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ABSTRACT: Objectives: The objectives of this study were to identify the composition of oral microbiota in a cohort of patients with sickle cell anemia (SCA) and a high mean number of decayed, missing, and filled permanent teeth (DMFT) and compare it to a cohort of patients with SCA and a low number of DMFT and elucidate the effect of fetal haemoglobin levels on the oral microbiota composition. Methods: Patients who had been diagnosed with SCA, who were homozygous for sickling β-globin mutation (βS/βS), who had Arab-Indian haplotype, and who ranged in age from 5 to 12 years were included in this study. Oral saliva from each participant (n = 100) was collected in GeneFiX™ Saliva DNA Microbiome Collection tube and DNA was extracted using GeneFiX™ DNA Isolation Kits. The composition of oral 16S rRNA from patients with SCA and high dental caries (n = 27, DMFT ≥5) and low dental caries (n = 73, DMFT ≤4) was analysed. Sequencing was performed on an Ion Personal Genome Machine using, Ion PGM Hi-Q view Sequencing 400-bp kit. Results: We observed an overall increase in abundance of Proteobacteria, Chloroflexi, and Bacteroidetes in the high DMFT index group compared to those with a low DMFT index. In addition, there was an overall increased abundance of microbiota from Proteobacteria, Fusobacteria, Firmicutes, and Bacteroidetes in the patients with SCA with low fetal haemoglobin compared to those with high fetal haemoglobin (P < .05). Enterobacteriaceae species were the most significant abundant species of bacteria found in both the high DMFT index group and low fetal haemoglobin cohort (P < .05). Conclusions: Our data indicate that SCA in Saudi patients with high DMFT have a higher predominance of pathogenic bacteria compared to those with low DMFT. Furthermore, SCA in Saudi patients with low fetal haemoglobin have a higher predominance of pathogenic bacteria compared to those with higher fetal haemoglobin.

Altered vitamin B6 metabolism due to pathogenic variants in the gene PNPO causes early onset epileptic encephalopathy, which can be treated with high doses of vitamin B6. We recently reported that single nucleotide polymorphisms (SNPs) that influence PNPO expression in the brain are associated with genetic generalized epilepsy (GGE). However, it is not known whether any of these GGE-associated SNPs influence vitamin B6 metabolite levels. Such an influence would suggest that vitamin B6 could play a role in GGE therapy. Here, we performed genome-wide association studies (GWAS) to assess the influence of GGE associated genetic variants on measures of vitamin B6 metabolism in blood plasma in 2232 healthy individuals. We also asked if SNPs that influence vitamin B6 were associated with GGE in 3122 affected individuals and 20,244 controls. Our GWAS of vitamin B6 metabolites reproduced a previous association and found a novel genome-wide significant locus. The SNPs in these loci were not associated with GGE. We found that 84 GGE-associated SNPs influence expression levels of PNPO in the brain as well as in blood. However, these SNPs were not associated with vitamin B6 metabolism in plasma. By leveraging polygenic risk scoring (PRS), we found suggestive evidence of higher catabolism and lower levels of the active and transport forms of vitamin B6 in GGE, although these findings require further replication. Keywords: Pyridoxine, GGE, GWAS, Genetics, SNP, Pharmacogenetics

Background: Coracoid process fracture with anterior shoulder instability is a rare presentation. With a coracoid body fracture extending to the tip, a biomechanically stronger Latarjet procedure cannot be performed, instead, a weaker procedure like the Bristow procedure can be done. Here we present a 7-year follow-up where a staged procedure of fixation of the coracoid process followed by an open Latarjet procedure utilizing the healed coracoid. Case presentation: A 35-year-old deep sea fisherman presented to us with recurrent episodes of right shoulder dislocations.Imaging showed a coracoid process fracture [Eyres type 2] with glenoid bone loss of 28 %. Primarily coracoid fracture fixation was done and 3 months post-operatively, an open latarjet was performed. The patient after 7 years is doing well with good stability of the operated shoulder joint. Conclusion: Our purpose in reporting this case is to point out that a Latarjet procedure can still be done in a patient whose coracoid process has fractured through the body with staged fixation of the coracoid fracture and using the same as graft at a later date in a patient with chronic anterior shoulder instability, thus providing the soft tissue and bony construct strength in a young high demand person.

Background: Chondral defects of the knee joint are commonly seen but it still remains a management challenge. (1) Recently joint preserving treatment options have become popular like the autologous chondrocyte implantation (ACI) and minced cartilage implantation (MCI). (2) ACI is the gold standard for larger lesions but it is a two-stage procedure and less cost effective when compared to MCI. Arthroplasty is mostly reserved for elderly patients and low demand patients. Case report: 35 year female suffered from persistent stress related knee pain. MRI revealed full thickness grade 3 ICRS cartilage lesion in the medial femoral condyle. She underwent Autocart procedure (Arthrex, Munich, Germany) followed by regular observed physiotherapy. Conclusion: She was followed up after 6 weeks, 3 months, 6 months and 1 year and 2 year. Lysholm score improved to 96.03 and her KOOS sub scores improved for pain (from 50 to 92), symptoms (from 55 to 95), sports and recreation (from 36 to 92), and quality of life (from 38 to 94). 1 year post-operative MRI revealed a healed cartilage lesion. The preoperative MRI AMADEUS score was 40 which improved to 1 year post-operative MOCART score of 80. Minced autologous cartilage implantation methods for full thickness cartilage defects is an attractive alternative when compared to other cartilage repair techniques even though long term data are still awaited.

Objective: To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole. Methods: Using data from the World Health Organization mortality database, we conducted an analysis of mortality trends from aortic disease between 2000 and 2019, Countries were categorized into middle-income and high-income countries (MICs and HICs) on the basis of income level. Age-standardized and sex-specific age-standardized mortality rates per 100,000 persons, along with male-to-female mortality ratios, were calculated. Trends over the study period were analyzed using joinpoint regression. Results: Our analysis comprised 29 MICs and 46 HICs, with an average population of 595 million and 1042 million during the observation period. During the observation period, age-standardized mortality rates from aortic disease decreased to 2.21 (2.17-2.25) and 2.28 (2.26-2.30) in MICs and HICs, respectively (average annual percentage change of −0.5% in MICs and −1.8% in HICs, P

In this study, condensation heat transfer of water vapor in a minichannel heat exchanger on smooth and pin fins surfaces was investigated experimentally. The experimental study was carried out to evaluate heat transfer coefficient, overall heat transfer coefficient, and Nusselt number over different ranges of vapor mass flux from 0.0064 to 0.0368 kg m−2 s−1 and cold-water flow rate range between 0.0013 kg s−1 to 0.0057 kg s−1. The minichannel has a rectangular shape with a hydraulic diameter of 1.3 mm. The experimental testing is carried out on aluminum surface with a channel that has a length of 270, width of 30 mm, and height of 1.3 mm. The pin fins surface is on the bottom of the condensing channel and the fins are circular and have diameter, height, and spacing of 1 mm, and are in-inline arrangement. It is found that condensation heat transfer coefficient on pin fins surface is about 15 % higher than that on smooth surface. It is found that the condensation heat transfer coefficient increases significantly with increasing the vapor mass flux. In addition, the effect of increasing the cold fluid flow rate is lower than that of the hot vapor flow rate, but it becomes more significant for higher vapor flux.

Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020 led to the implementation of nonpharmaceutical interventions (NPIs) to curb its spread. Studies have shown that adult asthma exacerbations and viral infections decreased during NPI use. However, few studies have shown the effects of NPIs on pediatric asthma exacerbations and infections during and after the pandemic. Objective: This study aimed to understand the impact of NPIs on asthma exacerbations and viral respiratory infections in pediatric patients at our institution from March 2018 to December 2022. Methods: The medical record numbers of children with asthma exacerbations seen at our institution between March 2018 and December 2022 were analyzed. Subjects were categorized on the basis of timing of their exacerbation in relation to NPI enforcement. We used the results from clinical testing with the BioFire Respiratory Panel (BRP) to detect up to 22 respiratory pathogens and then correlated these results with asthma exacerbation severity. Results: There were 5,758 asthma exacerbations recorded, with a 50% decline in average weekly exacerbations during NPI enforcement. Of the 70,682 BRP tests performed, 87% returned a positive result for at least 1 pathogen. Several viruses (respiratory syncytial virus, parainfluenza, and influenza) had a decrease in positivity rate with NPIs, whereas rhinovirus/enterovirus positivity rates were unchanged throughout the pandemic. Asthma exacerbations with a positive BRP result required higher clinical levels of care during the admission. Conclusion: NPIs were associated with significantly reduced numbers of asthma exacerbations and respiratory viral infections. The post-NPI period saw a return to prepandemic levels of asthma exacerbations and an unusual surge in respiratory syncytial virus infections, emphasizing the need for continuous monitoring and adaptive strategies in the postpandemic landscape.

Polymerase chain reaction (PCR)-based assays were widely deployed during the SARS-CoV-2 pandemic for population-scale testing. High-throughput molecular diagnostic laboratories required a high degree of process automation to cope with huge testing demands, fast turnaround times, and quality requirements. However, process developers and optimizers often neglected the critical step of preparing a PCR Master Mix. The construction of PCR Master Mix depends on operator skill during the manual pipetting of reagents. Manual procedures introduce variation, inconsistency, wastage, and potentially risks data integrity. To address this, we developed a liquid-handler-based solution for automated, traceable, and compliant PCR Master Mix preparation. Here, we show that a fully automated PCR Master Mix protocol can replace manual pipetting, even in a diagnostic environment, without affecting accuracy or precision. Ultimately, this method eliminated operator-induced wastage and improved the consistency of the quality of results.

Youth diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) often show deficits in various measures of higher-level cognition, such as, executive functioning. Poorer cognitive functioning in children with ADHD has been associated with differences in functional connectivity across the brain. However, little is known about the developmental changes to the brain’s functional properties linked to different cognitive abilities in this cohort. To characterize these changes, we analyzed fMRI data (ADHD = 373, NT = 106) collected while youth between the ages of 6 and 16 watched a short movie-clip. We applied machine learning models to identify patterns of network connectivity in response to movie-watching that differentially predict cognitive abilities in our cohort. Using out-of-sample cross validation, our models successfully predicted IQ, visual spatial, verbal comprehension, and fluid reasoning in children (ages 6 – 11), but not in adolescents with ADHD (ages 12–16). Connections with the default mode, memory retrieval, and dorsal attention were driving prediction during early and middle childhood, but connections with the somatomotor, cingulo-opercular, and frontoparietal networks were more important in middle childhood. This work demonstrated that machine learning approaches can identify distinct functional connectivity profiles associated with cognitive abilities at different developmental stages in children and adolescents with ADHD.

Tuberous Sclerosis Complex (TSC) is a rare genetic disorder that primarily affects the central nervous system and various body organs. This case series describes the case history of 2 siblings from the same parents who were diagnosed with TSC. Case 1 is a 13-year-old girl with bilateral renal AML (angiomyolipoma), multiple fat nodules in the liver, and subependymal nodules with tubers revealed in the brain magnetic resonance imaging (MRI). Case 2 is her brother, a 6-year-old boy, who presented with manifestations of subependymal giant cell astrocytoma (SEGA) and renal AML. TSC must be managed with early diagnosis and intervention due to the risk of hamartoma enlargement. These 2 cases found in siblings underline the varied clinical presentations of TSC and the complexities faced by families with TSC. Early diagnosis is important to avoid TSC-related complications because, as time goes by, the disease will impact the patient's quality of life and increase morbidity and mortality. This case series also highlights the advantages of dermatological screening for the early detection of TSC, family screening, the need for multiple imaging modalities and counseling of family members with TSC, as well as the need for ongoing follow-up of this rare disorder.

Maple syrup is an important part of the economy in various regions of the United States. Studies on maple syrup production potential mostly use climatic factors as determinants and, therefore, fail to account for non-climatic factors. In this study, we applied a stochastic production function framework to establish a relationship between maple syrup yield and a set of climatic (temperature and tapping season length) and non-climatic determining factors, such as the number of maple trees and utilization rate of the potential number of taps. Tree characteristics, climatic, and other factors had mixed effects on syrup yield. The number of maple trees, the number of taps, and the minimum temperature had marginal negative effects on average syrup yield, while the length of the season and the maximum temperature had positive effects. A predictive model was developed and used to estimate the potential production of maple syrup under low, medium and high utilization levels in Kentucky, a likely region for maple syrup production. This model could be useful for maple syrup research, education, and extension in maple-producing states.

