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The top-quark mass is measured in the all-hadronic top-antitop quark decay channel using proton-proton collisions at a centre-of-mass energy of \(\sqrt{s}=8\) TeV with the ATLAS detector at the CERN Large Hadron Collider. The data set used in the analysis corresponds to an integrated luminosity of 20.2 fb\(^{−1}\). The large multi-jet background is modelled using a data-driven method. The top-quark mass is obtained from template fits to the ratio of the three-jet to the dijet mass. The three-jet mass is obtained from the three jets assigned to the top quark decay. From these three jets the dijet mass is obtained using the two jets assigned to the W boson decay. The top-quark mass is measured to be 173.72 ± 0.55 (stat.) ± 1.01 (syst.) GeV.
Detailed information on the land cover types present and the horizontal position of the land–water interface is needed for sensitive coastal ecosystems throughout the Arctic, both to establish baselines against which the impacts of climate change can be assessed and to inform response operations in the event of environmental emergencies such as oil spills. Previous work has demonstrated potential for accurate classification via fusion of optical and SAR data, though what contribution either makes to model accuracy is not well established, nor is it clear what shorelines can be classified using optical or SAR data alone. In this research, we evaluate the relative value of quad pol RADARSAT-2 and Landsat 5 data for shoreline mapping by individually excluding both datasets from Random Forest models used to classify images acquired over Nunavut, Canada. In anticipation of the RADARSAT Constellation Mission (RCM), we also simulate and evaluate dual and compact polarimetric imagery for shoreline mapping. Results show that SAR data is needed for accurate discrimination of substrates as user’s and producer’s accuracies were 5–24% higher for models constructed with quad pol RADARSAT-2 and DEM data than models constructed with Landsat 5 and DEM data. Models based on simulated RCM and DEM data achieved significantly lower overall accuracies (71–77%) than models based on quad pol RADARSAT-2 and DEM data (80%), with Wetland and Tundra being most adversely affected. When classified together with Landsat 5 and DEM data, however, model accuracy was less affected by the SAR data type, with multiple polarizations and modes achieving independent overall accuracies within a range acceptable for operational mapping, at 89–91%. RCM is expected to contribute positively to ongoing efforts to monitor change and improve emergency preparedness throughout the Arctic.
A search is conducted for new resonant and non-resonant high-mass phenomena in dielectron and dimuon final states. The search uses 36.1 fb\(^{−1}\) of proton-proton collision data, collected at \(\sqrt{s}=13\) TeV by the ATLAS experiment at the LHC in 2015 and 2016. No significant deviation from the Standard Model prediction is observed. Upper limits at 95% credibility level are set on the cross-section times branching ratio for resonances decaying into dileptons, which are converted to lower limits on the resonance mass, up to 4.1 TeV for the E\(_6\)-motivated \(Z^′_χ\). Lower limits on the \({qqℓℓ}\) contact interaction scale are set between 2.4 TeV and 40 TeV, depending on the model.
Inclusive jet production cross-sections are measured in proton-proton collisions at a centre-of-mass energy of \(\sqrt{s} = 8\) TeV recorded by the ATLAS experiment at the Large Hadron Collider at CERN. The total integrated luminosity of the analysed data set amounts to 20.2 fb\(^{−1}\). Double-differential cross-sections are measured for jets defined by the anti-\(k_t\) jet clustering algorithm with radius parameters of \(R\) = 0.4 and \(R\) = 0.6 and are presented as a function of the jet transverse momentum, in the range between 70 GeV and 2.5 TeV and in six bins of the absolute jet rapidity, between 0 and 3.0. The measured cross-sections are compared to predictions of quantum chromodynamics, calculated at next-to-leading order in perturbation theory, and corrected for non-perturbative and electroweak effects. The level of agreement with predictions, using a selection of different parton distribution functions for the proton, is quantified. Tensions between the data and the theory predictions are observed.
