Topographical anatomy of the left ventricular summit: implications for invasive procedures.

BACKGROUND: Recent clinical reports have emphasized the clinical significance of the left ventricular summit (LVS), a specific triangular epicardial area, as the source of ventricular arrhythmias where radiofrequency ablation is of great difficulty. MATERIALS AND METHODS: The macroscopic morphology of the LVS has been assessed in 80 autopsied and 48 angio-computed tomography (CT) human hearts. According to Yamada's equation, the size was calculated based on the distance to the first, most prominent septal perforator. RESULTS: The size of the LVS varies from 33.69 to 792.2 mm2, is highly variable, and does not correlate with body mass index, sex, or age in general. The mean size of the LVS was 287.38 ± 144.95 mm2 in autopsied and angio-CT (p = 0.44). LVS is mostly disproportionately bisected by cardiac coronary veins to superior-inaccessible and inferior-accessible areas. The superior aspect dominates over the inferior in both groups (p = 0.04). The relation between superior and inferior groups determines three possible arrangements: the most common type is superior domination (50.2%), then inferior domination (26.6%), and finally, equal distribution (17.2%). In 10.9%, the inferior aspect is absent. Only 16.4% of the LVS were empty, without additional trespassing coronary arteries. CONCLUSIONS: The difference in size and content of the LVS is significant, with no correlation to any variable. The size depends on the anatomy of the most prominent septal perforator artery. The superior, inaccessible aspect dominates, and the LVS is seldom free from additional coronary vessels, thus making this region hazardous for electrophysiological procedures.

Applicability of computed tomography preoperative assessment of the LAA in LV summit ablations.

PURPOSE: Ventricular arrhythmias originating from the left ventricular summit (LVS) may present with challenges for catheter ablation. Recently, the left atrial appendage (LAA) became a new vantage point for mapping and ablating arrhythmias from that region, but data of possible usefulness is limited. METHODS: From September to December 2019, we retrospectively analyzed 48 consecutive patient hearts (20 male; mean age 57.9y ± 11.56) undergoing diagnostic coronary vessel imaging in 64 dual-source computer tomography angiography (CTA). Distances from the LAA to the LVS, LAA shape type, and coronary arteries in the LVS region were measured. Also, we compared the true LVS area from CTA with a calculated formula derived from LVS definition. RESULTS: The mean LVS area calculated from the formula was 291.58 mm2 (± 115.5) while the true area calculated from CT was 263.33 mm2 (± 99.49) (p = 0.44). The mean inaccessible area was 133.42 mm2 (± 72.89), accessible 95.67 mm2 (± 72.77). The mean LAA coverage over LVS was 196.08 mm2-which is approximately 75% of LVS size in general. The most common LAA shape was chicken wing (50%); windsock has the highest accessible area coverage on average (80.23%), followed by chicken wing (59.88%), broccoli (47.72%), and cactus (46.98%). The mean distance from LAA to the surface was 5.14 mm (1.5 to 10 mm) and was not correlated with BMI. LAA has a 98% coverage over the point of transition between the great cardiac vein and anterior interventricular vein. CONCLUSION: Angio-CT assessment of the LAA over the LVS structures may be helpful in decision making before an ablation procedure. LAA appears to be a promising mapping approach in LVS arrhythmias.

The structure and switchable dielectric properties of a dabco complex with chromium chloride.

We report a metal-organic material of the following formula [DabcoH22+]·CrCl3(H2O)3·2(Cl-) (DabcoH22+ = C6H14N22+, diprotonated 1,4-diazabicyclo[2.2.2]octanium). This compound exhibits a dielectric anomaly, which is attributed to the rotatory fluctuation of the Dabco molecule. The complementary results of single-crystal X-ray diffraction, DSC, dielectric, NMR and Raman spectroscopy provide information about the general mechanisms of the phase transition, which results from the ordering of the DabcoH22+ molecules. The reversibility of dielectric switching with no observable attenuation of the dielectric signal during multiple cycling is observed. The dielectric switching characteristic of the crystal makes it an interesting material for potential application in smart devices.

Detailed radiological study of the patent ductus arteriosus: a computed tomography study in the Polish population.

