An infinitely small quantity is defined as a one-dimensional quantity of finite length but with sizes of space, while an infinitely great quantity is reached by the superposition or accumulation of infinitely many finite quantities, by the way of the change in direction. The change in direction indicates that there is a jump from a finite quantity to infinitely many finite quantities (infinitely great). The form of the manifestation of the infinitely great is one quantitative continuum that cannot be operated by any algorithms and all parts of space we see is this one quantitative continuum. .Any value are this single quantitative continuum that indicates the infinitely great and compresses any quantities outside of it to nothing. As a result, the infinite exact value of a circumferential length (π) has been obtained here.

In dual loop reentrant ATs, the differentiation of the active circuit from the passive circuit in a dual loop reentry is still challenging. In such complicated AT cases, entrainment pacing is useful for determining the dominant circuit. However, we differentiated the active circuit by an AT activation map with an adjustment of the lower threshold value in the early meets late module. We also detected the gap of the previous PVI line by the same map with a further adjustment of the lower threshold value. The adjustment of the lower threshold might be advantageous for differentiating an active circuit of a dual loop reentry as well as gaps along the PVI line.

Background and Aim of the Study: Ischemic mitral valve regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is associated with worse long-term outcomes. The aim of this study was to assess the impact of mitral valve repair with CABG in patients with moderate IMR. Method: This observational study enrolled 3,215 consecutive patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease who underwent CABG between 2002 and 2017. The CABG alone and CABG with mitral valve surgery (MVs) groups were compared. The propensity score was calculated for each patient. Long-term all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were compared between the two groups. Results: A total of 101 patients who underwent CABG had moderate IMR in our database. Propensity score matching selected 40 pairs for final analysis. MVs was associated with increased risks of postoperative atrial fibrillation, blood transfusion, and longer hospitalization. There were no differences between the two groups in long-term outcomes, including all-cause mortality, cardiac mortality, and the incidence of MACCEs. Conclusions: Surgical treatment of moderate IMR combined with CABG was as safe as CABG alone, with no differences in long-term outcomes. Further studies are needed to determine the effects of MVs in patients with moderate IMR and severe coronary artery disease.

Rich user interfaces like Jupyter have the potential to make interacting with a supercomputer easier and more productive, consequently attracting new kinds of users and helping to expand the application of supercomputing to new science domains. For the scientist-user, the ideal rich user interface delivers a familiar, responsive, introspective, modular, and customizable platform upon which to build, run, capture, document, re-run, and share analysis workflows. From the provider or system administrator perspective, such a platform would also be easy to configure, deploy securely, update, customize, and support. Jupyter checks most if not all of these boxes. But from the perspective of leadership computing organizations that provide supercomputing power to users, such a platform should also make the unique features of a supercomputer center more accessible to users and more composable with high performance computing (HPC) workflows. Project Jupyter's core design philosophy of extensibility, abstraction, and agnostic deployment, has allowed HPC centers like NERSC to bring in advanced supercomputing capabilities that can extend the interactive notebook environment. This has enabled a rich scientific discovery platform, particularly for experimental facility data analysis and machine learning problems.  

Surgical TherapyThere are no consensus guidelines regarding PFE treatment. Due to tumor embolization risk, many groups advocate urgent resection in asymptomatic, low risk patients with left sided lesions.8-10, 24-27 It is generally agreed upon that symptomatic patients should be offered surgery. Surgical approaches to PFE are driven by tumor location and additional concomitant surgical procedures that may be required. For solitary tumors without valvular dysfunction, simple excision is the most common resection technique.26 Excision and valve repair/replacement has also been described with good results.Median sternotomy historically was the most popular surgical exposure. Increasing use of minimally invasive cardiac surgery however has led to tumor removal using mini thoracotomy/Heart Port access techniques (Table 1). Intracavitary ventricular-based tumors not readily visible through surgical incisions have been resected using cardioscopy assistance (Table 2). 16-26 Cardioscopy must be performed carefully to avoid injuring the intrinsic structure of the heart.Tumor resection principles include: complete tumor removal with preservation of cardiac structure. Cardiopulmonary bypass support is required. Procedures have been performed with and without electromechanical arrest. Recurrence rate following surgical resection is between 0 and 4%.10, 11, 28 Recurrent disease management is driven by tumor size, symptoms, and patient performance status.