A search for direct top squark pair production resulting in events with either a same-flavour opposite-sign dilepton pair with invariant mass compatible with a \(Z\) boson or a pair of jets compatible with a Standard Model (SM) Higgs boson (\(h\)) is presented. Requirements on the missing transverse momentum, together with additional selections on leptons, jets, jets identified as originating from \(b\)-quarks are imposed to target the other decay products of the top squark pair. The analysis is performed using proton-proton collision data at \(\sqrt{s}\) = 13 TeV collected with the ATLAS detector at the LHC in 2015–2016, corresponding to an integrated luminosity of 36.1 fb\(^{-1}\). No excess is observed in the data with respect to the SM predictions. The results are interpreted in two sets of models. In the first set, direct production of pairs of lighter top squarks (\(\tilde{t}_1\)) with long decay chains involving \(Z\) or Higgs bosons is considered. The second set includes direct pair production of the heavier top squark pairs (\(\tilde{t}_2\)) decaying via \(\tilde{t}_2\) → \(Z\tilde{t}_1\) or \(\tilde{t}_2\) → \(h\tilde{t}_1\). The results exclude at 95% confidence level \(\tilde{t}_2\) and \(\tilde{t}_1\) masses up to about 800 GeV, extending the exclusion region of supersymmetric parameter space covered by previous LHC searches.
Background:
Metastatic Adrenocortical Carcinoma (ACC) is a rare malignancy with a poor 5-year-survival rate (<15%). A surgical approach is recommended in selected patients if complete resection of distant metastasis can be achieved. To date there are only limited data on the outcome after surgical resection of hepatic metastases of ACC.
Methods:
A retrospective analysis of the German Adrenocortical Carcinoma Registry was conducted. Patients with liver metastases of ACC but without extrahepatic metastases or incomplete tumour resection were included.
Results:
Seventy-seven patients fulfilled these criteria. Forty-three patients underwent resection of liver metastases of ACC. Complete tumour resection (R0) could be achieved in 30 (69.8%). Median overall survival after liver resection was 76.1 months in comparison to 10.1 months in the 34 remaining patients with unresected liver metastases (p < 0.001). However, disease free survival after liver resection was only 9.1 months. Neither resection status (R0/R1) nor extent of liver resection were significant predictive factors for overall survival. Patients with a time interval to the first metastasis/recurrence (TTFR) of greater than 12 months or solitary liver metastases showed significantly prolonged survival.
Conclusions:
Liver resection in the case of ACC liver metastases can achieve long term survival with a median overall survival of more than 5 years, but disease free survival is short despite metastasectomy. Time to recurrence and single versus multiple metastases are predictive factors for the outcome.
In vitro models of the human blood-brain barrier (BBB) are highly desirable for drug development. This study aims to analyze a set of ten different BBB culture models based on primary cells, human induced pluripotent stem cells (hiPSCs), and multipotent fetal neural stem cells (fNSCs). We systematically investigated the impact of astrocytes, pericytes, and NSCs on hiPSC-derived BBB endothelial cell function and gene expression. The quadruple culture models, based on these four cell types, achieved BBB characteristics including transendothelial electrical resistance (TEER) up to 2,500 Ω cm\(^{2}\) and distinct upregulation of typical BBB genes. A complex in vivo-like tight junction (TJ) network was detected by freeze-fracture and transmission electron microscopy. Treatment with claudin-specific TJ modulators caused TEER decrease, confirming the relevant role of claudin subtypes for paracellular tightness. Drug permeability tests with reference substances were performed and confirmed the suitability of the models for drug transport studies.
Background
Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician’s awareness of kidney disease of patients hospitalized for CHD and also the patient’s awareness of CKD in a study visit following hospital discharge.
Methods
All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFR\(_{CKD-EPI}\) < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician’s awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician.
Results
Of the 536 patients, 32% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22%, and 72% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35% had impaired kidney function. Of 158 patients with kidney disease, 54 (34%) were aware of CKD. Determinants of patient’s awareness were severity of CKD (OR\(_{eGFR}\) 0.94; 95%CI 0.92–0.96), obesity (OR 1.97; 1.07–3.64), history of heart failure (OR 1.99; 1.00–3.97), and mentioning of kidney disease in the index event’s hospital discharge letter (OR 5.51; 2.35–12.9).
