Background: Transcatheter aortic valve replacement (TAVR) became the leading therapeutic strategy for aortic valve replacement in older patients with severe symptomatic aortic stenosis. ...Echocardiographic parameters that mark the left ventricle and right ventricle reverse remodeling after the TAVR are not well established. The aim of the current study is to describe the dynamics of both left ventricle (LV) and right ventricle (RV) strain derived from speckle tracking echocardiography in elderly patients at 3-months after the TAVR procedure. Methods: We enrolled 52 consecutive patients (77 + or - 4.9 years old, median STS score of 3.1) who underwent transfemoral TAVR at our tertiary care center. All patients were evaluated at baseline and 3 months following TAVR. Results: The LV global longitudinal strain (GLS) 3-month following TAVR was significantly improved compared with baseline values (-16 + or -4.2% vs -16 + or -4.2%; p < 0.001) but no significant changes in the RV GLS 3 and 6 segments model following TAVR were registered. The LV ejection fraction was significantly improved 3-months after the TAVR procedure. LV-GLS at baseline demonstrated a strong positive correlation with LV-GLS at 3 months (r = 0.69) and a moderate correlation with RV strain parameters (r = 0.38 and r = 0.56), but also a negative correlation with LVEF at follow-up (r=-0.61). Interestingly, in contrast to LVEF, none of the strain parameters correlated with age. NT-proBNP values were correlated with both LV-GLS (r = 0.37) and LVEF (r=-0.5) at baseline. However, at follow-up, baseline NT-proBNP values remained correlated only to LV-GLS at 3-months (r = 0.24), but the correlation was weak. Keywords: elderly population, transcatheter aortic valve replacement, aortic stenosis, global longitudinal strain, outcome
The idiopathic interstitial pneumonias (IIP) constitute a large cohort of the over 200 subtypes of interstitial lung disease (ILD). Idiopathic pulmonary fibrosis (IPF) is the most widely studied, ...arguably the most severe etiology of ILD and the most common IIP diagnosis. The objective of this narrative review is to outline the current evidence on optimal perioperative management of IPF. PubMed, Embase and Web of Science were analyzed for appropriate peer-reviewed references by utilizing key word search ("interstitial lung disease" OR "idiopathic pulmonary fibrosis" OR "idiopathic interstitial pneumonitis" OR "ILD" OR "IPF" AND "surgery" OR "anesthesia" OR "perioperative") within the past thirty years (1990-current). Non-English language references were excluded. A total of 205 references were curated by the authors. Eighty-seven consensus statements, clinical trials, retrospective cohort studies or case series met criteria and were incorporated into the findings of this narrative review.
After review, we conclude that complications, dominated by postoperative pulmonary complications, pose a significant barrier to safe perioperative care of patients with IPF. Ensuring that the preoperative IPF patient has been medically optimized is important for minimizing this risk. Initial assessment of the ARISCAT score, pulmonary function studies and cardiopulmonary exercise testing may identify IPF patients at particularly high perioperative pulmonary risk. Identifying IPF patients with 6-12-month declines in D
of >15%, V
<8.3 mL/kg/min, <80% predicted value FVC, a 50-meter reduction in the 6MWT or preoperative home oxygen use may be helpful in preoperative risk stratification. Medically optimizing treatable co-morbidities should be a priority in preoperative assessment. Regional or neuraxial anesthesia should be considered an optimal technique for the avoidance of general anesthesia related complications when indicated. Acute exacerbation and postoperative pneumonia have been identified as important postsurgical complications in both thoracic and nonthoracic surgical populations.
The low-spin structure of the semimagic 64Ni nucleus has been considerably expanded: combining four experiments, several 0+ and 2+ excited states were identified below 4.5 MeV, and their properties ...established. The Monte Carlo shell model accounts for the results and unveils an unexpectedly complex landscape of coexisting shapes: a prolate 0+ excitation is located at a surprisingly high energy (3463 keV), with a collective 2+ state 286 keV above it, the first such observation in Ni isotopes. The evolution in excitation energy of the prolate minimum across the neutron N=40 subshell gap highlights the impact of the monopole interaction and its variation in strength with N.