BACKGROUND: The aim of the study was to perform qualitative and quantitative computed tomography (CT) angiography-based evaluation of patent ductus arteriosus (PDA) morphology and its influence on morphology of the great vessels. MATERIALS AND METHODS: Two-thousand twenty-two patients underwent 64-slice or dual-source CT and were retrospectively screened for the presence of PDA. Those who had presence of PDA underwent evaluation of its anatomy and morphology. RESULTS: Thirty-two adult patients with PDA were evaluated (mean age 41.4 ± 17.4 years). Subjects with PDA had a higher value of aortic isthmus (p = 0.0148), main pulmonary artery (p < 0.0001), right (p =0.0007) and left (p = 0.0074) pulmonary arteries diameters than individuals from control group (16 adults, median age 43.3 ± 12.4 years). Types A, B, C, D, and E of PDA morphology occurred in 16 (50%), 3 (9%), 9 (28%), 2 (6%), and 2 (6%) patients, respectively. Subjects with the type A configuration of PDA tended to have a larger diameter at the aortic orifice (10.2 ± 5.2 mm vs. 6.4 ± 4.9 mm, p = 0.09) and a larger maximal diameter (10.3 ± 5.3 mm vs. 7.1 ± 4.7 mm, p = 0.14) compared to subjects with the type C configuration. The values of minimal, mean, and maximal diameters of PDA were 4.7 ± 1.9 mm, 7.0 ± 3.2 mm, and 9.4 ± 5.0 mm, respectively. The Spearman correlation coefficient between the main pulmonary artery and PDA diameters demonstrated a good correlation for minimal (r = 0.70, p < 0.001), mean (r = 0.62, p = 001), and maximal (r = 0.60, p = 0.0003) PDA diameters. CONCLUSIONS: Computed tomography enables quantitative and qualitative evaluation of PDA, including its type of morphology, length, and diameters. In the evaluated adult population with PDA, the majority of patients had dilation of the aortic isthmus and pulmonary arteries. PDA diameters correlate with diameters of the pulmonary arteries and this correlation is strongest between PDA diameter at the narrowest site and main pulmonary artery.

Bistability of magnetic states in Fe-Pd nanocap arrays.

Magnetic bistability between vortex and single domain states in nanostructures are of great interest from both fundamental and technological perspectives. In soft magnetic nanostructures, the transition from a uniform collinear magnetic state to a vortex state (or vice versa) induced by a magnetic field involves an energy barrier. If the thermal energy is large enough for overcoming this energy barrier, magnetic bistability with a hysteresis-free switching occurs between the two magnetic states. In this work, we tune this energy barrier by tailoring the composition of FePd alloys, which were deposited onto self-assembled particle arrays forming magnetic vortex structures on top of the particles. The bifurcation temperature, where a hysteresis-free transition occurs, was extracted from the temperature dependence of the annihilation and nucleation field which increases almost linearly with Fe content of the magnetic alloy. This study provides insights into the magnetization reversal process associated with magnetic bistability, which allows adjusting the bifurcation temperature range by the material properties of the nanosystem.

Serum rantes, transforming growth factor-ß1 and interleukin-6 levels correlate with cardiac muscle fibrosis in patients with aortic valve stenosis.

Regulated on Activation Normal T Expressed and Secreted (RANTES) chemokine is involved in the initiation of inflammation and immune-cell recruitment. Interleukin -6 (IL-6) is used as a general index of severity of the chronic inflammatory process. Finally, transforming growth factor-ß (TGF-ß) is an immune biomarker potentially involved in the regulation of valve fibrosis and calcification. The aim of this study was to analyze selected biomarkers associated with the different stages of immune-pathogenesis in aortic stenosis. Forty consecutive patients with moderate to severe aortic stenosis (AS) and without previous myocardial infarction history were included in the study and divided into two groups. Two imaging techniques, echocardiography and magnetic resonance, were used to estimate the degree of AS and left ventricular muscle function. Inflammatory biomarker serum levels including CCL5/RANTES, IL-6, and TGF-ß1 were determined based on ELISA measurements. Mean levels of RANTES, IL-6, and TGF-ß1 did not significantly differ between both groups. A negative correlation was found between RANTES serum level and left ventricle (LV) mass as assessed by MRI (r = -0.3358, P = 0.0341). A positive correlation (r = 0.3283, P = 0.0387) was found between IL-6 serum levels and LV mass as measured by MRI. In addition, a positive correlation (r = 0.6803, P = 0.01) was seen between IL-6 serum levels and LV muscle mass with positive late gadolinium enhancement (LGE). There was a positive correlation between TGF-ß1 serum level and ejection fraction as measured by echocardiography (r = 0.3217, P = 0.043). The relationship between selected inflammatory biomarkers, LV ejection fraction, LV mass, and LV muscle mass with LGE appeared to be independent of valvular pathobiologic process severity, as we did not observe differences in IL-6, RANTES, or TGF-ß1 between groups differing in severity. On the contrary, these markers appear to be linked to myocardial function and remodeling, which may provide valuable insights into the pathobiology of AS and provide a basis for future detection strategies of AS.

