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• Restraining the notch effect in the dowels significantly increases the connection ductility. • Post-elastic steel properties of the dowels strongly influence the displacement capacity. • Optimized detailing combined with an adequate steel allow to reach a high ductility. • Constriction of the dowels in the contact area with the plate has been observed. According to Eurocode 8 moderate to high dissipative behaviour of timber structures requires sufficient ductility of the critical regions. Earlier experiments on timber connections with slotted-in steel plates and laterally loaded common steel dowels rarely achieved high ductility values. Connections consisting of LVL-C members, dowel-type fasteners with different post-elastic steel properties, full confinement of the timber member and measures to restrain the notch effect were investigated by means of monotonic and cyclic tests with regards to the displacement ductility. The measures taken proved to be effective in enhancing the plastic deformation capacity of the steel dowels to a large extent. However, a new aspect was observed: the constriction of the dowels in the contact area with the plate. The research results provided a better understanding of the factors influencing the behaviour of slotted-in steel plate connection. [ABSTRACT FROM AUTHOR]

Abstract: Background: The number of adolescent and adult patients with congenital heart disease undergoing heart transplantation is increasing. We aimed to better define the characteristics of these patients and their survival after transplantation. Methods: We describe a group of patients with end-stage heart failure owing to congenital heart disease undergoing heart transplantation at a single tertiary center and compare their short- and long-term survival with a group of matched controls with dilated cardiomyopathy and the entire cohort of transplanted patients at our center. Results: Between 1985 and 2006, a total of 322 orthotopic heart transplantations were performed at our center. Thirteen patients (mean age, 27.5 years) had a diagnosis of congenital heart disease with a wide spectrum of lesions. The survival of these 13 patients was 85% at 30 days, 1, 5, and 10 years and 77% at 20 years, which did not differ significantly to the short- and long-term survival of the entire cohort of patients with heart transplantation and to the survival of age-matched controls with dilated cardiomyopathy. Conclusion: In our single-center experience, short- and long-term survival after heart transplantation in a selected, small group of patients with end-stage heart failure owing to congenital heart disease did not differ significantly compared with a group of age-matched controls and the entire cohort. [Copyright &y& Elsevier]

Background: During cardiopulmonary bypass (CPB), measurement of kaolin-based activated clotting time (kACT) is a standard practice in monitoring heparin-induced anticoagulation. Despite the fact that the kACT test from the Sonoclot Analyzer ( SkACT) has been commercially available for several years, no published data on the performance of SkACT are available. Thus, the aim of this in vitro study was to compare SkACT with an established kACT from Hemochron ( HkACT). Methods: Blood was withdrawn from 25 patients before elective cardiac surgery. SkACT and HkACT were measured in duplicate after in vitro administration of heparin (0, 1, 2 and 3 U/ml), calcium-free lactated Ringer's solution (25% and 50% haemodilution) and aprotinin (200 kIU/ml). Results: A total of 600 duplicate kACT measurements were obtained from 25 cardiac surgery patients. Overall, mean bias ± SD between SkACT and HkACT was 7 ± 70 s (1.3% ± 14.1%). Administration of heparin, haemodilution and aprotinin induced a comparable effect on both activated clotting time (ACT) tests. Mean bias ranged from −4 ± 39 s (−1.7% ± 12.9%) to 4 ± 78 s (3.2% ± 15.6%) for heparinzed blood samples after haemodilution or aprotinin application and increased after combined aprotinin administration and haemodilution. After haemodilution and administration of aprotinin, both ACT tests were less reliable for values >480 s in heparinized blood samples. Conclusion: Accuracy and performance of SkACT and HkACT were comparable after in vitro administration of heparin, aprotinin and haemodilution. Both ACT tests were considerably affected by aprotinin and haemodilution. [ABSTRACT FROM AUTHOR]

The new Volumetric Ejection Fraction monitoring system (VoLEF®), when combined with the Pulse Contour Cardiac Output monitoring system (PiCCO®) system, allows measurement of left and right heart end-diastolic volumes by thermodilution. The aim of this study was to evaluate whether the left heart end-diastolic volume index determined by the VoLEF system (LHEDI) better reflects left ventricular end-diastolic area index (LVEDAI) measured by transoesophageal echocardiography than does global end-diastolic volume index (GEDI) measured by the PiCCO system alone. Following induction of anaesthesia, PiCCO, VoLEF and transoesophageal echocardiography measurements were performed before and after a fluid challenge in 20 patients scheduled for elective cardiac surgery. Both left ventricular end-diastolic area index and global end-diastolic volume index, but not left heart end-diastolic volume index, significantly increased after fluid administration. Mean bias ± 2 SD for ΔLHEDI–ΔLVEDAI was − 2.2 ± 32.0% and for ΔGEDI–ΔLVEDAI − 0.6 ± 16.8%. In contrast to global end-diastolic volume index, the use of left heart end-diastolic volume index determined by the VoLEF system cannot be recommended as an estimate of left ventricular preload. [ABSTRACT FROM AUTHOR]