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Background & Aim: Rosacea is a chronic inflammatory, multifactorial disease for which combination therapy could be an effective treatment. In this study, we evaluate the effect of the combination therapy of brimonidine 0.33% and ivermectin 1% as a single cream for the treatment of papulopustular rosacea. Method: A stable and appropriate formulation was prepared by adding the aqueous phase to the lipid phase while being stirred. The stability and physicochemical properties of the formulation were evaluated under accelerated conditions. Twelve patients (36–60 years) with mild to moderate papulopustular rosacea and a Demodex count of five or more were treated with the combination of brimonidine 0.33% and ivermectin 1% cream. Clinician's Erythema Assessment (CEA), Patients Self‐Assessment (PSA), skin erythema (ΔE) and lightness (ΔL), and skin biophysical parameters including transepidermal water loss (TEWL), skin hydration, pH, and sebum content, as well as erythema and melanin index and ultrasound parameters, were measured before treatment and 4 and 8 weeks after. Adverse drug reactions were also recorded. Results: CEA and PSA decreased significantly from 3 to 2 after 8 weeks, respectively (p‐value = 0.014 for CEA and 0.010 for PSA). ΔE and ΔL, as well as skin erythema index and TEWL improved after 8 weeks of treatment (p < 0.05). Two patients withdrew from the study in the first week because of local adverse effects; one developed flushing following treatment and left the investigation after 4 weeks and another patient withdrew from the study after 4 weeks due to deciding to become pregnant. Conclusion: Eight‐week treatment with the combination of brimonidine 0.33% and ivermectin 1% was shown to be effective for improvement of erythema and inflammatory lesions in mild to moderate papulopustular rosacea. [ABSTRACT FROM AUTHOR]

The present study investigates the provision of heating, cooling, electricity, and domestic hot water consumption for a 100 m2 off‐grid zero‐energy residential building housing four occupants. Notably, the building is equipped with a hydrogen stove for cooking, and its electricity consumption is sustained throughout the year using renewable energies, independently of the electrical grid, with hydrogen energy storage. Using a Trombe wall for heating, surplus power is converted and stored in a dedicated hydrogen tank. TRNSYS software models analyze the system, demonstrating thermal comfort for 98.3% of the year. With 83 m2 of photovoltaic panels, the house operates off‐grid, slashing CO2 emissions by 8154.7 kg annually by reducing boiler energy consumption through waste heat utilization. The hydrogen tank minimizes the required battery size while the Trombe wall significantly contributes to heating, especially in colder climates. Remarkably, the building's renewable energy usage curtails emissions up to 8.5 times more than a Toyota Prius, showcasing its environmental impact in reducing greenhouse gas emissions. [ABSTRACT FROM AUTHOR]

This document discusses a case of a 32-year-old woman with hypocomplementemic urticarial vasculitis (HUV) who presented with various symptoms including hives, arthritis, shortness of breath, and chest pain. She was initially treated with medications but her symptoms worsened after giving birth. It was later discovered that she had multivalvular cardiac disease, including aortic and mitral valve regurgitation. The document explores the possible causes of valvular heart disease, including congenital heart diseases, genetic disorders, medications, and autoimmune and inflammatory conditions. The patient underwent valvular surgery to address the abnormalities. The association between cardiac valvular abnormalities and Jaccoud arthropathy, a type of arthritis, is also discussed, although it remains unclear. The treatment of HUV is based on limited case reports, with tocilizumab being a potential option. The document emphasizes the importance of rheumatologists being aware of the connection between rheumatologic and nonrheumatologic conditions that can cause multivalvular cardiac disease. [Extracted from the article]

