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This study investigated the potential of A 2 Zr 2 O 7 pyrochlore phase oxides (A = La, Ce, Nd, and Gd) as solid oxide fuel cell (SOFC) electrolyte materials. A 2 Zr 2 O 7 ceramics were synthesized using the sol-gel process, and their disordered pyrochlore structure was confirmed by X-ray Diffraction and Rietveld refinement. Field Emission Scanning Electron Microscopy (FE-SEM) was used to examine the morphology of the materials, while X-Ray Photoelectron Spectroscopy (XPS) confirmed a high oxygen ion concentration. UV–Vis Diffuse Reflectance Spectroscopy (DRS) and density of states calculations consistently showed similar bandgap patterns in all zirconate pyrochlore. Density Functional Theory (DFT) simulations provided insights into the electronic structure and migration pathways. A two-probe conductivity study confirmed the relation between the ionic conductivity and ordering degree of pyrochlore. At 750 °C, LZO, CZO, and GZO exhibited ionic conductivity values of 5.44 × 10−3 S/cm, 3.00 × 10−3 S/cm, and 2.01 × 10−3 S/cm respectively, while NZO demonstrated a conductivity of 1.27 × 10−2 S/cm at 700 °C, which is higher than that of the other samples. This study favours the use of the sol-gel route for processing zirconate pyrochlore materials, highlighting its ability to achieve high densities at lower temperatures and exhibit enhanced ionic conductivity. A 2 Zr 2 O 7 has emerged as a promising oxide-ion conducting solid electrolyte for intermediate temperature SOFC applications within the 600–750 °C temperature range. [Display omitted] [ABSTRACT FROM AUTHOR]

Patients with hemophilia frequently require supplementary interventions, either invasive (suturing, gel foam, or cauterization) or non-invasive (fibrin sealant/glue), to attain hemostasis post dental procedures. This study aimed to compare the efficacy of fibrin sealant against traditional methods for achieving hemostasis post dental surgery. The medical records of patients with factor VIII or IX deficiency, or von Willebrand disease, who underwent dental procedures in the Department of Dentistry, Seth GSMC and KEM Hospital, were evaluated for inclusion in this retrospective matched cohort study. Cohort-1 included those treated with a fibrin sealant (Tisseel Lyo) with/without traditional hemostatic measures post-procedure, while cohort-2 (controls) included those in whom no fibrin sealant was used. A total of 128 patients, 64 in each group, were evaluated. There was no statistically significant difference in demographics, disease-related variables, dental complaints, or preoperative treatment given between the groups. However, there was a significant reduction (P < 0.001) in the requirement for secondary procedures for hemostasis (suturing, gel foam application, and/or cauterization) and postoperative requirement for factor replacement (P = 0.003) in the fibrin glue group as compared to the controls. In this study, fibrin sealant demonstrated superior efficacy in mitigating the necessity for active hemostasis control. [ABSTRACT FROM AUTHOR]

There is accumulating evidence of the presence of Cancer Stem Cells (CSCs) within meningiomas (MGs). In the present study, we assessed the Immunohistochemistry (IHC) expression of stem cell markers SOX2, OCT4, CD133 in different grades of MGs and their correlation with Ki 67 index. A cross-sectional analytical study where 140 MGs cases were graded and classified according to WHO-2021 classification. IHC for SOX2, OCT4, CD133 and Ki-67 was carried out. Out of 140 cases, 59 cases (42.1%) showed OCT4 positivity, 38 cases (27.1%) showed CD133 positivity and only 21 cases (15%) showed SOX2 positivity. Ki 67 index ranged from 1-30%. Statistically significant difference (Chi Square p-value <0.001) was found between SOX 2, OCT4 and CD133 expressions (positive/negative) and the grades of MG cases. As the grades of MG cases increased, the positive expression of SOX2, OCT 4 and CD 133 also increased. The Mean Ki 67 index value was significantly raised when SOX2, OCT 4 and CD 133 IHC expressions were positive (Student t Test p-value <0.001). Our results strongly support the hypothesis of presence of CSCs, in MGs regardless of their grade. We recommend that CSCs IHC markers (SOX2, OCT4 and CD133) to be used on initial diagnosis in all cases of MGs along with Ki-67 index. It can help quantitate CSCs and in turn, recommend closer follow up in patients with high percentage of CSCs to predict early recurrence. [ABSTRACT FROM AUTHOR]

The development of low-cost, highly effective, environmentally friendly, multi-functional bio-cidal substances has become a top priority in the current scenario. This study aimed to create low-cost materials, such as green-engineered magnesium oxide (GEMgO) and chitosan-coated magnesium oxide (GECsMgO) nanoparticles (NPs), using Chara zeylanica Klein ex Willd extract as a reducing agent. The X-ray diffraction results confirmed the cubic face-centered structure of the GEMgO and GECsMgO NPs. The field emission scanning electron microscopy and transmission electron microscopy results showed that GEMgO and GECsMgO NPs exhibit a spherical structure and nanoflakes with spherical structures, respectively. The Mg–O stretching frequencies were measured at 779 and 456 cm−1 for GEMgO and 543 cm−1 for GECsMgO NPs in the Fourier-transform infrared spectra. The oxygen vacancies responsible for the biocidal activities of GEMgO and GEC-MgO NPs were observed in their photoluminescence spectra at 501 and 520 nm and at 506 and 524 nm, respectively. The antioxidant activity of GEMgO and GECsMgO NPs was investigated using a DPPH assay. The GECsMgO NPs exhibited higher scavenging activity than the GEMgO NPs. Antibacterial studies on gram-negative bacteria treated with GEMgO and GECsMgO NPs showed that GECsMgO NPs exhibited the highest antibacterial activity. The ultrastructural morphological results of E. coli showed that GECsMgO NPs can damage it better than GEMgO NPs. An MTT assay determined that GEC-MgO NPs had better anticancer properties than GEMgO NPs when tested against a blood cancer cell line (MOLT-7). Fibroblast L929 cell toxicity tests showed that GEC-MgO NPs were less toxic than GEMgO NPs. In the future, GECsMgO NPs can be used as biocidal agents in clinical and industrial applications. • GEMgO and GECsMgO nanoparticles were synthesized using the Green Engineering method. • GECsMgO NPs exhibit higher antibacterial activity against gram-negative bacteria than GEMgO NPs. • GECsMgO NPs exhibit potential anticancer activity against blood cancer cell lines. • GECsMgO NPs were less harmful to fibroblast cells than GEMgO NPs. [ABSTRACT FROM AUTHOR]

This study focused on the stabilization of lean premixed flames of n-butane/H 2 /air with swirl/bluff-body. The research explored four different hydrogen fractions (0, 20%, 40%, and 80%) at a constant equivalence ratio and Reynolds number. The turbulent reacting flow was resolved using a combination of Delayed Detached Eddy Simulation (DDES) and Flamelet Generated Manifold (FGM) model. The velocity fields and reaction zones were obtained through Particle Image Velocimetry (PIV) and OH* chemiluminescence measurements respectively. H 2 addition to n-butane significantly enhanced flame characteristics. The chemiluminescence imaging showed that the flame base became stronger with increasing hydrogen addition, reducing the risk of flame lift-off. Hydrogen addition not only increased the overall reaction rate but also changed the combustion intensity at the nozzle exit from weak to strong, which is crucial for flame stabilization. Interestingly, no flashback was observed even at 80% H 2 addition to n-butane at the same level of power rating. The flow strain rate analysis of the PIV measurements showed that the inclusion of hydrogen skewed the strain rate probability density functions towards the positive side, indicating an increase in the burning rate. The results demonstrate a progressive increase in preferential diffusion of H 2 from reactants to products as the H 2 enrichment in the fuel rises and resulted in a more intense flame. Also, the present simulation results were validated with the PIV data, and they showed good agreement. Specifically, an 80% H 2 blend exhibited a 16% peak enhancement in flame surface density compared to pure n-butane while concurrently reducing CO 2 emissions by 23.2%. The incorporation of H 2 also led to the increased vortex strength and strain rate within the flame. • H 2 addition changed the nature of the flame base from a weaker to a stronger one. • H 2 induced a double helical vortex structure in the flame with strong vorticity. • The preferential diffusion effect was dominant only at an 80% addition of H 2. • The CO 2 emissions were significantly reduced by 23.2% with 80% H 2. [ABSTRACT FROM AUTHOR]

