prism bar) were measured in 500 participants (mean 41.63 years; standard deviation 11.86 years) at 40 cm and 6 m. At 40 cm a strong correlation (p<0.001) between base in aligning prism (Exo FD) and positive fusional reserves was found. Of the participants with zero aligning prism 30% had reduced fusional reserves. At 6 m a weak correlation between base out aligning prism (Eso FD) and negative fusional reserves was found to break (p = 0.01) and to recovery (p = 0.048). Of the participants with zero aligning prism 12% reported reduced fusional reserves. Conclusions/Significance For near vision testing, the strong inverse correlation between base in aligning prism (Exo FD) and fusional vergence reserves supports the notion that both measures are indicators of decompensation of heterophoria. For distance vision testing and for those patients reporting zero aligning prism further research is required to determine why the relationship appears to be weak/non-existent? PMID:22905174

Triennial Report 2006-2009. Commission 10: Solar Activity

NASA Technical Reports Server (NTRS)

Klimchuk, James A.

2008-01-01

Commission 10 deals with solar activity in all of its forms, ranging from the smallest nanoflares to the largest coronal mass ejections. This report reviews scientific progress over the roughly two-year period ending in the middle of 2008. This has been an exciting time in solar physics, highlighted by the launches of the Hinode and STEREO missions late in 2006. The report is reasonably comprehensive, though it is far from exhaustive. Limited space prevents the inclusion of many significant results. The report is divided into following sections: Photosphere and Chromosphere; Transition Region; Corona and Coronal Heating; Coronal Jets; Flares; Coronal Mass Ejection Initiation; Global Coronal Waves and Shocks; Coronal Dimming; The Link Between Low Coronal CME signatures and Magnetic Clouds; Coronal Mass Ejections in the Heliosphere; and Coronal Mass Ejections and Space Weather. Primary authorship is indicated at the beginning of each section.

Determination of the coronal magnetic field from vector magnetograph data

NASA Technical Reports Server (NTRS)

Mikic, Zoran

1991-01-01

A new algorithm was developed, tested, and applied to determine coronal magnetic fields above solar active regions. The coronal field above NOAA active region AR5747 was successfully estimated on 20 Oct. 1989 from data taken at the Mees Solar Observatory of the Univ. of Hawaii. It was shown that observational data can be used to obtain realistic estimates of coronal magnetic fields. The model has significantly extended the realism with which the coronal magnetic field can be inferred from observations. The understanding of coronal phenomena will be greatly advanced by a reliable technique, such as the one presented, for deducing the detailed spatial structure of the coronal field. The payoff from major current and proposed NASA observational efforts is heavily dependent on the success with which the coronal field can be inferred from vector magnetograms. In particular, the present inability to reliably obtain the coronal field has been a major obstacle to the theoretical advancement of solar flare theory and prediction. The results have shown that the evolutional algorithm can be used to estimate coronal magnetic fields.

The green corona database and the coronal index of solar activity

NASA Astrophysics Data System (ADS)

Minarovjech, M.; Rušin, V.; Saniga, M.

2011-10-01

The green coronal line Fe XIV 530.3 nm ranks amongst the most pronounced emission lines in the visible part of the solar spectrum. Its observations outside solar eclipses started sporadically in 1939 (the Arosa coronal station), being extended, in 1946, to more coronal stations. It was found that the green corona intensities vary with solar cycle, so they are a good candidate to express solar activity in the corona. Several attempts have been made to create a single homogeneous coronal data set from different coronal stations. We will present our homogeneous coronal data set, based on the Lomnický Štít photometric scale. Also, the coronal index of solar activity as created from this database in the period 1939—2010 will be discussed.

[Selective proximal vagotomy in duodenal ulcer complicated by decompensated pyloroduodenal stenosis].

PubMed

Saenko, V F; Pustovit, A A; Shchitov, A V

1999-01-01

The result of surgical treatment of 281 patient with duodenal ulcer disease, complicated by decompensated pyloroduodenal stenosis, was presented. Analysis of compensational possibilities of stomach motility and application of elaborated method of diagnosis and preoperative preparation have permitted to perform in 243 (86.6%) of patients the organ-preserving operation. Operative interventions of resectional type are done in 38 (13.4%) of the patients. Late follow-up result of treatment was studied up in 172 patients in terms from 1 year to 5 years. Postresectional syndrome have occurred in 15 (8.5%), recurrency--in 10 (6%) of patients. Mortality was 1.2%.

Cardiorenal outcomes after slow continuous ultrafiltration therapy in refractory patients with advanced decompensated heart failure.

PubMed

Patarroyo, Maria; Wehbe, Edgard; Hanna, Mazen; Taylor, David O; Starling, Randall C; Demirjian, Sevag; Tang, W H Wilson

2012-11-06

The purpose of this study was to examine the clinical outcomes of using slow continuous ultrafiltration (SCUF) in patients with acute decompensated heart failure (HF) refractory to intensive medical therapy. Several studies have demonstrated the clinical usefulness of early SCUF in patients with acute decompensated HF to improve fluid overload and hemodynamics. We reviewed clinical data from 63 consecutive adult patients with acute decompensated HF admitted to the Heart Failure Intensive Care Unit from 2004 through 2009 who required SCUF because of congestion refractory to hemodynamically guided intensive medical therapy. The mean creatinine level was 1.9 ± 0.8 mg/dl on admission and 2.2 ± 0.9 mg/dl at SCUF initiation. After 48 hours of SCUF, there were significant improvements in hemodynamic variables (mean pulmonary arterial pressure: 40 ± 12 mm Hg vs. 33 ± 8 mm Hg, p = 0.002, central venous pressure: 20 ± 6 mm Hg vs. 16 ± 8 mm Hg, p = 0.007, mean pulmonary wedge pressure: 27 ± 8 mm Hg vs. 20 ± 7 mm Hg, p = 0.02, Fick cardiac index: 2.2 l/min/m(2) [interquartile range: 1.87 to 2.77 l/min/m(2)] vs. 2.6 l/min/m(2) [interquartile range: 2.2 to 2.9 l/min/m(2)], p = 0.0008), and weight loss (102 ± 25 kg vs. 99 ± 23 kg, p < 0.0001). However, there were no significant improvements in serum creatinine levels (2.2 ± 0.9 mg/dl vs. 2.4 ± 1 mg/dl, p = 0.12) and blood urea nitrogen (60 ± 30 mg/dl vs. 60 ± 28 mg/dl, p = 0.97). Fifty-nine percent required conversion to continuous hemodialysis during their hospital course, and 14% were dependent on dialysis at hospital discharge. Thirty percent died during hospitalization, and 6 patients were discharged to hospice care. In our single-center experience, SCUF after admission for acute decompensated HF refractory to standard medical therapy was associated with high incidence of subsequent transition to renal replacement therapy and high in-hospital mortality, despite significant improvement in hemodynamics. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The portal hypertension syndrome: etiology, classification, relevance, and animal models.

PubMed

Bosch, Jaime; Iwakiri, Yasuko

2018-02-01

Portal hypertension is a key complication of portal hypertension, which is responsible for the development of varices, ascites, bleeding, and hepatic encephalopathy, which, in turn, cause a high mortality and requirement for liver transplantation. This review deals with the present day state-of-the-art preventative treatments of portal hypertension in cirrhosis according to disease stage. Two main disease stages are considered, compensated and decompensated cirrhosis, the first having good prognosis and being mostly asymptomatic, and the second being heralded by the appearance of bleeding or non-bleeding complications of portal hypertension. The aim of treatment in compensated cirrhosis is preventing clinical decompensation, the more frequent event being ascites, followed by variceal bleeding and hepatic encephalopathy. Complications are mainly driven by an increase of hepatic vein pressure gradient (HVPG) to values ≥10 mmHg (defining the presence of Clinically Significant Portal Hypertension, CSPH). Before CSPH, the treatment is limited to etiologic treatment of cirrhosis and healthy life style (abstain from alcohol, avoid/correct obesity…). When CSPH is present, association of a non-selective beta-blocker (NSBB), including carvedilol should be considered. NSBBs are mandatory if moderate/large varices are present. Patients should also enter a screening program for hepatocellular carcinoma. In decompensated patients, the goal is to prevent further bleeding if the only manifestation of decompensation was a bleeding episode, but to prevent liver transplantation and death in the common scenario where patients have manifested first non-bleeding complications. Treatment is based on the same principles (healthy life style..) associated with administration of NSBBs in combination if possible with endoscopic band ligation if there has been variceal bleeding, and complemented with simvastatin administration (20-40 mg per day in Child-Pugh A/B, 10-20 mg in Child C). Recurrence shall be treated with TIPS. TIPS might be indicated earlier in patients with: 1) Difficult/refractory ascites, who are not the best candidates for NSBBs, 2) patients having bleed under NSBBs or showing no HVPG response (decrease in HVPG of at least 20% of baseline or to values equal or below 12 mmHg). Decompensated patients shall all be considered as potential candidates for liver transplantation. Treatment of portal hypertension has markedly improved in recent years. The present day therapy is based on accurate risk stratification according to disease stage.

Injury Patterns Sustained in Fatal Motor Vehicle Collisions with Driver's Third-Generation Airbag Deployment.

PubMed

Kuk, Mariya; Shkrum, Michael J

2018-05-01

The Office of the Chief Coroner for Ontario database for 2011-2012 was used to compare fatal injury patterns in drivers whose third-generation airbags deployed compared to first- and second-generation airbag deployments and airbag nondeployments with and without seatbelt use. There were 110 frontal and offset frontal crashes analyzed. The small sample size meant that the odds of craniocerebral, cervical spinal, thoracic, and abdominal injuries were not statistically different for airbag generation, deployment status, and seatbelt use; however, the risk of fatal thoracic injuries in third- and second-generation cases was increased. Seatbelt usage in third- and second-generation deployment cases reduced the risk of all injuries except abdominal trauma. High severity impacts and occupant compartment intrusion were frequently observed. The analyses in this retrospective study were challenged by data that were not collated in a standardized way and were limited in details about scene, vehicle, and driver variables. © 2017 American Academy of Forensic Sciences.

Subsite Awareness in Neuropathology Evaluation of National Toxicology Program (NTP) Studies: A Review of Select Neuroanatomical Structures with their Functional Significance in Rodents

PubMed Central

Rao, Deepa B.; Little, Peter B.; Sills, Robert

2013-01-01

This review manuscript is designed to serve as an introductory guide in neuroanatomy for toxicologic pathologists evaluating general toxicity studies. The manuscript provides an overview of approximately 50 neuroanatomical subsites and their functional significance across seven coronal sections of the brain. Also reviewed are three sections of the spinal cord, cranial and peripheral nerves (trigeminal and sciatic respectively), and intestinal autonomic ganglia. The review is limited to the evaluation of hematoxylin and eosin (H&E) stained tissue sections, as light microscopic evaluation of these sections is an integral part of the first-tier toxicity screening of environmental chemicals, drugs, and other agents. Prominent neuroanatomical sites associated with major neurological disorders are noted. This guide, when used in conjunction with detailed neuroanatomic atlases may aid in an understanding of the significance of functional neuroanatomy, thereby improving the characterization of neurotoxicity in general toxicity and safety evaluation studies. PMID:24135464

Development of a computer-assisted forensic radiographic identification method using the lateral cervical and lumbar spine.

PubMed

Derrick, Sharon M; Raxter, Michelle H; Hipp, John A; Goel, Priya; Chan, Elaine F; Love, Jennifer C; Wiersema, Jason M; Akella, N Shastry

2015-01-01

Medical examiners and coroners (ME/C) in the United States hold statutory responsibility to identify deceased individuals who fall under their jurisdiction. The computer-assisted decedent identification (CADI) project was designed to modify software used in diagnosis and treatment of spinal injuries into a mathematically validated tool for ME/C identification of fleshed decedents. CADI software analyzes the shapes of targeted vertebral bodies imaged in an array of standard radiographs and quantifies the likelihood that any two of the radiographs contain matching vertebral bodies. Six validation tests measured the repeatability, reliability, and sensitivity of the method, and the effects of age, sex, and number of radiographs in array composition. CADI returned a 92-100% success rate in identifying the true matching pair of vertebrae within arrays of five to 30 radiographs. Further development of CADI is expected to produce a novel identification method for use in ME/C offices that is reliable, timely, and cost-effective. © 2014 American Academy of Forensic Sciences.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fujiki, K.; Tokumaru, M.; Hayashi, K.

We developed an automated prediction technique for coronal holes using potential magnetic field extrapolation in the solar corona to construct a database of coronal holes appearing from 1975 February to 2015 July (Carrington rotations from 1625 to 2165). Coronal holes are labeled with the location, size, and average magnetic field of each coronal hole on the photosphere and source surface. As a result, we identified 3335 coronal holes and found that the long-term distribution of coronal holes shows a similar pattern known as the magnetic butterfly diagram, and polar/low-latitude coronal holes tend to decrease/increase in the last solar minimum relativemore » to the previous two minima.« less

An equatorial coronal hole at solar minimum

NASA Technical Reports Server (NTRS)

Bromage, B. J. I.; DelZanna, G.; DeForest, C.; Thompson, B.; Clegg, J. R.

1997-01-01

The large transequatorial coronal hole that was observed in the solar corona at the end of August 1996 is presented. It consists of a north polar coronal hole called the 'elephant's trunk or tusk'. The observations of this coronal hole were carried out with the coronal diagnostic spectrometer onboard the Solar and Heliospheric Observatory (SOHO). The magnetic field associated with the equatorial coronal hole is strongly connected to that of the active region at its base, resulting in the two features rotating at almost the same rate.

The potential role of brain asymmetry in the development of adolescent idiopathic scoliosis: a hypothesis.

PubMed

Niesluchowski, W; Dabrowska, A; Kedzior, K; Zagrajek, T

1999-10-01

The size asymmetry of cerebral hemispheres may predispose to head tilt and asymmetric blocking of the zygapophysial joints, potentially leading to the development of compensatory curvatures in the lower segments of the spine. To analyze the effects of spinal manipulation, maintained by an exercise program, on the progression of idiopathic adolescent scoliosis in 2 children aged 6 and 10. The scoliosis found was 16 and 60 degrees. For diagnosis and monitoring of therapy, we recorded qualitative parameters of shoulder asymmetry, axillary line asymmetry, and scapular angle position. Manual treatment consisted of the examinations of all sliding motion in zygapophysial joints and both sacroiliac joints and removing the limitations of the sliding motions according to the method of Karel Lewit. The treatment procedure consisted of 3 or 4 manipulations within 17 months and an exercise program. The manipulation effects were maintained by the exercise program. The exercises were done in 2 or 3 sessions weekly for a year. In both patients we observed that scoliosis decompensation was successfully stopped and the effects of the correction persisted for 10 years. Brain and head asymmetry may be only a transient state, predisposing to asymmetric blocking at the atlanto-occipital level. Removal of blocking may prevent curve progression in children who had adolescent idiopathic scoliosis. The manipulative therapy may also have a promising effect on retarding curve progression when used in skeletally immature patient.

Umbilical hernia in cirrhotic patients: outcome of elective repair.

PubMed

Lasheen, Adel; Naser, Hatem M; Abohassan, Ahmed

2013-12-01

Cirrhotic patients with umbilical hernia have an increased likelihood of complications following repair. The aim of this study was to assess the outcomes of elective umbilical hernia repair in cirrhotic patients. Fifty patients having uncomplicated umbilical hernia with a cirrhotic liver were studied prospectively. These patients divided into three groups' according to Child-Turcotte-Pugh (CTP) classification. After management of coagulopathy, correction of hypoalbuminaemia and electrolytes imbalance, and control of ascites, all patients underwent elective hernia repair under regional anesthesia. A comparison was made between the three groups as regard the size of the defect in the linea Alba, operative time, postoperative morbidity and mortality, length of hospital stay, time of return to daily life and postoperative changes in liver function tests (LFTs) in relation to the regional anesthesia applied. hernioplasty was done under spinal anesthesia in 13 patients (26%), under epidural anesthesia in 10 patients (20%), under intercostal nerve block in 7 patients (14%), and under local anesthesia in 20 patients (40%). There was an increased safety (less changes in LFTs) in cases done under local anesthesia and intercostal nerve block. The overall complications rate was 30%. There was an increased complications rate towards the decompensated cases. The differences in the mean length of hospital stay and mean time of return to daily life are statistically significant between the three groups. Umbilical hernia recurrence rate was 2% and no mortality was reported in the study groups.

Coronal magnetohydrodynamic waves and oscillations: observations and quests.

PubMed

Aschwanden, Markus J

2006-02-15

Coronal seismology, a new field of solar physics that emerged over the last 5 years, provides unique information on basic physical properties of the solar corona. The inhomogeneous coronal plasma supports a variety of magnetohydrodynamics (MHD) wave modes, which manifest themselves as standing waves (MHD oscillations) and propagating waves. Here, we briefly review the physical properties of observed MHD oscillations and waves, including fast kink modes, fast sausage modes, slow (acoustic) modes, torsional modes, their diagnostics of the coronal magnetic field, and their physical damping mechanisms. We discuss the excitation mechanisms of coronal MHD oscillations and waves: the origin of the exciter, exciter propagation, and excitation in magnetic reconnection outflow regions. Finally, we consider the role of coronal MHD oscillations and waves for coronal heating, the detectability of various MHD wave types, and we estimate the energies carried in the observed MHD waves and oscillations: Alfvénic MHD waves could potentially provide sufficient energy to sustain coronal heating, while acoustic MHD waves fall far short of the required coronal heating rates.

CORONAL MAGNETIC FIELDS DERIVED FROM SIMULTANEOUS MICROWAVE AND EUV OBSERVATIONS AND COMPARISON WITH THE POTENTIAL FIELD MODEL

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miyawaki, Shun; Nozawa, Satoshi; Iwai, Kazumasa

2016-02-10

We estimated the accuracy of coronal magnetic fields derived from radio observations by comparing them to potential field calculations and the differential emission measure measurements using EUV observations. We derived line-of-sight components of the coronal magnetic field from polarization observations of the thermal bremsstrahlung in the NOAA active region 11150, observed around 3:00 UT on 2011 February 3 using the Nobeyama Radioheliograph at 17 GHz. Because the thermal bremsstrahlung intensity at 17 GHz includes both chromospheric and coronal components, we extracted only the coronal component by measuring the coronal emission measure in EUV observations. In addition, we derived only themore » radio polarization component of the corona by selecting the region of coronal loops and weak magnetic field strength in the chromosphere along the line of sight. The upper limits of the coronal longitudinal magnetic fields were determined as 100–210 G. We also calculated the coronal longitudinal magnetic fields from the potential field extrapolation using the photospheric magnetic field obtained from the Helioseismic and Magnetic Imager. However, the calculated potential fields were certainly smaller than the observed coronal longitudinal magnetic field. This discrepancy between the potential and the observed magnetic field strengths can be explained consistently by two reasons: (1) the underestimation of the coronal emission measure resulting from the limitation of the temperature range of the EUV observations, and (2) the underestimation of the coronal magnetic field resulting from the potential field assumption.« less

Simulations of Emerging Magnetic Flux. II. The Formation of Unstable Coronal Flux Ropes and the Initiation of Coronal Mass Ejections

NASA Technical Reports Server (NTRS)

Leake, James E.; Linton, Mark G.; Antiochos, Spiro K.

2014-01-01

We present results from three-dimensional magnetohydrodynamic simulations of the emergence of a twisted convection zone flux tube into a pre-existing coronal dipole field. As in previous simulations, following the partial emergence of the sub-surface flux into the corona, a combination of vortical motions and internal magnetic reconnection forms a coronal flux rope. Then, in the simulations presented here, external reconnection between the emerging field and the pre-existing dipole coronal field allows further expansion of the coronal flux rope into the corona. After sufficient expansion, internal reconnection occurs beneath the coronal flux rope axis, and the flux rope erupts up to the top boundary of the simulation domain (approximately 36 Mm above the surface).We find that the presence of a pre-existing field, orientated in a direction to facilitate reconnection with the emerging field, is vital to the fast rise of the coronal flux rope. The simulations shown in this paper are able to self-consistently create many of the surface and coronal signatures used by coronal mass ejection (CME) models. These signatures include surface shearing and rotational motions, quadrupolar geometry above the surface, central sheared arcades reconnecting with oppositely orientated overlying dipole fields, the formation of coronal flux ropes underlying potential coronal field, and internal reconnection which resembles the classical flare reconnection scenario. This suggests that proposed mechanisms for the initiation of a CME, such as "magnetic breakout," are operating during the emergence of new active regions.

Optimizing Global Coronal Magnetic Field Models Using Image-Based Constraints

NASA Technical Reports Server (NTRS)

Jones-Mecholsky, Shaela I.; Davila, Joseph M.; Uritskiy, Vadim

2016-01-01

The coronal magnetic field directly or indirectly affects a majority of the phenomena studied in the heliosphere. It provides energy for coronal heating, controls the release of coronal mass ejections, and drives heliospheric and magnetospheric activity, yet the coronal magnetic field itself has proven difficult to measure. This difficulty has prompted a decades-long effort to develop accurate, timely, models of the field, an effort that continues today. We have developed a method for improving global coronal magnetic field models by incorporating the type of morphological constraints that could be derived from coronal images. Here we report promising initial tests of this approach on two theoretical problems, and discuss opportunities for application.

OPTIMIZING GLOBAL CORONAL MAGNETIC FIELD MODELS USING IMAGE-BASED CONSTRAINTS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, Shaela I.; Davila, Joseph M.; Uritsky, Vadim, E-mail: shaela.i.jonesmecholsky@nasa.gov

The coronal magnetic field directly or indirectly affects a majority of the phenomena studied in the heliosphere. It provides energy for coronal heating, controls the release of coronal mass ejections, and drives heliospheric and magnetospheric activity, yet the coronal magnetic field itself has proven difficult to measure. This difficulty has prompted a decades-long effort to develop accurate, timely, models of the field—an effort that continues today. We have developed a method for improving global coronal magnetic field models by incorporating the type of morphological constraints that could be derived from coronal images. Here we report promising initial tests of thismore » approach on two theoretical problems, and discuss opportunities for application.« less

The Dependence of the Peak Velocity of High-Speed Solar Wind Streams as Measured in the Ecliptic by ACE and the STEREO satellites on the Area and Co-latitude of Their Solar Source Coronal Holes.

PubMed

Hofmeister, Stefan J; Veronig, Astrid; Temmer, Manuela; Vennerstrom, Susanne; Heber, Bernd; Vršnak, Bojan

2018-03-01

We study the properties of 115 coronal holes in the time range from August 2010 to March 2017, the peak velocities of the corresponding high-speed streams as measured in the ecliptic at 1 AU, and the corresponding changes of the Kp index as marker of their geoeffectiveness. We find that the peak velocities of high-speed streams depend strongly on both the areas and the co-latitudes of their solar source coronal holes with regard to the heliospheric latitude of the satellites. Therefore, the co-latitude of their source coronal hole is an important parameter for the prediction of the high-speed stream properties near the Earth. We derive the largest solar wind peak velocities normalized to the coronal hole areas for coronal holes located near the solar equator and that they linearly decrease with increasing latitudes of the coronal holes. For coronal holes located at latitudes ≳ 60°, they turn statistically to zero, indicating that the associated high-speed streams have a high chance to miss the Earth. Similarly, the Kp index per coronal hole area is highest for the coronal holes located near the solar equator and strongly decreases with increasing latitudes of the coronal holes. We interpret these results as an effect of the three-dimensional propagation of high-speed streams in the heliosphere; that is, high-speed streams arising from coronal holes near the solar equator propagate in direction toward and directly hit the Earth, whereas solar wind streams arising from coronal holes at higher solar latitudes only graze or even miss the Earth.

Low coronal signatures of coronal mass ejections

NASA Astrophysics Data System (ADS)

Attrill, Gemma Diana Ruth

Coronal mass ejections (CMEs) are vast eruptions of magnetised plasma that explode from the solar atmosphere. This thesis focuses on understanding the nascent stages of CMEs, and their magnetic development as they expand into the interplanetary space of our solar system. This is an important part of our effort to understand the space weather environment that we live in, and increasingly interact with through satellite communications technologies. Predominantly through combining extreme ultra-violet imaging and magnetogram data, two low coronal signatures of CMEs, namely coronal waves and dimmings, are studied. A comprehensive list of observational properties of EIT coronal waves is compiled and potential counterparts in radio, Ha, soft X-rays and He n wavelengths are also discussed. New observational constraints on EIT coronal waves are presented, most notably diffuse coronal waves are shown to have a magnetic nature. Finding that many observational constraints are not satisfactorily explained by current theories, a new model for understanding the physical nature of diffuse coronal waves is developed. The new model interprets diffuse coronal "wave" bright fronts to be the low coronal magnetic footprint of CMEs. Implications for developing our understanding of how CMEs become large-scale in the low corona are discussed. Application of the model demonstrates how an understanding of the formation of complex global-scale coronal dimmings can be derived. For the first time it is shown that study of the evolution and magnetic nature of coronal dimming regions can be used to probe the post-eruptive evolution of the CME. Finally, a study is presented regarding why and how CME-related dimmings recover, despite the "open" magnetic connectivity of the ejecta to the Sun being maintained as indicated by electron heat flux measurements at 1 AU.

What Is Decompensated Cirrhosis?

MedlinePlus

... Performance VA Plans, Budget, & Performance VA Center for Innovation (VACI) Agency Financial Report ... Management Services Veterans Service Organizations Office of Accountability & Whistleblower ...

Features of solar wind streams on June 21-28, 2015 as a result of interactions between coronal mass ejections and recurrent streams from coronal holes

NASA Astrophysics Data System (ADS)

Shugay, Yu. S.; Slemzin, V. A.; Rod'kin, D. G.

2017-11-01

Coronal sources and parameters of solar wind streams during a strong and prolonged geomagnetic disturbance in June 2015 have been considered. Correspondence between coronal sources and solar wind streams at 1 AU has been determined using an analysis of solar images, catalogs of flares and coronal mass ejections, solar wind parameters including the ionic composition. The sources of disturbances in the considered period were a sequence of five coronal mass ejections that propagated along the recurrent solar wind streams from coronal holes. The observed differences from typical in magnetic and kinetic parameters of solar wind streams have been associated with the interactions of different types of solar wind. The ionic composition has proved to be a good additional marker for highlighting components in a mixture of solar wind streams, which can be associated with different coronal sources.

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

PubMed

Strom, Russell G; Bae, Junseok; Mizutani, Jun; Valone, Frank; Ames, Christopher P; Deviren, Vedat

2016-12-01

OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy (29° ± 10°, p = 0.045). CONCLUSIONS LIF+OP is an effective strategy for ASD of moderate severity. Compared with the authors' OP-only operations, LIF+OP was associated with faster recovery, fewer complications, and greater relief of pain and disability.

Characteristics of Low-latitude Coronal Holes near the Maximum of Solar Cycle 24

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hofmeister, Stefan J.; Veronig, Astrid; Reiss, Martin A.

We investigate the statistics of 288 low-latitude coronal holes extracted from SDO /AIA-193 filtergrams over the time range of 2011 January 01–2013 December 31. We analyze the distribution of characteristic coronal hole properties, such as the areas, mean AIA-193 intensities, and mean magnetic field densities, the local distribution of the SDO /AIA-193 intensity and the magnetic field within the coronal holes, and the distribution of magnetic flux tubes in coronal holes. We find that the mean magnetic field density of all coronal holes under study is 3.0 ± 1.6 G, and the percentaged unbalanced magnetic flux is 49 ± 16%.more » The mean magnetic field density, the mean unsigned magnetic field density, and the percentaged unbalanced magnetic flux of coronal holes depend strongly pairwise on each other, with correlation coefficients cc > 0.92. Furthermore, we find that the unbalanced magnetic flux of the coronal holes is predominantly concentrated in magnetic flux tubes: 38% (81%) of the unbalanced magnetic flux of coronal holes arises from only 1% (10%) of the coronal hole area, clustered in magnetic flux tubes with field strengths >50 G (10 G). The average magnetic field density and the unbalanced magnetic flux derived from the magnetic flux tubes correlate with the mean magnetic field density and the unbalanced magnetic flux of the overall coronal hole (cc>0.93). These findings give evidence that the overall magnetic characteristics of coronal holes are governed by the characteristics of the magnetic flux tubes.« less

Usefulness of the dynamic gadolinium-enhanced magnetic resonance imaging with simultaneous acquisition of coronal and sagittal planes for detection of pituitary microadenomas.

PubMed

Lee, Han Bee; Kim, Sung Tae; Kim, Hyung-Jin; Kim, Keon Ha; Jeon, Pyoung; Byun, Hong Sik; Choi, Jin Wook

2012-03-01

Does dynamic gadolinium-enhanced imaging with simultaneous acquisition of coronal and sagittal planes improve diagnostic accuracy of pituitary microadenomas compared with coronal images alone? Fifty-six patients underwent 3-T sella MRI including dynamic simultaneous acquisition of coronal and sagittal planes after gadolinium injection. According to conspicuity, lesions were divided into four scores (0, no; 1, possible; 2, probable; 3, definite delayed enhancing lesion). Additional information on supplementary sagittal images compared with coronal ones was evaluated with a 4-point score (0, no; 1, possible; 2, probable; 3, definite additional information). Accuracy of tumour detection was calculated. Average scores for lesion detection of a combination of two planes, coronal, and sagittal images were 2.59, 2.32, and 2.18. 6/10 lesions negative on coronal images were detected on sagittal ones. Accuracy of a combination of two planes, of coronal and of sagittal images was 92.86%, 82.14% and 75%. Six patients had probable or definite additional information on supplementary sagittal images compared with coronal ones alone (10.71%). Dynamic MRI with combined coronal and sagittal planes was more accurate for detection of pituitary microadenomas than routinely used coronal images. Simultaneous dynamic enhanced acquisition can make study time fast and costs low. We present a new dynamic MRI technique for evaluating pituitary microadenomas • This technique provides simultaneous acquisition of contrast enhanced coronal and sagittal images. • This technique makes the diagnosis more accurate and reduces the examination time. • Such MR imaging only requires one single bolus of contrast agent.

Could CCI or FBCI Fully Eliminate the Impact of Curve Flexibility When Evaluating the Surgery Outcome for Thoracic Curve Idiopathic Scoliosis Patient? A Retrospective Study

PubMed Central

Ni, Haijian; Zhu, Xiaodong; Li, Ming

2015-01-01

Purpose To clarify if CCI or FBCI could fully eliminate the influence of curve flexibility on the coronal correction rate. Methods We reviewed medical record of all thoracic curve AIS cases undergoing posterior spinal fusion with all pedicle screw systems from June 2011 to July 2013. Radiographical data was collected and calculated. Student t test, Pearson correlation analysis and linear regression analysis were used to analyze the data. Results 60 were included in this study. The mean age was 14.7y (10-18y) with 10 males (17%) and 50 females (83%). The average Risser sign was 2.7. The mean thoracic Cobb angle before operation was 51.9°. The mean bending Cobb angle was 27.6° and the mean fulcrum bending Cobb angle was 17.4°. The mean Cobb angle at 2 week after surgery was 16.3°. The Pearson correlation coefficient r between CCI and BFR was -0.856(P<0.001), and between FBCI and FFR was -0.728 (P<0.001). A modified FBCI (M-FBCI) = (CR-0.513)/BFR or a modified CCI (M-CCI) = (CR-0.279)/FFR was generated by curve estimation has no significant correlation with FFR (r=-0.08, p=0.950) or with BFR (r=0.123, p=0.349). Conclusions Fulcrum-bending radiographs may better predict the outcome of AIS coronal correction than bending radiographs in thoracic curveAIS patients. Neither CCI nor FBCI can fully eliminate the impact of curve flexibility on the outcome of correction. A modified CCI or FBCI can better evaluating the corrective effects of different surgical techniques or instruments. PMID:25984945

Could CCI or FBCI Fully Eliminate the Impact of Curve Flexibility When Evaluating the Surgery Outcome for Thoracic Curve Idiopathic Scoliosis Patient? A Retrospective Study.

PubMed

Yang, Changwei; Sun, Xiaofei; Li, Chao; Ni, Haijian; Zhu, Xiaodong; Yang, Shichang; Li, Ming

2015-01-01

To clarify if CCI or FBCI could fully eliminate the influence of curve flexibility on the coronal correction rate. We reviewed medical record of all thoracic curve AIS cases undergoing posterior spinal fusion with all pedicle screw systems from June 2011 to July 2013. Radiographical data was collected and calculated. Student t test, Pearson correlation analysis and linear regression analysis were used to analyze the data. 60 were included in this study. The mean age was 14.7 y (10-18 y) with 10 males (17%) and 50 females (83%). The average Risser sign was 2.7. The mean thoracic Cobb angle before operation was 51.9°. The mean bending Cobb angle was 27.6° and the mean fulcrum bending Cobb angle was 17.4°. The mean Cobb angle at 2 week after surgery was 16.3°. The Pearson correlation coefficient r between CCI and BFR was -0.856(P<0.001), and between FBCI and FFR was -0.728 (P<0.001). A modified FBCI (M-FBCI) = (CR-0.513)/BFR or a modified CCI (M-CCI) = (CR-0.279)/FFR was generated by curve estimation has no significant correlation with FFR (r=-0.08, p=0.950) or with BFR (r=0.123, p=0.349). Fulcrum-bending radiographs may better predict the outcome of AIS coronal correction than bending radiographs in thoracic curveAIS patients. Neither CCI nor FBCI can fully eliminate the impact of curve flexibility on the outcome of correction. A modified CCI or FBCI can better evaluating the corrective effects of different surgical techniques or instruments.

Flux Cancelation as the Trigger of Quiet-Region Coronal Jet Eruptions

NASA Technical Reports Server (NTRS)

Panesar, Navdeep K.; Sterling, Alphonse; Moore, Ronald L.

2017-01-01

Coronal jets are frequent magnetically channeled narrow eruptions. They occur in various solar environments: quiet regions, coronal holes and active regions. All coronal jets observed in EUV (Extreme UltraViolet) and X-ray images show a bright spire with a base brightening, also known as jet bright point (JBP). Recent studies show that coronal jets are driven by small-scale filament eruptions. Sterling et al. 2015 did extensive study of 20 polar coronal hole jets and found that X-ray jets are mainly driven by the eruption of minifilaments. What leads to these minifilament eruptions?

Remaking the medico-legal scene: a social history of the late-Victorian coroner in Oxford.

PubMed

Hurren, Elizabeth T

2010-04-01

There have been wide-ranging debates about medicine and the law encapsulated in the figure of the coroner in Victorian England. Recently the historical literature on coroners has been enriched by macro-studies. Despite this important research, the social lives of coroners and their daily interactions remain relatively neglected in standard historical accounts. This article redresses that issue by examining the working life of the coroner for Oxford during the late-Victorian era. Edward Law Hussey kept very detailed records of his time in office as coroner. New research material makes it feasible to trace his professional background, from doctor of the sick poor, to hospital house surgeon and then busy coroner. His career trajectory, personal interactions, and professional disputes, provide an important historical prism illuminating contemporary debates that occupied coroners in their working lives. Hussey tried to improve his medico-legal reach and the public image of his coroner's office by reducing infanticide rates, converting a public mortuary, and acquiring a proper coroner's court. His campaigns had limited success because the social scene in which he worked was complicated by the dominance of health and welfare agencies that resented his role as an expanding arm of the Victorian information state.

Structural and immunohistochemical changes in the hepatic vascular system in compensated and decompensated stenosis of the pulmonary trunk.

PubMed

Novikov, Yu V; Shormanov, S V; Kulikov, S V

2012-01-01

Modeling of pulmonary trunk stenosis leads to an increase in hepatic vascular resistance because of veno-arterial and veno-venous reactions. During the compensation phase, bundles of intimal musculature and myoelastic sphincters appear in the arteries, while in the efferent veins hypertrophy of the muscle rolls is observed. The decompensation phase of stenosis is characterized by relaxation of hepatic vascular walls, reduction of the number of arteries with intimal muscles and sphincter structures, and atrophy of muscle rolls in hepatic veins. Sclerotic changes develop in the vascular bed. Failure of the compensatory reactions results in development of chronic hepatic venous plethora with typical morphological manifestations.

Analysis and Modeling of Coronal Holes Observed by CORONAS-1. 1; Morphology and Magnetic Field Configuration

NASA Technical Reports Server (NTRS)

Obridko, Vladmir; Formichev, Valery; Kharschiladze, A. F.; Zhitnik, Igor; Slemzin, Vladmir; Hathaway, David H.; Wu, Shi T.

1998-01-01

Two low-latitude coronal holes observed by CORONAS-1 in April and June 1994 are analyzed together with magnetic field measurements obtained from Wilcox and Kitt Peak Solar Observatories. To estimate the comparable temperature of these two coronal holes, the YOHKOH observations are also utilized. Using this information, we have constructed three-dimensional magnetic field lines to illustrate the geometrical configuration of these coronal holes. The calculated synoptic maps are used to determine the existence of closed and open field regions of the hole. Finally, we have correlated the characteristics of two coronal holes with observed solar wind speed. We found that the brighter coronal hole has high speed solar wind, and the dimmer coronal hole has low speed solar wind.

Newborn Coronal Holes Associated with the Disappearance of Polarity Reversal Boundaries (P46)

NASA Astrophysics Data System (ADS)

Shelke, R.

2006-11-01

rajendra_shelke@yahoo.co.in Coronal holes play an important role in the occurrence of various kinds of solar events. The geomagnetic activity, coronal transients, type II radio bursts, and soft X ray blowouts have shown their strong association with coronal holes (Webb et al., 1978; Shelke and Pande, 1985; Bhatnagar, 1996; Hewish and Bravo, 1986). Recently, Shelke (2006) has linked the onset of interplanetary erupting stream disturbances with the evolutionary changes in the coronal holes. The present study reveals that there exists some physical relationship between the formation of new coronal holes and the disappearance of polarity reversal boundaries with or without the overlying prominences. About 124 new coronal holes are found to emerge at the locations where polarity reversal boundaries existed prior to their disappearance. Among them, nearly 66% and 18% newborn coronal holes have been associated with disappearing prominences and disappearing small unipolar magnetic regions (UMRs) with encircled polarity reversal boundaries respectively. Coronal holes and quiescent prominences are stable solar features that last for many solar rotations. A coronal hole is indicative of a radial magnetic field of a predominant magnetic polarity at the photosphere, whereas solar prominence overlying the polarity reversal boundary straddles both the polarities of a bipolar magnetic region. The new coronal hole emerges on the Sun, owing to the changes in magnetic field configuration leading to the opening of closed magnetic structure into the corona. The mechanism that leads to the eruption of polarity reversal boundaries with or without prominences seems to be interlinked with the mechanism that converts bipolar magnetic regions into unipolar magnetic regions characterizing coronal holes. The fundamental activity for the onset of erupting polarity reversal boundary seems to be the opening of preexisting closed magnetic structures into a new coronal hole, which can support mass motion including erupting prominence.

The role of the large-scale coronal magnetic field in the eruption of prominence/cavity systems

NASA Astrophysics Data System (ADS)

de Toma, G.; Gibson, S. E.; Fan, Y.; Torok, T.

2013-12-01

Prominence/cavity systems are large-scale coronal structures that can live for many weeks and even months and often end their life in the form of large coronal eruptions. We investigate the role of the surrounding ambient coronal field in stabilizing these systems against eruption. In particular, we examine the extent to which the decline with height of the external coronal magnetic field influences the evolution of these coronal systems and their likelihood to erupt. We study prominence/cavity systems during the rising phase of cycle 24 in 2010-2013, when a significant number of CMEs were associated with polar crown or large filament eruptions. We use EUV observations from SDO/AIA to identify stable and eruptive coronal cavities, and SDO/HMI magnetograms as boundary conditions to PFSS extrapolation to derive the ambient coronal field. We compute the decay index of the potential field for the two groups and find that systematic differences exist between eruptive and non-eruptive systems.

Observational features of equatorial coronal hole jets

NASA Astrophysics Data System (ADS)

Nisticò, G.; Bothmer, V.; Patsourakos, S.; Zimbardo, G.

2010-03-01

Collimated ejections of plasma called "coronal hole jets" are commonly observed in polar coronal holes. However, such coronal jets are not only a specific features of polar coronal holes but they can also be found in coronal holes appearing at lower heliographic latitudes. In this paper we present some observations of "equatorial coronal hole jets" made up with data provided by the STEREO/SECCHI instruments during a period comprising March 2007 and December 2007. The jet events are selected by requiring at least some visibility in both COR1 and EUVI instruments. We report 15 jet events, and we discuss their main features. For one event, the uplift velocity has been determined as about 200 km s-1, while the deceleration rate appears to be about 0.11 km s-2, less than solar gravity. The average jet visibility time is about 30 min, consistent with jet observed in polar regions. On the basis of the present dataset, we provisionally conclude that there are not substantial physical differences between polar and equatorial coronal hole jets.

Hanle Effect Diagnostics of the Coronal Magnetic Field: A Test Using Realistic Magnetic Field Configurations

NASA Astrophysics Data System (ADS)

Raouafi, N.-E.; Solanki, S. K.; Wiegelmann, T.

2009-06-01

Our understanding of coronal phenomena, such as coronal plasma thermodynamics, faces a major handicap caused by missing coronal magnetic field measurements. Several lines in the UV wavelength range present suitable sensitivity to determine the coronal magnetic field via the Hanle effect. The latter is a largely unexplored diagnostic of coronal magnetic fields with a very high potential. Here we study the magnitude of the Hanle-effect signal to be expected outside the solar limb due to the Hanle effect in polarized radiation from the H I Lyα and β lines, which are among the brightest lines in the off-limb coronal FUV spectrum. For this purpose we use a magnetic field structure obtained by extrapolating the magnetic field starting from photospheric magnetograms. The diagnostic potential of these lines for determining the coronal magnetic field, as well as their limitations are studied. We show that these lines, in particular H I Lyβ, are useful for such measurements.

Relative coronal abundances derived from X-ray observations 3: The effect of cascades on the relative intensity of Fe (XVII) line fluxes, and a revised iron abundance

NASA Technical Reports Server (NTRS)

Walker, A. B. C., Jr.; Rugge, H. R.; Weiss, K.

1974-01-01

Permitted lines in the optically thin coronal X-ray spectrum were analyzed to find the distribution of coronal material, as a function of temperature, without special assumptions concerning coronal conditions. The resonance lines of N, O, Ne, Na, Mg, Al, Si, S, and Ar which dominate the quiet coronal spectrum below 25A were observed. Coronal models were constructed and the relative abundances of these elements were determined. The intensity in the lines of the 2p-3d transitions near 15A was used in conjunction with these coronal models, with the assumption of coronal excitation, to determine the Fe XVII abundance. The relative intensities of the 2p-3d Fe XVII lines observed in the corona agreed with theoretical prediction. Using a more complete theoretical model, and higher resolution observations, a revised calculation of iron abundance relative to hydrogen of 0.000026 was made.

The relational dimension of care for maternity blues and its relation to decompensation of a psychiatric disorder during the intermediate postpartum period in Cameroon.

PubMed

Mboua, C P; Nkoum, B A; Abessouguié, S P

2016-08-01

In a setting such as Cameroon, where perinatal care offers few services for women with psychiatric problems during pregnancy, delivery, and the immediate postpartum period, the development of the relational dimension of care may help prevent severe psychiatric disorders . This study evaluates the role of the relational dimension of perinatal and early postpartum care (providing perinatal counseling and a space to speak) on women with blues on the intermediate-term outcomes of decompensation, in view of the importance of the emotional issues occurring in the perinatal period. Data collection used both diagnostic and clinical methods on a sample of 50 women from three hospitals in Cameroon who gave birth during the study period and agreed to participate. Of the 38 diagnosed with blues, 10 were available for observation during the intermediate post-partum: they were sorted into an experimental group that received perinatal counseling (n=5) and a control group that did not. The results suggest the importance to women with blues of a space for talking during the post-partum period. In particular, the quality of this counseling, in terms of the emotional responses of the nursing staff, determines the outcome of this management and can help to reduce the outset of depression and decompensation.

Assessing validity by comparing transition and static measures of dyspnea in patients with acute decompensated heart failure.

PubMed

Smithline, Howard A; Caglar, Selin; Blank, Fidela S J

2010-01-01

This study assessed the convergent validity of 2 dyspnea measures, the transition measure and the change measure, by comparing them with each other in patients admitted to the hospital with acute decompensated heart failure. Static measures of dyspnea were obtained at baseline (pre-static measure) and at time 1 hour and 4 hour (post-static measures). The change measure was calculated as the difference between the pre-static and post-static measures. Transition measures were obtained at time 1 hour and 4 hour. Visual analog scales and Likert scales were used. Both physicians and patients measured the dyspnea independently. A total of 112 patients had complete data sets at time 0 and 1 hour and 86 patients had complete data sets at all 3 time points. Correlations were calculated between the transition measures and static measures (pre-static, post-static, and change measure). Bland-Altman plots were generated and the mean difference and limits of agreement between the transition measures and the change measures were calculated. In general, short-term dyspnea assessment using transition measures and serial static measures can not be used to validate each other in this population of patients being admitted with acute decompensated heart failure. © 2010 Wiley Periodicals, Inc.

Psychiatric monitoring of not guilty by reason of insanity outpatients.

PubMed

Almeida, Fernando; Moreira, Diana; Moura, Helena; Mota, Victor

2016-02-01

Individuals deemed Not Guilty by Reason of Insanity (NGRI) by the courts, under Article 20 of the Portuguese Criminal Code, have often committed very serious crimes. It is unreasonable to consider that these patients were usually kept without adequate supervision after the security measure had been declared extinct. They often decompensated after leaving the institution where they complied with the security measure, and/or relapsed to alcohol and drug abuse. Very often, severe repeated crime erupted again. Considering this, there was an urgent need to keep a follow-up assessment of these patients in order to prevent them from relapsing in crime. This work presents the results of a psychiatric follow-up project with NGRI outpatients. The main goals of the project were: ensuring follow-up and appropriate therapeutic responses for these patients, maintaining all individuals in a care network, and preventing them from decompensating. The team consisted of a psychiatrist, a nurse, and a psychologist. Seventy-two patients were monitored during two years. Results demonstrated the unequivocal need to follow up decompensated patients after the court order is extinguished. Suggestions are presented for a better framing and psychiatric follow-up of these patients. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Liver cirrhosis: a risk factor for gallstone disease in chronic hepatitis C patients in China.

PubMed

Li, Xu; Wang, Zhongfeng; Wang, Le; Pan, Meng; Gao, Pujun

2017-06-01

We investigated the possible link between liver cirrhosis and gallstone risk in chronic hepatitis C (CHC) patients in China.To analyze the association between liver cirrhosis and gallstone development, we compared outcomes of 133 Chinese CHC patients with gallstones and an age-, sex-, and hepatitis C virus RNA level-matched control group of 431 CHC patients without gallstones.We found that liver cirrhosis was more prevalent in gallstone patients (40.6%) than in the control group (24.4%). Logistic regression analyses adjusting for demographic features and other gallstone risk factors revealed that liver cirrhosis increased the risk of gallstone development 2-fold (adjusted odds ratio [AOR]: 2.122; 95% confidence interval [CI]: 1.408-3.198). Moreover, multivariate analyses comparing the risk of gallstone development in liver cirrhosis patients with decompensated or compensated liver cirrhosis yielded an estimated AOR (95% CI) of 2.869 (1.277-6.450) in patients with decompensated liver cirrhosis. Gallstone risk also increased significantly with older age (>60 years) (AOR: 2.019; 95% CI: 1.017-4.009).Liver cirrhosis significantly correlates with increased risk of gallstone development in CHC patients in China. Decompensated liver cirrhosis and older age further heighten this risk in patients diagnosed with hepatitis C-related cirrhosis.

Non-HFE iron overload as a surrogate marker of disease severity in patients of liver cirrhosis.

