Anti-KAY (aa 6-66/501-520) polyclonal antibody

A climate model (CCSM4) is used to investigate the influence of anthropogenic forcing on late 20th century and early 21st century Arctic sea ice extent trends. On all timescales examined (2-50+ years), the most extreme negative observed late 20th century trends cannot be explained by modeled natural variability alone. Modeled late 20th century ice extent loss also cannot be explained by natural causes alone, but the six available CCSM4 ensemble members exhibit a large spread in their late 20th century ice extent loss. Comparing trends from the CCSM4 ensemble to observed trends suggests that internal variability explains approximately half of the observed 1979-2005 September Arctic sea ice extent loss. In a warming world, CCSM4 shows that multi-decadal negative trends increase in frequency and magnitude, and that trend variability on 2-10 year timescales increases. Furthermore, when internal variability counteracts anthropogenic forcing, positive trends on 2-20 year timescales occur until the middle of the 21st century. Citation: Kay, J. E., M. M. Holland, and A. Jahn (2011), Inter-annual to multi-decadal Arctic sea ice extent trends in a warming world, Geophys. Res. Lett., 38, L15708, doi:10.1029/2011GL048008.

Background: Functional tricuspid regurgitation (TR) occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods: From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6%) had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc.) and 40 patients (88.9%) had atrial fibrillation. Twenty-six patients (57.8%) were in New York Heart Association (NYHA) functional class III, and 19 (42.2%) in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%), 4 for bioprosthetic mitral valve replacement (8.9%), and 7 for tricuspid annuloplasty (15.6%). Results: The tricuspid valves were repaired with Kay's (7 cases, 15.6%) or De Vega technique (4 cases, 8.9%). Tricuspid valve replacement was performed in 34 cases (75.6%). One patient (2.2%) died. Postoperative low cardiac output (LCO) occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 +/- 7.1 mm from 33.7 +/- 6.2 mm preoperatively (P < 0.05). Conclusion: TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.