IntroductionChildren brought to the ER with signs of difficulty in breathing such as polypnea, accessory muscle use, flaring of the nostrils, dyspnea, wheezing, grunting, can initially misguide the ...doctor to a pulmonary disease, but further investigations can diagnose a cardiac malformation.Case series presentation, management and outcomeCase 1. A previously healthy 3 months old boy is brought to the ER for grunting especially during sleeping, polypnea and dry coughing. Oxygen saturation showed 84% on room air and 89% with oxygen. Chest X-ray showed cardiomegaly. Echocardiography certified totally anomalous venous drainage into the coronary sinus. He underwent surgery with favourable results.Case 2. 14 months old boy with previous history of recurrent bronchiolitis presented to the ER for dyspnea, wheezing, dry cough and rhinorrhea accompanied by pallor. Although he didn't have heart murmur, Chest X-ray showed cardiomegaly. Echocardiography certified the diagnoses of Ebstein disease with moderate tricuspid insufficiency. He never got operated; however, he is alive with no signs of pulmonary hypertension.Case 3. 5 weeks old boy is brought to the ER for polypnea, dyspnea, dry cough and difficulty in breastfeeding. He also had pallor and bilateral crackles. Heart murmur was inaudible and oxygen saturation was 90% on room air. Echocardiography showed severe coarctation of the aorta. He got cardiac surgery with good results.Case 4. 4 months old girl presented at the ER for wheezing, cough, dyspnea and grunting. She had pallor, rhonchi and no heart murmur. Oxygen saturation showed 85% on room air and 99% with oxygen; chest X-ray showed cardiomegaly. Echocardiography diagnosed the child with dilated cardiomyopathy. He initially got specific treatment with good results and he had no indication of surgery.ConclusionsAll cases were initially presumed to be acute pulmonary diseases. Chest X-rays and oxygen saturation monitoring along with specific clinical features (failure to thrive, cyanosis, pallor and fatigue during breastfeeding) are useful for orienting towards congenital cardiac malformations. Auscultation is not a reliable evaluation since heart murmur it is not always pathologic and it depends on the severity of the heart defect and on the physician's skills and praxis. Since echocardiography is the key in diagnosis, there should be done short courses for basic children echocardiography for ER paediatricians.
IntroductionChildren brought to the ER with signs of difficulty in breathing such as polypnea, accessory muscle use, flaring of the nostrils, dyspnea, wheezing, grunting, can initially misguide the ...doctor to a pulmonary disease, but further investigations can diagnose a cardiac malformation.Case series presentation, management and outcomeCase 1. A previously healthy 3 months old boy is brought to the ER for grunting especially during sleeping, polypnea and dry coughing. Oxygen saturation showed 84% on room air and 89% with oxygen. Chest X-ray showed cardiomegaly. Echocardiography certified totally anomalous venous drainage into the coronary sinus. He underwent surgery with favourable results.Case 2. 14 months old boy with previous history of recurrent bronchiolitis presented to the ER for dyspnea, wheezing, dry cough and rhinorrhea accompanied by pallor. Although he didn’t have heart murmur, Chest X-ray showed cardiomegaly. Echocardiography certified the diagnoses of Ebstein disease with moderate tricuspid insufficiency. He never got operated; however, he is alive with no signs of pulmonary hypertension.Case 3. 5 weeks old boy is brought to the ER for polypnea, dyspnea, dry cough and difficulty in breastfeeding. He also had pallor and bilateral crackles. Heart murmur was inaudible and oxygen saturation was 90% on room air. Echocardiography showed severe coarctation of the aorta. He got cardiac surgery with good results.Case 4. 4 months old girl presented at the ER for wheezing, cough, dyspnea and grunting. She had pallor, rhonchi and no heart murmur. Oxygen saturation showed 85% on room air and 99% with oxygen; chest X-ray showed cardiomegaly. Echocardiography diagnosed the child with dilated cardiomyopathy. He initially got specific treatment with good results and he had no indication of surgery.ConclusionsAll cases were initially presumed to be acute pulmonary diseases. Chest X-rays and oxygen saturation monitoring along with specific clinical features (failure to thrive, cyanosis, pallor and fatigue during breastfeeding) are useful for orienting towards congenital cardiac malformations. Auscultation is not a reliable evaluation since heart murmur it is not always pathologic and it depends on the severity of the heart defect and on the physician’s skills and praxis. Since echocardiography is the key in diagnosis, there should be done short courses for basic children echocardiography for ER paediatricians.
We report on multi-sensor platforms on plastic foils for environmental monitoring. Polymer-based capacitive sensors for humidity and volatile organic compounds (VOC)s, semiconducting metal oxides ...(MOX) based chemoresistive sensors for reducing/oxidizing gases and a Pt thermometer have been integrated together on a polyimide sheet and their performances characterized. The MOX gas sensors exhibited good sensitivity to CO and ethanol. The differential operation of the capacitive humidity sensors resulted in increased signals and reduced response/recovery times.
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