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We report the magnitude of the induced magnetic moment in CVD-grown epitaxial and rotated-domain graphene in proximity with a ferromagnetic Ni film, using polarized neutron reflectivity (PNR) and X-ray magnetic circular dichroism (XMCD). The XMCD spectra at the C K-edge confirms the presence of a magnetic signal in the graphene layer and the sum rules give a magnetic moment of up to $\sim\,0.47\,\mu$_B/C atom induced in the graphene layer. For a more precise estimation, we conducted PNR measurements. The PNR results indicate an induced magnetic moment of $\sim$ 0.53 $\mu$_B/C atom at 10 K for rotated graphene and $\sim$ 0.38 $\mu$_B/C atom at 10 K for epitaxial graphene. Additional PNR measurements on graphene grown on a non-magnetic Ni_9Mo_1 substrate, where no magnetic moment in graphene is measured, suggest that the origin of the induced magnetic moment is due to the opening of the graphene's Dirac cone as a result of the strong C pz-3d hybridization., Comment: 21 pages, 7 figures

Left main stem percutaneous coronary intervention (LMS-PCI) is a complex high-risk procedure which can be performed as an alternative to coronary artery bypass graft (CABG) procedure in surgical turn-down patients or where there is equipoise in percutaneous versus surgical strategies. Current guidelines suggest that PCI is an appropriate alternative to CABG in patients with unprotected LMS disease and low SYNTAX score. However, "real world" data on outcomes of LMS-PCI remain limited. This study aims to quantify and determine predictors of mortality following LMS-PCI.Using local coronary angioplasty registries from two UK centers, all LMS-PCI cases were identified from 2016 to 2020. Descriptive statistics and multivariate logistic regressions were used to examine the association between baseline and procedural characteristics with 30-day and 12-month mortality.We identified 484 cases of LMS-PCI between 2016 and 2020. There was a year-on-year increase in the number of LMS-PCI, the highest being in 2020. Covariates associated with higher 30-day mortality were age (OR 1.07, 95% CI: 1.02-1.12) and shock preprocedure (OR 23.88, 95% CI: 7.90-72.20). Covariates associated with higher 12-month mortality were age (OR 1.04, 95% CI: 1.01-1.08), acute coronary syndrome (ACS) (OR 2.50, 95% CI: 1.08-5.80), renal disease (OR 5.24, 95% CI: 1.47-18.68), and shock preprocedure (OR 7.93, 95% CI: 3.30-19.05). Overall, 30-day and 12-month mortality in this contemporary data set were 9.5% and 16.7%, respectively, with significantly lower rates in elective cases (p 0.01).Older age and cardiogenic shock preprocedure were associated with increased 30-day mortality after LMS-PCI. Twelve-month mortality was associated with older age, ACS presentation, preexisting renal disease, and cardiogenic shock preprocedure.

We set out to assess whether the preoperative prediction of patient-prosthesis mismatch by an algorithm popularised by Pibarot et al. is accurate compared to PPMM defined as AVA 2/m2 (‘any PPMM’) or as AVA 2/m2 (‘severe’ PPMM). We studied 37 patients (16 female), with mean age 72.3 +/− 8.4 years, who had unplanned SAVR during 2019. By echo, 17 (19.7%) patients had severe PPMM (mean AVA (SD) = 0.55 (0.04) cm2). For the 0.85cm2/m2 cut-off, 14/37 patients (37%) had PPMM (mean AVA (SD) 0.70 (0.15) cm2. By the Pibarot algorithm, 21 (56.7%) patients were predicted to have any PPMM and 10 (27%) severe PPMM. The preoperative algorithm for the avoidance of patient prosthetic mismatch does not accurately identify patients who have postoperative PPMM as defined by echocardiography. Further refinements of the algorithm seem necessary before it can be used widely in clinical practice.

Multiple guidelines exist for the diagnosis and management of mitral regurgitation (MR), the second most common valvular heart disease in high-income countries, with recommendations that do not always match. We systematically reviewed guidelines on diagnosis and management of MR, highlighting similarities and differences to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (1 June 2010 to 1 September 2021), the Guidelines International Network, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two reviewers independently screened the abstracts and identified articles of interest. Guidelines that were rigorously developed (as assessed with the Appraisal of Guidelines for Research and Evaluation II instrument) were retained for analysis. Five guidelines were retained. There was consensus on a multidisciplinary approach from the heart team and for the definition and grading of severe primary MR. There was general agreement on the thresholds for intervention in symptomatic and asymptomatic primary MR; however, discrepancies were present. There was agreement on optimization of medical therapy in severe secondary MR and intervention in patients symptomatic despite optimal medical therapy, but no consensus on the choice of intervention (surgical repair/replacement vs. transcatheter approach). Cut-offs for high-risk intervention in MR, risk stratification of progressive MR, and guidance on mixed valvular disease were sparse.