PubMed

Noor, Mohd Talha; Tiwari, Manish; Kumar, Ravindra

2016-01-01

Decompensated liver cirrhosis is an important cause of mortality worldwide. Various modifiable and non-modifiable factors are involved in the pathogenesis of cirrhosis and its complications. This study was aimed to evaluate the association of iron overload and disease severity in patients of liver cirrhosis and its association with HFE gene mutation. Forty-nine patients with decompensated liver cirrhosis were recruited. Clinical and laboratory parameters were compared in patients with and without iron overload. C282Y and H63D gene mutation analysis was performed in all patients with iron overload. Iron overload was found in 20 (40.82%) patients. A significant positive correlation of transferrin saturation with Child-Turcotte-Pugh (CTP) score (r = 0.705, p < 0.001) and model for end-stage liver disease (MELD) score (r = 0.668, p < 0.001) was found. Transferrin saturation was also independently associated with high CTP and MELD score on multivariate analysis. Mortality over 3 months was significantly more common in iron-overloaded patients (p = 0.028). C282Y homozygosity or C282Y/H63D compound heterozygosity was not found in any of the patients with iron overload. Iron overload was significantly associated with disease severity and reduced survival in patients of decompensated liver cirrhosis.

Bolus versus continuous low dose of enalaprilat in congestive heart failure with acute refractory decompensation.

PubMed

Podbregar, M; Voga, G; Horvat, M; Zuran, I; Krivec, B; Skale, R; Pareznik, R

1999-01-01

The first dose of angiotensin-converting enzyme (ACE) inhibitors may trigger a considerable fall of blood pressure in chronic heart failure. The response may be dose-related. To determine hemodynamic and systemic oxygenation effects of low-dose enalaprilat, we administered intravenous enalaprilat (0.004 mg/kg) as bolus (group B) or continuous 1-hour infusion (group C) in 20 patients with congestive heart failure due to ischemic heart disease with acute decompensation refractory to inotropic, vasodilator and diuretic therapy. Hemodynamic and systemic oxygenation variables were recorded at baseline (+0 min), +30, +60, +120, +180, and +360 min after the start of intervention. Mean arterial pressure (MAP) (p < 0. 001), mean pulmonary artery pressure (MPAP) (p < 0.001), pulmonary artery occlusion pressure (PAOP) (p < 0.001), oxygen extraction ratio (ER) (p < 0.026) decreased regardless of enalaprilat application. Compared to group B, there was in group C prolonged decrease of MAP, MPAP, PAOP, ER and increase of pulmonary artery oxyhemoglobin saturation in regard to baseline values. Cardiac index, heart rate, central venous pressure and oxygen consumption index did not change. A low dose of intravenous enalaprilat (0.004 mg/kg) can be used to safely improve hemodynamics and systemic oxygenation in congestive heart failure due to ischemic heart disease with acute refractory decompensation.

Invisibility of Solar Active Region Umbra-to-Umbra Coronal Loops: New Evidence that Magnetoconvection Drives Solar-Stellar Coronal Heating

NASA Technical Reports Server (NTRS)

Tiwari, Sanjiv K.; Thalmann, Julia K.; Panesar, Navdeep K.; Moore, Ronald L.; Winebarger, Amy R.

2017-01-01

Coronal heating generally increases with increasing magnetic field strength: the EUV/X-ray corona in active regions is 10--100 times more luminous and 2--4 times hotter than that in quiet regions and coronal holes, which are heated to only about 1.5 MK, and have fields that are 10--100 times weaker than that in active regions. From a comparison of a nonlinear force-free model of the three-dimensional active region coronal field to observed extreme-ultraviolet loops, we find that (1) umbra-to-umbra coronal loops, despite being rooted in the strongest magnetic flux, are invisible, and (2) the brightest loops have one foot in an umbra or penumbra and the other foot in another sunspot's penumbra or in unipolar or mixed-polarity plage. The invisibility of umbra-to-umbra loops is new evidence that magnetoconvection drives solar-stellar coronal heating: evidently, the strong umbral field at both ends quenches the magnetoconvection and hence the heating. Our results from EUV observations and nonlinear force-free modeling of coronal magnetic field imply that, for any coronal loop on the Sun or on any other convective star, as long as the field can be braided by convection in at least one loop foot, the stronger the field in the loop, the stronger the coronal heating.

Effect of the Coronal Wall Thickness of Dental Implants on the Screw Joint Stability in the Internal Implant-Abutment Connection.

PubMed

Lee, Ji-Hye; Huh, Yoon-Hyuk; Park, Chan-Jin; Cho, Lee-Ra

2016-01-01

To evaluate the effect of implant coronal wall thickness on load-bearing capacity and screw joint stability. Experimental implants were customized after investigation of the thinnest coronal wall thickness of commercially available implant systems with a regular platform diameter. Implants with four coronal wall thicknesses (0.2, 0.3, 0.4, and 0.5 mm) were fabricated. Three sets of tests were performed. The first set was a failure test to evaluate load-bearing capacity and elastic limit. The second and third sets were cyclic and static loading tests. After abutment screw tightening of each implant, vertical cyclic loading of 250 N or static loading from 250 to 800 N was applied. Coronal diameter expansion, axial displacement, and removal torque values of the implants were compared. Repeated measures analysis of variance (ANOVA) was used for statistical analysis (α = .05). Implants with 0.2-mm coronal wall thickness demonstrated significantly low load-bearing capacity and elastic limit (both P < .05). These implants also showed significantly large coronal diameter expansion and axial displacement after screw tightening (both P < .05). Greater vertical load and thinner coronal wall thickness significantly increased coronal diameter expansion of the implant, axial displacement of the abutment, and removal torque loss of the abutment screw (all P < .05). Implant coronal wall thickness of 0.2 mm produces significantly inferior load-bearing capacity and screw joint stability.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Antolin, P.; Rouppe van der Voort, L., E-mail: patrick.antolin@astro.uio.no, E-mail: v.d.v.l.rouppe@astro.uio.no

Observed in cool chromospheric lines, such as H{alpha} or Ca II H, coronal rain corresponds to cool and dense plasma falling from coronal heights. Considered as a peculiar sporadic phenomenon of active regions, it has not received much attention since its discovery more than 40 years ago. Yet, it has been shown recently that a close relationship exists between this phenomenon and the coronal heating mechanism. Indeed, numerical simulations have shown that this phenomenon is most likely due to a loss of thermal equilibrium ensuing from a heating mechanism acting mostly toward the footpoints of loops. We present here onemore » of the first high-resolution spectroscopic observations of coronal rain, performed with the CRisp Imaging Spectro Polarimeter (CRISP) instrument at the Swedish Solar Telescope. This work constitutes the first attempt to assess the importance of coronal rain in the understanding of the coronal magnetic field in active regions. With the present resolution, coronal rain is observed to literally invade the entire field of view. A large statistical set is obtained in which dynamics (total velocities and accelerations), shapes (lengths and widths), trajectories (angles of fall of the blobs), and thermodynamic properties (temperatures) of the condensations are derived. Specifically, we find that coronal rain is composed of small and dense chromospheric cores with average widths and lengths of {approx}310 km and {approx}710 km, respectively, average temperatures below 7000 K, displaying a broad distribution of falling speeds with an average of {approx}70 km s{sup -1}, and accelerations largely below the effective gravity along loops. Through estimates of the ion-neutral coupling in the blobs we show that coronal rain acts as a tracer of the coronal magnetic field, thus supporting the multi-strand loop scenario, and acts as a probe of the local thermodynamic conditions in loops. We further elucidate its potential in coronal heating. We find that the cooling in neighboring strands occurs simultaneously in general suggesting a similar thermodynamic evolution among strands, which can be explained by a common footpoint heating process. Constraints for coronal heating models of loops are thus provided. Estimates of the fraction of coronal volume with coronal rain give values between 7% and 30%. Estimates of the occurrence time of the phenomenon in loops set times between 5 and 20 hr, implying that coronal rain may be a common phenomenon, in agreement with the frequent observations of cool downflows in extreme-ultraviolet lines. The coronal mass drain rate in the form of coronal rain is estimated to be on the order of 5 Multiplication-Sign 10{sup 9} g s{sup -1}, a significant quantity compared to the estimate of mass flux into the corona from spicules.« less

Fault lines in forensic medical toxicology in Ireland exposed through replies of pathologists and coroners to anonymous questionnaires.

PubMed

Tormey, William P; Borovickova, Ingrid; Moore, Tara M

2014-01-01

The attitudes and experiences of pathologists and coroners to the provision of biochemical forensic toxicology in the Republic of Ireland were determined using separate questionnaires to each group anonymously. Replies were received from 36/88 (41%) of pathologists and 19/71 (27%) of coroners. 37% of coroners considered that histopathologists give an adequate opinion in forensic toxicology yet 58% of pathologists reported that they did not have adequate access to expert medical interpretative toxicological opinion. For drug-drug interactions and metabolic diseases, 69% of pathologists were unhappy with the processes and 68% of coroner replies did not know if vitreous samples were used appropriately. There is a clear requirement for retraining of coroners and for the appointment of medical toxicology expertise to improve the quality of service for coroners.

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection.

PubMed

Lee, Jung-Hee; Kim, Ki-Tack; Lee, Sang-Hun; Kang, Kyung-Chung; Oh, Hyun-Seok; Kim, Young-Jun; Jung, Hyuk

2016-08-01

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD). Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5 years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye's formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL > ideal LL) and undercorrection (degree of postoperative LL < ideal LL). Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (-6.9° vs. -2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139 mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA ≤ 50 mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (-64.3° vs. -37.1°), TK (22.6° vs. 15.8°), and SVA (-1 vs. 41 mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7 %) in the overcorrection group and eight (50 %) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series. Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.

Unresolved fine-scale structure in solar coronal loop-tops

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scullion, E.; Van der Voort, L. Rouppe; Wedemeyer, S.

2014-12-10

New and advanced space-based observing facilities continue to lower the resolution limit and detect solar coronal loops in greater detail. We continue to discover even finer substructures within coronal loop cross-sections, in order to understand the nature of the solar corona. Here, we push this lower limit further to search for the finest coronal loop substructures, through taking advantage of the resolving power of the Swedish 1 m Solar Telescope/CRisp Imaging Spectro-Polarimeter (CRISP), together with co-observations from the Solar Dynamics Observatory/Atmospheric Image Assembly (AIA). High-resolution imaging of the chromospheric Hα 656.28 nm spectral line core and wings can, under certainmore » circumstances, allow one to deduce the topology of the local magnetic environment of the solar atmosphere where its observed. Here, we study post-flare coronal loops, which become filled with evaporated chromosphere that rapidly condenses into chromospheric clumps of plasma (detectable in Hα) known as a coronal rain, to investigate their fine-scale structure. We identify, through analysis of three data sets, large-scale catastrophic cooling in coronal loop-tops and the existence of multi-thermal, multi-stranded substructures. Many cool strands even extend fully intact from loop-top to footpoint. We discover that coronal loop fine-scale strands can appear bunched with as many as eight parallel strands within an AIA coronal loop cross-section. The strand number density versus cross-sectional width distribution, as detected by CRISP within AIA-defined coronal loops, most likely peaks at well below 100 km, and currently, 69% of the substructure strands are statistically unresolved in AIA coronal loops.« less

Rationale and design of the Aquapheresis Versus Intravenous Diuretics and Hospitalization for Heart Failure (AVOID-HF) trial.

PubMed

Costanzo, Maria Rosa; Negoianu, Daniel; Fonarow, Gregg C; Jaski, Brian E; Bart, Bradley A; Heywood, J Thomas; Nabut, Jose L; Schollmeyer, Michael P

2015-09-01

In patients hospitalized with acutely decompensated heart failure, unresolved signs and symptoms of fluid overload have been consistently associated with poor outcomes. Regardless of dosing and type of administration, intravenous loop diuretics have not reduced heart failure events or mortality in patients with acutely decompensated heart failure. The results of trials comparing intravenous loop diuretics to mechanical fluid removal by isolated venovenous ultrafiltration have yielded conflicting results. Studies evaluating early decongestive strategies have shown that ultrafiltration removed more fluid and was associated with fewer heart failure-related rehospitalization than intravenous loop diuretics. In contrast, when used in the setting of worsening renal function, ultrafiltration was associated with poorer renal outcomes and no reduction in heart failure events. The AVOID-HF trial seeks to determine if an early strategy of ultrafiltration in patients with acutely decompensated heart failure is associated with fewer heart failure events at 90 days compared with a strategy based on intravenous loop diuretics. Study subjects from 40 highly experienced institutions are randomized to either early ultrafiltration or intravenous loop diuretics. In both treatment arms, fluid removal therapies are adjusted according to the patients' hemodynamic condition and renal function. The study was unilaterally terminated by the sponsor in the absence of futility and safety concerns after the enrollment of 221 subjects, or 27% of the originally planned sample size of 810 patients. The AVOID-HF trial's principal aim is to compare the safety and efficacy of ultrafiltration vs that of intravenous loop diuretics in patients hospitalized with acutely decompensated heart failure. Because stepped treatment approaches are applied in both ultrafiltration and intravenous loop diuretics groups and the primary end point is time to first heart failure event within 90 days, it is hoped that the AVOID-HF trial, despite its untimely termination by the sponsor, will provide further insight on how to optimally decongest patients with fluid-overloaded heart failure. Copyright © 2015. Published by Elsevier Inc.

Clinical and hemodynamic effects of intra-aortic balloon pump therapy in chronic heart failure patients with cardiogenic shock.

PubMed

Fried, Justin A; Nair, Abhinav; Takeda, Koji; Clerkin, Kevin; Topkara, Veli K; Masoumi, Amirali; Yuzefpolskaya, Melana; Takayama, Hiroo; Naka, Yoshifumi; Burkhoff, Daniel; Kirtane, Ajay; Dimitrios Karmpaliotis, S M; Moses, Jeffrey; Colombo, Paolo C; Garan, A Reshad

2018-03-20

The role of the intra-aortic balloon pump (IABP) in acute decompensated heart failure (HF) with cardiogenic shock (CS) is largely undefined. In this study we sought to assess the hemodynamic and clinical response to IABP in chronic HF patients with CS and identify predictors of response to this device. We retrospectively reviewed all patients undergoing IABP implantation from 2011 to 2016 at our institution to identify chronic HF patients with acute decompensation and CS (cardiac index <2.2 liters/min/m 2 and systolic blood pressure <90 mm Hg or need for vasoactive medications to maintain this level). Clinical deterioration on IABP was defined as failure to bridge to either discharge on medical therapy or durable heart replacement therapy (HRT; durable left ventricular assist device or heart transplant) with IABP alone. We identified 132 chronic HF patients with IABP placed after decompensation with hemodynamic evidence of CS. Overall 30-day survival was 84.1%, and 78.0% of patients were successfully bridged to HRT or discharge without need for escalation of device support. The complication rate during IABP support was 2.3%. Multivariable analysis identified ischemic cardiomyopathy (odds ratio [OR] 3.24, 95% confidence interval [CI] 1.16 to 9.06; p = 0.03) and pulmonary artery pulsatility index (PAPi) <2.0 (OR 5.04, 95% CI 1.86 to 13.63; p = 0.001) as predictors of clinical deterioration on IABP. Overall outcomes with IABP in acute decompensated chronic HF patients are encouraging, and IABP is a reasonable first-line device for chronic HF patients with CS. Baseline right ventricular function, as measured by PAPi, is a major predictor of outcomes with IABP in this population. Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure.

PubMed

Frea, Simone; Pidello, Stefano; Bovolo, Virginia; Iacovino, Cristina; Franco, Erica; Pinneri, Francesco; Galluzzo, Alessandro; Volpe, Alessandra; Visconti, Massimiliano; Peirone, Andrea; Morello, Mara; Bergerone, Serena; Gaita, Fiorenzo

2016-05-01

The purpose of this study was to evaluate the additional prognostic value of echocardiography in acute decompensation of advanced chronic heart failure (CHF), focusing on right ventricular (RV) dysfunction and its interaction with loading conditions. Few data are available on the prognostic role of echocardiography in acute HF and on the significance of pulmonary hypertension in patients with severe RV failure. A total of 265 NYHA IV patients admitted for acute decompensation of advanced CHF (EF 22 ± 7%, systolic blood pressure 107 ± 20 mmHg) were prospectively enrolled. Fifty-nine patients met the primary composite endpoint of cardiac death, urgent heart transplantation, and urgent mechanical circulatory support implantation at 90 days. Pulmonary hypertension failed to predict events, while patients with a low transtricuspid systolic gradient (TR gradient <20 mmHg) showed a worse outcome [hazard ratio (HR) 2.37, 95% confidence interval (CI) 1.12-5.00, P = 0.02]. RV dysfunction [tricuspid annular plane systolic excursion (TAPSE) ≤14 mm] in the presence of a low TR gradient identified patients at higher risk of events (HR 2.97, 95% CI 1.19-7.41, P = 0.02). Multivariate analysis showed as best predictors of outcome low RV contraction pressure index (RVCPI), defined as TAPSE × TR gradient, and high estimated right atrial pressure (eRAP). Adding RVCPI (<400 mm*mmHg) and eRAP (≥20 mmHg) to conventional clinical (ADHERE risk tree and NT-proBNP) and echocardiographic risk evaluation resulted in an increase in net reclassification improvement of +19.1% and +20.1%, respectively (P = 0.01) and in c-statistic from 0.59 to 0.73 (P < 0.01). In acute decompensation of advanced CHF, pulmonary hypertension failed to predict events. The in-hospital and short-term prognosis can be better predicted by eRAP and RVCPI. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study.

PubMed

de Souza, Vanessa; Zeitoun, Sandra Salloum; Lopes, Camila Takao; de Oliveira, Ana Paula Dias; Lopes, Juliana de Lima; de Barros, Alba Lucia Bottura Leite

2015-09-01

To assess the clinical usefulness of the operational definitions for the defining characteristics of the NANDA International nursing diagnoses, activity intolerance, decreased cardiac output and excess fluid volume, and the concomitant presence of those diagnoses in patients with decompensated heart failure. Content validity of the operational definitions for the defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output have been previously validated by experts. Their clinical usefulness requires clinical validation. This was a descriptive exploratory study. Two expert nurses independently assessed 25 patients with decompensated heart failure for the presence or absence of 29 defining characteristics. Interrater reliability was analysed using the Kappa coefficient as a measure of clinical usefulness. The Fisher's exact test was used to test the association of the defining characteristics of activity intolerance and excess fluid volume in the presence of decreased cardiac output, and the correlation between the three diagnoses. Assessments regarding the presence of all defining characteristics reached 100% agreement, except with anxiety. Five defining characteristics of excess fluid volume were significantly associated with the presence of decreased cardiac output. Concomitant presence of the three diagnoses occurred in 80% of the patients. However, there was no significant correlation between the three diagnoses. The operational definitions for the diagnoses had strong interrater reliability, therefore they were considered clinically useful. Only five defining characteristics were representative of the association between excess fluid volume and decreased cardiac output. Therefore, excess fluid volume is related to decreased cardiac output, although these diagnoses are not necessarily associated with activity intolerance. The operational definitions may favour early recognition of the sequence of responses to decompensation, guiding the choice of common interventions to improve or resolve excess fluid volume and decreased cardiac output. © 2015 John Wiley & Sons Ltd.

Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure.

PubMed

Ananthakrishna Pillai, Ajith; Ramasamy, Chandramohan; V, Saranya Gousy; Kottyath, Harichandrakumar

2018-03-11

Mitral stenosis may present with decompensated heart failure during pregnancy. Many patients do have advanced sub valve disease and present late with decompensated state. The outcomes of balloon mitral valvuloplasty (BMV) in such advanced sub valve disease with severe heart failure in pregnancy has not been specifically studied till now. A descriptive study looking at the immediate and long-term outcomes of pregnant patients with MS who presented with severe heart failure and sub valve disease who had undergone BMV. Ninety-six patients were studied. The mean gestational age was 23.4 ± 10.9 weeks .Mean SpO2 was 89% at admission,17% were in cardiogenic shock and 33.33 were on mechanical ventilation. The mean Wilkin's score was 9.71 ± 2.1 and sub valve score was 3.3 ± 0.12. BMV was successful in 77 (80.2%) patients and failed in 19. In 5.2% cases, acute severe MR occurred. There were 11 maternal deaths (six in failed and five in success group). A successful obstetric outcome was seen in 71 patients in success (92%) and 11/19 (57%) in failed (P < 0.001). The obstetric outcomes were better in success versus failure group. Anova post hoc analysis showed sustained gradient reductions at 1 and 5 year follow-up (P = 0.03) in success group. BMV offers substantial improvement in clinical outcomes among pregnant patients with MS and heart failure even with severe sub valve disease. The morality rate among failed was high at 31%. The obstetric outcomes were poor after a failed BMV. Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure. © 2018, Wiley Periodicals, Inc.

Clinical variables affecting survival in patients with decompensated diastolic versus systolic heart failure.

PubMed

Gorelik, Oleg; Almoznino-Sarafian, Dorit; Shteinshnaider, Miriam; Alon, Irena; Tzur, Irma; Sokolsky, Ilya; Efrati, Shai; Babakin, Zoanna; Modai, David; Cohen, Natan

2009-04-01

The impact of various clinical variables on long-term survival of patients with acutely decompensated diastolic heart failure (DHF) compared to systolic heart failure (SHF) has not been sufficiently investigated. Clinical, laboratory, electrocardiographic and echocardiographic data were collected and analyzed for all-cause mortality in 473 furosemide-treated patients aged >or=60 years, hospitalized for acutely decompensated HF. Diastolic heart failure patients (n = 183) were more likely to be older, female, hypertensive, obese, with shorter preexisting HF duration, atrial fibrillation, lower New York Heart Association (NYHA) class, lower maintenance furosemide dosages, and to receive calcium antagonists. The SHF group (290 patients) demonstrated prevailing coronary artery disease, nitrate or digoxin treatment, and electrocardiographic conduction disturbances (P

Altered Peripheral Blood Monocyte Phenotype and Function in Chronic Liver Disease: Implications for Hepatic Recruitment and Systemic Inflammation.

PubMed

Gadd, Victoria L; Patel, Preya J; Jose, Sara; Horsfall, Leigh; Powell, Elizabeth E; Irvine, Katharine M

2016-01-01

Liver and systemic inflammatory factors influence monocyte phenotype and function, which has implications for hepatic recruitment and subsequent inflammatory and fibrogenic responses, as well as host defence. Peripheral blood monocyte surface marker (CD14, CD16, CD163, CSF1R, CCR2, CCR4, CCR5, CXCR3, CXCR4, CX3CR1, HLA-DR, CD62L, SIGLEC-1) expression and capacity for phagocytosis, oxidative burst and LPS-stimulated TNF production were assessed in patients with hepatitis C (HCV) (n = 39) or non-alcoholic fatty liver disease (NAFLD) (n = 34) (classified as non-advanced disease, compensated cirrhosis and decompensated cirrhosis) and healthy controls (n = 11) by flow cytometry. The selected markers exhibited similar monocyte-subset-specific expression patterns between patients and controls. Monocyte phenotypic signatures differed between NAFLD and HCV patients, with an increased proportion of CD16+ non-classical monocytes in NAFLD, but increased expression of CXCR3 and CXCR4 in HCV. In both cohorts, monocyte CCR2 expression was reduced and CCR4 elevated over controls. CD62L expression was specifically elevated in patients with decompensated cirrhosis and positively correlated with the model-for-end-stage-liver-disease score. Functionally, monocytes from patients with decompensated cirrhosis had equal phagocytic capacity, but displayed features of dysfunction, characterised by lower HLA-DR expression and blunted oxidative responses. Lower monocyte TNF production in response to LPS stimulation correlated with time to death in 7 (46%) of the decompensated patients who died within 8 months of recruitment. Chronic HCV and NAFLD differentially affect circulating monocyte phenotype, suggesting specific injury-induced signals may contribute to hepatic monocyte recruitment and systemic activation state. Monocyte function, however, was similarly impaired in patients with both HCV and NAFLD, particularly in advanced disease, which likely contributes to the increased susceptibility to infection in these patients.

Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis.

PubMed

Grgurevic, Ivica; Puljiz, Zeljko; Brnic, Darko; Bokun, Tomislav; Heinzl, Renata; Lukic, Anita; Luksic, Boris; Kujundzic, Milan; Brkljacic, Boris

2015-11-01

To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH). Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT >3× upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria. Of 123 patients, LS was successfully measured in 79.7% and SS in 53.7%. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F ≥ 3, 10.8 kPa (AUC 0.954) for F ≥ 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0-4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index. RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC. • RT 2D-SWE is an accurate method for assessment of liver fibrosis. • RT 2D-SWE is applicable in 80% of patients with chronic viral hepatitis. • RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis. • Both liver and spleen stiffness increase with progression of liver fibrosis. • In cirrhosis, the difference between liver and spleen stiffness decreases.

A retrospective review of anesthesia and perioperative care in children with medium-chain acyl-CoA dehydrogenase deficiency.

PubMed

Allen, Claire; Perkins, Russell; Schwahn, Bernd

2017-01-01

Medium-chain acyl-CoA dehydrogenase deficiency is the most common genetically determined disorder of mitochondrial fatty acid oxidation. Decompensation can result in hypoglycemia, seizures, coma, and death but may be prevented by ensuring glycogen stores do not become depleted. Perioperative care is of interest as surgery, fasting, and infection may all trigger decompensation and the safety of anesthetic agents has been questioned. Current guidelines from the British Inherited Metabolic Disease Group advise on administering fluid containing 10% glucose during the perioperative period. To review the management of anesthesia and perioperative care for children with medium-chain acyl-CoA dehydrogenase deficiency and determine the frequency and nature of any complications. A retrospective review of case notes of children with medium-chain acyl-CoA dehydrogenase deficiency undergoing anesthesia between 1997 and 2014. Fourteen patients underwent 21 episodes of anesthesia. In 20 episodes, the patient received a glucose-containing fluid during their perioperative fast, of which eight received fluid containing 10% dextrose throughout the entire perioperative period. No episodes of hypoglycemia or decompensation occurred, but perioperative hyperglycemia occurred in five episodes. A propofol bolus was administered at induction in 16 episodes and volatile agents were administered for maintenance of anesthesia in all episodes without any observed complications. In one episode, delayed offset of atracurium was reported. Perioperative metabolic decompensation and hypoglycemia appear to be uncommon in children who are well and receive glucose supplementation. Hyperglycemia may occur as a consequence of surgery and glucose supplementation. Propofol boluses and volatile anesthetic agents were used without any apparent complications. Prolonged action of atracurium was reported in one case, suggesting that nondepolarizing muscle relaxants may have delayed offset in this patient group. We do not recommend any particular approach to anesthesia but would advise administering glucose supplementation according to current guidelines, frequent monitoring of blood glucose perioperatively, and monitoring of neuromuscular blockade. © 2016 John Wiley & Sons Ltd.

77 FR 24537 - Draft Standards and Best Practices for Interaction Between Medical Examiner/Coroner and Organ and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

... Best Practices for Interaction Between Medical Examiner/Coroner and Organ and Tissue Procurement... Committee Standards and Best Practices for Interaction Between Medical Examiner/Coroner Offices and Organ... coroner/medical examiner office representatives, law enforcement agencies, organizations, and all other...

Coronal holes as sources of solar wind

NASA Technical Reports Server (NTRS)

Nolte, J. T.; Krieger, A. S.; Timothy, A. F.; Gold, R. E.; Roelof, E. C.; Vaiana, G.; Lazarus, A. J.; Sullivan, J. D.; Mcintosh, P. S.

1976-01-01

We investigate the association of high-speed solar wind with coronal holes during the Skylab mission by: (1) direct comparison of solar wind and coronal X-ray data; (2) comparison of near-equatorial coronal hole area with maximum solar wind velocity in the associated streams; and (3) examination of the correlation between solar and interplanetary magnetic polarities. We find that all large near-equatorial coronal holes seen during the Skylab period were associated with high-velocity solar wind streams observed at 1 AU.

Repeated Structures Found After the Solar Maximum in the Butterfly Diagrams of Coronal Holes

NASA Astrophysics Data System (ADS)

Hofer, M. Y.; Storini, M.

2003-09-01

The influence of the solar cycle evolution on the coronal hole space-time distribution is well known, for polar as well as for equatorial isolated sources of high speed solar wind. Among them the long-lived coronal holes occurrence from the sunspot cycle 21 on is investigated, using the coronal hole catalogue based on HeI (1083 nm) observations (Sanchez-Ibarra and Barraza-Paredes). In at least these two solar cycles (n. 21 and n. 22) a similar structure in the latitude-time diagram of coronal holes is found. The area occurs shortly after the solar maximum at around ~35° heliolatitude and consists of over several Carrington Rotations stable coronal holes (>5 Carr. Rot.s). The diagonal disappears 2-3 years later at the helioequator. Furthermore, the analysis results in a close relation between long-lived isolated coronal holes and the soft X-class flares.

Coroners and death certification law reform: the Coroners and Justice Act 2009 and its aftermath.

PubMed

Luce, Tom

2010-10-01

After considering various different options for half a decade, the last Government legislated in 2009 to reform the England and Wales coroner and death certification systems. The Coroners and Justice Act 2009 provides for the creation of a new Chief Coroner post to lead the jurisdiction and for local medical examiners to oversee a new death certification scheme applicable equally to burial and cremation cases. In October 2010 the new Government announced that it judges the main coroner reform to be unaffordable, will not proceed with it and plans to repeal the provisions. It intends to implement the new death certification arrangements, which is welcome. The decision to abort the main coroner reform in spite of longstanding and widespread recognition of the need for major change is deplorable though in line with other failures over the last century to properly modernise this neglected service.

Disruption of a coronal streamer by an eruptive prominence and coronal mass ejection

NASA Technical Reports Server (NTRS)

Illing, R. M. E.; Hundhausen, A. J.

1986-01-01

The coronal mass ejection of August 18, 1980 is analyzed using images from the coronagraph on the Solar Maximum Mission (SMM) satellite. The event occurred at the site of a large coronal helmet streamer and evolved into the three-part structure of a bright frontal shell, followed by a relatively dark space surrounding a bright filamentary core as seen in many mass ejections of the SMM epoch. The bright core can be identified as material from a prominence whose eruption was observed from the ground. The mass of the frontal shell is equal to that of the coronal helmet streamer, indicating that the shell is the coronal material previously in the helmet streamer, displaced and set into motion by the erupting prominence and surrounding cavity. The mass ejected in the bright core (or prominences) is estimated to be 50 percent larger than the 'coronal' material in the front loop.

The Coronal Solar Magnetism Observatory

NASA Astrophysics Data System (ADS)

Tomczyk, S.; Landi, E.; Zhang, J.; Lin, H.; DeLuca, E. E.

2015-12-01

Measurements of coronal and chromospheric magnetic fields are arguably the most important observables required for advances in our understanding of the processes responsible for coronal heating, coronal dynamics and the generation of space weather that affects communications, GPS systems, space flight, and power transmission. The Coronal Solar Magnetism Observatory (COSMO) is a proposed ground-based suite of instruments designed for routine study of coronal and chromospheric magnetic fields and their environment, and to understand the formation of coronal mass ejections (CME) and their relation to other forms of solar activity. This new facility will be operated by the High Altitude Observatory of the National Center for Atmospheric Research (HAO/NCAR) with partners at the University of Michigan, the University of Hawaii and George Mason University in support of the solar and heliospheric community. It will replace the current NCAR Mauna Loa Solar Observatory (http://mlso.hao.ucar.edu). COSMO will enhance the value of existing and new observatories on the ground and in space by providing unique and crucial observations of the global coronal and chromospheric magnetic field and its evolution. The design and current status of the COSMO will be reviewed.

Main Properties of Forbush Effects Related to High-Speed Streams from Coronal Holes

NASA Astrophysics Data System (ADS)

Melkumyan, A. A.; Belov, A. V.; Abunina, M. A.; Abunin, A. A.; Eroshenko, E. A.; Oleneva, V. A.; Yanke, V. G.

2018-03-01

The IZMIRAN database of Forbush effects and interplanetary disturbances was used to study features of the action of high-speed solar wind streams from coronal holes on cosmic rays. Three hundred and fifty Forbush effects created by coronal holes without other actions were distinguished. The mean values and distributions have been found for different characteristics of events from this group and compared with all Forbush effects and Forbush effects caused by coronal ejections. Despite the great differences in high-speed streams from coronal holes, this group turned out to be more compact and uniform as compared to events related to coronal ejections. Regression dependences and correlation relations between different parameters of events for the studied groups have been obtained. It has been shown that Forbush effects caused by coronal ejections depend considerably more strongly on the characteristics of interplanetary disturbances as compared to Forbush effects related to coronal holes. This suggests a significant difference between the modulation mechanisms of Forbush effects of different types and corroborates earlier conclusions based on indirect data.

On the structure of solar and stellar coronae - Loops and loop heat transport

NASA Technical Reports Server (NTRS)

Litwin, Christof; Rosner, Robert

1993-01-01

We discuss the principal constraints on mechanisms for structuring and heating the outer atmospheres - the coronae - of stars. We argue that the essential cause of highly localized heating in the coronae of stars like the sun is the spatially intermittent nature of stellar surface magnetic fields, and that the spatial scale of the resulting coronal structures is related to the spatial structure of the photospheric fields. We show that significant constraints on coronal heating mechanisms derive from the observed variations in coronal emission, and, in addition, show that the observed structuring perpendicular to coronal magnetic fields imposes severe constraints on mechanisms for heat dispersal in the low-beta atmosphere. In particular, we find that most of commonly considered mechanisms for heat dispersal, such as anomalous diffusion due to plasma turbulence or magnetic field line stochasticity, are much too slow to account for the observed rapid heating of coronal loops. The most plausible mechanism appears to be reconnection at the interface between two adjacent coronal flux bundles. Based on a model invoking hyperresistivity, we show that such a mechanism naturally leads to dominance of isolated single bright coronal loops and to bright coronal plasma structures whose spatial scale transverse to the local magnetic field is comparable to observed dimensions of coronal X-ray loops.

The study of Equatorial coronal hole during maximum phase of Solar Cycle 21, 22, 23 and 24

NASA Astrophysics Data System (ADS)

Karna, Mahendra; Karna, Nishu

2017-08-01

The 11-year Solar Cycle (SC) is characterized by the periodic change in the solar activity like sunspot numbers, coronal holes, active regions, eruptions such as flares and coronal mass ejections. We study the relationship between equatorial coronal holes (ECH) and the active regions (AR) as coronal whole positions and sizes change with the solar cycle. We made a detailed study of equatorial coronal hole for four solar maximum: Solar Cycle 21 (1979,1980,1981 and 1982), Solar Cycle 22 (1989, 1990, 1991 and 1992), Solar Cycle 23 (1999, 2000, 2001 and 2002) and Solar Cycle 24 (2012, 2013, 2014 and 2015). We used publically available NOAA solar coronal hole data for cycle 21 and 22. We measured the ECH region using the EIT and AIA synoptic map for cycle 23 and 24. We noted that in two complete 22-year cycle of solar activity, the equatorial coronal hole numbers in SC 22 is greater than SC 21 and similarly, SC 24 equatorial coronal hole numbers are greater than SC 23. Moreover, we also compared the position of AR and ECH during SC 23 and 24. We used daily Solar Region Summary (SRS) data from SWPC/NOAA website. Our goal is to examine the correlation between equatorial holes, active regions, and flares.

Wing geometry of Culex coronator (Diptera: Culicidae) from South and Southeast Brazil

PubMed Central

2014-01-01

Background The Coronator Group encompasses Culex coronator Dyar & Knab, Culex camposi Dyar, Culex covagarciai Forattini, Culex ousqua Dyar, Culex usquatissimus Dyar, Culex usquatus Dyar and Culex yojoae Strickman. Culex coronator has the largest geographic distribution, occurring in North, Central and South America. Moreover, it is a potential vector-borne mosquito species because females have been found naturally infected with several arboviruses, i.e., Saint Louis Encephalitis Virus, Venezuelan Equine Encephalitis Virus and West Nile Virus. Considering the epidemiological importance of Cx. coronator, we investigated the wing shape diversity of Cx. coronator from South and Southeast Brazil, a method to preliminarily estimate population diversity. Methods Field-collected immature stages of seven populations from a large geographical area in Brazil were maintained in the laboratory to obtain both females and males linked with pupal and/or larval exuviae. For each individual female, 18 landmarks of left wings were marked and digitalized. After Procrustes superimposition, discriminant analysis of shape was employed to quantify wing shape variation among populations. The isometric estimator centroid size was calculated to assess the overall wing size and allometry. Results Wing shape was polymorphic among populations of Cx. coronator. However, dissimilarities among populations were higher than those observed within each population, suggesting populational differentiation in Cx. coronator. Morphological distances between populations were not correlated to geographical distances, indicating that other factors may act on wing shape and thus, determining microevolutionary patterns in Cx. coronator. Despite the population differentiation, intrapopulational wing shape variability was equivalent among all seven populations. Conclusion The wing variability found in Cx. coronator populations brings to light a new biological problem to be investigated: the population genetics of Cx. coronator. Because of differences in the male genitalia, we also transferred Cx. yojoae to the Apicinus Subgroup. PMID:24721508

DOE Office of Scientific and Technical Information (OSTI.GOV)

Antolin, P.; Vissers, G.; Shibata, K., E-mail: antolin@astro.uio.n, E-mail: g.j.m.vissers@astro.uio.n, E-mail: shibata@kwasan.kyoto-u.ac.j

Reported observations in H{alpha}, Ca II H, and K or other chromospheric lines of coronal rain trace back to the days of the Skylab mission. Corresponding to cool and dense plasma, coronal rain is often observed falling down along coronal loops in active regions. A physical explanation for this spectacular phenomenon has been put forward thanks to numerical simulations of loops with footpoint-concentrated heating, a heating scenario in which cool condensations naturally form in the corona. This effect has been termed 'catastrophic cooling' and is the predominant explanation for coronal rain. In this work, we further investigate the link betweenmore » this phenomenon and the heating mechanisms acting in the corona. We start by analyzing observations of coronal rain at the limb in the Ca II H line performed by the Hinode satellite, and derive interesting statistical properties concerning the dynamics. We then compare the observations with 1.5-dimensional MHD simulations of loops being heated by small-scale discrete events concentrated toward the footpoints (that could come, for instance, from magnetic reconnection events), and by Alfven waves generated at the photospheric level. Both our observation and simulation results suggest that coronal rain is a far more common phenomenon than previously thought. Also, we show that the structure and dynamics of condensations are far more sensitive to the internal pressure changes in loops than to gravity. Furthermore, it is found that if a loop is predominantly heated from Alfven waves, coronal rain is inhibited due to the characteristic uniform heating they produce. Hence, coronal rain may not only point to the spatial distribution of the heating in coronal loops but also to the agent of the heating itself. We thus propose coronal rain as a marker for coronal heating mechanisms.« less

Using coronal seismology to estimate the magnetic field strength in a realistic coronal model

NASA Astrophysics Data System (ADS)

Chen, F.; Peter, H.

2015-09-01

Aims: Coronal seismology is used extensively to estimate properties of the corona, e.g. the coronal magnetic field strength is derived from oscillations observed in coronal loops. We present a three-dimensional coronal simulation, including a realistic energy balance in which we observe oscillations of a loop in synthesised coronal emission. We use these results to test the inversions based on coronal seismology. Methods: From the simulation of the corona above an active region, we synthesise extreme ultraviolet emission from the model corona. From this, we derive maps of line intensity and Doppler shift providing synthetic data in the same format as obtained from observations. We fit the (Doppler) oscillation of the loop in the same fashion as done for observations to derive the oscillation period and damping time. Results: The loop oscillation seen in our model is similar to imaging and spectroscopic observations of the Sun. The velocity disturbance of the kink oscillation shows an oscillation period of 52.5 s and a damping time of 125 s, which are both consistent with the ranges of periods and damping times found in observations. Using standard coronal seismology techniques, we find an average magnetic field strength of Bkink = 79 G for our loop in the simulation, while in the loop the field strength drops from roughly 300 G at the coronal base to 50 G at the apex. Using the data from our simulation, we can infer what the average magnetic field derived from coronal seismology actually means. It is close to the magnetic field strength in a constant cross-section flux tube, which would give the same wave travel time through the loop. Conclusions: Our model produced a realistic looking loop-dominated corona, and provides realistic information on the oscillation properties that can be used to calibrate and better understand the result from coronal seismology. A movie associated with Fig. 1 is available in electronic form at http://www.aanda.org

Interspecific competition of a new invasive mosquito, Culex coronator, and two container mosquitoes, Aedes albopictus and Cx. quinquefasciatus (Diptera: Culicidae), across different detritus environments.

PubMed

Yee, D A; Skiff, J F

2014-01-01

The mosquito Culex coronator (Dyar and Knab) (Diptera: Culicidae) has undergone rapid range expansion in the United States since 2003, with its historical distribution in the southwest expanding eastward to the Atlantic coast. Although Cx. coronator nominally use small natural aquatic habitats for development, the use of containers (e.g., tires) makes it potentially important as container invasive. To determine the potential ecological effects of Cx. coronator on resident container species, we conducted a laboratory experiment to assess its competitive ability with two common tire-inhabiting species, Aedes albopictus (Skuse) and Culex quinquefasciatus (Say) (Diptera: Culicidae). Larvae were reared under a factorial design with each species alone and in combination (Cx. coronator + Ae. albopictus, Cx. coronator + Cx. quinquefasciatus) across three different resource environments (leaf detritus only, animal detritus only, animal + leaf). Mosquito performance (survival, adult male and female mass, and development time) was measured for each species across treatments. Female Cx. coronator developed slowest when grown with Ae. albopictus, or when grown with leaves only regardless of species combinations; similar patterns emerged for males although species effects were restricted to mass. Few differences were evident in performance for male and female Cx. coronator across detritus environments when grown with Cx. quinquefasciatus. Cx. quinquefasciatus did not vary in mass or development time in the presence of Cx. coronator compared with when grown alone. Ae. albopictus female mass was 15% lower in the presence of Cx. coronator. Survival of Cx. coronator was highest in animal and leaf detritus containers, although survival was generally lower when larvae were grown with Ae. albopictus. These findings suggest that the performance of Cx. coronator is similar to that of Cx. quinquefasciatus but it suffers in the presence of Ae. albopictus under some resource environments.

[Belated decompensation of an Imerslund-Grasbeck disease].

PubMed

Eitenschenck, L; Armari-Alla, C; Plantaz, D; Pagnier, A; Ducros, V

2005-12-01

Imerslund-Gräsbeck disease is an autosomic recessive disease characterised by a megaloblastic anemia due to a vitamin B12 deficiency and by a moderate proteinuria without kidney failure. It is caused by the malabsorption of Cobalamin-intrinsic factor complex bringing into play cubulin and other proteins (megaline, amnioless), some mutations of which are described at present. We report herein the observation of a child whose diagnosis was made belatedly during an acute decompensation with biological hemophagocytic syndrome. Its evolution was marked by the appearance of neurological disorders at the beginning of the vitamin B12 substitution treatment. These disorder regressed as the dosage was increase. The purpose of this observation is to recapitulate the main characteristics of this disease and to review the current data.

Acute organic brain syndrome: a review of 100 cases.

PubMed

Purdie, F R; Honigman, B; Rosen, P

1981-09-01

A retrospective review of 100 admissions to Denver General Hospital with a diagnosis of acute organic brain syndrome was conducted. A total of 44% of the patients were found to have a chronic organic brain syndrome with a superimposed acute insult which caused decompensation. The other 56% of patients developed acute organic brain syndromes de novo for a variety of reasons. The most common etiologic factors producing decompensation of the chronic OBS were infections (in 23%) and environmental changes (in 17%). The most common etiologic factor causing AOBS de novo was drug-related. In most cases, a toxicologic screen, lumbar puncture, and CT scan of the brain should be a part of the investigation of any patient with AOBS.

Lorcaserin Use in the Management of Morbid Obesity in a Pre-Liver Transplant Patient.

PubMed

Gutierrez, Julio A; Landaverde, Carmen; Wells, Jennifer T; Poordad, Fred

2016-07-01

Management of obesity and decompensated cirrhosis in those requiring liver transplantation (LT) is a challenging dilemma. Because of concerns for perioperative complications, many centers avoid transplant in those with a body mass index (BMI) greater than 40 kg/m(2) . Bariatric surgery is associated with increased risk attributable to complications of portal hypertension, including variceal rupture. Therefore, weight loss and LT options are limited. Several new classes of weight loss drugs are commercially available, including the anoretic, lorcaserin. This case illustrates the successful use of lorcaserin in a morbidly obese individual with decompensated cirrhosis evaluated for LT listing. (Hepatology 2016;64:301-302). © 2016 by the American Association for the Study of Liver Diseases.

Determination of Coronal Magnetic Fields from Vector Magnetograms

NASA Technical Reports Server (NTRS)

Mikic, Zoran

1997-01-01

During the course of the present contract we developed an 'evolutionary technique' for the determination of force-free coronal magnetic fields from vector magnetograph observations. The method can successfully generate nonlinear force- free fields (with non-constant-a) that match vector magnetograms. We demonstrated that it is possible to determine coronal magnetic fields from photospheric measurements, and we applied it to vector magnetograms of active regions. We have also studied theoretical models of coronal fields that lead to disruptions. Specifically, we have demonstrated that the determination of force-free fields from exact boundary data is a well-posed mathematical problem, by verifying that the computed coronal field agrees with an analytic force-free field when boundary data for the analytic field are used; demonstrated that it is possible to determine active-region coronal magnetic fields from photospheric measurements, by computing the coronal field above active region 5747 on 20 October 1989, AR6919 on 15 November 1991, and AR7260 on 18 August 1992, from data taken with the Stokes Polarimeter at Mees Solar Observatory, University of Hawaii; started to analyze active region 7201 on 19 June 1992 using measurements made with the Advanced Stokes Polarimeter at NSO/Sac Peak; investigated the effects of imperfections in the photospheric data on the computed coronal magnetic field; documented the coronal field structure of AR5747 and compared it to the morphology of footpoint emission in a flare, showing that the 'high- pressure' H-alpha footpoints are connected by coronal field lines; shown that the variation of magnetic field strength along current-carrying field lines is significantly different from the variation in a potential field, and that the resulting near-constant area of elementary flux tubes is consistent with observations; begun to develop realistic models of coronal fields which can be used to study flare trigger mechanisms; demonstrated that magnetic nonequilibrium can disrupt sheared coronal arcades, and that helmet streamers can disrupt, leading to coronal mass ejections. Our model has significantly extended the realism with which the coronal magnetic field can be inferred from actual observations. In a subsequent contract awarded by NASA, we have continued to apply and improve the evolutionary technique, to study the physical properties of active regions, and to develop theoretical models of magnetic fields.

A computed tomographic anatomical study of the upper sacrum. Application for a user guide of pelvic fixation with iliosacral screws in adult spinal deformity.

PubMed

Dubory, Arnaud; Bouloussa, Houssam; Riouallon, Guillaume; Wolff, Stéphane

2017-12-01

Widely used in traumatic pelvic ring fractures, the iliosacral (IS) screw technique for spino-pelvic fixation remains anecdotal in adult spinal deformity. The objective of this study was to assess anatomical variability of the adult upper sacrum and to provide a user guide of spino-pelvic fixation with IS screws in adult spinal deformity. Anatomical variability of the upper sacrum according to age, gender, height and weight was sought on 30 consecutive pelvic CT-scans. Thus, a user guide of spino-pelvic fixation with IS screws was modeled and assessed on ten CT-scans as described below. Two invariable landmarks usable during the surgical procedure were defined: point A (corresponding to the connector binding the IS screw to the spinal rod), equidistant from the first posterior sacral hole and the base of the S1 articular facet and 10 mm-embedded into the sacrum; point B (corresponding to the tip of the IS screw) located at the junction of the anterior third and middle third of the sacral endplate in the sagittal plane and at the middle of the endplate in the coronal plane. Point C corresponded to the intersection between the A-B direction and the external facet of the iliac wing. Three-dimensional reconstructions modeling the IS screw optimal direction according to the A-B-C straight line were assessed. Age had no effect on the anatomy of the upper sacrum. The distance between the base of the S1 superior articular facet and the top of the first posterior sacral hole was correlated with weight (r = 0.6; 95% CI [0.6-0.9]); p < 0.001). Sacral end-plate thickness increased for male patients (p < 0.001) and was strongly correlated with height (r = 0.6; 95% CI [0.29-0.75]); p < 0.001) and weight (r = 0.8; 95% CI [0.6-0.9]); p < 0.001). The thickness of the inferior part of the S1 vertebral body increased in male patients (p < 0.001). Other measured parameters slightly varied according to gender, height and weight. Simulating the described technique of pelvic fixation, no misplaced IS screw was found whatever the age, gender and morphologic parameters. This user guide of spinopelvic fixation with IS screws seems to be reliable and reproducible independently of age, gender and morphologic characteristics but needs clinical assessment. Level IV.