Summary: Cells, even from the same line, can maintain heterogeneity in metabolic activity. Here, we present a protocol, adapted for fluorescence-activated cell sorting (FACS), that separates resuspended cells according to their metabolic rate. We describe steps for driving lactate efflux, which produces an alkaline transient proportional to fermentative rate. This pH signature, measured using pH-sensitive dyes, identifies cells with the highest metabolic rate. We then describe a fluorimetric assay of oxygen consumption and acid production to confirm the metabolic contrast between subpopulations.For complete details on the use and execution of this protocol, please refer to Blaszczak et al.1 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Background: The last five decades have seen a surge in viral outbreaks, particularly in tropical and subtropical regions like Brazil, where endemic arboviruses such as Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV) pose significant threats. However, current diagnostic strategies exhibit limitations, leading to gaps in infection screening, arbovirus differential diagnoses, DENV serotyping, and life-long infection tracking. This deficiency impedes critical information availability regarding an individual's current infection and past infection history, disease risk assessment, vaccination needs, and policy formulation. Additionally, the availability of point-of-care diagnostics and knowledge regarding immune profiles at the time of infection are crucial considerations. Objectives: This review underscores the urgent need to strengthen diagnostic methods for arboviruses in Brazil and emphasizes the importance of data collection to inform public health policies for improved diagnostics, surveillance, and policy formulation. Methods: We evaluated the diagnostic landscape for arboviral infections in Brazil, focusing on tailored, validated methods. We assessed diagnostic methods available for sensitivity and specificity metrics in the context of Brazil. Results: Our review identifies high-sensitivity, high-specificity diagnostic methods for arboviruses and co-infections. Grifols transcription-mediated amplification assays are recommended for DENV, CHIKV, and ZIKV screening, while IgG/IgM ELISA assays outperform Rapid Diagnostic Tests (RDTs). The Triplex real-time RT-PCR assay is recommended for molecular screening due to its sensitivity and specificity. Conclusion: Enhanced diagnostic methods, on-going screening, and tracking are urgently needed in Brazil to capture the complex landscape of arboviral infections in the country. Recommendations include nationwide arbovirus differential diagnosis for DENV, ZIKV, and CHIKV, along with increased DENV serotyping, and lifelong infection tracking to combat enduring viral threats and reduce severe presentations.

Members of the Curcuma genus, a crop in the Zingiberaceae, are widely utilized rhizomatous herbs globally. There are two distinct species, C. comosa Roxb. and C. latifolia Roscoe, referred to the same vernacular name “Wan Chak Motluk” in Thai. C. comosa holds economic importance and is extensively used as a Thai traditional medicine due to its phytoestrogenic properties. However, its morphology closely resembles that of C. latifolia, which contains zederone, a compound known for its hepatotoxic effects. They are often confused, which may affect the quality, efficacy and safety of the derived herbal materials. Thus, DNA markers were developed for discriminating C. comosa from C. latifolia. This study focused on analyzing core DNA barcode regions, including rbcL, matK, psbA-trnH spacer and ITS2, of the authentic C. comosa and C. latifolia species. As a result, no variable nucleotides in core DNA barcode regions were observed. The complete chloroplast (cp) genome was introduced to differentiate between the two species. The comparison revealed that the cp genomes of C. comosa and C. latifolia were 162,272 and 162,289 bp, respectively, with a total of 133 identified genes. The phylogenetic analysis revealed that C. comosa and C. latifolia exhibited a very close relationship with other Curcuma species. The cp genome of C. comosa and C. latifolia were identified for the first time, providing valuable insights for species identification and evolutionary research within the Zingiberaceae family.

This paper investigates the thermal performance of straight microchannel heat sinks featuring square-shaped fins on the sidewalls using a CFD developed model. The study evaluates the performance of the heat sink in terms of the total thermal resistance (Rth) and pumping power (PPf). The results show that incorporating square-shaped fins improves thermal performance, however at the penalty of increased pressure drop. To combine heat transfer enhancement with increased pressure drop, the study uses the Figure of Merit (FOM) approach. The study finds that increasing the size of the fins reduces thermal resistance by an average of 53.5%, but Design 1, which has smaller fins, offers a higher FOM. Similarly, reducing the spacing between fins lowers thermal resistance by an average of 61.95%, but Design 5 with smaller spacing than Design 4 offers a higher FOM. Furthermore, smaller channel sizes reduce thermal resistance by an average of 51.43%, but Design 6, which has larger channel sizes than Design 7, provides a higher FOM. Additionally, reducing channel spacing reduces thermal resistance by an average of 62.2% without affecting the pumping power, and Design 8 with smaller spacing than Design 9 offers a higher FOM.

This study investigates pressure drop and heat transfer characteristics in a minichannel heat exchanger experimentally. The experimental testing was carried out on a minichannel with a hydraulic diameter of about 2.5 mm, with smooth and embedded with circular pin-fins. The testing was conducted with different hot fluids, air and water, over different Reynolds numbers ranges, and over different heat capacity ratios (0.25, 0.5, 0.75, and 1). The experimental study of the pressure drop covers a Reynolds number range between 100-1900 for the hot water, and Reynolds number range between 500-10,000 for the hot air. The hot fluid flows through a channel with an inline arrangement with a 1750 pin fin, while the cold fluid flows through a smooth channel. Increasing flow rates resulted in an increase in pressure drop and heat transfer coefficients. When using pin-fins surface instead of smooth surface, the overall heat transfer coefficient (U) increased by 190% when water is used as the heat transfer fluid (HTF), and the same coefficient increased by 42% when air is used as the heat transfer fluid. Similarly, the difference in pressure drop is low in the case of water-water, while in the case of air-water, the difference in pressure drop is more substantial as Reynolds number increases.

Simulation based work carried out in order to understand the thermohydraulic characteristics of fluid flow in helical microchannel, with circular cross-section, that is subjected to constant heat flux is detailed in this work. Water is used as the fluid in this study and the study is carried out for Reynolds number ranging from 50 to 500. The helical path of the fluid increases the heat transfer coefficient and pressure drop for a specific Reynolds number in comparison with that in a straight microchannel. The increase in heat transfer coefficient and pressure drop associated with the helical microchannel manifests as increased Nusselt number and Poiseuille number. At Reynolds number of 50, the Nusselt number of the helical microchannel is 1.36 times higher than that of the straight microchannel while at Reynolds number of 500, this enhancement increases to 2.33. Regarding Poiseuille number of helical microchannel, it is higher than that of the Poiseuille number of straight microchannel by 1.02 and 1.72 at Reynolds number of 50 and 500, respectively. It is identified from this study that by shifting from straight microchannel to helical microchannel, the enhancement in Nusselt number is higher than the associated penalty, i.e. increase in Poiseuille number.

Summary: Malignancy is enabled by pro-growth mutations and adequate energy provision. However, global metabolic activation would be self-terminating if it depleted tumor resources. Cancer cells could avoid this by rationing resources, e.g., dynamically switching between “baseline” and “activated” metabolic states. Using single-cell metabolic phenotyping of pancreatic ductal adenocarcinoma cells, we identify MIA-PaCa-2 as having broad heterogeneity of fermentative metabolism. Sorting by a readout of lactic acid permeability separates cells by fermentative and respiratory rates. Contrasting phenotypes persist for 4 days and are unrelated to cell cycling or glycolytic/respiratory gene expression; however, transcriptomics links metabolically active cells with interleukin-6 receptor (IL-6R)-STAT3 signaling. We verify this by IL-6R/STAT3 knockdowns and sorting by IL-6R status. IL-6R/STAT3 activates fermentation and transcription of its inhibitor, SOCS3, resulting in delayed negative feedback that underpins transitions between metabolic states. Among cells manifesting wide metabolic heterogeneity, dynamic IL-6R/STAT3 signaling may allow cell cohorts to take turns in progressing energy-intense processes without depleting shared resources.

