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Tetralogy of Fallot is the most common heart defect associated with cyanosis characterized by the co-occurrence of pulmonary stenosis, right ventricular hypertrophy, and ventricular septal defect with over-riding of the aorta. The present review purposed to summarize myocardial, valvular and vascular abnormalities, which were described in a series of patients following repair of tetralogy of Fallot. It was also aimed to describe potential differences in these parameter using different surgical strategies.

Soil macroporosity affects field-scale water-cycle processes, such as infiltration, nutrient transport and runoff 1 , 2 , that are important for the development of successful global strategies that address challenges of food security, water scarcity, human health and loss of biodiversity 3 . Macropores—large pores that freely drain water under the influence of gravity—often represent less than 1 per cent of the soil volume, but can contribute more than 70 per cent of the total soil water infiltration 4 , which greatly magnifies their influence on the regional and global water cycle. Although climate influences the development of macropores through soil-forming processes, the extent and rate of such development and its effect on the water cycle are currently unknown. Here we show that drier climates induce the formation of greater soil macroporosity than do more humid ones, and that such climate-induced changes occur over shorter timescales than have previously been considered—probably years to decades. Furthermore, we find that changes in the effective porosity, a proxy for macroporosity, predicted from mean annual precipitation at the end of the century would result in changes in saturated soil hydraulic conductivity ranging from −55 to 34 per cent for five physiographic regions in the USA. Our results indicate that soil macroporosity may be altered rapidly in response to climate change and that associated continental-scale changes in soil hydraulic properties may set up unexplored feedbacks between climate and the land surface and thus intensify the water cycle. Soil macroporosity responds rapidly to climate variations and may induce wide-ranging changes in soil hydraulic conductivity by the end of the century.

Introduction. There is a balanced relationship between the left ventricle (LV), the aortic valve and the aorta, the functioning of which is essential for optimal circulation. Associations between simultaneously assessed LV rotational mechanics and aortic valve annular (AVA) dimensions respecting the cardiac cycle have never been assessed in clinical circumstances in healthy individuals by three-dimensional speckle-tracking echocardiography (3DSTE). The present study aimed to perform an extensive investigation in order to clarify their possible associations. Methods. The present study comprised 111 healthy individuals (mean age 35.3 ± 12.0 years, 69 males). Results. With increase in end-diastolic AVA area, tendentious increase in apical LV rotation and consequential LV twist could be detected. Basal and apical rotations and LV twist were tendentiously higher in case of mean end-systolic AVA area compared to lower/higher than mean end-systolic AVA area. With increase in basal LV rotation, tendentious decrease in end-diastolic AVA dimensions could be detected. End-systolic AVA dimensions were tendentiously smaller in case of mean basal LV rotation compared to lower/higher than mean basal LV rotations. With increase in apical LV rotation, tendentious increase in end-diastolic AVA dimensions could be detected. End-systolic AVA dimensions were tendentiously higher in case of mean apical LV rotation compared to lower/higher than mean apical LV rotations. Conclusions. No obvious significant association could be detected between simultaneously assessed LV rotational mechanics and AVA dimensions respecting the cardiac cycle in healthy adults.

Introduction: Three-dimensional speckle-tracking echocardiography (3DSTE) can be used to accurately measure the dimensions of the left ventricle (LV) and aortic valve anulus (AVA) at the same time. The present study aimed to conduct an extensive 3DSTE-based investigation of simultaneously assessed end-diastolic and end-systolic LV volumes and AVA dimensions in healthy adults with LVs and AVAs of different sizes. Methods: One hundred and seven healthy adults (mean age 35.4 ± 12.2 years, 67 males) were voluntarily enrolled in the present study. Results: With increasing end-diastolic AVA area, tendentious increase in both end-diastolic and end-systolic LV volumes could be detected, resulting in preserved LV-EF. With increasing end-systolic AVA area, similar findings were present. Comparing the smaller than mean and the larger than mean end-systolic AVA area subgroups, the end-systolic LV volume proved to be significantly increased in the latter group. With the increase in end-diastolic LV volume, the AVA dimensions remained preserved. With the increase in end-systolic LV volume, only the highest end-systolic LV volume was associated with larger end-systolic AVA area and perimeter; the other parameters remained preserved. In certain circumstances, end-systolic AVA area and perimeter proved to be significantly increased compared to their end-diastolic counterpart. Conclusions: With the increase in end-diastolic and end-systolic AVA areas, a tendentious increase in both LV volumes could be detected in healthy adults. Larger end-diastolic LV volume was not associated with dilated AVA dimensions, while larger end-systolic LV volume was associated with dilated end-systolic AVA area and perimeter.