Large-Scale Coronal Heating, Clustering of Coronal Bright Points, and Concentration of Magnetic Flux

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Porter, J. G.; Hathaway, D. H.

1998-01-01

By combining quiet-region Fe XII coronal images from SOHO/EIT with magnetograms from NSO/Kitt Peak and from SOHO/MDI, we show that on scales larger than a supergranule the population of network coronal bright points and the magnetic flux content of the network are both markedly greater under the bright half of the quiet corona than under the dim half. These results (1) support the view that the heating of the entire corona in quiet regions and coronal holes is driven by fine-scale magnetic activity (microflares, explosive events, spicules) seated low in the magnetic network, and (2) suggest that this large-scale modulation of the magnetic flux and coronal heating is a signature of giant convection cells.

Coronal magnetic structure and the latitude and longitude distribution of energetic particles, 1-5 AU

NASA Technical Reports Server (NTRS)

Roelof, E. C.; Mitchell, D. G.

1979-01-01

The relation of the coronal magnetic field structure to the distribution of approximately 1 MeV protons in interplanetary space between 1 and 5 AU is discussed. After ordering the interplanetary data by its estimated coronal emission source location in heliographic coordinates, the multispacecraft measured proton fluxes are compared with coronal magnetic field structure infrared as observed in soft X-ray photographs and potential field calculations. Evidence for the propagation and possible acceleration of solar flare protons on high magnetic loop structure in the corona is presented. Further, it is shown that corotating proton flux enhancements are associated with regions of low coronal X-ray emission (including coronal holes), usually in association with solar wind stream structure.

Coronal disturbances and their terrestrial effects /Tutorial Lecture/

NASA Technical Reports Server (NTRS)

Rust, D. M.

1983-01-01

An assessment is undertaken of recent approaches to the prediction of the interplanetary consequences of coronal disturbances, with attention to the relationships of shocks and energetic particles to coronal transients, of proton events to gamma-ray and microwave bursts, of geomagnetic storms to filament eruptions, and of solar wind increases to the flare site magnetic field direction. A discussion is given concerning the novel phenomenon of transient coronal holes, which appear astride the long decay enhancements of 2-50 A X-ray emission following H-alpha filament eruptions. These voids in the corona are similar to long-lived coronal holes, which are the sources of high speed solar wind streams. The transient coronal holes may also be associated with transient solar wind speed increases.

Acceleration of the Fast Solar Wind by Solitary Waves in Coronal Holes

NASA Technical Reports Server (NTRS)

Ofman, Leon

2001-01-01

The purpose of this investigation is to develop a new model for the acceleration of the fast solar wind by nonlinear. time-dependent multidimensional MHD simulations of waves in solar coronal holes. Preliminary computational studies indicate that nonlinear waves are generated in coronal holes by torsional Alfv\\'{e}n waves. These waves in addition to thermal conduction may contribute considerably to the accelerate the solar wind. Specific goals of this proposal are to investigate the generation of nonlinear solitary-like waves and their effect on solar wind acceleration by numerical 2.5D MHD simulation of coronal holes with a broad range of plasma and wave parameters; to study the effect of random disturbances at the base of a solar coronal hole on the fast solar wind acceleration with a more advanced 2.5D MHD model and to compare the results with the available observations; to extend the study to a full 3D MHD simulation of fast solar wind acceleration with a more realistic model of a coronal hole and solar boundary conditions. The ultimate goal of the three year study is to model the, fast solar wind in a coronal hole, based on realistic boundary conditions in a coronal hole near the Sun, and the coronal hole structure (i.e., density, temperature. and magnetic field geometry,) that will become available from the recently launched SOHO spacecraft.

The observation of possible reconnection events in the boundary changes of solar coronal holes

NASA Technical Reports Server (NTRS)

Kahler, S. W.; Moses, J. Daniel

1989-01-01

Coronal holes are large scale regions of magnetically open fields which are easily observed in solar soft X-ray images. The boundaries of coronal holes are separatrices between large scale regions of open and closed magnetic fields where one might expect to observe evidence of solar magnetic reconnection. Previous studies by Nolte and colleagues using Skylab X-ray images established that large scale (greater than or equal to 9 x 10(4) km) changes in coronal hole boundaries were due to coronal processes, i.e., magnetic reconnection, rather than to photospheric motions. Those studies were limited to time scales of about one day, and no conclusion could be drawn about the size and time scales of the reconnection process at hole boundaries. Sequences of appropriate Skylab X-ray images were used with a time resolution of about 90 min during times of the central meridian passages of the coronal hole labelled Coronal Hole 1 to search for hole boundary changes which can yield the spatial and temporal scales of coronal magnetic reconnection. It was found that 29 of 32 observed boundary changes could be associated with bright points. The appearance of the bright point may be the signature of reconnection between small scale and large scale magnetic fields. The observed boundary changes contributed to the quasi-rigid rotation of Coronal Hole 1.

Acceleration of the Fast Solar Wind by Solitary Waves in Coronal Holes

NASA Technical Reports Server (NTRS)

Ofman, Leon

2000-01-01

The purpose of this investigation is to develop a new model for the acceleration of the fast solar wind by nonlinear, time-dependent multidimensional MHD simulations of waves in solar coronal holes. Preliminary computational studies indicate that solitary-like waves are generated in coronal holes nonlinearly by torsional Alfven waves. These waves in addition to thermal conduction may contribute considerably to the accelerate the solar wind. Specific goals of this proposal are to investigate the generation of nonlinear solitary-like waves and their effect on solar wind acceleration by numerical 2.5D MHD simulation of coronal holes with a broad range of plasma and wave parameters; to study the effect of random disturbances at the base of a solar coronal hole on the fast solar wind acceleration with a more advanced 2.5D MHD model and to compare the results with the available observations; to extend the study to a full 3D MHD simulation of fast solar wind acceleration with a more realistic model of a coronal hole and solar boundary conditions. The ultimate goal of the three year study is to model the fast solar wind in a coronal hole, based on realistic boundary conditions in a coronal hole near the Sun, and the coronal hole structure (i.e., density, temperature, and magnetic field geometry) that will become available from the recently launched SOHO spacecraft.

The Fate of Cool Material in the Hot Corona: Solar Prominences and Coronal Rain

NASA Astrophysics Data System (ADS)

Liu, Wei; Antolin, Patrick; Sun, Xudong; Vial, Jean-Claude; Berger, Thomas

2017-08-01

As an important chain of the chromosphere-corona mass cycle, some of the million-degree hot coronal mass undergoes a radiative cooling instability and condenses into material at chromospheric or transition-region temperatures in two distinct forms - prominences and coronal rain (some of which eventually falls back to the chromosphere). A quiescent prominence usually consists of numerous long-lasting, filamentary downflow threads, while coronal rain consists of transient mass blobs falling at comparably higher speeds along well-defined paths. It remains puzzling why such material of similar temperatures exhibit contrasting morphologies and behaviors. We report recent SDO/AIA and IRIS observations that suggest different magnetic environments being responsible for such distinctions. Specifically, in a hybrid prominence-coronal rain complex structure, we found that the prominence material is formed and resides near magnetic null points that favor the radiative cooling process and provide possibly a high plasma-beta environment suitable for the existence of meandering prominence threads. As the cool material descends, it turns into coronal rain tied onto low-lying coronal loops in a likely low-beta environment. Such structures resemble to certain extent the so-called coronal spiders or cloud prominences, but the observations reported here provide critical new insights. We will discuss the broad physical implications of these observations for fundamental questions, such as coronal heating and beyond (e.g., in astrophysical and/or laboratory plasma environments).

Relationship between coronal holes and high speed streams at L1: arrival times, durations, and intensities

NASA Astrophysics Data System (ADS)

Luo, B.; Bu, X.; Liu, S.; Gong, J.

2017-12-01

Coronal holes are sources of high-speed steams (HSS) of solar wind. When coronal holes appear at mid/low latitudes on the Sun, consequential HSSs may impact Earth and cause recurrent geospace environment disturbances, such as geomagnetic storms, relativistic electron enhancements at the geosynchronous orbit, and thermosphere density enhancements. Thus, it is of interests for space weather forecasters to predict when (arrival times), how long (time durations), and how severe (intensities) HSSs may impact Earth when they notice coronal holes on the sun and are anticipating their geoeffectiveness. In this study, relationship between coronal holes and high speed streams will be statistically investigated. Several coronal hole parameters, including passage times of solar central meridian, coronal hole longitudinal widths, intensities reflected by mean brightness, are derived using Solar Dynamics Observatory (SDO)/Atmospheric Imaging Assembly (AIA) images for years 2011 to 2016. These parameters will be correlated with in-situ solar wind measurements measured at the L1 point by the ACE spacecraft, which can give some results that are useful for space weather forecaster in predicting the arrival times, durations, and intensities of coronal hole high-speed streams in about 3 days advance.

CORONAL FOURIER POWER SPECTRA: IMPLICATIONS FOR CORONAL SEISMOLOGY AND CORONAL HEATING

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ireland, J.; McAteer, R. T. J.; Inglis, A. R., E-mail: jack.ireland@nasa.gov

The dynamics of regions of the solar corona are investigated using Atmospheric Imaging Assembly 171 Å and 193 Å data. The coronal emission from the quiet Sun, coronal loop footprints, coronal moss, and from above a sunspot is studied. It is shown that the mean Fourier power spectra in these regions can be described by a power law at lower frequencies that tails to a flat spectrum at higher frequencies, plus a Gaussian-shaped contribution that varies depending on the region studied. This Fourier spectral shape is in contrast to the commonly held assumption that coronal time series are well describedmore » by the sum of a long timescale background trend plus Gaussian-distributed noise, with some specific locations also showing an oscillatory signal. The implications of the observed spectral shape on the fields of coronal seismology and the automated detection of oscillations in the corona are discussed. The power-law contribution to the shape of the Fourier power spectrum is interpreted as being due to the summation of a distribution of exponentially decaying emission events along the line of sight. This is consistent with the idea that the solar atmosphere is heated everywhere by small energy deposition events.« less

New Evidence that Magnetoconvection Drives Solar–Stellar Coronal Heating

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tiwari, Sanjiv K.; Panesar, Navdeep K.; Moore, Ronald L.

2017-07-10

How magnetic energy is injected and released in the solar corona, keeping it heated to several million degrees, remains elusive. Coronal heating generally increases with increasing magnetic field strength. From a comparison of a nonlinear force-free model of the three-dimensional active region coronal field to observed extreme-ultraviolet loops, we find that (1) umbra-to-umbra coronal loops, despite being rooted in the strongest magnetic flux, are invisible, and (2) the brightest loops have one foot in an umbra or penumbra and the other foot in another sunspot’s penumbra or in unipolar or mixed-polarity plage. The invisibility of umbra-to-umbra loops is new evidencemore » that magnetoconvection drives solar-stellar coronal heating: evidently, the strong umbral field at both ends quenches the magnetoconvection and hence the heating. Broadly, our results indicate that depending on the field strength in both feet, the photospheric feet of a coronal loop on any convective star can either engender or quench coronal heating in the loop’s body.« less

Diagnostics of Coronal Magnetic Fields Through the Hanle Effect in UV and IR Lines

NASA Astrophysics Data System (ADS)

Raouafi, Nour E.; Riley, Pete; Gibson, Sarah; Fineschi, Silvano; Solanki, Sami K.

2016-06-01

The plasma thermodynamics in the solar upper atmosphere, particularly in the corona, are dominated by the magnetic field, which controls the flow and dissipation of energy. The relative lack of knowledge of the coronal vector magnetic field is a major handicap for progress in coronal physics. This makes the development of measurement methods of coronal magnetic fields a high priority in solar physics. The Hanle effect in the UV and IR spectral lines is a largely unexplored diagnostic. We use magnetohydrodynamic (MHD) simulations to study the magnitude of the signal to be expected for typical coronal magnetic fields for selected spectral lines in the UV and IR wavelength ranges, namely the HI Ly-α and the He I 10830 Å lines. We show that the selected lines are useful for reliable diagnosis of coronal magnetic fields. The results show that the combination of polarization measurements of spectral lines with different sensitivities to the Hanle effect may be most appropriate for deducing coronal magnetic properties from future observations.

Dynamic simulation of coronal mass ejections

NASA Technical Reports Server (NTRS)

Steinolfson, R. S.; Wu, S. T.

1980-01-01

A model is developed for the formation and propagation through the lower corona of the loop-like coronal transients in which mass is ejected from near the solar surface to the outer corona. It is assumed that the initial state for the transient is a coronal streamer. The initial state for the streamer is a polytropic, hydrodynamic solution to the steady-state radial equation of motion coupled with a force-free dipole magnetic field. The numerical solution of the complete time-dependent equations then gradually approaches a stationary coronal streamer configuration. The streamer configuration becomes the initial state for the coronal transient. The streamer and transient simulations are performed completely independent of each other. The transient is created by a sudden increase in the pressure at the base of the closed-field region in the streamer configuration. Both coronal streamers and coronal transients are calculated for values of the plasma beta (the ratio of thermal to magnetic pressure) varying from 0.1 to 100.

The Coronal Monsoon: Thermal Nonequilibrium Revealed by Periodic Coronal Rain

NASA Astrophysics Data System (ADS)

Auchère, Frédéric; Froment, Clara; Soubrié, Elie; Antolin, Patrick; Oliver, Ramon; Pelouze, Gabriel

2018-02-01

We report on the discovery of periodic coronal rain in an off-limb sequence of Solar Dynamics Observatory/Atmospheric Imaging Assembly images. The showers are co-spatial and in phase with periodic (6.6 hr) intensity pulsations of coronal loops of the sort described by Auchère et al. and Froment et al. These new observations make possible a unified description of both phenomena. Coronal rain and periodic intensity pulsations of loops are two manifestations of the same physical process: evaporation/condensation cycles resulting from a state of thermal nonequilibrium. The fluctuations around coronal temperatures produce the intensity pulsations of loops, and rain falls along their legs if thermal runaway cools the periodic condensations down and below transition-region temperatures. This scenario is in line with the predictions of numerical models of quasi-steadily and footpoint heated loops. The presence of coronal rain—albeit non-periodic—in several other structures within the studied field of view implies that this type of heating is at play on a large scale.

Changes of the boot-shaped coronal hole boundary during Whole Sun Month near sunspot minimum

NASA Astrophysics Data System (ADS)

Zhao, X. P.; Hoeksema, J. T.; Scherrer, P. H.

1999-05-01

The August 27, 1996, boot-shaped coronal hole is shown to rotate nearly rigidly at a rate of 13.25°/day, greater than the equatorial rotation rate of bipolar magnetic regions such as active regions and plages. The day-to-day variation of the coronal hole border is determined by comparing the rigid rotation projection of the disk-center hole boundary to coronal hole boundaries observed in successive daily coronal images. To determine the influence of the changing photospheric field on the location of the coronal hole boundary, a better approximation of the instantaneous global magnetic field distribution is developed and used as input to a potential-field source-surface model to compute the foot-point areas of open field lines. Day-to-day variations of the coronal hole boundary may be caused by changes of the magnetic field and plasma properties in the corona, as well as by the changing photospheric field.

Multidimensional Modeling of Coronal Rain Dynamics

NASA Astrophysics Data System (ADS)

Fang, X.; Xia, C.; Keppens, R.

2013-07-01

We present the first multidimensional, magnetohydrodynamic simulations that capture the initial formation and long-term sustainment of the enigmatic coronal rain phenomenon. We demonstrate how thermal instability can induce a spectacular display of in situ forming blob-like condensations which then start their intimate ballet on top of initially linear force-free arcades. Our magnetic arcades host a chromospheric, transition region, and coronal plasma. Following coronal rain dynamics for over 80 minutes of physical time, we collect enough statistics to quantify blob widths, lengths, velocity distributions, and other characteristics which directly match modern observational knowledge. Our virtual coronal rain displays the deformation of blobs into V-shaped features, interactions of blobs due to mostly pressure-mediated levitations, and gives the first views of blobs that evaporate in situ or are siphoned over the apex of the background arcade. Our simulations pave the way for systematic surveys of coronal rain showers in true multidimensional settings to connect parameterized heating prescriptions with rain statistics, ultimately allowing us to quantify the coronal heating input.

[Surface stress analysis of distal extension removable partial denture retained with two types of semi-precision attachments].

PubMed

Wang, Y; Mi, N; Qing, F; Liu, F; Chen, J

2001-10-01

The aims of this study are to analyze the surface stress of the periodontal supporting bone of the bilateral distol extension removable partial denture which is retained by using intra-coronal or extra-coronal semi-precision attachment, and to characterize the biomechanics of these two designs by using a strain gauge. A fresh human mandible specimen with 76|67 missing and six bilateral partial removable denture retained with six semi-precision attachments were made, including three attachments with intra-coronal studs and three attachments with extra-coronal vertical bars. A total of six 45 degrees rosette strain gauges were bonded at six prepared points on the surface of the mandible to measure the surface stress, including the middle point between 76 of the buccal edentulous alveolar crest area under the denture base verge(point 1), the distal buccal cervix of 5 (point 2), the buccal apical area of 5 (point 3), the buccal middle area of 34 roots (point 4, 5), the lingual middle area of 5 root (point 6). The static loads of 14N, 28N and 42N were applied vertically, buccally 45 degrees, lingually 45 degrees at the middle point of the 6|6 occlusal surface. The micro-strain was recorded, and the maximal/minimal principle stresses were calculated for each RPD and each point. The stress characteristics of these two types of attachments were compared and analyzed. In most situations, the stress of these two semi-precision attachments showed significant differences. The vertical load: The stress values of these intra-coronal and extra-coronal attachments at points 1, 2, 3, 4, 6 differed significantly(P < 0.05), including points 1, 2, (sigma intra < sigma extra) and points 3, 4, 6(sigma intra > sigma extra). Buccal loads: The stress values of these intra-coronal and extra-coronal attachments at points 1, 2, 3, 4, 5 differed significantly(P < 0.05), including points 1, 2(sigma intra < sigma extra) and points 3, 4, 5(sigma intra > sigma extra). Lingual loads: The stress values of these intra-coronal and extra-coronal attachments at points 2, 3, 4, 6 differed significantly (P < 0.05, sigma intra > sigma extra). The intra-coronal attachment generally produced higher stress at the site of the alveolar bone around the abutment than the extra-coronal attachment, but extra-coronal attachment produced higher stress at the edentulous alveolar crest and the distal cervical alveolar bone of the distal abutment than the intra-coronal attachment. The intra-coronal attachment is suggested to be applied in some cases that the periodontal condition of distal abutment was good, and the extra-coronal attachment is suggested to be used in some cases that the condition of the edentulous alveolar crest is fairly good, while the periodontal condition of the distal abutment was relatively weak.

Mayo Registry for Telemetry Efficacy in Arrest Study: An Assessment of the Utility of Telemetry in Predicting Clinical Decompensation.

PubMed

Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Harris, Dana; Bosworth, Veronica; Dumitrascu, Adrian; Clark, Brooke; Vadeboncoeur, Tyler; Kusumoto, Fred; Bowman, Cammi; Burton, M Caroline

2018-03-01

Our study assesses the utility of telemetry in identifying decompensation in patients with documented cardiopulmonary arrest. A retrospective review of inpatients who experienced a cardiopulmonary arrest from May 1, 2008, until June 30, 2014, was performed. Telemetry records 24 hours prior to and immediately preceding cardiopulmonary arrest were reviewed. Patient subanalyses based on clinical demographics were made as well as analyses of survival comparing patients with identifiable rhythm changes in telemetry to those without. Of 242 patients included in the study, 75 (31.0%) and 110 (45.5%) experienced telemetry changes at the 24-hour and immediately preceding time periods, respectively. Of the telemetry changes, the majority were classified as nonmalignant (n = 50, 66.7% and n = 66, 55.5% at 24 hours prior and immediately preceding, respectively). There was no difference in telemetry changes between intensive care unit (ICU) and non-ICU patients and among patients stratified according to the American Heart Association telemetry indications. There was no difference in survival when comparing patients with telemetry changes immediately preceding and at 24 hours prior to an event (n = 30, 27.3% and n = 15, 20.0%) to those without telemetry changes during the same periods (n = 27, 20.5% and n = 42, 25.2%; P = .22 and .39). Telemetry has limited utility in predicting clinical decompensation in the inpatient setting.

[Ultrafiltration versus intravenous diuretics in decompensated heart failure: a meta-analysis of randomized controlled trials].

PubMed

Zhao, Yu-liang; Zhang, Ling; Yang, Ying-ying; Tang, Yi; Liu, Fang; Fu, Ping

2013-08-13

To explore whether ultrafiltration is superior to intravenous diuretics in ameliorating fluid overload and preserving renal functions in decompensated heart failure patients. By searching in Pubmed, Cochrane Library, Embase, Springer, WanFang, CQVIP, CNKI and CBM database as well as related Chinese journals, qualified randomized controlled trials (RCTs) were included for meta-analysis by Revman 5.0 and STATA 10.0. Six RCTs were included with 241 patients in ultrafiltration group and 240 patients in intravenous diuretics group. Pooled analyses demonstrated ultrafiltration was superior to intravenous diuretics in the aspects of weight loss (WMD = 1.44 kg, 95%CI:0.33-2.55 kg, P = 0.01) and fluid removal (WMD = 1.23 kg, 95%CI:0.63-1.82 kg, P < 0.01) while no significant difference was observed in serum creatinine level (WMD = -5.70 µmol/L, 95%CI: -35.02-23.61 µmol/L, P = 0.70), serum creatinine change from baseline (WMD = 4.74 µmol/L, 95%CI:-13.72-23.20 µmol/L, P = 0.61), mortality (RR = 1.09, 95%CI: 0.69-1.70, P = 0.72) or rehospitalization (RR = 0.92, 95%CI:0.53-1.61, P = 0.78). For decompensated heart failure patients, ultrafiltration is superior to intravenous diuretics in mitigating fluid overload. No intergroup difference was observed in renal function preservation, mortality or rehospitalization.

The use of renal replacement therapy in acute decompensated heart failure.

PubMed

Udani, Suneel M; Murray, Patrick T

2009-01-01

The worsening of renal function in the context of decompensated heart failure is an increasingly common clinical scenario, dubbed the cardiorenal syndrome. Its development is not completely understood; however, it results from the hemodynamic and neurohumoral alterations that occur in the setting of left ventricular pressure and volume overload with poor cardiac output. Diuretics have been the mainstay of treatment; however, they are often unsuccessful in reversing the vicious cycle of volume overload, worsening cardiac function, and azotemia. Renal replacement therapy (RRT) in the form of isolated or continuous ultrafiltration (UF) with or without a component of solute clearance (hemofiltration or hemodialysis) has been increasingly utilized as a therapeutic tool in this setting. Initial clinical trial data on the use of UF have demonstrated promising cardiac outcomes with regard to fluid removal and symptom relief without worsening renal function. The addition of a component of solute clearance may provide additional benefits in these patients with varying degrees of renal impairment. The exact clinical setting in which the various forms of RRT should be applied as initial or early therapy for acute decompensated heart failure (ADHF) remains unknown. More research examining the use of RRT in ADHF is necessary; however, it appears that the patients with the most severe clinical presentations have the best chance of benefiting from the early application of RRT.

Assessment of left ventricular function using pulsed tissue Doppler imaging in healthy dogs and dogs with spontaneous mitral regurgitation.

PubMed

Teshima, Kenji; Asano, Kazushi; Sasaki, Yukie; Kato, Yuka; Kutara, Kenji; Edamura, Kazuya; Hasegawa, Atsuhiko; Tanaka, Shigeo

2005-12-01

Pulsed tissue Doppler imaging (pulsed TDI) has been demonstrated to be useful for the estimation of left ventricular (LV) systolic and diastolic functions in various human cardiac diseases. The objectives of this study were to investigate the relationship between pulsed TDI and LV function by using cardiac catheterization in healthy dogs and to evaluate the clinical usefulness of pulsed TDI in dogs with spontaneous mitral regurgitation (MR). The peak early diastolic velocity (E'), peak atrial systolic velocity (A'), and peak systolic velocity (S') were detectable in the velocity profiles of the mitral annulus in all the dogs. In the healthy dogs, S' and E' were correlated with LV peak +dP/dt and -dP/dt, respectively. E' was lower in dogs with MR than in dogs without cardiac diseases. E/E' in the MR dogs with decompensated heart failure was significantly increased in comparison with those with compensated heart failure. The sensitivity and specificity of the E/E' cutoff value of 13.0 for identifying decompensated heart failure were 80% and 83%, respectively. In addition, E/E' was significantly correlated with the ratio of left atrial to aortic diameter. These findings suggest that canine pulsed TDI can be applied clinically for estimation of cardiac function and detection of cardiac decompensation and left atrial volume overload in dogs with MR.

Functional liver image guided hepatic therapy (FLIGHT) with hepatobiliary iminodiacetic acid (HIDA) scans.

PubMed

Long, David E; Tann, Mark; Huang, Ke Colin; Bartlett, Gregory; Galle, James O; Furukawa, Yukie; Maluccio, Mary; Cox, John A; Kong, Feng-Ming Spring; Ellsworth, Susannah G

2018-05-01

Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated. We studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT. The following dosimetric endpoints were compared for FLIGHT versus standard SBRT planning: functional residual capacity <15 Gy (FRC 15 HIDA), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation. Compared with standard planning, FLIGHT significantly improved FRC 15 HIDA (mean improvement: 5.3%) as well as MLD, EUD, and FEUD (P < .05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m 2 , FRC 15 HIDA <2.11%/min/m 2 , and MELD ≥11 (P < .05). FLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning. Copyright © 2018. Published by Elsevier Inc.

[Inherited metabolic disorders in pediatric emergency services].

PubMed

Molina Gutiérrez, M A; López López, R; Morais López, A; Bueno Barriocanal, M; Martínez Ojinaga Nodal, E; Alcolea Sánchez, A M; García García, S

2015-06-01

Advances in the early diagnosis and treatment have led to improved survival, and a better quality of life for patients with inherited metabolic disorders (IMD). They can go to the Pediatric Emergency Services (PES) for reasons unrelated to their disease. The purpose of this study was to review the characteristics of visitors to the PES of these patients in a tertiary hospital. A retrospective observational study was conducted on all visits from patients with IMD to the PES of Hospital Infantil La Paz over the years 2011 and 2012. IMD type, complaint, duration of symptoms, need for hospitalization, and presence of metabolic decompensation was recorded. A total of 107 visits were analyzed, with the most frequent reason being for consultation of respiratory processes (30.8%). When the consultation was for vomiting, patients with protein-related disorders were those who delayed less in going to PES. One third of visitors were admitted, half of them due to metabolic decompensation of the underlying pathology. Patients with IMD came to PES for many different reasons, which in some cases were the cause or consequence of an acute metabolic decompensation that led to hospitalization. Being diseases with low prevalence, it would be useful to have diagnostic and therapeutic protocols in order to provide optimal care. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Determination of coronal magnetic fields from vector magnetograms

NASA Technical Reports Server (NTRS)

Mikic, Zoran

1992-01-01

The determination of coronal magnetic fields from vector magnetograms, including the development and application of algorithms to determine force-free coronal fields above selected observations of active regions is studied. Two additional active regions were selected and analyzed. The restriction of periodicity in the 3-D code which is used to determine the coronal field was removed giving the new code variable mesh spacing and is thus able to provide a more realistic description of coronal fields. The NOAA active region AR5747 of 20 Oct. 1989 was studied. A brief account of progress during the research performed is reported.

Constraints on active region coronal heating properties from observations and modeling of chromospheric, transition region, and coronal emission

NASA Astrophysics Data System (ADS)

Testa, P.; Polito, V.; De Pontieu, B.; Carlsson, M.; Reale, F.; Allred, J. C.; Hansteen, V. H.

2017-12-01

We investigate coronal heating properties in active region cores in non-flaring conditions, using high spatial, spectral, and temporal resolution chromospheric/transition region/coronal observations coupled with detailed modeling. We will focus, in particular, on observations with the Interface Region Imaging Spectrograph (IRIS), joint with observations with Hinode (XRT and EIS) and SDO/AIA. We will discuss how these observations and models (1D HD and 3D MHD, with the RADYN and Bifrost codes) provide useful diagnostics of the coronal heating processes and mechanisms of energy transport.

Analysis of cervical kyphosis and spinal balance in young idiopathic scoliosis patients classified by the apex of thoracic kyphosis.

PubMed

Ito, Kenyu; Imagama, Shiro; Ito, Zenya; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Tsushima, Mikito; Ishikawa, Yoshimoto; Matsumoto, Akiyuki; Nishida, Yoshihiro; Ishiguro, Naoki

2016-10-01

Sagittal balance has recently been the focus of studies aimed at understanding the correction force required for both coronal and sagittal malalignment. However, the correlation between cervical kyphosis and sagittal balance in AIS patients has yet to be thoroughly investigated. This study aimed to clarify the correlation between cervical alignment and spinal balance in patients with adolescent idiopathic scoliosis (AIS). Here, we hypothesized that cervical kyphosis patients can be classified into groups by the apex of thoracic kyphosis. This study included 92 AIS patients (84 females, 8 males; mean age, 15.1 years). Patients were divided into the cervical lordosis (CL), cervical sigmoid (CS), or cervical kyphosis (CK) groups and further classified according to the apex of thoracic kyphosis into High (above T3), Middle (T4-T9), and Low (below T10) groups. There were 17 (18.5 %), 22 (23.9 %), and 53 (57.6 %) patients with CL, CS, and CK, respectively. In the CK group, 13 had CK-High, 35 had CK-Middle, and 5 had CK-Low. The C7 sagittal vertical axis (C7SVA) measurements were most backward in CK-High and most forward in CK-Low. The T5-12 kyphosis (TK) measurement was significantly lower in CK-High. Most AIS patients had kyphotic cervical alignment. Patients with CK can be classified as having CK-High, CK-Middle, or CK-Low according to the apex of thoracic kyphosis. CK-High is due to thoracic hypokyphosis with a backward balanced C7SVA. CK-Middle is well-balanced cervical kyphosis. CK-Low has forward-bent global kyphosis of the cervicothoracic spine that positioned the C7SVA forward.

Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications.

PubMed

Fu, Kai-Ming G; Smith, Justin S; Burton, Douglas C; Kebaish, Khaled M; Shaffrey, Christopher I; Schwab, Frank; Lafage, Virginie; Arlet, Vincent; Hostin, Richard; Boachie, Oheneba; Akbarnia, Behrooz; Bess, Shay

2014-01-01

To evaluate the outcomes and complications of patients with adult spinal deformity treated in a primary versus revision fashion with long fusions to the sacropelvis. A retrospective review was performed of a multicenter consecutive series of patients with adult spinal deformity requiring fusion to the sacropelvis, either primarily or as revision, with minimum 2-year follow-up. Clinical (Scoliosis Research Society [SRS] 22 questionnaire) and radiographic parameters (including sagittal vertical axis [SVA], coronal Cobb angle, lumbar lordosis, and thoracic kyphosis) were compared between the groups. There were 63 patients who met inclusion criteria; mean patient age was 51.9 years, and mean follow-up was 43 months. Patients requiring primary fusion were older (58.0 years vs. 49.5 years, P=0.01) and at baseline had a lower SVA (2.1 cm vs. 6.8 cm, P=0.01) and greater thoracolumbar Cobb angle (51.2 degrees vs. 36.5 degrees, P=0.003). At last follow-up, patients undergoing primary fusion and patients undergoing revision treatment had similar SVA (2.9 cm vs. 1.8 cm, P=0.32) and lumbar lordosis (-42.3 degrees vs. -43.4 degrees, P=0.82); patients undergoing revision treatment had more favorable SRS 22 scores (3.65 vs. 3.14, P=0.005). There was no statistical difference in complication rates between the groups (44.4% vs. 35%, P=0.68). Patients requiring revision extension of instrumentation to the pelvis can be treated with the same expectation of radiographic and clinical success as patients treated primarily with fusion to the sacropelvis. The complication rate for the revision procedure is not insignificant and may be similar to a primary procedure that includes pelvic fixation. Copyright © 2014 Elsevier Inc. All rights reserved.

Correction Capability in the 3 Anatomic Planes of Different Pedicle Screw Designs in Scoliosis Instrumentation.

PubMed

Wang, Xiaoyu; Aubin, Carl-Eric; Coleman, John; Rawlinson, Jeremy

2017-05-01

Computer simulations to compare the correction capabilities of different pedicle screws in adolescent idiopathic scoliosis (AIS) instrumentations. To compare the correction and resulting bone-screw forces associated with different pedicle screws in scoliosis instrumentations. Pedicle screw fixation is widely used in surgical instrumentation for spinal deformity treatment. Screw design, correction philosophies, and surgical techniques are constantly evolving to achieve better control of the vertebrae and correction of the spinal deformity. Yet, there remains a lack of biomechanical studies that quantify the effects and advantages of different screw designs in terms of correction kinematics. The correction capabilities of fixed-angle, multiaxial, uniaxial, and saddle axial screws were kinematically analyzed, simulated, and compared. These simulations were based on the screw patterns and correction techniques proposed by 2 experienced surgeons for 2 AIS cases. Additional instrumentations were assessed to compare the correction and resulting bone-screw forces associated with each type of screw. The fixed-angle, uniaxial and saddle axial screws had similar kinematic behavior and performed better than multiaxial screws in the coronal and transverse planes (8% and 30% greater simulated corrections, respectively). Uniaxial and multiaxial screws were less effective than fixed-angle and saddle axial screws in transmitting compression/distraction to the anterior spine because of their sagittal plane mobility between the screw head and shank. Only the saddle axial screws allow vertebra angle in the sagittal plane to be independently adjusted. Pedicle screws of different designs performed differently for deformity corrections or for compensating screw placement variations in different anatomic planes. For a given AIS case, screw types should be determined based on the particular instrumentation objectives, the deformity's stiffness and characteristics so as to make the best of the screw designs.

Evaluation of time required for recontamination of coronally sealed canals medicated with calcium hydroxide and chlorhexidine.

PubMed

Gomes, B P F A; Sato, E; Ferraz, C C R; Teixeira, F B; Zaia, A A; Souza-Filho, F J

2003-09-01

To determine in vitro the time required for recontamination of coronally sealed canals medicated with either calcium hydroxide (CaOH2), 2% chlorhexidine gel (CG) or with a combination of both. Eighty intact, caries-free, premolar teeth with straight roots and mature apices were selected for the study. After biomechanical preparation of 75 teeth, they were randomly divided into nine groups according to the intracanal medicament and the coronal seal with 'Intermediate Restorative Material' (IRM) as follows: (i) 10 teeth medicated with CG, coronally unsealed; (ii) 10 teeth medicated with CaOH2, coronally unsealed; (iii) 10 teeth medicated with CaOH2 + CG, coronally unsealed; (iv) 10 teeth medicated with CG + coronal seal; (v) 10 teeth medicated with CaOH2 + coronal seal; (vi) 10 teeth medicated with CG + CaOH2 + coronal seal; (vii) 10 teeth without intracanal medicament and coronally sealed; (viii) 5 teeth without intracanal medicament and coronally unsealed, used as the positive control group (PC); (ix) 5 teeth with intact crowns used as the negative control group (NC). Glass flasks were filled with Brain Heart Infusion broth (BHI), so that only the root apex was in contact with the broth, while the crown was immersed in human saliva + BHI (3:1). The flasks were then incubated at 37 degrees C in an atmosphere of 10% CO2, and microbial growth was checked daily. All specimens of the PC showed contamination within 1 day of incubation, while the NC showed no evidence of broth turbidity. Recontamination was detected after an average time of 3.7 days in the unsealed canals medicated with CG, 1.8 days in the group medicated with CaOH2 and 2.6 days in the group medicated with CaOH2 + CG. When the crowns were sealed with IRM, recontamination was detected within 13.5 days in the canals medicated with CG, after 17.2 days in the group medicated with CaOH2 and after 11.9 days in the group medicated with CG + CaOH2. The group with no medication, but sealed with IRM, showed recontamination after 8.7 days. There were statistically significant differences between the teeth with or without coronal seal (P<0.05). The coronal seal delayed but did not prevent leakage of microorganisms. There was no difference between the various medicaments.

Magnetohydrodynamic Simulation of a Streamer Beside a Realistic Coronal Hole

NASA Technical Reports Server (NTRS)

Suess, S. T.; Wu, S. T.; Wang, A. H.; Poletto, G.

1994-01-01

Existing models of coronal streamers establish their credibility and act as the initial state for transients. The models have produced satisfactory streamer simulations, but unsatisfactory coronal hole simulations. This is a consequence of the character of the models and the boundary conditions. The models all have higher densities in the magnetically open regions than occur in coronal holes (Noci, et al., 1993).

Coronal Heating and the Magnetic Flux Content of the Network

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Porter, J. G.; Hathaway, D. H.; Rose, M. Franklin (Technical Monitor)

2001-01-01

Previously, from analysis of SOHO coronal images in combination with Kitt Peak magnetograms, we found that the quiet corona is the sum of two components: the large-scale corona and the coronal network. The large-scale corona consists of all coronal-temperature (T approximately 10(exp 6) K) structures larger than supergranules (greater than approximately 30,000 kilometers). The coronal network (1) consists of all coronal-temperature structures smaller than supergranules, (2) is rooted in and loosely traces the photospheric magnetic network, (3) has its brightest features seated on polarity dividing lines (neutral lines) in the network magnetic flux, and (4) produces only about 5% of the total coronal emission in quiet regions. The heating of the coronal network is apparently magnetic in origin. Here, from analysis of EIT coronal images of quiet regions in combination with magnetograms of the same quiet regions from SOHO/MDI and from Kitt Peak, we examine the other 95% of the quiet corona and its relation to the underlying magnetic network. We find: (1) Dividing the large-scale corona into its bright and dim halves divides the area into bright "continents" and dark "oceans" having spans of 2-4 supergranules. (2) These patterns are also present in the photospheric magnetograms: the network is stronger under the bright half and weaker under the dim half. (3) The radiation from the large-scale corona increases roughly as the cube root of the magnetic flux content of the underlying magnetic network. In contrast, the coronal radiation from an active region increases roughly linearly with the magnetic flux content of the active region. We assume, as is widely held, that nearly all of the large-scale corona is magnetically rooted in the network. Our results suggest that either the coronal heating in quiet regions has a large non-magnetic component, or, if the heating is predominantly produced via the magnetic field, the mechanism is significantly different than in active regions.

Elongated Coronal Hole

NASA Image and Video Library

2016-03-24

NASA Solar Dynamics Observatory shows a long coronal hole has rotated so that was temporarily facing right towards Earth Mar. 23-25, 2016. Coronal holes appear dark when viewed in some wavelengths of extreme ultraviolet light.

Isola spinal instrumentation system for idiopathic scoliosis.

PubMed

Benli, I T; Akalin, S; Aydin, E; Baz, A; Citak, M; Kiş, M; Duman, E

2001-01-01

Since the definition of three-dimensional components of the scoliotic deformity, there have been important improvements in the surgical treatment of the problem. A derotation maneuver was proposed as a treatment option with CD instrumentation, but the reports of imbalance and decompensation with this system repopularized sublaminar wiring and translation as a corrective maneuver. Isola spinal instrumentation is one of the modern systems that utilizes vertebral translation instead of rod rotation. This study analyzes the results of 24 patients with idiopathic scoliosis who had been followed up for at least 2 years, and were surgically treated with titanium Isola Spinal Instrumentation in the Department of Orthopaedics and Traumatology, Ankara Social Security Hospital. Patients were grouped according to the King-Moe classification. Patients with type III, IV or V curves received only posterior instrumentation while this procedure followed anterior release and discectomy in the same session in patients with type I or II curves. A translation maneuver was utilized in the correction of scoliotic curves using the cantilever technique, either alone or supplemented by sublaminar wiring with Songer multifilament titanium cables. This study aimed to elucidate the effects of this technique in the frontal and sagittal plane curves and the trunk balance. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of stable vertebra (SS), and shift of head (SH) in vertebral units (VU). The postoperative correction was significant in the frontal plane for all types of curves (p < 0.05). The postoperative correction was 80.9% +/- 9.5% in type III curves. Overall, the mean Cobb angle of the major curve value in the frontal plane was 66.9 degrees +/- 18.8 degrees, and it was corrected by 62.8% +/- 20.1%. The correction loss of Cobb angles in the frontal plane was 5.4 degrees +/- 5.5 degrees at the last follow-up visit. A normal physiologic thoracic contour (30 degrees - 50 degrees) was achieved in 83.3% of the patients and normal lumbar contour (40 degrees - 60 degrees) in 66.7% of the patients in the sagittal plane. The correction was found to be significant in all balance values (p < 0.05). The postoperative correction in LT values correlated with the correction of the Cobb angle values in the frontal plane. All patients had complete balance (SH: 0 VU and SS: 0 VU) or balanced curves (0 VU < SH, SS < 0.5 VU).Finally, the study concluded that the translation maneuver, especially when used with the cantilever technique, resulted in high correction rates in the frontal plane. Additionally, the technique was also successful in obtaining normal sagittal contours and correcting balance values.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Antolin, P.; Verwichte, E., E-mail: patrick.antolin@astro.uio.no, E-mail: erwin.verwichte@warwick.ac.uk

The condensations composing coronal rain, falling down along loop-like structures observed in cool chromospheric lines such as H{alpha} and Ca II H, have long been a spectacular phenomenon of the solar corona. However, considered a peculiar sporadic phenomenon, it has not received much attention. This picture is rapidly changing due to recent high-resolution observations with instruments such as the Hinode/Solar Optical Telescope (SOT), CRISP of the Swedish 1-m Solar Telescope, and the Solar Dynamics Observatory. Furthermore, numerical simulations have shown that coronal rain is the loss of thermal equilibrium of loops linked to footpoint heating. This result has highlighted themore » importance that coronal rain can play in the field of coronal heating. In this work, we further stress the importance of coronal rain by showing the role it can play in the understanding of the coronal magnetic field topology. We analyze Hinode/SOT observations in the Ca II H line of a loop in which coronal rain puts in evidence in-phase transverse oscillations of multiple strand-like structures. The periods, amplitudes, transverse velocities, and phase velocities are calculated, allowing an estimation of the energy flux of the wave and the coronal magnetic field inside the loop through means of coronal seismology. We discuss the possible interpretations of the wave as either standing or propagating torsional Alfven or fast kink waves. An estimate of the plasma beta parameter of the condensations indicates a condition that may allow the often observed separation and elongation processes of the condensations. We also show that the wave pressure from the transverse wave can be responsible for the observed low downward acceleration of coronal rain.« less

Imaging findings of anaplastic astrocytoma in a child with maple syrup urine disease: a case report.

PubMed

Aw-Zoretic, Jessie; Wadhwani, Nitin R; Lulla, Rishi R; Rishi, Lulla R; Ryan, Maura E

2015-09-01

Maple syrup urine disease (MSUD) is an inborn error of branched-chain amino acid metabolism, which usually presents in childhood with encephalopathy due to cerebral edema and dysmyelination. Even with treatment, metabolic stressors may precipitate later episodes of acute decompensation. Changes related to cerebral and white matter edema have been described by magnetic resonance imaging (MRI), and imaging can aid in both initial diagnosis and evaluation of decompensation. To date, there are no published known reports of cancer in patients with MSUD. Here, we present the first case report of an anaplastic astrocytoma in a teenager with MSUD, with a discussion of imaging findings and the use of magnetic resonance spectroscopy (MRS) to help distinguish between tumor and metabolic changes.

DIRECT OBSERVATION OF SOLAR CORONAL MAGNETIC FIELDS BY VECTOR TOMOGRAPHY OF THE CORONAL EMISSION LINE POLARIZATIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kramar, M.; Lin, H.; Tomczyk, S., E-mail: kramar@cua.edu, E-mail: lin@ifa.hawaii.edu, E-mail: tomczyk@ucar.edu

We present the first direct “observation” of the global-scale, 3D coronal magnetic fields of Carrington Rotation (CR) Cycle 2112 using vector tomographic inversion techniques. The vector tomographic inversion uses measurements of the Fe xiii 10747 Å Hanle effect polarization signals by the Coronal Multichannel Polarimeter (CoMP) and 3D coronal density and temperature derived from scalar tomographic inversion of Solar Terrestrial Relations Observatory (STEREO)/Extreme Ultraviolet Imager (EUVI) coronal emission lines (CELs) intensity images as inputs to derive a coronal magnetic field model that best reproduces the observed polarization signals. While independent verifications of the vector tomography results cannot be performed, wemore » compared the tomography inverted coronal magnetic fields with those constructed by magnetohydrodynamic (MHD) simulations based on observed photospheric magnetic fields of CR 2112 and 2113. We found that the MHD model for CR 2112 is qualitatively consistent with the tomography inverted result for most of the reconstruction domain except for several regions. Particularly, for one of the most noticeable regions, we found that the MHD simulation for CR 2113 predicted a model that more closely resembles the vector tomography inverted magnetic fields. In another case, our tomographic reconstruction predicted an open magnetic field at a region where a coronal hole can be seen directly from a STEREO-B/EUVI image. We discuss the utilities and limitations of the tomographic inversion technique, and present ideas for future developments.« less

Radio Studies of Coronal Holes.

DTIC Science & Technology

1981-03-01

Withbroe (1978) has pointed out, "The transport of energy by thermal conduction into the transition zone is a primary coronal cooling mechanism." Thus, the...temperature and particle density gradients in the transition zone are of critical importance in understanding the energy balance of a coronal hole. The...coronal hole has been provided by Konp and Orrall (1977), but a quantitative understanding requires a detailed knowledge of the energy balance in the

Identifying open magnetic field regions of the Sun and their heliospheric counterparts

NASA Astrophysics Data System (ADS)

Krista, L. D.; Reinard, A.

2017-12-01

Open magnetic regions on the Sun are either long-lived (coronal holes) or transient (dimmings) in nature. Both phenomena are fundamental to our understanding of the solar behavior as a whole. Coronal holes are the sources of high-speed solar wind streams that cause recurrent geomagnetic storms. Furthermore, the variation of coronal hole properties (area, location, magnetic field strength) over the solar activity cycle is an important marker of the global evolution of the solar magnetic field. Dimming regions, on the other hand, are short-lived coronal holes that often emerge in the wake of solar eruptions. By analyzing their physical properties and their temporal evolution, we aim to understand their connection with their eruptive counterparts (flares and coronal mass ejections) and predict the possibility of a geomagnetic storm. The author developed the Coronal Hole Automated Recognition and Monitoring (CHARM) and the Coronal Dimming Tracker (CoDiT) algorithms. These tools not only identify but track the evolution of open magnetic field regions. CHARM also provides daily coronal hole maps, that are used for forecasts at the NOAA Space Weather Prediction Center. Our goal is to better understand the processes that give rise to eruptive and non-eruptive open field regions and investigate how these regions evolve over time and influence space weather.

Origin of Pre-Coronal-Jet Minifilaments: Flux Cancellation

NASA Technical Reports Server (NTRS)

Panesar, Navdeep K.; Sterling, Alphonse; Moore, Ronald L.

2017-01-01

Coronal jets are frequent magnetically channeled narrow eruptions. All coronal jets observed in EUV and X-ray images show a bright spire with a base brightening, also known as jet bright point (JBP). Recent studies of jets show that coronal jets are driven by small-scale filament eruptions (e.g. Hong et al. 2011, Shen et al. 2012, Adams et al. 2014, Sterling et al. 2015). We recently investigated the triggering mechanism of ten on-disk quiet-region coronal jet eruptions and found that magnetic flux cancellation at the neutral line of minifilaments is the main cause of quiet-region jet eruptions (Panesar et al.2016).