This work reports on synthesis of fennel-based composites and their feasibility to remove and photo-degrade methylene blue dye from aqueous solution. Pristine fennel seeds (PFS) was impregnated with iron(III) oxide nanoparticles (Fe2O3 NP) and iron(III)-1,2,3,4-tetracarboxylic acid (Fe-TCA) to yield the composites fennel seeds-nanoparticles (FS-NP) and fennel seeds-tetracarboxylic acid (FS-TCA), respectively. Scanning electron microscope (SEM) images revealed that the surface of the adsorbents appeared to have a rough texture with cavities. Fourier transform infrared spectroscopy (FTIR) spectra confirmed the presence of −OH, −C=O, −COC, −COOH and −CO groups that could easily bind to the dye. The physicochemical characteristics such as cation exchange capacity (CEC) and Brunauer, Emmett and Teller (BET) surface area were enhanced after impregnation compared with PFS. The maximum adsorption capacity recorded at pH 10 for PFS was 13.2 mg/g while for FS-NP and FS-TCA was 32.8 and 42.9 mg/g, respectively This was ascribed to chemical interaction such as hydrogen bond, electrostatic attraction and π-π stacking. The isotherm and kinetic data were best described by Freundlich and pseudo-first order models. Thermodynamic parameters (∆Ho and ∆Go) showed spontaneity and endothermicity respectively. The positive values of ΔSo suggests that there was increased level of freedom at solid/liquid interface. PFS showed no activity for photocatalytic degradation properties while PF-NP and PF-TCA recorded 58.9 and 48.6% efficiencies, respectively. The data revealed that pseudo-second order described the photocatalytic processes of MB better than pseudo-first order kinetics.

Background: Whether statins reliably reduce the risk of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery remains controversial. We sought to determine the impact of statin use on new-onset postdischarge POAF in the Post-Surgical Enhanced Monitoring for Cardiac Arrhythmias and Atrial Fibrillation (SEARCH-AF) CardioLink-1 randomized controlled trial. Methods: We randomized 336 patients with risk factors for stroke (CHA2DS2-VASc score ≥ 2) and no history of preoperative atrial fibrillation (AF) to 30-day continuous cardiac rhythm monitoring after discharge from cardiac surgery with a wearable, patched-based device or to usual care. The primary endpoint was the occurrence of cumulative AF and/or atrial flutter lasting for ≥ 6 minutes detected by continuous monitoring, or AF and/or atrial flutter documented by a 12-lead electrocardiogram within 30 days of randomization. Results: The 260 patients (77.4%) discharged on statins were more likely to be male (P = 0.018) and to have lower CHA2DS2-VASc scores (P = 0.011). Patients treated with statins at discharge had a 2-fold lower rate of POAF than those who were not treated with statins in the entire cohort (18.4% vs 8.1%, log-rank P = 0.0076). On multivariable Cox regression including the CHA2DS2-VASc score adjustment, statin use was associated with a lower risk of POAF (hazard ratio 0.43, 95% confidence interval: 0.25-0.98, P = 0.043). Use of statins at a higher intensity was associated with lower risk of POAF, suggestive of a dose–response effect (log-rank Ptrend = 0.0082). Conclusions: The use of statins was associated with a reduction in postdischarge POAF risk among patients undergoing cardiac surgery. The routine use of high-intensity statin to prevent subacute POAF after discharge deserves further study. Résumé: Contexte: L’efficacité des statines dans la réduction du risque de fibrillation auriculaire postopératoire (FAPO) chez les patients ayant subi une chirurgie cardiaque ne fait pas l’unanimité. Nous avons tenté de déterminer l’effet de l’utilisation des statines sur la survenue d’une FAPO inaugurale consécutive au congé de l’hôpital dans l’essai SEARCH-AF CardioLink-1, un essai contrôlé à répartition aléatoire sur le suivi étroit en postopératoire des arythmies cardiaques et de la fibrillation auriculaire. Méthodologie: Nous avons réparti aléatoirement 336 patients présentant des facteurs de risque d’AVC (score CHA2DS2-VASc ≥ 2) sans antécédents de fibrillation auriculaire (FA) préopératoire dans deux groupes : les patients du premier groupe étaient équipés d’un dispositif portable sous forme de timbre pour la surveillance continue du rythme cardiaque pendant 30 jours après la sortie de l’hôpital suivant une chirurgie cardiaque; les patients du second groupe étaient suivis de façon conventionnelle. Le critère d’évaluation principal était la survenue cumulative de FA et/ou de flutter auriculaire durant ≥ 6 minutes détecté par la surveillance continue, ou la FA et/ou le flutter auriculaire confirmé par un électrocardiogramme à 12 dérivations dans les 30 jours suivant la répartition aléatoire. Résultats: Les 260 patients (77,4 %) prenant des statines à leur congé de l’hôpital étaient plus susceptibles d’être des hommes (p = 0,018) et d’avoir un score CHA2DS2-VASc plus faible (p = 0,011). Les patients traités par des statines à leur congé de l’hôpital avaient deux fois moins de risques de présenter une FAPO que les patients ne recevant pas de statines dans l’ensemble de la cohorte (18,4 % contre 8,1 %, valeur de p calculée selon le test de Mantel-Haenszel = 0,0076). Dans une régression de Cox multivariable incluant l’ajustement du score CHA2DS2-VASc, l’utilisation des statines a été associée à un risque moindre de FAPO (rapport des risques instantanés : 0,43, intervalle de confiance à 95 % de 0,25 à 0,98; p = 0,043). L’utilisation de statines à plus fortes doses a été associée à un risque moindre de FAPO, ce qui laisse croire à un effet dose-réponse (valeur de p de tendance selon le test de Mantel-Haenszel = 0,0082). Conclusions: L’utilisation de statines est associée à une réduction du risque de FAPO après le congé de l’hôpital chez les patients ayant subi une chirurgie cardiaque. L’utilisation systématique de statines à fortes doses pour prévenir la FAPO subaiguë après le congé d’hôpital mérite une étude plus approfondie.

Acromioclavicular joint injuries are common in young active patients. A wide variety of surgical techniques exist to address specific complications associated with surgery. Complications after surgery include loss of reduction, fracture of the clavicle or coracoid, failure of fixation, and prominent and symptomatic hardware. This technique aims to reduce these complications with an arthroscopic anatomic coracoclavicular ligament repair using knotless adjustable loop buttons with fifth-generation suture tape and no drilling of the coracoid.