Background/Objectives: The aortic valve has a prominent role in regulating blood flow and is of exceptional importance in clinical cardiological practice, as it can be affected by numerous abnormalities, so any clinical study that examines its physiological properties may be of significance. It is known that the dimensions of the aortic valve annulus (AVA) not only change during the cardiac cycle, but also undergo spatial displacement. Considering this, the question arises as to whether the AVA’s dimensions and their spatial displacement, represented by aortic annular plane systolic excursion (AAPSE), are related or not. Therefore, these parameters were simultaneously assessed using three-dimensional speckle-tracking echocardiography (3DSTE) in healthy adults. Methods: The present study’s cohort consisted of 148 healthy adults (mean age: 34.8 ± 12.4 years, 80 men). In all cases, two-dimensional Doppler echocardiography and 3DSTE were performed, the latter being used to assess the aortic valve. Results: In all subjects, end-diastolic and end-systolic AVA dimensions showed no association with an increase in AAPSE. In subjects with a greater end-diastolic AVA area (AVA-A), end-systolic AVA dimensions tended to decrease with increasing AAPSE; this trend reached statistical significance for end-systolic minimum AVA diameter, when comparing participants with AAPSE below versus above the mean. With increasing end-diastolic AVA-A, all other AVA parameters increased accordingly in all subjects and regardless of which AVA-A proved to be greater. In all subjects, and in those with a greater end-systolic AVA-A, the AAPSE proved to be similar regardless of the size of the end-diastolic AVA-A. In cases with a greater end-diastolic AVA-A, only one subject showed a very small end-diastolic AVA-A. With increasing end-systolic AVA-A, all other AVA dimensions were increased in all subjects and in cases with a greater end-diastolic or end-systolic AVA-A. AAPSE showed no significant differences between the subgroups examined, although it tended to be lower in cases with a greater end-diastolic AVA-A and the largest end-systolic AVA-A, and in subjects with a greater end-systolic AVA-A and the smallest end-systolic AVA-A. Moreover, individuals with a greater end-diastolic AVA-A and the smallest end-systolic AVA-A had a tendency for increased AAPSE. No correlations were present between AVA dimensions and AAPSE. Conclusions: 3DSTE-derived AVA dimensions showed no obvious associations with AAPSE in the same healthy adults.

Introduction: Mitral annular plane systolic excursion (MAPSE) is a quantitative feature of left ventricular (LV) function that can be easily measured by M-mode echocardiography. The more recent LV strains represent LV contractility, and they can be determined for the three main directions in the radial (RS), longitudinal (LS), and circumferential (CS) directions. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) seems to be ideal for the simultaneous assessment of all LV strains from the same acquired 3D dataset. Their associations, however, have not been fully analyzed in clinical settings in healthy volunteers yet. Therefore, the present study aimed to find associations between MAPSE and 3DSTE-derived LV strains in healthy circumstances. Methods: The present study consisted of 106 healthy adult volunteers (mean age 28.1 ± 6.3 years, 48 men). Complete two-dimensional Doppler echocardiography with MAPSE assessment and 3DSTE-derived LV strain measurements were performed in all cases. Results: Tendentiously reduced LV volumes with preserved LV ejection fraction were present in the case of mean MAPSE as compared to decreased/increased MAPSE. Global and regional LV-RS and LV-CS did not differ if MAPSE was increased, mean or decreased. Global LV-LS was reduced in the case of decreased MAPSE, mainly due to tendentiously higher apical LV-LS. MAPSE did not differ if global LV-RS and LV-CS were increased, mean or decreased. MAPSE was tendentiously increased in the presence of increased global LV-LS. Conclusions: Only 3DSTE-derived global LV-LS and MAPSE are associated in healthy adults; LV global strains in other directions show no relationship with MAPSE.