The evolution of active region loop plasma

NASA Technical Reports Server (NTRS)

Krall, K. R.; Antiochos, S. K.

1980-01-01

The adjustment of coronal active-region loops to changes in their heating rate is investigated numerically. The one-dimensional hydrodynamic equations are solved subject to boundary conditions in which heat flux-induced mass exchange between coronal and chromospheric components is allowed. The calculated evolution of physical parameters suggests that (1) mass supplied during chromospheric evaporation is much more effective in moderating coronal temperature excursions than when downward heat flux is dissipated by a static chromosphere, and (2) the method by which the chromosphere responds to changing coronal conditions can significantly influence coronal readjustment time scales. Observations are cited which illustrate the range of possible fluctuations in the heating rates.

Coronal Hole Front and Center

NASA Image and Video Library

2016-05-18

A substantial coronal hole had rotated so that it temporarily faced right towards Earth May, 17-19, 2016. This coronal hole area is the dark area at the top center of this image from NASA Solar Dynamics Observatory.

EFFECT OF CORONAL TEMPERATURE ON THE SCALE OF SOLAR CHROMOSPHERIC JETS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Iijima; Yokoyama, T.H., E-mail: h.iijima@eps.s.u-tokyo.ac.jp

2015-10-20

We investigate the effect of coronal temperature on the formation process of solar chromospheric jets using two-dimensional magnetohydrodynamic simulations of the region from the upper convection zone to the lower corona. We develop a new radiative magnetohydrodynamic code for the dynamic modeling of the solar atmosphere, employing an LTE equation of state, optically thick radiative loss in the photosphere, optically thin radiative loss in the chromosphere and the corona, and thermal conduction along the magnetic field lines. Many chromospheric jets are produced in the simulations by shock waves passing through the transition region. We find that these jets are projectedmore » farther outward when the coronal temperature is lower (similar to that in coronal holes) and shorter when the coronal temperature is higher (similar to that in active regions). When the coronal temperature is high, the deceleration of the chromospheric jets is consistent with the model in which deceleration is determined by the periodic chromospheric shock waves. However, when the coronal temperature is low, the gravitational deceleration becomes more important and the chromospheric jets approach ballistic motion.« less

Infrared coronal emission lines and the possibility of their laser emission in Seyfert nuclei

NASA Technical Reports Server (NTRS)

Greenhouse, Matthew A.; Feldman, Uri; Smith, Howard A.; Klapisch, Marcel; Bhatia, Anand K.; Bar-Shalom, Avi

1993-01-01

Results are presented from detailed balance calculations, and a compilation of atomic data and other model calculations designed to support upcoming ISO and current observing programs involving IR coronal emission lines, together with a table with a complete line list of infrared transitions within the ground configurations 2s2 2p(k), 3s2 3p(k), and the first excited configurations 2s 2p and 3s 3p of highly ionized astrophysically abundant elements. The temperature and density parameter space for dominant cooling via IR coronal lines is presented, and the relationship of IR and optical coronal lines is discussed. It is found that, under physical conditions found in Seyfert nuclei, 14 of 70 transitions examined have significant population inversions in levels that give rise to IR coronal lines. Several IR coronal line transitions were found to have laser gain lengths that correspond to column densities of 10 exp 24-25/sq cm which are modeled to exist in Seyfert nuclei. Observations that can reveal inverted level populations and laser gain in IR coronal lines are suggested.

Determination of coronal magnetic fields from vector magnetograms

NASA Technical Reports Server (NTRS)

Mikic, Zoran

1993-01-01

This report covers technical progress during the second year of the contract entitled 'Determination of Coronal Magnetic Fields from Vector Magnetograms,' NASW-4728, between NASA and Science Applications International Corporation, and covers the period January 1, 1993 to December 31, 1993. Under this contract SAIC has conducted research into the determination of coronal magnetic fields from vector magnetograms, including the development and application of algorithms to determine force-free coronal fields above selected observations of active regions. The contract began on June 30, 1992 and has a completion date of December 31, 1994. This contract is a continuation of work started in a previous contract, NASW-4571, which covered the period November 15, 1990 to December 14, 1991. During this second year we have concentrated on studying additional active regions and in using the estimated coronal magnetic fields to compare to coronal features inferred from observations.

Key aspects of coronal heating

PubMed Central

Klimchuk, James A.

2015-01-01

We highlight 10 key aspects of coronal heating that must be understood before we can consider the problem to be solved. (1) All coronal heating is impulsive. (2) The details of coronal heating matter. (3) The corona is filled with elemental magnetic stands. (4) The corona is densely populated with current sheets. (5) The strands must reconnect to prevent an infinite build-up of stress. (6) Nanoflares repeat with different frequencies. (7) What is the characteristic magnitude of energy release? (8) What causes the collective behaviour responsible for loops? (9) What are the onset conditions for energy release? (10) Chromospheric nanoflares are not a primary source of coronal plasma. Significant progress in solving the coronal heating problem will require coordination of approaches: observational studies, field-aligned hydrodynamic simulations, large-scale and localized three-dimensional magnetohydrodynamic simulations, and possibly also kinetic simulations. There is a unique value to each of these approaches, and the community must strive to coordinate better. PMID:25897094

Coronal emission-line polarization from the statistical equilibrium of magnetic sublevels. II. Fe XIV 5303 A

DOE Office of Scientific and Technical Information (OSTI.GOV)

House, L.L.; Querfeld, C.W.; Rees, D.E.

1982-04-15

Coronal magnetic fields influence in the intensity and linear polarization of light scattered by coronal Fe XIV ions. To interpret polarization measurements of Fe XIV 5303 A coronal emission requires a detailed understanding of the dependence of the emitted Stokes vector on coronal magnetic field direction, electron density, and temperature and on height of origin. The required dependence is included in the solutions of statistical equilibrium for the ion which are solved explicitly for 34 magnetic sublevels in both the ground and four excited terms. The full solutions are reduced to equivalent simple analytic forms which clearly show the requiredmore » dependence on coronal conditions. The analytic forms of the reduced solutions are suitable for routine analysis of 5303 green line polarimetric data obtained at Pic du Midi and from the Solar Maximum Mission Coronagraph/Polarimeter.« less

Safety of the 2D/3D direct-acting antiviral regimen in HCV-induced Child-Pugh A cirrhosis - A pooled analysis.

PubMed

Poordad, Fred; Nelson, David R; Feld, Jordan J; Fried, Michael W; Wedemeyer, Heiner; Larsen, Lois; Cohen, Daniel E; Cohen, Eric; Mobashery, Niloufar; Tatsch, Fernando; Foster, Graham R

2017-10-01

Chronic hepatitis C virus (HCV)-infected patients with cirrhosis are a high-priority population for treatment. To help inform the benefit-risk profile of the all-oral direct-acting antiviral (DAA) combination regimen of ombitasvir, paritaprevir, and ritonavir, with or without dasabuvir (OBV/PTV/r±DSV) in patients with Child-Pugh A cirrhosis, we undertook a comprehensive review of AbbVie-sponsored clinical trials enrolling patients with Child-Pugh A cirrhosis. Twelve phase II or III clinical trials of the 2-DAA regimen of OBV/PTV/r±ribavirin (RBV) or the 3-DAA regimen of OBV/PTV/r+DSV±RBV that included patients with Child-Pugh A cirrhosis were reviewed; patients who completed treatment by November 16, 2015 were included in a pooled, post hoc safety assessment. The number and percentage of patients with treatment-emergent adverse events (TEAEs), serious TEAEs, and TEAEs consistent with hepatic decompensation were reported. In 1,066 patients with Child-Pugh A cirrhosis, rates of serious TEAEs and TEAEs leading to study drug discontinuation were 5.3% (95% confidence interval [CI]: 4.1-6.8) and 2.2% (95% CI: 1.4-3.2), respectively. Thirteen patients (1.2%; 95% CI: 0.7-2.1) had a TEAE that was consistent with hepatic decompensation. The most frequent TEAEs consistent with hepatic decompensation were ascites (n=8), esophageal variceal hemorrhage (n=4), and hepatic encephalopathy (n=2). This pooled analysis in 1,066 HCV-infected patients with Child-Pugh A cirrhosis confirms the safety of OBV/PTV/r±DSV±RBV in this population. These results support the use of OBV/PTV/r±DSV±RBV in this high-priority population. Lay summary: This pooled safety analysis in 1,066 HCV-infected patients with compensated cirrhosis, receiving treatment with ombitasvir, paritaprevir, and ritonavir with or without dasabuvir, with or without ribavirin, shows that the rate of hepatic decompensation events was similar to previously reported rates in untreated patients. Copyright © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia

PubMed Central

2010-01-01

Introduction Inefficient clearance of copious respiratory secretion is a cause of non-invasive positive pressure ventilation (NPPV) failure, especially in chronic respiratory patients with community-acquired-pneumonia (CAP) and impaired consciousness. We postulated that in such a clinical scenario, when intubation and conventional mechanical ventilation (CMV) are strongly recommended, the suction of secretions with fiberoptic bronchoscopy (FBO) may increase the chance of NPPV success. The objective of this pilot study was, firstly, to verify the safety and effectiveness of early FBO during NPPV and, secondly, to compare the hospital outcomes of this strategy versus a CMV-based strategy in patients with decompensated chronic obstructive pulmonary disease (COPD) due to CAP who are not appropriate candidates for NPPV because of inefficient mucous clearance and hypercapnic encephalopathy (HE). Methods This is a 12-month prospective matched case-control study performed in one respiratory semi-intensive care unit (RSICU) with expertise in NPPV and in one intensive care unit (ICU). Fifteen acutely decompensated COPD patients with copious secretion retention and HE due to CAP undergoing NPPV in RSICU, and 15 controls (matched for arterial blood gases, acute physiology and chronic health evaluation score III, Kelly-Matthay scale, pneumonia extension and severity) receiving CMV in the ICU were studied. Results Two hours of NPPV significantly improved arterial blood gases, Kelly and cough efficiency scores without FBO-related complications. NPPV avoided intubation in 12/15 patients (80%). Improvement in arterial blood gases was similar in the two groups, except for a greater PaO2/fraction of inspired oxygen ratio with CMV. The rates of overall and septic complications, and of tracheostomy were lower in the NPPV group (20%, 20%, and 0%) versus the CMV group (80%, 60%, and 40%; P < 0.05). Hospital mortality, duration of hospitalisation and duration of ventilation were similar in the two groups. Conclusions In patients with decompensated COPD due to CAP who are candidates for CMV because of HE and inability to clear copious secretions, NPPV with early therapeutic FBO performed by an experienced team is a feasible, safe and effective alternative strategy. PMID:20429929

Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia.

PubMed

Scala, Raffaele; Naldi, Mario; Maccari, Uberto

2010-01-01

Inefficient clearance of copious respiratory secretion is a cause of non-invasive positive pressure ventilation (NPPV) failure, especially in chronic respiratory patients with community-acquired-pneumonia (CAP) and impaired consciousness. We postulated that in such a clinical scenario, when intubation and conventional mechanical ventilation (CMV) are strongly recommended, the suction of secretions with fiberoptic bronchoscopy (FBO) may increase the chance of NPPV success. The objective of this pilot study was, firstly, to verify the safety and effectiveness of early FBO during NPPV and, secondly, to compare the hospital outcomes of this strategy versus a CMV-based strategy in patients with decompensated chronic obstructive pulmonary disease (COPD) due to CAP who are not appropriate candidates for NPPV because of inefficient mucous clearance and hypercapnic encephalopathy (HE). This is a 12-month prospective matched case-control study performed in one respiratory semi-intensive care unit (RSICU) with expertise in NPPV and in one intensive care unit (ICU). Fifteen acutely decompensated COPD patients with copious secretion retention and HE due to CAP undergoing NPPV in RSICU, and 15 controls (matched for arterial blood gases, acute physiology and chronic health evaluation score III, Kelly-Matthay scale, pneumonia extension and severity) receiving CMV in the ICU were studied. Two hours of NPPV significantly improved arterial blood gases, Kelly and cough efficiency scores without FBO-related complications. NPPV avoided intubation in 12/15 patients (80%). Improvement in arterial blood gases was similar in the two groups, except for a greater PaO2/fraction of inspired oxygen ratio with CMV. The rates of overall and septic complications, and of tracheostomy were lower in the NPPV group (20%, 20%, and 0%) versus the CMV group (80%, 60%, and 40%; P < 0.05). Hospital mortality, duration of hospitalisation and duration of ventilation were similar in the two groups. In patients with decompensated COPD due to CAP who are candidates for CMV because of HE and inability to clear copious secretions, NPPV with early therapeutic FBO performed by an experienced team is a feasible, safe and effective alternative strategy.

Adherence to Positive Airway Pressure Therapy in Hospitalized Patients with Decompensated Heart Failure and Sleep-Disordered Breathing

PubMed Central

Sharma, Sunil; Chakraborty, Anasua; Chowdhury, Anindita; Mukhtar, Umer; Willes, Leslee; Quan, Stuart F.

2016-01-01

Study Objectives: Sleep-disordered breathing (SDB) has been implicated as a risk factor for the development of several adverse cardiovascular outcomes, but can be mitigated with positive airway pressure therapy (PAP). The nonadherence of patients with SDB on PAP in the outpatient setting ranges from 29% to 84%. However, adherence of PAP in patients with congestive heart failure (CHF) admitted for decompensated CHF and in whom SDB has been diagnosed in the hospital setting is not known. We hypothesized that despite a diagnosis in the hospital, the compliance of these patients with PAP therapy would not be different from the well-established adherence in patients with a diagnosis and treatment in the outpatient setting. Methods: The study was a retrospective analysis of patients admitted to an academic tertiary care hospital between March 2013 and February 2014. Patients presenting with decompensated CHF were screened and high-risk patients were started on PAP empirically and advised to undergo a postdischarge polysomnogram. Compliance of the patients with PAP was tracked for over 12 mo. Data from a similar outpatient group who underwent polysomnography during the study period were also reviewed. Results: Ninety-one patients underwent polysomnograhy postdischarge. Of the 91 patients, 81 patients agreed to PAP therapy. One patient was excluded as data were missing. The adherence at 3, 6, and 12 mo was 52%, 37%, and 27%, which was not significantly different than an outpatient control group. There was a trend for those with CHF plus SDB and compliant with PAP to have a higher probability of survival compared to those who were noncompliant (p = 0.07). Conclusions: Adherence of patients to PAP therapy in whom a SDB diagnosis is made during acute hospitalization for heart failure is comparable to patients in the ambulatory setting. Adherence in first 3 mo is a predictive marker for improved survival trend. Citation: Sharma S, Chakraborty A, Chowdhury A, Mukhtar U, Willes L, Quan SF. Adherence to positive airway pressure therapy in hospitalized patients with decompensated heart failure and sleep-disordered breathing. J Clin Sleep Med 2016;12(12):1615–1621. PMID:27568891

Raloxifene Plus Antipsychotics Versus Placebo Plus Antipsychotics in Severely Ill Decompensated Postmenopausal Women With Schizophrenia or Schizoaffective Disorder: A Randomized Controlled Trial.

PubMed

Weiser, Mark; Levi, Linda; Burshtein, Shimon; Hagin, Michal; Matei, Valentin P; Podea, Delia; Micluția, Ioana; Tiugan, Alexandru; Păcală, Bogdan; Grecu, Iosif Gabos; Noy, Adam; Zamora, Daisy; Davis, John M

2017-07-01

Several single-center studies have found raloxifene, an estrogen agonist, to be effective in ameliorating symptoms of schizophrenia in stable patients as augmentation of antipsychotics. This multicenter study assessed whether raloxifene plus antipsychotic treatment, in comparison to placebo plus antipsychotics, improves symptoms or cognition in severely ill decompensated schizophrenia patients. In this 16-week, double-blind, randomized, placebo-controlled study, 200 severely ill, decompensated postmenopausal women who met DSM-IV-TR criteria for schizophrenia or schizoaffective disorder were recruited from January 2011 to December 2012 and were randomized to receive either raloxifene 120 mg/d plus antipsychotics or placebo plus antipsychotics. The primary outcome measure was Positive and Negative Syndrome Scale (PANSS) total score at the end of the trial. The placebo plus antipsychotics group experienced statistically significant improvement in PANSS total score (P < .001) compared to the raloxifene plus antipsychotics group, using mixed models for repeated measures, with results favoring placebo by 4.5 points (95% CI, 2.3-6.7). These results were clearly outside the 95% confidence interval. This negative effect was more pronounced in patients who had more frequent relapses and in those with baseline PANSS scores of 100 or higher. There were no differences between groups in Clinical Global Impression Scale-Severity scores or Composite Brief Assessment of Cognition in Schizophrenia scores at 16 weeks (P > .3). Baseline follicle-stimulating hormone and estradiol levels did not alter the drug-placebo differences. Individuals in the active treatment arm showed worse outcome than those in the placebo arm, most likely as a result of chance variation, but the results unequivocally show no benefit of antipsychotics plus raloxifene versus antipsychotics plus placebo in this large randomized, double-blind, placebo-controlled trial in postmenopausal women. These data do not support the use of raloxifene in severely decompensated schizophrenia patients until reliable research identifies what subgroup of patients or domain of outcome is benefited. ClinicalTrials.gov identifier: NCT01280305. © Copyright 2017 Physicians Postgraduate Press, Inc.

THE CONTRIBUTION OF CORONAL JETS TO THE SOLAR WIND

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lionello, R.; Török, T.; Titov, V. S.

Transient collimated plasma eruptions in the solar corona, commonly known as coronal (or X-ray) jets, are among the most interesting manifestations of solar activity. It has been suggested that these events contribute to the mass and energy content of the corona and solar wind, but the extent of these contributions remains uncertain. We have recently modeled the formation and evolution of coronal jets using a three-dimensional (3D) magnetohydrodynamic (MHD) code with thermodynamics in a large spherical domain that includes the solar wind. Our model is coupled to 3D MHD flux-emergence simulations, i.e., we use boundary conditions provided by such simulationsmore » to drive a time-dependent coronal evolution. The model includes parametric coronal heating, radiative losses, and thermal conduction, which enables us to simulate the dynamics and plasma properties of coronal jets in a more realistic manner than done so far. Here, we employ these simulations to calculate the amount of mass and energy transported by coronal jets into the outer corona and inner heliosphere. Based on observed jet-occurrence rates, we then estimate the total contribution of coronal jets to the mass and energy content of the solar wind to (0.4–3.0)% and (0.3–1.0)%, respectively. Our results are largely consistent with the few previous rough estimates obtained from observations, supporting the conjecture that coronal jets provide only a small amount of mass and energy to the solar wind. We emphasize, however, that more advanced observations and simulations (including parametric studies) are needed to substantiate this conjecture.« less

Coronal hole evolution by sudden large scale changes

NASA Technical Reports Server (NTRS)

Nolte, J. T.; Gerassimenko, M.; Krieger, A. S.; Solodyna, C. V.

1978-01-01

Sudden shifts in coronal-hole boundaries observed by the S-054 X-ray telescope on Skylab between May and November, 1973, within 1 day of CMP of the holes, at latitudes not exceeding 40 deg, are compared with the long-term evolution of coronal-hole area. It is found that large-scale shifts in boundary locations can account for most if not all of the evolution of coronal holes. The temporal and spatial scales of these large-scale changes imply that they are the results of a physical process occurring in the corona. It is concluded that coronal holes evolve by magnetic-field lines' opening when the holes are growing, and by fields' closing as the holes shrink.

Coronal temperatures of selected active cool stars as derived from low resolution Einstein observations

NASA Technical Reports Server (NTRS)

Vilhu, Osmi; Linsky, Jeffrey L.

1990-01-01

Mean coronal temperatures of some active G-K stars were derived from Rev1-processed Einstein-observatory's IPC-spectra. The combined X-ray and transition region emission line data are in rough agreement with static coronal loop models. Although the sample is too small to derive any statistically significant conclusions, it suggests that the mean coronal temperature depends linearly on the inverse Rossby-number, with saturation at short rotation periods.

Recurring coronal holes and their rotation rates during the solar cycles 22-24

NASA Astrophysics Data System (ADS)

Prabhu, K.; Ravindra, B.; Hegde, Manjunath; Doddamani, Vijayakumar H.

2018-05-01

Coronal holes (CHs) play a significant role in making the Earth geo-magnetically active during the declining and minimum phases of the solar cycle. In this study, we analysed the evolutionary characteristics of the Recurring CHs from the year 1992 to 2016. The extended minimum of Solar Cycle 23 shows unusual characteristics in the number of persistent coronal holes in the mid- and low-latitude regions of the Sun. Carrington rotation maps of He 10830 Å and EUV 195 Å observations are used to identify the Coronal holes. The latitude distribution of the RCHs shows that most of them are appeared between ± 20° latitudes. In this period, more number of recurring coronal holes appeared in and around 100° and 200° Carrington longitudes. The large sized coronal holes lived for shorter period and they appeared close to the equator. From the area distribution over the latitude considered, it shows that more number of recurring coronal holes with area <10^{21} cm2 appeared in the southern latitude close to the equator. The rotation rates calculated from the RCHs appeared between ± 60° latitude shows rigid body characteristics. The derived rotational profiles of the coronal holes show that they have anchored to a depth well below the tachocline of the interior, and compares well with the helioseismology results.

On the Detection of Coronal Dimmings and the Extraction of Their Characteristic Properties

NASA Astrophysics Data System (ADS)

Dissauer, K.; Veronig, A. M.; Temmer, M.; Podladchikova, T.; Vanninathan, K.

2018-03-01

Coronal dimmings are distinct phenomena associated with coronal mass ejections (CMEs). The study of coronal dimmings and the extraction of their characteristic parameters help us to obtain additional information regarding CMEs, especially on the initiation and early evolution of Earth-directed CMEs. We present a new approach to detect coronal dimming regions based on a thresholding technique applied on logarithmic base-ratio images. Characteristic dimming parameters describing the dynamics, morphology, magnetic properties, and the brightness of coronal dimming regions are extracted by cumulatively summing newly dimmed pixels over time. It is also demonstrated how core dimming regions are identified as a subset of the overall identified dimming region. We successfully apply our method to two well-observed coronal dimming events. For both events, the core dimming regions are identified and the spatial evolution of the dimming area reveals the expansion of the dimming region around these footpoints. We also show that in the early impulsive phase of the dimming expansion the total unsigned magnetic flux involved in the dimming regions is balanced and that up to 30% of this flux results from the localized core dimming regions. Furthermore, the onset in the profile of the area growth rate is cotemporal with the start of the associated flares and in one case also with the fast rise of the CME, indicating a strong relationship of coronal dimmings with both flares and CMEs.

Observations and Numerical Models of Solar Coronal Heating Associated with Spicules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pontieu, B. De; Martinez-Sykora, J.; Moortel, I. De

Spicules have been proposed as significant contributors to the mass and energy balance of the corona. While previous observations have provided a glimpse of short-lived transient brightenings in the corona that are associated with spicules, these observations have been contested and are the subject of a vigorous debate both on the modeling and the observational side. Therefore, it remains unclear whether plasma is heated to coronal temperatures in association with spicules. We use high-resolution observations of the chromosphere and transition region (TR) with the Interface Region Imaging Spectrograph and of the corona with the Atmospheric Imaging Assembly on board themore » Solar Dynamics Observatory to show evidence of the formation of coronal structures associated with spicular mass ejections and heating of plasma to TR and coronal temperatures. Our observations suggest that a significant fraction of the highly dynamic loop fan environment associated with plage regions may be the result of the formation of such new coronal strands, a process that previously had been interpreted as the propagation of transient propagating coronal disturbances. Our observations are supported by 2.5D radiative MHD simulations that show heating to coronal temperatures in association with spicules. Our results suggest that heating and strong flows play an important role in maintaining the substructure of loop fans, in addition to the waves that permeate this low coronal environment.« less

Genesis Solar Wind Interstream, Coronal Hole and Coronal Mass Ejection Samples: Update on Availability and Condition

NASA Technical Reports Server (NTRS)

Allton, J. H.; Gonzalez, C. P.; Allums, K. K.

2017-01-01

Recent refinement of analysis of ACE/SWICS data (Advanced Composition Explorer/Solar Wind Ion Composition Spectrometer) and of onboard data for Genesis Discovery Mission of 3 regimes of solar wind at Earth-Sun L1 make it an appropriate time to update the availability and condition of Genesis samples specifically collected in these three regimes and currently curated at Johnson Space Center. ACE/SWICS spacecraft data indicate that solar wind flow types emanating from the interstream regions, from coronal holes and from coronal mass ejections are elementally and isotopically fractionated in different ways from the solar photosphere, and that correction of solar wind values to photosphere values is non-trivial. Returned Genesis solar wind samples captured very different kinds of information about these three regimes than spacecraft data. Samples were collected from 11/30/2001 to 4/1/2004 on the declining phase of solar cycle 23. Meshik, et al is an example of precision attainable. Earlier high precision laboratory analyses of noble gases collected in the interstream, coronal hole and coronal mass ejection regimes speak to degree of fractionation in solar wind formation and models that laboratory data support. The current availability and condition of samples captured on collector plates during interstream slow solar wind, coronal hole high speed solar wind and coronal mass ejections are de-scribed here for potential users of these samples.

Plasma properties and magnetic field structure of the solar corona, based on coordinated Max 1991 observations from SERTS, the VLA, and magnetographs

NASA Technical Reports Server (NTRS)

Brosius, Jeffrey W.

1995-01-01

The purposes of this investigation are to use existing, calibrated, coaligned sets of coordinated multiwaveband observations of the Sun to determine the coronal magnetic field strength and structure, and interpret the collective observations in terms of a self-consistent model of the coronal plasma and magnetic field. This information is vital to understanding processes such as coronal heating, solar wind acceleration, pre-flare energy storage, and active region evolution. Understanding these processes is the central theme of Max '91, the NASA-supported series of solar observing campaigns under which the observations acquired for this work were obtained. The observations came from NASA/GSFC's Solar EUV Rocket Telescope and Spectrograph (SERTS), the Very Large Array (VLA), and magnetographs. The technique of calculating the coronal magnetic field is to establish the contributions to the microwave emission from the two main emission mechanisms: thermal bremsstrahlung and thermal gyroemission. This is done by using the EUV emission to determine values of the coronal plasma quantities needed to calculate the thermal bremsstrahlung contribution to the microwave emission. Once the microwave emission mechanism(s) are determined, the coronal magnetic field can be calculated. A comparison of the coronal magnetic field derived from the coordinated multiwaveband observations with extrapolations from photospheric magnetograms will provide insight into the nature of the coronal magnetic field.

Coronal Jets in Closed Magnetic Regions on the Sun

NASA Astrophysics Data System (ADS)

Wyper, Peter Fraser; DeVore, C. R.

2015-04-01

Coronal jets are dynamic, collimated structures observed in solar EUV and X-ray emission. They appear predominantly in the open field of coronal holes, but are also observed in areas of closed field, especially active regions. A common feature of coronal jets is that they originate from the field above a parasitic polarity of opposite sign to the surrounding field. Some process - such as instability onset or flux emergence - induces explosive reconnection between the closed “anemone” field and the surrounding open field that generates the jet. The lesser number of coronal jets in closed-field regions suggests a possible stabilizing effect of the closed configuration with respect to coronal jet formation. If the scale of the jet region is small compared with the background loop length, as in for example type II spicules, the nearby magnetic field may be treated as locally open. As such, one would expect that if a stabilizing effect exists it becomes most apparent as the scale of the anemone region approaches that of the background coronal loops.To investigate if coronal jets are indeed suppressed along shorter coronal loops, we performed a number of simulations of jets driven by a rotation of the parasitic polarity (as in the previous open-jet calculations by Pariat et. al 2009, 2010, 2015) embedded in a large-scale closed bipolar field. The simulations were performed with the state of the art Adaptively Refined Magnetohydrodynamics Solver. We will report here how the magnetic configuration above the anemone region determines the nature of the jet, when it is triggered, and how much of the stored magnetic energy is released. We show that regions in which the background field and the parasitic polarity region are of comparable scale naturally suppress explosive energy release. We will also show how in the post-jet relaxation phase a combination of confined MHD waves and weak current layers are generated by the jet along the background coronal loops, both of which may have implications for coronal heating.This work was supported by an appointment to the NASA Postdoctoral Program (P.F.W.) and by NASA’s Living With a Star Targeted Research and Technology program (C.R.D.).

Coronal Magnetism: Hanle Effect in UV and IR Spectral Lines

NASA Astrophysics Data System (ADS)

Raouafi, N. E.; Riley, P.

2014-12-01

The plasma thermodynamics in the solar upper atmosphere, particularly in the corona, are dominated by the magnetic field, which controls the flow and dissipation of energy. The relative lack of knowledge of the coronal vector magnetic field is a major handicap for the progress in coronal physics. This makes the development of measurement methods of coronal magnetic fields a high priority in solar physics. The Hanle effect in the UV and IR spectral lines is a largely unexplored diagnostic. Here we use magnetohydrodynamic (MHD) simulations to study the magnitude of the signal to be expected for typical coronal magnetic fields for selected spectral lines in the UV and IR wavelength ranges, namely the H I Lyman series (i.e., α, β, and γ), O VI 103.2 nm line, and the He I 1083 nm line. We show that the selected lines may be useful for the diagnostic of coronal magnetic fields. We also show that the combination of polarization measurements of spectral lines with different sensitivities to the Hanle effect may be most appropriate for the interpretation of the data. We propose that UV coronal magnetic field mapper should be a central part of the science payload of any future spacebased solar observatory.

Hyperammonemic Coma—Barking Up the Wrong Tree

PubMed Central

Kruzel-Davila, Eti; Dori, Guy; Baron, Elzbieta; Bitterman, Haim

2007-01-01

Hepatic encephalopathy and myxedema coma share clinical features: coma, ascites, anemia, impaired liver functions, and a “metabolic” electroencephalogram (EEG). Hyperammonemia, a hallmark of hepatic encephalopathy, has also been described in hypothyroidism. Differentiation between the 2 conditions, recognition of their possible coexistence, and the consequent therapeutic implications are of utmost importance. We describe a case of an 82-year-old woman with a history of mild chronic liver disease who presented with hyperammonemic coma unresponsive to conventional therapy. Further investigation disclosed severe hypothyroidism. Thyroid hormone replacement resulted in gain of consciousness and normalization of hyperammonemia. In patients with an elevated ammonia level, altered mental status, and liver disease, who do not have a clear inciting event for liver disease decompensation, overwhelming evidence of hepatic decompensation, or who do not respond to appropriate therapy for hepatic encephalopathy, hypothyroidism should be considered and evaluated. PMID:17372808

[Tinnitus and psychological comorbidities].

PubMed

Zirke, N; Goebel, G; Mazurek, B

2010-07-01

Comorbidity is the presence of one or more disorders in addition to the main disorder. Comorbidities negatively influence the development of the main disease. For patients with tinnitus a comorbidity is an additional component complicating the habituation of ear noise and patients with decompensated tinnitus often have psychological comorbidities, e.g. affective, somatoform or anxiety disorders. At the time of first presentation and also during further follow-up, it is essential to pay particular attention to the presence of potential comorbid mental disorders. This is of special importance for patients with decompensated ear noise (severity grades 3 and 4). For ENT specialists it is important that the mental discomfort of patients must be taken seriously and should be identified through a targeted diagnosis. Effective treatment of the co-symptoms using cognitive behavior therapy (CBT) in conjunction with medication often reduces the severity of tinnitus perception and discomfort.

Content validation of the operational definitions of the nursing diagnoses of activity intolerance, excess fluid volume, and decreased cardiac output in patients with heart failure.

PubMed

de Souza, Vanessa; Zeitoun, Sandra Salloum; Lopes, Camila Takao; de Oliveira, Ana Paula Dias; Lopes, Juliana de Lima; de Barros, Alba Lucia Botura Leite

2014-06-01

To consensually validate the operational definitions of the nursing diagnoses activity intolerance, excessive fluid volume, and decreased cardiac output in patients with decompensated heart failure. Consensual validation was performed in two stages: analogy by similarity of defining characteristics, and development of operational definitions and validation with experts. A total of 38 defining characteristics were found. Operational definitions were developed and content-validated. One hundred percent of agreement was achieved among the seven experts after five rounds. "Ascites" was added in the nursing diagnosis excessive fluid volume. The consensual validation improves interpretation of human response, grounding the selection of nursing interventions and contributing to improved nursing outcomes. Support the assessment of patients with decompensated heart failure. © 2013 NANDA International.

Axillofemoral Bypass Markedly Improved Acute Decompensated Heart Failure and Kidney Injury in a Patient with Severely Calcified Stenosis of Thoracoabdominal Aorta (Atypical Aortic Coarctation).

PubMed

Ishizuka, Masato; Yamada, Shintaro; Maemura, Sonoko; Yamamoto, Keisuke; Takizawa, Masataka; Uozumi, Hiroki; Minegishi, Sachito; Kobayashi, Jotaro; Ikenouchi, Hiroshi

2017-10-21

Atypical aortic coarctation (AAC) has been reported to occur anywhere along the aorta, except for the ascending aorta. The associated symptoms include hypotension in the lower half of the body, secondary hypertension in the upper half of the body, and heart failure. Here we present an 80-year-old Asian woman complaining of progressive exertional dyspnea. She was diagnosed with acute decompensated heart failure and kidney injury due to severely calcified stenosis of the thoracoabdominal aorta, the so called AAC. She received hemodiafiltration, and pulmonary congestion improved in part. Generally, surgical treatments are quite invasive in elderly patients. Endovascular stent graft placement is less invasive, however, fracture and rupture should be considered at severely calcified lesions like this case. Therefore, we selected extra-anatomical axillofemoral bypass. Her recovery after the surgery was remarkable. In a few days, she became free from hemodiafiltration, intravenous diuretics, and oxygen administration. We thought the contributive factors are the increase in kidney blood flow and the correction of afterload mismatch. The decrease in pulse pressure may reflect the reduction in systemic arterial compliance by axillofemoral bypass. The operative mortality of axillofemoral bypass was reported to be acceptable, although the patency of the axillofemoral bypass graft was not high enough. In conclusion, axillofemoral bypass is effective and feasible for elderly patients with acute decompensated heart failure and kidney injury due to AAC.

Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate.

PubMed

Raimondi, Francesco; Rodriguez Fanjul, Javier; Aversa, Salvatore; Chirico, Gaetano; Yousef, Nadya; De Luca, Daniele; Corsini, Iuri; Dani, Carlo; Grappone, Lidia; Orfeo, Luigi; Migliaro, Fiorella; Vallone, Gianfranco; Capasso, Letizia

2016-08-01

To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient. In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation <65% for more than 40 seconds) and bradycardia or sudden increase of oxygen requirement by at least 50% in less than 10 minutes with a final fraction of inspired oxygen ≥0.7 to keep stable saturations. All eligible patients had an ultrasound scan before undergoing a chest radiograph, which was the reference standard. Forty-two infants (birth weight = 1531 ± 812 g; gestational age = 31 ± 3.5 weeks) were enrolled in 6 centers; pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases. Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage. Copyright © 2016 Elsevier Inc. All rights reserved.

[Management of corneal endothelial decompensation with Descemet's membrane endothelial keratoplasty in a patient with Ahmed glaucoma valve implant].

PubMed

Röck, T; Bartz-Schmidt, K-U; Röck, D; Yoeruek, E

2014-05-01

Currently, the main causes for developing bullous keratopathy are from problems related to intraocular surgery, trauma, infection, Fuchs' endothelial dystrophy and chronically elevated intraocular pressure. In the 1990s penetrating keratoplasty was once considered the therapy of choice for treatment of bullous keratopathy but in recent years it has been replaced by posterior lamellar keratoplasty. The Descemet membrane endothelial keratoplasty (DMEK) procedure represents the final development of posterior lamellar keratoplasty. The question now arises whether DMEK can be used in patients with bullous keratopathy and Ahmed glaucoma valve implant. A 72-year-old man was referred to our hospital for further evaluation with the diagnosis of bullous keratopathy and pseudoexfoliative glaucoma. The bullous keratopathy was caused by a variety of previous operations as well as decompensation of intraocular pressure. This article describes the therapy of bullous keratopathy by DMEK with existing Ahmed glaucoma valve implant. After surgery the cornea became clear and the best-corrected visual acuity improved from hand movement to 0.2. The intraocular pressure remained normal (10-14 mmHg) without antiglaucoma medication and the endothelial cell count decreased only slightly over a follow-up of 13 months. No complications were encountered. The DMEK surgical procedure seems to be possible in patients with Ahmed glaucoma valve implant and endothelial decompensation. However, further studies with a larger number of patients should follow to validate the replacement of penetrating keratoplasty and other posterior lamellar procedures by DMEK.

Antibiotic prophylaxis in cirrhosis: Good and bad.

PubMed

Fernández, Javier; Tandon, Puneeta; Mensa, Jose; Garcia-Tsao, Guadalupe

2016-06-01

Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute-on-chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis, and strategies to prevent them are essential. The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low-protein ascites with associated poor liver function. Antibiotic prophylaxis effectively prevents not only the development of bacterial infections in all these indications but also further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. However, antibiotic prophylaxis is also associated with a clinically relevant and increasing drawback, the development of infections due to multidrug-resistant organisms. Several strategies have been suggested to balance the risks and benefits of antibiotic prophylaxis. Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early deescalation policies are key to achieve this balance; nonantibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug-resistant bacteria in cirrhosis. (Hepatology 2016;63:2019-2031). © 2015 by the American Association for the Study of Liver Diseases. This article has been contributed to by U.S. government employees, and their contribution is in the public domain in the U.S.A.

HCV clearance after direct-acting antivirals in patients with cirrhosis by stages of liver impairment: The ITAL-C network study.

PubMed

Ippolito, Antonio Massimo; Milella, Michele; Messina, Vincenzo; Conti, Fabio; Cozzolongo, Raffaele; Morisco, Filomena; Brancaccio, Giuseppina; Barone, Michele; Santantonio, Teresa; Masetti, Chiara; Tundo, Paolo; Smedile, Antonina; Carretta, Vito; Gatti, Pietro; Termite, Antonio Patrizio; Valvano, Maria Rosa; Bruno, Giuseppe; Fabrizio, Claudia; Andreone, Pietro; Zappimbulso, Marianna; Gaeta, Giovanni Battista; Napoli, Nicola; Fontanella, Luca; Lauletta, Gianfranco; Cuccorese, Giuseppe; Metrangolo, Antonio; Francavilla, Ruggiero; Ciracì, Emanuela; Rizzo, Salvatore; Andriulli, Angelo

2017-09-01

Sustained virological response (SVR12) rates at 12 weeks after treatment for HCV-infected patients with decompensated cirrhosis are used when referring to those with moderate functional impairment, while few data are available for those with more severe impairment. The use of the cirrhosis staging system proposed by D'Amico might provide new insights on timing for antiviral therapy. We investigated efficacy (SVR12), safety, and post-treatment variations in clinical and laboratory parameters in 2612 patients with advanced fibrosis (n=575) or cirrhosis (n=2037). Cirrhosis was in the compensated phase (without/with varices) or had previously been in the decompensated stage. Different direct-acting antiviral (DAA) regimens were administered in accordance with scientific guidelines. The SVR12 rate was 97.6% in patients with advanced fibrosis. For patients with cirrhosis, the rate was 96.5% in stage 1, 95.1% in stage 2, 100% in stage 3, 95.7% in stage 4, and 93.6% in stage 5. These rates were independent of gender, age, HCV genotype, and treatment schedule. Positive changes in biochemical parameters and CPT classes following therapy were evident in compensated and previously decompensated patients. Our findings support the use of DAAs in patients with advanced cirrhosis (stages 3-5) who are at greatest risk and have the most to gain from therapy. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

NO[sub x] reduction by sulfur tolerant coronal-catalytic apparatus and method

DOEpatents

Mathur, V.K.; Breault, R.W.; McLarnon, C.R.; Medros, F.G.

1992-09-15

This invention presents an NO[sub x] environment effective reduction apparatus comprising a sulfur tolerant coronal-catalyst such as high dielectric coronal-catalysts like glass wool, ceramic-glass wool or zirconium glass wool and method of use. In one embodiment the invention comprises an NO[sub x] reduction apparatus of sulfur tolerant coronal-catalyst adapted and configured for hypercritical presentation to an NO[sub x] bearing gas stream at a minimum of at least about 75 watts/cubic meter. 7 figs.

NO.sub.x reduction by sulfur tolerant coronal-catalytic apparatus and method

DOEpatents

Mathur, Virendra K.; Breault, Ronald W.; McLarnon, Christopher R.; Medros, Frank G.

1993-01-01

This invention presents an NO.sub.x environment effective reduction apparatus comprising a sulfur tolerant coronal-catalyst such as high dielectric coronal-catalysts like glass wool, ceramic-glass wool or zirconium glass wool and method of use. In one embodiment the invention comprises an NO.sub.x reduction apparatus of sulfur tolerant coronal-catalyst adapted and configured for hypercritical presentation to an NO.sub.x bearing gas stream at a minimum of at least about 75 watts/cubic meter.

NO.sub.x reduction by sulfur tolerant coronal-catalytic apparatus and method

DOEpatents

Mathur, Virendra K.; Breault, Ronald W.; McLarnon, Christopher R.; Medros, Frank G.

1992-01-01

This invention presents an NO.sub.x environment effective reduction apparatus comprising a sulfur tolerant coronal-catalyst such as high dielectric coronal-catalysts like glass wool, ceramic-glass wool or zirconium glass wool and method of use. In one embodiment the invention comprises an NO.sub.x reduction apparatus of sulfur tolerant coronal-catalyst adapted and configured for hypercritical presentation to an NO.sub.x bearing gas stream at a minimum of at least about 75 watts/cubic meter.

NOx reduction by sulfur tolerant coronal-catalytic apparatus and method

DOEpatents

Mathur, V.K.; Breault, R.W.; McLarnon, C.R.; Medros, F.G.

1993-08-31

This invention presents an NO[sub x] environment effective reduction apparatus comprising a sulfur tolerant coronal-catalyst such as high dielectric coronal-catalysts like glass wool, ceramic-glass wool or zirconium glass wool and method of use. In one embodiment the invention comprises an NO[sub x] reduction apparatus of sulfur tolerant coronal-catalyst adapted and configured for hypercritical presentation to an NO[sub x] bearing gas stream at a minimum of at least about 75 watts/cubic meter.

An Airborne Infrared Spectrometer for Solar Eclipse Observations

NASA Astrophysics Data System (ADS)

Samra, Jenna; DeLuca, Edward E.; Golub, Leon; Cheimets, Peter; Philip, Judge

2016-05-01

The airborne infrared spectrometer (AIR-Spec) is an innovative solar spectrometer that will observe the 2017 solar eclipse from the NSF/NCAR High-Performance Instrumented Airborne Platform for Environmental Research (HIAPER). AIR-Spec will image five infrared coronal emission lines to determine whether they may be useful probes of coronal magnetism.The solar magnetic field provides the free energy that controls coronal heating, structure, and dynamics. Energy stored in coronal magnetic fields is released in flares and coronal mass ejections and ultimately drives space weather. Therefore, direct coronal field measurements have significant potential to enhance understanding of coronal dynamics and improve solar forecasting models. Of particular interest are observations of field lines in the transitional region between closed and open flux systems, providing important information on the origin of the slow solar wind.While current instruments routinely observe only the photospheric and chromospheric magnetic fields, AIR-Spec will take a step toward the direct observation of coronal fields by measuring plasma emission in the infrared at high spatial and spectral resolution. During the total solar eclipse of 2017, AIR-Spec will observe five magnetically sensitive coronal emission lines between 1.4 and 4 µm from the HIAPER Gulfstream V at an altitude above 14.9 km. The instrument will measure emission line intensity, width, and Doppler shift, map the spatial distribution of infrared emitting plasma, and search for waves in the emission line velocities.AIR-Spec consists of an optical system (feed telescope, grating spectrometer, and infrared detector) and an image stabilization system, which uses a fast steering mirror to correct the line-of-sight for platform perturbations. To ensure that the instrument meets its research goals, both systems are undergoing extensive performance modeling and testing. These results are shown with reference to the science requirements.

Transverse Oscillations of Coronal Loops

NASA Astrophysics Data System (ADS)

Ruderman, Michael S.; Erdélyi, Robert

2009-12-01

On 14 July 1998 TRACE observed transverse oscillations of a coronal loop generated by an external disturbance most probably caused by a solar flare. These oscillations were interpreted as standing fast kink waves in a magnetic flux tube. Firstly, in this review we embark on the discussion of the theory of waves and oscillations in a homogeneous straight magnetic cylinder with the particular emphasis on fast kink waves. Next, we consider the effects of stratification, loop expansion, loop curvature, non-circular cross-section, loop shape and magnetic twist. An important property of observed transverse coronal loop oscillations is their fast damping. We briefly review the different mechanisms suggested for explaining the rapid damping phenomenon. After that we concentrate on damping due to resonant absorption. We describe the latest analytical results obtained with the use of thin transition layer approximation, and then compare these results with numerical findings obtained for arbitrary density variation inside the flux tube. Very often collective oscillations of an array of coronal magnetic loops are observed. It is natural to start studying this phenomenon from the system of two coronal loops. We describe very recent analytical and numerical results of studying collective oscillations of two parallel homogeneous coronal loops. The implication of the theoretical results for coronal seismology is briefly discussed. We describe the estimates of magnetic field magnitude obtained from the observed fundamental frequency of oscillations, and the estimates of the coronal scale height obtained using the simultaneous observations of the fundamental frequency and the frequency of the first overtone of kink oscillations. In the last part of the review we summarise the most outstanding and acute problems in the theory of the coronal loop transverse oscillations.

Deformation and deceleration of coronal wave

NASA Astrophysics Data System (ADS)

Xue, Z. K.; Qu, Z. Q.; Yan, X. L.; Zhao, L.; Ma, L.

2013-08-01

Aims: We studied the kinematics and morphology of two coronal waves to better understand the nature and origin of coronal waves. Methods: Using multi-wavelength observations of the Atmospheric Imaging Assembly (AIA) on board the Solar Dynamics Observatory (SDO) and the Extreme Ultraviolet Imager (EUVI) on board the twin spacecraft Solar-TErrestrial RElations Observatory (STEREO), we present morphological and dynamic characteristics of consecutive coronal waves on 2011 March 24. We also show the coronal magnetic field based on the potential field source surface model. Results: This event contains several interesting aspects. The first coronal wave initially appeared after a surge-like eruption. Its front was changed and deformed significantly from a convex shape to a line-shaped appearance, and then to a concave configuration during its propagation to the northwest. The initial speeds ranged from 947 km s-1 to 560 km s-1. The first wave decelerated significantly after it passed through a filament channel. After the deceleration, the final propagation speeds of the wave were from 430 km s-1 to 312 km s-1. The second wave was found to appear after the first wave in the northwest side of the filament channel. Its wave front was more diffused and the speed was around 250 km s-1, much slower than that of the first wave. Conclusions: The deformation of the first coronal wave was caused by the different speeds along different paths. The sudden deceleration implies that the refraction of the first wave took place at the boundary of the filament channel. The event provides evidence that the first coronal wave may be a coronal MHD shock wave, and the second wave may be the apparent propagation of the brightenings caused by successive stretching of the magnetic field lines.

Energy released by the interaction of coronal magnetic fields

NASA Technical Reports Server (NTRS)

Sheeley, N. R., Jr.

1976-01-01

Comparisons between coronal spectroheliograms and photospheric magnetograms are presented to support the idea that as coronal magnetic fields interact, a process of field-line reconnection usually takes place as a natural way of preventing magnetic stresses from building up in the lower corona. This suggests that the energy which would have been stored in stressed fields is continuously released as kinetic energy of material being driven aside to make way for the reconnecting fields. However, this kinetic energy is negligible compared with the thermal energy of the coronal plasma. Therefore, it appears that these slow adjustments of coronal magnetic fields cannot account for even the normal heating of the corona, much less the energetic events associated with solar flares.

Resonant electrodynamic heating of stellar coronal loops: An LRC circuit analogue

NASA Technical Reports Server (NTRS)

Ionson, J. A.