Purpose: To determine clinical outcomes associated with micronized allogenic cartilage scaffold use for treatment of posterior glenoid cartilage defects at 2 years. Methods: A retrospective analysis of prospectively collected data was performed on a consecutive series of patients who underwent arthroscopic treatment of a symptomatic posterior glenoid cartilage defect with micronized allogenic cartilage scaffold between January 2019 and December 2020. The primary outcome was subjective shoulder value (SSV) at latest follow-up. Secondary outcomes included visual analog scale (VAS), recurrence of instability, and range of motion (ROM). Results: Seven patients, including 4 in the setting of primary posterior instability and 3 in the setting of recurrent symptoms after arthroscopic posterior glenohumeral stabilization, were included in the analysis with a mean follow up of 2.6 years (range, 2-3.7 years). Statistically significant improvements were seen in SSV (median = 40, interquartile range [IQR] = 40-50 before surgery; vs median = 85, IQR = 67.5-87.5 after surgery; P = .018) and VAS (median = 4, IQR = 4-6.3 before surgery; vs median = 1, IQR = 0-1.5 after surgery; P = .010). No significant differences were seen in ROM. There were no cases of recurrent instability or reoperation. Conclusions: The use of micronized allogenic cartilage scaffold for glenoid cartilage defects is associated with clinical improvement at 2-year follow-up. This is the case when performed in conjunction with index posterior labral repair when there is a concomitant glenoid cartilage defect or when performed in the setting of persistent pain and mechanical symptoms after prior posterior labral repair. Level of Evidence: Level IV, therapeutic case series.

MEMS heat sink having wavy microchannels integrating circular pin-fins for cooling of microelectronic chips is proposed and analyzed in this work; the pin-fins are placed at the valleys and peaks of the wavy structure. The pumping power and thermal resistance of the proposed MEMS heat sink is higher and lower than that of MEMS heat sink having straight microchannels. At Reynolds number of 250, the maximum temperature of the microelectronic chip, generating 106 W/m2, when using the proposed MEMS heat sink is only 0.77 of that when using MEMS heat sink having straight microchannels; this ratio lowers to 0.6 at Reynolds number of 1250. The thermal resistance of the proposed MEMS heat sink is only 0.72 and 0.43 of that of the MEMS heat sink having straight microchannels at Reynolds numbers of 250 and 1250, respectively. Regarding the pumping power of the proposed MEMS heat sink, it is higher than that of the MEMS heat sink having straight microchannels by 2 and 3.7 at the lowest and highest Reynolds numbers, respectively. This work also analyzes the contribution of geometric features on the behavior of the proposed MEMS heat sink in terms of maximum temperature of the microelectronic chip, thermal resistance, and pumping power as well as that of microchannel employed in the proposed MEMS heat sink in terms of Poiseuille and Nusselt numbers. Maximum temperature of the microelectronic chip and thermal resistance decrease along with increase in pumping power with increase in amplitude, diameter of pin-fins, and hydraulic diameter of microchannel as well as with decrease in wavelength. Poiseuille and Nusselt numbers increased with rise in amplitude, diameter of pin-fins, and hydraulic diameter as well as decrease in wavelength. In addition, experiments have been conducted on two designs of the proposed MEMS heat sink to generate data for purposes of validating the model. The experimental data are compared with data from simulations and the difference between the two are within the uncertainty of experimental data thereby validating the model.

Background: This study reports on the main criteria used by Canadian cardiac surgery residency program committees (RPCs) to select applicants and the perceptions of Canadian medical students interested in cardiac surgery. Methods: A 50-question online survey was sent to all 12 Canadian cardiac surgery RPCs. A similar 52-question online survey targeted at Canadian medical students interested in applying to cardiac surgery residency programs was distributed. Data from both surveys were analyzed using descriptive statistics. Results: A total of 62% of all cardiac surgery RPC members (66 of 106) participated, including committee members from all 12 programs (range: 1-12 members per program; 9%-100% response rate per program) and 67% of program directors (8 of 12). Forty-one Canadian medical students (22 pre-clerks [54%], 2 MD/PhD students [5%], and 17 clinical clerks [41%]) participated. Committee members considered the following criteria to be most important when selecting candidates: on-service clinical performance, the interview, quality of reference letters from cardiac surgeons, and completing a rotation at the target program’s institution. In contrast, the following criteria relating to the candidate were considered to be less important: wanting to practice in the city or province of training, having a connection to the program location, and personally knowing committee members. Medical students’ perceptions were concordant regarding what factors are the most important but they overestimated the influence of non-clinical factors and research productivity in increasing their competitiveness. Conclusion: Canadian cardiac surgery residency programs seek applicants who demonstrate clinical excellence, as assessed by surgical rotations and reference letters from colleagues, and strong interview performance. Résumé: Contexte: Cette étude fait état des principaux critères utilisés par les comités des programmes de résidence (CPR) canadiens en chirurgie cardiaque pour sélectionner les candidats, ainsi que des perceptions des étudiants en médecine canadiens qui s’intéressent à la chirurgie cardiaque. Méthodologie: Un sondage en ligne comptant 50 questions a été envoyé aux 12 CPR canadiens en chirurgie cardiaque. Un sondage en ligne semblable (comptant 52 questions) a été distribué aux étudiants en médecine qui souhaitaient soumettre leur candidature à un programme de résidence en chirurgie cardiaque au Canada. Les données des deux sondages ont été analysées à l’aide de statistiques descriptives. Résultats: Au total, 62 % des membres de CPR en chirurgie cardiaque (66 sur 106) ont répondu au sondage, y compris des membres des comités des 12 programmes (plage : 1 à 12 membres par programme; taux de réponse de 9 à 100 % par programme) et 67 % des directeurs de programme (8 sur 12). Au total, 41 étudiants en médecine canadiens (22 en préexternat [54 %], 2 étudiants au M.D./Ph. D. [5 %] et 17 stagiaires en formation clinique [41 %]) ont répondu au sondage. Les membres du comité ont considéré les critères suivants comme étant les plus importants dans le choix de candidats : le rendement clinique en service, l’entrevue, la qualité des lettres de recommandation de chirurgiens cardiaques et la réalisation d’un stage dans l’établissement associé au programme. En revanche, les critères suivants étaient considérés comme moins importants : le désir de pratiquer dans la ville ou la province de formation, un lien avec le lieu du programme, et la connaissance personnelle de membres du co-mité. Les perceptions des étudiants en médecine concordaient quant aux facteurs les plus importants, mais les étudiants surestimaient l’influence de facteurs non cliniques et de la productivité en recherche dans l’aspect concurrentiel de leur candidature. Conclusion: Les programmes de résidence canadiens en chirurgie cardiaque recherchent des candidats forts d’une excellence clinique, évaluée par les stages en chirurgie et les lettres de recommandation de collègues, et offrant une bonne performance en entrevue.

