Patient Self-Reported Allergies and Their Correlation with Thoracic Outlet Syndrome Outcomes.

OBJECTIVES: Thoracic outlet syndrome (TOS) is an uncommon neurovascular disorder that presents as neck and upper extremity pain secondary to brachial plexus trunk or subclavian vasculature compression. The orthopedic literature has correlated patient-reported allergies to postoperative patient-reported outcome (PRO) scores for a variety of surgical procedures. We sought to evaluate patient-reported allergies and PROs following surgical decompression for TOS. METHODS: A chart review was conducted after identifying patients who underwent surgical thoracic outlet decompression by a single surgeon. Patients were contacted and administered five PRO questionnaires via telephone: the QuickDASH Outcome Measure questionnaire (disabilities of the arm, shoulder, and hand [DASH]), the Cervical Brachial Symptom Questionnaire, the Single Assessment Numeric Evaluation, the 12-Item Short Form Survey, and the Numeric Rating Scale (a visual analogue scale). A bivariate analysis of Pearson's correlation coefficient (r) was used to determine the associations of allergies with questionnaires and demographic variables. RESULTS: Of the 393 patients (128 males and 265 females) identified in the study, 75 (24%) responded and completed all of the questionnaires, 18 (24%) males and 57 (76%) females. A significant correlation was found between the number of allergies reported and the QuickDASH Outcome Measure questionnaire (r = 0.375, P < 0.001), the Cervical Brachial Symptom Questionnaire (r = 0.295, P = 0.01), change in the Single Assessment Numeric Evaluation score (r = -0.310, P < 0.01), change in the visual analogue scale (r = 0.244, P = 0.035), sex (r = 0.245, P = 0.034), and the number of medications (r = 0.642, P < 0.001). CONCLUSIONS: The increased frequency of patient-reported allergies is significantly associated with worse PRO scores for women undergoing TOS surgical decompression. Better understanding this association can help physicians counsel patients on expected outcomes.

AEPF: Attention-Enabled Point Fusion for 3D Object Detection.

Current state-of-the-art (SOTA) LiDAR-only detectors perform well for 3D object detection tasks, but point cloud data are typically sparse and lacks semantic information. Detailed semantic information obtained from camera images can be added with existing LiDAR-based detectors to create a robust 3D detection pipeline. With two different data types, a major challenge in developing multi-modal sensor fusion networks is to achieve effective data fusion while managing computational resources. With separate 2D and 3D feature extraction backbones, feature fusion can become more challenging as these modes generate different gradients, leading to gradient conflicts and suboptimal convergence during network optimization. To this end, we propose a 3D object detection method, Attention-Enabled Point Fusion (AEPF). AEPF uses images and voxelized point cloud data as inputs and estimates the 3D bounding boxes of object locations as outputs. An attention mechanism is introduced to an existing feature fusion strategy to improve 3D detection accuracy and two variants are proposed. These two variants, AEPF-Small and AEPF-Large, address different needs. AEPF-Small, with a lightweight attention module and fewer parameters, offers fast inference. AEPF-Large, with a more complex attention module and increased parameters, provides higher accuracy than baseline models. Experimental results on the KITTI validation set show that AEPF-Small maintains SOTA 3D detection accuracy while inferencing at higher speeds. AEPF-Large achieves mean average precision scores of 91.13, 79.06, and 76.15 for the car class's easy, medium, and hard targets, respectively, in the KITTI validation set. Results from ablation experiments are also presented to support the choice of model architecture.

Automated Lane Centering: An Off-the-Shelf Computer Vision Product vs. Infrastructure-Based Chip-Enabled Raised Pavement Markers.