To address patient health literacy, the American Medical Association and the National Institutes of Health recommend that readability of patient education materials should not exceed an eighth grade reading level. However, patient-facing materials often remain above the recommended average reading level. Current online calculators provide readability scores; however, they lack the ability to provide text-specific feedback, which may streamline the process of simplifying patient materials. The purpose of this study was to evaluate Chat Generative Pretrained Transformer (ChatGPT) 3.5 as a tool for optimizing patient-facing hand surgery education materials through reading level analysis and simplification. The readability of 18 patient-facing hand surgery education materials was compared by a traditional online calculator for reading level and ChatGPT 3.5. The original excerpts were then entered into ChatGPT 3.5 and simplified by the artificial intelligence tool. The simplified excerpts were scored by the same calculators. The readability scores for the original excerpts from the online calculator and ChatGPT 3.5 were similar. The simplified excerpts' scores were lower than the originals, with a mean of 7.28, less than the maximum recommended 8. The use of ChatGPT 3.5 for the purpose of simplification and readability analysis of patient-facing hand surgery materials is efficient and may help facilitate the conveyance of important health information. ChatGPT 3.5 rendered readability scores comparable with traditional readability calculators, in addition to excerpt-specific feedback. It was also able to simplify materials to the recommended grade levels. By confirming ChatGPT3.5's ability to assess and simplify patient education materials, this study offers a practical solution for potentially improving patient comprehension, engagement, and health outcomes in clinical settings. [ABSTRACT FROM AUTHOR]

This work investigates the hydrogen embrittlement (HE) behavior of Nickel-201 alloy using experimental and numerical approaches. In experimentation, the effect of electrochemical hydrogen charging on the deformation behavior of tensile oligocrystals is investigated at different strain rates. Irrespective of the strain rate levels, all the hydrogen-charged tensile oligocrystals exhibited intergranular (IG) fracture exclusively along the random high-angle grain boundaries (RHAGBs). At the same time, no crack was observed along the coincident site lattice (CSL) Σ 3 type grain boundaries. The absence of an interconnected grain boundary network, lower stress levels, and insensitivity of H-induced IG fracture to the strain rate levels of investigated FCC oligocrystals (with low lattice hydrogen diffusion coefficient) established the insignificance of dynamic H-redistribution toward HE. In numerical simulations, a crystal plasticity-phase field fracture finite element model simulates the macroscopic tensile response and corresponding microscopic fracture evolution behavior for hydrogen-free and hydrogen-charged tensile oligocrystals. The experimental results corroborated by numerical simulations, validate that the reduction in fracture energy of RHAGBs, induced by hydrogen segregation through thermodynamic equilibrium during hydrogen charging prior to deformation, is the dominating factor governing HE. • Hydrogen embrittlement (HE) of Ni- oligocrystals at various strain rate is investigated. • Experimental results are corroborated by crystal plasticity-phase field fracture simulations. • H-induced intergranular fracture initiated and propagated along the RHAGBs only. • H-segregation by thermodynamic equilibrium established prior to deformation governs the HE. [ABSTRACT FROM AUTHOR]

—Hydrogen can be produced through water electrolysis using photovoltaic (PV) power in a way that is both pollution-free and friendly to the environment, rendering hydrogen a clean energy source. Proton Exchange Membrane (PEM) water electrolysis is an efficient hydrogen generation process because of its compact design, fast response, high efficiency and high current density. The fast fluctuations in solar power, however, are difficult for PEM water electrolysers to control effectively. To address the problems caused by intermittent power, a system for producing hydrogen consisting of a solar panel, battery, and commercial PEM electrolyser, alongside an electrical control strategy, is proposed. The Maximum Power Point Tracking (MPPT) Perturb and Observe (P&O) technique is employed for PV systems, while a bidirectional charge controller manages the charging and discharging of the battery. A Proportional-Integral (PI) controller is also utilised for the PEM electrolyser to ensure efficient operation. This setup provides a practical solution for hydrogen production. It enhances efficiency and reduces the risk of damage to the electrolyser, thereby making the process more sustainable and reliable. The proposed approach has been validated by simulation under different conditions. A comparative analysis has also demonstrated that the proposed system can perform well despite having less PV power. When comparing systems with and without batteries for energy storage, the system with the battery for energy storage has a 10% higher energy efficiency under the same operating conditions. This suggests that adding energy storage can increase energy utilization, maintain the DC link voltage constant, and achieve stable hydrogen production. [Display omitted] • The hydrogen system incorporates a battery to reduce fluctuations in solar photovoltaic power. • The study uses a static electrical model of a commercially available proton exchange membrane electrolyser. • P&O MPPT, bidirectional charge, and PI controllers are used for optimal energy management. • Comparative analysis shows improved efficiency and hydrogen production with batteries. [ABSTRACT FROM AUTHOR]

Research on the role of transcatheter heart valve (THV) deformation and calcium distribution in patients with bicuspid aortic valves (BAVs) undergoing transcatheter aortic valve replacement (TAVR) remains limited. The aim of this study was to evaluate the impact of THV deformation on clinical outcomes in individuals with BAVs undergoing TAVR and the influence of calcium on these outcomes. In total, 229 consecutive patients with BAVs who underwent TAVR with balloon-expandable valves and had computed tomography (CT) performed 30 days post-TAVR were analyzed. Patients were stratified into 3 groups: group 1 (n = 125), with no THV underexpansion or eccentricity; group 2 (n = 69), with underexpansion or eccentricity; and group 3 (n = 35), with both. Calcium distribution was assessed using CT, and its associations with clinical outcomes, including all-cause mortality at 3 years and leaflet thrombosis at 30 days, were determined. A subgroup analysis of patients with type 1 BAVs was conducted. Group 3 exhibited higher rates of all-cause mortality than the other groups, along with the highest risk for hypoattenuated leaflet thickening at 30 days. Multivariate analysis identified annular and left ventricular outflow tract calcification as independent predictors of all-cause mortality and hypoattenuated leaflet thickening. In patients with type 1 BAVs, excessive calcification at the raphe and opposite leaflet were associated with all-cause mortality at 3 years. THV deformation post-TAVR was significantly linked to all-cause mortality in patients with BAVs. Annular and left ventricular outflow tract calcification correlated with increased risks for all-cause mortality and leaflet thrombosis. (Assessment of Transcatheter and Surgical Aortic Bioprosthetic Valve Thrombosis and Its Treatment With Anticoagulation [RESOLVE]; NCT02318342) [Display omitted] [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a serious global threat demanding innovations for effective control of pathogens. The bacterial SOS response, regulated by the master regulators, LexA and RecA, contributes to AMR through advantageous mutations. Targeting the LexA/RecA system with a novel inhibitor could suppress the SOS response and potentially reduce the occurrence of AMR. RecA presents a challenge as a therapeutic target due to its conserved structure and function across species, including humans. Conversely, LexA which is absent in eukaryotes, can be potentially targeted, due to its involvement in SOS response which is majorly responsible for adaptive mutagenesis and AMR. Our studies combining bioinformatic, biochemical, biophysical, molecular, and cell-based assays present a unique inhibitor of mycobacterial LexA, wherein we show that the inhibitor interacts directly with the catalytic site residues of LexA of Mycobacterium tuberculosis (Mtb), consequently hindering its cleavage, suppressing SOS response thereby reducing mutation frequency and AMR. [ABSTRACT FROM AUTHOR]