Soil particles and bound nutrients that erode from agricultural land may end up in surface waters and cause undesirable changes to the environment. Various measures, among them constructed wetlands have been proposed as mitigation, but their efficiency varies greatly. This work was motivated by the assumption that the induced coagulation of particles may accelerate sedimentation in such wetlands and by that help reduce the amount of material that is lost from the vicinity of the diffuse source. Our specific aim was to laboratory-test the effectiveness of various salt-based coagulants in accelerating the process of sedimentation. We tested the effect of Na+, Mg2+, Ca2+, Fe3+ and Al3+ cations in 10, 20, 40 and 80 mg L-1 doses added to a soil solution in select, soluble forms of their chlorides, sulphates and hydroxides. We mixed such salts with 1 gram of physically dispersed, clay and silt rich (>85% in total) soil material in 500 mL of solution and used time-lapse photography and image analysis to evaluate the progress of sedimentation over 3 hours. We found that 20–40 mg L-1 doses of Mg2+, Ca2+ in their chloride or sulphate forms appeared to provide the best consensus in terms of efficiently accelerating sedimentation using environmentally present and acceptable salts but keeping their dosage to a minimum. Comprehensive in-field efficiency and environmental acceptability testing is warranted prior to any practical implementation, as well as an assessment of small scale economic and large-scale environmental benefits by retaining soil and nutrients at/near the farm.

Background and Objectives: The impact of peripheral below-the-knee (BTK) fractional flow reserve (FFR) on long-term clinical outcomes remains unknown. Materials and Methods: We enrolled 40 patients with severe BTK lesions (Rutherford 4–6). FFR (using 40 mg papaverin) and skin perfusion toe pressure (SPTP) by laser Doppler were measured during the index procedure. The primary outcomes were major adverse limb events (MALEs) (defined as reintervention on the index arterial segment or amputation of the index limb) and death during follow-up. Results: The median follow-up was 7 [IQR 4–8] years. After the index procedure, FFR increased significantly (p < 0.001) and post-revascularization SPTP was significantly higher in the FFR ≥ 0.80 group (p = 0.022). Multivariable regressions showed no association between change in FFR (absolute or percentage) and the risk of death (p = 0.39, p = 0.28) or MALEs (p = 0.83, p = 0.29), but both pre- and post-revascularization FFR values could predict MALEs at follow-up (p = 0.018, p = 0.012). Lower SPTP was also associated with the risk of MALEs (p = 0.027). SPTP > 97.8 mmHg was 100% specific for FFR ≥ 0.80. Conclusions: While there is no association between change in FFR and the risk of death or MALEs, lower FFR values either before or after revascularization were associated with higher long-term risk of MALEs. Moreover, a lower SPTP was associated with a higher risk of MALEs. Aiming for approximately 100 mmHg in SPTP represents a non-invasive surrogate of FFR ≥ 0.80. Larger studies are needed to validate the impact of post-revascularization FFR-SPTP-adjacent values on clinical outcomes.

Introduction. Volumetric changes in the left atrium (LA) and left ventricle (LV) are strongly associated in healthy circumstances, as recent three-dimensional speckle-tracking echocardiographic (3DSTE) studies confirmed. However, the complex relationship of LA and LV deformation in systole has never been assessed in healthy individuals. The present study purposed to perform comparative simultaneous analysis of systolic LA and LV strains in healthy adults by 3DSTE. Methods. The study consisted of 165 healthy adults (mean age: 33.2 ± 12.3 years; 90 males). Complete two-dimensional Doppler echocardiography with 3DSTE was performed in all cases. Results. The increase in global LA radial strain (RS) and longitudinal strain (LS) showed no associations with LV strains. The largest global LA circumferential strain (CS) was associated with the largest basal LV-RS. Lowest basal and global LV-CS could be demonstrated in the presence of mean global LA-CS as compared to the presence of lower than mean global LA-CS. Global LA-RS showed an increase, with global LV-RS being largest when global LV-RS was the largest. Basal and global LA-RS were largest in the case of lowest global LV-CS. Basal LA-LS was largest in the case of mean global LV-CS. With the increase in global LV-LS, basal and global LA-LS showed an increase but only up to a point; in the case of larger than mean global LV-LS, no further increase was detected in basal and global LA-LS. Conclusions. Complex associations between simultaneously assessed LA and LV deformations represented by 3DSTE-derived strains could be demonstrated in healthy adults.