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• In those with cardiac amyloidosis and heart failure-related cardiogenic shock, there was significant augmentation of cardiac index after intra-aortic balloon pump (IABP) and significant decreases in left ventricular and right ventricular filling pressures. • Predictors of lack of response to IABP by cardiac index were a smaller baseline left ventricular end-diastolic diameter size per centimeter and higher pre-IABP systemic vascular resistance. • Most patients with Society for Cardiovascular Angiography and Interventions stage C heart failure-related cardiogenic shock were stabilized successfully and bridged to advanced therapies with IABP alone. In those with heart failure-related cardiogenic shock (HF-CS), an intra-aortic balloon pump (IABP) may improve hemodynamics and be useful as a bridge to advanced therapies. We explore whether those with cardiac amyloidosis and HF-CS might experience hemodynamic improvement and describe the hemodynamic response after IABP. We retrospectively identified consecutive patients with a diagnosis of cardiac amyloid, either light chain or transthyretin, who were admitted to our intensive care unit with HF-CS. Patients were excluded if an IABP was placed during heart transplant or for shock related to acute myocardial infarction. Invasive hemodynamics before and after IABP placement were assessed. We identified 23 patients with cardiac amyloid who had an IABP placed for HF-CS. The 1-year survival rate was 74% and most (65%) were bridged to heart transplant, although 1 patient was bridged to destination left ventricular assist device. After IABP, the mean arterial pressure, cardiac index, and cardiac power index were significantly increased, whereas mean right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure were all significantly decreased. A smaller left ventricular end-diastolic diameter (per cm) was associated with a higher likelihood of a cardiac index of <2.2 L/min/m2 after IABP (odds ratio 0.16, 95% confidence interval 0.01–0.93, P =.04). IABP significantly improved cardiac index while decreasing right atrial pressure, mean pulmonary artery pressure, and pulmonary capillary wedge pressure in cardiac amyloidosis patients with HF-CS. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] The integrity of the airway epithelium is guarded by the airway basal cells that serve as progenitor cells and restore wounds in case of injury. Basal cells are a heterogenous population, and specific changes in their behavior are associated with chronic barrier disruption—mechanisms that have not been studied in detail in allergic rhinitis (AR). We aimed to study basal cell subtypes in AR and healthy controls. Single-cell RNA sequencing (scRNA-Seq) of the nasal epithelium was performed on nonallergic and house dust mite–allergic AR patients to reveal basal cell diversity and to identify allergy-related alterations. Flow cytometry, immunofluorescence staining, and in vitro experiments using primary basal cells were performed to confirm phenotypic findings at the protein level and functionally. The scRNA-Seq, flow cytometry, and immunofluorescence staining revealed that basal cells are abundantly and heterogeneously present in the nasal epithelium, suggesting specialized subtypes. The total basal cell fraction within the epithelium in AR is increased compared to controls. scRNA-Seq demonstrated that potentially beneficial basal cells are missing in AR epithelium, while an activated population of allergy-associated basal cells is more dominantly present. Furthermore, our in vitro proliferation, wound healing assay and air–liquid interface cultures show that AR-associated basal cells have altered progenitor capacity compared to nonallergic basal cells. The nasal basal cell population is abundant and diverse, and it shifts toward a diseased state in AR. The absence of potentially protective subtypes and the rise of a proinflammatory population suggest that basal cells are important players in maintaining epithelial barrier defects in AR. [ABSTRACT FROM AUTHOR]

Impaired upper limb movements are a key feature in dyskinetic cerebral palsy (CP). However, information on how specific movement patterns relate to manual ability, performance and underlying movement disorders is lacking. Insight in these associations may contribute to targeted upper limb management in dyskinetic CP. This study aimed to explore associations between deviant upper limb movement patterns and (1) manual ability, (2) severity of dystonia/choreoathetosis, and (3) movement time/trajectory deviation during reaching and grasping. Participants underwent three-dimensional upper limb analysis during reaching forwards (RF), reaching sideways (RS) and reach-and-grasp vertical (RGV) as well as clinical assessment. Canonical correlation and regression analysis with statistical parametric mapping were used to explore associations between clinical/performance parameters and movement patterns (mean and variability). Thirty individuals with dyskinetic CP participated (mean age 16±5 y; 20 girls). Lower manual ability was related to higher variability in wrist flexion/extension during RF and RS early in the reaching cycle (p < 0.05). Higher dystonia severity was associated with higher mean wrist flexion (40–82 % of the reaching cycle; p = 0.004) and higher variability in wrist flexion/extension (31–75 %; p < 0.001) and deviation (2–14 %; p = 0.007/60–73 %; p = 0.006) during RF. Choreoathetosis severity was associated with higher elbow pro/supination variability (12–19 %; p = 0.009) during RGV. Trajectory deviation was associated with wrist and elbow movement variability (p < 0.05). Current novel analysis of upper limb movement patterns and respective timings allows to detect joint angles and periods in the movement cycle wherein associations with clinical parameters occur. These associations are not present at each joint level, nor during the full movement cycle. This knowledge should be considered for individualized treatment strategies. • Statistical parametric mapping provides insight in the relation of kinematics and clinical parameters. • Higher movement variability around the wrist joint was associated with lower manual ability. • Higher dystonia severity related to higher wrist flexion in the second part of the reaching cycle. • Higher choreoathetosis severity related to higher movement variability at the elbow. [ABSTRACT FROM AUTHOR]

To validate the educational value of a newly created learning application in enhancing prostate MRI training of radiologists for detecting prostate cancer using an observer study. An interactive learning app, LearnRadiology, was developed using a web-based framework to display multi-parametric prostate MRI images with whole-mount histology for 20 cases curated for unique pathology and teaching points. Twenty new prostate MRI cases, different from the ones used in the web app, were uploaded on 3D Slicer. Three radiologists (R1: radiologist; R2, R3: residents) blinded to pathology results were asked to mark areas suspected of cancer and provide a confidence score (1–5, with 5 being high confidence level). Then after a minimum memory washout period of 1 month, the same radiologists used the learning app and then repeated the same observer study. The diagnostic performance for detecting cancers before and after accessing the learning app was measured by correlating MRI with whole-mount pathology by an independent reviewer. The 20 subjects included in the observer study had 39 cancer lesions (13 Gleason 3 + 3, 17 Gleason 3 + 4, 7 Gleason 4 + 3, and 2 Gleason 4 + 5 lesions). The sensitivity (R1: 54% → 64%, P = 0.08; R2: 44% → 59%, P = 0.03; R3: 62% → 72%, P = 0.04) and positive predictive value (R1: 68% → 76%, P = 0.23; R2: 52% → 79%, P = 0.01; R3: 48% → 65%, P = 0.04) for all 3 radiologists improved after using the teaching app. The confidence score for true positive cancer lesion also improved significantly (R1: 4.0 ± 1.0 → 4.3 ± 0.8; R2: 3.1 ± 0.8 → 4.0 ± 1.1; R3: 2.8 ± 1.2 → 4.1 ± 1.1; P < 0.05). The web-based and interactive LearnRadiology app learning resource can support medical student and postgraduate education by improving diagnostic performance of trainees for detecting prostate cancer. [ABSTRACT FROM AUTHOR]

