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Graphene, a two-dimensional carbon sheet with single-atom thickness, shows immense promise in several nanoscientific and nanotechnological applications, including in sensors, catalysis, and biomedicine. Although several studies have shown the cytotoxicity of graphene oxide in different cell types, there are no comprehensive studies on human embryonic kidney (HEK293) cells that include transcriptomic analysis and an in vitro investigation into the mechanisms of cytotoxicity following exposure to graphene oxide. Therefore, we exposed HEK293 cells to different concentrations of graphene oxide for 24 h and performed several cellular assays. Cell viability and proliferation assays revealed a significant dose-dependent cytotoxic effect on HEK293 cells. Cytotoxicity assays showed increased lactate dehydrogenase (LDH) leakage and reactive oxygen species (ROS) generation, and decreased levels of reduced glutathione (GSH) and increased level of oxidized glutathione indicative of oxidative stress. This detailed mechanistic approach showed that graphene oxide exposure elicits significant decreases in mitochondrial membrane potential and ATP synthesis, as well as in DNA damage and caspase 3 activity. Furthermore, our RNA-Seq analysis revealed that HEK293 cells exposed to graphene oxide significantly altered the expression of genes involved in multiple apoptosis-related biological pathways. Moreover, graphene oxide exposure perturbed the expression of key transcription factors, promoting these apoptosis-related pathways by regulating their downstream genes. Our analysis provides mechanistic insights into how exposure to graphene oxide induces changes in cellular responses and massive cell death in HEK293 cells. To our knowledge, this is the first study describing a combination of cellular responses and transcriptome in HEK293 cells exposed to graphene oxide nanoparticles, providing a foundation for understanding the molecular mechanisms of graphene oxide-induced cytotoxicity and for the development of new therapeutic strategies.

We experimentally introduce a normalized differential method to enhance the time domain signal-to-noise ratio (SNR) of an optical fiber distributed acoustic sensor (DAS). The reported method is calibrated against the typical differential method in noisy DAS systems, including those utilizing a relatively wide linewidth laser or few-mode fiber. In these two systems, the normalized differential method respectively identifies the position information of various vibration events with 1.7 dB and 0.53 dB SNR improvement. We further demonstrate the ability to locate positions along a fiber that are subjected to vibrations of frequencies higher than the theoretical maximum, but without determining these frequencies.

In this study, a facile and effective method for the synthesis of Au@Pd nanocomposites via a chemical reduction method was proposed. Moreover, a novel electrochemical sensor based on the Au@Pd core-shell nanocomposites were constructed and used for detection of hydroquinone (HQ). The morphologies and structures of Au nanorods (NRs) and Au@Pd nanomaterials were characterized by transmission electron microscopy (TEM), high resolution transmission electron microscopy (HRTEM) and electrochemical methods. By tuning the amount of Pd precursor, different Au@Pd core-shell nanocomposites were gained. It could be clearly shown that the Au 3 @Pd 6 (n Au :n Pd = 3:6) modified the glassy carbon electrode (Au 3 @Pd 6 /GCE) possessed a sensitive electrochemical response toward HQ and the oxidation peak appeared at nearly 0 V at the potential window range of -0.3 to 0.3 V. Meanwhile, the experimental results found a broad concentration range of 4-5000 µM, a low detection limit of 0.63 µM and desirable sensitivity of 1.127 mA mM -1 cm -2 . The mentioned sensor was successfully applied for HQ determination in the lake water and tap water samples. It is expected that the proposed method can be used for the synthesis of other metal nanostructures with distinguished electrocatalytic abilities and used for environmental monitoring of hydroquinone., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background:  Modern supraannular aortic xenografts offer a special design, thus providing maximized opening area for improved hemodynamics. The aim of this study was a prospectively randomized comparison of the Trifecta and the Perimount Magna Ease valves based on metric annulus sizing., Methods:  A total of 100 patients with aortic stenosis undergoing aortic valve replacement (AVR) with or without concomitant procedures were prospectively included. After decalcification of the annulus, stratified intraoperative randomization was performed. The diameter of the aortic annulus was measured using metric Hegar dilators and randomization was based on this metric annulus diameter. Exercise echocardiography was performed at 10-month follow-up., Results:  Mean age was 69 years, with 36% female. Predominant implanted valve sizes were 23 mm (39%) and 25 mm (32%). Unadjusted mean pressure gradient was significantly lower and effective orifice area larger for the Trifecta group (10.8 ± 5 vs. 13.2 ± 4 mm Hg, p  = 0.02 and 1.93 ± 0.39 vs. 1.70 ± 0.30 cm 2 , p  = 0.002) at discharge. In patients with small annuli, based on the metric annulus size there were no significant differences in gradients or the orifice area. At exercise echocardiography follow-up, there were no significant hemodynamic differences between both prostheses., Conclusions:  The Trifecta and the Perimount Magna Ease prostheses both show excellent hemodynamic performance after AVR. In patients with larger annuli, the Trifecta valve seems to be even superior to the Magna Ease, which may be advantageous in obese patients., Competing Interests: None., (Georg Thieme Verlag KG Stuttgart · New York.)

Ovarian cancer incidence continues to increase at an alarming rate. Although various therapeutic approaches exist for ovarian cancer, they have limitations, including undesired side effects. Therefore, nanoparticle (NP)-mediated therapy may be a viable, biocompatible, and suitable alternative. To the best of our knowledge, no comprehensive analysis has been undertaken on the cytotoxicity and cellular pathways involved in ovarian cancer cells, particularly SKOV3 cells. Here, we investigated the effect of palladium NPs (PdNPs) and the molecular mechanisms and cellular pathways involved in ovarian cancer. We assayed cell viability, proliferation, cytotoxicity, oxidative stress, DNA damage, and apoptosis and performed an RNA-Seq analysis. The results showed that PdNPs elicited concentration-dependent decreases in cell viability and proliferation and induced increasing cytotoxicity at increasing concentrations, as determined by leakage of lactate dehydrogenase, increased levels of reactive oxygen species and malondialdehyde, and decreased levels of antioxidants like glutathione and superoxide dismutase. Furthermore, our study revealed that PdNPs induce mitochondrial dysfunction by altering mitochondrial membrane potential, reducing adenosine triphosphate levels, inducing DNA damage, and activating caspase 3, all of which significantly induced apoptosis in SKOV3 cells following PdNPs treatment. Gene ontology (GO) term analysis of PdNPs-exposed SKOV3 cells showed various dysregulated pathways, particularly nucleosome assembly, telomere organization, and rDNA chromatin silencing. When genes downregulated by PdNPs were applied to GO term enrichment analysis, nucleosome assembly was the top-ranked biological pathway. We also provide evidence for an association between PdNPs exposure and multiple layers of epigenetic transcriptional control and establish a molecular basis for NP-mediated apoptosis. These findings provide a foundation, potential targets, and novel insights into the mechanism underlying toxicity and pathways in SKOV3 cells, and open new avenues to identify novel targets for ovarian cancer treatment.