This study, utilising data from the World Bank Enterprise Survey, probes the diverse effects of bribery on the growth of firms in India. The central question we ask is: what motivates certain firms to engage in bribery while others abstain? Employing the endogenous switching regression model, we aim to uncover the intricacies of this heterogeneity. Our findings suggest that bribery can facilitate growth, yet there is substantial heterogeneity in its impact on firms. The impact varies across firm groups: it positively influences those engaging in bribery, while non-bribers would have experienced adverse effects if they had engaged in bribery. Thus, we observe that firms' decision to dis(engage) in bribery is influenced by the returns they derive from such a decision. This suggests that firms' decision to (dis)engage in bribery is a conscious, strategic and rational one, driven by choice rather than coercion. [ABSTRACT FROM AUTHOR]

Hip-spine syndrome (HSS) was first described in 1983 to describe the symptomatology resulting from concomitant lumbar degenerative stenosis and hip osteoarthritis. Numerous studies have sought to understand the underlying pathology and appropriate management of this syndrome. The purpose of this article is to review the literature for the specific imaging characteristics and the optimal surgical treatment of HSS. A systematic review was conducted via an electronic database search through PubMed to identify all publications related to HSS. All publications that contained data on patients who underwent surgical treatment for HSS and reported patient-reported outcome measures or radiographic data were included. Exclusion criteria consisted of publications in a language other than English, review articles, and technique articles. Fifteen articles that focused on the surgical management of HSS were identified. Of these 15 articles, 8 reported radiographic outcomes, with most reporting no significant change in spinopelvic parameters before and after surgery. Thirteen articles reported clinical outcomes, with 8 of those 13 articles identifying patient-reported outcome measures to be significantly improved following surgery. The data on the surgical management of HSS remains sparse. While there is some evidence that total hip arthroplasty in patients who previously underwent spinal fusion may have higher complication rates, there remains debate regarding which surgical problem to address first, the hip or the spine. [ABSTRACT FROM AUTHOR]

• A MAE-IC-ICP-MS method was set up to determine Se species in rice plants. • The accumulated Se by rice plants in Se(VI)-added soil was higher than that in Se(IV)-added soil. • Arsenite and As(V) facilitated the conversion of Se(IV) into Se-Cys and Se-Me. • Arsenite and As(V) had higher antagonism on Se species in Se(VI)-added soil than that in Se(IV)-added soil. • Arsenite had higher inhibiting effect on the Se species than As(V) in Se(VI)-added soil. Selenium (Se) in paddy rice is one of the significant sources of human Se nutrition. However, the effect of arsenic (As) pollution in soil on the translocation of Se species in rice plants is unclear. In this research, a pot experiment was designed to examine the effect of the addition of 50 mg As/kg soil as arsenite or arsenate on the migration of Se species from soil to indica Minghui 63 and Luyoumingzhan. The results showed that the antagonism between inorganic As and Se was closely related to the rice cultivar and Se oxidation state in soil. Relative to the standalone selenate treatment, arsenite significantly (p < 0.05) decreased the accumulation of selenocystine, selenomethionine and selenate in the roots, stems, sheaths, leaves, brans and kernels of both cultivars by 21.4%-100.0%, 40.0%-100.0%, 41.0%-100%, 5.4%-96.3%, 11.3%-100.0% and 26.2%-39.7% respectively, except for selenocystine in the kernels of indica Minghui 63 and selenomethionine in the leaves of indica Minghui 63 and the stems of indica Luyoumingzhan. Arsenate also decreased (p < 0.05) the accumulation of selenocystine, selenomethionine and selenate in the roots, stems, brans and kernels of both cultivars by 34.9%-100.0%, 30.2%-100.0%, 11.3%-100.0% and 5.6%-39.6% respectively, except for selenate in the stems of indica Minghui 63. However, relative to the standalone selenite treatment, arsenite and arsenate decreased (p < 0.05) the accumulation of selenocystine, selenomethionine and selenite only in the roots of indica Minghui 63 by 45.5%-100.0%. Our results suggested that arsenite and arsenate had better antagonism toward Se species in selenate-added soil than that in selenite-added soil; moreover, arsenite had a higher inhibiting effect on the accumulation of Se species than arsenate. [Display omitted] [ABSTRACT FROM AUTHOR]

• Sesamum indicum , a commercial oilseed crop shows less productivity during severe and recurrent drought exposure. But its wild relative S. radiatum is considered as a potential candidate for drought-resistance. • Upon exposure to drought (15 days), the wild taxa sustained cellular turgor, regulated lipid peroxidation through enhanced accumulation of osmolytes, and higher activity of antioxidants than the cultivar. • The wild taxa recovered at a faster rate upon rewatering, and can be used to improve the drought-tolerance of sesame, thereby to combat the forthcoming climate crisis. Drought is one of the most significant abiotic stresses that affect plant performance, lowers agricultural output, and, in extreme cases, results in crop loss. The major challenge faced by farmers is to ensure the production of crop varieties under extreme environmental conditions. Sesame (Sesamum indicum L.) is a traditionally important major cash crop for small and marginal farmers in some developing countries since it requires less intensive care and investment. Although sesame is considered as a resilient crop, it remains sensitive to severe drought. In this study, the morpho-physiological, biochemical, and antioxidant responses of wild and cultivar species of Sesamum viz., S. radiatum , and S. indicum subjected to different irrigation treatments such as mild (75 % Field capacity), moderate (50 % FC) and severe (25 % FC) drought and subsequent recovery (rewatered to 100 % FC) were evaluated in comparison with control groups. Present findings revealed that both species displayed differential responses to the drought stress and subsequent recovery. In particular, the wild taxa demonstrated better drought tolerance, probably due to their higher leaf-relative water content, decreased lipid peroxidation, enhanced accumulation of osmolytes, and increased activities of enzymatic and non-enzymatic antioxidants. On the other hand, the cultivar presented reduced leaf-relative water content, increased lipid peroxidation, higher electrolyte leakage, and reduced antioxidant activities, mostly at 25 % FC. Present data suggests that the cultivar was strictly exacerbated, mostly during severe water deficits; however, the wild species could re-adjust to the water deficit circumstances and recover completely. The current study implies the potential of wild species that can be used to improve the drought tolerance of commercial sesame by utilizing the same in breeding programs. [ABSTRACT FROM AUTHOR]

Copyright of Psychologie Française is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Refractive surgeries have evolved from the archaic incisional corneal procedures to the use of sophisticated femtosecond lasers and new-generation phakic intraocular lenses (pIOL) for surgical correction of refractive errors. The armamentarium of modern-day refractive surgery includes corneal-based procedures such as photorefractive keratectomy, laser-assisted in situ keratomileusis and keratorefractive lenticule extraction, as well as lensbased pIOL implantation. The current procedures are associated with a high index of efficacy and predictability, with enhanced safety and a significant reduction in sight-threatening complications. Patient counselling and case selection is imperative to achieve optimal visual outcomes and patient satisfaction. This review article provides a comprehensive overview of current refractive surgery procedures, with an emphasis on decision-making. Evolving frontiers in refractive surgeries like customised corneal ablation and presbyopia correcting pIOL are also discussed. [ABSTRACT FROM AUTHOR]