Conclusions
Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient’s awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician’s awareness for kidney dysfunction may improve patient’s awareness of CKD.
Frequency analysis of the rf emission of oscillating Josephson supercurrent is a powerful passive way of probing properties of topological Josephson junctions. In particular, measurements of the Josephson emission enable the detection of topological gapless Andreev bound states that give rise to emission at half the Josephson frequency f\(_{J}\) rather than conventional emission at f\(_{J}\). Here, we report direct measurement of rf emission spectra on Josephson junctions made of HgTe-based gate-tunable topological weak links. The emission spectra exhibit a clear signal at half the Josephson frequency f\(_{J}\)/2. The linewidths of emission lines indicate a coherence time of 0.3–4 ns for the f\(_{J}\)/2 line, much shorter than for the f\(_{J}\) line (3–4 ns). These observations strongly point towards the presence of topological gapless Andreev bound states and pave the way for a future HgTe-based platform for topological quantum computation.
Background:
To prevent bone loss in hip arthroplasty, several short stem systems have been developed, including the Mayo conservative hip system. While there is a plethora of data confirming inherent advantages of these systems, only little is known about potential complications, especially when surgeons start to use these systems.
Methods:
In this study, we present a retrospective analysis of the patients’ outcome, complications and the complication management of the first 41 Mayo conservative hips performed in 37 patients. For this reason, functional scores, radiographic analyses, peri- and postoperative complications were assessed at an average follow-up of 35 months.
Results:
The overall HHS improved from 61.2 pre-operatively to 85.6 post-operatively. The German Extra Short Musculoskeletal Function Assessment Questionnaire (XSFMA-D) improved from 30.3 pre-operatively to 12.2 post-operatively. The most common complication was an intraoperative non-displaced fracture of the proximal femur observed in 5 cases (12.1%). Diabetes, higher BMI and older ages were shown to be risk factors for these intra-operative periprosthetic fractures (p < 0.01). Radiographic analysis revealed a good offset reconstruction in all cases.
Conclusion:
In our series, a high complication rate with 12.1% of non-displaced proximal femoral fractures was observed using the Mayo conservative hip. This may be attributed to the flat learning curve of the system or the inherent patient characteristics of the presented cohort."
Background:
The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present.
Methods:
A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley.
Results:
Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness.
Conclusions:
The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley.
The coronal unicondylar fracture of the distal femur (AO 33-B3) is a rare intraarticular injury within the weight bearing area of the knee, initially described by Albert Hoffa in 1904. We report an unusual combination of a Hoffa fracture with lateral patellar dislocation in a young adult. Our patient sustained the injury by a sudden twist of his leg during sports. He presented clinically with knee swelling, dislocation of the patella, and localized tenderness; unable to bare weight. After plane radiograph confirmed the injury, manual reduction of the patella was done by hyperextension of the knee and medialward pressure. Afterwards, a CT scan and MRI were conducted. The injury was surgically treated with lag-screws, locking-plate and MPFL-reconstruction.
Bei der Cu-Zn-Lagerstätte bei Kupferberg, 10 km nordöstlich von Kulmbach, handelt es sich um Bayerns größten, historischen Buntmetallabbau. Der etwa 4 km lange Zug einzelner, stratiformer Erzlinsen befindet sich im Nordwesten in der parautochthonen Randschiefer Formation und im Südosten in der Prasinit-Phyllit Formation, die ein Teil der allochthonen Münchberger Gneismasse ist. Bisherige Versuche, die Genese der Lagerstätte zu erklären, scheiterten daran, den versatzlosen Übertritt einer stratiformen Lagerstätte über eine regional bedeutende Störungszone zu erklären.