The effect of Fe on the structure and electrical conductivity of sodium borosilicate glasses.

We report the synthesis and characterization of iron-bearing sodium borosilicate glasses with an Fe2O3 content lower than 10 mol%. Using Mössbauer spectroscopy we demonstrate that Fe ions most probably have a tetrahedral oxygen environment for an iron oxide content higher than 5 mol%. Additionally, the Mössbauer results along with the X-ray diffraction studies indicate the formation of magnetite nanoclusters. The electrical conductivity of iron-containing sodium borosilicate glasses is studied over a wide temperature range. The impact of iron content on the dielectric permittivity and electrical properties is discussed. Finally, ionic conduction is identified in the high temperature region and its physical origin is explained. A similar activation energy of the dc conductivity and the activation energy of the electrical relaxation suggest that both the relaxation and conduction processes can be ascribed to the same type of entities.

Fabrication of flexible highly ordered porous alumina templates by combined nanosphere lithography and anodization.

In this work, we propose a new method for the large-scale production of flexible, periodic alumina arrays with well-ordered pores. We show the incorporation of pre-patterning based on polystyrene (PS) nanosphere lithography into an aluminium anodization process. We prepared ordered monolayers of PS spheres with average diameters of (510 ± 10) nm and (430 ± 10) nm on a large area (1.5 × 1.5 cm2) of the Si substrate. Next, we deposited a 5 µm aluminium layer on arrays of PS nanospheres using the sputtering technique. After the deposition, we covered the aluminium film with a polymer Scotch adhesive tape, and separated it from the silicon substrate by ultrasonic-assisted lift-off. Finally, we performed the anodization of the aluminium. We compared the pore and cell sizes, and the pore distance for the templates obtained by this technique, with reference to the templates prepared by a two-step anodization process. Using this new approach, we obtained highly ordered hexagonal 2D lattices over a large area of up to 2 cm2 with sparse defects, amounting to not more than four defects per 1000 µm2 on average. Here, we show that the use of indentation techniques is not necessary and can be replaced by a fast, cheap and easy pre-patterning step based on nanosphere lithography.

Magnetic transition from dot to antidot regime in large area Co/Pd nanopatterned arrays with perpendicular magnetization.

We have studied the transition between two different magnetization reversal mechanisms for thin Co/Pd multilayers with perpendicular magnetic anisotropy, appearing in magnetic dot and antidot arrays, which were prepared by nanosphere lithography. Various ordered arrays of nanostuctures, both magnetic dots and antidots, were created by varying size and distance between the nanospheres employing RF-plasma etching. We have shown that the coercivity values reach a maximum for the array of antidots with a separation length close to the domain wall width. In this case, each area between three adjacent holes corresponds to a single domain configuration, which can be switched individually. On the contrary, small hole sizes and large volume of material between them results in domain wall propagation throughout the system accompanied by strong domain wall pinning at the holes. We have also shown the impact of edge effects on the magnetic anisotropy energy.

Ordered FePdCu nanoisland arrays made by templated solid-state dewetting.

Ordered FePdCu nanoisland arrays were formed by annealing at 600 °C, which caused solid state dewetting of [Cu/Fe/Pd] multilayers deposited on self-assembled SiO2 nanospheres with a size of 100 nm. A single FePdCu island was formed on the top of each SiO2 nanosphere. The structure of the obtained system was studied by x-ray diffraction (XRD), while its magnetic properties were studied by SQUID magnetometry. A partially ordered L10 alloy appeared in the annealed films, leading to magnetic hardening of the material. The paper presents the influence of the patterning on the system properties. It is shown that templated dewetting is a method providing nanoislands with well-controlled sizes and positions. The role of copper admixture in controlling the structural and magnetic properties is also discussed.

Computed tomography in the evaluation of the anomalous origin of the coronary artery: coexistence with other congenital heart disease in an adult population.