1980-01-01

The electrodynamic coupling of stellar coronal loops to underlying beta velocity fields. A rigorous analysis revealed that the physics can be represented by a simple yet equivalent LRC circuit analogue. This analogue points to the existence of global structure oscillations which resonantly excite internal field line oscillations at a spatial resonance within the coronal loop. Although the width of this spatial resonance, as well as the induced currents and coronal velocity field, explicitly depend upon viscosity and resistivity, the resonant form of the generalized electrodynamic heating function is virtually independent of irreversibilities. This is a classic feature of high quality resonators that are externally driven by a broad band source of spectral power. Applications to solar coronal loops result in remarkable agreement with observations.

The temperature structure, mass, and energy flow in the corona and inner solar wind

NASA Technical Reports Server (NTRS)

Withbroe, George L.

1988-01-01

Remote-sensing and in situ data are used to constrain a radiative energy balance model in order to study the radial variations of coronal temperatures, densities, and outflow speeds in several types of coronal holes and in an unstructured quiet region of the corona. A one-fluid solar wind model is used which takes into account the effects of radiative and inward conductive losses in the low corona and the chromospheric-coronal transition region. The results show that the total nonradiative energy input in magnetically open coronal regions is 5 + or - 10 to the 5th ergs/sq cm, and that most of the energy heating the coronal plasma is dissipated within 2 solar radii of the solar surface.

Observational Consequences of Coronal Heating Mechanisms

NASA Technical Reports Server (NTRS)

Winebarger, Amy R.; Cirtain, Jonathan C.; Golub, Leon; Kobayashi, Ken

2014-01-01

The coronal heating problem remains unsolved today, 80 years after its discovery, despite 50 years of suborbital and orbital coronal observatories. Tens of theoretical coronal heating mechanisms have been suggested, but only a few have been able to be ruled out. In this talk, we will explore the reasons for the slow progress and discuss the measurements that will be needed for potential breakthrough, including imaging the solar corona at small spatial scales, measuring the chromospheric magnetic fields, and detecting the presence of high temperature, low emission measure plasma. We will discuss three sounding rocket instruments developed to make these measurements: the High resolution Resolution Coronal Imager (Hi-C), the Chromospheric Lyman-Alpha Spectropolarimeter (CLASP), and the Marshall Grazing Incidence X-ray Spectrometer (MaGIXS).

New Instruments to Isolate the Coronal Heating Mechanism

NASA Technical Reports Server (NTRS)

Winebarger, Amy

2014-01-01

The coronal heating problem remains unsolved today, 80 years after its discovery, despite 50 years of suborbital and orbital coronal observatories. Tens of theoretical coronal heating mechanisms have been suggested, but only a few have been able to be ruled out. In this talk, we will explore the reasons for the slow progress and discuss the measurements that will be needed for potential breakthrough, including imaging the solar corona at small spatial scales, measuring the chromospheric magnetic fields, and detecting the presence of high temperature, low-emission measure plasma. We will discuss three sounding rocket instruments developed to make these measurements: the High-resolution Resolution Coronal Imager (Hi-C), the Chromospheric Lyman-Alpha Spectropolarimeter (CLASP), and the Marshall Grazing Incidence X-ray Spectrometer (MaGIXS).

Detection of the nipple in automated 3D breast ultrasound using coronal slab-average-projection and cumulative probability map

NASA Astrophysics Data System (ADS)

Kim, Hannah; Hong, Helen

2014-03-01

We propose an automatic method for nipple detection on 3D automated breast ultrasound (3D ABUS) images using coronal slab-average-projection and cumulative probability map. First, to identify coronal images that appeared remarkable distinction between nipple-areola region and skin, skewness of each coronal image is measured and the negatively skewed images are selected. Then, coronal slab-average-projection image is reformatted from selected images. Second, to localize nipple-areola region, elliptical ROI covering nipple-areola region is detected using Hough ellipse transform in coronal slab-average-projection image. Finally, to separate the nipple from areola region, 3D Otsu's thresholding is applied to the elliptical ROI and cumulative probability map in the elliptical ROI is generated by assigning high probability to low intensity region. False detected small components are eliminated using morphological opening and the center point of detected nipple region is calculated. Experimental results show that our method provides 94.4% nipple detection rate.

The cyclical variation of energy flux and photospheric magnetic field strength from coronal holes

NASA Technical Reports Server (NTRS)

Webb, D. F.; Davis, J. M.

1985-01-01

The average soft X-ray emission from coronal holes observed on images obtained during rocket flights from 1974 to 1981 is measured. The variation of this emission over the solar cycle was then compared with photospheric magnetic flux measurements within coronal holes over the same period. It was found that coronal hole soft X-ray emission could be detected and that this emission appeared to increase with the rise of the sunspot cycle from activity minimum to maximum. These quantitative results confirmed previous suggestions that the coronal brightness contrast between holes and large-scale structure decreased during this period of the cycle. Gas pressures at the hole base were estimated for assumed temperatures and found to vary from about 0.03 dyne/sq cm in 1974 to 0.35 dyne/sq cm in 1981. The increase in coronal hole X-ray emission was accompanied by a similar trend in the surface magnetic flux of near-equatorial holes between 1975 and 1980 (Harvey et al., 1982).

Coronal Structures in Cool Stars: XMM-NEWTON Hybrid Stars and Coronal Evolution

NASA Technical Reports Server (NTRS)

Dupree, Andrea K.; Mushotzky, Richard (Technical Monitor)

2003-01-01

This program addresses the evolution of stellar coronas by comparing a solar-like corona in the supergiant Beta Dra (G2 Ib-IIa) to the corona in the allegedly more evolved state of a hybrid star, alpha TrA (K2 II-III). Because the hybrid star has a massive wind, it appears likely that the corona will be cooler and less dense as the magnetic loop structures are no longer closed. By analogy with solar coronal holes, when the topology of the magnetic field is configured with open magnetic structures, both the coronal temperature and density are lower than in atmospheres dominated by closed loops. The hybrid stars assume a pivotal role in the definition of coronal evolution, atmospheric heating processes and mechanisms to drive winds of cool stars. We are attempting to determine if this model of coronal evolution is correct by using XMM-NEWTON RGS spectra for the 2 targets we were allocated through the Guest Observer program.

Coronal ``Wave'': Magnetic Footprint of a Coronal Mass Ejection?

NASA Astrophysics Data System (ADS)

Attrill, Gemma D. R.; Harra, Louise K.; van Driel-Gesztelyi, Lidia; Démoulin, Pascal

2007-02-01

We investigate the properties of two ``classical'' EUV Imaging Telescope (EIT) coronal waves. The two source regions of the associated coronal mass ejections (CMEs) possess opposite helicities, and the coronal waves display rotations in opposite senses. We observe deep core dimmings near the flare site and also widespread diffuse dimming, accompanying the expansion of the EIT wave. We also report a new property of these EIT waves, namely, that they display dual brightenings: persistent ones at the outermost edge of the core dimming regions and simultaneously diffuse brightenings constituting the leading edge of the coronal wave, surrounding the expanding diffuse dimmings. We show that such behavior is consistent with a diffuse EIT wave being the magnetic footprint of a CME. We propose a new mechanism where driven magnetic reconnections between the skirt of the expanding CME magnetic field and quiet-Sun magnetic loops generate the observed bright diffuse front. The dual brightenings and the widespread diffuse dimming are identified as innate characteristics of this process.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fang, X.; Xia, C.; Keppens, R.

We present the first multidimensional, magnetohydrodynamic simulations that capture the initial formation and long-term sustainment of the enigmatic coronal rain phenomenon. We demonstrate how thermal instability can induce a spectacular display of in situ forming blob-like condensations which then start their intimate ballet on top of initially linear force-free arcades. Our magnetic arcades host a chromospheric, transition region, and coronal plasma. Following coronal rain dynamics for over 80 minutes of physical time, we collect enough statistics to quantify blob widths, lengths, velocity distributions, and other characteristics which directly match modern observational knowledge. Our virtual coronal rain displays the deformation ofmore » blobs into V-shaped features, interactions of blobs due to mostly pressure-mediated levitations, and gives the first views of blobs that evaporate in situ or are siphoned over the apex of the background arcade. Our simulations pave the way for systematic surveys of coronal rain showers in true multidimensional settings to connect parameterized heating prescriptions with rain statistics, ultimately allowing us to quantify the coronal heating input.« less

Solar radio bursts of spectral type II, coronal shocks, and optical coronal transients

NASA Technical Reports Server (NTRS)

Maxwell, A.; Dryer, M.

1981-01-01

An examination is presented of the association of solar radio bursts of spectral type II and coronal shocks with solar flare ejecta observed in H-alpha, the green coronal line, and white-light coronagraphs. It is suggested that fast-moving optical coronal transients should for the most part be identified with piston-type phenomena well behind the outward-traveling shock waves that generate type II radio bursts. A general model is presented which relates type II radio bursts and coronal shocks to optically observed ejecta and consists of three main velocity regimes: (1) a quasi-hemispherical shock wave moving outward from the flare at speeds of 1000-2000 km/sec and Alfven Mach number of about 1.5; (2) the velocity of the piston driving the shock, on the order of 0.8 that of the shock; and (3) the regime of the slower-moving H-alpha ejecta, with velocities of 300-500 km/sec.

The mean coronal magnetic field determined from Helios Faraday rotation measurements

NASA Technical Reports Server (NTRS)

Patzold, M.; Bird, M. K.; Volland, H.; Levy, G. S.; Seidel, B. L.; Stelzried, C. T.

1987-01-01

Coronal Faraday rotation of the linearly polarized carrier signals of the Helios spacecraft was recorded during the regularly occurring solar occultations over almost a complete solar cycle from 1975 to 1984. These measurements are used to determine the average strength and radial variation of the coronal magnetic field at solar minimum at solar distances from 3-10 solar radii, i.e., the range over which the complex fields at the coronal base are transformed into the interplanetary spiral. The mean coronal magnetic field in 1975-1976 was found to decrease with radial distance according to r exp-alpha, where alpha = 2.7 + or - 0.2. The mean field magnitude was 1.0 + or - 0.5 x 10 to the -5th tesla at a nominal solar distance of 5 solar radii. Possibly higher magnetic field strengths were indicated at solar maximum, but a lack of data prevented a statistical determination of the mean coronal field during this epoch.

Intravertebral deformation in idiopathic scoliosis: a transverse plane computer tomographic study.

PubMed

Kotwicki, Tomasz; Napiontek, Marek

2008-03-01

The scoliotic vertebrae are submitted to (1) the displacement in the 3-dimensional space and (2) the bone remodeling, which results in a 3-dimensional intrinsic vertebral deformation. Both phenomena are most expressed inside the apical zone of the curve and can be measured in a computer tomographic (CT) scan. A comparative study of CT thoracic scans in scoliotic and normal children was performed to provide a better description of the altered anatomy with respect to patomechanism of scoliosis. Twenty-three scoliotic girls, aged 14.3 +/- 2.1 years, a case of a right thoracic curve with a Cobb angle of 60.6 +/- 19.3 degrees, and 24 controls, free of spinal deformity, sex- and age-matched, underwent CT examination of the thorax at the level of Th8 to Th9 vertebra. The rotation angle of the apical vertebra and the sagittal to coronal rib cage diameters ratio were measured. The intravertebral deformation was assessed by measuring the angles between the axis of the whole vertebra and the axes of the spinous or transverse processes. The ratio of sagittal to coronal chest diameter was reduced in scoliosis patients (P < 0.001) and correlated with the Cobb angle. The angle between the axis of vertebra and the spinous process increased (P = 0.008), and its value was positively correlated with the rotation angle of the vertebra (r = 0.78, P < 0.05); however, the rotation was oriented clockwise, whereas the spinous process deviation was counterclockwise. The angle between the spinous and the transverse process revealed greater values on the concave side (P < 0.001), whereas the transverse processes were not deviated from the axis of vertebra (P = 0.469). A constant pattern, previously not described, of the alteration of morphology of the apical vertebra due to the intravertebral bone remodeling was identified. The intravertebral deformation accompanied the displacement of the vertebra with a linear correlation; however, the 2 phenomena were developing in the opposite directions. Level III, cross-sectional study.

Posterior-only surgical correction of dystrophic scoliosis in 31 patients with neurofibromatosis Type 1 using the multiple anchor point method.

PubMed

Deng, Ang; Zhang, Hong-Qi; Tang, Ming-Xing; Liu, Shao-Hua; Wang, Yu-Xiang; Gao, Qi-Le

2017-01-01

OBJECTIVE The objective of this study was to evaluate the clinical efficacy of posterior-only surgical correction of dystrophic scoliosis in patients with neurofibromatosis Type 1 (NF1) using a multiple anchor point method (MAPM). METHODS From 2005 to 2014, 31 patients (mean age 13.5 years old, range 10-22 years old) suffering from dystrophic scoliosis associated with NF1 underwent posterior-only surgical correction using a MAPM. The apex of the deformity was thoracic (n = 25), thoracolumbar (n = 4), and lumbar (n = 2). The mean preoperative coronal Cobb angle was 69.1° (range 48.9°-91.4°). The mean Cobb angle on the side-bending radiograph of the convex side was 58.2° (range 40°-79.8°). The mean flexibility and apical vertebral rotation (AVR) were 15.6% (range 8.3%-28.2%) and 2.5° (range 2°-3°), respectively. The mean angle of sagittal kyphosis was 58.3° (range 34.1°-79.6°). RESULTS The mean follow-up period was 53 months (range 12-96 months). The mean postoperative coronal Cobb angle was 27.4° (range 16.3°-46.7°). Postoperatively, the mean AVR and angle of sagittal kyphosis were 1.2° (range 1°-2°) and 22.4° (range 4.2°-36.3°), respectively. All patients showed good correction of all indices postoperatively. The mean postoperative correction rate was 58.7% (range 46.3%-74.1%). At the final follow-up evaluation, the corrective loss rate of the Cobb angle was only 2.3%. Only 1 patient required revision surgery. No severe complications such as spinal cord, neural, or large vascular injury occurred during the operation. CONCLUSIONS Posterior-only surgical correction of dystrophic scoliosis in patients with NF1 using a MAPM could yield satisfactory clinical efficacy of correction and fusion.

Impulsively Generated Wave Trains in Coronal Structures. II. Effects of Transverse Structuring on Sausage Waves in Pressurelesss Slabs

NASA Astrophysics Data System (ADS)

Li, Bo; Guo, Ming-Zhe; Yu, Hui; Chen, Shao-Xia

2018-03-01

Impulsively generated sausage wave trains in coronal structures are important for interpreting a substantial number of observations of quasi-periodic signals with quasi-periods of order seconds. We have previously shown that the Morlet spectra of these wave trains in coronal tubes depend crucially on the dispersive properties of trapped sausage waves, the existence of cutoff axial wavenumbers, and the monotonicity of the dependence of the axial group speed on the axial wavenumber in particular. This study examines the difference a slab geometry may introduce, for which purpose we conduct a comprehensive eigenmode analysis, both analytically and numerically, on trapped sausage modes in coronal slabs with a considerable number of density profiles. For the profile descriptions examined, coronal slabs can trap sausage waves with longer axial wavelengths, and the group speed approaches the internal Alfvén speed more rapidly at large wavenumbers in the cylindrical case. However, common to both geometries, cutoff wavenumbers exist only when the density profile falls sufficiently rapidly at distances far from coronal structures. Likewise, the monotonicity of the group speed curves depends critically on the profile steepness right at the structure axis. Furthermore, the Morlet spectra of the wave trains are shaped by the group speed curves for coronal slabs and tubes alike. Consequently, we conclude that these spectra have the potential for inferring the subresolution density structuring inside coronal structures, although their detection requires an instrumental cadence of better than ∼1 s.

Do solar decimetric spikes originate in coronal X-ray sources?

NASA Astrophysics Data System (ADS)

Battaglia, M.; Benz, A. O.

2009-06-01

Context: In the standard solar flare scenario, a large number of particles are accelerated in the corona. Nonthermal electrons emit both X-rays and radio waves. Thus, correlated signatures of the acceleration process are predicted at both wavelengths, coinciding either close to the footpoints of a magnetic loop or near the coronal X-ray source. Aims: We attempt to study the spatial connection between coronal X-ray emission and decimetric radio spikes to determine the site and geometry of the acceleration process. Methods: The positions of radio-spike sources and coronal X-ray sources are determined and analyzed in a well-observed limb event. Radio spikes are identified in observations from the Phoenix-2 spectrometer. Data from the Nançay radioheliograph are used to determine the position of the radio spikes. RHESSI images in soft and hard X-ray wavelengths are used to determine the X-ray flare geometry. Those observations are complemented by images from GOES/SXI. Results: We find that the radio emission originates at altitudes much higher than the coronal X-ray source, having an offset from the coronal X-ray source amounting to 90´´ and to 113´´ and 131´´ from the two footpoints, averaged over time and frequency. Conclusions: Decimetric spikes do not originate from coronal X-ray flare sources contrary to previous expectations. However, the observations suggest a causal link between the coronal X-ray source, related to the major energy release site, and simultaneous activity in the higher corona.

Renewal: New Aspects of Acceleration and Transport of Solar Energetic Particles (SEPs) from the Sun to the Earth

DTIC Science & Technology

2014-10-31

Hole .......................................................4 2. SOHO EIT Image with Coronal Holes and FPA Vector...Diagram of CME Deflection by a Coronal Hole Figure 2: SOHO EIT Image with Coronal Holes and FPA Vector Approved for public release; distribution

77 FR 31041 - Draft Standards and Best Practices for Interaction Between Medical Examiner/Coroner and Organ and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... Best Practices for Interaction Between Medical Examiner/Coroner and Organ and Tissue Procurement... titled ``Organ and Tissue Procurement Committee Standards and Best Practices for Interaction Between Medical Examiner/Coroner Offices and Organ Tissue Procurement Organizations'' from May 12, 2012, to June...

Coronal Hole Faces Earth

NASA Image and Video Library

2017-08-14

A substantial coronal hole rotated into a position where it is facing Earth (Aug. 9-11, 2017). Coronal holes are areas of open magnetic field that spew out charged particles as solar wind that spreads into space. If that solar wind interacts with our own magnetosphere it can generate aurora. In this view of the sun in extreme ultraviolet light, the coronal hole appears as the dark stretch near the center of the sun. It was the most distinctive feature on the sun over the past week. Movies are available at https://photojournal.jpl.nasa.gov/catalog/PIA21874

Returning Coronal Hole

NASA Image and Video Library

2017-02-06

A substantial coronal hole rotated across the face of the sun this past week and is again streaming solar wind towards Earth (Jan. 30 - Feb. 2, 2017). This same coronal hole was facing Earth about a month ago and has rotated into a similar position again. Coronal holes are areas of open magnetic field from which solar wind particles stream into space. In this wavelength of extreme ultraviolet light it appears as a dark area near the center and lower portion of the sun. Movies are available at http://photojournal.jpl.nasa.gov/catalog/PIA11177

A Triumvirate: Three Coronal Holes

NASA Image and Video Library

2015-09-10

Three substantial coronal holes rotated across the face of the Sun the week of Sept. 8-10, 2015 as seen by NASA Solar Dynamics Observatory. Coronal holes are areas where the Sun magnetic field is open and a source of streaming solar wind. They appear darker in extreme ultraviolet light because there is less material in the hole areas being imaged in this specific wavelength of light. It is a little unusual to have three coronal holes at the same time, but neither is it a rare occurrence. http://photojournal.jpl.nasa.gov/catalog/PIA19950

Coronal Hole Coming Around

NASA Image and Video Library

2016-12-06

A substantial coronal hole began to rotate into view over the past few days (Dec. 1-2, 2016). Coronal holes are magnetically open areas of the sun's magnetic field structure that spew streams of high speed solar wind into space. In about a week or so that coronal hole might send streams of particles in the direction of Earth. Often times these streams can interact with Earth's magnetosphere and generate aurora. The images were taken in a wavelength of extreme ultraviolet light. Movies are available at http://photojournal.jpl.nasa.gov/catalog/PIA21208

Coronal Field Opens at Lower Height During the Solar Cycles 22 and 23 Minimum Periods: IMF Comparison Suggests the Source Surface Should Be Lowered (Postprint)

DTIC Science & Technology

2012-03-01

understood simply from differences in the areas of the coronal holes , as opposed to differences in the surface fields within them. In this study, we...invoke smaller source surface radii in the potential-field source-surface (PFSS) model to construct a consistent picture of the observed coronal holes ...that the values of ≈1.9 R and ≈1.8 R for the cycles 22 and 23 minimum periods, respectively, produce the best results. The larger coronal holes

Unilateral coronal craniosynostosis in Abraham Lincoln and his family.

PubMed

Fishman, Ronald S

2010-09-01

Premature closure of one coronal skull suture produces a characteristic arching or relative elevation of the superior orbital rim on the involved side. This sign is associated with facial asymmetry, and both signs are usually the most conspicuous features in patients with mild unilateral coronal craniosynostosis. Photographs suggest that at least 9 individuals over 5 generations of the Abraham Lincoln family had premature closure of 1 coronal suture. In 8 males, there was involvement of the left side; in 1 female, there was involvement of the right side.

Density and white light brightness in looplike coronal mass ejections - Temporal evolution

NASA Technical Reports Server (NTRS)

Steinolfson, R. S.; Hundhausen, A. J.

1988-01-01

Three ambient coronal models suitable for studies of time-dependent phenomena were used to investigate the propagation of coronal mass ejections initiated in each atmosphere by an identical energy source. These models included those of a static corona with a dipole magnetic field, developed by Dryer et al. (1979); a steady polytropic corona with an equatorial coronal streamer, developed by Steinolfson et al. (1982); and Steinolfson's (1988) model of heated corona with an equatorial coronal streamer. The results indicated that the first model does not adequately represent the general characteristics of observed looplike mass ejections, and the second model simulated only some of the observed features. Only the third model, which included a heating term and a streamer, was found to yield accurate simulation of the mess ejection observations.

Coronal magnetic fields and the solar wind

NASA Technical Reports Server (NTRS)

Newkirk, G., Jr.

1972-01-01

Current information is presented on coronal magnetic fields as they bear on problems of the solar wind. Both steady state fields and coronal transient events are considered. A brief critique is given of the methods of calculating coronal magnetic fields including the potential (current free) models, exact solutions for the solar wind and field interaction, and source surface models. These solutions are compared with the meager quantitative observations which are available at this time. Qualitative comparisons between the shapes of calculated magnetic field lines and the forms visible in the solar corona at several recent eclipses are displayed. These suggest that: (1) coronal streamers develop above extended magnetic arcades which connect unipolar regions of opposite polarity; and (2) loops, arches, and rays in the corona correspond to preferentially filled magnetic tubes in the approximately potential field.

Flux-tube divergence, coronal heating, and the solar wind

NASA Technical Reports Server (NTRS)

Wang, Y.-M.

1993-01-01

Using model calculations based on a self-consistent treatment of the coronal energy balance, we show how the magnetic flux-tube divergence rate controls the coronal temperature and the properties of the solar wind. For a fixed input of mechanical and Alfven-wave energy at the coronal base, we find that as the divergence rate increases, the maximum coronal temperature decreases but the mass flux leaving the sun gradually increases. As a result, the asymptotic wind speed decreases with increasing expansion factor near the sun, in agreement with empirical studies. As noted earlier by Withbroe, the calculated mass flux at the sun is remarkably insensitive to parameter variations; when combined with magnetohydrodynamic considerations, this self-regulatory property of the model explains the observed constancy of the mass flux at earth.

Simultaneous Solar Maximum Mission (SMM) and very large array observations of solar active regions

NASA Technical Reports Server (NTRS)

Lang, K. R.

1986-01-01

The research deals mainly with Very Large Array and Solar Maximum Mission observations of the ubiquitous coronal loops that dominate the structure of the low corona. As illustrated, the observations of thermal cyclotron lines at microwave wavelengths provide a powerful new method of accurately specifying the coronal magnetic field strength. Processes are delineated that trigger solar eruptions from coronal loops, including preburst heating and the magnetic interaction of coronal loops. Evidence for coherent burst mechanisms is provided for both the Sun and nearby stars, while other observations suggest the presence of currents that may amplify the coronal magnetic field to unexpectedly high levels. The existence is reported of a new class of compact, variable moving sources in regions of apparently weak photospheric field.

Does Tibial Slope Affect Perception of Coronal Alignment on a Standing Anteroposterior Radiograph?

PubMed

Schwartz, Adam J; Ravi, Bheeshma; Kransdorf, Mark J; Clarke, Henry D

2017-07-01

A standing anteroposterior (AP) radiograph is commonly used to evaluate coronal alignment following total knee arthroplasty (TKA). The impact of coronal alignment on TKA outcomes is controversial, perhaps due to variability in imaging and/or measurement technique. We sought to quantify the effect of image rotation and tibial slope on coronal alignment. Using a standard extramedullary tibial alignment guide, 3 cadaver legs were cut to accept a tibial tray at 0°, 3°, and 7° of slope. A computed tomography scan of the entire tibia was obtained for each specimen to confirm neutral coronal alignment. Images were then obtained at progressive 10° intervals of internal and external rotation up to 40° maximum in each direction. Images were then randomized and 5 blinded TKA surgeons were asked to determine coronal alignment. Continuous data values were transformed to categorical data (neutral [0], valgus [L], and varus [R]). Each 10° interval of external rotation of a 7° sloped tibial cut (or relative internal rotation of a tibial component viewed in the AP plane) resulted in perception of an additional 0.75° of varus. The slope of the proximal tibia bone cut should be taken into account when measuring coronal alignment on a standing AP radiograph. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors influencing coroners' verdicts: an analysis of verdicts given in 12 coroners’ districts to researcher-defined suicides in England in 2005

PubMed Central

Palmer, Bret S.; Bennewith, Olive; Simkin, Sue; Cooper, Jayne; Hawton, Keith; Kapur, Nav; Gunnell, David

2015-01-01

Abstract Background To investigate the variation between coroners in the verdicts given to deaths thought by researchers to be probable suicides and analyse factors associated with the coroners’ verdict. Methods Data were collected from 12 English coroner districts on all deaths in 2005 given a suicide, open, accidental or narrative verdict where suicide was considered a possibility. The data were reviewed by three experienced suicide researchers. Regression models were used to investigate factors associated with the coroners’ verdict. Results The researchers classified 593 deaths as suicide, of which 385 (65.4%) received a suicide verdict from the coroner. There was marked variation between coroner districts in the verdicts they gave. The suicide method was associated strongly with the coroners’ verdict; deaths from poisoning and drowning were the least likely to be given suicide verdicts. The other factors strongly associated with a coroner's verdict of suicide were: whether a note was left, age over 60 years and being married or widowed compared with being single. Conclusion Coroners vary considerably in the verdicts they give to individuals who probably died by suicide. This may compromise the usefulness of suicide statistics for assessing area differences in rates for public health surveillance. PMID:24722626

STEREO OBSERVATIONS OF FAST MAGNETOSONIC WAVES IN THE EXTENDED SOLAR CORONA ASSOCIATED WITH EIT/EUV WAVES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kwon, Ryun-Young; Ofman, Leon; Kramar, Maxim

2013-03-20

We report white-light observations of a fast magnetosonic wave associated with a coronal mass ejection observed by STEREO/SECCHI/COR1 inner coronagraphs on 2011 August 4. The wave front is observed in the form of density compression passing through various coronal regions such as quiet/active corona, coronal holes, and streamers. Together with measured electron densities determined with STEREO COR1 and Extreme UltraViolet Imager (EUVI) data, we use our kinematic measurements of the wave front to calculate coronal magnetic fields and find that the measured speeds are consistent with characteristic fast magnetosonic speeds in the corona. In addition, the wave front turns outmore » to be the upper coronal counterpart of the EIT wave observed by STEREO EUVI traveling against the solar coronal disk; moreover, stationary fronts of the EIT wave are found to be located at the footpoints of deflected streamers and boundaries of coronal holes, after the wave front in the upper solar corona passes through open magnetic field lines in the streamers. Our findings suggest that the observed EIT wave should be in fact a fast magnetosonic shock/wave traveling in the inhomogeneous solar corona, as part of the fast magnetosonic wave propagating in the extended solar corona.« less

A two-year prospective study of coronally positioned flap with or without acellular dermal matrix graft.

PubMed

de Queiroz Côrtes, Antonieta; Sallum, Antonio Wilson; Casati, Marcio Z; Nociti, Francisco H; Sallum, Enilson A

2006-09-01

Evaluation of the treatment of gingival recessions with coronally positioned flap with or without acellular dermal matrix allograft (ADM) after a period of 24 months. Thirteen patients with bilateral gingival recessions were included. The defects were randomly assigned to one of the treatments: coronally positioned flap plus ADM or coronally positioned flap alone. The clinical measurements were taken before the surgeries and after 6, 12 and 24 months. At baseline, the mean values for recession height were 3.46 and 3.58 mm for the defects treated with and without the graft, respectively (p>0.05). No significant differences between the groups were observed after 6 and 12 months in this parameter. However, after 24 months, the group treated with coronally positioned flap alone showed a greater recession height when compared with the group treated with ADM (1.62 and 1.15 mm, respectively--p<0.05). A significant increase in the thickness of keratinized tissue was observed in the group treated with ADM as compared with coronally positioned flap alone (p<0.05). ADM may reduce the residual gingival recession observed after 24 months in defects treated with coronally positioned flap. In addition, a greater gingival thickness may be achieved when the graft is used.

Neutral-Line Magnetic Shear and Enhanced Coronal Heating in Solar Active Regions

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Porter, J. G.; Gary, G. A.; Shimizu, T.

1997-01-01

By examining the magnetic structure at sites in the bright coronal interiors of active regions that are not flaring but exhibit persistent strong coronal heating, we establish some new characteristics of the magnetic origins of this heating. We have examined the magnetic structure of these sites in five active regions, each of which was well observed by both the Yohkoh SXT and the Marshall Space Flight Center Vector Magnetograph and showed strong shear in its magnetic field along part of at least one neutral line (polarity inversion). Thus, we can assess whether this form of nonpotential field structure in active regions is a characteristic of the enhanced coronal heating and vice versa. From 27 orbits' worth of Yohkoh SXT images of the five active regions, we have obtained a sample of 94 persistently bright coronal features (bright in all images from a given orbit), 40 long (greater than or approximately equals 20,000 km) neutral-line segments having strong magnetic shear throughout (shear angle greater than 45 deg), and 39 long neutral-line segments having weak magnetic shear throughout (shear angle less than 45 deg). From this sample, we find that: (1) all of our persistently bright coronal features are rooted in magnetic fields that are stronger than 150 G; (2) nearly all (95%) of these enhanced coronal features are rooted near neutral lines (closer than 10,000 km); (3) a great majority (80%) of the bright features are rooted near strong-shear portions of neutral lines; (4) a great majority (85%) of long strong-shear segments of neutral lines have persistently bright coronal features rooted near them; (5) a large minority (40%) of long weak-shear segments of neutral lines have persistently bright coronal features rooted near them; and (6) the brightness of a persistently bright Coronal feature often changes greatly over a few hours. From these results, we conclude that most persistent enhanced heating of coronal loops in active regions: (1) requires the presence of a polarity inversion in the magnetic field near at least one of the loop footpoints; (2) is greatly aided by the presence of strong shear in the core magnetic field along that neutral line; and (3) is controlled by some variable process that acts in this magnetic environment. We infer that this variable process is low-lying reconnection accompanying flux cancellation.

Coronal Heating and the Magnetic Flux Content of the Network

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Porter, J. G.; Hathaway, D. H.; Whitaker, Ann F. (Technical Monitor)

2001-01-01

Previously, from analysis of SOHO/EIT coronal images in combination with Kitt Peak magnetograms (Falconer et al 1998, ApJ, 501, 386-396), we found that the quiet corona is the sum of two components: the e-scale corona and the coronal network. The large-scale corona consists of all coronal-temperature (T approx. 10(exp 6) K) structures larger than supergranules (>approx.30,000 km). The coronal network (1) consists of all coronal-temperature structures smaller than supergranules, (2) is rooted in and loosely traces the photospheric magnetic network, (3) has its brightest features seated on polarity dividing fines (neutral lines) in the network magnetic flux, and (4) produces only about 5% of the total coronal emission in quiet regions. The heating of the coronal network is apparently magnetic in origin. Here, from analysis of EIT coronal images of quiet regions in combination with magnetograms of the same quiet regions from SOHO/MDI and from Kitt Peak, we examine the other 95% of the quiet corona and its relation to the underlying magnetic network. We find: (1) Dividing the large-scale corona into its bright and dim halves divides the area into bright "continents" and dark "oceans" having spans of 2-4 supergranules. (2) These patterns are also present in the photospheric magnetograms: the network is stronger under the bright half and weaker under the dim half. (3) The radiation from the large-scale corona increases roughly as the cube root of the magnetic flux content of the underlying magnetic network. In contrast, Fisher et A (1998, ApJ, 508, 985-998) found that the coronal radiation from an active region increases roughly linearly with the magnetic flux content of the active region. We assume, as is widely held, that nearly all of the large-scale corona is magnetically rooted in the network. Our results, together with the result of Fisher et al (1999), suggest that either the coronal heating in quiet regions has a large non-magnetic component, or, if the heating is predominantly produced via the magnetic field, the mechanism is significantly different than in active regions. This work is funded by NASA's Office of Space Science through the Solar Physics Supporting Research and Technology Program and the Sun-Earth Connection Guest Investigator Program.

On Heating the Sun's Corona by Magnetic Explosions: Feasibility in Active Regions and prospects for Quiet Regions and Coronal Holes

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Falconer, D. A.; Porter, Jason G.; Suess, Steven T.

1999-01-01

We build a case for the persistent strong coronal heating in active regions and the pervasive quasi-steady heating of the corona in quiet regions and coronal holes being driven in basically the same way as the intense transient heating in solar flares: by explosions of sheared magnetic fields in the cores of initially closed bipoles. We begin by summarizing the observational case for exploding sheared core fields being the drivers of a wide variety of flare events, with and without coronal mass ejections. We conclude that the arrangement of an event's flare heating, whether there is a coronal mass ejection, and the time and place of the ejection relative to the flare heating are all largely determined by four elements of the form and action of the magnetic field: (1) the arrangement of the impacted, interacting bipoles participating in the event, (2) which of these bipoles are active (have sheared core fields that explode) and which are passive (are heated by injection from impacted active bipoles), (3) which core field explodes first, and (4) which core-field explosions are confined within the closed field of their bipoles and which ejectively open their bipoles. We then apply this magnetic-configuration framework for flare heating to the strong coronal heating observed by the Yohkoh Soft X-ray Telescope in an active region with strongly sheared core fields observed by the MSFC vector magnetograph. All of the strong coronal heating is in continually microflaring sheared core fields or in extended loops rooted against the active core fields. Thus, the strong heating occurs in field configurations consistent with the heating being driven by frequent core-field explosions that are smaller but similar to those in confined flares and flaring arches. From analysis of the thermal and magnetic energetics of two selected core-field microflares and a bright extended loop, we find that (1) it is energetically feasible for the sheared core fields to drive all of the coronal heating in the active region via a staccato of magnetic microexplosions, (2) the microflares at the feet of the extended loop behave as the flares at the feet of flaring arches in that more coronal heating is driven within the active bipole than in the extended loop, (3) the filling factor of the X-ray plasma in the core field microflares and in the extended loop is approximately 0.1, and (4) to release enough magnetic energy for a typical microflare (10^27 - 10^28 erg), a microflaring strand of sheared core field need expand and/or untwist by only a few percent at most. Finally, we point out that (1) the field configurations for strong coronal heating in our example active region (i.e., neutral-line core fields, many embedded in the feet of extended loops) are present in abundance in the magnetic network in quiet regions and coronal holes, and (2) it is known that many network bipoles do microflare and that many produce detectable coronal heating. We therefore propose that exploding sheared core fields are the drivers of most of the heating and dynamics of the solar atmosphere, ranging from the largest and most powerful coronal mass ejections and flares, to the vigorous microflaring and coronal heating in active regions, to the multitude of fine-scale explosive events in the magnetic network. The low-lysing exploding core fields in the network drive microflares, spicules, global coronal heating, and ,consequently, the solar wind.

Suppression of heating of coronal loops rooted in opposite polarity sunspot umbrae

NASA Astrophysics Data System (ADS)

Tiwari, Sanjiv K.; Thalmann, Julia K.; Moore, Ronald L.; Panesar, Navdeep; Winebarger, Amy R.

2016-05-01

EUV observations of active region (AR) coronae reveal the presence of loops at different temperatures. To understand the mechanisms that result in hotter or cooler loops, we study a typical bipolar AR, near solar disk center, which has moderate overall magnetic twist and at least one fully developed sunspot of each polarity. From AIA 193 and 94 A images we identify many clearly discernible coronal loops that connect plage or a sunspot of one polarity to an opposite-polarity plage region. The AIA 94 A images show dim regions in the umbrae of the spots. To see which coronal loops are rooted in a dim umbral area, we performed a non-linear force-free field (NLFFF) modeling using photospheric vector magnetic field measurements obtained with the HMI onboard SDO. After validation of the NLFFF model by comparison of calculated model field lines and observed loops in AIA 193 and 94, we specify the photospheric roots of the model field lines. The model field then shows the coronal magnetic loops that arch from the dim umbral areas of the opposite polarity sunspots. Because these coronal loops are not visible in any of the coronal EUV and X-ray images of the AR, we conclude they are the coolest loops in the AR. This result suggests that the loops connecting opposite polarity umbrae are the least heated because the field in umbrae is so strong that the convective braiding of the field is strongly suppressed.We hypothesize that the convective freedom at the feet of a coronal loop, together with the strength of the field in the body of the loop, determines the strength of the heating. In particular, we expect the hottest coronal loops to have one foot in an umbra and the other foot in opposite-polarity penumbra or plage (coronal moss), the areas of strong field in which convection is not as strongly suppressed as in umbra. Many transient, outstandingly bright, loops in the AIA 94 movie of the AR do have this expected rooting pattern. We will also present another example of AR in which we find a similar rooting pattern of coronal loops.

Geometry of solar coronal rays

NASA Astrophysics Data System (ADS)

Filippov, B. P.; Martsenyuk, O. V.; Platov, Yu. V.; Den, O. E.

2016-02-01

Coronal helmet streamers are the most prominent large-scale elements of the solar corona observed in white light during total solar eclipses. The base of the streamer is an arcade of loops located above a global polarity inversion line. At an altitude of 1-2 solar radii above the limb, the apices of the arches sharpen, forming cusp structures, above which narrow coronal rays are observed. Lyot coronagraphs, especially those on-board spacecrafts flying beyond the Earth's atmosphere, enable us to observe the corona continuously and at large distances. At distances of several solar radii, the streamers take the form of fairly narrow spokes that diverge radially from the Sun. This radial direction displays a continuous expansion of the corona into the surrounding space, and the formation of the solar wind. However, the solar magnetic field and solar rotation complicate the situation. The rotation curves radial streams into spiral ones, similar to water streams flowing from rotating tubes. The influence of the magnetic field is more complex and multifarious. A thorough study of coronal ray geometries shows that rays are frequently not radial and not straight. Coronal streamers frequently display a curvature whose direction in the meridional plane depends on the phase of the solar cycle. It is evident that this curvature is related to the geometry of the global solar magnetic field, which depends on the cycle phase. Equatorward deviations of coronal streamers at solar minima and poleward deviations at solar maxima can be interpreted as the effects of changes in the general topology of the global solar magnetic field. There are sporadic temporal changes in the coronal rays shape caused by remote coronal mass ejections (CMEs) propagating through the corona. This is also a manifestation of the influence of the magnetic field on plasma flows. The motion of a large-scale flux rope associated with a CME away from the Sun creates changes in the structure of surrounding field lines, which are similar to the kink propagation along coronal rays. Careful analysis of these events could give us valuable information about the coronal plasma.

Coronal Magnetography of Solar Active Regions Using Coordinated SOHO/CDS and VLA Observations

NASA Technical Reports Server (NTRS)

Brosius, Jeffrey W.

1999-01-01

The purpose of this project is to apply the coronal magnetographic technique to SOHO (Solar Heliospheric Observatory) /CDS (Coronal Diagnostic Spectrometer) EUV (Extreme Ultraviolet Radiation) and coordinated VLA microwave observations of solar active regions to derive the strength and structure of the coronal magnetic field. A CDS observing plan was developed for obtaining spectra needed to derive active region differential emission measures (DEMs) required for coronal magnetography. VLA observations were proposed and obtained. SOHO JOP 100 was developed, tested, approved, and implemented to obtain coordinated CDS (Coronal Diagnostic Spectrometer)/EIT (Ultraviolet Imaging Telescope)/ VLA (Very Large Array)/ TRACE (Transition Region and Coronal Explorer)/ SXT (Solar X Ray Telescope) observations of active regions on April 12, May 9, May 13, and May 23. Analysis of all four data sets began, with heaviest concentration on COS data. It is found that 200-pixel (14 A in NIS1) wavelength windows are appropriate for extracting broadened Gaussian line profile fit parameters for lines including Fe XIV at 334.2, Fe XVI at 335.4, Fe XVI at 360.8, and Mg IX at 368.1 over the 4 arcmin by 4 arcmin CDS field of view. Extensive efforts were focused on learning and applying were focused on learning and applying CDS software, and including it in new IDL procedures to carry out calculations relating to coronal magnetography. An important step is to extract Gaussian profile fits to all the lines needed to derive the DEM in each spatial pixel of any given active region. The standard CDS absolute intensity calibration software was applied to derived intensity images, revealing that ratios between density-insensitive lines like Fe XVI 360.8/335.4 yield good agreement with theory. However, the resulting absolute intensities of those lines are very high, indicating that revisions to the CDS absolute intensity calibrations remain to be included in the CDS software, an essential step to deriving reliable coronal magnetograms. With lessons learned and high quality data obtained during the past year, coronal magnetography will be successfully pursued under my new SOHO GI program.

Dietary Salt Exacerbates Isoproterenol-induced Cardiomyopathy in Rats

EPA Science Inventory

Spontaneously Hypertensive Heart Failure rats (SHHFs) take far longer to develop compensated heart failure and congestive decompensation than common surgical models of heart failure. Isoproterenol (ISO) infusion can accelerate cardiomyopathy in young SHHFs, while dietary salt loa...

Myotonic Dystrophy Initially Presenting as Tachycardiomyopathy Successful Catheter Ablation of Atrial Flutter

PubMed Central

Asbach, S.; Gutleben, K. J.; Dahlem, P.; Brachmann, J.; Nölker, G.

2010-01-01

Myotonic dystrophy is a genetic muscular disease that is frequently associated with cardiac arrhythmias. Bradyarrhythmias, such as sinus bradycardia and atrioventricular block, are more common than tachyarrhythmias. Rarely, previously undiagnosed patients with myotonic dystrophy initially present with a tachyarrhythmia. We describe the case of a 14-year-old boy, who was admitted to the hospital with clinical signs and symptoms of decompensated heart failure and severely reduced left ventricular function. Electrocardiography showed common-type atrial flutter with 2 : 1 conduction resulting in a heart rate of 160 bpm. Initiation of medical therapy for heart failure as well as electrical cardioversion led to a marked clinical improvement. Catheter ablation of atrial flutter was performed to prevent future cardiac decompensations and to prevent development of tachymyopathy. Left ventricular function normalized during followup. Genetic analysis confirmed the clinical suspicion of myotonic dystrophy as known in other family members in this case. PMID:20871860

[Main types of depression with the prevalence of overvalued ideas within the pubertal decompensation of personality disorders].

PubMed

Krylova, E S; Beburishvili, A A

2009-01-01

Authors observed 96 patients (81 males and 15 females) with overvalued depressions within the pubertal decompensation of personality disorders. Past medical history and prospective observation showed that those conditions develop over the long period of distimia and pose a high risk of suicide. Such conditions differ mildly in content - metaphysical, dysmorphophobical or hypohondriacal, but far more significantly in a parity of structural components of overvalued symptoms, which consist of an ideational cultivation, an affective filling and a component of inclination. According to prevalence of one of the components three main types of such depressions were described: classical, obsessive and type of overvalued inclination. There was established a correlation between type of depression and patient's personality structure and it influenced on the clinical course of depression, the choice of therapy and on prognosis on personality disorders compensation probability in adulthood.

Deriving the Properties of Coronal Pressure Fronts in 3D: Application to the 2012 May 17 Ground Level Enhancement

NASA Astrophysics Data System (ADS)

Rouillard, A. P.; Plotnikov, I.; Pinto, R. F.; Tirole, M.; Lavarra, M.; Zucca, P.; Vainio, R.; Tylka, A. J.; Vourlidas, A.; De Rosa, M. L.; Linker, J.; Warmuth, A.; Mann, G.; Cohen, C. M. S.; Mewaldt, R. A.

2016-12-01

We study the link between an expanding coronal shock and the energetic particles measured near Earth during the ground level enhancement of 2012 May 17. We developed a new technique based on multipoint imaging to triangulate the three-dimensional (3D) expansion of the shock forming in the corona. It uses images from three vantage points by mapping the outermost extent of the coronal region perturbed by the pressure front. We derive for the first time the 3D velocity vector and the distribution of Mach numbers, M FM, of the entire front as a function of time. Our approach uses magnetic field reconstructions of the coronal field, full magnetohydrodynamic simulations and imaging inversion techniques. We find that the highest M FM values appear near the coronal neutral line within a few minutes of the coronal mass ejection onset; this neutral line is usually associated with the source of the heliospheric current and plasma sheet. We illustrate the variability of the shock speed, shock geometry, and Mach number along different modeled magnetic field lines. Despite the level of uncertainty in deriving the shock Mach numbers, all employed reconstruction techniques show that the release time of GeV particles occurs when the coronal shock becomes super-critical (M FM > 3). Combining in situ measurements with heliospheric imagery, we also demonstrate that magnetic connectivity between the accelerator (the coronal shock of 2012 May 17) and the near-Earth environment is established via a magnetic cloud that erupted from the same active region roughly five days earlier.

Combined metopic and unilateral coronal synostoses: a phenotypic conundrum.

PubMed

Sauerhammer, Tina M; Patel, Kamlesh; Oh, Albert K; Proctor, Mark R; Mulliken, John B; Rogers, Gary F

2014-03-01

Most types of craniosynostosis cause predictable changes in cranial shape. However, the phenotype of combined metopic and unilateral coronal synostoses is anomalous. The purpose of this observational study was to better clarify the clinical and radiographic features of this rare entity. A retrospective review of a craniofacial database was performed. Patients with combined metopic and unilateral coronal synostoses were included in this study. Data collected included demographic information, physical and radiographic findings, genetic evaluation, treatment, and operative outcomes. Of 687 patients treated between 1989 and 2010, only 3 patients had combined metopic and unilateral coronal synostoses. All patients were diagnosed through computed tomography on the first day of life. Phenotypic features included the following: (1) narrowed forehead with a prominent midline ridge, (2) severe bilateral brow retrusion with an acute indentation on the side of the patient coronal suture, (3) facial and nasal angulation similar to isolated unilateral coronal synostosis, and (4) anterior displacement of the ear on the fused side. In addition, the cranial vertex was deviated toward the side of the open coronal suture. Two patients had a head circumference below the 25th percentile; 2 of the 3 had a TWIST gene mutation consistent with Saethre-Chotzen syndrome. One patient was managed through fronto-orbital advancement and required a revision. The other 2 patients had early endoscopic release, followed by postoperative helmet therapy; one improved but still required open cranial remodeling. The other has near-normal phenotype, and no further surgery is planned. Combined metopic and unilateral coronal synostoses present a rare and unusual phenotype. Although early intervention improves the deformity, revisional procedures are usually required.

Magnetic Flux Cancellation as the Trigger Mechanism of Solar Coronal Jets

NASA Technical Reports Server (NTRS)

McGlasson, Riley A.; Panesar, Navdeep K.; Sterling, Alphonse C.; Moore, Ronald L.