Plasmacytomas are malignant tumours characterised by abnormal monoclonal proliferation of plasma cells. They may be osseous or may arise from soft tissues. Extramedullary plasmacytoma (EMP) accounts for only 1% of all head and neck malignancies. Septal plasmacytomas are extremely rare. Here, we report a case of an 80-year-old male patient with alocalised plasmacytoma arising from the nasal septum, which was resected endoscopically, with post-op radiotherapy and no recurrence in 1 year of follow-up. A multidisciplinary approach is required for the optimal diagnosis and management. It is essential to exclude any systemic involvement before arriving at a diagnosis of solitary plasmacytoma. Depending on lesion resectability, a combined therapy is the treatment of choice. [ABSTRACT FROM AUTHOR]

Laryngopharyngeal reflux disease (LPRD) is a common condition affecting patients reporting to an otolaryngologist. However, the diagnosis of this condition is usually hinged on the combination of largely non-specific symptoms, and clinical findings on laryngoscopy. This study aimed at evaluating the utility of digital image analysis to quantitatively evaluate the severity of signs as recorded with laryngoscopy in patients of LPRD. The study group included individuals who were aged between 18 and 65 years and reported to the ENT OPD. These were then divided into two groups depending on symptoms and laryngoscopic findings. The LPRD group had symptomatic patients with an Reflux finding score (RFS) score >7. Those with an RFS of <6 were designated as the 'Normal group'. The Laryngoscopic images were recorded and analyzed using Image J software as per the set protocol. The Red Green Blue (RGB) values of the laryngoscopic images of each group were obtained and subjected to statistical analysis. 200 participants were enrolled in the study with 100 participants in the LPRD group (mean age = 46.2, 40 males, 60 females) and 100 in the control group (mean age = 43.6, 55 males, 45 females). The measured RGB values were more in the LPRD group as compared to the control group and the results were statistically significant (P < 0.001). By providing an objective value to the degree of inflammation, RGB value measurement provides a quick, economical, adaptable tool for auxiliary and corroborative information for the diagnosis of LPRD. [ABSTRACT FROM AUTHOR]

This review explores standardized clinical assessments for evaluating autonomic nervous system function. Here, we emphasize components of the autonomic medical history as the first pivotal test of the autonomic assessment. We further focus on standard noninvasive cardiovascular autonomic tests including heart rate responses to deep breathing, Valsalva maneuvers, and orthostatic challenges, along with insights from neurochemical tests and quantitative sudomotor axon reflex testing. The article also covers practical aspects of cardiovascular autonomic monitoring, including patient set-up using beat-to-beat blood pressure and ECG, specific assessment protocols, and their respective clinical interpretations that provide insight into adrenergic, cardiovagal, and sudomotor function. [ABSTRACT FROM AUTHOR]

The mechanism of vasovagal syncope (VVS) is multifaceted and involves a delicate balance within the autonomic nervous system (ANS). This review delves into the complex interplay between the ANS and VVS, elucidating the pivotal role that autonomic imbalance plays in the pathophysiology of this condition. Through a comprehensive exploration of the sympathetic and parasympathetic branches of the ANS, this review provides insights into the mechanisms that underlie VVS. In addition, this article discusses established and emerging research on the management of VVS. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is highly prevalent in the transcatheter aortic valve replacement (TAVR) population, but clear management guidelines are lacking. The aims of this study were to elucidate the prevalence and consequences of severe TR in patients with aortic stenosis undergoing TAVR and to examine the change in TR post-TAVR, including predictors of improvement and its impact on longer term mortality. Using Centers for Medicare and Medicaid Services–linked TVT (Transcatheter Valve Therapy) Registry data, a propensity-matched analysis was performed among patients undergoing TAVR with baseline mild, moderate, or severe TR. Kaplan-Meier estimates were used to assess the impact of TR on 3-year mortality. Multivariable analysis identified predictors of 30-day TR improvement. Of the 312,320 included patients, 84% had mild, 13% moderate, and 3% severe TR. In a propensity-matched cohort, severe baseline TR was associated with higher in-hospital mortality (2.5% vs 2.1% for moderate TR and 1.8% for mild TR; P = 0.009), higher 1-year mortality (24% vs 19.6% for moderate TR and 16.6% for mild TR; P < 0.0001), and 3-year mortality (54.2% vs 48.5% for moderate TR and 43.3% for mild TR; P < 0.0001). Among the patients with severe TR at baseline, 76.4% improved to moderate or less TR 30 days after TAVR. Baseline mitral regurgitation moderate or greater, preserved ejection fraction, higher aortic valve gradient, and better kidney function predicted TR improvement after TAVR. However, severe 30-day residual TR was associated with higher 1-year mortality (27.4% vs 18.7% for moderate TR and 16.8% for mild TR; P < 0.0001). Severe baseline and 30-day residual TR after TAVR are associated with increased mortality up to 3 years. This analysis identifies a higher risk group that could be evaluated for the recently approved tricuspid interventions. [Display omitted] [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Is vascular training in paediatric surgical oncology considered desirable ? A voluntary survey of work practice was undertaken with the surgeon membership of The International Society Of Paediatric Surgical Oncology (IPSO) using a structured designed questionnaire. A total of 149 IPSO surgeon members completed the survey. 57% (N = 84) of surgeons surveyed had no specific training in vascular surgery. 43% surgeons (N = 63) stated they had acquired some skills in residency training and/or with transplantation surgery. 65% (N = 96) of respondent surgeons stated that vascular surgical training must be incorporated into pediatric surgical oncology training and 27% (N = 40) agreed that it was considered desirable. 89% (N = 133) of surgeon respondents had encountered major vascular injury during work practice while operating on pediatric solid tumors. Vascular injury repairs were undertaken and attempted by pediatric surgeons though expert assistance of vascular surgeons proved crucially essential in many instances. Emergent operations included patch repairs, vessel ligation techniques and insertion of vascular graft prostheses. Interventional radiology services to arrest life-threatening hemorrhage were also reportedly utilized by respondents. Vascular injuries have significant potential for devastating patient outcomes including never event 'mortality'. The IPSO surgeon survey highlights that there are visible 'gaps' in skills training. Training to be a pediatric oncology surgeon must incorporate acquisition of skill sets proficiency in vascular surgery. [ABSTRACT FROM AUTHOR]

There is limited data on predicting successful chronic total occlusion crossing using primary antegrade wiring (AW). The aim of this study was to develop and validate a machine learning (ML) prognostic model for successful chronic total occlusion crossing using primary AW. We used data from 12,136 primary AW cases performed between 2012 and 2023 at 48 centers in the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; NCT02061436) to develop 5 ML models. Hyperparameter tuning was performed for the model with the best performance, and the SHAP (SHapley Additive exPlanations) explainer was implemented to estimate feature importance. Primary AW was successful in 6,965 cases (57.4%). Extreme gradient boosting was the best performing ML model with an average area under the receiver-operating characteristic curve of 0.775 (± 0.010). After hyperparameter tuning, the average area under the receiver-operating characteristic curve of the extreme gradient boosting model was 0.782 in the training set and 0.780 in the testing set. Among the factors examined, occlusion length had the most significant impact on predicting successful primary AW crossing followed by blunt/no stump, presence of interventional collaterals, vessel diameter, and proximal cap ambiguity. In contrast, aorto-ostial lesion location had the least impact on the outcome. A web-based application for predicting successful primary AW wiring crossing is available online (PROGRESS-CTO website) (https://www.progresscto.org/predict-aw-success). We developed an ML model with 14 features and high predictive capacity for successful primary AW in chronic total occlusion percutaneous coronary intervention. [Display omitted] [ABSTRACT FROM AUTHOR]