Background: Early evidence suggested that the impact of the COVID-19 pandemic was less severe in Africa compared to other parts of the world. However, more recent studies indicate higher SARS-CoV-2 infection and COVID-19 mortality rates on the continent than previously documented. Research is needed to better understand SARS-CoV-2 infection and immunity in Africa. Methods: In early 2021, we studied the immune responses in healthcare workers (HCWs) at Lagos University Teaching Hospital (n = 134) and Oxford-AstraZeneca COVID-19 vaccine recipients from the general population (n = 116) across five local government areas (LGAs) in Lagos State, Nigeria. Western blots were used to simultaneously detect SARS-CoV-2 spike and nucleocapsid (N) antibodies (n = 250), and stimulation of peripheral blood mononuclear cells with N followed by an IFN-γ ELISA was used to examine T cell responses (n = 114). Results: Antibody data demonstrated high SARS-CoV-2 seroprevalence of 72·4% (97/134) in HCWs and 60·3% (70/116) in the general population. Antibodies directed to only SARS-CoV-2 N, suggesting pre-existing coronavirus immunity, were seen in 9·7% (13/134) of HCWs and 15·5% (18/116) of the general population. T cell responses against SARS-CoV-2 N (n = 114) were robust in detecting exposure to the virus, demonstrating 87·5% sensitivity and 92·9% specificity in a subset of control samples tested. T cell responses against SARS-CoV-2 N were also observed in 83.3% of individuals with N-only antibodies, further suggesting that prior non-SARS-CoV-2 coronavirus infection may provide cellular immunity to SARS-CoV-2. Conclusions: These results have important implications for understanding the paradoxically high SARS-CoV-2 infection with low mortality rate in Africa and supports the need to better understand the implications of SARS-CoV-2 cellular immunity.

This article investigates fluid distribution in multichannel microfluidic devices with U-shaped manifolds. The parameters investigated include Reynolds number, microchannel width, microchannel spacing width, and microchannel length. The study is carried out using a microfluidic device having 50 microchannels employing water as the working fluid. The flow distribution in the microfluidic device is investigated for microchannel widths between 100 µm to 500 µm and for Reynolds number ranging between 0.04 to 100. The effect of channel spacing width on flow distribution is investigated for microchannel spacing widths between 100 µm to 500 µm. The increase in Reynolds number affects the flow distribution by increasing the non-uniformity of the flow. It is found that increasing the microchannel width causes more non-uniformity in the flow. It is also found that increasing the microchannel spacing width decreased the non-uniformity of the flow distribution. It is found that increasing the channel width from 100 µm to 300 µm increased the flow maldistribution by 83%, and increasing the microchannel spacing width from 100 µm to 300 µm decreased the flow maldistribution by 42%. It is observed that the microchannel width has a stronger influence on the flow distribution compared with microchannel spacing width. The study is useful for examining the flow maldistribution in microfluidic devices as their performance is dependent on flow rate.

Summary: Acidic environments reduce the intracellular pH (pHi) of most cells to levels that are sub-optimal for growth and cellular functions. Yet, cancers maintain an alkaline cytoplasm despite low extracellular pH (pHe). Raised pHi is thought to be beneficial for tumor progression and invasiveness. However, the transport mechanisms underpinning this adaptation have not been studied systematically. Here, we characterize the pHe-pHi relationship in 66 colorectal cancer cell lines and identify the acid-loading anion exchanger 2 (AE2, SLC4A2) as a regulator of resting pHi. Cells adapt to chronic extracellular acidosis by degrading AE2 protein, which raises pHi and reduces acid sensitivity of growth. Acidity inhibits mTOR signaling, which stimulates lysosomal function and AE2 degradation, a process reversed by bafilomycin A1. We identify AE2 degradation as a mechanism for maintaining a conducive pHi in tumors. As an adaptive mechanism, inhibiting lysosomal degradation of AE2 is a potential therapeutic target.

Ferroelectric materials such as BaTiO3 show tremendous potential for emerging advances in memory devices, particular neuromorphic type devices. High density of memory can be obtained by stabilising polar domain walls at the nanoscale, regions of discontinuity between the well-defined polarization order parameter, but little is known about what controls their structure and dynamics in real nanoscale materials. Indeed, chiral polar domain walls have been observed in heterogeneous ferroelectrics, such as oxygen-deficient BaTiO3, but very little is known about how such polar-domains walls interact with defects. Indeed, a critical understanding of how dynamics of domain-walls depend on point-defects is crucial to create engineered ferroelectric memory devices. We perform large-scale simulations of nansocale domain-wall dynamics in pristine and defective BaTiO3 using reactive force-field developed by us earlier (Phys. Chem. Chem. Phys., 2019, 21, 18240–18249), and capture their dynamical dependence on point defects using a graph dynamical neural-network approach, which we adapted to interrogate solids with well-defined order-parameters, and implemented using Pytorch based libraries. Our machine learning (ML) approach goes beyond the traditional post-processing methods to capture both spatial and temporal heterogeneities of large-scale molecular dynamics simulations of complex defective ferroelectric oxide materials. We crucially find that isolated oxygen vacancies introduce very localized spatial regions (∼ 1–2 unit-cell in length) that show slow dipole relaxation due to formation of defect-dipoles, and that these defect-dipoles in turn slow the intrinsic dynamics of domain walls. Further, the roughness of domain walls, also influenced by vacancies, introduce dynamic heterogeneity along the domain-wall [1]. As such we find a novel mechanism by which quenched disorder due to defects introduce dynamic heterogeneity thereby influencing response to external fields (particularly time varying fields) in a ferroelectric. Our study also emphasizes the need for creating digital twins of dynamical quantities to achieve autonomous in operando control of nanoscale switching.

The increasing cost of energy and low cost of white cabbage (WC) has made storage of white cabbage in cold storage room capital intensive, thus alternative and sustainable preservation methods are being sought. To adopt drying as a sustainable preservation method for WC, study of the heat transfer processes and energy use is very essential. This study presents the results of the drying kinetics, thermodynamic properties and energy consumption kinetics during drying of WC in hot air oven dryer (HAD) and microwave dryer (MD), as well as the reconstitution kinetics of WC. The results showed that both samples dried under a single rate drying period. The effective moisture diffusivity of HAD and MD ranges from 3.26 ×10−9to 6.07×10−9 m2s−1 and 1.23×10−8 to 4.02×10−8 m2/s, respectively. The activation energy of the samples dried in HAD and MD is 28.59933 kJmol−1K−1 and 10.026 J/g s−1, respectively. The specific energy consumption (SEC) was higher at the lowest drying temperature and microwave power level. SEC kinetic study revealed higher SEC at lower drying temperature and microwave power, and was intense right from the beginning of the drying process. Luka et al. model proved more appropriate in simulating the drying kinetic of WC. Thermodynamic analysis of the dryers revealed that the drying process was endergonic and endothermic. Drying methods and water temperature influenced the rate of reconstitution of WC.