To validate the educational value of a newly created learning application in enhancing prostate MRI training of radiologists for detecting prostate cancer using an observer study. An interactive learning app, LearnRadiology, was developed using a web-based framework to display multi-parametric prostate MRI images with whole-mount histology for 20 cases curated for unique pathology and teaching points. Twenty new prostate MRI cases, different from the ones used in the web app, were uploaded on 3D Slicer. Three radiologists (R1: radiologist; R2, R3: residents) blinded to pathology results were asked to mark areas suspected of cancer and provide a confidence score (1–5, with 5 being high confidence level). Then after a minimum memory washout period of 1 month, the same radiologists used the learning app and then repeated the same observer study. The diagnostic performance for detecting cancers before and after accessing the learning app was measured by correlating MRI with whole-mount pathology by an independent reviewer. The 20 subjects included in the observer study had 39 cancer lesions (13 Gleason 3 + 3, 17 Gleason 3 + 4, 7 Gleason 4 + 3, and 2 Gleason 4 + 5 lesions). The sensitivity (R1: 54% → 64%, P = 0.08; R2: 44% → 59%, P = 0.03; R3: 62% → 72%, P = 0.04) and positive predictive value (R1: 68% → 76%, P = 0.23; R2: 52% → 79%, P = 0.01; R3: 48% → 65%, P = 0.04) for all 3 radiologists improved after using the teaching app. The confidence score for true positive cancer lesion also improved significantly (R1: 4.0 ± 1.0 → 4.3 ± 0.8; R2: 3.1 ± 0.8 → 4.0 ± 1.1; R3: 2.8 ± 1.2 → 4.1 ± 1.1; P < 0.05). The web-based and interactive LearnRadiology app learning resource can support medical student and postgraduate education by improving diagnostic performance of trainees for detecting prostate cancer. [ABSTRACT FROM AUTHOR]

Diabetes Technology Society assembled a panel of clinician experts in diabetology, cardiology, clinical chemistry, nephrology, and primary care to review the current evidence on biomarker screening of people with diabetes (PWD) for heart failure (HF), who are, by definition, at risk for HF (Stage A HF). This consensus report reviews features of HF in PWD from the perspectives of 1) epidemiology, 2) classification of stages, 3) pathophysiology, 4) biomarkers for diagnosing, 5) biomarker assays, 6) diagnostic accuracy of biomarkers, 7) benefits of biomarker screening, 8) consensus recommendations for biomarker screening, 9) stratification of Stage B HF, 10) echocardiographic screening, 11) management of Stage A and Stage B HF, and 12) future directions. The Diabetes Technology Society panel recommends 1) biomarker screening with one of two circulating natriuretic peptides (B-type natriuretic peptide or N-terminal prohormone of B-type natriuretic peptide), 2) beginning screening five years following diagnosis of type 1 diabetes (T1D) and at the diagnosis of type 2 diabetes (T2D), 3) beginning routine screening no earlier than at age 30 years for T1D (irrespective of age of diagnosis) and at any age for T2D, 4) screening annually, and 5) testing any time of day. The panel also recommends that an abnormal biomarker test defines asymptomatic preclinical HF (Stage B HF). This diagnosis requires follow-up using transthoracic echocardiography for classification into one of four subcategories of Stage B HF, corresponding to risk of progression to symptomatic clinical HF (Stage C HF). These recommendations will allow identification and management of Stage A and Stage B HF in PWD to prevent progression to Stage C HF or advanced HF (Stage D HF). [ABSTRACT FROM AUTHOR]

Evidence for modulating the sodium chloride (NaCl) intake of patients hospitalized with acute heart failure (AHF) is inconclusive. Salt restriction may not benefit; hypertonic saline may aid diuresis. To compare the safety and efficacy of oral NaCl during intravenous (IV) diuretic therapy in renal function and weight. Seventy hospitalized patients with AHF who were being treated with IV furosemide infusion consented to receive, randomly, 2 grams of oral NaCl or placebo 3 times a day in a double-blind manner during diuresis. Treatment efficacy (bivariate primary endpoints of change in serum creatinine levels and change in weight) was measured at 96 hours, and adverse safety events were tracked for 90 days. Sixty-five patients (34 NaCl, 31 placebo) were included for analysis after 5 withdrew. A median of 13 grams of NaCl was given compared to placebo. At 96 hours, there was no significant difference between treatment groups with respect to the primary endpoint (P = 0.33); however, the trial was underpowered, and there was greater than expected standard deviation in weight change. The mean change in creatinine levels and weight was 0.15 ± 0.44 mg/dL and 4.6 ± 4.2 kg in the placebo group compared with 0.04 ± 0.40 mg/dL and 4.0 ± 4.3 kg in the NaCl group (P = 0.30 and 0.57, respectively). Across efficacy and safety endpoints, we observed no significant difference between the 2 groups other than changes in serum sodium levels (-2.6 ± 2.7 in the placebo group and -0.3 ± 3.3 mEq/L in the NaCl group; P < 0.001) and in serum blood urea nitrogen levels (11 ± 15 in the placebo group; 3.1 ± 13 mEq/L in the NaCl group; P = 0.025). In this single-center study, liberal vs restrictive oral sodium chloride intake strategies did not impact the safety and efficacy of intravenous diuretic therapy in patients with AHF. (ClinicalTrials.gov registration NCT04334668.) [Display omitted] [ABSTRACT FROM AUTHOR]

The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use. To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery. Single healthcare system. PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test–Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation. There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score. Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse. • 15.3% of candidates were consuming alcohol at risky levels. • The majority with a positive PEth test denied recent alcohol use. • PEth testing may provide utility over self-reported alcohol use. [ABSTRACT FROM AUTHOR]

Climate change presents profound challenges to marine ecosystems and fisheries, necessitating effective management and adaptive strategies. Simultaneously, marine fisheries exacerbate climate change by emitting greenhouse gases through fuel combustion and electricity consumption. This article reviews 142 studies on the bidirectional interactions between climate change and marine fisheries (ICCMF), utilizing bibliometric methods including co-occurrence network analysis, cluster analysis, and conceptual framework analysis to identify research trends, challenges, and gaps. The bibliometric analysis reveals an explosive growth in publications and patents related to ICCMF since 2020. The key themes in ICCMF research encompass: (a) the impacts of climate change on marine fisheries, (b) the contribution of marine fisheries to climate change, (c) stakeholder perceptions and responses to climate change, and (d) adaptive management strategies for climate-resilient fisheries. Notably, recent studies have increasingly focused on carbon emissions and carbon sinks in marine fishery industries, emphasizing the need for further research into carbon reduction practices to mitigate climate change. This review identifies several challenges, including geographical disparities, knowledge inequality, "parachute science" and "helicopter research," issues with data quality and management, and inadequate capacity to adapt to climate change. Key research gaps include the limited representation of perspectives from the Global South, the absence of sustained partnerships, imbalances in research collaboration, restricted data accessibility and reliability, and an inadequate understanding of fisheries' carbon emissions. This review provides valuable insights for researchers, policymakers, and stakeholders, highlighting the need for strategic management approaches to mitigate adverse impacts and promote marine ecosystem sustainability. • Comprehensive review of the bidirectional interaction between climate change and marine fisheries. • Hotspot recently was exploring carbon emissions and carbon sinks from marine fisheries. • Four major research domains were extracted based on keyword co-occurrence networks. • Most studies were in the global north; research in the global south was limited. • Insufficient data accessibility and reliability was the main gap in the research. [ABSTRACT FROM AUTHOR]

• Rigorous context analyses in seven countries over three continents. • Including different perspectives during context-analysis, prior to implementation. • Identifying anticipated challenges in Group Care implementation. • Development of a supporting tool for Group Care implementation. Despite increasing interest in Group Care worldwide, implementation is challenging. Group Care is an evidence-based perinatal care model including three core components: health assessment, interactive learning, and community building. It has several advantages for service users and providers compared to individual perinatal care. We aimed to identify anticipated challenges when implementing Group Care, and to develop a supporting tool based on these challenges. Context analyses through Rapid Qualitative Inquiries were conducted in 26 sites in seven countries to gain insight into the anticipated challenges when implementing Group Care. Data triangulation and investigator triangulation were applied. The context analyses generated 330 semi-structured interviews with service users and other stakeholders, 10 focus group discussions, and 56 review meetings with the research teams. We identified six surface structure anticipated challenges categories (content, materials, facilitators, timing, location, group composition), and five deep structure anticipated challenges categories (health assessment, scheduling Group Care into regular care, enrolment, (possible) partner organisations, financials) occurring in all participating sites, leading to the development of the Anticipated Challenges Framework. Completing the Anticipated Challenges Framework raises awareness of anticipated challenges if sustainable Group Care implementation is to succeed and encourages the initiation of a concrete action plan to tackle these challenges. Application of the framework may offer important insights to health systems administrators and other key stakeholders before implementing Group Care. In the medium- and long-term, insights gained may lead to greater possibilities for sustainability and to the most cost-effective approaches for implementing Group Care. [ABSTRACT FROM AUTHOR]