Safe autonomous vehicle (AV) operations depend on an accurate perception of the driving environment, which necessitates the use of a variety of sensors. Computational algorithms must then process all of this sensor data, which typically results in a high on-vehicle computational load. For example, existing lane markings are designed for human drivers, can fade over time, and can be contradictory in construction zones, which require specialized sensing and computational processing in an AV. But, this standard process can be avoided if the lane information is simply transmitted directly to the AV. High definition maps and road side units (RSUs) can be used for direct data transmission to the AV, but can be prohibitively expensive to establish and maintain. Additionally, to ensure robust and safe AV operations, more redundancy is beneficial. A cost-effective and passive solution is essential to address this need effectively. In this research, we propose a new infrastructure information source (IIS), chip-enabled raised pavement markers (CERPMs), which provide environmental data to the AV while also decreasing the AV compute load and the associated increase in vehicle energy use. CERPMs are installed in place of traditional ubiquitous raised pavement markers along road lane lines to transmit geospatial information along with the speed limit using long range wide area network (LoRaWAN) protocol directly to nearby vehicles. This information is then compared to the Mobileye commercial off-the-shelf traditional system that uses computer vision processing of lane markings. Our perception subsystem processes the raw data from both CEPRMs and Mobileye to generate a viable path required for a lane centering (LC) application. To evaluate the detection performance of both systems, we consider three test routes with varying conditions. Our results show that the Mobileye system failed to detect lane markings when the road curvature exceeded ±0.016 m-1. For the steep curvature test scenario, it could only detect lane markings on both sides of the road for just 6.7% of the given test route. On the other hand, the CERPMs transmit the programmed geospatial information to the perception subsystem on the vehicle to generate a reference trajectory required for vehicle control. The CERPMs successfully generated the reference trajectory for vehicle control in all test scenarios. Moreover, the CERPMs can be detected up to 340 m from the vehicle's position. Our overall conclusion is that CERPM technology is viable and that it has the potential to address the operational robustness and energy efficiency concerns plaguing the current generation of AVs.

Development of an Energy Efficient and Cost Effective Autonomous Vehicle Research Platform.

Commercialization of autonomous vehicle technology is a major goal of the automotive industry, thus research in this space is rapidly expanding across the world. However, despite this high level of research activity, literature detailing a straightforward and cost-effective approach to the development of an AV research platform is sparse. To address this need, we present the methodology and results regarding the AV instrumentation and controls of a 2019 Kia Niro which was developed for a local AV pilot program. This platform includes a drive-by-wire actuation kit, Aptiv electronically scanning radar, stereo camera, MobilEye computer vision system, LiDAR, inertial measurement unit, two global positioning system receivers to provide heading information, and an in-vehicle computer for driving environment perception and path planning. Robotic Operating System software is used as the system middleware between the instruments and the autonomous application algorithms. After selection, installation, and integration of these components, our results show successful utilization of all sensors, drive-by-wire functionality, a total additional power* consumption of 242.8 Watts (*Typical), and an overall cost of $118,189 USD, which is a significant saving compared to other commercially available systems with similar functionality. This vehicle continues to serve as our primary AV research and development platform.

VarSome: the human genomic variant search engine.

SUMMARY: VarSome.com is a search engine, aggregator and impact analysis tool for human genetic variation and a community-driven project aiming at sharing global expertise on human variants. AVAILABILITY AND IMPLEMENTATION: VarSome is freely available at http://varsome.com. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Evaluation and treatment of thoracic outlet syndrome during the global pandemic due to SARS-CoV-2 and COVID-19.

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.

Measurements and models of the correlation of redundant spatial coherence measurements for the incoherently scattered field.

Sonar systems that exploit correlation for navigation, such as correlation velocity logs and micronavigation for synthetic aperture sonar, often make redundant estimates of the spatial coherence of the scattered field at several spatial lags. Two models for the correlation of these redundant measurements are described. First, an analytical model is derived using the assumption of stationary Gaussian statistics. Next, a numerical model is described that accounts for non-stationary processes present in measurements of seafloor scattering. These models are compared to normal-incidence scattering data collected at Seneca Lake, NY. Both models show good agreement with the measurements when the spatial separation between redundant hydrophone pairs is less than the coherence length. At greater spatial separation, the analytical model diverges from the measurements. This disagreement is explained by a lack of stationarity in the measured data which is captured by the numerical model. Finally, spatial variations in the volume scattering strength of the sediment are identified as a source of the non-stationarity in the measurements.

Effect of modified Soxhlet (Soxtec) and Folch extraction method selection on the total lipid determination of aged beef.