Background: The new United Network for Organ Sharing (UNOS) heart allocation policy prioritizes temporary percutaneous over durable left ventricular assist devices (LVAD) as bridge to transplant. We sought to examine 1‐year outcomes of heart transplant recipients bridged with Impella versus durable LVADs. Methods: All primary adult orthotopic heart transplant recipients registered in UNOS between January 2016 and June 2021 were analyzed. Recipients were identified as being bridged with isolated durable or percutaneous LVAD at the time of transplant. Baseline characteristics were compared and 1‐year survival was examined using the Kaplan Meier method and multivariable Cox proportional hazards regression. Results: : During our study period, heart transplant recipients bridged with LVADs were divided between 5422(94%) durable and 324(6%) percutaneous options. Impella‐bridged recipients were more likely to be status 1A under the old allocation system (98% vs. 70%, p <.01) and status 2 or higher under the new allocation system (99% vs. 24%, p <.01). Impella‐bridged recipients were less likely to be obese (27% vs. 42%, p <.01), have ischemic cardiomyopathy (27% vs. 34%, p <.01), and were more likely to be on inotropic agents at the time of transplant (68% vs. 6%, p <.01). One‐year post‐transplant survival was not significantly different between the two groups on univariable (HR.87, 95% CI.56–1.37) or multivariable analysis (aHR.63, 95% CI.37–1.07). Conclusions: Following the UNOS allocation policy change, Impella utilization has increased with no significant difference in 1‐year survival compared to bridge with durable LVADs. Impella may be a reasonable alternative to durable LVADs in select patients. [ABSTRACT FROM AUTHOR]

Introduction: Frailty status affects outcomes after heart transplantation, but the optimal way to assess frailty prior to transplant remains unknown. Methods: This single‐center, observational study assessed 44 heart transplant candidates for frailty using three methods. The Short Physical Performance Battery (SPPB) and Fried Frailty Phenotype (FFP) were used as two physical assessments of frailty. The Frailty Risk Score (FRS) was used as a chart‐review based assessment measuring 20 different biopsychosocial and functional components, including biomarkers, depression, cognitive impairment, and sleep. Results: We determined the correlation between FRS, SPPB, and FFP and how each correlated with clinical outcomes. Of 44 participants, mean age was 60 years. FRS correlated with SPPB and FFP (P =.043, P <.001, respectively). Higher frailty as measured by SPPB and FRS was significantly associated with lack of achieving waitlist status (P =.022; P =.002) and not being transplanted (P =.026; P =.008). Higher frailty by SPPB and FFP was also associated with mortality (P =.010; P =.025). Conclusion: SPPB and chart‐review FRS showed potential for predicting waitlist and transplant status of heart transplant candidates, while SPPB and FFP were associated with mortality. Additional studies may serve to validate these observations. [ABSTRACT FROM AUTHOR]

The infectious disease coronavirus disease 2019 (COVID‐19) was declared a pandemic by the World Health Organization in March 2020. The impact of COVID‐19 on solid organ transplantations, including heart transplantation, is currently unclear. Many transplant programs have been forced to swiftly re‐evaluate and adapt their practices, leading to a marked decrease in transplants performed. This trend has been due to various factors, including increased donor COVID‐19 screening scrutiny and recipient waiting list management in anticipation of COVID‐19 critical care surge capacity planning. In the face of these unknown variables, determining when and how to proceed with transplantation in our population of patients with end‐stage cardiomyopathies is challenging. Here, we describe our center's experience with orthotopic heart transplantation (OHT) in one of the country's pandemic epicenters, where we performed eight OHTs in the first 2 months after community spread began in late February 2020. [ABSTRACT FROM AUTHOR]

Background: There are no data on the validity of the modified Nutrition Risk in the Critically Ill (m‐NUTRIC)‐score and Nutritional Risk Screening 2002 (NRS‐2002)‐score in Iranian intensive care unit (ICU) patients. The Malnutrition Universal Screening Tool (MUST) is still used in most Iranian ICUs. Our goal was to test the validity of these tools in the Iranian ICU population. Methods: The association between nutrition risk scores and outcomes (longer length of stay [LOS], prolonged mechanical ventilation [MV], and 28‐day mortality) was assessed using the multivariable logistic regression. The performance of nutrition risk tools to predict 28‐day mortality was assessed using the receiver operating characteristic curve. A logistic regression model was used to test the interaction between nutrition risk category, energy adequacy, and 28‐day mortality. Results: Four hundred forty patients were included. Both the m‐NUTRIC and NRS‐2002 scores were significantly associated with all 3 outcomes (all P <.001). However, no significant association was identified between the MUST and all 3 outcomes (P >.05). The area under the curve for predicting 28‐day mortality was 0.806 (95% CI, 0.756–0.851), 0.695 (95% CI, 0.632–0.752), and 0.551 (95% CI, 0.483–0.612) for m‐NUTRIC, NRS‐2002, and MUST, respectively. Greater energy adequacy was associated with a lower 28‐day mortality rate in patients with high m‐NUTRIC but not in those with low m‐NUTRIC score (P interaction =.015). Conclusion: In the Iranian ICU population, the m‐NUTRIC score may be a valid tool for identifying patients who would benefit from more aggressive nutrition therapy. [ABSTRACT FROM AUTHOR]