There are limited data available on clinical outcomes after stereotactic body radiation therapy (SBRT) for nonspinal bone metastases. We performed a systematic review and meta-analysis to characterize local control (LC), overall survival (OS), pain response rates, and toxicity after SBRT. The primary outcomes were 1-year LC, incidence of acute and late grade 3 to 5 toxicities, and overall pain response rate at 3 months. The secondary outcome was 1-year OS. The Newcastle-Ottawa scale was used for assessment of study bias, with a median score of 5 for included studies (range, 4-8). Weighted random-effects meta-analyses were conducted to estimate effect sizes. We identified 528 patients with 597 nonspinal bone lesions in 9 studies (1 prospective study and 8 retrospective observational studies) treated with SBRT. The estimated 1-year LC rate was 94.6% (95% CI, 87.0%-99.0%). The estimated 3-month combined partial and complete pain response rate after SBRT was 87.7% (95% CI, 55.1%-100.0%). The estimated combined acute and late grade 3 to 5 toxicity rate was 0.5% (95% CI, 0%-5.0%), with an estimated pathologic fracture rate of 3.1% (95% CI, 0.2%-9.1%). The estimated 1-year OS rate was 71.0% (95% CI, 51.7%-87.0%). SBRT results in excellent LC and palliation of symptoms with minimal related toxicity. Prospective investigations are warranted to further characterize long-term outcomes of SBRT for patients with nonspinal bone metastases. [ABSTRACT FROM AUTHOR]

We have studied the flash sintering behavior of high bandgap ceramics (halides) namely Lithium Fluoride (LiF), Magnesium Fluoride (MgF 2), and Sodium Chloride (NaCl). All three halides demonstrate flash sintering behavior albeit at elevated temperatures of ∼0.8 homologous temperature and a very high electric field. The achieved relative densities after flash sintering are 89 % for LiF, 88 % for MgF 2 , and 96 % for NaCl. Conductivity-temperature plots reveal a likely transition from ionic conduction to electronic conduction, exemplified by a substantial decrease in activation energy. Interestingly, despite their high bandgaps, the halides exhibit flash sintering and electronic conduction at the flash state. However, electronic conduction likely occurs due to electrochemical reduction. Evidence of electromigration is observed near the grain boundary triple points. This work also shows a likely correlation between band gap/electrode potential and onset electric field/homologous temperature during flash sintering for the first time. [ABSTRACT FROM AUTHOR]

Vosoritide is administered as a daily subcutaneous injection in children with achondroplasia. In clinical trials, families of children aged 2–4 years reported difficulty with drug administration due to child fear, pain, and distress. Study aims were to gain a better understanding of the current vosoritide administration experience in this cohort and to investigate whether topical anaesthesia and ice application prior to injections improved the child and family experience. A qualitative descriptive study design ensured in-depth understanding of family experience. Parents were interviewed to explore experience of vosoritide administration for their child at two time points, before (Phase 1) and after (Phase 2) the introduction of topical anaesthesia and ice application prior to injections. Interviews were analysed using thematic analysis. Seven families participated. Children's ages ranged from 2 years 2 months to 3 years 11 months. Five themes emerged from data analysis: (1) The reality of the burden of care; (2) Child experience as the greatest obstacle; (3) Parents juggle multiple emotional considerations; (4) Many factors may impact experience; and (5) Short-term and long-term impacts. Administration of vosoritide in this cohort presents multiple challenges for families. Factors which influenced experience differed between families. Responses to topical anaesthesia and ice application also varied between children, improving administration experience for some children and worsening experience for others. This study highlights the need for individualised care for young children receiving daily injections. Support should be provided to families to identify factors that improve experience. • Daily vosoritide injections present challenges for families and children. • Experience can be impacted by many factors, varying significantly between children. • Sensory interventions may be beneficial for some families, however may worsen the experience for others. [ABSTRACT FROM AUTHOR]

Orthognathic surgery results in the positional change of the maxilla and mandible that may affect speech. The present study evaluated the effect of combined maxillary advancement and mandibular setback surgery on articulation proficiency and speech intelligibility in patients with non-syndromic skeletal Class III malocclusion. In this prospective study, twenty-five patients with skeletal class III malocclusion and consecutively treated with Lefort-1 maxillary advancement and mandibular setback (BSSO) orthognathic surgery were included in this study. The speech sample was recorded with a digital audio tape recorder one day before surgery and at 3, 6, 9, 12 and 18 months after surgery. Three qualified and experienced speech and language pathologists evaluated articulation errors and intelligibility of speech samples. Repeated One-way analysis of variance was used to compare articulation proficiency and speech intelligibility at different time intervals. The substitution, omission, distortion and addition errors showed no significant changes at 3 months and 6 months. The total articulation errors decreased to zero at 9 months and no significant increase was observed till 18 months (P < 0.05). Speech intelligibility showed statistically non-significant improvement at any time interval. Cephalometric skeletal parameters SNA and N ḻ A°. were significantly correlated with addition and total articulation errors at 18 months follow up. The ortho-surgical treatment improves speech (decreases. articulation errors) in most of the patients usually 6–9 months post-surgery. Speech intelligibility is not affected by bimaxillary orthognathic surgery in skeletal class III patients. The articulation errors were correlated to changes in position of maxilla. [Display omitted] [ABSTRACT FROM AUTHOR]

Conduction disturbances requiring a permanent pacemaker (PPM) are a frequent complication of transcatheter aortic valve replacement (TAVR) with few reports of rates, predictors, and long-term clinical outcomes following implantation of the third-generation, balloon-expandable SAPIEN 3 (S3) transcatheter heart valve (THV). The aim of this study was to investigate the rates, predictors, and long-term clinical outcomes of PPM implantation following TAVR with the S3 THV. The current study included 857 patients in the PARTNER 2 S3 registries with intermediate and high surgical risk without prior PPM, and investigated predictors and 5-year clinical outcomes of new PPM implanted within 30 days of TAVR. Among 857 patients, 107 patients (12.5%) received a new PPM within 30 days after TAVR. By multivariable analysis, predictors of PPM included increased age, pre-existing right bundle branch block, larger THV size, greater THV oversizing, moderate or severe annulus calcification, and implantation depth >6 mm. At 5 years (median follow-up 1,682.0 days [min 2.0 days, max 2,283.0 days]), new PPM was not associated with increased rates of all-cause mortality (Adj HR: 1.20; 95% CI: 0.85-1.70; P = 0.30) or repeat hospitalization (Adj HR: 1.22; 95% CI: 0.67-2.21; P = 0.52). Patients with new PPM had a decline in left ventricular ejection fraction at 1 year that persisted at 5 years (55.1 ± 2.55 vs 60.4 ± 0.65; P = 0.02). PPM was required in 12.5% of patients without prior PPM who underwent TAVR with a SAPIEN 3 valve in the PARTNER 2 S3 registries and was not associated with worse clinical outcomes, including mortality, at 5 years. Modifiable factors that may reduce the PPM rate include bioprosthetic valve oversizing, prosthesis size, and implantation depth. [Display omitted] [ABSTRACT FROM AUTHOR]