Mastitis is the inflammation of the mammary gland due to microbial infiltration causing a reduced mammary function. This study aims at developing a vaccine using Malaysian local isolate of Staphylococcus aureus and evaluating serum amyloid A, Interleukin-10, IgM and IgG responses periodically. Four bacterin concentrations (10 6 , 10 7 , 10 8 and 10 9  cfu/ml of the local isolate of S. aureus) were adjuvanted with aluminium potassium sulphate. Thirty cows grouped into 4 treatment groups (G-) were vaccinated (2 ml) intramuscularly, with a fifth G-A as control. The mean concentration (MC) of serum amyloid A (SAA) was significantly different (sig-d) (p ˂ 0.05) in G-D at 0 h post vaccination (PV), 3 h PV, 24 h PV, weeks 1, 2, 3 and 4 PV (6-, 15-, 5-, 12-, 11-, 4- and 11-fold increased (FI) respectively). The MC of serum amyloid A was also sig-d in G-E at 0 h PV, weeks 1, 2 and 4 PV (3, 8, 5 and 8 FI respectively). The MC of IL-10 was sig-d in G-D and C at 3 h PV and week 2 PV (5 and 2 FI respectively). The IgM MC was sig-d in G-B and C at 3 h PV (5 and 6 FI respectively), at 24 h PV (5 and 9 FI respectively), at week 3 PV(2 and 2 FI respectively) and week 4 PV (3 and 4 FI respectively). The MC of IgG was sig-d in G-E at 0 h, 3 h and week 3 PV(5, 6 and 2 FI respectively) and in G-D at weeks 1-4 (3, 3, 3 and 5 FI respectively). In conclusion, elevated levels of SAA, IgG and IL-10 in G-D(10 8 ) informed our choice of best dosage which can be used to evoke immunity in cows.

Objectives: This study sought to examine whether the prognosis of patients with severe aortic stenosis (AS) having high versus low transvalvular mean pressure gradients (MPGs) is intrinsically different after transcatheter aortic valve replacement (TAVR), even after strict matching of baseline parameters., Background: Patients with low MPG are characterized by higher cardiovascular risk and more comorbidities than other AS patients are., Methods: In this retrospective, single-center study involving 2,282 patients, 3 groups were derived according to the following criteria: 1) high-gradient AS (HG-AS) (MPG ≥40 mm Hg); 2) low-flow, low-gradient AS (LFLG-AS) (MPG <40 mm Hg, ejection fraction [EF] ≤40%, stroke volume index ≤35 ml/m 2 ); 3) paradoxical LFLG-AS (pLFLG-AS) (similar to LFLG-AS but with EF ≥50%). Propensity score matching that included EF was used to compare 1-year survival., Results: A total of 136 patients with HG-AS or LFLG-AS were identified. Kaplan-Meier survival curves were significantly different (p = 0.039), with death occurring in 11 versus 21 patients (hazard ratio: 2.12; 95% confidence interval: 1.02 to 4.39; p = 0.044), respectively. A total of 226 patients with HG-AS or pLFLG-AS were identified and here the curves were identical (p = 0.468), with death occurring in 18 versus 21 patients (hazard ratio: 1.26; 95% confidence interval: 0.67 to 2.38; p = 0.469)., Conclusions: This is the first study comparing survival after TAVR of patients with high versus low MPG in matched study populations. Mortality in patients with LFLG-AS was twice that of HG-AS patients. However, it appears that patients with pLFLG-AS might benefit from TAVR to the same extent as patients with HG-AS. There must be still unmasked factors that influence mortality of patients with LFLG-AS., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Medical-image-based diagnosis is a tedious task' and small lesions in various medical images can be overlooked by medical experts due to the limited attention span of the human visual system, which can adversely affect medical treatment. However, this problem can be resolved by exploring similar cases in the previous medical database through an efficient content-based medical image retrieval (CBMIR) system. In the past few years, heterogeneous medical imaging databases have been growing rapidly with the advent of different types of medical imaging modalities. Recently, a medical doctor usually refers to various types of imaging modalities all together such as computed tomography (CT), magnetic resonance imaging (MRI), X-ray, and ultrasound, etc of various organs in order for the diagnosis and treatment of specific disease. Accurate classification and retrieval of multimodal medical imaging data is the key challenge for the CBMIR system. Most previous attempts use handcrafted features for medical image classification and retrieval, which show low performance for a massive collection of multimodal databases. Although there are a few previous studies on the use of deep features for classification, the number of classes is very small. To solve this problem, we propose the classification-based retrieval system of the multimodal medical images from various types of imaging modalities by using the technique of artificial intelligence, named as an enhanced residual network (ResNet). Experimental results with 12 databases including 50 classes demonstrate that the accuracy and F1.score by our method are respectively 81.51% and 82.42% which are higher than those by the previous method of CBMIR (the accuracy of 69.71% and F1.score of 69.63%)., Competing Interests: The authors declare no conflict of interest.

Accurate segmentation of the iris area in input images has a significant effect on the accuracy of iris recognition and is a very important preprocessing step in the overall iris recognition process. In previous studies on iris recognition, however, the accuracy of iris segmentation was reduced when the images of captured irises were of low quality due to problems such as optical and motion blurring, thick eyelashes, and light reflected from eyeglasses. Deep learning-based iris segmentation has been proposed to improve accuracy, but its disadvantage is that it requires a long processing time. To resolve this problem, this study proposes a new method that quickly finds a rough iris box area without accurately segmenting the iris region in the input images and performs ocular recognition based on this. To address this problem of reduced accuracy, the recognition is performed using the ocular area, which is a little larger than the iris area, and a deep residual network (ResNet) is used to resolve the problem of reduced recognition rates due to misalignment between the enrolled and recognition iris images. Experiments were performed using three databases: Institute of Automation Chinese Academy of Sciences (CASIA)-Iris-Distance, CASIA-Iris-Lamp, and CASIA-Iris-Thousand. They confirmed that the method proposed in this study had a higher recognition accuracy than existing methods.

We report a microwave irradiation method for the preparation of reduced graphene oxide (RGO) based Co 3 O 4 nanocomposites as anodes for lithium-ion (li-ion) batteries. The Co 3 O 4 /RGO nanocomposites displayed good electrochemical behavior as anodic materials for li-ion batteries when compared to pure Co 3 O 4 . The Co 3 O 4 /RGO nanocomposites with low RGO content resulted in stable electrochemical performance with 100% coulombic efficiency at a high current density of 500 mA/g for 50 cycles. The enhanced capacity of the Co 3 O 4 /RGO nanocomposites is due to the incorporation of RGO, which resulted in a four times larger surface area than that of Co 3 O 4 . This increased surface area could facilitate the absorption of more lithium ions, resulting in excellent electrochemical performance. Interestingly, the novelty of this work is that the designed li-ion batteries showed stable electrochemical performance even at a high temperature of 100 °C, which might be useful for rechargeable battery applications in a wide temperature range.

