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BACKGROUND In most centres, clinically significant percutaneous paravalvular leak (PVL) closure following valve replacement surgery is reserved for those considered high-risk for surgery. There is a paucity of data regarding the long-term outcomes of these patients. AIMS Our goals were to assess the long-term outcomes of patients undergoing percutaneous PVL closure. METHODS A total of 100 consecutive transcatheter PVL closure procedures (74 mitral, 26 aortic) were performed in 95 patients between February 2005 and August 2019 at our hospital. Data collected included procedural success rates, indication-specific outcomes and mortality. RESULTS Mean follow-up was 5.6±6.1 years, mean age 62.6±15.2 years, and 45.4% were female. The device was successfully implanted in 88 procedures (88.0%). Patients who presented with heart failure (n=57) had a significant improvement in NYHA classification (29.2% Class III/IV versus 100.0%, p

The article discusses the human capital of the individual and the total human capital of the enterprise, approaches to their measurement and assessment of the effectiveness of managing total capital, including assets and total human capital.

The article examines the features of determining the break-even point of a tourist product and margin income that provides compensation for fixed costs and profit from the volume of sales that exceeds the break-even point.

Background The significance of depression/anxiety among ACHD patients in terms of health care utilization is unknown and data on the association with mortality are scarce. Methods Analyses comprised 8334 ACHD patients, age ≥ 18 years, insured by a large healthcare organization (2007–2011). Depression/anxiety were determined by diagnoses and treatments recorded in the organization database. Adjusted utilization relative rates (RRs) were estimated with negative binomial models and mortality hazard ratios (HRs) with the Cox proportional hazard model. Results ACHD patients with depression/anxiety (N = 2950, 35%) were more likely to be older (mean ± SD: 54 ± 17 vs. 45 ± 18 years), women (61% vs. 45%), and have comorbidities than counterparts without depression/anxiety. Following multivariable adjustment, patients with depression/anxiety had more primary care and cardiology clinic visits, more emergency department visits and more hospitalizations. RRs (95% confidence interval) were: 1.31 (1.27–1.35); 1.07 (1.01–1.13); 1.60 (1.46–1.77); and 1.18 (1.08–1.29) respectively, for diagnosis before the study period, and 1.36 (1.31–1.42); 1.22 (1.14–1.30); 1.43 (1.24–1.60) and 1.47 (1.33–1.64), respectively, for diagnosis during the study. Stratifying by age, the highest adjusted primary care and cardiology visit RRs were found among 18–24 years old patients and the lowest among patients ≥65 years. Between 2007 and 2017, 905 patients died. Depression/anxiety were associated with increased mortality risk with adjusted HRs: 1.10 (95% CI: 0.94–1.29) for past diagnosis and 1.40 (1.17–1.67) for study period depression/anxiety diagnosis. Conclusions Depression/anxiety in ACHD patients is associated with increased health-care utilization and a higher risk of death. The efficacy of addressing patients' psychosocial needs in optimizing health-care utilization and improving prognosis needs further evaluation.

Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.

The paper presents models of bands (levels) in solid (SiC)1-x(AlN)x luminescence centers and n-SiC/p-(SiC)1-x(AlN)x heterostructures (light-emitting diodes). The diagram of (SiC)1-x(AlN)x energy gaps shows the positions of luminescence levels, subject to x. A SiC/SiC–AlN series of electroluminescence bands, for the first time, is found to have a continuous relationship between the positions of short-wave and long-wave band maxima in a K-minimum conduction band, respectively, as continuous functions of contact current density.

The main methods for producing 4H-SiC single crystals and films of its solid solutions are considered. A new technique for producing single crystals of SiC polytypes is described. A new nonlinear model of the Schottky barrier height (BS) has been developed, and the current-voltage characteristics of Schottky diodes have been obtained, their comparison with the I–V characteristics of silicon-based diodes has been made.

Object The authors describe the use of inside-outside occipital screws in 21 children with occipitocervical instability requiring occipitocervical fusion. Methods The ages of the patients were from 2 to 15 years, and patients presented with a variety of causes of occipitocervical instability, including congenital disorders, posttraumatic instability, idiopathic degeneration, and postoperative instability. Surgeries frequently included foramen magnum decompression, duraplasty, and laminectomy, but all patients required occipitocervical instrumentation and arthrodesis. Postoperative orthosis included the use of either a cervical collar or halo device. In all but one case, patients were followed postoperatively for at least 12 months. Results The mean age of patients was 9.93 years. Inside-outside screws were used in all reported cases. Rib autograft was used in all patients. In addition, demineralized bone matrix was used in 2 cases, and bone morphogenetic protein was used in 2 patients. Two patients required halo placement, and the other 19 were placed in cervical collars. The average time postoperative orthotics were used was 2.82 months. Arthrodesis was determined radiographically and was noted in all patients. No operative complications were noted; however, postoperative complications included 1 wound infection, 2 cases of hardware loosening, and the need for tracheostomy in 2 patients. Conclusions Inside-outside screws were found to be a useful component of occipitocervical instrumentation in pediatric patients ranging from 2 to 15 years of age. Arthrodesis was demonstrated in all cases.