Generative adversarial network (GAN)-generated image detection is a crucial yet challenging problem. The advancement of diverse generative models makes it simpler to build realistic synthetic images, but it also increases the likelihood of using images maliciously. Recent techniques of fake image detection often overfit to specific GANs, incapable of generalizing to other GANs. Each GAN leaves its distinct fingerprint on the images it generates. We propose a simple and compact attention network that exploits high-frequency and noise residual patterns of images. We design two-channel image representations in the preprocessing phase, with one channel using a bilateral high pass filter (BiHPF) for high-frequency patterns and the other using photo response non-uniformity (PRNU) for noise residuals capturing from GAN-generated and real images. The feature maps pass through the attention network with a dense layer for classification tasks. We assess the generalizability and robustness of the model through extensive experiments. The model is evaluated on a benchmark dataset in various settings, including cross-category, cross-GAN models with varying class settings and different color manipulations. This study demonstrates that the proposed model outperforms state-of-the-art (SOTA) methods by approximately 5% in different experiment settings. • Each GAN leaves a distinctive noise imprint on the images it generates. • A simple and small two-channel CNN framework based on an attention mechanism. • The RGB image is transformed into a 2-channel image by using BiHPF and PRNU. • These features are then used as input to the CNN classifier. • A generalized and robust model evaluated in cross-category and cross-GAN. [ABSTRACT FROM AUTHOR]

To describe the characteristics and outcomes of older (65+) Medicare beneficiaries with traumatic brain injury (TBI) treated in inpatient rehabilitation facilities between 2013 and 2018. Descriptive study using IRF Patient Assessment Instrument (IRF-PAI) data reporting trends of the sociodemographic and clinical characteristics and outcomes of inpatient rehabilitation facilities Medicare patients with TBI. Inpatient rehabilitation facilities in the United States. 99,804 older Medicare fee-for-service and Medicare Advantage patients with TBI (N=99,804). Not applicable. Length of stay, self-care, and mobility functional outcomes, discharge destination. The number of older Medicare beneficiaries with TBI treated in inpatient rehabilitation facilities increased from 14,657 in 2013 to 18,791 in 2018, an increase of 28.2%. In addition to this overall increase in patients, we also found the percentage of men increased slightly (52.9% to 54.8%), there was a higher percentage of patients with tier 3 comorbidities, there was a decrease in the variability of length of stay, there was slightly more self-care and mobility improvement and a slightly higher percentage of patients discharged to the community (67.8% in 2013 and 71.6% in 2018). Newer standardized data showed that prior to the injury, more than one-third used a walker and more than three-quarters had a history of recent falls. Between 2013 and 2018, the number of Medicare beneficiaries with TBI treated in IRFs increased by approximately 28%. The characteristics of IRF older patients with TBI changed between 2013 and 2018 toward a slightly higher proportion of men, more comorbidities, and a higher percentage being discharged home after inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. By the predicted PPM method (PPM P), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPM M), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPM P (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P =.03) or severe PPM P (38.8%, P =.02). Using the PPM M method, there was no difference between the no (17.7%) and moderate PPM M groups (21.1%) in the primary outcome (P =.16). However, those with no PPM M or moderate PPM M were improved compared with severe PPM M (27.4%, P <.001 and P =.02, respectively). Severe PPM analyzed by PPM P was only 2.1% for surgical aortic valve replacement patients. The PPM M method overestimated the incidence of severe PPM relative to PPM P , but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical. [ABSTRACT FROM AUTHOR]

This review article provides a comprehensive overview of the fundamentals, modelling approaches, experimental studies, and challenges associated with hydrogen gas flow in pipelines. It elucidates key aspects of hydrogen gas flow, including density, compressibility factor, and other relevant properties crucial for understanding its behavior in pipelines. Equations of state are discussed in detail, highlighting their importance in accurately modeling hydrogen gas flow. In the subsequent sections, one-dimensional and three-dimensional modelling techniques for gas distribution networks and localized flow involving critical components are explored. Emphasis is placed on transient flow, friction losses, and leakage characteristics, shedding light on the complexities of hydrogen pipeline transportation. Experimental studies investigating hydrogen pipeline transportation dynamics are outlined, focusing on the impact of leakage on surrounding environments and safety parameters. The challenges and solutions associated with repurposing natural gas pipelines for hydrogen transport are discussed, along with the influence of pipeline material on hydrogen transportation. Identified research gaps underscore the need for further investigation into areas such as transient flow behavior, leakage mitigation strategies, and the development of advanced modelling techniques. Future perspectives address the growing demand for hydrogen as a clean energy carrier and the evolving landscape of hydrogen-based energy systems. [Display omitted] • Hydrogen gas characteristics are useful to model flow in pipelines. • Flammability, embrittlement, and leak risks associated with hydrogen pose challenges in transportation. • Temperature variation and pressure drop across critical components are important aspects of pipeline design. [ABSTRACT FROM AUTHOR]

Rural patients face known healthcare disparities and worse cardiovascular outcomes compared to urban residents due to inequitable access and delayed care. Few studies have assessed rural-urban differences in outcomes following Transcatheter Aortic Valve Implantation (TAVI). We compared short-term post-TAVI outcomes between rural and urban patients. We performed a retrospective analysis of n = 413 patients who underwent TAVI at our large academic medical center, between 2011 and 2020 (rural/urban patients = 93/320. Rural/urban males = 53/173). Primary outcomes were all-cause mortality and cardiovascular mortality. Secondary outcomes included stroke/transient ischemic attack, myocardial infarction, atrial fibrillation, acute kidney injury, bleeding, vascular complications, and length of stay. The mean age in years was 77 [IQR 70–82] for rural patients and 78 [IQR 72–84] for urban patients. Baseline characteristics were similar between groups, except for a greater frequency of active smokers and diabetics as well as a greater body mass index in the rural group. There were no statistically significant differences in all-cause or cardiovascular mortality between the groups. There was also no statistically significant difference in secondary outcomes. Rural and urban patients had no statistically significant difference in all-cause mortality or cardiovascular mortality following TAVI. Given its minimally invasive nature and quality-centric, multidisciplinary care provided by the TAVI Heart Teams, TAVI may be the preferred modality for the treatment of severe aortic stenosis in rural populations. • Rural patients face known healthcare disparities and worse outcomes compared to urban residents due to inequitable access and delayed care. • Few studies have assessed rural-urban differences in outcomes following transcatheter aortic valve implantation. • This study compared all-cause and cardiac mortality between rural and urban patients following transcatheter aortic valve implantation. • Rural and urban patients had no statistically significant difference in all-cause mortality or cardiovascular mortality. • Transcatheter aortic valve implantation may be the preferred modality for the treatment of severe aortic stenosis in rural populations. [ABSTRACT FROM AUTHOR]

Impaired cholesterol efflux and/or uptake can influence arterial lipid accumulation leading to atherosclerosis. Here, we report that tripartite motif-containing protein 13 (TRIM13), a RING-type E3 ubiquitin ligase, plays a role in arterial lipid accumulation leading to atherosclerosis. Using molecular approaches and KO mouse model, we found that TRIM13 expression was induced both in the aorta and peritoneal macrophages (pMφ) of ApoE−/− mice in response to Western diet (WD) in vivo. Furthermore, proatherogenic cytokine interleukin-1β also induced TRIM13 expression both in pMφ and vascular smooth muscle cells. Furthermore, we found that TRIM13 via ubiquitination and degradation of liver X receptor (LXR)α/β downregulates the expression of their target genes ABCA1/G1 and thereby inhibits cholesterol efflux. In addition, TRIM13 by ubiquitinating and degrading suppressor of cytokine signaling 1/3 (SOCS1/3) mediates signal transducer and activator of transcription 1 (STAT1) activation, CD36 expression, and foam cell formation. In line with these observations, genetic deletion of TRIM13 by rescuing cholesterol efflux and inhibiting foam cell formation protects against diet-induced atherosclerosis. We also found that while TRIM13 and CD36 levels were increased, LXRα/β, ABCA1/G1, and SOCS3 levels were decreased both in Mφ and smooth muscle cells of stenotic human coronary arteries as compared to nonstenotic arteries. More intriguingly, the expression levels of TRIM13 and its downstream signaling molecules were correlated with the severity of stenotic lesions. Together, these observations reveal for the first time that TRIM13 plays a crucial role in diet-induced atherosclerosis, and that it could be a potential drug target against this vascular lesion. [ABSTRACT FROM AUTHOR]