Introduction: The application of non-invasive ventilation(NIV) after coronary artery bypass grafting(CABG) brings the possibility of reducing loss of functional capacity and complications in the patient. However, the evidence is controversial about immediate or conventional use. Objective: Assess the impact of immediate NIV after extubation on oxygenation and functional capacity of patients undergoing to CABG. Methods: Randomized clinical trial. Patients were assessed before and after surgery using the Functional Independence Measure(FIM), six-minute walk test(6MWT) and peripheral muscle strength(MRC). On the first day after the surgery, two groups formed immediate NIV(NIVI) and conventional NIV(NIVC). Hemogasometry was collected before and after NIV. Complication rates were also assessed. NIVI performed ventilation after one hour of orotracheal extubation, at NIVC performed NIV on the first postoperative day, 24 hours after extubation. After discharge, the above variables were reevaluated. Results: 79 patients were evaluated, 46(58.22%) men, mean age 65±9 years. NIVI reduced the reintubation rate, only 1 (3%) compared to NIVC with 5 (12%) patients, p=0.01. In the post-Intervention the inspired oxygen fraction (FiO2) was 0.43±0.07 in the conventional group and 0.30±0.10 in the intervention group, p=0.01. The post-intervention PaO2/FiO2 ratio was 191±45 and NIVI 266±29(p <0.001) and one day later in the NIVC it was 210±39 and NIVI 279±37(p <0.001). VNII lost 51±36 meters in the 6MWT compared to the NIVC that lost 95±40 meters(p <0.01). Conclusion: NIVI after extubation of patients undergoing to CABG, reduced the loss of functional capacity, improved blood gases and decreased the rate of reintubation.

The rare but deadly post myocardial infarction (MI) mechanical complications are categorized as ventricular free wall rupture, ventricular septal rupture (VSD) and papillary muscle rupture in decreasing order of incidence. The incidence of the mechanical complications has been mitigated by early revascularization in recent years but mortality remains high. The cardiac rupture if contained by clot, scar and pericardium leads to a LV pseudoaneurysm that delays or diminishes the fatal outcome. Mechanical complications and pseudoaneurysm are recognized by echocardiography. We report a previously unreported occurrence of a pseudoaneurysm involving the adjacent walls of both the ventricles, LV basal and inferoseptal walls and the adjacent right ventricular inferior wall (RV). The LV and RV communicated via a hole in the pseudoaneurysmal wall. The echocardiographic images initially showed the LV pseudoaneurysm bulging into the RV rather than into the pericardium. The color Doppler showed shunting through the LV pseudoaneurysm into the RV creating an unusual VSD. The CT angiograms corroborated the echo findings. The LV pseudoaneurysm had a tear in it and this led to bleeding not into pericardium but into the adjacent RV pseudoaneurysm, hence creating a very unusual VSD. Subsequently, our patient went for surgical repair of pseudoaneurysm and the surgical findings confirmed the imaging findings that there was a massive LV pseudoaneurysm from the inferior and inferoseptal walls, the adjacent RV wall was involved with the pseudoaneurysm and a communication between LV pseudoaneuysm sac and the RV was seen. Such pathology has not been described in the past.

Shrub encroachment (SE) has been occurring and studied worldwide over the last century. What remains to be investigated is how soil and vegetation characteristics vary under canopy of different species of shrubs for restoration goals. Thus, this study aimed to compare the effect of three shrub species (Amygdalus scoparia, Ebenus stellata, and Daphne mezereum) on soil and vegetation characteristics under their canopies in semiarid rangelands in Iran for restoration purposes of degraded areas. Fifteen sites were randomly selected in such three shrub species which were found close to each other in each site. Soil and vegetation characteristics were measured under the three shrubs, comparing with outside the shrub canopies (control). One-way ANOVA and non-metric dimensional scaling were used to clarify the differences of the effects of different shrub species on sub-canopy soil and plants. The results indicated that the effect of different species of shrubs on soil properties was not equal, more pronounced by A. scoparia. Similarly, the highest value of herbaceous Shannon-Wiener diversity index was recorded under A. scoparia (2.07) as compared with D. mezerum (1.76), E. stellata (1.41). The highest and lowest values of Menhinick richness index were observed under A. scoparia (3.43) and E. stellata (1.46), respectively. Compared with two other shrubs, a taller canopy in A. scoparia (3.50m vs. 2.60m and 1.83m) probably led to greater litter input by the shrub. Different effects of different species of shrubs on sub-canopy soil and vegetation should be considered in the restoration projects of degraded semiarid rangelands.

Acinetobacter baumannii (AB) is a ubiquitous gram-negative coccobacillus that has the ability to colonize and survive in a variety of environments and develop various resistance mechanisms. In our study; Between 2010 and 2012, 5400 patients were screened, 74 of them had MDR AB infection. MDR AB infection is associated with high morbidity and mortality.