U-Pb Zirkondatierungen an mafischen und felsischen Vulkaniten im Umfeld der Lagerstätte bestätigten das Bild eines kambrisch-ordovizischen Extensionsvulkanismus. Das Fehlen von N-MORB-ähnlichen geochemischen Signaturen in den untersuchten Proben der gesamten südwestlichen, saxothuringischen Vogtland Synklinale deutet auf eine gescheiterte Riftbildung am Nordrand Gondwanas hin und setzt somit den geotektonischen Rahmen für die Ablagerung der Wirtsformation(en).
Die Cu-Zn-Vererzung selbst liegt hier im Wesentlichen als Vergesellschaftung von Pyrit, Chalkopyrit, Sphalerit, Quarz und Kalzit in kohlenstoffreichem Tonschiefer vor. Die verschiedenen Untersuchungen an den beiden Erzlinsen zeigten, dass in der „St. Veits“ Erzlinse eine syngenetische Pyrit-Anreicherung mit charakteristisch niedrigen Co/Ni-Verhältnissen (ø = 3,7) vorliegt. Darüber hinaus konnte dort noch mindestens eine hydrothermale Pyrit-Generation (Co/Ni-Verhältnis ca. 35) nachgewiesen werden, die nur dort auftritt, wo auch Chalkopyrit angereichert ist und deutlich höhere Co/Ni-Verhältnisse aufweist (ø = 35). Die Ermittlung der Cu-Isotopenverhältnisse des Chalkopyrits zeigte ein δ65Cu-Spektrum von -0,26 bis 0,36 ‰, was stark für eine hydrothermale Anreicherung unter hohen (>250 °C) Temperaturbedingungen spricht.
Während sich die Erzlinsen in der Randschiefer und Prasinit-Phyllit Formation hinsichtlich ihrer Sulfid-Mineralogie so ähnlich sind, dass sie bisher immer als eine Lagerstätte angesprochen wurden, erbrachte ein statistischer Vergleich der beiden δ34S-Datensätze, dass es sich hier nur mit einer Wahrscheinlichkeit von ca. 2 % um Stichproben der gleichen Grundgesamtheit handelt. Entsprechend liegen innerhalb der Kupferberger Lagerstätte zwei unterschiedliche Schichten, reich an syngenetischem Pyrit, vor. Die Tatsache, dass das δ34S-Spektrum potentieller Schwefelquellen für die hydrothermale Chalkopyrit-Mineralisation theoretisch sehr groß, de facto aber mit dem δ34S-Spektrum der syngenetischen Sulfidanreicherung fast identisch ist (δ34S = 3,2 ± 0,6 ‰ bzw. δ34S = 3,1 ± 0,9 ‰), spricht für eine schichtinterne Sulfidmobilisierung.
Aus den hier erbrachten Ergebnissen wird ein genetisches Modell für die Kupferberger Lagerstätte geschlussfolgert, in dem jeweils eine der zahlreichen sedimentären, Pyrit-reichen Schichten aus der Randschiefer und der Prasinit-Phyllit Formation bei der Überschiebung der Münchberger Gneismasse tektonisch in Kontakt gebracht wurden. Im Zuge eben dieser Raumnahme der allochthonen Masse wurden Teile der Randschiefer Formation unter Grünschiefer-fazielle Bedingungen gebracht. Dabei kam es sowohl zur Freisetzung von Buntmetallen, die vorher zum Großteil in Pyrit gebunden waren, als auch zur Entwässerung der umliegenden Tonschiefer. Durch die überlagernden, impermeablen metamorphen Decken wurde das entstandene metallreiche Fluid an der Überschiebungsbahn kanalisiert. Durch den Druckabfall in der Spröde-Duktil-Übergangszone kam es zum Sieden des aufsteigenden Fluids, was zur Ausfällung der Sulfide führte. Die Bildung bedeutender Erzlinsen erfolgte vor allem dort, wo das übersättigte Fluid auf Pyrit-reiche Schwarzschiefer bzw. Phyllite traf. Da die Abbauwürdigkeit dieser Erzlinsen im Wesentlichen auf die epigenetische Überprägung im Zuge der Deckenüberschiebung zurückzuführen ist, handelt es sich bei der Kupferberger Cu-Zn-Vererzung um eines der seltenen Beispiele für eine tatsächliche metamorphogene bzw. syntektonische Buntmetalllagerstätte.