BACKGROUND: The aim of the study is to assess the prevalence of anomalous origin of the coronary artery in cardiac computed tomography (CT) and to evaluate its coexistence with other congenital heart disease. MATERIALS AND METHODS: 7,115 patients, who underwent 64-slice or dual source cardiac CT in the years 2005-2011 were screened for the presence of anomalous origin of the coronary artery. RESULTS: Anomalous origin of coronary artery was found in 62 (0.87%) patients (34 males, mean age 57.4 ± 15.1 years). Anomalous aortic and pulmonary origin of coronary artery concerned 59 (0.83%) and 3 (0.04%) cases, respectively. Concomitant heart defects were observed in 5 (0.07%) patients, all with anomalous aortic origin of coronary artery. Malformations included transposition of great arteries (4 patients) and single ventricle in (1 patient). CONCLUSIONS: The incidence of anomalous origin of a coronary artery in cardiac CT is similar to invasive coronary angiography. In an adult population the vast majority of those anomalies are isolated abnormalities without concomitant other congenital heart defects.

Morphological characteristics of potentially malignant pulmonary nodules in high-risk male smokers detected in lung cancer screening trial in Cracow, Poland.

The purpose of this paper was to present morphological characteristics of potentially malignant nodules revealed in a group of male smokers aged 50-74 with a very high risk for developing lung cancer estimated in the study for lung cancer screening in Cracow (Poland). Nine hundred male smokers aged 50 to 74 years were invited to the study and were asked in questionnaires about e.g. smoking exposure history. Exclusion criteria included e.g. positive cancer history and chest computed tomography (CT) examination in the previous year. Based on CT results and characteristics of pulmonary nodules subjects were classified to group A (low risk), group B (indeterminate) and group C (high-risk individuals - required work-up). Final diagnosis was based on pathological results of postoperative material. Thirty-nine males of mean age 63.4 (standard deviation (SD): 6.69 years) revealed 41 potentially malignant pulmonary nodules in baseline screening. In 14 subjects 16 type C pulmonary nodules were histologically proved. Nine nodules were found to be benign lesions, while 7 nodules revealed malignant lung cancer: 5 cases of adenocarcinoma and 2 cases of adenosquamous carcinoma. We determined morphological characteristics of potentially malignant pulmonary nodules in 39 high-risk male smokers and proved lung cancer in 7 subjects.

Interactions between an M. tuberculosis strain overexpressing mtrA and mononuclear phagocytes.

PURPOSE: It was previously shown that the bacterial two-component regulatory signal transduction (2CR) system MtrAB may be associated with the ability of M. tuberculosis (Mtb) to survive in macrophages. In the present work Mtb mutants: Rv-78 with overexpression of mtrA and Rv-129 with elevated level of phosphorylation-defective MtrA were used for further investigation of the potential influence of the MtrAB system on Mtb interaction with human monocytes. MATERIAL/METHODS: Flow cytometry was used to determine the expression of MHC class II molecules. The expression of genes for inducible nitric oxide synthase (iNOS) and cathepsin G was quantified by RT-PCR. The association of Mtb strains with Rab5 and Rab7 positive vacuoles was investigated applying confocal microscopy. IL-10 and IL-12 secretion by monocytes as well as the Mtb susceptibility to cathepsin G were investigated. RESULTS: Mutation-carried and wild type Mtb strains inhibited MHC class II expression on monocytes to a similar extent. Monocyte stimulation with mycobacteria led to the increased production of IL-10 but no detectable amounts of IL-12 or NO were observed. Expression of the gene for iNOS was not detected while that for cathepsin G was shown, however its intensity was not associated with MtrA mutation. Mtb mutant strains were more effectively enclosed in phagosomes containing the late endosome marker Rab7 as compared to the control. CONCLUSIONS: The results may confirm the importance of the MtrAB system in mycobacterial capacity for successful survival in phagocytes, especially in the context of high degree of colocalization of Mtb Rv-78 to mature phagosomes.

[Schizophrenic psychoses and suicide in the clinic. Risk factors, psychopharmacologic treatment]. / Schizophrene Psychosen und Kliniksuizid. Risikofaktoren, psychopharmakologische Behandlung.