Soil degradation restricts the development of agriculture and the degree of soil degradation is related to land use type. Quick and efficient evaluation of the degree of soil degradation is needed for the timeous implementation of remedial measures to ensure soil sustainability. Earthworm community characteristics are closely related to soil management practices and soil quality and could be used for evaluation purposes. In this Loess Plateau study, the degree of soil degradation under nine different land use types (natural and planted woodland, shrubbery, and grassland, plus cropland, orchard, and abandoned land) was related to the earthworm community characteristics (density, biomass, and the Shannon-Wiener, Species richness, and Pielou’s evenness indices) using a soil degradation index calculated from soil physicochemical properties determined for each land use type. The earthworm community characteristics associated with a low degree of degradation were significantly higher than those associated with a high degradation degree. Compared to the artificially managed land use types, earthworms in the natural ones showed higher biomass, density, and diversity. The earthworm density, biomass, and Shannon-Weiner index were significantly correlated with soil organic matter and total nitrogen content. These findings indicate that earthworm community characteristics can comprehensively characterise the physicochemical properties and biological characteristics of soils under different land use types. Linear correlations showed a significant relationship between the soil degradation index and the earthworm community characteristics, indicating that the latter could be used effectively to evaluate and represent the degree of degradation of soils on the Loess Plateau over a certain degradation range.

Introduction: Subselection inner catheters (Inner-Cath) are used adjunctively with outer guiding catheters (Outer-Cath) during cardiac resynchronization therapy (CRT) device implantation. This study aims to investigate the feasibility and efficacy of left ventricular lead placement (LV-LP) guided by Inner-Cath alone. Methods: A total of 74 patients undergoing de novo CRT implantation were investigated. LV-LP was initially guided by Inner-Cath in 42 patients (Inner-Cath group) and Outer-Cath in 32 patients (Outer-Cath group). In the Inner-Cath group, a 7Fr Inner-Cath was advanced to the coronary sinus through a 7 Fr sheath inserted in a subclavian vein. In the Outer-Cath group , 9Fr or 10Fr Outer-Caths were used. Success rate of LV-LP, additional use of inner or outer catheters and procedure-related complications were compared between groups. Results: LV-LP was successful in all patients in the Inner-Cath group while LV-LP had to be abandoned in 2 patients of the Outer-Cath group due to CS perforation caused by Outer-Cath manipulation. Procedure time was significantly shorter in the Inner-Cath group (148 vs 168 min; P=0.024). Deployment of both an inner and outer cath became necessary less frequently for the Inner-Cath group (4.8% vs 56.3%; P<0.001). Mechanical CS injuries due to guiding catheter manipulation were only observed in the Outer-Cath group (0% vs 15.6%, P=0.013). Conclusion: LV-LP guided by Inner-Cath alone was feasible in over 95% of the patients without severe complications. This methodology for LV-LP may be preferable in CRT candidates with severe LV dysfunction in terms of shorter procedure time, smaller guiding sheath and less complications.

Introduction: The complex electrophysiological phenomena related to the atrioventricular node (AVN) are due to its complex anatomical structures. Aside from the inferior nodal extension (INE), other node-like tissues, such as the retroaortic node (RN), have been less described and may also share the mechanism of normal conduction and abnormal conduction in AVN re-entrant tachycardia (AVNRT). Methods: High-density sections of the entire AVN were obtained from rats and rabbits. Fibrosis was analyzed by Masson’s trichrome staining. Connexin (Cx43, Cx40, and Cx45) and ion channel (Nav1.5, Cav3.1, and HCN4) proteins were immunohistochemically labeled for the analysis of tissue features. Three-dimensional (3D) reconstruction of the AV junction was performed to clarify the relationships among different structures. Results: The RN expressed the same connexin isoforms as the compact node (CN) and INE. Nav1.5 labeling was present at a low level in the CN, RN and INE, where Cav3.1 and HCN4 were expressed. The CN connected with the RN in a narrow strip pattern at the level of the start of the CN. The RN presented as a shuttle shape and was the only tissue directly connected with the atrium in the anterior septum. Conclusion: The RN connects with the AVN anatomically, suggesting that there is direct electrical conduction between them. The entrance of the atria into the AVN is the distal part of the RN, which may form the fast pathway of the AVN.

