Abstract
Introduction
Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for many patients with degenerative aortic stenosis. Nevertheless, need for permanent pacemaker ...implantation (PPI) continues being the Achilles heel after TAVR, especially for self-expanding valves. On the other hand, computed tomography (CT) scan provides several measurements with paramount importance for the success of the procedure. The aim of our study was to investigate whether CT-scan could help to identify patients at high risk for PPI need after TAVR.
Methods
We included all consecutive patients who underwent successful TAVR in a single center, since 2018 to 2022. Patients with previous PPI, "valve in valve" procedures, or without CT-scan measures of interest were excluded. Patients were followed-up at least 30 days after index procedure. Clinical, electrocardiographic and procedural characteristics were recorded, as well as CT-scan variables, such as annulus and left ventricle outflow tract (LVOT) perimeter and major and minor axis of both. Eccentricity index (EI) was calculated using the formula for the ellipse (the square root of 1-(minor axis/major axis)2), where the closer to 0 means more circular and the closer to 1 more eccentric ellipse. Multivariate binary logistic regression, including known clinical and electrocardiographic predictors of PPI after TAVR, along with CT-scan measurements, was done searching for the model best predicting PPI-need 30 days after TAVR.
Results
From the 297 patients undergoing TAVR in our centre during the study period, 106 were excluded because they met one of the excluding criteria (64 because of the lack of complete CT-scan data). Thus, 191 patients form the study population. 40 patients (20.9%) required a PPI. Characteristics of patients with/out PPI are shown at Table 1. After multivariate regression analysis, the best model predicting PPI included pre-existing complete right bundle branch block (RBBB) (HR: 3.86; 95%CI 1.35-11.02, p=0.013), larger valve size (HR (29-34 mm vs. 23-26 mm): 3.00; 95%CI 1.34-6.75, p=0.006) and LVOT EI (HR for every increase in 0.01: 0.96; 95%CI 0.94-0.99, p=0.021). C-statistic of the model was estimated in 0.762 (95%CI 0.677-0.847, p<0.001). ROC curve obtained with the model is shown at Figure 1.
Conclusions
Previous CT-scan measurements may help to identify patients at high risk for PPI after self-expanding TAVR. In our series, the strongest predictors for PPI were RBBB, LVOT EI (the lower the eccentricity, the higher the risk) and use of larger prostheses size (29 and 34 mm), which may be considered as a surrogate of the annular perimeter obtained by CT-scan.Baseline characteristicsROC curve
Symbiotic infection with fungal endophytes has been shown to decrease herbivory in several temperate grasses. We tested the hypothesis that foliar endophytes of grasses may also affect below-ground ...processes upon their host death, by altering the litter quality for detritivores or the microenvironment for decomposition. Microcosm-litterbag experiments were used to assess decay rates for litter produced by endophyte (Neotyphodium sp.) infected vs uninfected Lolium multiflorum plants, and to examine endophyte-mediated effects of prior site occupants on current litter decomposition. We found that litter from endophyte-infected L. multiflorum decomposed more slowly than litter from endophyte-free conspecifics and from a naturally uninfected grass, Bromus unioloides. Furthermore, the endophyte-grass association modified the decomposition environment, so that B. unioloides litter decomposed faster when placed underneath a thick layer of endophyte-free L. multiflorum litter. Litter decay rates increased with the amount of root debris remaining in situ from the previous season, but were not affected by the infection status of prior site occupants. The lower decomposability of litter from infected L. multiflorum plants persisted across a range of microenvironments, as determined by different amounts of above-ground litter and soil moisture conditions. Endophyte infection tended to reduce the N content of decaying litter; however, litter N and C/N ratio mainly accounted for interspecific differences in decomposition. Our results imply that fungal endophytes not only can affect herbivory food chains, but also soil organisms and the ecosystem processes they regulate. This study suggests a novel role for symbiotic foliar endophytes in linking above-ground and below-ground sub-systems.
Abstract
Background
The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other ...services, including delivery of surgery.
Methods
This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories.
Results
Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning.
Conclusion
Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.
Graphical Abstract
Surgical services are adapting to mitigate the surge in patients with COVID-19 in need of critical care support. All non-essential elective surgery has been cancelled, or is pending cancellation, in healthcare systems around the globe, impacting millions of patients. The postpandemic phase will require re-establishment of surgical services, and capacity building to restore normalcy and to appropriately reduce the backlog of cases by priority. A framework for evaluation and a plan to incorporate surgical care into the WHO strategies for national health plans and pandemic mitigation is urgently needed.
Graphical Abstract
Preparing for the next wave
Mutations in the filaggrin gene, which cause the skin disease ichthyosis vulgaris and are a genetic risk factor for atopic dermatitis, alter the cutaneous microbiome thereby affecting keratinocyte ...host defense responses following skin barrier disruption.