2017-01-01

Coronal jets are narrow eruptions in the solar corona, and are often observed in extreme ultraviolet (EUV) and X-Ray images. They occur everywhere on the solar disk: in active regions, quiet regions, and coronal holes (Raouafi et al. 2016). Recent studies indicate that most coronal jets in quiet regions and coronal holes are driven by the eruption of a minifilament (Sterling et al. 2015), and that this eruption follows flux cancellation at the magnetic neutral line under the pre-eruption minifilament (Panesar et al. 2016). We confirm this picture for a large sample of jets in quiet regions and coronal holes using multithermal extreme ultraviolet (EUV) images from the Solar Dynamics Observatory (SDO)/Atmospheric Imaging Assembly (AIA) and line-of-sight magnetograms from the SDO/Helioseismic and Magnetic Imager (HMI). We report observations of 60 randomly selected jet eruptions. We have analyzed the magnetic cause of these eruptions and measured the base size and the duration of each jet using routines in SolarSoft IDL. By examining the evolutionary changes in the magnetic field before, during, and after jet eruption, we found that each of these jets resulted from minifilament eruption triggered by flux cancellation at the neutral line. In agreement with the above studies, we found our jets to have an average base diameter of 7600 +/- 2700 km and an average jet-growth duration of 9.0 +/- 3.6 minutes. These observations confirm that minifilament eruption is the driver and that magnetic flux cancellation is the primary trigger mechanism for nearly all coronal hole and quiet region coronal jet eruptions.

Decision-making in a death investigation: Emotion, families and the coroner.

PubMed

Tait, Gordon; Carpenter, Belinda; Quadrelli, Carol; Barnes, Michael

2016-03-01

The role of the coroner in common law countries such as Australia, England, Canada and New Zealand is to preside over death investigations where there is uncertainty as to the manner of death, a need to identify the deceased, a death of unknown cause, or a violent or unnatural death. The vast majority of these deaths are not suspicious and thus require coroners to engage with grieving families who have been thrust into a legal process through the misfortune of a loved one's sudden or unexpected death. In this research, 10 experienced coroners discussed how they negotiated the grief and trauma evident in a death investigation. In doing so, they articulated two distinct ways in which legal officers engaged with emotions, which are also evident in the literature. The first engages the script of judicial dispassion, articulating a hierarchical relationship between reason and emotion, while the second introduces an ethic of care via the principles of therapeutic jurisprudence, and thus offers a challenge to the role of emotion in the personae of the professional judicial officer. By using Hochschild's work on the sociology of emotions, this article discusses the various ways in which coroners manage the emotion of a death investigation through emotion work. While emotional distance may be an understandable response by coroners to the grief and trauma experienced by families and directed at cleaner coronial decision-making, the article concludes that coroners may be better served by offering emotions such as sympathy, consideration and compassion directly to the family in those situations where families are struggling to accept, or are resistant to, coroners' decisions.

TRIGGER MECHANISM OF SOLAR SUBFLARES IN A BRAIDED CORONAL MAGNETIC STRUCTURE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tiwari, Sanjiv K.; Alexander, Caroline E.; Winebarger, Amy R.

Fine-scale braiding of coronal magnetic loops by continuous footpoint motions may power coronal heating via nanoflares, which are spontaneous fine-scale bursts of internal reconnection. An initial nanoflare may trigger an avalanche of reconnection of the braids, making a microflare or larger subflare. In contrast to this internal triggering of subflares, we observe external triggering of subflares in a braided coronal magnetic field observed by the High-resolution Coronal Imager (Hi-C). We track the development of these subflares using 12 s cadence images acquired by SDO/AIA in 1600, 193, 94 Å, and registered magnetograms of SDO/HMI, over four hours centered on the Hi-Cmore » observing time. These data show numerous recurring small-scale brightenings in transition-region emission happening on polarity inversion lines where flux cancellation is occurring. We present in detail an example of an apparent burst of reconnection of two loops in the transition region under the braided coronal field which is appropriate for releasing a short reconnected loop downward and a longer reconnected loop upward. The short loop presumably submerges into the photosphere, participating in observed flux cancellation. A subflare in the overlying braided magnetic field is apparently triggered by the disturbance of the braided field by the reconnection-released upward loop. At least 10 subflares observed in this braided structure appear to be triggered this way. How common this external trigger mechanism for coronal subflares is in other active regions, and how important it is for coronal heating in general, remain to be seen.« less

IRIS Observations of Coronal Rain and Prominences: Return Flows of the Chromosphere-Corona Mass Cycle

NASA Astrophysics Data System (ADS)

Liu, Wei; Berger, Thomas; Antolin, Patrick; Schrijver, Karel

2014-06-01

It has recently been recognized that a mass cycle (e.g., Berger et al. 2011; McIntosh et al. 2012) between the hot, tenuous solar corona and the cool, dense chromosphere underneath it plays an important role in the mass budget and dynamic evolution of the solar atmosphere. Although the corona ultimately loses mass through the solar wind and coronal mass ejections, a fraction of its mass returns to the chromosphere in coronal rain, downflows of prominences, and other as-yet unidentified processes. We present here analysis of joint observations of IRIS, SDO/AIA, and Hinode/SOT of such phenomena. By utilizing the wide temperature coverage (logT: 4 - 7) provided by these instruments combined, we track the coronal cooling sequence (e.g., Schrijver 2001; Liu et al. 2012; Berger et al. 2012) leading to the formation of such material at transition region or chromospheric temperatures (logT: 4 - 5) in the million-degree corona. We compare the cooling times with those expected from the radiative cooling instability. We also measure the kinematics and densities of such downflows and infer their mass fluxes, which are compared to the upward mass fluxes into the corona, e.g., those associated with spicules and flux emergence. Special attention is paid to coronal rain formed near cusp-shaped portions of coronal loops, funnel-shaped prominences at dips of coronal loops, and their respective magnetic environments. With the information about where and when such catastrophic cooling events take place, we discuss the implications for the enigmatic coronal heating mechanisms (e.g., Antolin et al. 2010).

Coronal hole boundaries evolution at small scales. I. EIT 195 Å  and TRACE 171 Å view

NASA Astrophysics Data System (ADS)

Madjarska, M. S.; Wiegelmann, T.

2009-09-01

Aims: We aim to study the small-scale evolution at the boundaries of an equatorial coronal hole connected with a channel of open magnetic flux to the polar region and an “isolated” one in the extreme-ultraviolet spectral range. We determine the spatial and temporal scale of these changes. Methods: Imager data from TRACE in the Fe ix/x 171 Å passband and EIT on-board Solar and Heliospheric Observatory in the Fe xii 195 Å passband were analysed. Results: We found that small-scale loops known as bright points play an essential role in coronal hole boundary evolution at small scales. Their emergence and disappearance continuously expand or contract coronal holes. The changes appear to be random on a time scale comparable to the lifetime of the loops seen at these temperatures. No signature was found for a major energy release during the evolution of the loops. Conclusions: Although coronal holes seem to maintain their general shape during a few solar rotations, a closer look at their day-by-day and even hour-by-hour evolution demonstrates significant dynamics. The small-scale loops (10´´-40´´ and smaller) which are abundant along coronal hole boundaries contribute to the small-scale evolution of coronal holes. Continuous magnetic reconnection of the open magnetic field lines of the coronal hole and the closed field lines of the loops in the quiet Sun is more likely to take place. Movies are only available in electronic form at http://www.aanda.org

Coronal Heating: Testing Models of Coronal Heating by Forward-Modeling the AIA Emission of the Ansample of Coronal Loops

NASA Astrophysics Data System (ADS)

Malanushenko, A. V.

2015-12-01

We present a systemic exploration of the properties of coronal heating, by forward-modeling the emission of the ensemble of 1D quasi-steady loops. This approximations were used in many theoretical models of the coronal heating. The latter is described in many such models in the form of power laws, relating heat flux through the photosphere or volumetric heating to the strength of the magnetic field and length of a given field line. We perform a large search in the parameter space of these power laws, amongst other variables, and compare the resulting emission of the active region to that observed by AIA. We use a recently developed magnetic field model which uses shapes of coronal loops to guide the magnetic model; the result closely resembles observed structures by design. We take advantage of this, by comparing, in individual sub-regions of the active region, the emission of the active region and its synthetic model. This study allows us to rule out many theoretical models and formulate predictions for the heating models to come.

Effects of non-Maxwellian electron velocity distribution functions and nonspherical geometry on minor ions in the solar wind

NASA Technical Reports Server (NTRS)

Burgi, A.

1987-01-01

A previous model has shown that in order to account for the charge state distribution in the low-speed solar wind, a high coronal temperature is necessary and that this temperature peak goes together with a peak of nx/np in the corona. In the present paper, one of the assumptions made previously, i.e., that coronal electrons are Maxwellian, is relaxed, and a much cooler model is presented, which could account for the same oxygen charge states in the solar wind due to the inclusion of non-Maxwellian electrons. Also, due to a different choice of the coronal magnetic field geometry, this model would show no enhancement of the coronal nx/np. Results of the two models are then compared, and observational tests to distinguish between the two scenarios are proposed: comparison of directly measured coronal Te to charge state measurements in the solar wind, determination of the coronal nx/np measurement of ion speeds in the acceleration region of the solar wind, and measurement of the frozen-in silicon charge state distribution.

The Magnetic Origins of Solar Activity

NASA Technical Reports Server (NTRS)

Antiochos, S. K.

2012-01-01

The defining physical property of the Sun's corona is that the magnetic field dominates the plasma. This property is the genesis for all solar activity ranging from quasi-steady coronal loops to the giant magnetic explosions observed as coronal mass ejections/eruptive flares. The coronal magnetic field is also the fundamental driver of all space weather; consequently, understanding the structure and dynamics of the field, especially its free energy, has long been a central objective in Heliophysics. The main obstacle to achieving this understanding has been the lack of accurate direct measurements of the coronal field. Most attempts to determine the magnetic free energy have relied on extrapolation of photospheric measurements, a notoriously unreliable procedure. In this presentation I will discuss what measurements of the coronal field would be most effective for understanding solar activity. Not surprisingly, the key process for driving solar activity is magnetic reconnection. I will discuss, therefore, how next-generation measurements of the coronal field will allow us to understand not only the origins of space weather, but also one of the most important fundamental processes in cosmic and laboratory plasmas.

Sources of magnetic fields in recurrent interplanetary streams

NASA Technical Reports Server (NTRS)

Burlaga, L. F.; Behannon, K. W.; Hansen, S. F.; Pneuman, G. W.; Feldman, W. C.

1978-01-01

The paper examines sources of magnetic fields in recurrent streams observed by the Imp 8 and Heos spacecraft at 1 AU and by Mariner 10 en route to Mercury between October 31, 1973 and February 9, 1974, during Carrington rotations 1607-1610. Although most fields and plasmas at 1 AU were related to coronal holes and the magnetic field lines were open in those holes, some of the magnetic fields and plasmas at 1 AU were related to open field line regions on the sun which were not associated with known coronal holes, indicating that open field lines may be more basic than coronal holes as sources of the solar wind. Magnetic field intensities in five equatorial coronal holes, certain photospheric magnetic fields, and the coronal footprints of the sector boundaries on the source surface are characterized.

REVIEWS OF TOPICAL PROBLEMS: Coronal magnetic loops

NASA Astrophysics Data System (ADS)

Zaitsev, Valerii V.; Stepanov, Alexander V.

2008-11-01

The goal of this review is to outline some new ideas in the physics of coronal magnetic loops, the fundamental structural elements of the atmospheres of the Sun and flaring stars, which are involved in phenomena such as stellar coronal heating, flare energy release, charged particle acceleration, and the modulation of optical, radio, and X-ray emissions. The Alfvén-Carlqvist view of a coronal loop as an equivalent electric circuit allows a good physical understanding of loop processes. Describing coronal loops as MHD-resonators explains various ways in which flaring emissions from the Sun and stars are modulated, whereas modeling them by magnetic mirror traps allows one to describe the dynamics and emission of high-energy particles. Based on these approaches, loop plasma and fast particle parameters are obtained and models for flare energy release and stellar corona heating are developed.

A CORONAL HOLE'S EFFECTS ON CORONAL MASS EJECTION SHOCK MORPHOLOGY IN THE INNER HELIOSPHERE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wood, B. E.; Wu, C.-C.; Howard, R. A.

2012-08-10

We use STEREO imagery to study the morphology of a shock driven by a fast coronal mass ejection (CME) launched from the Sun on 2011 March 7. The source region of the CME is located just to the east of a coronal hole. The CME ejecta is deflected away from the hole, in contrast with the shock, which readily expands into the fast outflow from the coronal hole. The result is a CME with ejecta not well centered within the shock surrounding it. The shock shape inferred from the imaging is compared with in situ data at 1 AU, wheremore » the shock is observed near Earth by the Wind spacecraft, and at STEREO-A. Shock normals computed from the in situ data are consistent with the shock morphology inferred from imaging.« less

Coronal structures deduced from photospheric magnetic field and He I lambda 10830 observations

NASA Technical Reports Server (NTRS)

Harvey, Karen L.

1995-01-01

The National Solar Observatory synoptic program provides an extensive and unique data base of high-resolution full-disk observations of the line-of-sight photospheric magnetic fields and of the He I lambda 10830 equivalent width. These data have been taken nearly daily for more than 21 years since 1974 and provide the opportunity to investigate the behavior of the magnetic fields in the photosphere and those inferred for the corona spanning on the time scales of a day to that of a solar cycle. The intensity of structures observed in He I lambda 10830 are strongly modulated by overlying coronal radiation; areas with low coronal emission are generally brighter in He I lambda 10830, while areas with high coronal emission are darker. For this reason, He I lambda 10830 was selected in the mid-1970's as way to identify and monitor coronal holes, magnetic fields with an open configuration, and the sources of high-speed solar wind streams. The He I lambda 10830 spectroheliograms also show a wide variety of other structures from small-scale, short-lived dark points (less than 30 arc-sec, hours) to the large-scale, long-lived two 'ribbon' flare events that follow the filament eruptions (1000 arc-sec, days). Such structures provide clues about the connections and changes in the large-scale coronal magnetic fields that are rooted in concentrations of magnetic network and active regions in the photosphere. In this paper, what observations of the photospheric magnetic field and He I lambda 10830 can tell us about the short- and long-term evolution of the coronal magnetic fields will be discussed, focussing on the quiet Sun and coronal holes. These data and what we infer from them will be compared with direct observations of the coronal structure from the Yohkoh Soft X-ray Telescope.

The Solar Wind from Pseudostreamers and their Environs: Opportunities for Observations with Parker Solar Probe and Solar Orbiter

NASA Astrophysics Data System (ADS)

Panasenco, O.; Velli, M.; Panasenco, A.; Lionello, R.

2017-12-01

The solar dynamo and photospheric convection lead to three main types of structures extending from the solar surface into the corona - active regions, solar filaments (prominences when observed at the limb) and coronal holes. These structures exist over a wide range of scales, and are interlinked with each other in evolution and dynamics. Active regions can form clusters of magnetic activity and the strongest overlie sunspots. In the decay of active regions, the boundaries separating opposite magnetic polarities (neutral lines) develop specific structures called filament channels above which filaments form. In the presence of flux imbalance decaying active regions can also give birth to lower latitude coronal holes. The accumulation of magnetic flux at coronal hole boundaries also creates conditions for filament formation: polar crown filaments are permanently present at the boundaries of the polar coronal holes. Mid-latitude and equatorial coronal holes - the result of active region evolution - can create pseudostreamers if other coronal holes of the same polarity are present. While helmet streamers form between open fields of opposite polarities, the pseudostreamer, characterized by a smaller coronal imprint, typically shows a more prominent straight ray or stalk extending from the corona. The pseudostreamer base at photospheric heights is multipolar; often one observes tripolar magnetic configurations with two neutral lines - where filaments can form - separating the coronal holes. Here we discuss the specific role of filament channels on pseudostreamer topology and on solar wind properties. 1D numerical analysis of pseudostreamers shows that the properties of the solar wind from around PSs depend on the presence/absence of filament channels, number of channels and chirality at thepseudostreamer base low in the corona. We review and model possible coronal magnetic configurations and solar wind plasma properties at different distances from the solar surface that may be observed by Parker Solar Probe and Solar Orbiter.

Coronal imbalance in Lenke 5C adolescent idiopathic scoliosis regarding selecting the lowest instrumented vertebra: Lower-end vertebra versus lower-end vertebra +1 in posterior fusion.

PubMed

Hu, Bowen; Yang, Xi; Yang, Huiliang; Liu, Limin; Chen, Peiran; Wang, Linnan; Zhu, Ce; Zhou, Chunguang; Song, Yueming

2018-06-18

Choosing the fusion level for posterior fusion in Lenke 5C adolescent idiopathic scoliosis patients is highly associated with coronal balance. Previous studies indicated that in patients with lowest end vertebra tilt > 25°, surgeons could extend distal fusion to avoid coronal imbalance. This study aimed to assess the risk factors for coronal imbalance in Lenke 5C scoliosis, and to discuss how to select fusion level. We reviewed 59 Lenke 5C AIS patients in one institution with at least 2-years' follow-up from 2010 through 2015. Preoperative, and 3-month and 2-year postoperative follow-up radiographs were measured using a number of specific measurements related to coronal balance. Patients were categorized into an LEV group and an LEV+1 group. Coronal imbalance was found in 6/31 patients in the LEV+1 group at final follow-up , and not in the LEV-group at the first or final follow-up. The C7 plumb line shifted to the convex side of the central sacral vertical line in 47/59 patients, including all of the 19 CIB patients after surgery. Patients who underwent fusion at LEV+1 with > 25° LEV tilt also showed poor results regarding coronal imbalance. Statistically, coronal balance at the final follow-up was correlated with preoperative bending lumbosacral hemi-curve (p=0.002) and all of the 6 patients with CIB had bending lumbosacral hemi-curve exceeds 15°. No significant difference were found in SRS-22 scores between the two groups at 2-year-follow-up. Distal fusion extension at LEV+1 is more likely to result in coronal imbalance at the first and final follow-up, especially when bending lumbosacral hemi-curve exceeds 15°. Fusion at LEV+1 should not be chosen when LEV is at L4. Copyright © 2018. Published by Elsevier Inc.

Delisting HCV-infected liver transplant candidates who improved after viral eradication: Outcome 2 years after delisting.

PubMed

Perricone, Giovanni; Duvoux, Christophe; Berenguer, Marina; Cortesi, Paolo A; Vinaixa, Carmen; Facchetti, Rita; Mazzarelli, Chiara; Rockenschaub, Susanne-Rasoul; Martini, Silvia; Morelli, Cristina; Monico, Sara; Volpes, Riccardo; Pageaux, Georges-Philippe; Fagiuoli, Stefano; Belli, Luca S

2018-05-11

Treating patients with decompensated cirrhosis with direct-acting antiviral (DAA) therapy while on the waiting list for liver transplantation results in substantial improvement of liver function allowing 1 in 4 patients to be removed from the waiting list or delisted, as reported in a previous study promoted by the European Liver and Intestine Transplant Association (ELITA). The aim of this study was to report on clinical outcomes of delisted patients, including mortality risk, hepatocellular carcinoma development and clinical decompensation requiring relisting. One hundred and forty-two HCV-positive patients on the liver transplant waiting list for decompensated cirrhosis, negative for hepatocellular carcinoma, between February 2014 and June 2015 were treated with DAA therapy and were prospectively followed up. Forty-four patients (30.9%) were delisted following clinical improvement. This percentage was higher than in the original study because of a number of patients being delisted long after starting DAAs. The median Child-Pugh and MELD score of delisted patients was 5.5 and 9 respectively. Four patients were relisted, because of HCC diagnosis in 1 case and 3 patients developed ascites. One further patient died (2.4%) because of rapidly progressing hepatocellular carcinoma twenty-two months after delisting. Of the 70 patients who received a liver graft, 9 died (13%). Antiviral therapy allows for a long-term improvement of liver function and the delisting of one-third of treated patients with risk of liver-related complications after delisting being very low. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Implementation of digital optical capillaroscopy for quantifying and estimating the microvascular abnormalities in type 2 diabetes mellitus

NASA Astrophysics Data System (ADS)

Gurfinkel, Yu. I.; Suchkova, O. V.; Sasonko, M. L.; Priezzhev, A. V.

2016-04-01

This study is aimed to define the extent of digital capillaroscopy possibilities for the quantification and estimation of microvascular abnormalities in type 2 diabetes mellitus (T2DM). A total of 196 adult persons were enrolled in the study including the group of compensated T2DM (n = 52), decompensated diabetics (n = 68), and healthy volunteers (n = 76) with normal blood glucose and without signs of cardiovascular pathology. All participants of the study were examined with the digital optical capillaroscope ("AET", Russia). This instrument is equipped with an image-processing program allowing for quantifying the diameters of the arterial and venous segments of the capillaries and their ratio (coefficient of remodeling), perivascular zone size, capillary blood velocity, and the degree of arterial loops narrowing and the density of the capillary network. Also we estimated the relative amount of coil-shaped capillaries. The study revealed significant difference in the capillary density and the remodeling coefficient in comparison of T2DM patients with non-diabetic individuals. Significant changes are found in the decompensated T2DM group compared to the compensated group of diabetic patients. Furthermore, the number of coil-shaped capillaries differed greatly in T2DM patients as compared to the healthy subjects. The study did not reveal any statistically significant differences in the capillary density between the patients with compensated and decompensated T2DM. The digital optical capillaroscope equipped with the advanced image-processing algorithm opens up new possibilities for obtaining clinically important information on microvascular abnormalities in patients suffering from diabetes mellitus.

Renal water handling in rats with decompensated liver cirrhosis.

PubMed

Jonassen, T E; Christensen, S; Kwon, T H; Langhoff, S; Salling, N; Nielsen, S

2000-12-01

The present study was performed to investigate the renal handling of water in rats with decompensated liver cirrhosis. Liver cirrhosis was induced by intraperitoneal administration of carbon tetrachloride twice weekly for 16 wk. Control rats were treated with vehicle. The cirrhotic rats developed severe disturbances in water homeostasis: urine production was decreased and hyperosmotic, the rats had significantly decreased plasma sodium concentration and ascites, and the ability to excrete an intravenous water load was significantly impaired. Plasma concentrations of vasopressin and aldosterone were increased. Mean arterial pressure, glomerular filtration rate (GFR), and fractional lithium excretion were decreased. Acute vasopressin type 2-receptor blockade with the selective nonpeptide antagonist OPC-31260 (800 microg. kg(-1). h(-1)) was performed during conditions whereby volume depletion was prevented by computer-driven, servo-controlled intravenous volume replacement with 150 mM glucose. The aquaretic response to OPC-31260 was similar in cirrhotic and control rats. However, the OPC 31260-induced rises in fractional water excretion (delta V/GFR; +24%) and fractional distal water excretion (delta V/C(Li); +46%) were significantly increased in the cirrhotic rats, where V is flow rate and delta is change. This suggests that vasopressin-mediated renal water reabsorption capacity was increased in the cirrhotic rats. Semiquantitative immunoblotting revealed that the expression of the vasopressin-regulated water channel aquaporin-2 was unchanged in membrane fractions of both whole kidney and inner medulla from cirrhotic rats. Together, these results suggest a relative escape from vasopressin on collecting duct water reabsorption in rats with decompensated liver cirrhosis.

Corona sign: manifestation of peripheral corneal epithelial edema as a possible marker of the progression of corneal endothelial dysfunction.

PubMed

Inoue, Tomoyuki; Hara, Yuko; Kobayashi, Takeshi; Zheng, Xiaodong; Suzuki, Takashi; Shiraishi, Atsushi; Ohashi, Yuichi

2016-09-01

To describe a characteristic form of the corona sign and its clinical relevance to the degree of corneal endothelial decompensation and investigate the underlying mechanism using a rabbit model. These observational cases include 31 patients undergoing penetrating keratoplasty (PKP) and 15 patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) with special attention to the circumferentially developed corneal epithelial edema. We also conducted a laboratory observation of horizontal water flow in the rabbit cornea. We consistently observed the corona sign at the superior periphery during the initial stage of corneal endothelial decompensation after PKP. With progressive corneal endothelial cellular loss, the epithelial edema gradually expanded circumferentially in the periphery. The endothelial cellular density associated with the corona sign significantly (P < 0.01) decreased compared with that without the sign. The endothelial cellular density decreased significantly (P < 0.05) in cases with a circumferential corona sign compared with a superior corona sign. After DSAEK, however, the corneal epithelial edema subsided from the center but persisted peripherally as a corona sign in all cases. By 3 months postoperatively, the epithelial edema was confined to the superior periphery along with uneventful corneal endothelial healing. Rabbit experiments showed that total corneal endothelial decompensation decreased the horizontal intracorneal water migration (Inoue-Ohashi phenomenon) in the corneal periphery and induced peripheral corneal edema. The slit-lamp microscopic findings of the corona-like epithelial edema in the peripheral cornea are associated with the stage of corneal endothelial function. To support this, the developmental mechanism of the corona sign was demonstrated experimentally.

Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease.

PubMed

Pons, Mònica; Simón-Talero, Macarena; Millán, Laura; Ventura-Cots, Meritxell; Santos, Begoña; Augustin, Salvador; Genescà, Joan

2016-10-01

Transient elastography has been proposed as a tool to predict the risk of decompensation in patients with chronic liver disease. We aimed to identify risk groups of disease progression, using a combination of baseline liver stiffness measurement (LSM) and its change over time (delta-LSM) in patients with compensated advanced chronic liver disease (cACLD). Ninety-four patients with baseline LSM ≥10kPa, Child-Pugh score 5 and without previous decompensation were included. A second LSM was performed during follow-up and data on liver function and liver-related events were collected. The primary endpoint was a composite that included death, liver decompensation and impairment in at least 1 point in Child-Pugh score. After a median follow-up of 43.6 months, 15% of patients presented the primary endpoint. Multivariate analysis identified baseline LSM (OR 1.12, P=0.002) and delta-LSM (OR 1.02, P=0.048) as independent predictors of the primary endpoint. A high risk group represented by patients with baseline LSM ≥21kPa and delta-LSM ≥10% (risk of progression 47.1%, 95% CI: 23-71%) was identified, while patients with LSM <21kPa and delta-LSM <10% presented zero risk of progression (P=0.03). Simple classification rules using baseline LSM and delta-LSM identify cACLD patients at low or high risk of disease progression. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Biomarkers for acute kidney injury in decompensated cirrhosis: A Prospective Study.

PubMed

Jaques, David A; Spahr, Laurent; Berra, Gregory; Poffet, Vincent; Lescuyer, Pierre; Gerstel, Eric; Garin, Nicolas; Martin, Pierre-Yves; Ponte, Belen

2018-01-25

Acute kidney injury (AKI) is a frequent complication in cirrhotic patients. As serum creatinine is a poor marker of renal function in this population, we aimed to study the utility of several biomarkers in this context. A prospective study was conducted in hospitalized patients with decompensated cirrhosis. Serum creatinine (SCr), Cystatin C (CystC), NGAL and urinary NGAL, KIM-1, protein, albumin and sodium were measured on three separate occasions. Renal resistive index (RRI) was obtained. We analyzed the value of these biomarkers to determine the presence of AKI, its etiology [prerenal, acute tubular necrosis (ATN), or hepatorenal (HRS)], its severity and a composite clinical outcome at 30 days (death, dialysis and intensive care admission). We included 105 patients, of which 55 had AKI. SCr, CystC, NGAL (plasma and urinary), urinary sodium and RRI at inclusion were independently associated with the presence of AKI. SCr, CystC and plasma NGAL were able to predict the subsequent development of AKI. Pre-renal state showed lower levels of SCr, NGAL (plasma and urinary) and RRI. ATN patients had high levels of NGAL (plasma and urinary) as well as urinary protein and sodium. HRS patients presented an intermediate pattern. All biomarkers paralleled the severity of AKI. SCr, CystC and plasma NGAL predicted the development of the composite clinical outcome with the same performance as the MELD score. In patients with decompensated cirrhosis, early measurement of renal biomarkers provides valuable information on AKI etiology. It could also improve AKI diagnosis and prognosis. This article is protected by copyright. All rights reserved.

Evolution and Activity in the Solar Corona: A Comparison of Coronal and Chromospheric Structures Seen in Soft X-Rays, White Light and H-Alpha Emission

NASA Technical Reports Server (NTRS)

Bagenal, Fran

2001-01-01

The work completed under this project, 'Evolution and Activity in the Solar Corona: A Comparison of Coronal and Chromospheric Structures Seen in Soft X-Rays, White Light and H-Alpha Emission', includes the following presentations: (1) Analysis of H-alpha Observations of High-altitude Coronal Condensations; (2) Multi-spectral Imaging of Coronal Activity; (3) Measurement and Modeling of Soft X-ray Loop Arcades; (4) A Study of the Origin and Dynamics of CMEs; and various poster presentations and thesis dissertations.

Coronal partings

NASA Astrophysics Data System (ADS)

Nikulin, Igor F.; Dumin, Yurii V.

2016-02-01

The basic observational properties of "coronal partings"-the special type of quasi-one-dimensional magnetic structures, identified by a comparison of the coronal X-ray and EUV images with solar magnetograms-are investigated. They represent the channels of opposite polarity inside the unipolar large-scale magnetic fields, formed by the rows of magnetic arcs directed to the neighboring sources of the background polarity. The most important characteristics of the partings are discussed. It can be naturally assumed that-from the evolutionary and spatial points of view-the partings can transform into the coronal holes and visa versa. The classes of global, intersecting, and complex partings are identified.

The First Ionization Potential Effect from the Ponderomotive Force: On the Polarization and Coronal Origin of Alfvén Waves

NASA Astrophysics Data System (ADS)

Laming, J. Martin

2017-08-01

We investigate in more detail the origin of chromospheric Alfvén waves that give rise to the separation of ions and neutrals—the first ionization potential (FIP) effect—through the action of the ponderomotive force. In open field regions, we model the dependence of fractionation on the plasma upflow velocity through the chromosphere for both shear (or planar) and torsional Alfvén waves of photospheric origin. These differ mainly in their parametric coupling to slow mode waves. Shear Alfvén waves appear to reproduce observed fractionations for a wider range of model parameters and present less of a “fine-tuning” problem than do torsional waves. In closed field regions, we study the fractionations produced by Alfvén waves with photospheric and coronal origins. Waves with a coronal origin, at or close to resonance with the coronal loop, offer a significantly better match to observed abundances than do photospheric waves, with shear and torsional waves in such a case giving essentially indistinguishable fractionations. Such coronal waves are likely the result of a nanoflare coronal heating mechanism that, as well as heating coronal plasmas, releases Alfvén waves that can travel down to loop footpoints and cause FIP fractionation through the ponderomotive force as they reflect from the chromosphere back into the corona.

The First Ionization Potential Effect from the Ponderomotive Force: On the Polarization and Coronal Origin of Alfvén Waves

DOE Office of Scientific and Technical Information (OSTI.GOV)

Laming, J. Martin, E-mail: laming@nrl.navy.mil

We investigate in more detail the origin of chromospheric Alfvén waves that give rise to the separation of ions and neutrals—the first ionization potential (FIP) effect—through the action of the ponderomotive force. In open field regions, we model the dependence of fractionation on the plasma upflow velocity through the chromosphere for both shear (or planar) and torsional Alfvén waves of photospheric origin. These differ mainly in their parametric coupling to slow mode waves. Shear Alfvén waves appear to reproduce observed fractionations for a wider range of model parameters and present less of a “fine-tuning” problem than do torsional waves. Inmore » closed field regions, we study the fractionations produced by Alfvén waves with photospheric and coronal origins. Waves with a coronal origin, at or close to resonance with the coronal loop, offer a significantly better match to observed abundances than do photospheric waves, with shear and torsional waves in such a case giving essentially indistinguishable fractionations. Such coronal waves are likely the result of a nanoflare coronal heating mechanism that, as well as heating coronal plasmas, releases Alfvén waves that can travel down to loop footpoints and cause FIP fractionation through the ponderomotive force as they reflect from the chromosphere back into the corona.« less

A universal model for solar eruptions.

PubMed

Wyper, Peter F; Antiochos, Spiro K; DeVore, C Richard

2017-04-26

Magnetically driven eruptions on the Sun, from stellar-scale coronal mass ejections to small-scale coronal X-ray and extreme-ultraviolet jets, have frequently been observed to involve the ejection of the highly stressed magnetic flux of a filament. Theoretically, these two phenomena have been thought to arise through very different mechanisms: coronal mass ejections from an ideal (non-dissipative) process, whereby the energy release does not require a change in the magnetic topology, as in the kink or torus instability; and coronal jets from a resistive process involving magnetic reconnection. However, it was recently concluded from new observations that all coronal jets are driven by filament ejection, just like large mass ejections. This suggests that the two phenomena have physically identical origin and hence that a single mechanism may be responsible, that is, either mass ejections arise from reconnection, or jets arise from an ideal instability. Here we report simulations of a coronal jet driven by filament ejection, whereby a region of highly sheared magnetic field near the solar surface becomes unstable and erupts. The results show that magnetic reconnection causes the energy release via 'magnetic breakout'-a positive-feedback mechanism between filament ejection and reconnection. We conclude that if coronal mass ejections and jets are indeed of physically identical origin (although on different spatial scales) then magnetic reconnection (rather than an ideal process) must also underlie mass ejections, and that magnetic breakout is a universal model for solar eruptions.

Critical Magnetic Field Strengths for Unipolar Solar Coronal Plumes In Quiet Regions and Coronal Holes?

NASA Technical Reports Server (NTRS)

Avallone, Ellis; Tiwari, Sanjiv K.; Panesar, Navdeep K.; Moore, Ronald L.; Winebarger, Amy

2017-01-01

Coronal plumes are bright magnetic funnels that are found in quiet regions and coronal holes that extend high into the solar corona whose lifetimes can last from hours to days. The heating processes that make plumes bright involve the magnetic field at the base of the plume, but their intricacies remain mysterious. Raouafi et al. (2014) infer from observation that plume heating is a consequence of magnetic reconnection at the base, whereas Wang et al. (2016) infer that plume heating is a result of convergence of the magnetic flux at the plume's base, or base flux. Both papers suggest that the base flux in their plumes is of mixed polarity, but do not quantitatively measure the base flux or consider whether a critical magnetic field strength is required for plume production. To investigate the magnetic origins of plume heating, we track plume luminosity in the 171 Å wavelength as well as the abundance and strength of the base flux over the lifetimes of six unipolar coronal plumes. Of these, three are in coronal holes and three are in quiet regions. For this sample, we find that plume heating is triggered when convergence of the base flux surpasses a field strength of approximately 300 - 500 Gauss, and that the luminosity of both quiet region and coronal hole plumes respond similarly to the strength of the magnetic field in the base.

Added Value of Coronal Reformations for Duty Radiologists and for Referring Physicians or Surgeons in the CT Diagnosis of Acute Appendicitis

PubMed Central

Lee, Kyoung Ho; Hahn, Seokyung; Lee, Kyung Won; Lee, Hak Jong; Kim, Tae Jung; Kang, Sung-Bum; Shin, Joong Ho; Park, Byung Joo

2006-01-01

Objective To assess the added value of coronal reformation for radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis. Materials and Methods Contrast-enhanced CT was performed using 16-detector-row scanners in 110 patients, 46 of whom had appendicitis. Transverse (5-mm thickness, 4-mm increment), coronal (5-mm thickness, 4-mm increment), and combined transverse and coronal sections were interpreted by four radiologists, two surgeons and two emergency physicians. The area under the receiver operating characteristic curve (Az value), sensitivity, specificity (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared. Results For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs. 0.986, p = 0.076) and pooled sensitivity (92% [95% CI: 88, 96] vs. 96% [93, 99]), and enhanced appendiceal visualization in true-positive cases (p = 0.031). For non-radiologists, no such enhancement was observed, and the confidence for excluding acute appendicitis declined (p = 0.013). Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (p < 0.05). Conclusion The added value of coronal reformation is more apparent for radiologists compared to referring physicians or surgeons in the CT diagnosis of acute appendicitis. PMID:16799269

ST-segment elevation during levosimendan infusion.

PubMed

Barillà, Francesco; Giordano, Federica; Jacomelli, Ilaria; Pellicano, Mariano; Dominici, Tania

2012-07-01

Levosimendan increases the sensitivity of the heart to calcium and consequently exerts positive inotropic effects. Levosimendan is indicated in acutely decompensated severe congestive heart failure. We report that levosimendan infusion may induce myocardial ischemia in patients with acute heart failure.

SX-Ella Danis stent in massive upper gastrointestinal bleeding in cirrhosis - a case series.

PubMed

Jain, Mayank; Balkrishanan, Mahadevan; Snk, Chenduran; Cgs, Sridhar; Ramakrishnan, Ravi; Venkataraman, Jayanthi

2018-06-01

We report our experience of three cases of decompensated cirrhosis with massive upper gastrointestinal bleeding, which required insertion of an SX-Ella Danis stent for hemostasis. The procedure is safe and effective.

Combination of granulocyte colony-stimulating factor and erythropoietin improves outcomes of patients with decompensated cirrhosis.

PubMed

Kedarisetty, Chandan Kumar; Anand, Lovkesh; Bhardwaj, Ankit; Bhadoria, Ajeet Singh; Kumar, Guresh; Vyas, Ashish Kumar; David, Paul; Trehanpati, Nirupama; Rastogi, Archana; Bihari, Chhagan; Maiwall, Rakhi; Garg, Hitendra Kumar; Vashishtha, Chitranshu; Kumar, Manoj; Bhatia, Vikram; Sarin, Shiv Kumar

2015-06-01

Patients with decompensated cirrhosis have significantly reduced survival without liver transplantation. Granulocyte colony-stimulating factor (G-CSF) has been shown to increase survival in patients with acute-on-chronic liver failure, and erythropoietin promoted hepatic regeneration in animal studies. We performed a double-blind, randomized, placebo-controlled trial to determine whether co-administration of these growth factors improved outcomes for patients with advanced cirrhosis. In a prospective study, consecutive patients with decompensated cirrhosis seen at the Institute of Liver and Biliary Sciences, New Delhi (from May 2011 through June 2012) were randomly assigned to groups given subcutaneous G-CSF (5 μg/kg/d) for 5 days and then every third day (12 total doses), along with subcutaneous darbopoietin α(40 mcg/wk) for 4 weeks (GDP group, n = 29), or only placebos (control group, n = 26). All patients also received standard medical therapy and were followed for 12 months. Histology was performed on liver biopsies. The primary end point was survival at 12 months. Baseline characteristics of patients were comparable; alcohol intake was the most common etiology of cirrhosis. A higher proportion of patients in the GDP group than controls survived until 12 months (68.6% vs 26.9%; P = .003). At 12 months, Child-Turcotte Pugh scores were reduced by 48.6% in the GDP group and 39.1% in the control group, from baseline (P = .001); Model for End Stage Liver Disease scores were reduced by 40.4% and 33%, respectively (P = .03). The need for large-volume paracentesis was significantly reduced in GDP group, compared with controls (P < .05). A lower proportion of patients in the GDP group developed septic shock (6.9%) during follow-up compared with controls (38.5%; P = .005). No major adverse events were observed in either group. In a single-center randomized trial, a significantly larger proportion of patients with decompensated cirrhosis given a combination of G-CSF and darbopoietin α survived for 12 months more than patients given only placebo. The combination therapy also reduced liver severity scores and sepsis to a greater extent than placebo. Clinicaltrials.gov ID: NCT01384565. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Using the Minimally Invasive Impella 5.0 via the Right Subclavian Artery Cutdown for Acute on Chronic Decompensated Heart Failure as a Bridge to Decision.

PubMed

Bansal, Aditya; Bhama, Jay K; Patel, Rajan; Desai, Sapna; Mandras, Stacy A; Patel, Hamang; Collins, Tyrone; Reilly, John P; Ventura, Hector O; Parrino, P Eugene

2016-01-01

Outcomes of traditional mechanical support paradigms (extracorporeal membrane oxygenation, intraaortic balloon pump [IABP], and permanent left ventricular assist device [LVAD]) in acute decompensated heart failure have generally been suboptimal. Novel approaches, such as minimally invasive LVAD therapy (Impella 5.0 device), promise less invasive but equivalent hemodynamic support. However, it is yet unknown whether the outcomes with such devices support widespread acceptance of this new technology. We recently started utilizing the right subclavian artery (RSA) for Impella 5.0 implantation and report our early experience and outcomes with this novel approach. A single-center retrospective review was performed of 24 patients with acute on chronic decompensated heart failure who received the Impella 5.0 via the RSA from June 2011 to May 2014. The device was implanted via a cutdown through an 8-mm vascular graft sewn to the RSA. The device was positioned with fluoroscopy and transesophageal echocardiography. The mean age of the patients was 51.29 years, and 75% were male. At implantation, all patients were mechanically ventilated on at least 2 inotropes with persistent cardiogenic shock, and 17 (70.8%) were on IABP support. Postimplantation, 21 (87.5%) tolerated extubation, and all 17 of the patients with IABPs tolerated discontinuation of IABP support. The reduction in the Model for End-Stage Liver Disease score preimplantation vs postimplantation was statistically significant (21.17 vs 14.88, P=0.0014), suggesting improvement in end organ function. A significant decrease was also seen in creatinine levels before and after implantation (2.17 mg/dL vs 1.50 mg/dL, P=0.0043). The endpoint of support included recovery in 6 patients (25.0%), permanent LVAD in 9 (37.5%), and heart transplantation in 2 (8.3%). Death occurred in 7 patients (29.2%) as a result of multisystem organ failure, infection, or patient withdrawal of care. Minimally invasive LVAD therapy using the Impella 5.0 via the RSA cutdown is an attractive option in acute on chronic decompensated heart failure. Improvement in end organ function allows for transition to recovery or to advanced surgical therapies such as permanent LVAD and heart transplantation. Significant advantages to this approach include improved left ventricular unloading, lower anticoagulation need, and the potential for ambulation and physical therapy.

Using the Minimally Invasive Impella 5.0 via the Right Subclavian Artery Cutdown for Acute on Chronic Decompensated Heart Failure as a Bridge to Decision

PubMed Central

Bansal, Aditya; Bhama, Jay K.; Patel, Rajan; Desai, Sapna; Mandras, Stacy A.; Patel, Hamang; Collins, Tyrone; Reilly, John P.; Ventura, Hector O.; Parrino, P. Eugene

2016-01-01

Background: Outcomes of traditional mechanical support paradigms (extracorporeal membrane oxygenation, intraaortic balloon pump [IABP], and permanent left ventricular assist device [LVAD]) in acute decompensated heart failure have generally been suboptimal. Novel approaches, such as minimally invasive LVAD therapy (Impella 5.0 device), promise less invasive but equivalent hemodynamic support. However, it is yet unknown whether the outcomes with such devices support widespread acceptance of this new technology. We recently started utilizing the right subclavian artery (RSA) for Impella 5.0 implantation and report our early experience and outcomes with this novel approach. Methods: A single-center retrospective review was performed of 24 patients with acute on chronic decompensated heart failure who received the Impella 5.0 via the RSA from June 2011 to May 2014. The device was implanted via a cutdown through an 8-mm vascular graft sewn to the RSA. The device was positioned with fluoroscopy and transesophageal echocardiography. Results: The mean age of the patients was 51.29 years, and 75% were male. At implantation, all patients were mechanically ventilated on at least 2 inotropes with persistent cardiogenic shock, and 17 (70.8%) were on IABP support. Postimplantation, 21 (87.5%) tolerated extubation, and all 17 of the patients with IABPs tolerated discontinuation of IABP support. The reduction in the Model for End-Stage Liver Disease score preimplantation vs postimplantation was statistically significant (21.17 vs 14.88, P=0.0014), suggesting improvement in end organ function. A significant decrease was also seen in creatinine levels before and after implantation (2.17 mg/dL vs 1.50 mg/dL, P=0.0043). The endpoint of support included recovery in 6 patients (25.0%), permanent LVAD in 9 (37.5%), and heart transplantation in 2 (8.3%). Death occurred in 7 patients (29.2%) as a result of multisystem organ failure, infection, or patient withdrawal of care. Conclusion: Minimally invasive LVAD therapy using the Impella 5.0 via the RSA cutdown is an attractive option in acute on chronic decompensated heart failure. Improvement in end organ function allows for transition to recovery or to advanced surgical therapies such as permanent LVAD and heart transplantation. Significant advantages to this approach include improved left ventricular unloading, lower anticoagulation need, and the potential for ambulation and physical therapy. PMID:27660567

The Labial-Coronal Effect Revisited: Japanese Adults Say Pata, but Hear Tapa

ERIC Educational Resources Information Center

Tsuji, Sho; Gomez, Nayeli Gonzalez; Medina, Victoria; Nazzi, Thierry; Mazuka, Reiko

2012-01-01

The labial-coronal effect has originally been described as a bias to initiate a word with a labial consonant-vowel-coronal consonant (LC) sequence. This bias has been explained with constraints on the human speech production system, and its perceptual correlates have motivated the suggestion of a perception-production link. However, previous…

Solar and stellar coronal plasmas

NASA Technical Reports Server (NTRS)

Golub, L.

1985-01-01

Progress made in describing and interpreting coronal plasma processes and the relationship between the solar corona and its stellar counterparts is reported. Topics covered include: stellar X-ray emission, HEAO 2 X-ray survey of the Pleiades, closed coronal structures, X-ray survey of main-sequence stars with shallow convection zones, implications of the 1400 MHz flare emission, and magnetic field stochasticity.

View of coronal hole processed from television transmission of ATM

NASA Image and Video Library

1973-08-20

S73-32883 (20 Aug. 1973) --- This false color isophote, processed from an Aug. 20, 1973 television transmission of Apollo Telescope Mount (ATM) experiments from Skylab 3, dramatically reveals a significant change in the coronal hole as compared to the previous day. Solar rotation accounts for the new location of the coronal hole. Photo credit: NASA

Coronal Seismology -- Achievements and Perspectives

NASA Astrophysics Data System (ADS)

Ruderman, Michael

Coronal seismology is a new and fast developing branch of the solar physics. The main idea of coronal seismology is the same as of any branches of seismology: to determine basic properties of a medium using properties of waves propagating in this medium. The waves and oscillations in the solar corona are routinely observed in the late space missions. In our brief review we concentrate only on one of the most spectacular type of oscillations observed in the solar corona - the transverse oscillations of coronal magnetic loops. These oscillations were first observed by TRACE on 14 July 1998. At present there are a few dozens of similar observations. Shortly after the first observation of the coronal loop transverse oscillations they were interpreted as kink oscillations of magnetic tubes with the ends frozen in the dense photospheric plasma. The frequency of the kink oscillation is proportional to the magnetic field magnitude and inversely proportional to the tube length times the square root of the plasma density. This fact was used to estimate the magnetic field magnitude in the coronal loops. In 2004 the first simultaneous observation of the fundamental mode and first overtone of the coronal loop transverse oscillation was reported. If we model a coronal loop as a homogeneous magnetic tube, then the ratio of the frequencies of the first overtone and the fundamental mode should be equal to 2. However, the ratio of the observed frequencies was smaller than 2. This is related to the density variation along the loop. If we assume that the corona is isothermal and prescribe the loop shape (usually it is assumed that it has the shape of half-circle), then, using the ratio of the two frequencies, we can determine the temperature of the coronal plasma. The first observation of transverse oscillations of the coronal loops showed that they were strongly damped. This phenomenon was confirmed by the subsequent observations. At present, the most reliable candidate for the explanation of the oscillation damping is resonant absorption. The damping due to resonant absorption is, broadly speaking, proportional to the inhomogeneity scale of the density in the loop in the transverse direction. This fact was used to estimate the density inhomogeneity scale from the observations. The first observation of the coronal loop transverse oscillations gave a strong boost to the theoretical study of this phenomenon. In the last ten years theorists sufficiently refined their models taking into account such loop properties as the density variation in the longitudinal and transverse directions, the twist of the magnetic field, the non-circular loop cross-section, the variation of the cross-section along the loop, and the loop curvature. Now, to obtain more accurate estimates of the coronal plasma parameters, we need the following from the observations: (i) Since the frequency of the loop oscillation depends on the plasma density, more accurate data on this quantity is required. (ii) Since the estimate of the coronal temperature strongly depends of the loop shape, an accurate three-dimensional picture of the loop is desirable. (iii) The fundamental frequency and first overtone of the loop oscillation are sufficiently affected by the variation of the loop cross-section. The observational data on this quantity is important for further progress of the coronal seismology.