Mastitis is an inflammatory condition of the udder that occurs as a result of the release of leucocytes into the udder in a response to bacterial invasion. The major causes of mastitis are an array of gram positive and negative bacteria, however, algae, virus, fungi, mechanical or thermal injury to the gland have also been identified as possible causes. Mastitis vaccines are yet to be developed using Malaysian local isolate of bacteria. The objective of the present experimental trial was to develop a monovalent vaccine against mastitis using S. aureus of Malaysian isolate and to evaluate the clinical responses such as temperature, respiratory rates and heart rates in vaccinated cows. S. aureus is a major causative bacteria in clinical and subclinical types of mastitis in cows. Four concentrations of the bacterin (10 6 , 10 7 , 10 8 and 10 9  cfu/ml of the local isolate of S. aureus) were prepared using Aluminium potassium sulfate adjuvant. Thirty cows were grouped into four treatment groups (B, C, D and E) with a fifth group as control (A). These groups were vaccinated intramuscularly(IM) with the prepared monovalent vaccine and its influence on the vital signs were intermittently measured. The mean of rectal temperature was significantly different (p˂ 0.05) at 0hr Post Vaccination [1]" in groups D and E (39.5 ± 0.15 °C and 39.4 ± 0.15 °C respectively) and at 3 h PV in groups C, D and E (39.8 ± 0.14 °C, 39.9 ± 0.14 °C and 40.3 ± 0.14 °C respectively) compared to the control group. This indicated a sharp increased rectal temperatures between 0hr and 3 h PV in groups C, D and E which later declined at 24 h PV. The mean of rectal temperature of group E was significantly different (p˂ 0.05) at weeks 1 and 2 PV (39.87 ± 0.19 °C and 39.80 ± 0.18 °C respectively) compared to the control group. The mean of heart rate was significantly different (p˂ 0.05) at week 1 PV in groups D and E (83.0 ± 3.8 beats/minute and 80.0 ± 3.8 °C respectively) compared to control. A trending decrease was however observed in heart rates of group E from weeks through 4 PV and in group D from weeks 1 through 3 PV. The mean of respiratory rates was significantly different (p˂ 0.05) at week 3 PV in group B and D (31.0 ± 1.2 breaths/minute and 28.0 ± 1.2 breaths/minute) compared to control. In conclusion, this study highlights responses of these vital signs due to vaccination against S. aureus causing mastitis in cows. To the best of our knowledge the findings of this study adds value to the shallow literature on vital signs alterations in cows vaccinated against mastitis as elevated levels of temperature and heart rates of group D and E indicated obvious response., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to perform a comprehensive analysis of factors that affect procedural outcomes of transcatheter aortic valve replacement using the ACURATE neo prosthesis (Symetis/Boston, Ecublens, Switzerland)., Background: Predictors of procedural outcomes using the ACURATE neo prosthesis are poorly understood., Methods: A total of 500 patients underwent transfemoral aortic valve replacement with the ACURATE neo prosthesis. Device landing zone calcification was stratified as severe, moderate, or mild. Anatomic and procedural predictors of second-degree or greater paravalvular leakage and permanent pacemaker implantation were assessed., Results: Post-procedural second-degree or greater paravalvular leakage was more frequent with increasing device landing zone calcification (mild 0.8% vs. moderate 5.0% vs. severe 13.0%; p < 0.001), whereas permanent pacemaker implantation was independent of device landing zone calcification. More severe periannular calcification (odds ratio [OR]: 1.007; 95% confidence interval [CI]: 1.003 to 1.010; p < 0.001), less oversizing (OR: 0.867; 95% CI: 0.773 to 0.971; p = 0.014), the presence of annular plaque protrusions (OR: 2.756; 95% CI: 1.138 to 6.670; p = 0.025), and aortic movement of the delivery system after full deployment (OR: 5.593; 95% CI: 1.299 to 24.076; p = 0.02), and sinotubular junction height (OR: 1.156; 95% CI: 1.007 to 1.328; p = 0.04) independently predicted second-degree or greater paravalvular leakage. Predictors of permanent pacemaker implantation were pre-existing right bundle branch block (OR: 3.122; 95% CI: 1.261 to 7.731; p = 0.01) and more oversizing (OR: 1.111; 95% CI: 1.009 to 1.222; p = 0.03)., Conclusions: Successful transcatheter aortic valve replacement using the ACURATE neo device predominantly depends on careful patient selection with appropriate oversizing and taking into account the individual anatomy and calcium distribution of the aortic root., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) levels correlate with higher peri-procedural mortality after transcatheter aortic valve replacement (TAVR). The long-term prognostic value of NT-proBNP within the first days after TAVR, however, remains unclear. This study examined early changes in NT-proBNP prior to and within 6 days after TAVR, the diagnostic value of this biomarker regarding aortic regurgitation (AR), and its prognostic value regarding one-year mortality., Methods and Results: NT-proBNP concentrations were measured in 504 consecutive patients undergoing transapical (TA) or transfemoral (TF) TAVR before and directly after TAVR as well as 4 h and 1, 2, 3, and 6 days after TAVR. The follow-up period was 1 year. NT-proBNP was elevated in all patients at baseline (median 2141 ng/L [IQR 1021-5319 ng/L]). NT-proBNP changes in the first 6 days after TAVR showed significant differences depending on the approach, with a greater and more prolonged rise evident in TA-TAVR patients. NT-proBNP was an independent predictor of mortality in TA patients with AR, with an AUC of 0.794 (95% CI 0.663-0.925; P = 0.003) when measured on day 3 after TAVR. For TF patients with AR and reduced left ventricular systolic function, the AUC for prediction of mortality was 0.897 (95% CI 0.778-1.0; P = 0.004) on day 2., Conclusions: The prognostic information of early post-procedural NT-proBNP concentrations is superior to pre-procedural values regarding all-cause mortality within 1 year. Post-procedural NT-proBNP must be interpreted in relation to the TAVR approach. NT-proBNP predicts mortality in TF-TAVR patients with AR and reduced left ventricular function., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Due to increasing clinical experience with transcatheter aortic valve implantation (TAVI) procedures, sophisticated imaging and advanced device technology, TAVI complication rates are low; however, patients requiring conversion to surgery are confronted with an increased mortality risk. In this retrospective study, we evaluated the predictors for conversion and the outcomes of these patients., Methods: We analysed the records of all patients undergoing TAVI in our centre from 2011 to 2016 and focused on cases that required conversion to sternotomy. We investigated reasons and risk factors for conversion as well as 30-day and 1-year outcomes., Results: During the study period, 32 (2.1%) of 1775 patients undergoing TAVI required immediate conversion to sternotomy. Annular rupture (5 of 32; 16%), device embolization (9 of 32; 28%) and pericardial tamponade (15 of 32; 47%) were the most common reasons for conversion. Usage of a self-expandable valve showed to be the only predictor for conversion (odds ratio 0.38, 95% confidence interval 0.16-0.90; P = 0.03). Survival at 30 days and 1 year was 56% and 41%, respectively. Patients who survived 30 days after conversion showed higher preoperative ejection fraction, shorter duration of surgery and shorter perfusion time., Conclusions: In this high-volume, single-centre experience, conversion to sternotomy during TAVI occurred in about 2%, with annular rupture, device embolization and pericardial tamponade being the most common causes. Complications requiring conversion showed to be unpredictable. However, in view of these life-threatening complications, the 30-day survival rate exceeding 50% emphasizes the importance of an experienced and well-attuned heart team providing immediate access to surgical bailout procedures.