• Electrical dyssynchrony occurs in 20% of patients with cardiac amyloidosis and is more common in elderly white patients with transthyretin amyloidosis and coronary artery disease. • QRS prolongation is not determined by the degree of left ventricular wall thickness. • Electrical dyssynchrony is associated with a higher New York Heart Association class, higher risk for permanent pacemaker implant and higher risk for all-cause mortality. Conduction-system involvement in cardiac amyloidosis (CA) is common. The prevalence, clinical correlates and impact on outcome related to ventricular electrical dyssynchrony in CA remain insufficiently elucidated. Data from a prospectively maintained registry of patients with CA diagnosed in the Cleveland Clinic's amyloidosis clinic was used to determine the frequency of electrical dyssynchrony (defined as a QRS > 130 msec). The relation with the clinical profile and clinical outcome was assessed. To determine the impact of hypertrophy on QRS prolongation, a QRS-matched cohort without CA was used for comparison of cardiac magnetic resonance imaging. A total of 1140 patients with CA (39% AL, 61% TTR) were evaluated, of whom 230 (20%) had electrical dyssynchrony. The type of conduction block was predominantly a right bundle branch block (BBB, 48%) followed by left BBB (35%) and intraventricular conduction delay (17%). Presence of transthyretin amyloidosis (ATTR-CA), older age, male gender, white race, and coronary artery disease were independently (P < 0.05 for all) associated with electrical dyssynchrony, and patients were more commonly prescribed a mineralocorticoid receptor antagonist. In ATTR-CA, specifically, every increase in ATTR-CA disease stage was associated with a 1.55-fold (1.23--1.95; P < 0.001) increased odds for electrical dyssynchrony. In a subset of patients with CA who underwent cardiac magnetic resonance imaging (n = 41), left ventricular mass index was unrelated to the QRS duration (r = 0.187; P = 0.283) in CA, in contrast to a non-CA QRS-matched cohort (r = 0.397; P < 0.001). Patients with electrical dyssynchrony were more symptomatic at initial presentation, as illustrated by a higher New York Heart Association class (P = 0.041). During a median follow-up of 462 days (IQR:138--996 days), a higher proportion of patients with electrical dyssynchrony died from all-cause death (P = 0.037) or developed a permanent pacing indication (3% vs 10.4%; P < 0.001) during follow-up. Electrical dyssynchrony is common in CA, especially in ATTR-CA, and is associated with worse functional status and clinical outcome. Given the high rate of permanent pacing indications at follow-up, additional studies are necessary to determine the best monitoring and pacing strategies in CA. [Display omitted] [ABSTRACT FROM AUTHOR]

• Development non gantry mounted 'set-and-forget' QA procedure for 9 beam parameters. • Freedom to measure at all gantry angles. • The sensitivity is comparable to the scintillator detector. • Measurement time is reduced by 40%. • QA results over 12 months at our pencil beam scanning proton centre. To implement a single set-up monthly QA procedure for 9 different beam parameters at different gantry angles and evaluate its clinical implementation over a 12 month period. We developed a QA procedure using an array detector (PTW Octavius 1500XDR) embedded in a rotational unit (PTW Octavius 4D) at our proton facility. With a single set-up we can monitor field central axis position, field symmetry, field size, flatness, penumbrae, output, spot size, spot position and range at different gantry angles (AAPM TG 224). The set-up is irradiated with homogenous 2D fields with dynamic aperture and spot patterns at five gantry angles. A modular top is used to check the range consistency. Absolute γ analysis were performed to compare measured dose distributions to calculated dose. All other parameters are directly extracted from the measurements. Additionally, the sensitivity of the set-up to small changes in beam parameters were compared to the Lynx detector (IBA). Over a 12 month period, output, symmetry, and flatness were within ± 2 %; FWHM, spot positions, penumbra widths, and central axis fields were within ± 1 mm. Range differences were all within 1/2 of the energy spacing (±0.6 MeV) relative to baseline. Most (2 %, 2 mm) γ-analysis showed agreement scores higher than 90 %. The sensitivity is comparable to the Lynx detector and measurement time is reduced by 40 %. The time-efficient monthly QA procedure that we developed can accurately be used to measure a large range of beam parameters at different gantry angles, within the TG 224 AAPM recommendations. [ABSTRACT FROM AUTHOR]

The "frozen elephant trunk" (FET) technique was developed by Karck et al., who modified Borst's ET technique by using a stent graft to secure the distal ET section. Working in collaboration with Vascutek Terumo, we in Hannover Medical School introduced the 4-branched hybrid FET graft In 2012 (Thoraflex Hybrid). However, the results after open aortic arch repair mainly depend on perioperative management and patient factors. Over the years, peri-operative management and operative techniques have evolved greatly contributing to better results. We describe our surgical technique of implantation of this hybrid graft in acute aortic dissection Stanford type A, DeBakey type I (AADA DeBakey I) patients. [ABSTRACT FROM AUTHOR]

Several tricuspid annuloplasty (TA) techniques are used for concomitant repair of functional tricuspid regurgitation (TR). This study compared the midterm clinical and valvular outcome among 3 annuloplasty techniques. TA was performed in 307 patients (aged 75.9 ± 10.4 years) with a rigid ring (RA) in 184, a flexible band (FA) in 80, or a suture annuloplasty (SA) in 43. Study end points were survival and recurrence of TR >grade 2 at 5 years. TA was performed concomitantly to mitral valve surgery in 136 patients (44.3%), aortic valve surgery in 18 (5.9%), coronary artery bypass grafting in 13 (4.2%), or a combined procedure in 140 (45.6%). Most had TR >grade 2 (78.5%), without significant differences between the TA groups (P =.878). Within a median follow-up of 3.4 years (interquartile range, 2.2-5.0 years), the 5-year survival was 80.1% ± 3.4% for RA, 83.5% ± 4.7% for FA, and 85.1% ± 6.5% for SA (P =.471). Independent risk factors for late mortality were renal impairment (hazard ratio [HR], 2.83; 95% CI, 1.16-6.89; P =.022), diabetes (HR, 2.10; 95% CI, 1.07-4.11; P =.030), and severe right ventricular dysfunction by tricuspid annulus plane systolic excursion <10 mm (HR, 11.52; 95% CI, 4.98-26.66; P <.001). Pulmonary hypertension was nearly significant (HR, 1.92; 95% CI, 0.98-3.74; P =.057). The cumulative incidence of TR recurrence at 5 years was 15.9%, 19.4%, and 21.1% for RA, FA, and SA, respectively (P =.342). Severe pulmonary hypertension (HR, 2.64; 95% CI, 1.38-5.07; P =.003), preoperative TR grade (HR, 1.82; 95% CI, 1.01-3.27; P =.046), and residual TR >grade 2 at discharge (HR, 3.38; 95% CI, 1.64-6.96; P =.001) were predictive for later TR recurrence, regardless of the annuloplasty technique. This study demonstrates that advanced pathophysiological right circulatory impairment, such as severe pulmonary hypertension and right ventricular dysfunction, affects the midterm survival and TR recurrence rate more than the annuloplasty technique used for concomitant repair of functional TR. [ABSTRACT FROM AUTHOR]