This study compared the modified Soxhlet (Soxtec) and Folch extraction methods for determining the total lipid or intramuscular fat (IMF) content of aged beef samples. Ageing periods tested were 0, 5, 8, 10 and 12 weeks during which samples were held in vacuo and at ~ 1.0 °C. Prior to solvent extraction, all samples were freeze-dried and ground. The Folch method was found to result in higher IMF values and therefore higher extraction efficiency when compared to the Soxtec. A linear relationship was evident between the two methods that described 80.9% of the variation between IMF values. An interaction between ageing period and extraction method was identified, although ageing period did not independently impact on averaged IMF findings. Based on these observations and reagent toxicity not being a limiting factor, it is recommended that the Folch extraction method be used to determine beef IMF, although it is acknowledged that the Soxtec method IMF results were strongly aligned with those found using the Folch extraction method and tended towards comparability for beef aged < 5 weeks.

Mapping Type IV Secretion Signals on the Primase Encoded by the Broad-Host-Range Plasmid R1162 (RSF1010).

UNLABELLED: The plasmid R1162 (RSF1010) encodes a primase essential for its replication. This primase makes up the C-terminal part of MobA, a multifunctional protein with the relaxase as a separate N-terminal domain. The primase is also translated separately as the protein RepB'. Here, we map two signals for type IV secretion onto the recently solved structure of RepB'. One signal is located internally within RepB' and consists of a long α-helix and an adjacent disordered region rich in arginines. The second signal is made up of the same α-helix and a second, arginine-rich region at the C-terminal end of the protein. Successive arginine-to-alanine substitutions revealed that either signal can be utilized by the type IV secretion complex of the plasmid R751. The internal signal also enables conjugal transfer when linked to the relaxase part of MobA. Both signals are similar to those previously identified for type IV secretion substrates in the Vir system of Agrobacterium tumefaciens. Moreover, the C-terminal arginine-rich segment of RepB' has been shown to be secreted by Vir. However, with R751, the signals require MobB, an R1162-encoded accessory protein active in conjugal transfer. The results of two-hybrid assays revealed that MobB interacts, via its membrane-associated domain, with the R751 plasmid coupling protein TraG. In addition, MobB interacts with a region of MobA just outside the RepB' domain. Therefore, MobB is likely an adaptor that is essential for recognition of the primase-associated signals by the R751 secretion machinery. IMPORTANCE: For most plasmids, type IV secretion is an intrinsic part of the mechanism for conjugal transfer. Protein relaxases, bound to the 5' end of the transferring strand, are mobilized into recipient cells by the type IV pathway. In this work, we identify and characterize two signals for secretion in the primase domain of MobA, the relaxase of the IncQ plasmid R1162 (RSF1010). We also show that the adaptor protein MobB is required for engagement of these signals with the R751 coupling protein TraG. These results clarify the location and properties of secretion signals active during the conjugal transfer of plasmid DNA.

In vitro quantification of time dependent thrombus size using magnetic resonance imaging and computational simulations of thrombus surface shear stresses.

Thrombosis and thromboembolization remain large obstacles in the design of cardiovascular devices. In this study, the temporal behavior of thrombus size within a backward-facing step (BFS) model is investigated, as this geometry can mimic the flow separation which has been found to contribute to thrombosis in cardiac devices. Magnetic resonance imaging (MRI) is used to quantify thrombus size and collect topographic data of thrombi formed by circulating bovine blood through a BFS model for times ranging between 10 and 90 min at a constant upstream Reynolds number of 490. Thrombus height, length, exposed surface area, and volume are measured, and asymptotic behavior is observed for each as the blood circulation time is increased. Velocity patterns near, and wall shear stress (WSS) distributions on, the exposed thrombus surfaces are calculated using computational fluid dynamics (CFD). Both the mean and maximum WSS on the exposed thrombus surfaces are much more dependent on thrombus topography than thrombus size, and the best predictors for asymptotic thrombus length and volume are the reattachment length and volume of reversed flow, respectively, from the region of separated flow downstream of the BFS.

Performance of tonpilz transducers with segmented piezoelectric stacks using materials with high electromechanical coupling coefficient.