An accurate prognosis of renal function decline in Autosomal Dominant Polycystic Kidney Disease (ADPKD) is crucial for early intervention. Current biomarkers used are height-adjusted total kidney volume (HtTKV), estimated glomerular filtration rate (eGFR), and patient age. However, manually measuring kidney volume is time-consuming and subject to observer variability. Additionally, incorporating automatically generated features from kidney MRI images, along with conventional biomarkers, can enhance prognostic improvement. To address these issues, we developed two deep-learning algorithms. Firstly, an automated kidney volume segmentation model accurately calculates HtTKV. Secondly, we utilize segmented kidney volumes, predicted HtTKV, age, and baseline eGFR to predict chronic kidney disease (CKD) stages > =3A, > =3B, and a 30% decline in eGFR after 8 years from the baseline visit. Our approach combines a convolutional neural network (CNN) and a multi-layer perceptron (MLP). Our study included 135 subjects and the AUC scores obtained were 0.96, 0.96, and 0.95 for CKD stages > =3A, > =3B, and a 30% decline in eGFR, respectively. Furthermore, our algorithm achieved a Pearson correlation coefficient of 0.81 between predicted and measured eGFR decline. We extended our approach to predict distinct CKD stages after eight years with an AUC of 0.97. The proposed approach has the potential to enhance monitoring and facilitate prognosis in ADPKD patients, even in the early disease stages. [ABSTRACT FROM AUTHOR]

Rhinoplasty enhances facial symmetry and functionality. However, the accurate and reliable quantification of nasal defects pre-surgery remains an ongoing challenge. This study introduces a novel approach for defect quantification using 2D images and artificial intelligence, providing a tool for better preoperative planning and improved surgical outcomes. A pre-trained AI model for facial landmark detection was utilised on a dataset of 250 images of male patients aged 18 to 24 who underwent rhinoplasty for cosmetic nasal deformity correction. The analysis concentrated on 36 different distances between the facial landmarks. These distances were normalised using min-max scaling to counter image size and quality variations. Post-normalisation, statistical parameters, including mean, median, and standard deviation, were calculated to identify and quantify nasal defects. The methodology was tested and validated using images from different ethnicities and regions, showing promising potential as a beneficial surgical aid. The normalised data produced reliable quantifications of nasal defects (average 76.2%), aiding in preoperative planning and improving surgical outcomes and patient satisfaction. The developed method can be extended to other facial plastic surgeries. Furthermore, it can be used to create app-based software, assist medical education, and improve patient-doctor communication. This novel method for defect quantification in rhinoplasty using AI and image processing holds significant potential in improving surgical planning, outcomes, and patient satisfaction, marking an essential step in the fusion of AI and plastic surgery. [ABSTRACT FROM AUTHOR]

Whether transcatheter mitral valve replacement (TMVR) devices perform similarly with respect to the underlying mitral regurgitation (MR) etiology remains unknown. The aim of the present analysis was to assess outcomes of TMVR according to the MR underlying etiology among the CHoice of OptImal transCatheter trEatment for Mitral Insufficiency (CHOICE-MI) registry. Of 746 patients, 229 patients (30.7%) underwent TMVR. The study population was subdivided according to primary, secondary, or mixed MR. Patients with mitral annular calcification were excluded. The primary study endpoint was a composite endpoint of all-cause mortality or hospitalization for heart failure at 1 year. Secondary study endpoints were all-cause and cardiovascular mortality at 1 year, New York Heart Association functional class, and residual MR, both at discharge and 1 year. The predominant MR etiology was secondary MR (58.4%), followed by primary MR (28.7%) and mixed MR (12.9%). Technical success and procedural mortality were similar according to MR etiology. Discharge echocardiography revealed residual MR 2+ in 11.3%, 3.7%, and 5.3% of patients with primary, secondary, and mixed MR, respectively (P =.1). MR elimination was similar in all groups up to the 1-year follow-up. There was no difference in terms of primary combined outcome occurrence according to MR etiology. One-year all-cause mortality was reported in 28.8%, 24.2%, and 32.1% of patients with primary, secondary, and mixed MR, respectively (P =.07). In our study we did not find differences in short-term and 1-year outcomes after TMVR according to MR etiology. [ABSTRACT FROM AUTHOR]

The fifth-generation SAPIEN 3 Ultra Resilia valve (S3UR) incorporates several design changes as compared with its predecessors, the SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) valves, including bovine leaflets treated with a novel process intended to reduce structural valve deterioration via calcification, as well as a taller external skirt on the 29-mm valve size to reduce paravalvular leak (PVL). The clinical performance of S3UR compared with S3 and S3U in a large patient population has not been previously reported. The aim of this study was to compare S3UR to S3/S3U for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR). Patients enrolled in the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between January 1, 2021, and June 30, 2023, who underwent TAVR with S3UR or S3U/S3 valve platforms were propensity-matched and evaluated for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes. 10,314 S3UR patients were propensity matched with 10,314 patients among 150,539 S3U/S3 patients. At 30 days, there were no statistically significant differences in death, stroke, or bleeding, but a numerically higher hospital readmission rate in the S3UR cohort (8.5% vs 7.7%; P = 0.04). At discharge, S3UR patients exhibited significantly lower mean gradients (9.2 ± 4.6 mm Hg vs 12.0 ± 5.7 mm Hg; P < 0.0001) and larger aortic valve area (2.1 ± 0.7 cm2 vs 1.9 ± 0.6 cm2; P < 0.0001) than patients treated with S3/S3U. The 29-mm valve size exhibited significant reduction in mild PVL (5.3% vs 9.4%; P < 0.0001). S3UR TAVR is associated with lower mean gradients and lower rates of PVL than earlier generations of balloon expandable transcatheter heart valve platforms. [Display omitted] [ABSTRACT FROM AUTHOR]

Since a few years ago, photocatalysis technique have drawn more interest driven by their propensity to address environmental challenges and provide renewable energy sources. Herein, we synthesized a direct S-scheme Zn 0.5 Cd 0.5 S/MoS 2 composite by employing facile in-situ hydrothermal method for drug degradation and H 2 generation coupled with benzyl alcohol (BA) oxidation. Further, the structural, morphological, compositional, and thermal properties of as-synthesized material were all thoroughly studied. The experimental results revealed that Zn 0.5 Cd 0.5 S/10%MoS 2 (ZCMS-10) composite exhibited 92.54% degradation efficiency for KTC drug within 150 min under natural solar light. Furthermore, throughout five cycles, this study showed outstanding recyclability. Additionally, as-synthesized material demonstrated remarkable H 2 generation coupled with oxidation of BA into benzaldehyde (BAL). The H 2 generation rate was found to be 2.3470 mmolg−1h−1 and conversion 38.52% of BA with the selectivity of 95.48% for BAL. The enhanced photocatalytic performance might be attributed to the effective charge transfer between Zn 0.5 Cd 0.5 S and MoS 2 , facilitated by the direct S-scheme mechanism. Based on the findings of radical trapping experiments, the charge transfer process over the photocatalyst was completely studied. This study provides insights into the development of effective photocatalysts for environmental remediation and generation of renewable energy. • Multi-functional Z-scheme Zn 0.5 Cd 0.5 S/MoS 2 composite was synthesized. • Photodegradation efficacy for KTC of 92.54% over composite was observed. • Composite exhibited H 2 generation of 2.3470 mmolg−1h−1. • Zn 0.5 Cd 0.5 S/MoS 2 showed superior selective oxidation of BA. [ABSTRACT FROM AUTHOR]