Background: The extent of aortic valve calcification is an important determinant of procedural success in transcatheter aortic valve implantation (TAVI). We sought to validate device landing zone calcium volume (DLZ-CV) measurements on contrast-enhanced multidetector computed tomography (MDCT) with non-contrast-enhanced scans as reference., Methods: We determined DLZ-CV in 141 patients undergoing transfemoral TAVI. Non-contrast-enhanced images were analyzed using a threshold of 130 HU as reference (DLZ-CV 130 ). For contrast-enhanced scans, we applied various thresholds including 450 HU (DLZ-CV 450 ), 850 HU (DLZ-CV 850 ), mean aortic attenuation (Atten Ao ) + 2 SD (DLZ-CV 2SD ), Atten Ao  + 4 SD (DLZ-CV 4SD ), Atten Ao  + 4 SD + 5 mm 3 volume filter (DLZ-CV 4SD+ ), and based on visual estimation (DLZ-CV vis ). We compared DLZ-CV values between patients with versus without paravalvular leak (PVL), and between patients with versus without post-dilatation stratified by the type of prosthesis., Results: All DLZ-CV measurements on contrast-enhanced scans significantly differed from DLZ-CV 130 (p < 0.001 for all comparisons). The best approximation to DLZ-CV 130 was achieved with DLZ-CV 4SD+ (508 mm 3 [332-772]; Pearson correlation: R = 0.87, p < 0.001; Bland-Altman: mean difference 1339 mm 3 [limits of agreement 79;2600]). Moreover, DLZ-CV 4SD+ allowed for discrimination of PVL ≥1° or the need for post-dilatation in patients receiving self-expanding prostheses. Procedural outcome using balloon-expandable prostheses was independent of DLZ-CV., Conclusion: Measurement of DLZ-CV using contrast-enhanced scans with unadjusted thresholds results in incorrect estimation of the calcium volume. The use of a scan-specific individual HU threshold including a volume filter (DLZ-CV 4SD+ ) provides the best approximation to the reference and allows for discrimination of PVL ≥ 1° in patients receiving the Acurate neo prosthesis., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Transcather aortic valve implantation (TAVI) has become a safe and indispensable treatment option for patients with severe symptomatic aortic stenosis (AS) who are at high or prohibitive surgical risk. In the past years, outcomes after TAVI have improved significantly and TAVI has emerged as a qualified alternative to surgical aortic valve replacement (SAVR) in the treatment of intermediate risk patients. Besides optimized patient screening, advanced imaging and increased examiner experience, transcatheter heart valve (THV) design addressed several key issues like vascular complications, pacemaker implantation and paravalvular leakage rates and improved considerably over time. Currently, several trials are investigating the role of TAVI in low surgical risk patients, novel indications and peri-operative management. In this review we give an overview on 1) current generation TAVI devices; on 2) recent clinical trial results and guidelines; and on 3) future trends and novel developments in the field of interventional treatment of AS.

Autonomous landing of an unmanned aerial vehicle or a drone is a challenging problem for the robotics research community. Previous researchers have attempted to solve this problem by combining multiple sensors such as global positioning system (GPS) receivers, inertial measurement unit, and multiple camera systems. Although these approaches successfully estimate an unmanned aerial vehicle location during landing, many calibration processes are required to achieve good detection accuracy. In addition, cases where drones operate in heterogeneous areas with no GPS signal should be considered. To overcome these problems, we determined how to safely land a drone in a GPS-denied environment using our remote-marker-based tracking algorithm based on a single visible-light-camera sensor. Instead of using hand-crafted features, our algorithm includes a convolutional neural network named lightDenseYOLO to extract trained features from an input image to predict a marker's location by visible light camera sensor on drone. Experimental results show that our method significantly outperforms state-of-the-art object trackers both using and not using convolutional neural network in terms of both accuracy and processing time.

The recent advancements in computer vision have opened new horizons for deploying biometric recognition algorithms in mobile and handheld devices. Similarly, iris recognition is now much needed in unconstraint scenarios with accuracy. These environments make the acquired iris image exhibit occlusion, low resolution, blur, unusual glint, ghost effect, and off-angles. The prevailing segmentation algorithms cannot cope with these constraints. In addition, owing to the unavailability of near-infrared (NIR) light, iris recognition in visible light environment makes the iris segmentation challenging with the noise of visible light. Deep learning with convolutional neural networks (CNN) has brought a considerable breakthrough in various applications. To address the iris segmentation issues in challenging situations by visible light and near-infrared light camera sensors, this paper proposes a densely connected fully convolutional network (IrisDenseNet), which can determine the true iris boundary even with inferior-quality images by using better information gradient flow between the dense blocks. In the experiments conducted, five datasets of visible light and NIR environments were used. For visible light environment, noisy iris challenge evaluation part-II (NICE-II selected from UBIRIS.v2 database) and mobile iris challenge evaluation (MICHE-I) datasets were used. For NIR environment, the institute of automation, Chinese academy of sciences (CASIA) v4.0 interval, CASIA v4.0 distance, and IIT Delhi v1.0 iris datasets were used. Experimental results showed the optimal segmentation of the proposed IrisDenseNet and its excellent performance over existing algorithms for all five datasets.

Haptoglobin (Hp) and Serum Amyloid A (SAA) are a group of blood proteins whose concentrations in animals can be influenced by infection, inflammation, surgical trauma or stress. Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis (CLA), and Mycolic acid is a virulent factor extracted from C. pseudotuberculosis. There is a dearth of sufficient evidence on the clinical implication of MAs on the responses of Hp and SAA in goats. Therefore, this study was conducted to evaluate the potential effects of Mycolic acid (MAs) and C. pseudotuberculosis on the responses of Hp and SAA in female goats. A total of 12 healthy female goats was divided into three groups; A, B and C each comprising of 4 goats and managed for a period of three months. Group (A) was inoculated with 2 mL of sterile phosphate buffered saline (as a negative control group) intradermally, while group (B) and (C) were inoculated intradermally with 2 ml each of mycolic acid and 1‏ × 10 9  cfu of active C. pseudotuberculosis respectively. The result of the study showed that the Hp concentration in goats inoculated with C. pseudotuberculosis was significantly increased up to 7-fold (1.17 ± 0.17 ng/L) while MAs showed a 3-fold increased (0.83 ± 0.01 ng/L) compared with the control. Whereas SAA concentration in C. pseudotuberculosis and MAs groups showed a significant 3-fold (17.85 ± 0.91 pg/mL) and 2-fold (10.97 ± 0.71 pg/mL) increased compared with the control. This study concludes that inoculation of C. pseudotuberculosis and MAs have significant effects on Hp and SAA levels, which indicates that MAs could have a role in the pathogenesis of caseous lymphadenitis., (Copyright © 2018. Published by Elsevier Ltd.)