The Evolution of Open Magnetic Flux Driven by Photospheric Dynamics

NASA Technical Reports Server (NTRS)

Linker, Jon A.; Lionello, Roberto; Mikic, Zoran; Titov, Viacheslav S.; Antiochos, Spiro K.

2010-01-01

The coronal magnetic field is of paramount importance in solar and heliospheric physics. Two profoundly different views of the coronal magnetic field have emerged. In quasi-steady models, the predominant source of open magnetic field is in coronal holes. In contrast, in the interchange model, the open magnetic flux is conserved, and the coronal magnetic field can only respond to the photospheric evolution via interchange reconnection. In this view the open magnetic flux diffuses through the closed, streamer belt fields, and substantial open flux is present in the streamer belt during solar minimum. However, Antiochos and co-workers, in the form of a conjecture, argued that truly isolated open flux cannot exist in a configuration with one heliospheric current sheet (HCS) - it will connect via narrow corridors to the polar coronal hole of the same polarity. This contradicts the requirements of the interchange model. We have performed an MHD simulation of the solar corona up to 20R solar to test both the interchange model and the Antiochos conjecture. We use a synoptic map for Carrington Rotation 1913 as the boundary condition for the model, with two small bipoles introduced into the region where a positive polarity extended coronal hole forms. We introduce flows at the photospheric boundary surface to see if open flux associated with the bipoles can be moved into the closed-field region. Interchange reconnection does occur in response to these motions. However, we find that the open magnetic flux cannot be simply injected into closed-field regions - the flux eventually closes down and disconnected flux is created. Flux either opens or closes, as required, to maintain topologically distinct open and closed field regions, with no indiscriminate mixing of the two. The early evolution conforms to the Antiochos conjecture in that a narrow corridor of open flux connects the portion of the coronal hole that is nearly detached by one of the bipoles. In the later evolution, a detached coronal hole forms, in apparent violation of the Antiochos conjecture. Further investigation reveals that this detached coronal hole is actually linked to the extended coronal hole by a separatrix footprint on the photosphere of zero width. Therefore, the essential idea of the conjecture is preserved, if we modify it to state that coronal holes in the same polarity region are always linked, either by finite width corridors or separatrix footprints. The implications of these results for interchange reconnection and the sources of the slow solar wind are briefly discussed.

The Evolution of Open Magnetic Flux Driven by Photospheric Dynamics

NASA Astrophysics Data System (ADS)

Linker, Jon A.; Lionello, Roberto; Mikić, Zoran; Titov, Viacheslav S.; Antiochos, Spiro K.

2011-04-01

The coronal magnetic field is of paramount importance in solar and heliospheric physics. Two profoundly different views of the coronal magnetic field have emerged. In quasi-steady models, the predominant source of open magnetic field is in coronal holes. In contrast, in the interchange model, the open magnetic flux is conserved, and the coronal magnetic field can only respond to the photospheric evolution via interchange reconnection. In this view, the open magnetic flux diffuses through the closed, streamer belt fields, and substantial open flux is present in the streamer belt during solar minimum. However, Antiochos and coworkers, in the form of a conjecture, argued that truly isolated open flux cannot exist in a configuration with one heliospheric current sheet—it will connect via narrow corridors to the polar coronal hole of the same polarity. This contradicts the requirements of the interchange model. We have performed an MHD simulation of the solar corona up to 20 R sun to test both the interchange model and the Antiochos conjecture. We use a synoptic map for Carrington rotation 1913 as the boundary condition for the model, with two small bipoles introduced into the region where a positive polarity extended coronal hole forms. We introduce flows at the photospheric boundary surface to see if open flux associated with the bipoles can be moved into the closed-field region. Interchange reconnection does occur in response to these motions. However, we find that the open magnetic flux cannot be simply injected into closed-field regions—the flux eventually closes down and disconnected flux is created. Flux either opens or closes, as required, to maintain topologically distinct open- and closed-field regions, with no indiscriminate mixing of the two. The early evolution conforms to the Antiochos conjecture in that a narrow corridor of open flux connects the portion of the coronal hole that is nearly detached by one of the bipoles. In the later evolution, a detached coronal hole forms, in apparent violation of the Antiochos conjecture. Further investigation reveals that this detached coronal hole is actually linked to the extended coronal hole by a separatrix footprint on the photosphere of zero width. Therefore, the essential idea of the conjecture is preserved, if we modify it to state that coronal holes in the same polarity region are always linked, either by finite width corridors or separatrix footprints. The implications of these results for interchange reconnection and the sources of the slow solar wind are briefly discussed.

Contagious Coronal Heating from Recurring Emergence of Magnetic Flux

NASA Astrophysics Data System (ADS)

Moore, R. L.; Falconer, D. A.; Sterling, A. C.

2002-01-01

For each of six old bipolar active regions, we present and interpret Yohkoh/SXT and SOHO/MDI observations of the development, over several days, of enhanced coronal heating in and around the old bipole in response to new magnetic flux emergence within the old bipole. The observations show: 1. In each active region, new flux emerges in the equatorward side of the old bipole, around a lone remaining leading sunspot and/or on the equatorward end of the neutral line of the old bipole. 2. The emerging field is marked by intense internal coronal heating, and enhanced coronal heating occurs in extended loops stemming from the emergence site. 3. In five of the six cases, a "rooster tail" of coronal loops in the poleward extent of the old bipole also brightens in response to the flux emergence. 4. There are episodes of enhanced coronal heating in surrounding magnetic fields that are contiguous with the old bipole but are not directly connected to the emerging field. From these observations, we suggest that the accommodation of localized newly emerged flux within an old active region entails far reaching adjustments in the 3D magnetic field throughout the active region and in surrounding fields in which the active region is embedded, and that these adjustments produce the extensive enhanced coronal heating. We Also Note That The Reason For The recurrence of flux emergence in old active regions may be that active-region flux tends to emerge in giant-cell convection downflows. If so, the poleward "rooster tail" is a coronal flag of a long-lasting downflow in the convection zone. This work was funded by NASA's Office of Space Science through the Solar Physics Supporting Research and Technology Program and the Sun-Earth Connection Guest Investigator Program.

Classification and Physical parameters EUV coronal jets with STEREO/SECCHI.

NASA Astrophysics Data System (ADS)

Nistico, Giuseppe; Bothmer, Volker; Patsourakos, Spiro; Zimbardo, Gaetano

In this work we present observations of EUV coronal jets, detected with the SECCHI (Sun Earth Connection Coronal and Heliospheric Investigation) imaging suites of the two STEREO spacecraft. Starting from catalogues of polar and equatorial coronal hole jets (Nistico' et al., Solar Phys., 259, 87, 2009; Ann. Geophys. in press), identified from simultaneous EUV and white-light coronagraph observations, taken during the time period March 2007 to April 2008 when solar activity was at minimum, we perfom a detailed study of some events. A basic char-acterisation of the magnetic morphology and identification of the presence of helical structure were established with respect to recently proposed models for their origin and temporal evo-lution. A classification of the events with respect to previous jet studies shows that amongst the 79 events, identified into polar coronal holes, there were 37 Eiffel tower -type jet events commonly interpreted as a small-scale ( 35 arcsec) magnetic bipole reconnecting with the ambi-ent unipolar open coronal magnetic fields at its looptops, 12 lambda-type jet events commonly interpreted as reconnection with the ambient field happening at the bipoles footpoints. Five events were termed micro-CME type jet events because they resembled classical three-part structured coronal mass ejections (CMEs) but on much smaller scales. The remainig 25 cases could not be uniquely classified. Thirty-one of the total number of events exhibited a helical magnetic field structure, indicative for a torsional motion of the jet around its axis of propaga-tion. The jet events are found to be also present in equatorial coronal holes. We also present the 3-D reconstruction, temperature, velocity, and density measurements of a number of jets during their evolution.

DERIVING THE PROPERTIES OF CORONAL PRESSURE FRONTS IN 3D: APPLICATION TO THE 2012 MAY 17 GROUND LEVEL ENHANCEMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rouillard, A. P.; Plotnikov, I.; Pinto, R. F.

2016-12-10

We study the link between an expanding coronal shock and the energetic particles measured near Earth during the ground level enhancement of 2012 May 17. We developed a new technique based on multipoint imaging to triangulate the three-dimensional (3D) expansion of the shock forming in the corona. It uses images from three vantage points by mapping the outermost extent of the coronal region perturbed by the pressure front. We derive for the first time the 3D velocity vector and the distribution of Mach numbers, M {sub FM}, of the entire front as a function of time. Our approach uses magneticmore » field reconstructions of the coronal field, full magnetohydrodynamic simulations and imaging inversion techniques. We find that the highest M {sub FM} values appear near the coronal neutral line within a few minutes of the coronal mass ejection onset; this neutral line is usually associated with the source of the heliospheric current and plasma sheet. We illustrate the variability of the shock speed, shock geometry, and Mach number along different modeled magnetic field lines. Despite the level of uncertainty in deriving the shock Mach numbers, all employed reconstruction techniques show that the release time of GeV particles occurs when the coronal shock becomes super-critical ( M {sub FM} > 3). Combining in situ measurements with heliospheric imagery, we also demonstrate that magnetic connectivity between the accelerator (the coronal shock of 2012 May 17) and the near-Earth environment is established via a magnetic cloud that erupted from the same active region roughly five days earlier.« less

Morphology of Pseudostreamers and Solar Wind Properties

NASA Astrophysics Data System (ADS)

Panasenco, Olga; Velli, Marco

2016-05-01

The solar dynamo and photospheric convection lead to three main types of structures extending from the solar surface into the corona - active regions, solar filaments (prominences when observed at the limb) and coronal holes. These structures exist over a wide range of scales, and are interlinked with each other in evolution and dynamics. Active regions can form clusters of magnetic activity and the strongest overlie sunspots. In the decay of active regions, the boundaries separating opposite magnetic polarities (neutral lines) develop the specific structures called filament channels above which filaments form. In the presence of flux imbalance decaying active regions can also give birth to lower latitude coronal holes. The accumulation of magnetic flux at coronal hole boundaries also creates the conditions for filament formation: polar crown filaments are permanently present at the boundaries of the polar coronal holes. Middle-latitude and equatorial coronal holes - the result of active region evolution - can create pseudostreamers (PSs) if other coronal holes of the same polarity are present. While helmet streamers form between open fields of opposite polarities, the pseudostreamer, characterized by a smaller coronal imprint, typically shows a more prominent straight ray or stalk extending from the corona. The pseudostreamer base at photospheric heights is multipolar; often one observes tripolar magnetic configurations with two neutral lines - where filaments can form - separating the coronal holes. Here we discuss the specific role of filament channels on pseudostreamer topology and on solar wind properties. 1D numerical analysis of PSs shows that the properties of the solar wind from around PSs depend on the presence/absence of filament channels, number of channels and chirality at the PS base low in the corona.

Coronal "wave": Magnetic Footprint Of A Cme?

NASA Astrophysics Data System (ADS)

Attrill, Gemma; Harra, L. K.; van Driel-Gesztelyi, L.; Demoulin, P.; Wuelser, J.

2007-05-01

We propose a new mechanism for the generation of "EUV coronal waves". This work is based on new analysis of data from SOHO/EIT, SOHO/MDI & STEREO/EUVI. Although first observed in 1997, the interpretation of coronal waves as flare-induced or CME-driven remains a debated topic. We investigate the properties of two "classical" SOHO/EIT coronal waves in detail. The source regions of the associated CMEs possess opposite helicities & the coronal waves display rotations in opposite senses. We observe deep dimmings near the flare site & also widespread diffuse dimming, accompanying the expansion of the EIT wave. We report a new property of these EIT waves, namely, that they display dual brightenings: persistent ones at the outermost edge of the core dimming regions & simultaneously diffuse brightenings constituting the leading edge of the coronal wave, surrounding the expanding diffuse dimmings. We show that such behaviour is consistent with a diffuse EIT wave being the magnetic footprint of a CME. We propose a new mechanism where driven magnetic reconnections between the skirt of the expanding CME & quiet-Sun magnetic loops generate the observed bright diffuse front. The dual brightenings & widespread diffuse dimming are identified as innate characteristics of this process. In addition we present some of the first analysis of a STEREO/EUVI limb coronal wave. We show how the evolution of the diffuse bright front & dimmings can be understood in terms of the model described above. We show that an apparently stationary part of the bright front can be understood in terms of magnetic interchange reconnections between the expanding CME & the "open" magnetic field of a low-latitude coronal hole. We use both the SOHO/EIT & STEREO/EUVI events to demonstrate that through successive reconnections, this new model provides a natural mechanism via which CMEs can become large-scale in the lower corona.

Contagious Coronal Heating from Recurring Emergence of Magnetic Flux

NASA Technical Reports Server (NTRS)

Moore, Ronald L.; Falconer, David; Sterling, Alphonse; Whitaker, Ann F. (Technical Monitor)

2001-01-01

For each of six old bipolar active regions, we present and interpret Yohkoh/SXT and SOHO/MDI observations of the development, over several days, of enhanced coronal heating in and around the old bipole in response to new magnetic flux emerge= within the old bipole. The observations show: 1. In each active region, new flux emerges in the equatorward side of the old bipole, around a lone remaining leading sunspot and/or on the equatorward end of the neutral line of the old bipole. 2. The emerging field is marked by intense internal coronal heating, and enhanced coronal heating occurs in extended loops stemming from the emergence site. 3. In five of the six cases, a "rooster tail" of coronal loops in the poleward extent of the old bipole also brightens in response to the flux emergence. 4. There are episodes of enhanced coronal heating in surrounding magnetic fields that are contiguous with the old bipole but are not directly connected to the emerging field. From these observations, we suggest that the accommodation of localized newly emerged flux within an old active region entails far reaching adjustments in the 3D magnetic field throughout the active region and in surrounding fields in which the active region is embedded, and that these adjustments produce the extensive enhanced coronal heating. We also note that the reason for the recurrence of flux emergence in old active regions may be that active region flux tends to emerge in giant-cell convection downflows. If so, the poleward "rooster tail" is a coronal flag of a long-lasting downflow in the convection zone. This work was funded by NASA's Office of Space Science through the Solar Physics Supporting Research and Technology Program and the Sun-Earth Connection Guest Investigator Program.

Space- and Ground-based Coronal Spectro-Polarimetry

NASA Astrophysics Data System (ADS)

Fineschi, Silvano; Bemporad, Alessandro; Rybak, Jan; Capobianco, Gerardo

This presentation gives an overview of the near-future perspectives of ultraviolet and visible-light spectro-polarimetric instrumentation for probing coronal magnetism from space-based and ground-based observatories. Spectro-polarimetric imaging of coronal emission-lines in the visible-light wavelength-band provides an important diagnostics tool of the coronal magnetism. The interpretation in terms of Hanle and Zeeman effect of the line-polarization in forbidden emission-lines yields information on the direction and strength of the coronal magnetic field. As study case, this presentation will describe the Torino Coronal Magnetograph (CorMag) for the spectro-polarimetric observation of the FeXIV, 530.3 nm, forbidden emission-line. CorMag - consisting of a Liquid Crystal (LC) Lyot filter and a LC linear polarimeter - has been recently installed on the Lomnicky Peak Observatory 20cm Zeiss coronagraph. The preliminary results from CorMag will be presented. The linear polarization by resonance scattering of coronal permitted line-emission in the ultraviolet (UV)can be modified by magnetic fields through the Hanle effect. Space-based UV spectro-polarimeters would provide an additional tool for the disgnostics of coronal magnetism. As a case study of space-borne UV spectro-polarimeters, this presentation will describe the future upgrade of the Sounding-rocket Coronagraphic Experiment (SCORE) to include the capability of imaging polarimetry of the HI Lyman-alpha, 121.6 nm. SCORE is a multi-wavelength imager for the emission-lines, HeII 30.4 nm and HI 121.6 nm, and visible-light broad-band emission of the polarized K-corona. SCORE has flown successfully in 2009. This presentation will describe how in future re-flights SCORE could observe the expected Hanle effect in corona with a HI Lyman-alpha polarimeter.

CME Interaction with Coronal Holes and Their Interplanetary Consequences

NASA Technical Reports Server (NTRS)

Gopalswamy, N.; Makela, P.; Xie, H.; Akiyama, S.; Yashiro, S.

2008-01-01

A significant number of interplanetary (IP) shocks (-17%) during cycle 23 were not followed by drivers. The number of such "driverless" shocks steadily increased with the solar cycle with 15%, 33%, and 52% occurring in the rise, maximum, and declining phase of the solar cycle. The solar sources of 15% of the driverless shocks were very close the central meridian of the Sun (within approx.15deg), which is quite unexpected. More interestingly, all the driverless shocks with their solar sources near the solar disk center occurred during the declining phase of solar cycle 23. When we investigated the coronal environment of the source regions of driverless shocks, we found that in each case there was at least one coronal hole nearby suggesting that the coronal holes might have deflected the associated coronal mass ejections (CMEs) away from the Sun-Earth line. The presence of abundant low-latitude coronal holes during the declining phase further explains why CMEs originating close to the disk center mimic the limb CMEs, which normally lead to driverless shocks due to purely geometrical reasons. We also examined the solar source regions of shocks with drivers. For these, the coronal holes were located such that they either had no influence on the CME trajectories. or they deflected the CMEs towards the Sun-Earth line. We also obtained the open magnetic field distribution on the Sun by performing a potential field source surface extrapolation to the corona. It was found that the CMEs generally move away from the open magnetic field regions. The CME-coronal hole interaction must be widespread in the declining phase, and may have a significant impact on the geoeffectiveness of CMEs.

Comparison of Two Coronal Magnetic Field Models to Reconstruct a Sigmoidal Solar Active Region with Coronal Loops

NASA Astrophysics Data System (ADS)

Duan, Aiying; Jiang, Chaowei; Hu, Qiang; Zhang, Huai; Gary, G. Allen; Wu, S. T.; Cao, Jinbin

2017-06-01

Magnetic field extrapolation is an important tool to study the three-dimensional (3D) solar coronal magnetic field, which is difficult to directly measure. Various analytic models and numerical codes exist, but their results often drastically differ. Thus, a critical comparison of the modeled magnetic field lines with the observed coronal loops is strongly required to establish the credibility of the model. Here we compare two different non-potential extrapolation codes, a nonlinear force-free field code (CESE-MHD-NLFFF) and a non-force-free field (NFFF) code, in modeling a solar active region (AR) that has a sigmoidal configuration just before a major flare erupted from the region. A 2D coronal-loop tracing and fitting method is employed to study the 3D misalignment angles between the extrapolated magnetic field lines and the EUV loops as imaged by SDO/AIA. It is found that the CESE-MHD-NLFFF code with preprocessed magnetogram performs the best, outputting a field that matches the coronal loops in the AR core imaged in AIA 94 Å with a misalignment angle of ˜10°. This suggests that the CESE-MHD-NLFFF code, even without using the information of the coronal loops in constraining the magnetic field, performs as good as some coronal-loop forward-fitting models. For the loops as imaged by AIA 171 Å in the outskirts of the AR, all the codes including the potential field give comparable results of the mean misalignment angle (˜30°). Thus, further improvement of the codes is needed for a better reconstruction of the long loops enveloping the core region.

Joint SDO and IRIS Observations of a Novel, Hybrid Prominence-Coronal Rain Complex

NASA Astrophysics Data System (ADS)

Liu, Wei; Antolin, Patrick; Sun, Xudong; Gao, Lijia; Vial, Jean-Claude; Gibson, Sarah; Okamoto, Takenori; Berger, Thomas; Uitenbroek, Han; De Pontieu, Bart

2016-10-01

Solar prominences and coronal rain are intimately related phenomena, both involving cool material at chromospheric temperatures within the hot corona and both playing important roles as part of the return flow of the chromosphere-corona mass cycle. At the same time, they exhibit distinct morphologies and dynamics not yet well understood. Quiescent prominences consist of numerous long-lasting, filamentary downflow threads, while coronal rain is more transient and falls comparably faster along well-defined curved paths. We report here a novel, hybrid prominence-coronal rain complex in an arcade-fan geometry observed by SDO/AIA and IRIS, which provides new insights to the underlying physics of such contrasting behaviors. We found that the supra-arcade fan region hosts a prominence sheet consisting of meandering threads with broad line widths. As the prominence material descends to the arcade, it turns into coronal rain sliding down coronal loops with line widths 2-3 times narrower. This contrast suggests that distinct local plasma and magnetic conditions determine the fate of the cool material, a scenario supported by our magnetic field extrapolations from SDO/HMI. Specifically, the supra-arcade fan (similar to those in solar flares; e.g., McKenzie 2013) is likely situated in a current sheet, where the magnetic field is weak and the plasma-beta could be close to unity, thus favoring turbulent flows like those prominence threads. In contrast, the underlying arcade has a stronger magnetic field and most likely a low-beta environment, such that the material is guided along magnetic field lines to appear as coronal rain. We will discuss the physical implications of these observations beyond prominence and coronal rain.

Magnetic Flux Cancellation as the Trigger of Solar Coronal Jets

NASA Astrophysics Data System (ADS)

McGlasson, R.; Panesar, N. K.; Sterling, A. C.; Moore, R. L.

2017-12-01

Coronal jets are narrow eruptions in the solar corona, and are often observed in extreme ultraviolet (EUV) and X-ray images. They occur everywhere on the solar disk: in active regions, quiet regions, and coronal holes (Raouafi et al. 2016). Recent studies indicate that most coronal jets in quiet regions and coronal holes are driven by the eruption of a minifilament (Sterling et al. 2015), and that this eruption follows flux cancellation at the magnetic neutral line under the pre-eruption minifilament (Panesar et al. 2016). We confirm this picture for a large sample of jets in quiet regions and coronal holes using multithermal (304 Å 171 Å, 193 Å, and 211 Å) extreme ultraviolet (EUV) images from the Solar Dynamics Observatory (SDO) /Atmospheric Imaging Assembly (AIA) and line-of-sight magnetograms from the SDO /Helioseismic and Magnetic Imager (HMI). We report observations of 60 randomly selected jet eruptions. We have analyzed the magnetic cause of these eruptions and measured the base size and the duration of each jet using routines in SolarSoft IDL. By examining the evolutionary changes in the magnetic field before, during, and after jet eruption, we found that each of these jets resulted from minifilament eruption triggered by flux cancellation at the neutral line. In agreement with the above studies, we found our jets to have an average base diameter of 7600 ± 2700 km and an average duration of 9.0 ± 3.6 minutes. These observations confirm that minifilament eruption is the driver and magnetic flux cancellation is the primary trigger mechanism for nearly all coronal hole and quiet region coronal jet eruptions.

Impact of the quality of coronal restoration and root canal filling on the periapical health in adult syrian subpopulation

PubMed Central

Alafif, Hisham

2014-01-01

Background: The purpose of this study was to determine the status of periapical tissues of endodontically treated teeth according to coronal restorations and root canal fillings separately and in concomitant in adult Syrian subpopulation. Methods: 784 endodontically treated teeth from two hundred randomly selected Syrian adult patients were radiographically evaluated. According to predetermined criteria, the quality of coronal restorations and root canal filling of each tooth was scored as adequate or inadequate. The status of periapical tissues was also classified as healthy or diseased. Results were analyzed using Chi-squared test. Results: Adequate coronal restorations were determined in 58.54% of cases which was accompanied with less periapical pathosis than that in teeth with inadequate restorations (P < 0.01). 14% of teeth were restored by posts which showed no significant impact on the periapical tissues health. 18.5% of endodontic treatments were evaluated as adequate with less number of periapical radiolucencies than that of inadequate root canal fillings (P < 0.01). Absence of periapical pathosis was 96.6% in cases with both adequate coronal restorations and root canals fillings. The rate was 88.5% in cases with only adequate root canals fillings, and about 70% in cases with only adequate coronal restorations. When the treatment was inadequate in both coronal and root canals fillings, success rate was only observed in 48.8%. Conclusion: The most important factor with regard to the periradicular tissue health is the quality of root canal filling without neglecting the influence of coronal restoration (regardless of its type). There is a high prevalence rate of periapical pathosis in Syrian subpopulation due to poor dental practice. PMID:25565729

Comparison of Two Coronal Magnetic Field Models to Reconstruct a Sigmoidal Solar Active Region with Coronal Loops

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duan, Aiying; Zhang, Huai; Jiang, Chaowei

Magnetic field extrapolation is an important tool to study the three-dimensional (3D) solar coronal magnetic field, which is difficult to directly measure. Various analytic models and numerical codes exist, but their results often drastically differ. Thus, a critical comparison of the modeled magnetic field lines with the observed coronal loops is strongly required to establish the credibility of the model. Here we compare two different non-potential extrapolation codes, a nonlinear force-free field code (CESE–MHD–NLFFF) and a non-force-free field (NFFF) code, in modeling a solar active region (AR) that has a sigmoidal configuration just before a major flare erupted from themore » region. A 2D coronal-loop tracing and fitting method is employed to study the 3D misalignment angles between the extrapolated magnetic field lines and the EUV loops as imaged by SDO /AIA. It is found that the CESE–MHD–NLFFF code with preprocessed magnetogram performs the best, outputting a field that matches the coronal loops in the AR core imaged in AIA 94 Å with a misalignment angle of ∼10°. This suggests that the CESE–MHD–NLFFF code, even without using the information of the coronal loops in constraining the magnetic field, performs as good as some coronal-loop forward-fitting models. For the loops as imaged by AIA 171 Å in the outskirts of the AR, all the codes including the potential field give comparable results of the mean misalignment angle (∼30°). Thus, further improvement of the codes is needed for a better reconstruction of the long loops enveloping the core region.« less

The nature of micro CMEs within coronal holes

NASA Astrophysics Data System (ADS)

Bothmer, Volker; Nistico, Giuseppe; Zimbardo, Gaetano; Patsourakos, Spiros; Bosman, Eckhard

Whilst investigating the origin and characteristics of coronal jets and large-scale CMEs identi-fied in data from the SECCHI (Sun Earth Connection Coronal and Heliospheric Investigation) instrument suites on board the two STEREO satellites, we discovered transient events that originated in the low corona with a morphology resembling that of typical three-part struc-tured coronal mass ejections (CMEs). However, the CMEs occurred on considerably smaller spatial scales. In this presentation we show evidence for the existence of small-scale CMEs from inside coronal holes and present quantitative estimates of their speeds and masses. We interprete the origin and evolution of micro CMEs as a natural consequence of the emergence of small-scale magnetic bipoles related to the Sun's ever changing photospheric magnetic flux on various scales and their interactions with the ambient plasma and magnetic field. The analysis of CMEs is performed within the framework of the EU Erasmus and FP7 SOTERIA projects.

Magnetic Nulls and Super-radial Expansion in the Solar Corona

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gibson, Sarah E.; Dalmasse, Kevin; Tomczyk, Steven

Magnetic fields in the Sun’s outer atmosphere—the corona—control both solar-wind acceleration and the dynamics of solar eruptions. We present the first clear observational evidence of coronal magnetic nulls in off-limb linearly polarized observations of pseudostreamers, taken by the Coronal Multichannel Polarimeter (CoMP) telescope. These nulls represent regions where magnetic reconnection is likely to act as a catalyst for solar activity. CoMP linear-polarization observations also provide an independent, coronal proxy for magnetic expansion into the solar wind, a quantity often used to parameterize and predict the solar wind speed at Earth. We introduce a new method for explicitly calculating expansion factorsmore » from CoMP coronal linear-polarization observations, which does not require photospheric extrapolations. We conclude that linearly polarized light is a powerful new diagnostic of critical coronal magnetic topologies and the expanding magnetic flux tubes that channel the solar wind.« less

Magnetic Nulls and Super-Radial Expansion in the Solar Corona

NASA Technical Reports Server (NTRS)

Gibson, Sarah E.; Dalmasse, Kevin; Rachmeler, Laurel A.; De Rosa, Marc L.; Tomczyk, Steven; De Toma, Giuliana; Burkepile, Joan; Galloy, Michael

2017-01-01

Magnetic fields in the Sun's outer atmosphere, the corona, control both solar-wind acceleration and the dynamics of solar eruptions. We present the first clear observational evidence of coronal magnetic nulls in off-limb linearly polarized observations of pseudostreamers, taken by the Coronal Multichannel Polarimeter (CoMP) telescope. These nulls represent regions where magnetic reconnection is likely to act as a catalyst for solar activity.CoMP linear-polarization observations also provide an independent, coronal proxy for magnetic expansion into the solar wind, a quantity often used to parameterize and predict the solar wind speed at Earth. We introduce a new method for explicitly calculating expansion factors from CoMP coronal linear-polarization observations, which does not require photospheric extrapolations. We conclude that linearly polarized light is a powerful new diagnostic of critical coronal magnetic topologies and the expanding magnetic flux tubes that channel the solar wind.

Relating magnetic reconnection to coronal heating

PubMed Central

Longcope, D. W.; Tarr, L. A.

2015-01-01

It is clear that the solar corona is being heated and that coronal magnetic fields undergo reconnection all the time. Here we attempt to show that these two facts are related—i.e. coronal reconnection generates heat. This attempt must address the fact that topological change of field lines does not automatically generate heat. We present one case of flux emergence where we have measured the rate of coronal magnetic reconnection and the rate of energy dissipation in the corona. The ratio of these two, , is a current comparable to the amount of current expected to flow along the boundary separating the emerged flux from the pre-existing flux overlying it. We can generalize this relation to the overall corona in quiet Sun or in active regions. Doing so yields estimates for the contribution to coronal heating from magnetic reconnection. These estimated rates are comparable to the amount required to maintain the corona at its observed temperature. PMID:25897089

The Magnetic Evolution of Coronal Hole Bright Points

NASA Astrophysics Data System (ADS)

He, Y.; Muglach, K.

2017-12-01

Space weather refers to the state of the heliosphere and the geospace environment that are caused primarily by solar activity. Coronal mass ejections and flares originate in active regions and filaments close to the solar surface and can cause geomagnetic storms and solar energetic particles events, which can damage both spacecraft and ground-based systems that are critical for society's well-being. Coronal bright points are small-scale magnetic regions on the sun that seem to be similar to active regions, but are about an order of magnitude smaller. Due to their shorter lifetime, the complete evolutionary cycle of these mini active regions can be studied, from the time they appear in extreme-ultraviolet (EUV) images to the time they fade. We are using data from the Solar Dynamics Observatory (SDO) to study both the coronal EUV flux and the photospheric magnetic field and compare them to activities of the coronal bright point.

Coronal Magnetism and Forward Solarsoft Idl Package

NASA Astrophysics Data System (ADS)

Gibson, S. E.

2014-12-01

The FORWARD suite of Solar Soft IDL codes is a community resource for model-data comparison, with a particular emphasis on analyzing coronal magnetic fields. FORWARD may be used both to synthesize a broad range of coronal observables, and to access and compare to existing data. FORWARD works with numerical model datacubes, interfaces with the web-served Predictive Science Inc MAS simulation datacubes and the Solar Soft IDL Potential Field Source Surface (PFSS) package, and also includes several analytic models (more can be added). It connects to the Virtual Solar Observatory and other web-served observations to download data in a format directly comparable to model predictions. It utilizes the CHIANTI database in modeling UV/EUV lines, and links to the CLE polarimetry synthesis code for forbidden coronal lines. FORWARD enables "forward-fitting" of specific observations, and helps to build intuition into how the physical properties of coronal magnetic structures translate to observable properties.

Electrical energy sources for organic synthesis on the early earth

NASA Technical Reports Server (NTRS)

Chyba, Christopher; Sagan, Carl

1991-01-01

It is pointed out that much of the contemporary origin-of-life research uses the original estimates of Miller and Urey (1959) for terrestrial energy dissipation by lightning and coronal discharges being equal to 2 x 10 to the 19th J/yr and 6 x 10 to the 19th J/yr, respectively. However, data from experiments that provide analogues to naturally-occurring lightning and coronal discharges indicate that lightning energy yields for organic synthesis (nmole/J) are about one order of magnitude higher than the coronal discharge yields. This suggests that, on early earth, organic production by lightning may have dominated that due to coronal emission. New values are recommended for lightning and coronal discharge dissipation rates on the early earth, 1 x 10 to the 18th J/yr and 5 x 10 to the 17th J/yr, respectively.

Solar burst precursors and energy build-up at microwave wavelengths

NASA Technical Reports Server (NTRS)

Lang, Kenneth R.; Wilson, Robert F.

1986-01-01

We summarize high-resolution microwave observations (VLA) of heating and magnetic triggering in coronal loops. Magnetic changes that precede solar eruptions on time scales of tens of minutes involve primarily emerging coronal loops and the interaction of two or more loops. Thermal cyclotron lines have been detected in coronal loops, suggesting the presence of hot current sheets that enhance emission from relatively thin layers of enhanced temperature and constant magnetic field. These current sheets may play a role in the excitation of solar bursts. A filament-associated source with a high brightness temperature and steep radiation spectrum occurs above a region of apparently weak photospheric field. This source might be attributed to currents that enhance coronal magnetic fields. Compact (phi=5 sec) transient sources with lifetimes of 30 to 60 minutes have also been detected in regions of apparently weak photospheric field. We conclude by comparing VLA observations of coronal loops with simultaneous SMM-XRP observations.

Solar burst precursors and energy build-up at microwave wavelengths

NASA Astrophysics Data System (ADS)

Lang, Kenneth R.; Wilson, Robert F.

We summarize high-resolution microwave observations (VLA) of heating and magnetic triggering in coronal loops. Magnetic changes that precede solar eruptions on time scales of tens of minutes involve primarily emerging coronal loops and the interaction of two or more loops. Thermal cyclotron lines have been detected in coronal loops, suggesting the presence of hot current sheets that enhance emission from relatively thin layers of enhanced temperature and constant magnetic field. These current sheets may play a role in the excitation of solar bursts. A filament-associated source with a high brightness temperature and steep radiation spectrum occurs above a region of apparently weak photospheric field. This source might be attributed to currents that enhance coronal magnetic fields. Compact (phi=5 sec) transient sources with lifetimes of 30 to 60 minutes have also been detected in regions of apparently weak photospheric field. We conclude by comparing VLA observations of coronal loops with simultaneous SMM-XRP observations.

Propagation and Dissipation of MHD Waves in Coronal Holes

NASA Astrophysics Data System (ADS)

Dwivedi, B. N.

2006-11-01

bholadwivedi@gmail.com In view of the landmark result on the solar wind outflow, starting between 5 Mm and 20 Mm above the photosphere in magnetic funnels, we investigate the propagation and dissipation of MHD waves in coronal holes. We underline the importance of Alfvén wave dissipation in the magnetic funnels through the viscous and resistive plasma. Our results show that Alfvén waves are one of the primary energy sources in the innermost part of coronal holes where the solar wind outflow starts. We also consider compressive viscosity and thermal conductivity to study the propagation and dissipation of long period slow longitudinal MHD waves in polar coronal holes. We discuss their likely role in the line profile narrowing, and in the energy budget for coronal holes and the solar wind. We compare the contribution of longitudinal MHD waves with high frequency Alfvén waves.

Evidence that magnetic energy shedding in solar filament eruptions is the drive in accompanying flares and coronal mass ejections

NASA Technical Reports Server (NTRS)

Moore, Ronald L.

1988-01-01

The dependence of the magnetic energy on the field expansion and untwisting of the flux tube in which an erupting solar filament is embedded has been determined in order to evaluate the energy decrease in the erupting flux tube. Magnetic energy shedding by the filament-field eruption is found to be the driving mechanism in both filament-eruption flares and coronal mass ejections. Confined filament-eruption flares, filament-eruption flares with sprays and coronal mass ejections, and coronal mass ejections from quiescent filament eruptions are all shown to be similar types of events.

EUV Coronal Waves: Atmospheric and Heliospheric Connections and Energetics

NASA Astrophysics Data System (ADS)

Patsourakos, S.

2015-12-01

Since their discovery in late 90's by EIT on SOHO, the study EUV coronal waves has been a fascinating andfrequently strongly debated research area. While it seems as ifan overall consensus has been reached about the nurture and nature of this phenomenon,there are still several important questions regarding EUV waves. By focusing on the most recentobservations, we will hereby present our current understanding about the nurture and nature of EUV waves,discuss their connections with other atmospheric and heliospheric phenomena (e.g.,flares and CMEs, Moreton waves, coronal shocks, coronal oscillations, SEP events) and finallyassess their possible energetic contribution to the overall budget of relatederuptive phenomena.

Solar activity during Skylab: Its distribution and relation to coronal holes

NASA Technical Reports Server (NTRS)

Speich, D. M.; Smith, J. B., Jr.; Wilson, R. M.; Mcintosh, P. S.

1978-01-01

Solar active regions observed during the period of Skylab observations (May 1973-February 1974) were examined for properties that varied systematically with location on the sun, particularly with respect to the location of coronal holes. Approximately 90 percent of the optical and X-ray flare activity occurred in one solar hemisphere (136-315 heliographic degrees longitude). Active regions within 20 heliographic degrees of coronal holes were below average in lifetimes, flare production, and magnetic complexity. Histograms of solar flares as a function of solar longitude were aligned with H alpha synoptic charts on which active region serial numbers and coronal hole boundaries were added.

Non-adversarial justice and the coroner's court: a proposed therapeutic, restorative, problem-solving model.

PubMed

King, Michael S

2008-12-01

Increasingly courts are using new approaches that promote a more comprehensive resolution of legal problems, minimise any negative effects that legal processes have on participant wellbeing and/or that use legal processes to promote participant wellbeing. Therapeutic jurisprudence, restorative justice, mediation and problem-solving courts are examples. This article suggests a model for the use of these processes in the coroner's court to minimise negative effects of coroner's court processes on the bereaved and to promote a more comprehensive resolution of matters at issue, including the determination of the cause of death and the public health and safety promotion role of the coroner.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chitta, L. P.; Peter, H.; Solanki, S. K.

How and where are coronal loops rooted in the solar lower atmosphere? The details of the magnetic environment and its evolution at the footpoints of coronal loops are crucial to understanding the processes of mass and energy supply to the solar corona. To address the above question, we use high-resolution line-of-sight magnetic field data from the Imaging Magnetograph eXperiment instrument on the Sunrise balloon-borne observatory and coronal observations from the Atmospheric Imaging Assembly onboard the Solar Dynamics Observatory of an emerging active region. We find that the coronal loops are often rooted at the locations with minor small-scale but persistentmore » opposite-polarity magnetic elements very close to the larger dominant polarity. These opposite-polarity small-scale elements continually interact with the dominant polarity underlying the coronal loop through flux cancellation. At these locations we detect small inverse Y-shaped jets in chromospheric Ca ii H images obtained from the Sunrise Filter Imager during the flux cancellation. Our results indicate that magnetic flux cancellation and reconnection at the base of coronal loops due to mixed polarity fields might be a crucial feature for the supply of mass and energy into the corona.« less

Understanding the rotation of coronal holes

NASA Astrophysics Data System (ADS)

Wang, Y.-M.; Sheeley, N. R., Jr.

1993-09-01

In an earlier study we found that the rotation of coronal holes could be understood on the basis of a nearly current-free coronal field, with the holes representing open magnetic regions. In this paper we illustrate the model by focusing on the case of CH1, the rigidly rotating boot-shaped hole observed by Skylab. We show that the interaction between the polar fields and the flux associated with active regions produces distortions in the coronal field configuration and thus in the polar-hole boundaries; these distortions corotate with the perturbing nonaxisymmetric flux. In the case of CH1, positive-polarity field lines in the northern hemisphere 'collided' with like-polarity field lines fanning out from a decaying active region complex located just below the equator, producing a midlatitude corridor of open field lines rotating at the rate of the active region complex. Sheared coronal holes result when nonaxisymmetric flux is present at high latitudes, or equivalently, when the photospheric neutral line extends to high latitudes. We demonstrate how a small active region, rotating at the local photospheric rate, can drift through a rigidly rotating hole like CH1. Finally, we discuss the role of field-line reconnection in maintaining a quasi-potential coronal configuration.

Mode Conversion of a Solar Extreme-ultraviolet Wave over a Coronal Cavity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zong, Weiguo; Dai, Yu, E-mail: ydai@nju.edu.cn

2017-01-10

We report on observations of an extreme-ultraviolet (EUV) wave event in the Sun on 2011 January 13 by Solar Terrestrial Relations Observatory and Solar Dynamics Observatory in quadrature. Both the trailing edge and the leading edge of the EUV wave front in the north direction are reliably traced, revealing generally compatible propagation velocities in both perspectives and a velocity ratio of about 1/3. When the wave front encounters a coronal cavity near the northern polar coronal hole, the trailing edge of the front stops while its leading edge just shows a small gap and extends over the cavity, meanwhile gettingmore » significantly decelerated but intensified. We propose that the trailing edge and the leading edge of the northward propagating wave front correspond to a non-wave coronal mass ejection component and a fast-mode magnetohydrodynamic wave component, respectively. The interaction of the fast-mode wave and the coronal cavity may involve a mode conversion process, through which part of the fast-mode wave is converted to a slow-mode wave that is trapped along the magnetic field lines. This scenario can reasonably account for the unusual behavior of the wave front over the coronal cavity.« less

On the Role of Interchange Reconnection in the Generation of the Slow Solar Wind

NASA Astrophysics Data System (ADS)

Edmondson, J. K.

2012-11-01

The heating of the solar corona and therefore the generation of the solar wind, remain an active area of solar and heliophysics research. Several decades of in situ solar wind plasma observations have revealed a rich bimodal solar wind structure, well correlated with coronal magnetic field activity. Therefore, the reconnection processes associated with the large-scale dynamics of the corona likely play a major role in the generation of the slow solar wind flow regime. In order to elucidate the relationship between reconnection-driven coronal magnetic field structure and dynamics and the generation of the slow solar wind, this paper reviews the observations and phenomenology of the solar wind and coronal magnetic field structure. The geometry and topology of nested flux systems, and the (interchange) reconnection process, in the context of coronal physics is then explained. Once these foundations are laid out, the paper summarizes several fully dynamic, 3D MHD calculations of the global coronal system. Finally, the results of these calculations justify a number of important implications and conclusions on the role of reconnection in the structural dynamics of the coronal magnetic field and the generation of the solar wind.

NEW OBSERVATION OF FAILED FILAMENT ERUPTIONS: THE INFLUENCE OF ASYMMETRIC CORONAL BACKGROUND FIELDS ON SOLAR ERUPTIONS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Y.; Xu, Z.; Su, J.

2009-05-01

Failed filament eruptions not associated with a coronal mass ejection (CME) have been observed and reported as evidence for solar coronal field confinement on erupting flux ropes. In those events, each filament eventually returns to its origin on the solar surface. In this Letter, a new observation of two failed filament eruptions is reported which indicates that the mass of a confined filament can be ejected to places far from the original filament channel. The jetlike mass motions in the two failed filament eruptions are thought to be due to the asymmetry of the background coronal magnetic fields with respectmore » to the locations of the filament channels. The asymmetry of the coronal fields is confirmed by an extrapolation based on a potential field model. The obvious imbalance between the positive and negative magnetic flux (with a ratio of 1:3) in the bipolar active region is thought to be the direct cause of the formation of the asymmetric coronal fields. We think that the asymmetry of the background fields can not only influence the trajectories of ejecta, but also provide a relatively stronger confinement for flux rope eruptions than the symmetric background fields do.« less

Future space missions and ground observatory for measurements of coronal magnetic fields

NASA Astrophysics Data System (ADS)

Fineschi, Silvano; Gibson, Sarah; Bemporad, Alessandro; Zhukov, Andrei; Damé, Luc; Susino, Roberto; Larruquert, Juan

2016-07-01

This presentation gives an overview of the near-future perspectives for probing coronal magnetism from space missions (i.e., SCORE and ASPIICS) and ground-based observatory (ESCAPE). Spectro-polarimetric imaging of coronal emission-lines in the visible-light wavelength-band provides an important diagnostics tool of the coronal magnetism. The interpretation in terms of Hanle and Zeeman effect of the line-polarization in forbidden emission-lines yields information on the direction and strength of the coronal magnetic field. As study case, this presentation will describe the Torino Coronal Magnetograph (CorMag) for the spectro-polarimetric observation of the FeXIV, 530.3 nm, forbidden emission-line. CorMag - consisting of a Liquid Crystal (LC) Lyot filter and a LC linear polarimeter. The CorMag filter is part of the ESCAPE experiment to be based at the French-Italian Concordia base in Antarctica. The linear polarization by resonance scattering of coronal permitted line-emission in the ultraviolet (UV)can be modified by magnetic fields through the Hanle effect. Space-based UV spectro-polarimeters would provide an additional tool for the disgnostics of coronal magnetism. As a case study of space-borne UV spectro-polarimeters, this presentation will describe the future upgrade of the Sounding-rocket Coronagraphic Experiment (SCORE) to include new generation, high-efficiency UV polarizer with the capability of imaging polarimetry of the HI Lyman-α, 121.6 nm. SCORE is a multi-wavelength imager for the emission-lines, HeII 30.4 nm and HI 121.6 nm, and visible-light broad-band emission of the polarized K-corona. SCORE has flown successfully in 2009. The second lauch is scheduled in 2016. Proba-3 is the other future solar mission that would provide the opportunity of diagnosing the coronal magnetic field. Proba-3 is the first precision formation-flying mission to launched in 2019). A pair of satellites will fly together maintaining a fixed configuration as a 'large rigid structure' in space. The paired satellites will together form a 150-m long solar coronagraph (ASPIICS) to study the Sun's faint corona closer to the solar limb than has ever before been achieved. High-resolution imaging in polarized visible-light of shock waves generated by Coronal Mass Ejections would provide a diagnostics of the magnetic field in the pre-shock ambient corona.

Microfilament-Eruption Mechanism for Solar Spicules

NASA Technical Reports Server (NTRS)

Sterling, Alphonse C.; Moore, Ronald L.

2017-01-01

Recent studies indicate that solar coronal jets result from eruption of small-scale filaments, or "minifilaments" (Sterling et al. 2015, Nature, 523, 437; Panesar et al. ApJL, 832L, 7). In many aspects, these coronal jets appear to be small-scale versions of long-recognized large-scale solar eruptions that are often accompanied by eruption of a large-scale filament and that produce solar flares and coronal mass ejections (CMEs). In coronal jets, a jet-base bright point (JBP) that is often observed to accompany the jet and that sits on the magnetic neutral line from which the minifilament erupts, corresponds to the solar flare of larger-scale eruptions that occurs at the neutral line from which the large-scale filament erupts. Large-scale eruptions are relatively uncommon (approximately 1 per day) and occur with relatively large-scale erupting filaments (approximately 10 (sup 5) kilometers long). Coronal jets are more common (approximately 100s per day), but occur from erupting minifilaments of smaller size (approximately 10 (sup 4) kilometers long). It is known that solar spicules are much more frequent (many millions per day) than coronal jets. Just as coronal jets are small-scale versions of large-scale eruptions, here we suggest that solar spicules might in turn be small-scale versions of coronal jets; we postulate that the spicules are produced by eruptions of "microfilaments" of length comparable to the width of observed spicules (approximately 300 kilometers). A plot of the estimated number of the three respective phenomena (flares/CMEs, coronal jets, and spicules) occurring on the Sun at a given time, against the average sizes of erupting filaments, minifilaments, and the putative microfilaments, results in a size distribution that can be fitted with a power-law within the estimated uncertainties. The counterparts of the flares of large-scale eruptions and the JBPs of jets might be weak, pervasive, transient brightenings observed in Hinode/CaII images, and the production of spicules by microfilament eruptions might explain why spicules spin, as do coronal jets. The expected small-scale neutral lines from which the microfilaments would be expected to erupt would be difficult to detect reliably with current instrumentation, but might be apparent with instrumentation of the near future. A full report on this work appears in Sterling and Moore 2016, ApJL, 829, L9.

Hemodynamic-GUIDEd Management of Heart Failure

ClinicalTrials.gov

2018-03-29

Heart Failure; Heart Failure, Systolic; Heart Failure, Diastolic; Heart Failure NYHA Class II; Heart Failure NYHA Class III; Heart Failure NYHA Class IV; Heart Failure，Congestive; Heart Failure With Reduced Ejection Fraction; Heart Failure With Normal Ejection Fraction; Heart Failure; With Decompensation

Treatment of bunion deformity in the athlete.