Tonpilz acoustic transducers for use underwater often include a stack of piezoelectric material pieces polarized along the length of the stack and having alternating polarity. The pieces are interspersed with electrodes, bonded together, and electrically connected in parallel. The stack is normally much shorter than a quarter wavelength at the fundamental resonance frequency so that the mechanical behavior of the transducer is not affected by the segmentation. When the transducer bandwidth is less than a half octave, as has conventionally been the case, for example, with lead zirconate titanate (PZT) material, stack segmentation has no significant effect on the mechanical behavior of the device in its normal operating band near the fundamental resonance. However, when a high coupling coefficient material such as lead magnesium niobate-lead titanate (PMN-PT) is used to achieve a wider bandwidth with the tonpilz, the performance difference between a segmented stack and a similar piezoelectric section with electrodes only at the two ends can be significant. This paper investigates the effects of stack segmentation on the performance of wideband underwater tonpilz acoustic transducers. Included is a discussion of a particular tonpilz transducer design using single crystal piezoelectric material with high coupling coefficient compared with a similar design using more traditional PZT ceramics.

Conventional and kilohertz-frequency spinal cord stimulation produces intensity- and frequency-dependent inhibition of mechanical hypersensitivity in a rat model of neuropathic pain.

BACKGROUND: Spinal cord stimulation (SCS) is a useful neuromodulatory technique for treatment of certain neuropathic pain conditions. However, the optimal stimulation parameters remain unclear. METHODS: In rats after L5 spinal nerve ligation, the authors compared the inhibitory effects on mechanical hypersensitivity from bipolar SCS of different intensities (20, 40, and 80% motor threshold) and frequencies (50, 1 kHz, and 10 kHz). The authors then compared the effects of 1 and 50 Hz dorsal column stimulation at high- and low-stimulus intensities on conduction properties of afferent Aα/ß-fibers and spinal wide-dynamic-range neuronal excitability. RESULTS: Three consecutive daily SCS at different frequencies progressively inhibited mechanical hypersensitivity in an intensity-dependent manner. At 80% motor threshold, the ipsilateral paw withdrawal threshold (% preinjury) increased significantly from pre-SCS measures, beginning with the first day of SCS at the frequencies of 1 kHz (50.2 ± 5.7% from 23.9 ± 2.6%, n = 19, mean ± SEM) and 10 kHz (50.8 ± 4.4% from 27.9 ± 2.3%, n = 17), whereas it was significantly increased beginning on the second day in the 50 Hz group (38.9 ± 4.6% from 23.8 ± 2.1%, n = 17). At high intensity, both 1 and 50 Hz dorsal column stimulation reduced Aα/ß-compound action potential size recorded at the sciatic nerve, but only 1 kHz stimulation was partially effective at the lower intensity. The number of actions potentials in C-fiber component of wide-dynamic-range neuronal response to windup-inducing stimulation was significantly decreased after 50 Hz (147.4 ± 23.6 from 228.1 ± 39.0, n = 13), but not 1 kHz (n = 15), dorsal column stimulation. CONCLUSIONS: Kilohertz SCS attenuated mechanical hypersensitivity in a time course and amplitude that differed from conventional 50 Hz SCS, and may involve different peripheral and spinal segmental mechanisms.

Sternoclavicular joint surgery: how far does danger lurk below?

BACKGROUND: Surgical stabilization of the sternoclavicular joint (SCJ) is infrequent, and cardiothoracic surgery assistance is often recommended. Patient safety and surgeon efficiency may be improved by greater understanding of the anatomic relationships near the SCJ. The purpose of this study is to determine the distances from the SCJ to critical structures in the superior mediastinum. MATERIALS AND METHODS: Distances from the posterior SCJ to adjacent mediastinal structures were recorded using contrast computed tomography scans of 49 consecutive patients. Patient sex, height, body mass index, side, age, and thickness of the sternum and medial clavicle were also recorded. RESULTS: The mean distance to the nearest anatomic structure deep to the clavicular region of the SCJ was 6.6 mm and was 12.5 mm for the sternal region. The clavicle was an average thickness of 18 mm, and the sternum was an average thickness of 17 mm. The closest structure was the brachiocephalic vein. An artery was identified as the closest structure in 21.2% of patients. Distance differences between the right and left sides were noted, but sex had no bearing on distance to structures. CONCLUSION: Multiple mediastinal structures are close to the SCJ. The most frequent structure at risk of injury deep to the SCJ is the brachiocephalic vein. Such knowledge may improve patient safety.