Innumerable Escherichia coli of animal origin are identified, which are of economic significance, likewise, cattle, sheep and goats are the carrier of enterohaemorrhagic E. coli, which are less pathogenic, and can spread to people by way of direct contact and through the contamination of foodstuff or portable drinking water, causing serious illness. The immunization of ruminants has been carried out for ages and is largely acknowledged as the most economical and maintainable process of monitoring E. coli infection in ruminants. Yet, only a limited number of E. coli vaccines are obtainable. Mucosal surfaces are the most important ingress for E. coli and thus mucosal immune responses function as the primary means of fortification. Largely contemporary vaccination processes are done by parenteral administration and merely limited number of E. coli vaccines are inoculated via mucosal itinerary, due to its decreased efficacy. Nevertheless, aiming at maximal mucosal partitions to stimulate defensive immunity at both mucosal compartments and systemic site epitomises a prodigious task. Enormous determinations are involved in order to improve on novel mucosal E. coli vaccines candidate by choosing apposite antigens with potent immunogenicity, manipulating novel mucosal itineraries of inoculation and choosing immune-inducing adjuvants. The target of E. coli mucosal vaccines is to stimulate a comprehensive, effective and defensive immunity by specifically counteracting the antibodies at mucosal linings and by the stimulation of cellular immunity. Furthermore, effective E. coli mucosal vaccine would make vaccination measures stress-free and appropriate for large number of inoculation. On account of contemporary advancement in proteomics, metagenomics, metabolomics and transcriptomics research, a comprehensive appraisal of the immeasurable genes and proteins that were divulged by a bacterium is now in easy reach. Moreover, there exist marvellous prospects in this bourgeoning technologies in comprehending the host bacteria affiliation. Accordingly, the flourishing knowledge could massively guarantee to the progression of immunogenic vaccines against E. coli infections in both humans and animals. This review highlight and expounds on the current prominence of mucosal and systemic immunogenic vaccines for the prevention of E. coli infections in ruminants., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Recent developments in intelligence surveillance camera systems have enabled more research on the detection, tracking, and recognition of humans. Such systems typically use visible light cameras and images, in which shadows make it difficult to detect and recognize the exact human area. Near-infrared (NIR) light cameras and thermal cameras are used to mitigate this problem. However, such instruments require a separate NIR illuminator, or are prohibitively expensive. Existing research on shadow detection in images captured by visible light cameras have utilized object and shadow color features for detection. Unfortunately, various environmental factors such as illumination change and brightness of background cause detection to be a difficult task. To overcome this problem, we propose a convolutional neural network-based shadow detection method. Experimental results with a database built from various outdoor surveillance camera environments, and from the context-aware vision using image-based active recognition (CAVIAR) open database, show that our method outperforms previous works., Competing Interests: The authors declare no conflict of interest.

Acute kidney injury (AKI) following transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The biomarkers neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) are predictive of AKI after cardiac surgery, but there is little data regarding these biomarkers after TAVI. We evaluated the associations between NGAL, KIM-1, and IL-18 levels and the incidence and severity of AKI and changes in serum creatinine after TAVI. This was a prospective pilot study of 66 TAVI cases. Urinary biomarkers were measured at baseline and at 2, 4, and 12 hours after TAVI. Demographics, procedural features, and renal function until discharge were compared between patients with and without subsequent AKI. Seventeen patients (25.8%) developed AKI postoperatively (stage 1, n = 14; stage 2, n = 1; stage 3, n = 2). There were no significant differences in unadjusted mean NGAL, KIM-1, and IL-18 levels between patients with and without AKI at 2, 4, and 12 hours following surgery. After adjusting for the Society of Thoracic Surgeons risk of mortality, this study of three urinary biomarkers showed no association with AKI or creatinine after TAVI. Ongoing efforts to predict and modify the risk of AKI after TAVI remain challenging.

A paradigm shift is required to prevent the increasing automobile accident deaths that are mostly due to the inattentive behavior of drivers. Knowledge of gaze region can provide valuable information regarding a driver's point of attention. Accurate and inexpensive gaze classification systems in cars can improve safe driving. However, monitoring real-time driving behaviors and conditions presents some challenges: dizziness due to long drives, extreme lighting variations, glasses reflections, and occlusions. Past studies on gaze detection in cars have been chiefly based on head movements. The margin of error in gaze detection increases when drivers gaze at objects by moving their eyes without moving their heads. To solve this problem, a pupil center corneal reflection (PCCR)-based method has been considered. However, the error of accurately detecting the pupil center and corneal reflection center is increased in a car environment due to various environment light changes, reflections on glasses surface, and motion and optical blurring of captured eye image. In addition, existing PCCR-based methods require initial user calibration, which is difficult to perform in a car environment. To address this issue, we propose a deep learning-based gaze detection method using a near-infrared (NIR) camera sensor considering driver head and eye movement that does not require any initial user calibration. The proposed system is evaluated on our self-constructed database as well as on open Columbia gaze dataset (CAVE-DB). The proposed method demonstrated greater accuracy than the previous gaze classification methods., Competing Interests: The authors declare no conflict of interest.

Objectives: Evaluate the role of balloon aortic valvuloplasty (BAV) in improving candidacy of patients for transcatheter aortic valve replacement (TAVR)., Background: Patients who are not candidates for TAVR may undergo BAV to improve functional and clinical status., Methods: 117 inoperable or high-risk patients with critical aortic stenosis underwent BAV as a bridge-to-decision for TAVR. Frailty measures including gait speed, serum albumin, hand grip, activities of daily living (ADL); and NYHA functional class before and after BAV were compared., Results: Mean age was 81.6 ± 8.5 years and the mean Society of Thoracic Surgeons predicted risk of mortality was 9.57 ± 5.51, with 19/117 (16.2%) patients non-ambulatory. There was no significant change in mean GS post-BAV, but all non-ambulatory patients completed GS testing at follow-up. Albumin and hand grip did not change after BAV, but there was a significant improvement in mean ADL score (4.85 ± 1.41 baseline to 5.20 ± 1.17, P = 0.021). The number of patients with Class IV congestive heart failure (CHF) was significantly lower post BAV (71/117 [60.7%] baseline versus 18/117 [15.4%], P = 0.008). 78/117 (66.7%) of patients were referred to definitive valve therapy after BAV., Conclusions: When evaluating frailty measures post BAV, we saw no significant improvement in mean GS, however, we observed a significant improvement in non-ambulatory patients and ADL scores. We also describe improved Class IV CHF symptoms. With this improved health status, the majority of patients underwent subsequent valve therapy, demonstrating that BAV may improve candidacy of patients for TAVR., (© 2017, Wiley Periodicals, Inc.)

Aims: The aim of this study was to validate the recently developed STS/ACC TAVR in-hospital mortality risk score for predicting in-hospital mortality after transcatheter aotic valve implantation (TAVI) and to compare its ability to predict 30-day mortality with that of four other established risk models (EuroSCORE I, EuroSCORE II, STS-PROM, and German AV Score)., Methods and Results: The study cohort included 946 consecutive patients who underwent TAVI between 2013 and 2015. Each of the five scores was fitted as a continuous linear variable into a logistic regression model estimating 30-day mortality. The STS/ACC TAVR score was additionally analysed for in-hospital mortality. C-statistics and likelihood ratio (LR) test p-values were estimated for each model to describe the model fit. The ability of the STS/ACC score to predict in-hospital mortality was similar to the reported STS/ACC TVT registry data (this study's C-statistic 0.65 vs. STS/ACC TVT registry 0.66). The STS-PROM score (C-statistic=0.68; LR p<0.0001) and the new STS/ACC TAVR score (C-statistic=0.68; LR p<0.0001) were superior to the other scores (EuroSCORE I [C-statistic=0.55; LR p=0.02], EuroSCORE II [C-statistic=0.58; LR p=0.02], German AV Score [C-statistic=0.62; LR p<0.01]) for prediction of 30-day mortality., Conclusions: These data show the superiority of the STS-PROM and STS/ACC TAVR scores compared with other existing risk calculation models in predicting 30-day mortality after TAVI in a German all-comers population. The STS/ACC TAVR score, however, is easier to calculate (12 vs. 28 variables), and may thus gain wider acceptance and be accompanied by improved inter-observer reliability.