Experimental studies have suggested the beneficial effects of curcuminoids as natural polyphenols against traumatic brain injury (TBI). The aim of this study was to investigate the effects of supplementation with curcuminoids on inflammatory and oxidative stress biomarkers, clinical outcomes and nutritional status in critically ill patients with TBI. A total of 62 ICU‐admitted adult patients with TBI were randomly allocated to receive either a daily dose of 500 mg curcuminoids or matched placebo via enteral nutrition for 7 consecutive days based on stratified block randomization by age and sex. Inflammatory and oxidative stress as well as clinical outcomes and nutritional status of the patients were measured at baseline and at the end of the study. There were no overall group effects regarding to all dependent variables. Compared with baseline, serum levels of IL‐6, TNF‐α, MCP‐1 and CRP were significantly reduced in patients receiving curcuminoids (p <.05) without any significant changes in placebo group; however, changes in the activities of GPx and SOD in serum were not significant between two groups. Moreover, APACHEII and NUTRIC score were significantly improved following curcuminoids consumption in comparison with placebo (p <.05). The findings of this study suggest that short‐term supplementation with curcuminoids may have beneficial effects on inflammation, clinical outcomes and nutritional status of critically ill patients with TBI. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome is a common complication of severe viral pneumonia, such as influenza and COVID‐19, that requires critical care including ventilatory support, use of corticosteroids and other adjunctive therapies to arrest the attendant massive airways inflammation. Although recommended for the treatment of viral pneumonia, steroid therapy appears to be a double‐edged sword, predisposing patients to secondary bacterial and invasive fungal infections (IFIs) whereby impacting morbidity and mortality. Mucormycosis is a fungal emergency with a highly aggressive tendency for contiguous spread, associated with a poor prognosis if not promptly diagnosed and managed. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions including corticosteroid therapy are known risk factors for mucormycosis. Upon the background lung pathology, immune dysfunction and corticosteroid therapy, patients with severe viral pneumonia are likely to develop IFIs like aspergillosis and mucormycosis. Notably, the combination of steroid therapy and DM can augment immunosuppression and hyperglycaemia, increasing the risk of mucormycosis in a susceptible individual. Here, we report a case of sinonasal mucormycosis in a 44‐year‐old woman with hyperglycaemia secondary to poorly controlled diabetes following dexamethasone therapy on a background of influenza pneumonia and review 15 available literatures on reported cases of influenza and COVID‐19 associated mucormycosis. [ABSTRACT FROM AUTHOR]

Previous studies have shown a beneficial effect of curcuminoids supplementation on serum concentrations of adipokines; however, there are no published studies that have examined this effect among critically ill patients. We aimed to assess the effects of supplementation with curcuminoids on serum concentrations of leptin and adiponectin in critically ill patients with traumatic brain injury (TBI). In this trial, 62 critically ill patients with TBI, aged 18-65 years, were randomly allocated to receive either 500 mg/day curcuminoids (co-administered with 5 mg/day piperine) or matched placebo for 7 days. Patients in both intervention groups received routine treatments for TBI as well as enteral nutrition. Serum concentrations of leptin and adiponectin were measured at baseline and at the end of trial. We found a significant reduction in serum levels of leptin in both curcuminoids (47.1%) and placebo (22.8%) groups; though the magnitude of reduction was greater in the former (p < .05). Supplementation with curcumioinds was not found to alter serum concentrations of adiponectin (p > .05). Supplementation with curcumioinds significantly reduced serum levels of leptin but had no significant effect on adiponectin levels in critically ill patients with TBI. Further clinical trials, particularly those with a long-term period, are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