Der vorliegende Text ist das Transkript der ersten deutschen Gesamtübersetzung von Suetons Kaiserviten, die 1536 bei dem Straßburger Drucker Jakob Cammerlander erschien und die in der Dissertation „Sueton in Straßburg. Die Übersetzung der Kaiserviten durch Jakob Vielfeld (1536)“ (Spolia Berolinensia; Verlag Olms, Hildesheim 2017) umfassend untersucht worden ist.
Das Transkript präsentiert diese Übersetzung, obwohl Digitalisate des Cammerlanderdruckes existieren. Dem liegt zugrunde, dass das Transkript im Zuge der erwähnten Dissertation entstand, deren Zentrum der direkte und detaillierte Textvergleich bildet; der Nachvollzug dieses Textvergleichs sollte mithilfe des entsprechend aufbereiteten Transkripts erleichtert werden. Außerdem war es das Ziel, neben den Detailuntersuchungen auch den bisher wenig beachteten deutschen Sueton als ganzen stärker zur Geltung zu bringen.
Aber auch ohne die Konsultation der Studie kann das Transkript Grundlage für den bequemen Vergleich der Übersetzung mit dem lateinischen Text in der Referenzausgabe von Maximilian Ihm (editio maior, 1907) sein. Gegenüber dem digitalisierten Druck sind die deutschen Kaiserviten besonders durch zwei Eingriffe für moderne Leser aufbereitet worden: Zum einen enthält der frühneuzeitliche Druck keine Abschnittszählung, sodass es umständlicher ist, frühneuhochdeutsche Textstellen den entsprechenden Passagen in der Ausgabe Ihms zuzuordnen, und so ist das Transkript durchgängig mit Abschnittsziffern ausgestattet, die sich an der lateinischen Edition orientieren. Zum anderen kommen bei der Wiedergabe der deutschen Übersetzung – auch dies in Analogie zu Ihms Ausgabe – konsequent moderne Interpunktionsregeln zum Einsatz, wodurch sich die gedanklichen Strukturen des Textes leichter überblicken lassen und dieser insgesamt flüssiger zu lesen ist.
The aim of the study was to evaluate the reliability and validity of cardiorespiratory and metabolic variables, that is, peak oxygen uptake (V'O\(_{2peak}\)) and heart rate (HR\(_{peak}\)), obtained from an agility‐like incremental exercise test for team sport athletes. To investigate the test–retest reliability, 25 team sport athletes (age: 22 ± 3 years, body mass: 75 ± 7 kg, height: 182 ± 6 cm) performed an agility‐like incremental exercise test on the SpeedCourt (SC) system incorporating multidirectional change‐of‐direction (COD) movements twice. For each step of the incremental SC test, the athletes covered a 40‐m distance interspersed with a 10‐sec rest period. Each 40 m distance was split into short sprints (2.25–6.36 m) separated by multidirectional COD movements (0°–180°), which were performed in response to an external visual stimulus. All performance and physiological data were validated with variables obtained from a ramp‐like treadmill and Yo‐Yo intermittent recovery level 2 test (Yo‐Yo IR2). The incremental SC test revealed high test–retest reliability for the time to exhaustion (ICC = 0.85, typical error [TE] = 0.44, and CV% = 3.88), V'O\(_{2peak}\), HR\(_{peak}\), ventilation, and breathing frequency (ICC = 0.84, 0.72, 0.89, 0.77, respectively). The time to exhaustion (r = 0.50, 0.74) of the incremental SC test as well as the peak values for V'O\(_{2}\) (r = 0.59, 0.52), HR (r = 0.75, 0.78), ventilation (r = 0.57, 0.57), and breathing frequency (r = 0.68, 0.68) were significantly correlated (P ≤ 0.01) with the ramp‐like treadmill test and the Yo‐Yo IR2, respectively. The incremental SC test represents a reliable and valid method to assess peak values for V'O\(_{2}\) and HR with respect to the specific demand of team sport match play by incorporating multidirectional COD movements, decision making, and cognitive components.