Academic conferences offer numerous submission tracks to support the inclusion of a variety of researchers and topics. Work in progress papers are one such submission type where authors present preliminary results in a poster session. They have recently gained popularity in the area of Human Computer Interaction (HCI) as a relatively easier pathway to attending the conference due to their higher acceptance rate as compared to the main tracks. However, it is not clear if these work in progress papers are further extended or transitioned into more complete and thorough full papers or are simply one-off pieces of research. In order to answer this we explore self-citation patterns of four work in progress editions in two popular HCI conferences (CHI2010, CHI2011, HRI2010 and HRI2011). Our results show that almost 50% of the work in progress papers do not have any self-citations and approximately only half of the self-citations can be considered as true extensions of the original work in progress paper. Specific conferences dominate as the preferred venue where extensions of these work in progress papers are published. Furthermore, the rate of self-citations peaks in the immediate year after publication and gradually tails off. By tracing author publication records, we also delve into possible reasons of work in progress papers not being cited in follow up publications. In conclusion, we speculate on the main trends observed and what they may mean looking ahead for the work in progress track of premier HCI conferences.

Background: Device landing zone (DLZ) calcification is an important determinant of procedural success in transcatheter aortic valve implantation (TAVI)., Objective: To evaluate the impact of DLZ calcification on procedural outcome with different types of transcatheter heart valves (THVs)., Methods: Aortic valve calcium density (AVC dens ) was determined by non-contrast-enhanced computed tomography in 1232 patients undergoing transfemoral TAVI. We stratified the outcome data according to the extent of AVC dens (mild, moderate, severe) and compared balloon-expandable (BE) with self-expanding (SE) THV. Moreover, THVs were subdivided according to their radial force (BE: high; SE mod : moderate; SE low : low)., Results: With BE THV, PVR ≥2° (2.1 vs. 7.9%; p < 0.001), post-dilatation (12.3 vs. 36.6%; p < 0.001), malpositioning (8.4 vs. 13.0%; p = 0.01), device embolization (0.4 vs. 2.6%; p = 0.004), and the need for a second valve (1.2 vs. 3.6%; p = 0.01) were less frequent than with SE devices, but mean transaortic gradients at discharge were higher [12.0 mmHg (8.0-15.0) vs. 9.0 mmHg (6.0-11.0); p < 0.001], and aortic root injury was more frequent (2.7 vs. 0.8%; p = 0.01). In cases of severe calcification, differences between BE and SE THV regarding PVR, post-dilatation, and hemodynamics were mostly pronounced, followed by patients with moderate AVC dens . In cases with low AVC dens , the best outcomes with respect to PVR, pacemaker implantation, and hemodynamics were achieved with SE low THV., Conclusions: In severe and moderate DLZ calcification, BE devices may have advantages, whereas in mild DLZ calcification, SE low THV showed the most favorable profile.

We aim to evaluate the contemporary role and outcomes of balloon aortic valvuloplasty (BAV), based on physician intent, for the management of severe aortic stenosis. This is a prospective, 2-center study of 100 consecutive high-risk patients with severe aortic stenosis who underwent BAV. Before BAV, physicians assigned intent as (1) bridge to decision (BTD); (2) therapeutic bridge to planned therapy; or (3) palliation. Patients in the BTD arm underwent clinical assessment at 30 days to determine eligibility for definitive valve therapy. All patients were followed up to 1 year, with outcomes measured including procedural complications, Kansas City Cardiomyopathy Questionnaires scores, 30-day and 1-year mortality, and definitive valve therapy. Enrolled patients had a mean age of 80.6 (±9.6) years, Society of Thoracic Surgeons predicted risk of mortality of 11.4% (±7.1%), and 91 (91.0%) patients had class III or IV New York Heart Association congestive heart failure. Intent in the 100 study patients was 76 BTD; 20 therapeutic bridge to planned therapy; and 4 palliation. Thirty-day mortality for all patients was 6 of 100 (6.0%), and 1-year mortality for all patients who received definitive valve therapy was 6 of 54 (11.1%). For patients surviving to 30 days, adjusted (by Society of Thoracic Surgeons predicted risk of mortality) Kansas City Cardiomyopathy Questionnaires scores were significantly improved from baseline for all patients and BTD patients. In conclusion, as a bridge to decision and treatment tool, BAV appears to have a valuable role in properly selecting and improving patients to undergo definitive valve replacement., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Periprocedural myocardial infarction (MI), a rare complication after transcatheter aortic valve implantation (TAVI), is associated with worse outcome. According to the Valve Academic Research Consortium (VARC-2), MI is defined by an increase in cardiac troponin (cTn) and creatine kinase MB (CK-MB) levels; however, many patients show periprocedurally elevated cTn without clinical evidence of MI. The aims of this study were to establish reference values of cardiac troponin I measured with a high-sensitivity assay (hs-cTnI) and to assess the periprocedural diagnostic value of this biomarker in patients who underwent TAVI. Hs-cTnI and CK-MB levels were assessed before and up to 3 days after transfemoral (TF) or transapical (TA) TAVI in 515 patients. A high proportion (61.2%) of patients had elevated hs-cTnI at baseline. According to VARC-2 criteria, almost all TA-patients (99.5%) showed an MI based on hs-cTnI compared with 4.2% based on CK-MB. In TF-patients, 81.1% had an MI based on hs-cTnI compared with 9.0% based on CK-MB. Only 10 patients (2%), however, had a type 1 MI. The ninety-ninth percentile for hs-cTnI was 285 ng/L in the TAVI cohort. After applying a TAVI-specific cutoff the frequency of MI was lower and more realistic (TF: 5% vs 81.1%; p <0.001; TA: 22.2% vs 99.5%; p <0.001). In conclusion, the VARC-2 definition leads to an overestimation of periprocedural MI. Our new TAVI-specific reference values yield a more realistic estimation of the myocardial ischemic risk. hs-cTnI, however, does not seem to be the biomarker of choice for MI detection in this setting., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The aim of the present study was to investigate whether transfemoral implantation of the Acurate neo transcatheter heart valve without pre-dilation is feasible., Methods: Between December 2014 and December 2016, 294 patients were treated with the Acurate neo prosthesis at our center. Of these, 72 cases were performed without pre-dilation. The decision to omit pre-dilation was at the discretion of the operator, preferably in the case of mild to moderate aortic valve calcification (AVC). Propensity matching (1:1) resulted in 48 cases in each group. Main outcomes of interest were device success according to VARC-2 criteria, residual aortic regurgitation (AR) ≥ 2°, and rate of post-dilation., Results: Median [IQR] age in patients without pre-dilation was 82.7 years [78.6–85.6], STS score was 4.6% [3.4–6.1], and AVC-score was 1436 AU [1043–1682] with mild and moderate AVC in 63.9% and 36.1% of cases, respectively. Device success was achieved in 94.4% of cases, post-dilation was necessary in 26.4%, and one (1.4%) patient had moderate AR. In the matched population, there were no differences regarding device success, rate of AR ≥ 2°, need for post-dilation, and post-procedural mean gradient, but the group without pre-dilation had shorter procedure (34.0 min [27.0–38.8] vs. 43.0 min [34.3–52.0]; p < 0.001) and fluoroscopy times (7.4 min [5.7–9.0] vs. 9.9 min [7.9–13.5]; p < 0.001)., Conclusion: In select patients with mild to moderate AVC, transfemoral implantation of the Acurate neo without pre-dilation is feasible and safe. This allows for a straightforward procedure that may be performed without rapid pacing in the majority of cases.