The integration of renewable energy (RE)‐based distributed generation (DG) with electric power distribution systems (DSs) in association with smart grid technology has numerous benefits, however, due to their intermittent nature, the utilisation of RE‐based DG may pose threats to the proper operation of conventional overcurrent (OC) protection schemes. The resulting threats, malfunctions, and non‐selective actions could occur by relays within the DS, and the development of efficient protection schemes is necessary. The objective of this study is to propose and simulate an adaptive OC protection scheme in DSs in the presence of doubly‐fed induction generator (DFIG) wind turbines based on wind speed forecast data with considerations for wind speed forecast uncertainty and a low‐voltage ride‐through requirement for wind turbines. In each time interval and possible operating mode, the output power of DFIG‐based wind turbines and relay setting parameters are determined offline. The results show that the proposed protection scheme prevents malfunctions and non‐selective operations of relays, and also provides faster fault isolations, as compared to the conventional OC protection scheme. [ABSTRACT FROM AUTHOR]

The diagnosis of cancer by modern computer tools, at the very first stages of the incident, is a very important issue that has involved many researchers. In the meantime, skin cancer is a great deal of research because many people are involved with it. The purpose of this paper is to introduce an innovative method based on tissue frequency analyzes to obtain the accurate and real‐time evaluation of skin cancers. According to the Biological resonance theory, body cells have natural and unique frequencies based on their biological fluctuations, which, if the structure, profile and cellular status change, its frequency also varies. This concept and theory is considered as the basis for analyzing skin tissue health in the proposed method. Reflected ultrasound waves from tissue have been processed and studied based on frequency analysis as a new method for early detection and diagnosis of accurate location and type of skin diseases. The developed algorithm was approved through 400 patients from CRED; its ability to evaluate benign and malignant skin lesions was shown (AUC = 0.959), with comparable clinical precision; as for the selected threshold, sensitivity, and specificity were 93.8% and 97.3%, respectively. Therefore, this method can detect skin malignancy with an accurate, noninvasive and real‐time procedure. [ABSTRACT FROM AUTHOR]

Abstract: Background: As the population of patients with a Fontan palliation grows so does, the number of patients with cardiac failure necessitating orthotopic heart transplant (OHT) and combined heart–liver transplant (CHLT). There is recent evidence that current era cardiac transplant in Fontan patients has improved outcomes, but most studies have a preponderance of pediatrics patients in their cohorts. We examine our institutional experience with adult OHT and CHLT transplantation for failed Fontan physiology. Methods and Results: Retrospective analysis of patients at the Ahmanson/UCLA Adult Congenital Heart Disease Center who underwent OHT or CHLT for failing Fontan physiology from January 1, 2002 to May 31, 2017. We identified 20 patients with single‐ventricle physiology and Fontan palliation who underwent OHT or CHLT. The median age was 29.5 years (range 19‐44). Five patients underwent CHLT because of biopsy proven hepatic cirrhosis. The median length of hospital stay was 23 days (range 8‐76) post‐OHT and 51 days (range 26‐77) post‐CHLT. During a median follow‐up of 56 months (range 2‐178), there was one mortality occurring at 34 months post‐OHT due to coronary vasculopathy. Most frequent early postoperative complications included bleeding and infection (55% and 20%, respectively) and surgical reintervention for bleeding complications (n = 8, 40%). One CHLT patient experienced clinically significant hepatic rejection requiring admission and steroid treatment. Conclusions: Despite inherent risks and complexities of OHT or CHLT in patients with a failed Fontan, transplant is a reasonable therapy. Peri‐ and postoperative complications are common and may require surgical reintervention. Continued observation of practices and unifying themes may help improve patient selection, pre‐ and postoperative treatment and ultimately outcomes. [ABSTRACT FROM AUTHOR]

Abstract: In 2005, the Lung Allocation Score (LAS) was implemented as the allocation system for lungs in the US. We sought to compare 5‐year lung transplant outcomes before and after the institution of the LAS. Between 2000 and 2011, 501 adult patients were identified, with 132 from January 2000 to April 2005 (Pre‐LAS era) and 369 from May 2005 to December 2011 (Post‐LAS era). Kruskal‐Wallis or chi‐squared test was used to determine significance between groups. Survival was censored at 5 years. Overall, the post‐LAS era was associated with more restrictive lung disease, higher LAS scores, shorter wait‐list times, more preoperative immunosuppression, and more single lung transplantation. In addition, post‐LAS patients had higher O2 requirements with greater preoperative pulmonary impairment. Postoperatively, 30‐day mortality improved in post‐LAS era (1.6% vs 5.3%, P = .048). During the pre‐ and post‐LAS eras, 5‐year survival was 52.3% and 55.3%, respectively (P = .414). The adjusted risk of mortality was not different in the post‐LAS era (P = .139). Freedom from chronic lung allograft dysfunction was significantly higher in the post‐LAS era (P = .002). In this single‐center report, implementation of the LAS score has led to allocation to sicker patients without decrement in short‐ or medium‐term outcomes. Freedom from CLAD at 5 years is improving after LAS implementation. [ABSTRACT FROM AUTHOR]