Internal endpoint temperature (level of cooking doneness) effects on the fatty acid and mineral profiles of grilled lamb m. longissimus lumborum.

This study compared the fatty acid and mineral concentrations of lamb meat that was prepared to different levels of cooking doneness. Ten m. longissimus lumborum were each sectioned into 4 slices that were randomly assigned to be uncooked or grilled to an internal end-point temperature of 60 °C (rare), 71 °C (medium), or 77 °C (well done). It was found that cooking loss increased as the level of cooking doneness increased. The proportion of most major fatty acids were not altered by cooking. However, when adjusted for cooking loss (i.e., mg/135 g serve of lamb as-is equivalent prepared to each level of cooking doneness), the concentration of most major fatty acids, including C16:0, C18:0, C18:1n-9, and many conjugated linoleic acids, were lowered after grilling to any level of cooking doneness and compared to the uncooked samples. The omega-6 to omega-3 ratio was lowest for the uncooked samples and highest for those prepared to a well done level of cooking doneness. Conversely, the concentration of health claimable omega-3 fatty acids in the uncooked meat was retained upon cooking and across all the different internal endpoint temperatures. Calcium, magnesium, phosphorous, potassium, and sodium were reduced with preparation of lamb meat to any level of cooking doneness, compared with uncooked meat. Zinc, iron, and selenium were retained within the cooked samples. These findings show that consumer preference for a level of cooking doneness will have only minor effects on the concentration of minerals and fatty acids in lamb meat.

Origin and fate of the 3' ends of single-stranded DNA generated by conjugal transfer of plasmid R1162.

During conjugation, a single strand of DNA is cleaved at the origin of transfer (oriT) by the plasmid-encoded relaxase. This strand is then unwound from its complement and transferred in the 5'-to-3' direction, with the 3' end likely extended by rolling-circle replication. The resulting, newly synthesized oriT must then be cleaved as well, prior to recircularization of the strand in the recipient. Evidence is presented here that the R1162 relaxase contains only a single nucleophile capable of cleaving at oriT, with another molecule therefore required to cleave at a second site. An assay functionally isolating this second cleavage shows that this reaction can take place in the donor cell. As a result, there is a flux of strands with free 3' ends into the recipient. These ends are susceptible to degradation by exonuclease I. The degree of susceptibility is affected by the presence of an uncleaved oriT within the strand. A model is presented where these internal oriTs bind and trap the relaxase molecule covalently bound to the 5' end of the incoming strand. Such a mechanism would result in the preferential degradation of transferred DNA that had not been properly cleaved in the donor.

A role for nociceptive, myelinated nerve fibers in itch sensation.

Despite its clinical importance, the underlying neural mechanisms of itch sensation are poorly understood. In many diseases, pruritus is not effectively treated with antihistamines, indicating the involvement of nonhistaminergic mechanisms. To investigate the role of small myelinated afferents in nonhistaminergic itch, we tested, in psychophysical studies in humans, the effect of a differential nerve block on itch produced by intradermal insertion of spicules from the pods of a cowhage plant (Mucuna pruriens). Electrophysiological experiments in anesthetized monkey were used to investigate the responsiveness of cutaneous, nociceptive, myelinated afferents to different chemical stimuli (cowhage spicules, histamine, capsaicin). Our results provide several lines of evidence for an important role of myelinated fibers in cowhage-induced itch: (1) a selective conduction block in myelinated fibers substantially reduces itch in a subgroup of subjects with A-fiber-dominated itch, (2) the time course of itch sensation differs between subjects with A-fiber- versus C-fiber-dominated itch, (3) cowhage activates a subpopulation of myelinated and unmyelinated afferents in monkey, (4) the time course of the response to cowhage is different in myelinated and unmyelinated fibers, (5) the time of peak itch sensation for subjects with A-fiber-dominated itch matches the time for peak response in myelinated fibers, and (6) the time for peak itch sensation for subjects with C-fiber-dominated itch matches the time for the peak response in unmyelinated fibers. These findings demonstrate that activity in nociceptive, myelinated afferents contributes to cowhage-induced sensations, and that nonhistaminergic itch is mediated through activity in both unmyelinated and myelinated afferents.

Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population.

Background: Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. Methods: A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. Results: The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Conclusion: Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.

Functional organization of MobB, a small protein required for efficient conjugal transfer of plasmid R1162.

MobB is a small (molecular weight = 15,097) protein encoded by the broad-host-range plasmid R1162 and is required for its efficient transfer by conjugation. The C-terminal half of the protein contains a membrane domain essential for transfer. This region can be replaced by a putative membrane domain from another, unrelated protein, and thus is likely to function independently from the rest of MobB. The other, functionally active region of MobB, identified by mutagenesis, is at the N-terminal end. One mutation affecting this region inhibits replication, suggesting that this part of the protein is contacting and sequestering the relaxase-linked primase. The overall organization reflects a multimeric and bipolar organization, with molecules of MobB anchored in the membrane at one end and engaging the relaxase at the other. This arrangement could increase the transfer frequency by raising the probability of contact between the relaxase and the membrane-embedded, coupling protein for type IV secretion.

Cross-sectional and longitudinal assessment of aortic root dilation and valvular anomalies in hypermobile and classic Ehlers-Danlos syndrome.

OBJECTIVES: To delineate the prevalence of cardiac findings in hypermobile and classic Ehlers-Danlos syndrome and provide longitudinal analysis of aortic root growth. STUDY DESIGN: A retrospective chart review was conducted, and data were analyzed for cross-sectional prevalence of aortic dilation and valvular anomalies. The clinical implications of aortic root growth were determined by assessment of progression of aortic root measurements over time and clinical symptoms. RESULTS: Patients whose first echocardiogram was obtained in late childhood or adulthood were less likely to have aortic dilation (P < .002) than those whose first echocardiogram was obtained in early childhood. Longitudinally, seven individuals had dilated aortas before age 14, and only one individual continued to show dilation after age 14 (P = .0143). No patient with a normal aortic root in childhood had development of dilation in adulthood. Fifteen of the 252 patients (6.0%) had mitral valve prolapse (MVP), although only one patient (0.4%) had MVP that was mild to moderate. CONCLUSIONS: Although aortic root size and MVP are increased in patients with these types of Ehlers-Danlos syndrome, they tend to be of little clinical consequence. Echocardiography may still be warranted as part of cardiovascular assessment, but decreased frequency of screening is recommended especially in symptom-free adults.

Recent Developments on High Curie Temperature PIN-PMN-PT Ferroelectric Crystals.

Pb(In(0.5)Nb(0.5))O(3)-Pb(Mg(1/3)Nb(2/3))O(3)-PbTiO(3) (PIN-PMN-PT) ferroelectric crystals attracted extensive attentions in last couple years, due to their higher usage temperatures range (> 30°C) and coercive fields (~5kV/cm), meanwhile maintaining similar electromechanical couplings (k(33)> 90%) and piezoelectric coefficients (d(33)~1500pC/N), when compared to their binary counterpart Pb(Mg(1/3)Nb(2/3))O(3)-PbTiO(3). In this article, we reviewed recent developments on the PIN-PMN-PT single crystals, including the Bridgman crystal growth, dielectric, electromechanical, piezoelectric and ferroelectric behaviors as function of temperature and dc bias. Mechanical quality factor Q was studied as function of orientation and phase. Of particular interest is the dynamic strain, which related to the Q and d(33), was found to be improved when compared to binary system, exhibiting the potential usage of PIN-PMN-PT in high power application. Furthermore, PIN-PMN-PT crystals exhibit improved thickness dependent properties, due to their small domain size, being on the order of 1µm. Finally, the manganese acceptor dopant in the ternary crystals was investigated and discussed briefly in this paper.