The frozen elephant trunk is a standard treatment method for aortic arch pathologies extending into the descending aorta. We previously described the phenomenon of early postoperative intraluminal thrombosis within the frozen elephant trunk. We investigated the features and predictors of intraluminal thrombosis. A total of 281 patients (66% male, mean age 60 ± 12 years) underwent frozen elephant trunk implantation between May 2010 and November 2019. In 268 patients (95%), early postoperative computed tomography angiography was available to assess intraluminal thrombosis. The incidence of intraluminal thrombosis after frozen elephant trunk implantation was 8.2%. Intraluminal thrombosis was diagnosed early after the procedure (4.6 ± 2.9 days) and could be successfully treated with anticoagulation in 55% of patients. A total of 27% developed embolic complications. Mortality (27% vs 11%, P =.044) and morbidity were significantly higher in patients with intraluminal thrombosis. Our data showed a significant association of intraluminal thrombosis with prothrombotic medical conditions and anatomic slow flow features. The incidence of heparin-induced thrombopenia was higher in patients with intraluminal thrombosis (18% vs 3.3%, P =.011). Stent-graft diameter index, anticipated endoleak Ib, and degenerative aneurysm were significant independent predictors of intraluminal thrombosis. Therapeutic anticoagulation was a protective factor. Glomerular filtration rate, extracorporeal circulation time, postoperative rethoracotomy, and intraluminal thrombosis (odds ratio, 3.19, P =.047) were independent predictors of perioperative mortality. Intraluminal thrombosis is an underrecognized complication after frozen elephant trunk implantation. In patients with risk factors of intraluminal thrombosis indication for frozen elephant trunk should be carefully evaluated and postoperative anticoagulation considered. Early thoracic endovascular aortic repair extension should be considered in patients with intraluminal thrombosis to prevent embolic complications. Stent-graft designs should be improved to prevent intraluminal thrombosis after frozen elephant trunk implantation. [Display omitted] [ABSTRACT FROM AUTHOR]

The supraaortic vessel anastomosis stent bridging (SAVSTEB) technique simplifies the reattachment of the supraaortic vessels in aortic arch surgery; however, follow-up data are limited. The study aimed to investigate the stent-related performance and complications. Between February 2009 and September 2020, 112 patients underwent total arch replacement with a tetrabranched graft and using the SAVSTEB technique. Mean age was 59.3±12.7 years, and male gender prevailed. Nineteen percent of these patients had acute aortic dissection extending into the supraaortic vessels, 12% had chronically dissected vessels, and 70% had unaffected vessels. The left subclavian artery, left common carotid artery, and innominate artery were bridged in 88%, 75%, and 2%, respectively, and an aberrant right subclavian artery was bridged in 2%. Total stent experience was 341 stent-years, and stent patency was found in 98%. Technical success was achieved in all but 1 case. One percent of patients had major stent thrombosis requiring reintervention. Minor stent thrombosis was found in 2%. No endoleak was found, and the number of new-onset dissections distal to the stent was 4%. Freedom from stent-related events was estimated at 89.1% ± 0.5% at 3 years. The stroke rate was 10%, with the highest incidence among nondissected vessels. The vertebral artery was overstented in 15%, and 2% of these cases were associated radiographically with stroke. SAVSTEB is a comparatively simple, safe, and efficacious technique to create the anastomosis between tetrabranched arch grafts and the supraaortic arteries in the short and intermediate term. Bleeding from the anastomoses, kinking, and scar-associated stenosis are negligible; however, vertebral overstenting remains a critical technical issue. [Display omitted] [ABSTRACT FROM AUTHOR]

Various post-harvest processes of rice are commonly employed, especially during the off-season, to ensure its consumption feasibility, which often affect the grain quality. Different forms of drying, storage and processing of rice are evaluated to identify their effects on grain quality. Microwave drying has emerged as an alternative to the widely-used intermittent-drying and fixed-bed-dryer methods of drying paddy rice. Control of drying-air temperatures (between 40 °C and 60 °C) according to the rice variety can improve quality, especially for exotic varieties. Keeping stored grain in hygroscopic balance, with water content between 11% to 15%, at temperatures between 16 °C and 20 °C and with intergranular relative humidity near 60%, allows 12 months of storage in a controlled environment without significant deterioration. Other innovations, notably the application of artificial refrigeration to grain stored in bulk in vertical cylindrical silos and the use of impermeable packaging for storage, ensure the conservation of grain mass. The different stages and equipments used to obtain polished, brown and parboiled rice result in significant changes in the nutritional value of rice because of the removal of the outermost layers of the grains. Polishing reduces the nutritional value and physical homogeneity of rice. Brown rice retains more bioactive compounds and nutrients because it does not lose the outer layer of the grains in the polishing processes. Parboiled rice, although less nutritious than brown rice, has better grain integrity and milling yield and less loss of nutrients than white rice. [ABSTRACT FROM AUTHOR]

Sarcopenia, a prevalent syndrome in heart failure (HF) and cancer, and subcutaneous adipopenia are associated with worse outcomes; however, they have not been studied in patients suffering from HF and cancer. We hypothesized that the presence of sarcopenia and subcutaneous adipopenia are associated with worse outcomes among patients with HF and cancer hospitalized for acute decompensated HF (ADHF). We included 409 consecutive patients hospitalized for ADHF from 2017 to 2020 with computed tomography of the chest one month before the discharge date. Semi-automatic measurements were made at T12 (Figure 1A) and adjusted for height squared to obtain skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI). To compare survival, patients with cancer were further grouped based on sarcopenia (lowest sex-stratified SMI tertile cutoffs of 29.6 cm2/m2 in males and 26.7 cm2/m2 in females) and subcutaneous adipopenia (lowest sex-stratified SATI tertile cutoffs of 22.7 cm2/m2 in males and 42.1 cm2/m2 in females). The mean age of our study cohort was 72±14 years, 44% were female, and 172 (42%) had a cancer history (39.5% metastatic). There were no significant differences in SMI or SATI between patients with versus without cancer, but patients with cancer had higher all-cause mortality (HR 1.48, 95%CI 1.14-1.92, p=0.004). During a median 14.8 (1.6-30.9) months of follow-up, all-cause mortality was higher in patients with cancer with sarcopenia (72.9%) versus without (57.5%) (Figure 1); this remained significant on adjustment for age, male sex, Caucasian race, coronary artery disease (CAD), chronic kidney disease, chronic obstructive pulmonary disease (COPD), metastasis, left ventricular ejection fraction, and NT-proBNP (HR 1.66, 95%CI 1.08-2.56, p=0.021). Furthermore, after similar multivariable adjustment, higher all-cause mortality was seen in patients with cancer with subcutaneous adipopenia (69.0%) versus without (59.6%) (HR 1.61, 95%CI 1.05-2.48, p=0.029). Metastasis remained an independent predictor of mortality in both models, along with CAD, COPD, and elevated NT-proBNP. Among patients with HF and cancer, lower skeletal muscle and subcutaneous adipose tissue quantity were independently associated with increased mortality risk after adjustment for predictors of disease severity. [ABSTRACT FROM AUTHOR]

Villages are changing as a consequence of global processes of transformation, as well as a summation of small-scale and individual decisions. Village communities are challenged by the way identities change, and search for ways to reflect and exchange ideas on what has disappeared, what aspects of life remain and will be possible. Our aim was to support individual villagers in order to better understand what is changing and to collectively define a future image. The methodology of action research brings in a future-forming orientation: to discuss what might become and to reflect on what is already there. Combined with aspects of participatory design, we set up different actions in Hoepertingen, a village in Haspengouw. Through walking with villagers, generating scenarios, envisioning, enacting, prototyping and more, we assembled and compared different meaning constructs, experimented with possible solutions and developed dialogues about these scenarios. In this paper, we will discuss the ways in which these participatory actions supported us to envision how public places in villages change and generate reflection, and debate about how inhabitants can contribute to this change. • Enhancing (spatial) agency is a shared challenge for different professionals. • Large, open unbuilt spaces and small roads are potentially valuable public spaces in villages. • Villagers prioritize ownership, rather than accessible design for all. [ABSTRACT FROM AUTHOR]