For all 5,352 patients treated for schizophrenia at the Psychiatric Hospital of the University of Munich in 1981 and 1992, detailed routine and data processing-assisted documentations were made of the psychopharmacological therapies. Nineteen of the patients committed suicide while undergoing inpatient treatment; the control group consisted of all other patients (n = 5,333). More than 77 sociodemographic and anamnestic variables as well as 195 items from the admission summaries were taken into account while comparing the groups. Furthermore, the pharmacological data were classified according to drug groups and comparison was based on the mean frequency of prescription of each group. We analyzed the mean number of prescriptions for neuroleptics, tranquilizers, and antidepressants, which were further differentiated into sedating and nonsedating types. For frequently administered drugs, mean daily doses were also compared. Bivariate analysis of the data suggests that the suicide cases presented depressive signs, symptoms, and tendencies already present on admission more frequently than with controls; the same applies to previously attempted suicides. Discriminating analysis showed that the variables "feeling of loss of feelings," thought insertion," "visible depression," "free-floating anxiety," "suicidal tendencies," and "previously attempted suicide" have the greatest predictive value with respect to suicide, in descending order. No differences in psychopharmacological treatment between suicides and controls were found, apart from a significantly higher percentage of antidepressive treatments and a higher mean number of antidepressant prescriptions for the suicides.

Risk factors for suicides of inpatients with depressive psychoses.

Research on identifying the relevant risk factors for suicides is faced with a multitude of methodological problems. The present study attempts to improve on some of these problems and to isolate those risk factors that are accessible in the early stages of the treatment of inpatients. A total of 3792 inpatients with monopolar or bipolar depression were treated during the period 1981-1992. Suicides (n=33) and controls (n=3759) were compared with respect to 77 sociodemographic and anamnestic variables and 195 standardised items of the admission summary. In addition to an analysis of contingency tables a discriminant analysis was performed. The suicide rate of patients with depressive psychosis was 2.7 times higher than the average rate of 0.324% for the entire clinic. Suicidal tendencies on admission proved to be the best predictor with a frequency of 91% in the suicide group and 40% in the control group, previous attempted suicide being the second best predictor. We conclude that the rate of inpatient suicide may have been underestimated for methodological reasons in the past decades. Many of the risk factors discussed in the literature may be of little predictive value at least in the initial stages of hospital treatment.

[Psychopathological syndromes in treatment with gyrase inhibitors]. / Psychopathologische Syndrome unter Behandlung mit Gyrasehemmern.

Psychopathological and neurological adverse drug reactions (ADR) have been repeatedly reported during treatment with gyrase inhibitors (fluorquinolones). Results of earlier studies indicated a high risk for ADR especially in the elderly with high dosage medication, psychiatric history and renal dysfunction. The pathophysiological mechanisms involved in the development of adverse CNS effects are not completely understood. GABA-ergic and monoaminergic mechanisms might play a major part. In a retrospective study conducted by the authors 4189 reports of consultant psychiatric examinations were analyzed. In 29 patients the suspicion of psychopathological ADR during treatment with ofloxacin or ciprofloxacin was documented. Psychopathological findings included delirious states, paranoid, depressive and manic syndromes, agitation, sleep disturbances, sopor and stupor. In elderly patients delirious and paranoid syndromes were predominant, whereas affective disturbances occurred more often in younger patients. In most cases multiple morbidity, liver or kidney diseases, simultaneous treatment with other antibiotics and immunosuppressants, former psychiatric disorders or psychosocial stress factors were present. The results of the study, methodological problems, aspects of risk analysis and implications for medical treatment are discussed.

[Munchausen syndrome by proxy]. / Münchhausen-by-proxy-Syndrom.

The term "Munchausen by proxy" denotes a special form of factitious disorder and a rare kind of child abuse. We present the case of a 12-year-old boy, whose mother's manipulations culminated in his immobilization in a wheelchair and the implantation of a pacemaker. Problems of diagnosis and clinical management of Munchausen by proxy are discussed.

[Development of modern classification systems and their effects on forensic psychiatric expert assessment]. / Zur Entwicklung moderner Klassifikationssysteme und ihre Auswirkungen auf die forensisch-psychiatrische Begutachtung.

The world-wide use of modern classification systems such as DSM-III and ICD-10 forces forensic psychiatry to examine the basic concepts of these systems, if the gap already existing between clinical and forensic psychiatry is not to widen. On the one hand concentrating on the historical development of these systems this article shows their limited value in forensic psychiatry. On the other hand a possible way of arriving at more empirically based forensic expert opinions with the help of these classification systems is discussed. The concept of comorbidity of these new systems is given special attention in this connection.

Computational elimination of interferent effects in flame atomic-absorption spectrometry.

Empirical formulae, which describe quantitatively the interferent effects in flame atomic-absorption analysis, have been proposed. The formulae enable calculation of the total multi-interferent effect of a complex system, on the basis of characteristic coefficients established for simple analyte-interferent pairs. The approach may be used for the computational elimination of interferent effects and for correction of analytical results. Experimental verification has confirmed that the corrected results are consistent with the actual concentrations.