The data reported here constitute the results of the first long-term monitoring campaign of daily PM10 and PM2.5 concentration levels in Buenos Aires city. Twenty-four hour averages atmospheric ...concentrations of PM10 and PM2.5 were measured (not simultaneously) at a site near downtown Buenos Aires, since December 1998–September 1999. The values of PM2.5 concentrations correlate well with the concentrations of carbon monoxide (CO) during the winter period, indicating that direct traffic emissions have an important contribution to PM2.5. The data are less correlated for the case of PM10, indicating that the sources of the coarse fraction are not only traffic emissions, with an important contribution of other sources, for example re-suspended material.
Scanning electron microscopy and atomic force microscopy images of atmospheric particles on nucleopore filters are shown. Information about the ion and metal content of these particles is reported.
To determine clinical and epidemiological features of scorpion stings in two departments of Colombia, a descriptive study was performed in the hospitals of 10 towns from Antioquia (2 256 071 ...inhabitants) and five from Tolima (630 424 inhabitants). One hundred and twenty-nine cases were admitted during one year, 51 in Antioquia, 78 in Tolima and 41 were children less than 15 years old. Most stings (70.5%) occurred inside the house; 27.9% were on the hands and 26.4% on the feet. The scorpion species involved were
Tityus pachyurus (51),
Centruroides gracilis (31),
T. fuehrmanni (29),
T. asthenes (7) and
Chactas spp. (1). In 10 cases the scorpion involved was not identified. Systemic envenoming signs (e.g. vomiting, tachypnea) were significantly more frequent in children than in adults (
P < 0.05). Four children had hypertension, but none developed pulmonary oedema. One 3-year-old girl, stung by
T. asthenes, had acute oedematous pancreatitis. Ninety-eight patients had mild envenoming. Moderate (27 patients) and severe (four patients) envenoming was significantly more frequent in children than in adults (
P = 0.003; relative risk = 2.97). A pepsin-digested anti-
Centruroides spp. antivenom was administered to 19 of 31 patients presenting systemic envenoming signs. No adverse reactions to antivenom were observed.
Several fields of orthopedics have concluded benefits from volume thresholds. We postulate that we could similarly optimize periprosthetic joint infection (PJI) treatment by creating a regional ...referral center, concentrating expertise and resources. Here, we review our reasoning and our first-year experience of a PJI referral center in the United States.
An electrochemical quartz crystal microbalance is used for a continuous monitoring of the growth of the polymer poly(3,4-ethylenedioxy) thiophene tetrabutylammonium perchlorate (PEDOT-TBAP), ...electropolymerized in acetonitrile on a gold electrode of a 10 MHz AT-cut quartz crystal resonator. The surface acoustic impedance of the resonator is analyzed starting from the electrical admittance continuously measured by means of a network analyzer. Changes in the acoustic impedance suggest that a mechanical resonance phenomenon occurs during the electrodeposition. To determine the origin of this effect, the evolution of the physical properties of the coating is analyzed. This analysis shows a significant change of the Viscoelastic properties of the coating during the electropolymerization and especially during the time interval of the suspected mechanical resonance. The effect of the surface roughness on the mechanical impedance of the coating is analyzed. This study seems to indicate that the changes in the effective Viscoelastic properties of the coating are due to the changes in the surface roughness. The mechanical resonance effect also seems to be more a result of this change in the coating effective Viscoelastic properties than of the growth of the coating thickness where coating Viscoelastic properties are maintained constant.
Diabetic obese patients are susceptible to the development of cardiovascular disease, including hypertension and cardiac dysfunction culminating in diabetic cardiomyopathy (DC), which represents a ...life-threatening health problem with increased rates of morbidity and mortality. The aim of the study is to characterize the effects of a new benzofuran
-acylhydrazone compound, LASSBio-2090, on metabolic and cardiovascular alterations in Zucker diabetic fatty (ZDF) rats presenting DC.
Male non-diabetic lean Zucker rats (ZL) and ZDF rats treated with vehicle (dimethylsulfoxide) or LASSBio-2090 were used in this study. Metabolic parameters, cardiovascular function, left ventricle histology and inflammatory protein expression were analyzed in the experimental groups.
LASSBio-2090 administration in ZDF rats reduced glucose levels to 85.0 ± 1.7 mg/dL (
< 0.05). LASSBio-2090 also lowered the cholesterol and triglyceride levels from 177.8 ± 31.2 to 104.8 ± 5.3 mg/dL and from 123.0 ± 11.4 to 90.9 ± 4.8 mg/dL, respectively, in obese diabetic rats (
< 0.05). LASSBio-2090 normalized plasma insulin, insulin sensitivity and endothelial function in aortas from diabetic animals (
< 0.05). It also enhanced systolic and diastolic left-ventricular function and reverted myocardial remodeling by blocking the threefold elevation of TNF-α levels in hearts from ZDF rats.
LASSBio-2090 alleviates metabolic disturbance and cardiomyopathy in an obese and diabetic rat model, thus representing a novel strategy for the treatment of cardiovascular complications in obesity-associated type 2 diabetes mellitus.
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