Background and Aims: The accumulation of fat increases the formation of lipid peroxides, which are partly scavenged by alpha-tocopherol (α-TOH). Here, we aimed to investigate the associations between different measures of (abdominal) fat and levels of urinary α-TOH metabolites in middle-aged individuals.Methods and Results: In this cross-sectional analysis in the Netherlands Epidemiology of Obesity study (N = 511, 53% women; mean [SD] age of 55 [6.1] years), serum α-TOH and α-TOH metabolites from 24-h urine were measured as alpha-tocopheronolactone hydroquinone (α-TLHQ, oxidized) and alpha-carboxymethyl-hydroxychroman (α-CEHC, enzymatically converted) using liquid-chromatography-tandem mass spectrometry. Body mass index and total body fat were measured, and abdominal subcutaneous and visceral adipose tissue (aSAT and VAT) were assessed using magnetic resonance imaging. Using multivariable-adjusted linear regression analyses, we analysed the associations of BMI, TBF, aSAT and VAT with levels of urinary α-TOH metabolites, adjusted for confounders. We observed no evidence for associations between body fat measures and serum α-TOH. Higher BMI and TBF were associated with lower urinary levels of TLHQ (0.95 [95%CI: 0.90, 1.00] and 0.94 [0.88, 1.01] times per SD, respectively) and with lower TLHQ relative to CEHC (0.93 [0.90, 0.98] and 0.93 [0.87, 0.98] times per SD, respectively). We observed similar associations for VAT (TLHQ: 0.94 [0.89, 0.99] times per SD), but not for aSAT.Conclusions: Opposite to our research hypothesis, higher abdominal adiposity was moderately associated with lower levels of oxidized α-TOH metabolites, which might reflect lower vitamin E antioxidative activity in individuals with higher abdominal fat instead. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency (ID) is frequent and associated with diminished exercise capacity in heart failure (HF), but its contribution to unexplained dyspnea without a HF diagnosis at rest remains unclear.Methods and Results: Consecutive patients with unexplained dyspnea and normal echocardiography and pulmonary function tests at rest underwent prospective standardized cardiopulmonary exercise testing with echocardiography in a tertiary care dyspnea clinic. ID was defined as ferritin of <300 µg/L and a transferrin saturation of <20% and its impact on peak oxygen uptake (peakVO2), biventricular response to exercise, and peripheral oxygen extraction was assessed. Of 272 patients who underwent cardiopulmonary exercise testing with echocardiography, 63 (23%) had ID. For a similar respiratory exchange ratio, patients with ID had lower peakVO2 (14.6 ± 7.6 mL/kg/minvs 17.8 ± 8.8 mL/kg/min; P = .009) and maximal workload (89 ± 50 watt vs 108 ± 56 watt P = .047), even after adjustment for the presence of anemia. At rest, patients with ID had a similar left ventricular and right ventricular (RV) contractile function. During exercise, patients with ID had lower cardiac output reserve (P < .05) and depressed RV function by tricuspid s' (P = .004), tricuspid annular plane systolic excursion (P = .034), and RV end-systolic pressure-area ratio (P = .038), with more RV-pulmonary artery uncoupling measured by tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure ratio (P = .023). RV end-systolic pressure-area ratio change from rest to peak exercise, as a load-insensitive metric of RV contractility, was lower in patients with ID (2.09 ± 0.72 mm Hg/cm2 vs 2.58 ± 1.14 mm Hg/cm2; P < .001). ID was associated with impaired peripheral oxygen extraction (peakVO2/peak cardiac output; P = .036). Cardiopulmonary exercise testing with echocardiography resulted in a diagnosis of HF with preserved ejection fraction in 71 patients (26%) based on an exercise E/e' ratio of >14, with equal distribution in patients with (28.6%) or without ID (25.4%, P = .611). None of these findings were influenced in a sensitivity analysis adjusted for a final diagnosis of HFpEF as etiology for the unexplained dyspnea.Conclusions: In patients with unexplained dyspnea without clear HF at rest, ID is common and associated with decreased exercise capacity, diminished biventricular contractile reserve, and decreased peripheral oxygen extraction. [ABSTRACT FROM AUTHOR]

Polyploidy, or genome doubling, has occurred repeatedly through plant evolution. While polyploid plants are used extensively in agriculture and horticulture, they have so far found limited use in forestry. Here we review the potentials of polyploid trees under climate change, and investigate if there is support for increased use. We find that polyploid trees like other plants have consistent increases in cell sizes compared to diploids, and that leaf-area based rates of photosynthesis tend to increase with increasing levels of ploidy. While no particular trend could be discerned in terms of biomass between trees of different ploidy levels, physiology is affected by polyploidization and several studies point towards a high potential for polyploid trees to adapt to drought stress. The ploidy level of most tree species is unknown, and analysis of geographical patterns in frequencies of polyploid trees are inconclusive. Artificial polyploid trees are often created by colchicine and in a few cases these have been successfully applied in forestry, but the effects of induced polyploidization in many economically important tree species remains untested. Polyploids would also be increasingly useful in tree breeding programs, to create synthetic hybrids or sterile triploids that could control unwanted spreading of germplasm in nature. In conclusion, this review suggests that polyploid trees may be superior under climate change in some cases, but that the potential of polyploids is not yet fully known and should be evaluated on a case-to-case basis for different tree species. [Display omitted] • We reviewed contemporary literature on polyploid trees. • Although polyploidy is common, the ploidy level of many tree species is unknown. • Polyploidy alters anatomy, physiology and growth of trees, making some more stress tolerant. • Increased use of polyploid trees could be advantageous under climate change conditions. • Polyploids should be further investigated for their potential to increase productivity in forestry. [ABSTRACT FROM AUTHOR]

A 2D plane strain extended finite element method (XFEM) model was developed to simulate three-point bending fracture toughness tests for human bone conducted in hydrated and dehydrated conditions. Bone microstructures and crack paths observed by micro-CT imaging were simulated using an XFEM damage model. Critical damage strains for the osteons, matrix, and cement lines were deduced for both hydrated and dehydrated conditions and it was found that dehydration decreases the critical damage strains by about 50%. Subsequent parametric studies using the various microstructural models were performed to understand the impact of individual critical damage strain variations on the fracture behavior. The study revealed the significant impact of the cement line critical damage strains on the crack paths and fracture toughness during the early stages of crack growth. Furthermore, a significant sensitivity of crack growth resistance and crack paths on critical strain values of the cement lines was found to exist for the hydrated environments where a small change in critical strain values of the cement lines can alter the crack path to give a significant reduction in fracture resistance. In contrast, in the dehydrated state where toughness is low, the sensitivity to changes in critical strain values of the cement lines is low. Overall, our XFEM model was able to provide new insights into how dehydration affects the micromechanisms of fracture in bone and this approach could be further extended to study the effects of aging, disease, and medical therapies on bone fracture. [ABSTRACT FROM AUTHOR]

To develop and test the feasibility, reliability and validity of the Coma Recovery Scale-Revised For Accelerated Standardized Testing (CRSR-FAST), a short form of the CRS-R for use in the Intensive Care Unit (ICU). Three trained examiners completed 4 study examinations (1 CRS-R and 3 CRSR-FAST assessments) over a maximum period of 48 hours to establish concurrent validity, interrater reliability and test-retest reliability. The full-length CRS-R served as the reference standard and examiners were masked to patient diagnosis and other CRS-R findings (except for test-retest reliability). Test administration order and assignment of raters to testing condition (i.e., reliability or validity) was pseudo-randomized to prevent order effects. Intensive Care Unit at a Level I trauma center. Forty-five consecutively-enrolled patients with traumatic disorders of consciousness receiving care in the ICU. N/A. Duration of CRSR-FAST administration (feasibility); Agreement between CRSR-FAST and full-length CRS-R determination of consciousness (concurrent validity); Agreement between CRSR-FAST scores obtained by the same rater on two consecutive examinations (test-retest reliability); Agreement between CRSR-FAST scores obtained by two different raters on the same day (inter-rater reliability). Forty-five participants (mean [SD] age 44 [20] years, 67% male, 8 [5] days post injury, CRS-R Total Score = 7 [5], CRS-R range = 1-22) completed the study. The sensitivity, specificity, and accuracy of the CRSR-FAST for detecting consciousness were 81%, 89%, and 84%, respectively. Simple kappa for concurrent validity, Mak's rho for test-retest reliability and inter-rater reliability were 0.68, 0.76 and 0.91, respectively (i.e., substantial). CRSR-FAST administration time was 6.5 [3] minutes. Preliminary findings suggest that the CRSR-FAST is a feasible and valid tool for serial assessment of consciousness in the ICU. The CRSR-FAST may improve diagnostic accuracy, facilitate decision-making regarding continuation of life-sustaining therapy, aid disposition planning, and improve acute and post-acute care coordination. None. [ABSTRACT FROM AUTHOR]