PubMed

Baxter, D E

1994-01-01

Bunions occur in athletes. Often, the bunion is compensated and has a congruous joint, needing minimal treatment. If the bunion rapidly progresses, the sesamoids sublux, and the joint becomes incongruous; surgery becomes necessary. Surgery for decompensated bunions and secondary problems is discussed.

FGFR2c-mediated ERK-MAPK activity regulates coronal suture development

PubMed Central

Pfaff, Miles J.; Xue, Ke; Li, Li; Horowitz, Mark C.; Steinbacher, Derek M.; Eswarakumar, Jacob V.P.

2017-01-01

Fibroblast growth factor receptor 2 (FGFR2) signaling is critical for proper craniofacial development. A gain-of-function mutation in the 2c splice variant of the receptor’s gene is associated with Crouzon syndrome, which is characterized by craniosynostosis, the premature fusion of one or more of the cranial vault sutures, leading to craniofacial maldevelopment. Insight into the molecular mechanism of craniosynostosis has identified the ERK-MAPK signaling cascade as a critical regulator of suture patency. The aim of this study is to investigate the role of FGFR2c-induced ERK-MAPK activation in the regulation of coronal suture development. Loss-of-function and gain-of-function Fgfr2c mutant mice have overlapping phenotypes, including coronal synostosis and craniofacial dysmorphia. In vivo analysis of coronal sutures in loss-of-function and gain-of-function models demonstrated fundamentally different pathogenesis underlying coronal suture synostosis. Calvarial osteoblasts from gain-of-function mice demonstrated enhanced osteoblastic function and maturation with concomitant increase in ERK-MAPK activation. In vitro inhibition with the ERK protein inhibitor U0126 mitigated ERK protein activation levels with a concomitant reduction in alkaline phosphatase activity. This study identifies FGFR2c-mediated ERK-MAPK signaling as a key mediator of craniofacial growth and coronal suture development. Furthermore, our results solve the apparent paradox between loss-of-function and gain-of-function FGFR2c mutants with respect to coronal suture synostosis. PMID:27034231

A Universal Model for Solar Eruptions

NASA Technical Reports Server (NTRS)

Wyper, Peter F.; Antiochos, Spiro K.; Devore, C. Richard

2017-01-01

Magnetically driven eruptions on the Sun, from stellar-scale coronal mass ejections1 to small-scale coronal X-ray and extreme-ultraviolet jets, have frequently been observed to involve the ejection of the highly stressed magnetic flux of a filament. Theoretically, these two phenomena have been thought to arise through very different mechanisms: coronal mass ejections from an ideal (non-dissipative) process, whereby the energy release does not require a change in the magnetic topology, as in the kink or torus instability; and coronal jets from a resistive process, involving magnetic reconnection. However, it was recently concluded from new observations that all coronal jets are driven by filament ejection, just like large mass ejections. This suggests that the two phenomena have physically identical origin and hence that a single mechanism may be responsible, that is, either mass ejections arise from reconnection, or jets arise from an ideal instability. Here we report simulations of a coronal jet driven by filament ejection, whereby a region of highly sheared magnetic field near the solar surface becomes unstable and erupts. The results show that magnetic reconnection causes the energy release via 'magnetic breakout', a positive feedback mechanism between filament ejection and reconnection. We conclude that if coronal mass ejections and jets are indeed of physically identical origin (although on different spatial scales) then magnetic reconnection (rather than an ideal process) must also underlie mass ejections, and that magnetic breakout is a universal model for solar eruptions.

Evidence for Precursors of the Coronal Hole Jets in Solar Bright Points

NASA Astrophysics Data System (ADS)

Bagashvili, Salome R.; Shergelashvili, Bidzina M.; Japaridze, Darejan R.; Kukhianidze, Vasil; Poedts, Stefaan; Zaqarashvili, Teimuraz V.; Khodachenko, Maxim L.; De Causmaecker, Patrick

2018-03-01

A set of 23 observations of coronal jet events that occurred in coronal bright points has been analyzed. The focus was on the temporal evolution of the mean brightness before and during coronal jet events. In the absolute majority of the cases either single or recurrent coronal jets (CJs) were preceded by slight precursor disturbances observed in the mean intensity curves. The key conclusion is that we were able to detect quasi-periodical oscillations with characteristic periods from sub-minute up to 3–4 minute values in the bright point brightness that precedes the jets. Our basic claim is that along with the conventionally accepted scenario of bright-point evolution through new magnetic flux emergence and its reconnection with the initial structure of the bright point and the coronal hole, certain magnetohydrodynamic (MHD) oscillatory and wavelike motions can be excited and these can take an important place in the observed dynamics. These quasi-oscillatory phenomena might play the role of links between different epochs of the coronal jet ignition and evolution. They can be an indication of the MHD wave excitation processes due to the system entropy variations, density variations, or shear flows. It is very likely a sharp outflow velocity transverse gradients at the edges between the open and closed field line regions. We suppose that magnetic reconnections can be the source of MHD waves due to impulsive generation or rapid temperature variations, and shear flow driven nonmodel MHD wave evolution (self-heating and/or overreflection mechanisms).

Coronal rain in magnetic bipolar weak fields

NASA Astrophysics Data System (ADS)

Xia, C.; Keppens, R.; Fang, X.

2017-07-01

Aims: We intend to investigate the underlying physics for the coronal rain phenomenon in a representative bipolar magnetic field, including the formation and the dynamics of coronal rain blobs. Methods: With the MPI-AMRVAC code, we performed three dimensional radiative magnetohydrodynamic (MHD) simulation with strong heating localized on footpoints of magnetic loops after a relaxation to quiet solar atmosphere. Results: Progressive cooling and in-situ condensation starts at the loop top due to radiative thermal instability. The first large-scale condensation on the loop top suffers Rayleigh-Taylor instability and becomes fragmented into smaller blobs. The blobs fall vertically dragging magnetic loops until they reach low-β regions and start to fall along the loops from loop top to loop footpoints. A statistic study of the coronal rain blobs finds that small blobs with masses of less than 1010 g dominate the population. When blobs fall to lower regions along the magnetic loops, they are stretched and develop a non-uniform velocity pattern with an anti-parallel shearing pattern seen to develop along the central axis of the blobs. Synthetic images of simulated coronal rain with Solar Dynamics Observatory Atmospheric Imaging Assembly well resemble real observations presenting dark falling clumps in hot channels and bright rain blobs in a cool channel. We also find density inhomogeneities during a coronal rain "shower", which reflects the observed multi-stranded nature of coronal rain. Movies associated to Figs. 3 and 7 are available at http://www.aanda.org

Influence of the remaining coronal structure on the resistance of teeth with intraradicular retainer.

PubMed

Pereira, Jefferson Ricardo; Neto, Tatiany de Mendonça; Porto, Vinícius de Carvalho; Pegoraro, Luiz Fernando; do Valle, Accácio Lins

2005-01-01

The aim of this study was to compare the resistance of endodontically treated teeth with intraradicular retainer different amounts of remaining coronal structure. Fifty freshly extracted maxillary canines were endodontically treated and randomly assigned to five groups (n=10), as follows: group 1 (control) = teeth with custom cast post and core; group 2 = teeth without remaining coronal structure; group 3, 4 and 5 = teeth with 1 mm, 2 mm and 3 mm of remaining coronal structure, respectively. All specimens in groups 2 to 5 were restored with prefabricated post and resin core. The teeth were embedded in acrylic resin and the fracture strength was measured on a universal testing machine at 45 degrees to the long axis of the tooth until failure. Data were analyzed statistically by one-way analysis of variance and Tukey's test. There was no significant differences (p>0.05) between the control group and group 2, and between groups 3, 4 and 5 (p>0.05). Control group and group 2 had significantly higher resistance strength than groups 3, 4 and 5 (p<0.00001). The findings of this study showed that teeth without remaining coronal structure had significantly higher fracture strength than those with remaining coronal structure (1 mm, 2 mm and 3 mm). When the dental crown was not completely removed, the amount of remaining coronal dentin did not significantly affect the fracture strength of endodontically treated teeth with intraradicular retainer.

Observations and Modeling of Transition Region and Coronal Heating Associated with Spicules

NASA Astrophysics Data System (ADS)

De Pontieu, B.; Martinez-Sykora, J.; De Moortel, I.; Chintzoglou, G.; McIntosh, S. W.

2017-12-01

Spicules have been proposed as significant contributorsto the coronal energy and mass balance. While previous observationshave provided a glimpse of short-lived transient brightenings in thecorona that are associated with spicules, these observations have beencontested and are the subject of a vigorous debate both on the modelingand the observational side so that it remains unclear whether plasmais heated to coronal temperatures in association with spicules. We use high-resolution observations of the chromosphere and transition region with the Interface Region Imaging Spectrograph (IRIS) and ofthe corona with the Atmospheric Imaging Assembly (AIA) onboard theSolar Dynamics Observatory (SDO) to show evidence of the formation of coronal structures as a result of spicular mass ejections andheating of plasma to transition region and coronaltemperatures. Our observations suggest that a significant fraction of the highly dynamic loop fan environment associated with plage regions may be the result of the formation of such new coronal strands, a process that previously had been interpreted as the propagation of transient propagating coronal disturbances (PCD)s. Our observationsare supported by 2.5D radiative MHD simulations that show heating tocoronal temperatures in association with spicules. Our results suggest that heating and strong flows play an important role in maintaining the substructure of loop fans, in addition to the waves that permeate this low coronal environment. Our models also matches observations ofTR counterparts of spicules and provides an elegant explanation forthe high apparent speeds of these "network jets".

FGFR2c-mediated ERK-MAPK activity regulates coronal suture development.

PubMed

Pfaff, Miles J; Xue, Ke; Li, Li; Horowitz, Mark C; Steinbacher, Derek M; Eswarakumar, Jacob V P

2016-07-15

Fibroblast growth factor receptor 2 (FGFR2) signaling is critical for proper craniofacial development. A gain-of-function mutation in the 2c splice variant of the receptor's gene is associated with Crouzon syndrome, which is characterized by craniosynostosis, the premature fusion of one or more of the cranial vault sutures, leading to craniofacial maldevelopment. Insight into the molecular mechanism of craniosynostosis has identified the ERK-MAPK signaling cascade as a critical regulator of suture patency. The aim of this study is to investigate the role of FGFR2c-induced ERK-MAPK activation in the regulation of coronal suture development. Loss-of-function and gain-of-function Fgfr2c mutant mice have overlapping phenotypes, including coronal synostosis and craniofacial dysmorphia. In vivo analysis of coronal sutures in loss-of-function and gain-of-function models demonstrated fundamentally different pathogenesis underlying coronal suture synostosis. Calvarial osteoblasts from gain-of-function mice demonstrated enhanced osteoblastic function and maturation with concomitant increase in ERK-MAPK activation. In vitro inhibition with the ERK protein inhibitor U0126 mitigated ERK protein activation levels with a concomitant reduction in alkaline phosphatase activity. This study identifies FGFR2c-mediated ERK-MAPK signaling as a key mediator of craniofacial growth and coronal suture development. Furthermore, our results solve the apparent paradox between loss-of-function and gain-of-function FGFR2c mutants with respect to coronal suture synostosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Magnetic Flux Cancelation as the Trigger of Solar Coronal Jets in Coronal Holes

NASA Astrophysics Data System (ADS)

Panesar, Navdeep K.; Sterling, Alphonse C.; Moore, Ronald L.

2018-02-01

We investigate in detail the magnetic cause of minifilament eruptions that drive coronal-hole jets. We study 13 random on-disk coronal-hole jet eruptions, using high-resolution X-ray images from the Hinode/X-ray telescope(XRT), EUV images from the Solar Dynamics Observatory (SDO)/Atmospheric Imaging Assembly (AIA), and magnetograms from the SDO/Helioseismic and Magnetic Imager (HMI). For all 13 events, we track the evolution of the jet-base region and find that a minifilament of cool (transition-region-temperature) plasma is present prior to each jet eruption. HMI magnetograms show that the minifilaments reside along a magnetic neutral line between majority-polarity and minority-polarity magnetic flux patches. These patches converge and cancel with each other, with an average cancelation rate of ∼0.6 × 1018 Mx hr‑1 for all 13 jets. Persistent flux cancelation at the neutral line eventually destabilizes the minifilament field, which erupts outward and produces the jet spire. Thus, we find that all 13 coronal-hole-jet-driving minifilament eruptions are triggered by flux cancelation at the neutral line. These results are in agreement with our recent findings for quiet-region jets, where flux cancelation at the underlying neutral line triggers the minifilament eruption that drives each jet. Thus, from that study of quiet-Sun jets and this study of coronal-hole jets, we conclude that flux cancelation is the main candidate for triggering quiet-region and coronal-hole jets.

Reconnection-Driven Coronal-Hole Jets with Gravity and Solar Wind

NASA Technical Reports Server (NTRS)

Karpen, J. T.; Devore, C. R.; Antiochos, S. K.; Pariat, E.

2017-01-01

Coronal-hole jets occur ubiquitously in the Sun's coronal holes, at EUV and X-ray bright points associated with intrusions of minority magnetic polarity. The embedded-bipole model for these jets posits that they are driven by explosive, fast reconnection between the stressed closed field of the embedded bipole and the open field of the surrounding coronal hole. Previous numerical studies in Cartesian geometry, assuming uniform ambient magnetic field and plasma while neglecting gravity and solar wind, demonstrated that the model is robust and can produce jet-like events in simple configurations. We have extended these investigations by including spherical geometry,gravity, and solar wind in a nonuniform, coronal hole-like ambient atmosphere. Our simulations confirm that the jet is initiated by the onset of a kink-like instability of the internal closed field, which induces a burst of reconnection between the closed and external open field, launching a helical jet. Our new results demonstrate that the jet propagation is sustained through the outer corona, in the form of a traveling nonlinear Alfven wave front trailed by slower-moving plasma density enhancements that are compressed and accelerated by the wave. This finding agrees well with observations of white-light coronal-hole jets, and can explain microstreams and torsional Alfven waves detected in situ in the solar wind. We also use our numerical results to deduce scaling relationships between properties of the coronal source region and the characteristics of the resulting jet, which can be tested against observations.

A Survey of Coronal Dimmings and EIT Wave Transients

NASA Technical Reports Server (NTRS)

Thompson, Barbara J.

2003-01-01

We present the results of a comprehensive catalog of EIT wave transients and coronal dimmings. We will compiled a set of more than 170 events, and we present strong evidence for the association of the co-development of coronal dimmings and EIT waves. Both limb and disk events are included in this study. We also include the speeds, locations, and associated flare timing in this study.

Dynamical behaviour in coronal loops

NASA Technical Reports Server (NTRS)

Haisch, Bernhard M.

1986-01-01

Rapid variability has been found in two active region coronal loops observed by the X-ray Polychromator (XRP) and the Hard X-ray Imaging Spectrometer (HXIS) onboard the Solar Maximum Mission (SMM). There appear to be surprisingly few observations of the short-time scale behavior of hot loops, and the evidence presented herein lends support to the hypothesis that coronal heating may be impulsive and driven by flaring.

Dynamical behaviour in coronal loops

NASA Astrophysics Data System (ADS)

Haisch, Bernhard M.

Rapid variability has been found in two active region coronal loops observed by the X-ray Polychromator (XRP) and the Hard X-ray Imaging Spectrometer (HXIS) onboard the Solar Maximum Mission (SMM). There appear to be surprisingly few observations of the short-time scale behavior of hot loops, and the evidence presented herein lends support to the hypothesis that coronal heating may be impulsive and driven by flaring.

Evidence of suppressed heating of coronal loops rooted in opposite polarity sunspot umbrae

NASA Astrophysics Data System (ADS)

Tiwari, Sanjiv K.; Thalmann, Julia K.; Winebarger, Amy R.; Panesar, Navdeep K.; Moore, Ronald

2015-04-01

Observations of active region (AR) coronae in different EUV wavelengths reveal the presence of various loops at different temperatures. To understand the mechanisms that result in hotter or cooler loops, we study a typical bipolar AR, near solar disk center, which has moderate overall magnetic twist and at least one fully developed sunspot of each polarity. From AIA 193 and 94 A images we identify many clearly discernible coronal loops that connect opposite-polarity plage or a sunspot to a opposite-polarity plage region. The AIA 94 A images show dim regions in the umbrae of the spots. To see which coronal loops are rooted in a dim umbral area, we performed a non-linear force-free field (NLFFF) modeling using photospheric vector magnetic field measurements obtained with the Heliosesmic Magnetic Imager (HMI) onboard SDO. After validation of the NLFFF model by comparison of calculated model field lines and observed loops in AIA 193 and 94 A, we specify the photospheric roots of the model field lines. The model field then shows the coronal magnetic loops that arch from the dim umbral area of the positive-polarity sunspot to the dim umbral area of a negative-polarity sunspot. Because these coronal loops are not visible in any of the coronal EUV and X-ray images of the AR, we conclude they are the coolest loops in the AR. This result suggests that the loops connecting opposite polarity umbrae are the least heated because the field in umbrae is so strong that the convective braiding of the field is strongly suppressed.From this result, we further hypothesize that the convective freedom at the feet of a coronal loop, together with the strength of the field in the body of the loop, determines the strength of the heating. In particular, we expect the hottest coronal loops to have one foot in an umbra and the other foot in opposite-polarity penumbra or plage (coronal moss), the areas of strong field in which convection is not as strongly suppressed as in umbrae. Many transient, outstandingly bright, loops in the AIA 94 A movie of the AR do have this expected rooting pattern.

Automated detection of open magnetic field regions in EUV images

NASA Astrophysics Data System (ADS)

Krista, Larisza Diana; Reinard, Alysha

2016-05-01

Open magnetic regions on the Sun are either long-lived (coronal holes) or transient (dimmings) in nature, but both appear as dark regions in EUV images. For this reason their detection can be done in a similar way. As coronal holes are often large and long-lived in comparison to dimmings, their detection is more straightforward. The Coronal Hole Automated Recognition and Monitoring (CHARM) algorithm detects coronal holes using EUV images and a magnetogram. The EUV images are used to identify dark regions, and the magnetogam allows us to determine if the dark region is unipolar - a characteristic of coronal holes. There is no temporal sensitivity in this process, since coronal hole lifetimes span days to months. Dimming regions, however, emerge and disappear within hours. Hence, the time and location of a dimming emergence need to be known to successfully identify them and distinguish them from regular coronal holes. Currently, the Coronal Dimming Tracker (CoDiT) algorithm is semi-automated - it requires the dimming emergence time and location as an input. With those inputs we can identify the dimming and track it through its lifetime. CoDIT has also been developed to allow the tracking of dimmings that split or merge - a typical feature of dimmings.The advantage of these particular algorithms is their ability to adapt to detecting different types of open field regions. For coronal hole detection, each full-disk solar image is processed individually to determine a threshold for the image, hence, we are not limited to a single pre-determined threshold. For dimming regions we also allow individual thresholds for each dimming, as they can differ substantially. This flexibility is necessary for a subjective analysis of the studied regions. These algorithms were developed with the goal to allow us better understand the processes that give rise to eruptive and non-eruptive open field regions. We aim to study how these regions evolve over time and what environmental factors influence their growth and decay over short and long time-periods (days to solar cycles).

Large-Scale Coronal Heating from "Cool" Activity in the Solar Magnetic Network

NASA Technical Reports Server (NTRS)

Falconer, D. A.; Moore, R. L.; Porter, J. G.; Hathaway, D. H.

1999-01-01

In Fe XII images from SOHO/EIT, the quiet solar corona shows structure on scales ranging from sub-supergranular (i.e., bright points and coronal network) to multi-supergranular (large-scale corona). In Falconer et al 1998 (Ap.J., 501, 386) we suppressed the large-scale background and found that the network-scale features are predominantly rooted in the magnetic network lanes at the boundaries of the supergranules. Taken together, the coronal network emission and bright point emission are only about 5% of the entire quiet solar coronal Fe XII emission. Here we investigate the relationship between the large-scale corona and the network as seen in three different EIT filters (He II, Fe IX-X, and Fe XII). Using the median-brightness contour, we divide the large-scale Fe XII corona into dim and bright halves, and find that the bright-half/dim half brightness ratio is about 1.5. We also find that the bright half relative to the dim half has 10 times greater total bright point Fe XII emission, 3 times greater Fe XII network emission, 2 times greater Fe IX-X network emission, 1.3 times greater He II network emission, and has 1.5 times more magnetic flux. Also, the cooler network (He II) radiates an order of magnitude more energy than the hotter coronal network (Fe IX-X, and Fe XII). From these results we infer that: 1) The heating of the network and the heating of the large-scale corona each increase roughly linearly with the underlying magnetic flux. 2) The production of network coronal bright points and heating of the coronal network each increase nonlinearly with the magnetic flux. 3) The heating of the large-scale corona is driven by widespread cooler network activity rather than by the exceptional network activity that produces the network coronal bright points and the coronal network. 4) The large-scale corona is heated by a nonthermal process since the driver of its heating is cooler than it is. This work was funded by the Solar Physics Branch of NASA's office of Space Science through the SR&T Program and the SEC Guest Investigator Program.

Long-term outcomes of anterior spinal fusion for treating thoracic adolescent idiopathic scoliosis curves: average 15-year follow-up analysis.

PubMed

Sudo, Hideki; Ito, Manabu; Kaneda, Kiyoshi; Shono, Yasuhiro; Takahata, Masahiko; Abumi, Kuniyoshi

2013-05-01

Retrospective review. To assess the long-term outcomes of anterior spinal fusion (ASF) for treating thoracic adolescent idiopathic scoliosis (AIS). Although ASF is reported to provide good coronal and sagittal correction of the main thoracic (MT) AIS curves, the long-term outcomes of ASF is unknown. A consecutive series of 25 patients with Lenke 1 MT AIS were included. Outcome measures comprised radiographical measurements, pulmonary function, and Scoliosis Research Society outcome instrument (SRS-30) scores (preoperative SRS-30 scores were not documented). Postoperative surgical revisions and complications were recorded. Twenty-five patients were followed-up for 12 to 18 years (average, 15.2 yr). The average MT Cobb angle correction rate and the correction loss at the final follow-up were 56.7% and 9.2°, respectively. The average preoperative instrumented level of kyphosis was 8.3°, which significantly improved to 18.6° (P = 0.0003) at the final follow-up. The average percent-predicted forced vital capacity and forced expiratory volume in 1 second were significantly decreased during long-term follow-up measurements (73% and 69%; P = 0.0004 and 0.0016, respectively). However, no patient had complaints related to pulmonary function. The average total SRS-30 score was 4.0. Implant breakage was not observed. All patients, except 1 who required revision surgery, demonstrated solid fusion. Late instrumentation-related bronchial problems were observed in 1 patient who required implant removal and bronchial tube repair, 13 years after the initial surgery. Overall radiographical findings and patient outcome measures of ASF for Lenke 1 MT AIS were satisfactory at an average follow-up of 15 years. ASF provides significant sagittal correction of the main thoracic curve with long-term maintenance of sagittal profiles. Percent-predicted values of forced vital capacity and forced expiratory volume in 1 second were decreased in this cohort; however, no patient had complaints related to pulmonary function.

Morphologic and biomechanical comparison of spinous processes and ligaments from scoliotic and kyphotic patients.

PubMed

Beaubien, Brian P; Freeman, Andrew L; Buttermann, Glenn R

2016-01-25

The spinous processes and supraspinous and interspinous ligaments (SSL and ISL, respectively) limit flexion and may relate to spinal curvature. Spinous process angles and mechanical properties of explanted human thoracic posterior SSL/ISL complexes were compared for scoliosis (n=14) vs. kyphosis (n=8) patients. The median thoracic coronal Cobb angle for scoliosis patients was 48°, and sagittal angles for kyphosis patients was 78°. Spinous processes were gripped and four strain steps of 4% were applied and held. Percent relaxation was calculated over each step, equilibrium load data were fit to an exponential equation, and a Kelvin model was fit to the load from all four curves. Failure testing was also performed. Median ligament complex dimensions from scoliosis and kyphosis patients were, respectively: ISL width=16.5mm and 16.0mm; SSL width=4.3mm and 3.8mm; ISL+SSL area=17.2mm and 25.7mm; these differences were not significant. Significant differences did exist in terms of spinous process angle vs. spine axis (47° for scoliosis and 32° for kyphosis) and SSL thickness (2.1mm for scoliosis and 3.0mm for kyphosis). Fourth-step median relaxation was 42% for scoliosis and 49% for kyphosis. Median linear region stiffness was 42N/mm for scoliosis and 51N/mm for kyphosis. Median failure load was 191N for scoliotic and 175N for kyphotic ligaments. Differences in loading, relaxation, viscoelastic and failure parameters were not statistically significant, except for a trend for greater initial rate of relaxation (T1) for scoliosis ligaments. However, we found significant morphological differences related to the spinous processes, which suggests a need for future biomechanical studies related to the musculoskeletal aspects of spinal alignment and posture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Solar and stellar coronal plasmas

NASA Technical Reports Server (NTRS)

Golub, Leon

1989-01-01

Progress in observational, theoretical, and radio studies of coronal plasmas is summarized. Specifically work completed in the area of solar and stellar magnetic fields, related photospheric phenomena and the relationships between magnetism, rotation, coronal and chromospheric emission in solar-like stars is described. Also outlined are theoretical studies carried out in the following areas, among others: (1) neutral beams as the dominant energy transport mechanism in two ribbon-flares; (2) magneto hydrodynamic and circuit models for filament eruptions; and (3) studies of radio emission mechanisms in transient events. Finally, radio observations designed for coronal activity studies of the sun and of solar-type coronae are described. A bibliography of publications and talks is provided along with reprints of selected articles.

Non-inductive current driven by Alfvén waves in solar coronal loops

NASA Astrophysics Data System (ADS)

Elfimov, A. G.; de Azevedo, C. A.; de Assis, A. S.

1996-08-01

It has been shown that Alfvén waves can drive non-inductive current in solar coronal loops via collisional or collisionless damping. Assuming that all the coronal-loop density of dissipated wave power (W= 10-3 erg cm-3 s-1), which is necessary to keep the plasma hot, is due to Alfvén wave electron heating, we have estimated the axial current density driven by Alfvén waves to be ≈ 103 105 statA cm-2. This current can indeed support the quasi-stationary equilibrium and stability of coronal loops and create the poloidal magnetic field up to B θ≈1-5 G.

The Fundamental Structure of Coronal Loops

NASA Technical Reports Server (NTRS)

Winebarger, Amy; Warren, Harry; Cirtain, Jonathan; Kobayashi, Ken; Korreck, Kelly; Golub, Leon; Kuzin, Sergey; Walsh, Robert; DePontieu, Bart; Title, Alan;

A Multiwavelength Study of Coronal Structure: A Simultaneous Observation from NIXT and YOHKOH

NASA Technical Reports Server (NTRS)

Golub, Leon

1998-01-01

Solar soft X-ray images taken simultaneously by the Yohkoh and the Normal Incidence X-ray Telescope (NIXT) reveal significantly different coronal structures. Coronal loops are more clearly seen in the Yohkoh images, and the isolated island-like structures seen in the NIXT image have been found to correspond to the footpoints of the Yohkoh loops. The difference is due to the difference in the temperature response of the telescopes: NIXT is sensitive to temperatures ranging from 0.9 to 3 MK, while Yohkoh is more sensitive to temperatures above 2.5 MK. The morphological differences reflect the multi-temperature (1-5 MK) nature of the solar coronal plasmas.

Permanent Decompensated Congenital Hypothyroidism in Newborns with Whole-Blood Thyroid-Stimulating Hormone Concentrations between 8 and 10 mU/L: The Case for Lowering the Threshold.

PubMed

McGrath, Niamh; Hawkes, Colin P; Mayne, Philip; Murphy, Nuala P

2018-01-01

Congenital hypothyroidism (CHT) has a reported incidence of approximately 1 in 2,000-4,000 births. There is no consensus on the optimal cut-off whole-blood thyroid-stimulating hormone (TSH) concentration that should be used for newborn screening (NBS). The NBS programme in the Republic of Ireland has used a cut-off of 8 mU/L since 1979. The aim of this study was to determine if raising the cut-off to 10 mU/L would have resulted in undetected cases of permanent or decompensated CHT. All cases of CHT with a screening whole-blood TSH concentration between 8.0 and 9.9 mU/L were identified from the Republic of Ireland's NBS programme. Baseline demographics and imaging results were recorded. All cases over 3 years of age were evaluated to determine if CHT was permanent or transient. Of 2,361,174 infants screened in the Republic of Ireland between July 1979 and December 2016, a total of 1,063 babies were diagnosed with CHT and treated with levothyroxine. This included 33 (3.5%) infants with a whole-blood TSH concentration between 8 and 9.9 mU/L. Thirteen of these 33 infants had decompensated hypothyroidism with low plasma free thyroxine level at diagnosis and 9 (41%) of the 21 evaluable cases have confirmed permanent CHT. Although lowering screening TSH cut-offs can increase the cost of NBS, as well as anxiety for families, many infants with borderline increases in whole-blood TSH concentrations on NBS have persistent CHT and low thyroxine concentrations in infancy. We recommend that this is considered when developing and reviewing NBS protocols for identifying infants with CHT. © 2018 S. Karger AG, Basel.

Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis.

PubMed

Peacock, W F; Hollander, J E; Diercks, D B; Lopatin, M; Fonarow, G; Emerman, C L

2008-04-01

Morphine is a long-standing therapy in acute decompensated heart failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and chi(2) tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1%) received morphine and 126 580 (85.9%) did not. There were no clinically relevant differences between the groups in the initial age, heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin, ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4% vs 2.8%), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7% vs 14.4%), and had greater mortality (13.0% vs 2.4%) (all p<0.001). Even after risk adjustment and exclusion of ventilated patients, morphine was an independent predictor of mortality (OR 4.84 (95% CI 4.52 to 5.18), p<0.001). Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity-Matched Analysis.

PubMed

Ho, Edwin C; Parker, John D; Austin, Peter C; Tu, Jack V; Wang, Xuesong; Lee, Douglas S

2016-02-12

There is limited evidence that the use of nitrates in acute decompensated heart failure early after presentation to a hospital can improve clinical outcomes. We aimed to determine whether early nitrate exposure is associated with improved survival in a large retrospective cohort study. We examined 11 078 acute decompensated heart failure patients who presented to emergency departments in Ontario, Canada, between 2004 and 2007, in the Enhanced Feedback For Effective Cardiac Treatment and the Emergency Heart failure Mortality Risk Grade studies. In propensity-matched analyses, we examined the effect of nitrate administration in the acute emergency department setting for its impact on death at 7, 30, and 365 days. In propensity-matched analyses, we found no difference in survival between those who received nitrates in the emergency department and the non-nitrate comparator group. Hazard ratios for mortality were 0.76 (95% CI; 0.51, 1.12) over 7 days, 0.97 (95% CI; 0.77, 1.21) over 30 days, and 0.91 (95% CI; 0.82, 1.02) over 1 year of follow-up. There was no significant difference in survival or hospital length of stay between nitrate and non-nitrate controls in extended follow-up. There was also no significant effect of nitrates in subgroups stratified by presence of chest pain, troponin elevation, chronic nitrate use, and known coronary artery disease. In acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short-term or near-term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

MiR-338 controls BPA-triggered pancreatic islet insulin secretory dysfunction from compensation to decompensation by targeting Pdx-1.

PubMed

Wei, Jie; Ding, Dongxiao; Wang, Tao; Liu, Qiong; Lin, Yi

2017-12-01

Bisphenol A (BPA) can disrupt glucose homeostasis and impair pancreatic islet function; however, the mechanisms behind these effects are poorly understood. Male mice (4 wk old) were treated with BPA (50 or 500 μg/kg/d) for 8 wk. Whole-body glucose homeostasis, pancreatic islet morphology and function, and miR-338-mediated molecular signal transduction analyses were examined. We showed that BPA treatment led to a disruption of glucose tolerance and a compensatory increase of pancreatic islets insulin secretion and pancreatic and duodenal homeobox 1 ( Pdx1 ) expression in mice. Inhibition of Pdx1 reduced glucose-stimulated insulin secretion and ATP production in the islets of BPA-exposed mice. Based on primary pancreatic islets, we also confirmed that miR-338 regulated Pdx1 and thus contributed to BPA-induced insulin secretory dysfunction from compensation to decompensation. Short-term BPA exposure downregulated miR-338 through activation of G-protein-coupled estrogen receptor 1 (Gpr30), whereas long-term BPA exposure upregulated miR-338 through suppression of glucagon-like peptide 1 receptor (Glp1r). Taken together, our results reveal a molecular mechanism, whereby BPA regulates Gpr30/Glp1r to mediate the expression of miR-338, which acts to control Pdx1-dependent insulin secretion. The Gpr30/Glp1r-miR-338-Pdx1 axis should be represented as a novel mechanism by which BPA induces insulin secretory dysfunction in pancreatic islets.-Wei, J., Ding, D., Wang, T., Liu, Q., Lin, Y. MiR-338 controls BPA-triggered pancreatic islet insulin secretory dysfunction from compensation to decompensation by targeting Pdx-1. © FASEB.

Galectin-3: A Link between Myocardial and Arterial Stiffening in Patients with Acute Decompensated Heart Failure?

PubMed

Lala, Radu Ioan; Darabantiu, Dan; Pilat, Luminita; Puschita, Maria

2016-02-01

Heart failure is accompanied by abnormalities in ventricular-vascular interaction due to increased myocardial and arterial stiffness. Galectin-3 is a recently discovered biomarker that plays an important role in myocardial and vascular fibrosis and heart failure progression. The aim of this study was to determine whether galectin-3 is correlated with arterial stiffening markers and impaired ventricular-arterial coupling in decompensated heart failure patients. A total of 79 inpatients with acute decompensated heart failure were evaluated. Serum galectin-3 was determined at baseline, and during admission, transthoracic echocardiography and measurements of vascular indices by Doppler ultrasonography were performed. Elevated pulse wave velocity and low arterial carotid distensibility are associated with heart failure in patients with preserved ejection fraction (p = 0.04, p = 0.009). Pulse wave velocity, carotid distensibility and Young's modulus did not correlate with serum galectin-3 levels. Conversely, raised galectin-3 levels correlated with an increased ventricular-arterial coupling ratio (Ea/Elv) p = 0.047, OR = 1.9, 95% CI (1.0‑3.6). Increased galectin-3 levels were associated with lower rates of left ventricular pressure rise in early systole (dp/dt) (p=0.018) and raised pulmonary artery pressure (p = 0.046). High galectin-3 levels (p = 0.038, HR = 3.07) and arterial pulmonary pressure (p = 0.007, HR = 1.06) were found to be independent risk factors for all-cause mortality and readmissions. This study showed no significant correlation between serum galectin-3 levels and arterial stiffening markers. Instead, high galectin-3 levels predicted impaired ventricular-arterial coupling. Galectin-3 may be predictive of raised pulmonary artery pressures. Elevated galectin-3 levels correlate with severe systolic dysfunction and together with pulmonary hypertension are independent markers of outcome.

Combined ursodeoxycholic acid (UDCA) and fenofibrate in primary biliary cholangitis patients with incomplete UDCA response may improve outcomes.

PubMed

Cheung, A C; Lapointe-Shaw, L; Kowgier, M; Meza-Cardona, J; Hirschfield, G M; Janssen, H L A; Feld, J J

2016-01-01

Fibrates appear to improve biochemistry in patients with primary biliary cholangitis (PBC), but it is unclear which factors predict response and whether treatment improves transplant-free survival. To evaluate biochemical profiles, liver-related outcomes and adverse events following fenofibrate therapy in PBC patients with incomplete response to ursodeoxycholic acid (UDCA). A retrospective cohort study was performed at a tertiary centre. Cox regression was used to compare outcomes between patients treated with fibrates and UDCA (FF) or UDCA alone, adjusted for a propensity score to account for treatment selection bias. A total of 120 patients were included (FF group n = 46, UDCA group n = 74, median fenofibrate treatment 11 months); 41% vs. 7% met the Toronto criteria for biochemical response [alkaline phosphatase ≤1.67 times the upper limit of normal] in the FF and UDCA groups, respectively (P = 0.0001). Fenofibrate was also associated with improved decompensation-free and transplant-free survival [hazard ratio (HR) 0.09, 95% CI 0.03-0.32, P = 0.0002]. However, only fenofibrate use, not biochemical response, was independently associated with improved outcomes on multivariable analysis (HR 0.40, 95% CI 0.17-0.93, P = 0.03). Twenty-two percent discontinued fenofibrate due to adverse events (most common: abdominal pain and myalgias). In cirrhotic patients, bilirubin increased more rapidly in the FF group (P = 0.005). Fenofibrate therapy is associated with significant improvement in alkaline phosphatase, decompensation-free and transplant-free survival in PBC patients with incomplete UDCA response. However, fenofibrate should be used cautiously in cirrhosis, with close monitoring for clinical/biochemical decompensation. Additional studies are required to assess the validity of alkaline phosphatase as an appropriate response criteria for fibrate therapy. © 2015 John Wiley & Sons Ltd.

Hepatic Venous Pressure Gradient Predicts Long-Term Mortality in Patients with Decompensated Cirrhosis

PubMed Central

Kim, Tae Yeob; Lee, Jae Gon; Kim, Ji Yeoun; Kim, Sun Min; Kim, Jinoo; Jeong, Woo Kyoung

2016-01-01

Purpose The present study aimed to investigate the role of hepatic venous pressure gradient (HVPG) for prediction of long-term mortality in patients with decompensated cirrhosis. Materials and Methods Clinical data from 97 non-critically-ill cirrhotic patients with HVPG measurements were retrospectively and consecutively collected between 2009 and 2012. Patients were classified according to clinical stages and presence of ascites. The prognostic accuracy of HVPG for death, survival curves, and hazard ratios were analyzed. Results During a median follow-up of 24 (interquartile range, 13-36) months, 22 patients (22.7%) died. The area under the receiver operating characteristics curves of HVPG for predicting 1-year, 2-year, and overall mortality were 0.801, 0.737, and 0.687, respectively (all p<0.01). The best cut-off value of HVPG for predicting long-term overall mortality in all patients was 17 mm Hg. The mortality rates at 1 and 2 years were 8.9% and 19.2%, respectively: 1.9% and 11.9% with HVPG ≤17 mm Hg and 16.2% and 29.4% with HVPG >17 mm Hg, respectively (p=0.015). In the ascites group, the mortality rates at 1 and 2 years were 3.9% and 17.6% with HVPG ≤17 mm Hg and 17.5% and 35.2% with HVPG >17 mm Hg, respectively (p=0.044). Regarding the risk factors for mortality, both HVPG and model for end-stage liver disease were positively related with long-term mortality in all patients. Particularly, for the patients with ascites, both prothrombin time and HVPG were independent risk factors for predicting poor outcomes. Conclusion HVPG is useful for predicting the long-term mortality in patients with decompensated cirrhosis, especially in the presence of ascites. PMID:26632394

The Effect of Passive Heat Stress and Exercise-Induced Dehydration on the Compensatory Reserve During Simulated Hemorrhage.

PubMed

Gagnon, Daniel; Schlader, Zachary J; Adams, Amy; Rivas, Eric; Mulligan, Jane; Grudic, Gregory Z; Convertino, Victor A; Howard, Jeffrey T; Crandall, Craig G

2016-09-01

Compensatory reserve represents the proportion of physiological responses engaged to compensate for reductions in central blood volume before the onset of decompensation. We hypothesized that compensatory reserve would be reduced by hyperthermia and exercise-induced dehydration, conditions often encountered on the battlefield. Twenty healthy males volunteered for two separate protocols during which they underwent lower-body negative pressure (LBNP) to hemodynamic decompensation (systolic blood pressure <80 mm Hg). During protocol #1, LBNP was performed following a passive increase in core temperature of ∼1.2°C (HT) or a normothermic time-control period (NT). During protocol #2, LBNP was performed following exercise during which: fluid losses were replaced (hydrated), fluid intake was restricted and exercise ended at the same increase in core temperature as hydrated (isothermic dehydrated), or fluid intake was restricted and exercise duration was the same as hydrated (time-match dehydrated). Compensatory reserve was estimated with the compensatory reserve index (CRI), a machine-learning algorithm that extracts features from continuous photoplethysmograph signals. Prior to LBNP, CRI was reduced by passive heating [NT: 0.87 (SD 0.09) vs. HT: 0.42 (SD 0.19) units, P <0.01] and exercise-induced dehydration [hydrated: 0.67 (SD 0.19) vs. isothermic dehydrated: 0.52 (SD 0.21) vs. time-match dehydrated: 0.47 (SD 0.25) units; P <0.01 vs. hydrated]. During subsequent LBNP, CRI decreased further and its rate of change was similar between conditions. CRI values at decompensation did not differ between conditions. These results suggest that passive heating and exercise-induced dehydration limit the body's physiological reserve to compensate for further reductions in central blood volume.

Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes†

PubMed Central

Testani, Jeffrey M.; Coca, Steven G.; McCauley, Brian D.; Shannon, Richard P.; Kimmel, Stephen E.

2011-01-01

Aims One of the primary determinants of blood flow in regional vascular beds is perfusion pressure. Our aim was to investigate if reduction in blood pressure during the treatment of decompensated heart failure would be associated with worsening renal function (WRF). Our secondary aim was to evaluate the prognostic significance of this potentially treatment-induced form of WRF. Methods and results Subjects included in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial limited data were studied (386 patients). Reduction in systolic blood pressure (SBP) was greater in patients experiencing WRF (−10.3 ± 18.5 vs. −2.8 ± 16.0 mmHg, P < 0.001) with larger reductions associated with greater odds for WRF (odds ratio = 1.3 per 10 mmHg reduction, P < 0.001). Systolic blood pressure reduction (relative change > median) was associated with greater doses of in-hospital oral vasodilators (P ≤ 0.017), thiazide diuretic use (P = 0.035), and greater weight reduction (P = 0.023). In patients with SBP-reduction, WRF was not associated with worsened survival [adjusted hazard ratio (HR) = 0.76, P = 0.58]. However, in patients without SBP-reduction, WRF was strongly associated with increased mortality (adjusted HR = 5.3, P < 0.001, P interaction = 0.001). Conclusion During the treatment of decompensated heart failure, significant blood pressure reduction is strongly associated with WRF. However, WRF that occurs in the setting of SBP-reduction is not associated with an adverse prognosis, whereas WRF in the absence of this provocation is strongly associated with increased mortality. These data suggest that WRF may represent the final common pathway of several mechanistically distinct processes, each with potentially different prognostic implications. PMID:21693504

Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes.

PubMed

Testani, Jeffrey M; Coca, Steven G; McCauley, Brian D; Shannon, Richard P; Kimmel, Stephen E

2011-08-01

One of the primary determinants of blood flow in regional vascular beds is perfusion pressure. Our aim was to investigate if reduction in blood pressure during the treatment of decompensated heart failure would be associated with worsening renal function (WRF). Our secondary aim was to evaluate the prognostic significance of this potentially treatment-induced form of WRF. Subjects included in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial limited data were studied (386 patients). Reduction in systolic blood pressure (SBP) was greater in patients experiencing WRF (-10.3 ± 18.5 vs. -2.8 ± 16.0 mmHg, P < 0.001) with larger reductions associated with greater odds for WRF (odds ratio = 1.3 per 10 mmHg reduction, P < 0.001). Systolic blood pressure reduction (relative change > median) was associated with greater doses of in-hospital oral vasodilators (P ≤ 0.017), thiazide diuretic use (P = 0.035), and greater weight reduction (P = 0.023). In patients with SBP-reduction, WRF was not associated with worsened survival [adjusted hazard ratio (HR) = 0.76, P = 0.58]. However, in patients without SBP-reduction, WRF was strongly associated with increased mortality (adjusted HR = 5.3, P < 0.001, P interaction = 0.001). During the treatment of decompensated heart failure, significant blood pressure reduction is strongly associated with WRF. However, WRF that occurs in the setting of SBP-reduction is not associated with an adverse prognosis, whereas WRF in the absence of this provocation is strongly associated with increased mortality. These data suggest that WRF may represent the final common pathway of several mechanistically distinct processes, each with potentially different prognostic implications.

Biomarkers in Acutely Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

PubMed Central

Bishu, Kalkidan; Deswal, Anita; Chen, Horng H.; LeWinter, Martin M.; Lewis, Gregory D.; Semigran, Marc J.; Borlaug, Barry A.; McNulty, Steven; Hernandez, Adrian F.; Braunwald, Eugene; Redfield, Margaret M.

2013-01-01

Background Acute decompensated heart failure (ADHF) occurs with preserved (HFpEF, EF≥50%) or reduced (HFrEF, EF<50%) ejection fraction. Natriuretic peptide (NP) levels are lower in HFpEF than HFrEF. We hypothesized that lower NP levels in HFpEF may be associated with other differences in biomarkers; specifically, renin-angiotensin-aldosterone system (RAAS) activation, oxidative stress and a biomarker that reflects collagen synthesis. Methods In this pre-specified ancillary analysis of ADHF patients enrolled in the Diuretic Optimization Strategies Evaluation (DOSE) study, clinical features and NT-proBNP, cystatin C, plasma renin activity (PRA), aldosterone, oxidative stress (uric acid) and procollagen type III N-terminal peptide (PIIINP) were compared in HFpEF and HFrEF at enrollment and 60 day follow-up. Results Compared to HFrEF (n=219), HFpEF (n=81) patients were older, heavier, more commonly female, less treated with RAAS antagonists, but with similar NYHA class, jugular venous pressure and edema severity. NT-proBNP was lower and systolic blood pressure (BP) and cystatin C were higher in HFpEF. Despite higher systolic BP and less RAAS antagonist use in HFpEF, PRA and aldosterone levels were similar in HFpEF and HFrEF as were uric acid and PIIINP levels. Changes in biomarker levels from enrollment to 60 days were similar between HFrEF (n=149) and HFpEF (n=50). Conclusion Lower NP levels in decompensated HFpEF occur in association with similar ADHF severity, more impaired vascular and renal function but similar elevation of biomarkers that reflect RAAS activation, oxidative stress and collagen synthesis as in HFrEF. PMID:23137508

Comparison of compensatory reserve during lower-body negative pressure and hemorrhage in nonhuman primates.

PubMed

Hinojosa-Laborde, Carmen; Howard, Jeffrey T; Mulligan, Jane; Grudic, Greg Z; Convertino, Victor A

2016-06-01

Compensatory reserve was measured in baboons (n = 13) during hemorrhage (Hem) and lower-body negative pressure (LBNP) using a machine-learning algorithm developed to estimate compensatory reserve by detecting reductions in central blood volume during LBNP. The algorithm calculates compensatory reserve index (CRI) from normovolemia (CRI = 1) to cardiovascular decompensation (CRI = 0). The hypothesis was that Hem and LBNP will elicit similar CRI values and that CRI would have higher specificity than stroke volume (SV) in predicting decompensation. Blood was removed in four steps: 6.25%, 12.5%, 18.75%, and 25% of total blood volume. Four weeks after Hem, the same animals were subjected to four levels of LBNP that was matched on the basis of their central venous pressure. Data (mean ± 95% confidence interval) indicate that CRI decreased (P < 0.001) from baseline during Hem (0.69 ± 0.10, 0.57 ± 0.09, 0.36 ± 0.10, 0.16 ± 0.08, and 0.08 ± 0.03) and LBNP (0.76 ± 0.05, 0.66 ± 0.08, 0.36 ± 0.13, 0.23 ± 0.11, and 0.14 ± 0.09). CRI was not different between Hem and LBNP (P = 0.20). Linear regression analysis between Hem CRI and LBNP CRI revealed a slope of 1.03 and a correlation coefficient of 0.96. CRI exhibited greater specificity than SV in both Hem (92.3 vs. 82.1) and LBNP (94.8 vs. 83.1) and greater ROC AUC in Hem (0.94 vs. 0.84) and LBNP (0.94 vs. 0.92). These data support the hypothesis that Hem and LBNP elicited the same CRI response, suggesting that measurement of compensatory reserve is superior to SV as a predictor of cardiovascular decompensation.