Objective To investigate the prevalence and characteristics of cerebrovascular accidents (CVA) in a large population of adults with congenital heart disease (CHD). Methods and results In a retrospective analysis of aggregated European and Canadian databases a total population of 23 153 patients with CHD was followed up to the age of 16-91 years (mean 36.4 years). Among them, 458 patients (2.0%) had one or more CVA, with an estimated event rate of 0.05% per patient-year. Permanent neurological sequelae were noted in 116 patients (25.3%). The prevalence of CVA in selected diagnostic categories was as follows: open atrial septal defect 93/2351 (4.0%); closed atrial or ventricular septal defect 57/4035 (1.4%); corrected tetralogy of Fallot 52/2196 (2.4%); Eisenmenger physiology 24/467 (5.1%); other cyanotic 50/215 (23.3%); mechanical prostheses (29/882 (3.3%). Associated conditions in patients with CVA were absence of sinus rhythm (25%), transvenous pacemakers (7%), endocarditis (2%), cardiac surgery (11%) and catheter intervention (2%), but with the exception of absent sinus rhythm these were not significantly more prevalent in patients with CVA. Conclusion CVA are a major contributor to morbidity in this young population despite absence of classical cardiovascular risk factors. Although the prevalence of CVA in patients with CHD appears low, it is 10-100 times higher than expected in control populations of comparable age. Residua occur in a strong minority of patients. The subjects at highest risk are those patients with CHD with cyanotic lesions, in whom the prevalence is over 10-fold above the average

Study design Case report. Objective To review the management of a neurologically intact patient with complete cervical spondyloptosis with particular attention to the role and timing of closed preoperative cervical traction and subsequent stabilization. Summary of background data Traumatic cervical spondyloptosis is typically associated with complete and irreversible spinal cord injury. In these patients, cervical traction can be implemented to restore anatomic alignment in preparation for stabilization with minimal consequence. When a patient presents neurologically intact, the management becomes more complicated. Preservation of function and restoration of anatomic alignment collectively represent the goals of therapy. The current literature does not clearly define the role of cervical traction in such cases. Methods A patient with traumatic cervical spondyloptosis at the C7-T1 level presented to our institution and was found to be neurologically intact. Computed tomography demonstrated complete spondyloptosis with multiple fractures through the posterior elements. Results The spondyloptosis was reduced with closed cervical traction and underwent anterior and posterior instrumented stabilization. No new deficit occurred in the patient after reduction. Conclusion Fractures of the posterior elements functionally decompress the spinal canal and thereby allow for cervical traction to be safely implemented in patients with spondyloptosis. Safe restoration of anatomic alignment in the neurologically intact spondyloptotic patient is crucial to minimize the extent of surgical stabilization and create a long-term stable construct of the fracture dislocation.

To reduce the large absorption effect in diamond anvil pressure cells for soft x rays, perforated anvils employed as diamond-backing plates (DBPs) used in conjunction with miniature anvils (MAs) made of 1/100 carat diamonds were tested for high-pressure efficacy. Static pressures beyond 100 GPa were generated using a piston/cylinder cell having 0.2 mm culets. Tests were carried out in 0.1 mm cavities drilled in a Re gasket, using Ar samples and ruby chips for manometry. Except for a single failure of a 0.3 mm culet MA, no damage was detected in the DBPs drilled with truncated conical holes tapering from 0.3 mm to 1, 1.5, and 2 mm diameter. Another arrangement in which one anvil was partially drilled leaving a 0.5 mm thick wall behind the culet achieved 100 GPa. Detailed discussions are given concerning the benefits of the DBP/MA cells for high-pressure studies with soft x rays and for background reduction in Raman, IR, UV, and 57Fe Mossbauer spectroscopies.

The influence of basic discharge parameters on the efficiency of bacterial decontamination in liquids has been studied, The experiments have been carried out with a voltage of 19 kV, a pulse repetition rate of 0.1-10 Hz, and a pulse energy of 3-10 J. The pulses were applied to electrodes located in a water-filled cell. The suspension contained staphilococci or E. Coli with a concentration of 10/sup 6/-10/sup 8/ per ml. At 10 J/ml energy input, the bacterial decontamination efficiency was found to be 100%. Even at low -2.5 J/ml energy density, the efficiency of removing the bacteria was still more than 94%.