Damage induced by lipid peroxidation has been associated with impaired glucose homeostasis. Vitamin E (α-tocopherol, α-TOH) competitively reacts with lipid peroxyl radicals to mitigate oxidative damage, and forms oxidized vitamin E metabolites. Accordingly, we aimed to investigate the associations between α-TOH metabolites (oxidized and enzymatic) in both circulation and urine and measures of glucose homeostasis in the general middle-aged population. This cross-sectional study was embedded in the population-based Netherlands Epidemiology of Obesity (NEO) Study. α-TOH metabolites in blood (α-TOH and α-CEHC-SO 3) and urine [sulfate (SO 3) and glucuronide (GLU) of both α-TLHQ (oxidized) and α-CEHC (enzymatic)] were quantified by liquid chromatography coupled with tandem mass spectrometry (LC/MS–MS). Measures of glucose homeostasis (HOMA-B, HOMA-IR, Insulinogenic index and Matsuda index) were obtained from fasting and postprandial blood samples. Multivariable linear regression analyses were performed to assess the associations of α-TOH metabolites and measures of glucose homeostasis. We included 498 participants (45% men) with mean (SD) age of 55.8 (6.1) years who did not use glucose-lowering medication. While blood α-TOH was not associated with measures of glucose homeostasis, urinary oxidized metabolites (α-TLHQ-SO 3 /GLU) were associated with HOMA-IR and Matsuda index. For example, a one-SD higher α-TLHQ-SO 3 was associated with 0.92 (95% CI: 0.87, 0.97) fold lower HOMA-IR and 1.06 (1.01, 1.11) fold higher Matsuda index, respectively. Similar results were obtained for the urinary α-TLHQ to α-CEHC ratio as a measure of oxidized-over-enzymatic conversion of α-TOH. Higher urinary levels of oxidized α-TOH metabolites as well as higher oxidized-to-enzymatic α-TOH metabolite ratio, but not circulating α-TOH or enzymatic metabolites, were associated with lower insulin resistance. Rather than circulating α-TOH, estimates of the conversion of α-TOH might be informative in relation to health and disease. [ABSTRACT FROM AUTHOR]

Existing research demonstrates that parity is associated with risk for obesity. The majority of those who undergo bariatric surgery are women, yet little is known about whether having children before bariatric surgery is associated with pre- and postsurgical weight outcomes. We aim to evaluate presurgical body mass index (BMI) and postsurgical weight loss among a racially diverse sample of women with and without children. Metropolitan hospital system. Women (n = 246) who underwent bariatric surgery were included in this study. Participants self-reported their number of children. Presurgical BMI and postsurgical weight outcomes at 1 year, including change in BMI (ΔBMI), percentage excess weight loss (%EWL), and percentage total weight loss (%TWL) were calculated from measured height and weight. Those with children had a lower presurgical BMI (P =.01) and had a smaller ΔBMI (P =.01) at 1 year after surgery than those without children, although %EWL and %TWL at 1 year did not differ by child status or number of children. After controlling for age, race, and surgery type, the number of children a woman had was related to smaller ΔBMI at 1 year post surgery (P =.01). Although women with children had lower reductions in BMI than those without children, both women with and without children achieved successful postsurgical weight loss. Providers should assess for number of children and be cautious not to deter women with children from having bariatric surgery. 1. Women with children had a lower pre-surgical BMI than those without children 2. Weight loss outcomes at 1-year were similar for women with and without children 3. Number of children was inversely correlated with change in BMI at 1-year [ABSTRACT FROM AUTHOR]

Background: Alterations in myocardial mitochondrial function and metabolism have been implicated in the pathophysiology of heart failure with reduced ejection fraction (HFrEF). The impact of mechanical dyssynchrony and its alleviation through cardiac resynchronization therapy (CRT) on myocardial mitochondrial function and metabolism remain poorly understood.Methods: HFrEF patients with an indication for CRT underwent targeted metabolomic analysis of 84 energetic substrates at baseline (coronary sinus and peripheral venous blood). Mitochondrial membrane potential (Ψm) as an indicator of mitochondrial function was assessed non-invasively through 99mTC-sestamibi myocardial washout. Changes in peripheral metabolism and Ψm were assessed 6-months after CRT and their association with left ventricular remodeling and peakVO2 was assessed. Principle component analysis (PCA) was used as dimension reduction strategy for metabolic analysis.Results: Forty-five HFrEF-patients underwent CRT-implant (76% male, ejection fraction 29±6%). At baseline, PCA of coronary (CS) vs peripheral blood (PB) illustrated preferred cardiac uptake of β-hydroxybutyrate (CS vs PB-ratio=-78%; p<0.005) together with anaplerotic amino-acids, and glycolytic pyruvate breakdown to lactate. Baseline Ψm-dysfunction was associated with shift away from free fatty acids oxidation (FAO). Myocardial β-hydroxybutyrate extraction strongly associated with peakVO2 (-0.836; p<0.001). CRT improved Ψm (25±5% vs 18±6%; p=0.002), in parallel with metabolic remodeling, with increased reliance on FAO, and less reliance on β-hydroxybutyrate and glycolytic pyruvate breakdown to lactate. Changes in myocardial mitochondrial function and metabolism were associated with left ventricular reverse remodeling.Conclusion: HFrEF-patients exhibit baseline mitochondrial dysfunction, which is associated with alterations in myocardial substrate utilization, including less FAO, more reliance on ketone bodies, anaplerotic amino-acids and the breakdown of glycolytic pyruvate to lactate. CRT is capable of inducing mitochondrial and metabolic reverse remodeling which is associated with cardiac morphology changes. [ABSTRACT FROM AUTHOR]

The influence of Coronavirus-2019 (COVID-19) on heart transplantation is considerable. Reports of COVID-19 infection in recently transplanted patients are scarce. We present a 60-year-old male patient with COVID-19 infection, diagnosed 6 days after transplantation. His clinical course revealed 2 phases. Initially, there were mild respiratory symptoms for which he was treated with remdesivir and noninvasive respiratory support. In a second phase with clinical deterioration on postoperative day 22, further respiratory decline led to the administration of convalescent plasma, with satisfactory response and further improvement of his condition. [ABSTRACT FROM AUTHOR]

Findings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking. This study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery. This study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites. Participants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015–2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery. Compared to presurgery, fewer patients' PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P <.001; 14.3% versus 5.1%) and 2 years postsurgery (P <.0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P <.0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P <.001), with a trend toward statistical significance at 2 years (P =.06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P <.001) and 2 years (P <.0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points. This study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction. • Prevalence of clinical depression was lower post-operatively than pre-operatively. • Prevalence of clinical depression increased from year 1 to year 2, post-operatively. • Depression was associated with less weight loss. • Depression was associated with lower patient satisfaction. [ABSTRACT FROM AUTHOR]

Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. Single bariatric center. Patients (N = 567) who underwent bariatric surgery from 2014–2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2–4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy. - Some patients undergoing bariatric surgery have limited cognitive abilities - Limited health literacy and numeracy influence weight loss outcomes - Limited abilities may be more important during the weight maintenance period [ABSTRACT FROM AUTHOR]

Background: Discontinuous intrarenal venous flow patterns, as assessed by renal Doppler ultrasound examination, are associated with changes in hemodynamics such as volume expansion and poorer diuretic response in patients with heart failure (HF). We aimed to study intrarenal venous and arterial flow patterns after decongestive treatment in patients with acute HF.Methods and Results: Fifteen patients with acute HF were enrolled. Intrarenal venous and arterial flow patterns were assessed at baseline, 1 hour after administration of loop diuretics, at day 2 and day 3. Among patients hospitalized for acute HF, 13 (87%) had a discontinuous venous flow pattern at admission. After decongestive treatment, a significant improvement of the venous impedance index (P = .021) and venous discontinuity index (P = .004) was observed at day 3 compared with baseline. There was no effect on the intrarenal arterial flow patterns.Conclusions: In patients who exhibit discontinuous renal venous flow patterns hospitalized for decongestive treatment owing to acute HF led to a normalization of intrarenal venous flow to a continuous pattern. [ABSTRACT FROM AUTHOR]