RecQ4 is a member of the RecQ helicase family, an evolutionarily conserved class of enzymes, dedicated to preserving genomic integrity by operating in telomere maintenance, DNA repair and replication. While reduced RecQ4 activity is associated with cancer predisposition and premature aging, RecQ4 upregulation is related to carcinogenesis and metastasis. Within the RecQ family, RecQ4 assumes an exceptional position, lacking several characteristic RecQ domains. Here we present the crystal structure of human RecQ4, encompassing the conserved ATPase core and a novel C-terminal domain that lacks resemblance to the RQC domain observed in other RecQ helicases. The new domain features a zinc-binding site and two distinct types of winged-helix domains, which are not involved in canonical DNA binding or helicase activity. Based on our structural and functional analysis, we propose that RecQ4 exerts a helicase mechanism, which may be more closely related to bacterial RecQ helicases than to its human family members.
Eclosion in flies and other insects is a circadian-gated behaviour under control of a central and a peripheral clock. It is not influenced by the motivational state of an animal, and thus presents an ideal paradigm to study the relation and signalling pathways between central and peripheral clocks, and downstream peptidergic regulatory systems. Little is known, however, about eclosion rhythmicity under natural conditions, and research into this direction is hampered by the physically closed design of current eclosion monitoring systems.
We describe a novel open eclosion monitoring system (WEclMon) that allows the puparia to come into direct contact with light, temperature and humidity. We demonstrate that the system can be used both in the laboratory and outdoors, and shows a performance similar to commercial closed funnel-type monitors. Data analysis is semi-automated based on a macro toolset for the open imaging software Fiji. Due to its open design, the WEclMon is also well suited for optogenetic experiments. A small screen to identify putative neuroendocrine signals mediating time from the central clock to initiate eclosion showed that optogenetic activation of ETH-, EH and myosuppressin neurons can induce precocious eclosion. Genetic ablation of myosuppressin-expressing neurons did, however, not affect eclosion rhythmicity.
Background:
Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care.
Methods:
Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators.
Results:
In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago.
Conclusions:
Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.
Background:
There is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome. However, increased cross clamp time is the strongest argument for surgeons not performing RAT-AVR. Rapid deployment aortic valve systems have the potential to decrease cross-clamp time and ease this procedure. We assessed clinical outcome of rapid deployment and conventional valves through RAT.
Methods:
Sixty-eight patients (mean age 76 ± 6 years, 32% females) underwent RAT-AVR between 9/2013 and 7/2015. According to the valve type implanted the patients were divided into two groups. In 43 patients (R-group; mean age 74.1 ± 6.6 years) a rapid deployment valve system (Edwards Intuity, Edwards Lifesciences Corp; Irvine, Calif) and in 25 patients (C-group; mean age 74.2 ± 6.6 years) a conventional stented biological aortic valve was implanted.
Results:
Aortic cross-clamp (42.1 ± 12 min vs. 68.3 ± 20.3 min; p < 0.001) and bypass time (80.4 ± 39.3 min vs. 106.6 ± 23.2 min; p = 0.001) were shorter in the rapid deployment group (R-group). We observed no differences in clinical outcome. Postoperative gradients (R-group: max gradient, 14.3 ± 8 mmHg vs. 15.5 ± 5 mmHg (C-group), mean gradient, 9.2 ± 1.7 mmHg (R-group) vs. 9.1 ± 2.3 mmHg (C-group) revealed no differences. However, larger prostheses were implanted in C-group (25 mm; IQR 23–27 mm vs. 23 mm; IQR 21–25; p = 0.009).
Conclusions:
Our data suggest that the rapid deployment aortic valve system reduced cross clamp and bypass time in patients undergoing RAT-AVR with similar hemodynamics as with larger size stented prosthesis. However, larger studies and long-term follow-up are mandatory to confirm our findings.