This article details the mathematical modeling and experimental validation of a liquid based MEMS heat sink using wavy microchannels with pin-fins for cooling of microelectronic chips with heat flux of 1000 kW/m2. The characteristics of the heat sink are evaluated using thermal resistance, pumping power, Poiseuille number, and Nusselt number. Investigations are done for Reynolds number varying from 250 to 1500 for understanding the working of the proposed MEMS heat sink as well as to evaluate the contribution of different geometric parameters (amplitude, wavelength, hydraulic diameter, and diameter of pin-fins) on its performance. Over this Reynolds number range, the thermal resistance of MEMS heat sinks using wavy microchannel with pin-fins is 7–10% lower than that of MEMS heat sinks using wavy microchannel while the corresponding pumping power increased by 66–148%; at the lowest Reynolds number, the proposed MEMS heat sink reduced the maximum substrate temperature by 5 °C compared with that of MEMS heat sinks employing wavy microchannels and at the highest Reynolds number, this temperature difference is 2 °C. The influence of geometric parameters is the highest at the low Reynolds number and their influence reduces with rise in Reynolds number. It is established based on the studies that increase in amplitude, hydraulic diameter, and diameter of pin-fins lead to decrease in thermal resistance and rise in pumping power; however, rise in wavelength raises and decreases the thermal resistance and pumping power, respectively. The contribution of hydraulic diameter and wavelength to thermal resistance and pumping power is greater than that of amplitude and diameter of pin-fins. The average Poiseuille number and Nusselt number associated with many combinations of dimensions of MEMS heat sinks using wavy microchannels with pin-fins are provided in this work and this information is particularly useful for designers of the proposed MEMS heat sink.

Molecular recognition was utilized to fabricate bioinspired calcium phosphate (Ca-P) coating on bioabsorbable magnesium alloys through small biomolecules such as Vitamin C (VC). Ca-P and VC hybrid coating (Ca-PVC) was successfully fabricated on AZ31 Mg alloy. The surface morphology and chemical composition of the coatings were investigated using SEM, XRD, and FTIR together with XPS. The results showed that the Ca-PVC coating was composed of bamboo leaf-like Ca-P particles with a thickness of about three times that of the Ca-P coating. The surface roughness of the Ca-PVC coating (1.12 ± 0.12 μm) was lower than that (3.14 ± 1.93 μm) of Ca-P coating, suggesting the formation of refined Ca-P particles resulting from the VC addition. The corrosion resistance of the coated samples was characterized via electrochemical polarization, impedance spectroscopy, and immersion hydrogen evolution tests. The cell toxicity of the coated samples was evaluated utilizing mouse MC3T3-E1 pre-osteoblasts. The charge transfer resistance (Rct) of the Ca-PVC coated alloy increased as compared to the bare and Ca-P coated alloy samples. The Ca-PVC coated alloy exhibited minimal corrosion current density (1.36 × 10−6 A cm−2), which is one order of magnitude lower in comparison to that of the Ca-P coated alloy. These results confirm that VC addition greatly enhanced the coating resistance on AZ31 Mg alloy. It was also noticed that the Ca-PVC coated samples rapidly induced the formation of apatite after immersion in Hank's solution. VC was mainly transformed to L-Threonic acid, which facilitated the nucleation process of the Ca-PVC coating and significantly increased the thickness, density, and bonding strength of the coating. With enhanced corrosion resistance property and excellent biocompatibility, Ca-PVC coating has great potential for application in biodegradable Mg-based alloys.

The outcome of this review is to assess the association between pre-pregnancy obesity and PPCM incidence. There were a total of 5.373.581 participants were included in this study. Pre-pregnancy obesity was significantly associated with PPCM incidence compared to normal-weight subjects (OR = 1.79 (1.16,2.76); p = 0.008; I2 = 59%, Pheterogeneity = 0.04). The sub-group analysis showed that pre-pregnancy women with obesity class I (OR = 1.58 (1.20,2.07); p = 0.001; I2 = 0%, Pheterogeneity = 0.64) and class II and III (OR = 2.65 (2.04,3.45); p

A machine learning solution for the potential inversion problem in elastic scattering is outlined. The inversion scheme consists of two major components, a generative network featuring a variational autoencoder which extracts the targeted static two-point correlation functions from experimentally measured scattering cross sections, and a Gaussian process framework which probabilistically infers the relevant structural parameters from the inverted correlation functions. Via a case study of charged colloidal suspensions, the feasibility of this approach for quantitative study of molecular interaction is critically benchmarked and its merit over existing deterministic approaches, in terms of numerical accuracy and computationally efficiency, is demonstrated.

With new instrumentation design, robotics, and in-operando hyphenated analytical tool automation, the intelligent discovery of synthesis pathways is becoming feasible. It can potentially bridge the gap for the scale-up of new materials. We review current progress and describe a new system that uses an autonomous continuous flow chemistry framework to translate high-quality lead molecules and materials to quantities that can meet scalability demands. At the core is a continuous flow synthesis platform that can design its viable synthesis pathway to a particular molecule or material and then autonomously carry it out. This is realized by integrating: (1) A workflow/architecture for multimode chemical/materials characterization in-line. The in-line characterization modes are NMR, ESR, IR, Raman, UV-Vis, GC-MS, and HPLC, along with ex-situ modes for X-Ray and neutron scattering; (2) Integration for feedback/analysis/data storage of the control variables; (3) A core software stack that includes deep learning and reinforcement learning alongside quantum chemistry and molecular dynamics; (4) On-demand compute architectures that parse calculations to compute resources needed which include light-weight edge, mid-level edge (NVIDA DGX-2), and high-performance computing. We demonstrate preliminary results on how this autonomous reactor system can enhance our ability to deliver deuterated materials, copolymers, and site-substituted molecules.