Progressive autograft dilation and need for later reoperation remain major concerns of the Ross procedure. The study investigates the clinical outcome after the Ross operation, including a longitudinal analysis of autograft dimensions over 25 years. From November 1991 to April 2019, 137 patients underwent a Ross procedure at the University Hospitals of UCL (Université catholique de Louvain)-Brussels and Ghent. Inclusion criteria were less than or equal to 18 years of age and pulmonary autograft implantation by root replacement. Outcome focused on survival, reoperation rate, and autograft size evolution through linear mixed-model analysis. A Ross or Ross-Konno operation was performed in 110 (80%) and 27 (20%) patients at a median age of 10.4 (interquartile range [IQR], 4.7-14.3) years and 0.5 (IQR, 0.04-5.2) years, respectively. Overall 10-year and 20-year survival was 87% ± 3% and 85% ± 3%, respectively, but was 93% ± 3% for isolated Ross patients. Right ventricular outflow tract–conduit exchange was required in 20.3%, whereas autograft-related reoperation was performed in 14 (10.7%) patients at a median interval of 14 (IQR, 9-16) years, for aortic regurgitation (n = 2) and autograft dilation (n = 12). Autograft z-values increased significantly at the sinus and sinotubular junction (STJ) compared with the annulus (annulus = 0.05 ± 0.38/y, sinus = 0.14 ± 0.25/y, STJ = 0.17 ± 0.34/y; P =.015). The z-value slope for autograft dimensions was significantly steeper for Ross-Konno vs Ross patients (annulus: P =.029; sinus: P <.001; STJ: P =.012), and for children having aortic arch repair (annulus: P =.113, sinus: P =.038; STJ: P =.029). The Ross operation offers children requiring aortic valve replacement an excellent survival perspective, with an acceptable risk of autograft reoperation within the first 25 years. Contrary to the autograft annulus, dilation of the sinus and STJ size is of concern. Closer surveillance of autograft dimensions might be required in patients who underwent a Ross-Konno procedure or aortic arch reconstruction. [ABSTRACT FROM AUTHOR]

Background: Large longitudinal studies on change in directly measured peak oxygen uptake (VO2peak) is lacking, and its significance for change of cardiovascular risk factors is uncertain. We aimed to assess ten-year change in VO2peak and the influence of leisure-time physical activity (LTPA), and the association between change in VO2peak and change in cardiovascular risk factors.Methods and Results: A healthy general population sample had their VO2peak directly measured in two (n = 1431) surveys of the Nord-Trøndelag Health Study (HUNT3; 2006-2008 and HUNT4; 2017-19). Average ten-year decline in VO2peak was non-linear and progressed from 3% in the third to about 20% in the eight decade in life and was more pronounced in men. The fit linear mixed models including an additional 2,933 observations from subjects participating only in HUNT3 showed similar age-related decline. Self-reported adherence to LTPA recommendations was associated with better maintenance of VO2peak, with intensity seemingly more important than minutes of LTPA with higher age. Adjusted linear regression analyses showed that one mL/kg/min better maintenance of VO2peak was associated with favorable changes of individual cardiovascular risk factors (all p ≤ 0.002). Using logistic regression one mL/kg/min better maintenance of VO2peak was associated with lower adjusted odds ratio of hypertension (0.95 95% CI 0.92 to 0.98), dyslipidemia (0.92 95% CI 0.89 to 0.94), and metabolic syndrome (0.86 95% CI 0.83 to 0.90) at follow-up.Conclusions: Although VO2peak declines progressively with age, performing LTPA and especially high-intensity LTPA is associated with less decline. Maintaining VO2peak is associated with an improved cardiovascular risk profile. [ABSTRACT FROM AUTHOR]

Characterize the temporal profile of recovery of communication after severe brain injury. Retrospective cohort study. Inpatient rehabilitation hospital. Patients with severe acquired brain injury and no evidence of communication on the Coma Recovery Scale-Revised (CRS-R) (N=175). Time from injury to recovery of intentional communication (IC, inconsistent yes/no responses) and functional communication (FC, consistent and accurate yes/no responses) on the CRS-R Communication subscale. Patients (N=175) were included in the primary observation period of the first 8 weeks of inpatient rehabilitation (median [interquartile range, IQR]: 48 [27-61] years old, 105 men, 28 [21-38] days postinjury, 100 traumatic etiology). Fifty-four patients (31%) did not recover IC or FC. Thirty patients (17%) recovered IC only (median [IQR] days from injury to IC= 40 [34-54]), 72 patients (41%) recovered IC followed by FC (days from injury to FC=50 [42-61]), and 19 patients (11%) recovered FC without first recovering IC (43 [32-63]). The patients who recovered neither IC nor FC within 8 weeks of admission were admitted to rehabilitation later than those who recovered IC and/or FC (P <.01). Sixteen patients who did not recover communication within 8 weeks of admission to rehabilitation subsequently recovered FC prior to discharge. In patients with severe brain injury receiving inpatient rehabilitation, discernible yes-no responses emerged approximately 6 weeks postinjury and became reliable 1 week later. Approximately 1 in 3 patients did not demonstrate IC or FC within 8 weeks of admission to rehabilitation, although 33% of these individuals recovered communication prior to discharge. In total, 61% of patients recovered FC prior to discharge from rehabilitation. • Recovery of communication after severe acquired brain injury was investigated in an inpatient rehabilitation setting. • Half of patients recover functional communication within 7 weeks postinjury. • Referral to rehabilitation in severe acute cases should be encouraged because late recovery of communication is possible. [ABSTRACT FROM AUTHOR]

Based on the unusual characteristics of the male pedipalp and male genital morphology, a new genus and new species of Gagrellinae harvestmen, Thunbergia gretae n. gen. n. sp. (male and female) from Shaanxi Province, China, is proposed. The tibia and tarsus of the pedipalp form elaborate palpal claws, resembling gaspipe pliers, probably used to grasp the legs or the pedipalps of the female during courtship. There is no comparable modification of the pedipalp in the female. The penis lacks wing or sac-like (saccate) elements normally present in Gagrellinae, and the penis base is markedly inflated to form a bulb-like structure harbouring the penis muscle. Two or three opisthosomal tergites are fused to the opisthosomal scute and, in combination, cause the male and female bodies to appear elongated and slender. Three further species belong to Thunbergia n. gen., namely Thunbergia grandis (Roewer 1912), Thunbergia wangi (Zhu & Song 1999) and Thunbergia zhui (Zhang & Zhang 2013). The genus Melanopa Thorell, 1889, to which the new species T. gretae n. sp. superficially seems to belong, is re-defined by revision of the type species from Burma (now Myanmar). With respect to courtship behaviour morphological interdependence of penial and of pedipalpal structures within Gagrellinae and Leiobuninae are addressed. [ABSTRACT FROM AUTHOR]