Ensuring fair and equitable allocation of donor hearts in the US is the charge of the Organ Procurement and Transplantation Network ( OPTN). However, the recent increase of candidates waiting without a corresponding increase in available donors, higher waitlist mortality rates in higher status patients, the presence of disadvantaged subgroups, and the changing management of heart failure patients with increased VAD usage, has necessitated review of allocation policy. Therefore, the Heart Subcommittee of the OPTN/ UNOS Thoracic Committee is exploring a further-tiered allocation system, devising a 'straw man' model as a starting point for modeling analyses and public discussion. On May 4, 2015, an American Society of Transplantation ( AST)-endorsed forum to discuss these potential proposed changes took place. Attendees included 41 people, mostly highly experienced transplant cardiologists and cardiothoracic surgeons, representing 19 heart transplant centers across the US, UNOS, and the Scientific Registry of Transplant Recipients ( SRTR). There was unanimous agreement that the potential proposed policy will require careful wording to avoid ambiguity and 'gaming' of the system, and strong support for abolishment of local organ sharing in favor of geographic sharing. However, contention existed concerning the appropriate prioritization levels of ECMO, temporary VAD/ TAH patients as well as the 30-day LVAD listing. [ABSTRACT FROM AUTHOR]

Excess cellular iron increases reactive oxygen species ( ROS) production and causes cellular damage. Mitochondria are the major site of iron metabolism and ROS production; however, few studies have investigated the role of mitochondrial iron in the development of cardiac disorders, such as ischemic heart disease or cardiomyopathy ( CM). We observe increased mitochondrial iron in mice after ischemia/reperfusion (I/R) and in human hearts with ischemic CM, and hypothesize that decreasing mitochondrial iron protects against I/R damage and the development of CM. Reducing mitochondrial iron genetically through cardiac-specific overexpression of a mitochondrial iron export protein or pharmacologically using a mitochondria-permeable iron chelator protects mice against I/R injury. Furthermore, decreasing mitochondrial iron protects the murine hearts in a model of spontaneous CM with mitochondrial iron accumulation. Reduced mitochondrial ROS that is independent of alterations in the electron transport chain's ROS producing capacity contributes to the protective effects. Overall, our findings suggest that mitochondrial iron contributes to cardiac ischemic damage, and may be a novel therapeutic target against ischemic heart disease. [ABSTRACT FROM AUTHOR]

Cell therapy has been intensely studied for over a decade as a potential treatment for ischaemic heart disease. While initial trials using skeletal myoblasts, bone marrow cells and peripheral blood stem cells showed promise in improving cardiac function, benefits were found to be short-lived likely related to limited survival and engraftment of the delivered cells. The discovery of putative cardiac 'progenitor' cells as well as the creation of induced pluripotent stem cells has led to the delivery of cells potentially capable of electromechanical integration into existing tissue. An alternative strategy involving either direct reprogramming of endogenous cardiac fibroblasts or stimulation of resident cardiomyocytes to regenerate new myocytes can potentially overcome the limitations of exogenous cell delivery. Complimentary approaches utilizing combination cell therapy and bioengineering techniques may be necessary to provide the proper milieu for clinically significant regeneration. Clinical trials employing bone marrow cells, mesenchymal stem cells and cardiac progenitor cells have demonstrated safety of catheter based cell delivery, with suggestion of limited improvement in ventricular function and reduction in infarct size. Ongoing trials are investigating potential benefits to outcome such as morbidity and mortality. These and future trials will clarify the optimal cell types and delivery conditions for therapeutic effect. [ABSTRACT FROM AUTHOR]