Transcatheter aortic valve replacement (TAVR) has become the default treatment option for high-risk patients with aortic stenosis and an alternative to surgical aortic valve replacement in intermediate-risk patients. There are, however, concerns regarding strokes during TAVR. Reported stroke rates vary strongly depending on the type of study, stroke definition, cohort and study period. Furthermore, stroke after TAVR occurs in three distinct phases: 1) early high-risk, directly procedure related; 2) elevated risk interval between day 2 and day 30; 3) late hazard interval. Each of these phases is caused by the different aetiologies of stroke. This review summarises the different aetiologies and potential strategies for managing stroke during TAVR., Competing Interests: Disclosure: The authors have no conflicts to declare.

Gaze-based interaction (GBI) techniques have been a popular subject of research in the last few decades. Among other applications, GBI can be used by persons with disabilities to perform everyday tasks, as a game interface, and can play a pivotal role in the human computer interface (HCI) field. While gaze tracking systems have shown high accuracy in GBI, detecting a user's gaze for target selection is a challenging problem that needs to be considered while using a gaze detection system. Past research has used the blinking of the eyes for this purpose as well as dwell time-based methods, but these techniques are either inconvenient for the user or requires a long time for target selection. Therefore, in this paper, we propose a method for fuzzy system-based target selection for near-infrared (NIR) camera-based gaze trackers. The results of experiments performed in addition to tests of the usability and on-screen keyboard use of the proposed method show that it is better than previous methods.

Tricuspid regurgitation (TR) is the most common lesion of the tricuspid valve (TV). Mild TR is common and usually is benign. However, moderate or severe TR can lead to irreversible myocardial damage and adverse outcomes. Despite these findings, few patients with significant TR undergo surgery. The treatment of functional (secondary) TR in particular remains controversial because of high rates of residual or recurrent TR and poor outcomes following surgical intervention. Traditional teaching that functional TR resolves on its own if the underlying disease is successfully treated has proven to be incorrect. This review aims to clarify management of TR by describing the anatomy, pathophysiology, diagnosis, and treatment of TR, including the eventual possibility of percutaneous TV therapy., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers. We compared the outcomes of surgery for TAAD in high-volume (HV) and LV centers in a single metropolitan area to determine the optimal setting for treatment. Thirty-five of the 37 cardiac surgery programs in the Dallas Ft. Worth metropolitan area participate in a regional consortium to measure outcomes collected in the Society of Thoracic Surgeons Adult Cardiac Database. From January 01, 2008, to December 31, 2014, 29 programs had treated TAAD. Those programs performing at least 100 operations for TAAD were considered HV centers and the others LV. Surgery for TAAD was performed in 672 patients over the 7-year study period with HV centers performing 469 of 672 (70%) of the operations. Despite similar preoperative characteristics, operative mortality was significantly lower in HV versus LV centers (14.1% vs 24.1%; p = 0.001). There was no significant difference in postoperative paralysis rates (2.6% vs 4.5%; p = 0.196), stroke rates (10.7% vs 9.4%; p = 0.623), or 30-day readmission rates (12.1% vs 15.5%; p = 0.292). An improved survival rate in HV centers was maintained over a 5-year follow-up period. Surgery for TAAD in a single large metropolitan area was most commonly performed in HV centers. In conclusion, the treatment of acute thoracic aortic dissection is recommended to be performed in reference centers because of lower early and midterm mortality., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Inverse associations between Body Mass Index (BMI) and Body Surface Area (BSA) with mortality in patients after Transcatheter Aortic Valve Implantation (TAVI) have been reported. This "obesity paradox" is controversial, and it remains unclear which parameter, BMI or BSA, is of greater prognostic value. The aim of this study was to investigate the association of BMI and BSA on short- and mid-term outcomes after TAVI., Methods and Results: This prospective, observational study consisted of 917 consecutive patients undergoing TAVI at our center from 2011 to 2014. The association between BMI/BSA and mortality (at 30 days and 1 year) was assessed using restricted cubic spline functions in propensity-adjusted (by Society of Thoracic Surgeons (STS) risk factors) logistic and Cox proportional models, respectively. The median age of the patients was 82.6 years, with a mean STS Predicted Risk of Mortality (STS-PROM) of 6.6 ± 4.3 %. Throughout the study period (mean follow-up time was 297 days), 150 (16.4 %) patients died; 72 (7.9 %) patients died within 30 days of TAVI. After risk adjustment, the association between body constitution and 30-day mortality was not significant for either measure (BMI p = 0.25; BSA p = 0.32). However, BMI (p = 0.01), but not BSA (p = 0.13), was significantly associated with 1-year survival. There was no association between stroke, vascular complications, or length of stay with BMI or BSA., Conclusions: BMI was associated with survival at 1-year after TAVI. Despite the trend towards implementing BSA in risk score calculation, BMI may be more suitable for the assessment of TAVI patients.

This study was performed to assess the acute intraprocedural effects of transcatheter direct mitral annuloplasty using the Cardioband device on 3-dimensional (3D) anatomy of the mitral annulus. Of 45 patients with functional mitral regurgitation (MR) enrolled in a single arm, multicenter, prospective trial, 22 had complete pre- and post-implant 3D transesophageal echocardiography (TEE) images stored in native data format that allowed off-line 3D reconstruction. Images with the highest volume rate and best image quality were selected for analysis. Multiple measurements of annular geometry were compared from baseline to post-implant using paired t tests with Bonferroni correction to account for multiple comparisons. The device was successfully implanted in all patients, and MR was reduced to moderate in 2 patients, mild in 17 patients, and trace in 3 patients after final device cinching. Compared with preprocedural TEE, postprocedural TEE showed statistically significantly reductions in annular circumference (137 ± 15 vs 128 ± 17 mm; p = 0.042), intercommissural distance (42.4 ± 4.3 vs 38.6 ± 4.4 mm; p = 0.029), anteroposterior distance (40.0 ± 5.4 vs 37.0 ± 5.7 mm; p = 0.025), and aortic-mitral angle (117 ± 8° vs 112 ± 8°; p = 0.032). This study demonstrates that transcatheter direct mitral annuloplasty with the Cardioband device results in acute remodeling of the mitral annulus with successful reduction of functional MR., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Mitral regurgitation (MR) can be divided into two major etiologies, primary and secondary MR. Primary MR, also termed degenerative or organic MR, is a disease of the valve itself and is treated routinely by surgical repair in all but prohibitive risk patients. In these patients, transcatheter repair techniques, including edge to edge repair with the MitraClip device have been largely successful and widely adopted. Transcatheter placement of artificial chords has also been performed. The potential role for transcatheter mitral valve replacement (TMVR) in primary MR will likely be quite limited. Secondary or functional MR is due to a disease of the left ventricle and not the valve itself. The MR is a result of dilation of the left ventricle causing distraction of the papillary muscles with tethering of the mitral leaflets and lack of leaflet coaptation. Medical therapy is the mainstay treatment, with resynchronization used in appropriate patients. Surgical repair, usually with an undersized annuloplasty, is used in a limited number of patients. Transcatheter edge to edge repair is used extensively outside the US in secondary MR and is the subject of a pivotal trial in the US. However, it is in this group of patients with secondary MR that there is the largest clinical unmet need and, hence, the greatest potential opportunity for TMVR. At least ten TMVR platforms are in early feasibility, first in human, or preclinical trial stages. Four devices have cumulative early human experience in <100 patients. In this article, we discuss those patients most likely to benefit from TMVR and detail lessons learned from the first human studies regarding patient selection.