To investigate the influence of the presence of a tracheostomy tube to assess pain with the Nociception Coma Scale-Revised (NCS-R) in patients with disorders of consciousness (DOC). A cohort study in which patients were evaluated at a single time point. Patients were evaluated in a tertiary care hospital. Patients (N=125) (unresponsive wakefulness syndrome [UWS]: 46 patients, minimally conscious state [MCS]: 74 patients, emerging from MCS [eMCS]: 5 patients, mean age: 46±16y, time since injury: 817±1280d) in a convenience sample were evaluated with the NCS-R after noxious stimulation. Not applicable. We compared the NCS-R scores of patients with and without tracheostomy with a Mann-Whitney U test. A secondary outcome was to evaluate the influence of the presence of a tracheostomy on the previously described cutoff score of 2. The presence of a tracheostomy was associated with lower verbal subscores (P =.002) as well as total scores (P =.039). The cutoff score of 2 remained valid for the group of patients with tracheostomy with a high sensitivity (71.43%) and specificity (89.29%), as well as when we excluded the verbal subscore of the NCS-R (sensitivity=83.2% and specificity=92.4%). Our study confirms the validity of the NCS-R in DOC patients with a tracheostomy. However, the presence of a nonspeaking tracheostomy should be clearly mentioned when applying the NCS-R, because it significantly lowers the verbal subscore. • The Nociception Coma Scale-Revised (NCS-R) has been developed to assess nociception in patients with disorders of consciousness. • Verbal and total scores of the NCS-R are lower in patients with a tracheostomy. • Facial and motor subscores do not differ between patients with or without tracheostomy. • NCS-R scores should be cautiously interpreted in the presence of tracheostomy. • However, our findings support the use of the NCS-R in real clinical practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the effect of congestion and decongestive therapy on left atrial (LA) mechanics and to determine the relationship between LA improvement after decongestive therapy and clinical outcome in immediate or chronic heart failure with reduced ejection fraction (HFrEF). LA mechanics are affected by volume/pressure overload in decompensated HFrEF. A total of 31 patients with HFrEF and immediate heart failure (age 64 ± 15 years, 74% male, left ventricular ejection fraction 20 ± 12%) underwent serial echocardiography during decongestive therapy with simultaneous hemodynamic monitoring. LA function was assessed by strain (rate) imaging. Patients were re-evaluated 6 weeks after discharge and prospectively followed up for the composite endpoint of heart failure readmission and all-cause mortality. LA reservoir function was markedly reduced at baseline and improved with decongestion (peak atrial longitudinal strain from 6.4 ± 2.2% to 8.8 ± 3.0% and strain rate from 0.29 ± 0.11 s–1 to 0.38 ± 0.13 s–1), independent of changes in left ventricular global longitudinal strain, LA end-diastolic volume, and mitral regurgitation severity (p < 0.001). Both measures continued to rise at 6 weeks (up to 13.4 ± 6.1% and 0.50 ± 0.19 s–1, respectively; p < 0.001). LA pump strain rate only increased 6 weeks after discharge (–0.25 ± 0.12 s–1 to –0.55 ± 0.29 s–1; p < 0.010). Changes in LA mechanics correlated with changes in wedge pressure (r = –0.61; p < 0.001). Lower peak atrial longitudinal strain values after decongestion were associated with increased risk for the composite endpoint of heart failure and mortality (p < 0.019). LA reservoir and booster function, while severely impaired during immediate decompensation, significantly improve during and after decongestive therapy. Poor LA reservoir function after decongestion is associated with worse outcome. [ABSTRACT FROM AUTHOR]

This study assessed the impact of right-atrial (RA) pacing on left-atrial (LA) physiology and clinical outcome. Data for the effects of RA pacing on LA synchronicity, function, and structure after cardiac resynchronization therapy (CRT) are scarce. The effect of RA pacing on LA function, morphology, and synchronicity was assessed in a prospective imaging cohort of heart failure (HF) patients in sinus rhythm with a guideline-based indication for CRT. Additionally, in a retrospective outcome cohort of consecutive HF patients undergoing CRT implantation, the relationship to RA pacing was assessed using various outcome endpoints. High versus low atrial pacing burden was defined as atrial pacing above or below 50% in both cohorts. A total of 36 patients were included in the imaging cohort (68 ± 11 years of age). Six months after CRT, patients with high RA pacing burden showed less improvement in LA maximum and minimum volumes and total emptying fraction (p < 0.05). Peak atrial longitudinal strain and reservoir and booster strain rates but not conduit strain rate improved after CRT in patients with low RA pacing burden but worsened in patients with high RA pacing burden (p < 0.05 for all). A high RA pacing burden induced significant intra-atrial dyssynchrony (maximum opposing wall delay: 44 ± 13 ms vs. 97 ± 17 ms, respectively; p = 0.022). A total of 569 patients were included in the outcome cohort. After covariate adjustments were made, a high RA pacing burden was associated with reduced LV reverse remodeling (β = 8.738; 95% confidence interval [CI]: 3.101 to 14.374; p = 0.002) and new-onset or recurrent atrial fibrillation (41% vs. 22%, respectively, at a median of 31 months [range 22 to 44 months follow-up]; p < 0.001). There were no differences in time to first HF hospitalization or all-cause mortality (p = 0.185) after covariate adjustment. However, in a recurrent event analysis, HF readmissions were more common in patients exposed to a high RA pacing burden (p = 0.003). RA pacing in CRT patients negatively influences LA morphology, function, and synchronicity, which is associated with worse clinical outcome, including diminished LV reverse remodeling, increased risk for new-onset or recurrent AF and heart failure readmission. Strategies reducing RA pacing burden may be warranted. [ABSTRACT FROM AUTHOR]

We report on a large series of patients treated at the S. Orsola Hospital, University of Bologna (Bologna, Italy) and Hannover Medical School (Hannover, Germany), with the aim to evaluate the early and midterm results. Between January 2007 and March 2017, 437 patients underwent total aortic arch replacement with the frozen elephant trunk technique. The frozen elephant trunk prostheses used were the custom-made Chavan-Haverich (Hanover, Germany) (n = 27, 6%), Jotec E-vita open (Jotec Inc, Hechingen, Germany) (n = 192, 44%), and Vascutek Thoraflex-Hybrid (Vascutek, Inchinnan, Scotland) (n = 218, 50%). The main indications were thoracic aortic aneurysm (n = 135, 31%), chronic aortic dissection (n = 182, 41.6%), and acute aortic dissection (n = 120, 27.5%). Overall in-hospital mortality was 14.9%, and permanent neurologic deficit and spinal cord injury were 10.8% and 5.5%, respectively. Patients with chronic aortic dissection presented a better in-hospital mortality rate than the thoracic aortic aneurysm and acute aortic dissection groups. Independent risk factors for mortality in the overall population were prolonged cardiopulmonary bypass time, age, urgent/emergency surgery, and Marfan syndrome. The median (p25, p75) follow-up time was 2.6 (1.4-4.4) years, and the mortality rate was 7.01 (95% confidence interval, 5.7-8.7) per 100 patient-years. A total of 86 patients (23.1%) required an additional procedure during the follow-up; 61 (16.3%) required endovascular extensions, and 25 (6.7%) required aortic surgery. The frozen elephant trunk technique is a treatment option for all complex pathologies of the thoracic aorta. Patients with thoracic aortic aneurysms presented a higher mortality rate, and in patients with acute aortic dissection, the malperfusion syndrome still remains a catastrophic complication. The midterm follow-up showed satisfactory results in terms of survival and freedom from reintervention. [ABSTRACT FROM AUTHOR]

We aimed to determine the proportion of "fit" versus "vulnerable" older patients with cancer included in phase II and III oncology registration trials, as compared to the proportions in a real life oncology setting. Trial and patient characteristics of older (≥70 years) patients treated at the OECI-designated clinical cancer centre in Kortrijk and included in a phase II or III oncology registration trial were collected retrospectively. These patients were matched individually with randomly-selected patients from the general oncology setting, based on gender, age, tumour type, tumour stage, and treatment intent. Patients' fitness, based on routine Geriatric-8 (G8) screening, was retrieved from prospectively constructed databases. Between November 2012 and October 2018, 218 older patients with cancer were included in a phase II or III oncology registration trial. Of those, 41 cases with a mean age of 76.0 years were included in the analyses. A Fisher's Exact Test revealed a statistical significant difference between cases and matched controls, with a higher proportion of "fit" patients included in phase II or III oncology registration trials compared to the proportion in the matched control group (respectively 70.7% and 41.5%, p <.010). We provide evidence for the hypothesis that older patients included in phase II or III oncology trials are significantly fitter than the real life oncology population. Some form of geriatric evaluation should be integrated in future cancer clinical trials to enable stratification according to this parameter and allow subgroup analysis. This will broaden the application and interpretation of trial results. [ABSTRACT FROM AUTHOR]