The serious lag in domestic oil refining technology is not only due to material and financial problems, but also to the lack of due attention to the newest trends in development of many existing processes which could fundamentally alter their process design. Supercritical fluid extraction could be one of these revolutionary trends. Scientific research in this area began approximately 100 years ago [1].

Objective To analyze the safety and efficacy of neuroendoscopic colloid cyst resection and to assess patient satisfaction. Methods A retrospective analysis of a single surgeon's experience with neuroendoscopic resection of colloid cysts was performed. Surgeries performed in 56 patients were reviewed. Surgeries involved an anterolateral neuroendoscopic technique. Patients were followed postoperatively for an average of 14.9 months. Patients were also interviewed regarding their preoperative symptoms, resolution of symptoms postoperatively, and their degree of satisfaction. Results The median operative time was 82 minutes, and the median duration of hospital stay was 5 days. During surgery, the ventricles were explored for residual cyst wall or cyst content, and none were encountered. On immediate postoperative imaging, cyst recurrence was not noted for any patient, and only 1 patient has had evidence of recurrence on long-term follow-up. Various preoperative symptoms were described by patients; depending on the specific symptoms, 70%–100% resolution of symptoms was shown after surgery. Along with clinical follow-up, patients were interviewed regarding their perception of surgery and recovery. Of the patients contacted, 100% reported satisfaction with the surgery, and 91% noted satisfaction with their recovery. Reported complications included memory loss, infection, deep vein thrombosis, and postoperative hematoma. There were 2 perioperative deaths (3.5%) related to surgery. Conclusions Neuroendoscopic colloid cyst resection can reliably achieve complete lesion removal with short operative times. In addition, there is a high level of reported patient satisfaction. To our knowledge, this is the largest case series of neuroendoscopic colloid cyst resections from a single surgeon.

Transrectal prostate biopsy is considered a relatively safe procedure, with a quite small number of complications. We report a patient with a rectourethral fistula after a repeat transrectal prostate biopsy. To our knowledge, this is the first incident in the published literature.

Background: Traditionally, endoscopic transsphenoidal pituitary surgery is performed using 2-dimensional (2D) endoscopes, which lack depth of field and contribute to image distortion. Recently, a new generation of 3D endoscopes has been introduced for improved endoscopic depth perception. Little data exist comparing surgical outcomes with 2D vs 3D endoscopic systems. This study examines perioperative and postoperative factors in patients undergoing pituitary surgery using 2D vs 3D endoscopes. The objective of this work was to determine the differences in perioperative and postoperative factors in patients undergoing pituitary surgery using 2D vs 3D endoscopy. Methods: Retrospective chart review at a tertiary academic referral center. Statistical comparison was undertaken for perioperative (estimated blood loss, operative time) and postoperative factors (length of stay, complications, and readmission rate). Results: A total of 58 patients underwent endoscopic pituitary surgery during the 24-month study period (22 functional, 36 nonfunctional lesions). The 2D endoscopic system was used for pituitary tumor resection in 32 patients (55%), and the 3D endoscopic system in 26 patients (45%). No significant difference existed between 2D and 3D endoscopic systems for operative time (p = 0.275) or estimated blood loss (p = 0.312). Additionally, no difference was found between groups for cerebrospinal fluid (CSF) leak rate (p = 0.581), postoperative endocrine complications (p = 0.081), length of hospital stay (p = 0.934), or hospital readmission rate (p = 1.0). Conclusion: 3D endoscopy affords the surgeon improved depth of field and stereoscopic vision. Our data demonstrate that 3D endoscopy does not result in significantly different perioperative or postoperative outcomes vs 2D endoscopic surgery. © 2011 ARS-AAOA, LLC.

Introduction: Two-dimensional (2D) endoscopes are limited by poor depth perception, lack of stereoscopic vision, and image distortion. Recently, a new three-dimensional (3D) endoscopic system that provides improved stereoscopic vision has been developed. No data exist comparing the results and outcomes of 2D versus 3D endoscopy in treatment of a large cohort of pituitary adenoma patients. We compared the results of transnasal endoscopic pituitary surgery using the 2D and 3D endoscopy systems. Methods: A total of 115 patients underwent endoscopic transnasal transsphenoidal pituitary adenomectomy at Emory University Hospital. In all cases, pituitary tumor resection was performed by a single neurosurgeon (NO). The endoscopic transnasal approach and closure were performed by the otolaryngology service. The 3D endoscopic system was used for pituitary adenomectomy in 72 patients (63%), and the 2D system was used in 43 patients (37%) over a 2-year period. A retrospective analysis included preoperative, perioperative, and postoperative metrics. The statistical comparison was completed using the t test and the chi-square test. Results: The preoperative data for the two groups (3D vs. 2D) is presented: the average age 49.5 versus 45.9, tumor size (all tumors) 6.9 versus 5.8 cm3, and tumor size (macroadenomas) (94/115) 8.3 versus 7.1 cm3 with Knosp cavernous sinus invasion grade of 1.8 versus 1.4. The perioperative data (3D vs. 2D) includes: median operative time of 145 versus 168 minutes, EBL 200 versus 200 mL, LD placement 35/72 (49%) versus 21/43 (49%). The postoperative data (3D versus 2D) includes: hospital stay 5 days versus 5 days, endocrine complications 7/72 (10%) versus 5/43 (12%), CSF leak rate 5/72 (7%) versus 4/43 (9%), remission for functioning tumors was 20/30 (67%) versus 12/21 (57%), readmission rate was 15/72 (21%) versus 10/43 (23%), reoperation rate was 4/72 (6%) versus 8/43 (19%), and transsphenoidal CSF leak repair 0/72 (0%) versus 3/43 (7%). The reoperation rate and the CSF leak repair rate were statistically different (P