Adequate valve performance after surgical mitral valve repair with an annuloplasty ring is not always sustained over time. The risk of repeat mitral valve surgery may be high in these patients. Transcatheter mitral valve-in-ring (MViR) is emerging as an alternative for high-risk patients. The authors sought to assess contemporary outcomes of MViR using third-generation balloon-expandable aortic transcatheter heart valves. Patients who underwent MViR and were enrolled in the STDS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between August 2015 and December 2022 were analyzed. A total of 820 patients underwent MViR at 236 sites, mean age was 72.2 ± 10.4 years, 50.9% were female, mean STS score was 8.2% ± 6.9%, and most (78%) were in NYHA functional class III to IV. Mean left ventricular ejection fraction was 47.8% ± 14.2%, mean mitral gradient was 8.9 ± 7.0 mm Hg, and 75.5% had ≥ moderate mitral regurgitation. Access was transseptal in 93.9% with 88% technical success. All-cause mortality at 30 days was 8.3%, and at 1 year, 22.4%, with a reintervention rate of 9.1%. At 1-year follow-up, 75.6% were NYHA functional class I to II, Kansas City Cardiomyopathy Questionnaire score increased by 25.9 ± 29.1 points, mean mitral valve gradient was 8.4 ± 3.4 mm Hg, and 91.7% had ≤ mild mitral regurgitation. MViR with third-generation balloon-expandable aortic transcatheter heart valves is associated with a significant reduction in mitral regurgitation and improvement in symptoms at 1 year, but with elevated valvular gradients and a high reintervention rate. MViR is a reasonable alternative for high-risk patients unable undergo surgery who have appropriate anatomy for the procedure. (STS/ACC TVT Registry Mitral Module [TMVR]; NCT02245763) [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] • The free energy landscape for silicon and arsenic permeation was traced. • The transport cycle reveals novel energy constraints on silicon and arsenic permeation. • Predicted functionally important residues were validated in yeast. • Altering conserved amino acids in loop C and loop D directly influenced metalloid uptake of OsNIP2;1. • Protein variants with lower arsenic uptake were identified to reduce arsenic levels with minimum counterproductive effects. Nodulin-26-like intrinsic proteins (NIPs) are integral membrane proteins belonging to the aquaporin family, that facilitate the transport of neutral solutes across the bilayer. The OsNIP2;1 a member of NIP-III class of aquaporins is permeable to beneficial elements like silicon and hazardous arsenic. However, the atomistic cross-talk of these molecules traversing the OsNIP2;1 channel is not well understood. Due to the lack of genomic variation but the availability of high confidence crystal structure, this study aims to highlight structural determinants of metalloid permeation through OsNIP2;1. The molecular simulations, combined with site-directed mutagenesis were used to probe the role of specific residues in the metalloid transport activity of OsNIP2;1. We drew energetic landscape of OsNIP2;1, for silicic and arsenous acid transport. Potential Mean Force (PMF) construction illuminate three prominent energetic barriers for metalloid passage through the pore. One corresponds to the extracellular molecular entry in the channel, the second located on ar/R filter, and the third size constriction in the cytoplasmic half. Comparative PMF for silicic acid and arsenous acid elucidate a higher barrier for silicic acid at the cytoplasmic constrict resulting in longer residence time for silicon. Furthermore, our simulation studies explained the importance of conserved residues in loop-C and loop-D with a direct effect on pore dynamics and metalloid transport. Next we assessed contribution of predicted key residues for arsenic uptake, by functional complementation in yeast. With the aim of reducing arsenic uptake while maintaining beneficial elements uptake, we identified novel OsNIP2;1 mutants with substantial reduction in arsenic uptake in yeast. We provide a comprehensive assessment of pore lining residues of OsNIP2;1 with respect to metalloid uptake. The findings will expand mechanistic understanding of aquaporin's metalloid selectivity and facilitate variant interpretation to develop novel alleles with preference for beneficial metalloid species and reducing hazardous ones. [ABSTRACT FROM AUTHOR]

To understand the implications of a tiered extracorporeal membrane oxygenation (ECMO) criteria framework and the outcomes of patients with COVID-19 acute respiratory distress syndrome who we were consulted on for ECMO but ultimately declined. All patients declined for ECMO support by a large regional health care system between March 2020 and July 2021 were included. Restrictive selection criteria were enacted midway through the study stratifying the cohort into 2 groups. Primary outcomes included 30-day mortality. Secondary outcomes included reasons for declining ECMO and survival stratified by phase. One hundred ninety-three patients with COVID-19 acute respiratory distress syndrome were declined for ECMO within the study period out of 260 ECMO consults. At the time of consult, 71.0% (n = 137) were mechanically ventilated and 38% (n = 74) were proned and chemically paralyzed. Thirty-day mortality was 66% (n = 117), which increased from 53% to 73% (P =.010) when restrictive criteria were enacted. Patients with multisystem organ failure, prolonged ventilator time, and advanced age had respectively an 11-fold (odds ratio, 10.6; 95% CI, 1.7-65.2), 4-fold (odds ratio, 3.5; 95% CI, 1.1-12.0), and 4-fold (odds ratio, 4.4; 95% CI, 1.9-10.2) increase in the odds of mortality. Patients with COVID-19 acute respiratory distress syndrome declined for ECMO represent a critically ill cohort. We observed an increase in the severity of disease and 30-day mortality in consults in the latter phase of our study period. These findings may reflect our use of tiered selection criteria coupled with ongoing education and communication with referring centers, sparing both patients likely to respond to medical therapy and those who were unsalvageable by ECMO. [Display omitted] [ABSTRACT FROM AUTHOR]

Auscultation is a process where a stethoscope is used to listen to the heart sound signal to analyse the heart's functionality. Due to the stethoscope's non-invasiveness, convenience, and cost-effectiveness, it is the most common primary screening tool medical fraternities use. However, the scarcity of medical experts and the subjectivity in the analysis hinders the reliability of diagnosis using auscultation. Therefore, computer-aided analysis of heart sound signals will be helpful in this scenario. This paper presents a hybrid deep learning-based method to classify the heart sound signal into five classes. The method begins with the signal pre-processing followed by decomposition using Discrete Wavelet Transform (DWT) up to five levels. The obtained DWT coefficients are used to train the hybrid model, composed of two Convolution neural network (CNN) layers following one Gated Recurrent Unit (GRU) network layer. CNN models are suitable for extracting meaningful features, while the GRU exploits the time-dependent features. This combination helps classify the heart sound signal since they exhibit complex quasi-cyclic features. An overall accuracy of 99.3% is obtained for a publicly available dataset. It shows the proposed method's efficacy for classifying heart sound signal and superiority over the existing methods. Such a method will be beneficial in reducing the burden of heart valve diseases by early detection of diseases and initiating the proper medication. [ABSTRACT FROM AUTHOR]

The paper presented introduces an innovative accident prevention system that employs deep learning models and sensors to identify and alert drivers who lose concentration while driving for a variety of reasons. The system targets drowsiness, cell phone use, and alcohol consumption, which are among the leading causes of automobile accidents. The proposed solution employs neural networks to identify specific patterns associated with driver inattention and generates an audible alert to refocus the driver's attention on the road. In addition, the system utilizes alcohol-detection sensors, as alcohol consumption is another significant cause of accidents. This system seeks to reduce the number of casualties by enhancing road safety considering the high number of daily collisions, which are primarily caused by speeding. The paper describes the design, architecture, and implementation of the system on a modest scale to provide a lifesaving, cost-effective solution. [ABSTRACT FROM AUTHOR]