Background & Aims: Data on the management of primary sclerosing cholangitis (PSC) in European expert centres are sparse. In this study, a PSC group from the ERN RARE-LIVER surveyed European hepatologists to uncover differences in real-life clinical practices. Methods: In April 2020 a survey questionnaire was sent to members of the International PSC Study Group and ERN RARE-LIVER. Participants were asked about the size of their PSC cohort, use of medical treatments including ursodeoxycholic acid (UDCA) and surveillance for cholangiocarcinoma, gallbladder polyps and inflammatory bowel disease (IBD). Data were presented descriptively. Results: Eighty-two of 278 members responded. Fifty percent of physicians prescribed UDCA routinely to all their patients with PSC, whereas 12% never prescribed UDCA. UDCA was used for one or more indications including: alkaline phosphatase >1.5x the upper limit of normal, severe PSC changes, pruritus, PSC-IBD or patient demand. Few physicians offered other medical treatments than UDCA. The use of medical treatments was generally comparable in small (

This work carries out an investigation on the performance of a MEMS microchannel heatsink with multiple zig-zag microchannels (MCHSzz). The heat sink is realized in silicon and uses water as the coolant. The study is conducted by employing Fluent module of Ansys Workbench. The performance of zig-zag and straight MCHS are compared for Reynolds number (Re) from 250 to 1500. The performance of the MCHS is quantified in terms of total thermal resistance (Rth) and pumping power (PPf) where Rth of zig-zag MCHS is better than that with straight microchannel; the enhanced thermal performance is achieved at the cost of increased PPf. Based on the cases studied in this work, it is observed that the relative change in Rth varied from 26% to 51% with increase in Re and the corresponding relative change in PPf varied from 40% to 120% with increase in Re. By employing zig-zag microchannels, it is possible to significantly reduce convective thermal resistance (Rth,cov), for a particular Re. Additionally, the influence of microchannel hydraulic diameter, orientation of microchannel, number of repeating units, and microchannel spacing are studied in this work. It is identified that the Rth and PPf over the considered range of Re decreased and increased, respectively, regardless of the geometric parameters. Additionally, Rth decreased with increase in geometric parameters for a specific Reynolds value until a threshold value beyond which no changes occur.

In the last decade, the atomically-focused electron beams utilized in scanning transmission electron microscopes (STEMs) have been shown to induce a broad set of local structural transformations in materials, opening pathways for directing material synthesis and modification atom-by-atom. The mechanisms underlying these transformations remain largely unknown, due to the intractability of modeling the myriad of reaction pathways that can be accessed through high-energy electron scattering. The information on materials’ structure and dynamics that can be extracted from STEM images is similarly left underexplored. Here, we report the observation of anomalous on-site dynamics of individual silicon impurity atoms in graphene during STEM imaging. Density functional theory-based structural optimizations of anisotropically-strained molecular nanographenes reveal two distinct (but nearly degenerate) stable structures for four-fold coordinated silicon impurities, where interconversion between the two structures manifests slight changes of the silicon position within the lattice site. Implications for defect-based strain engineering in graphene are discussed.

Background: There has been a rise in the incidence of injection drug use and associated infective endocarditis. Methods: The clinical outcomes of 39 patients admitted with injection drug use–associated infective endocarditis were collected with a mean follow-up of 14 months. The outcomes were compared for patients treated medically with those undergoing surgical intervention. Results: The mean age was 39 ± 11 years; 54% were female. Thirty-two patients (82%) had native and 7 (18%) prosthetic infective endocarditis. The tricuspid valve was affected in 17 patients (43%), the mitral in 10 (26%), the aortic in 4 (10%), and multiple valves in 8 (20%). Sixteen (41%) patients underwent surgery, and 23 (59%) were treated with medical therapy. The indications for surgery included heart failure, systemic emboli, recurrent infection, and vegetation size ≥10 mm. Patients undergoing surgery had a higher rate of paravalvular abscess (25% vs 0%, P = 0.02), valve perforation (37% vs 11%, P = 0.04), and mitral valve involvement (44% vs 13%, P = 0.06), whereas medically treated patients had higher tricuspid valve involvement (61% vs 19%, P = 0.02). During follow-up, 26% of medical and 31% of surgical cohort patients died (P = 0.7). Mortality was highest (54%) among those who continued medical management despite an indication for surgery. Univariate predictors of mortality were age (odds ratio [OR] 1.09, 95% confidence interval [CI]: 1.01-1.17; P = 0.02), heart failure (OR 6.9; 95% CI: 1.24-37.49; P = 0.02), septicemia (OR 4.40; 95% CI:0.99-19.54; P = 0.05), and shock (OR 10.8; 95% CI: 1.68-69.92; P = 0.01). Conclusions: Despite contemporary therapy, patients with injection drug use–associated infective endocarditis remain at high risk of complications and poor clinical outcomes. These findings highlight the need for developing new care pathways and a team approach for effective management. Résumé: Introduction: Il y a eu une augmentation de l’incidence de l’endocardite infectieuse associée à l’usage de drogues par injection. Méthodes: Nous avons recueilli au cours d’un suivi moyen de 14 mois les résultats cliniques de 39 patients admis en raison d’une endocardite infectieuse associée à l’usage de drogues par injection. Les résultats ont été comparés pour les patients traités médicalement avec ceux subissant une intervention chirurgicale. Résultats: L’âge moyen était de 39 ± 11 ans; 54 % étaient des femmes. Trente-deux patients (82 %) avaient une endocardite infectieuse sur valve native et 7 (18 %), une endocardite infectieuse sur prothèse valvulaire. La valve tricuspide était touchée chez 17 patients (43 %), la valve mitrale, chez 10 patients (26 %), la valve aortique, chez 4 patients (10 %), et plusieurs valves, chez 8 patients (20 %). Seize (41 %) patients ont subi une intervention chirurgicale, et 23 (59 %) ont reçu un traitement médical. Les indications d’intervention chirurgicale étaient les suivantes : l’insuffisance cardiaque, les embolies systémiques, l’infection récurrente et la taille de la végétation ≥ 10 mm. Les patients qui avaient subi une intervention chirurgicale ont plus fréquemment eu des abcès paravalvulaires (25 % vs 0 %, P = 0,02), des perforations de valves (37 % vs 11 %, P = 0,04) et des atteintes de la valve mitrale (44 % vs 13 %, P = 0,06), tandis que les patients qui avaient reçu un traitement médical ont plus fréquemment eu des atteintes de la valve tricuspide (61 % vs 19 %, P = 0,02). Durant le suivi, 26 % des patients de la cohorte du traitement médical et 31 % des patients de la cohorte de l’intervention chirurgicale sont morts (P = 0,7). La mortalité était plus élevée (54 %) chez les patients qui poursuivaient la prise en charge médicale malgré l’indication chirurgicale. Les prédicteurs univariés de la mortalité étaient l’âge (rapport de cotes [RC] 1,09, intervalle de confiance [IC] à 95 % : 1,01-1,17; P = 0,02), l’insuffisance cardiaque (RC 6,9; IC à 95 % : 1,24-37,49; P = 0,02), la septicémie (RC 4,40; IC à 95 % : 0,99-19,54; P = 0,05) et le choc (RC 10,8; IC à 95 % : 1,68-69,92; P = 0,01). Conclusions: En dépit de l’approche thérapeutique contemporaine, les patients atteints d’une endocardite infectieuse associée à l’usage de drogues par injection restent exposés à un risque élevé de complications et de mauvais résultats cliniques. Ces résultats illustrent la nécessité d’élaborer de nouveaux cheminements cliniques et une approche du travail en équipe pour assurer une prise en charge efficace.