Background: Atrial fibrillation (AF) genetics studies have focused on a linear genotype- phenotype relationship, i.e. genetic predisposition to the arrhythmia. Genome wide association studies have implicated numerous upstream mechanisms responsible for AF. Objective: We hypothesized that the genetic predisposing factors for AF might be associated with non-AF clinical phenotypes and sought to characterize electrophysiology parameters as a function of AF genetic risk. Methods:. Biosamples were obtained from 405 subjects for classification of carrier status at 12 single nucleotide polymorphisms with a known association to AF allowing calculation of a validated AF genetic risk score. We then analyzed subgroups within the total population; in order to understand the effect on (a) sinus node function and cardiac conduction (b) primary atrial flutter (c) left atrial appendage morphology. Results: We evaluated 405 patients consisting of a range of genetic risk scores from −1.016 to +2.178. Within this, we identified 86 patients without prescribed chronotropic pharmacotherapy with a 24-hour Holter recording to investigate sinus node function; 181 patients with invasive H-V measurement at the time of electrophysiologic study to investigate cardiac conduction; 78 undergoing cavotricuspid isthmus ablation for typical atrial flutter without prior diagnosis of AF; and 284 patients with cardiac imaging of the left atrial appendage. Conclusions: A common AF genetic risk score is associated with a number of non-AF electrophysiologic relevant phenotypes. Sinus node function, AV node physiology, post flutter ablation AF risk, atrial appendage morphology all appear to be associated with the common genetic AF risk.

A B S T R A C T Objective: To investigate the relationship between gastric wall fat halo sign and potentially associated cardiovascular disease (CVD) in thoracic computed tomography (CT). Material and Methods: Between October 2018 and June 2019, 62 patients with gastric wall fat halo sign and 97 controls were prospectively evaluated. Patient height, weight, body mass index (BMI), sex, age, ascending aorta, descending aorta, main pulmonary artery, right and left pulmonary artery, long and short cardiac axis and maximum transverse thorax diameters; and ascending, arcus, descending aorta and coronary artery calcium scores were recorded for the two groups. Results: No significant differences were found in sex, age, height, body weight or BMI between the two groups (p > 0.125). Patients with gastric wall fat halo sign had significantly larger diameters of the ascending aorta, the descending aorta, the main pulmonary artery, the right and left pulmonary arteries, and the short and long cardiac axes and a higher cardiothoracic ratio (CTR) than the control group (p < 0.001). Additionally, the calcium scores of the ascending, arcus, and descending aortas and the coronary arteries were significantly higher detected in patients group (p < 0.001). Conclusion: The gastric wall fat halo is the result of excessive fat accumulation and can be observed in overweight people, especially those with increased visceral fat tissue. Additionally, patients with a gastric wall fat halo have a higher cardiovascular risk because of increased vascular diameters, CTR, heart sizes and calcium scores.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

As long-term outcomes of congenital heart diseases improve, the probability of adult patients presenting for heart transplantation for late failure of congenitally corrected heart disease also increases. In patients with dextro-transposition of the great arteries (d-TGA) who were initially treated in the era of Mustard or Senning procedures and before Jatene procedure was introduced, progressive systemic right ventricular failure represents a problem in the very long-term follow-up. We report a rare case of heart transplantation as a third operation 36 years after Mustard procedure in a patient with d-TGA experiencing late failure of the systemic right ventricle.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

A document by Muhamad Chairul Basrun Umanailo. Click on the document to view its contents.

In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) <50% or symptoms are class I indications for aortic valve intervention. However, an EF <50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 (<25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.

Background: Although the burden of influenza is well characterized, the burden of community-onset non-influenza respiratory viruses has not been systematically assessed. Understanding the severity and seasonality of non-influenza viruses, including human coronaviruses, will provide a better understanding of the overall disease burden from respiratory viruses that could better inform resource utilization for hospitals and highlight the value of preventative strategies, including vaccines. Methods: From October 2017 to September 2019, a retrospective study was performed in a pre-defined catchment area to estimate the population-based incidence of community-onset respiratory viruses associated with hospitalization. Included patients were >18 years old, resided in New York City, were hospitalized for >24 hours, and had a respiratory virus detected within 3 calendar-days of admission. Disease burden was measured by hospital length of stay (LOS), intensive care unit (ICU) admissions, and in-hospital mortality and compared among those with laboratory-confirmed influenza versus those with laboratory-confirmed non-influenza viruses (human coronaviruses, parainfluenza viruses, respiratory syncytial virus, human metapneumovirus, and adenovirus). Results: During the study period, 4,232 eligible patients were identified of whom 50.9% were >65 years of age. For each virus, the population-based incidence was highest for those >80 years of age. When compared to those with influenza viruses detected, those with non-influenza respiratory viruses detected (combined) had higher population-based incidence, significantly more ICU admissions, and higher in-house mortality. Conclusions: The burden of non-influenza respiratory viruses for hospitalized adults is substantial. Prevention and treatment strategies are needed for non-influenza respiratory viruses, particularly for older adults.