Papillary fibroelastomas of the mitral chordae tendineae are rare, primary benign tumors. They are either incidentally diagnosed during echocardiography or discovered after transient ischemic attack, stroke, or myocardial infarction. Removal of papillary fibroelastomas should be considered, given the increased risk for embolization causing cerebrovascular accident or mortality in patients with echocardiographic evidence of papillary fibroelastoma not undergoing surgical procedures. Although fibroelastoma removal can be performed in most cases without disrupting mitral valve competency, sternotomy and minithoracotomy are the typical approaches for excision. Herein, we report the first robotic excision of a mitral chord papillary fibroelastoma., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients, and the preferred treatment option for high-risk patients with severe aortic stenosis. Given that this therapy was intended for elderly patients with limited life expectancy, long-term durability has not been in the focus. Now that TAVI is increasingly being used in patients with intermediate-risk and lower-risk profiles, device durability has gained importance. The available mid-term results for TAVI are promising; however, little is known about the fate of TAVI devices beyond 5 years. The experience with long-term durability of surgical valves shows that ≥10-year follow-up is required to ensure reliable durability data. In this Review, we discuss the existing studies of TAVI durability, highlight differences between surgical and transcatheter treatment of aortic stenosis that might influence durability, and present a clinical solution for failed prostheses. Furthermore, we suggest how device durability might influence the future selection of patients for TAVI.

Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) has been associated with increased postoperative morbidity and mortality. Long-term outcomes after TAVR with the Edwards SAPIEN valve in patients who develop AKI postoperatively are currently not well described. We retrospectively reviewed 384 consecutive patients undergoing TAVR at 2 institutions from August 2006 to April 2012. AKI was defined and staged according to Valve Academic Research Consortium-2 criteria. The incidence, multivariate predictors, and association of AKI with 3-year mortality were evaluated. Stage 1 AKI occurred in 24.0% of patients (92 of 384), stage 2 in 5.5% (21 of 384), and stage 3 in 8.1% (31 of 384). The overall operative mortality rate was 7.6%, with a mortality of 3.0% in patients with no kidney injury, 7.6% in stage 1, 23.8% in stage 2, and 32.3% in stage 3. The incidence of new postoperative dialysis was 3.1%. Survival at 3 years for no-AKI/stage 1/stage 2/stage 3 was 59.2 ± 3.3%, 43.4 ± 5.2%, 27.8 ± 10.0%, and 25.4 ± 7.9%, respectively. Logistic regression modeling for the combination of stage 2 or 3 AKI after surgery demonstrated that the last preoperative creatinine (for each 1 mg/dl increase, odds ratio = 3.23, 95% CI 1.83 to 5.69; p <0.001) and dye load (for each 10 ml increase, odds ratio = 1.04, 95% CI 1.01 to 1.08; p = 0.006) were significant predictors for AKI. In conclusion, AKI after TAVR is associated with increased postoperative and 3-year mortality. Significant multivariate predictors are potentially modifiable before the procedure., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Data demonstrating the outcome of transcatheter aortic valve replacement (TAVR) in the very elderly patients are limited, as they often represent only a small proportion of the trial populations., Objectives: The purpose of this study was to compare the outcomes of nonagenarians to younger patients undergoing TAVR in current practice., Methods: We analyzed data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. Outcomes at 30 days and 1 year were compared between patients ≥90 years versus <90 years of age using cumulative incidence curves. Quality of life was assessed with the 12-item Kansas City Cardiomyopathy Questionnaire., Results: Between November 2011 and September 2014, 24,025 patients underwent TAVR in 329 participating hospitals, of which 3,773 (15.7%) were age ≥90 years. The 30-day and 1-year mortality rates were significantly higher among nonagenarians (age ≥90 years vs. <90 years: 30-day: 8.8% vs. 5.9%; p < 0.001; 1 year: 24.8% vs. 22.0%; p < 0.001, absolute risk: 2.8%, relative risk: 12.7%). However, nonagenarians had a higher mean Society of Thoracic Surgeons Predicted Risk of Operative Mortality score (10.9% vs. 8.1%; p < 0.001) and, therefore, had similar ratios of observed to expected rates of 30-day death (age ≥90 years vs. <90 years: 0.81, 95% confidence interval: 0.70 to 0.92 vs. 0.72, 95% confidence interval: 0.67 to 0.78). There were no differences in the rates of stroke, aortic valve reintervention, or myocardial infarction at 30 days or 1 year. Nonagenarians had lower (worse) median Kansas City Cardiomyopathy Questionnaire scores at 30 days; however, there was no significant difference at 1 year., Conclusions: In current U.S. clinical practice, approximately 16% of patients undergoing TAVR are ≥90 years of age. Although 30-day and 1-year mortality rates were statistically higher compared with younger patients undergoing TAVR, the absolute and relative differences were clinically modest. TAVR also improves quality of life to the same degree in nonagenarians as in younger patients. These data support safety and efficacy of TAVR in select very elderly patients., (Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Objectives: Several alternative transapical (TA) aortic prostheses for aortic valve implantation (AVI) have recently become available. Data directly comparing the performance of these different TA-AVI valves, however, are sparse. Therefore, we sought to analyse the performance of the better-established balloon-expandable SAPIEN XT™ valve system, and compare it with the recently approved self-expandable ACURATE TA™ system by means of propensity score (PS) analysis., Methods: Samples from a total of 310 consecutive patients treated with transapical transcatheter aortic valve implantation (TAVI) were included (2010-2014). The ACURATE valve was implanted in 40% (n = 131), SAPIEN in 60% (n = 179). To adjust for baseline differences, 1:1 PS matching was used, and resulted in 103 matched pairs. In addition to demographical and clinical variables, potential anatomical confounders (calcification grade: computed tomography (CT) Agatston score; annulus diameter: CT-effective diameter) were included within the PS estimation., Results: For ACURATE- versus SAPIEN-treated patients, the mean age was 83.1 ± 5.4 vs 79.8 ± 9.5 (P < 0.001). Mean Society of Thoracic Surgeon scores were 7.7 ± 4.6 vs 8.1 ± 6.0 (P = 0.56). PS matching resulted in bias reduction <0.2, indicating excellent balance and allowing for valid outcome comparison. Device success, 30-day mortality rate and 1-year survival were comparable. Pacemaker and 30-day neurological event rates were not significantly different. The need for post-ballooning was significantly higher in the self-expandable group (40% vs 9%; P < 0.001). Echocardiography upon discharge demonstrated excellent functional outcomes regarding residual paravalvular leaks (ACURATE: 3% vs SAPIEN: 4%, P = 1.0) with slightly higher mean gradients in the ACURATE group (12 ± 5 mmHg vs 10 ± 5 mmHg, P = 0.003)., Conclusions: The two transapical TAVI devices demonstrated comparable haemodynamic performance and clinical outcome. The self-expandable valve required more frequent post-ballooning without affecting the safety profile., (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)