The paper proposes a uniform approach to formalization of image processing, analysis, and recognition problems. The properties of a family of local algorithms are considered.

Each wheat cultivar has a characteristic spectrum of gliadins. This makes it possible to use blocks of the components of reserve proteins as genetic markers when estimating seed purity and identity. However, identification of the blocks that constitute the electrophoretic spectrum is a complicated task. For this purpose artificial neural network (ANN) technology is proposed. Using experimental data, a teaching database and testing databases have been created. ANN was shown to be highly efficient (efficiency up to 100%) expert system for deciphering the electrophoretic spectra of gliadins of durum wheat cultivars.

A new approach is proposed to image processing, analysis, and recognition problems which leads to unambiguous description and synthesis of appropriate algorithms. The synthesis technique produces existing algorithms as well as new algorithms not previously described.

ObjectiveWe sought to examine the frequency of early postoperative complications and preoperative predictors of prolonged hospitalization in adults with repaired tetralogy of Fallot undergoing pulmonary valve replacement.MethodsThis was a retrospective study of consecutive adult patients undergoing surgical intervention between 1995 and 2006. A multivariate logistic regression model was used to identify determinants of prolonged hospitalization.ResultsOne hundred sixteen patients (mean age, 36 ± 11 years) underwent 118 pulmonary valve replacements. Most (95%) operations included additional procedures, such as pulmonary artery/outflow tract reconstruction or tricuspid valve annuloplasty. The early postoperative mortality (

A 4b/cell 1Gb data flash based on a low-cost NROM process technology is achieved. The design includes a two-phase programming algorithm for supporting a fast and accurate threshold-voltage control. The read scheme incorporates a simple error-detection mechanism combined with an accurate drain-side sensing circuit with a built-in offset cancellation

The efficacy and toxicity of once-daily (od) versus twice-daily (bd) dosing of vancomycin was compared in 121 hospitalized patients. Eighteen patients were then withdrawn from the study. Clinical and bacteriological responses were evaluated in all patients (n = 103). Nephrotoxicity was assessed in patients who did not receive nephrotoxic agents (n = 76). Ototoxicity was assessed in patients who completed two audiograms and were not receiving ototoxic agents (n = 63). No significant difference was found between the two groups for favourable clinical response: 47/51 (92.1%) and 49/52 (94.2%) in the od and bd groups, respectively. In 34 patients vancomycin was the only effective antibiotic. Fifteen of 18 (83.3%) evaluated episodes in the od and 12/16 (75.0%) evaluated episodes in the bd group showed a favourable bacteriological response. There were no significant differences between the od and bd groups for all adverse events. Nephrotoxicity developed in 4/37 (10.8%) and 3/39 (7.7%) patients, respectively. Hearing loss developed in 1/31 (3.2%) and 5/32 (15.6%). Phlebitis occurred in 7/51 (13.7%) and 12/52 (23.0%). Red man syndrome occurred in 7/51 (13.7%) and 5/52 (9.6%) in od and bd groups, respectively. The efficacy and safety profile of od administration of vancomycin is similar to that of the customary, but less convenient, bd administration.

Lens performance parameters have been traditionally described using terms such as resolution, astigmatism, field curvature, proximity effects, and distortion. However, with decreasing geometries, decreasing exposure wavelengths and tighter bandwidths (such as 248 nm excimer laser lithography), lens characterization in terms of depth of focus (DOF) and exposure latitudes for the entire lens becomes more critical. The challenge is to define a focus and exposure setting that allows one to operate in the `common corridor.' `Common corridor' is defined as the resulting focus-exposure process window for the entire field of the lens encompassing all geometries of a specific line size. A modification to the MONO-LITH software package allows this calculation to be done quickly and easily.