A number of guidelines exist with recommendations for diagnosis and management of mitral stenosis (MS). We systematically reviewed existing guidelines for diagnosis and management of MS, highlighting their similarities and differences, in order to guide clinical decision-making. We searched national and international guidelines in MEDLINE and EMBASE (5/4/2011–5/9/2021), the Guidelines International Network, Guideline Library, National Guideline Clearinghouse, National Library for Health Guidelines Finder, Canadian Medical Association Clinical Practice Guidelines Infobase, and websites of relevant organizations. Two independent reviewers screened titles and abstracts, and the full text of potentially relevant articles where needed. Selected guidelines were assessed for rigor of development; only guidelines with Appraisal of Guidelines for Research and Evaluation II instrument score >50% were included in the final analysis. Four guidelines were retained for analysis. There was consensus for percutaneous mitral balloon commissurotomy as first-line treatment of symptomatic severe rheumatic MS with suitable anatomy. In patients with unfavourable anatomy, surgical intervention should be considered. Exercise testing is indicated if discrepancy exists between symptoms and echocardiographic measurements. There was no clear divide between rheumatic MS and degenerative MS for their respective diagnoses and management. Pregnancy in severe MS is discouraged and the stenosis should be treated before conception. Long-term antibiotic prophylaxis is recommended for patients with rheumatic MS. Recommendations for the management of patients with mixed valvular diseases are lacking.

BACKGROUND Timing of aortic valve intervention is dependent on the accuracy and reproducibility of echocardiographic (ECHO) parameters. We aimed to assess haemodynamic subsets of aortic stenosis (AS), their change over time, and variability of ECHO parameters. METHOD This retrospective, longitudinal study compared sequential ECHO over 15 months to identify concordant or discordant aortic valve area (AVA) and mean pressure gradient (MPG) in order to determine the real world variability of echocardiographic indices. RESULTS We included 143 patients with a mean age of 76.0 years. The median length of time between studies was 112 days (IQR 38-208). Initially, participants were classified as 9 (6.4%) mild, 47 (33.6%) moderate, and 84 (60.0%%) severe AS. In 80 (55.9%) AVA and MPG were concordant; stroke volume index (SVi) was

Diagnostic criteria are used, as the name suggests, to make diagnosis of disease. They should encompass those characteristics that we find in every patient with the disease they are designed for. Therefore, it is extremely difficult to design such criteria. Classification criteria, on the other hand, are intended to be used only in already diagnosed patients, to classify them as having the respective disease, mainly for research purposes. Nevertheless, since classification criteria encompass those characteristics of the disease that are present in the majority of patients, it is only natural to try to use them as a helping tool in the diagnostic endeavor. This should be done appropriately, bearing in mind that the patient not fulfilling every one of them, can and may be still diagnosed as having ankylosing spondylitis, even though he/she cannot be classified as such. Classification criteria for ankylosing spondylitis (AS) have changed over time, due to the new insight obtained into the pathogenic mechanisms of the disease. Moreover, a patient fulfilling them is sometimes the initial step mandated by the paying authorities for reimbursement of therapies. All these reasons and others highlight the need to understand the different facets of the diagnostic/classification criteria and their best use.

Shoulder involvement is one of the most frequent findings in rheumatology and many of the rheumatic diseases can determine inflammatory lesions, as well as degenerative ones. Due to the non-specificity of clinical symptoms, imaging methods are emerging into the daily practice in order to establish an accurate diagnosis. Objectives. The aim of the study was to determine the presence of different pathologic changes in patients with shoulder pain, depending on the concurrent disease and associated risk factors. Material and methods. We included in our retrospective study 40 consecutive patients that presented with shoulder pain, during the past 6 months, in the Department of Rheumatology. All those patients underwent ultrasound evaluation according to EULAR Guidelines for musculoskeletal Ultrasound in Rheumatology. Results. Rotator cuff lesions, which most commonly underlie non traumatic pain in adults, were detected with frequencies similar to the ones described by the literature. It seems that comorbidities, as the presence of diabetes, may influence tendon degeneration or rupture. Conclusions. Although it included a relatively low number of subjects, our paper reveals data similar to the ones previously published and underlines the necessity of applying an algorithm for managing shoulder pathology, that should mandatory include ultrasonography examination, in order to obtain an accurate diagnosis and individualize each patient's therapeutic approach and improve their life quality.

Conductive domain walls in ferroelectrics offer a promising concept of nanoelectronic circuits with 2D domain-wall channels playing roles of memristors or synoptic interconnections. However, domain wall conduction remains difficult to control and pA-range currents typically measured on individual walls are too low for single-channel devices. Charged domain walls show higher conductivity, but are generally unstable and difficult to create. Here, we show highly conductive and stable channels on ubiquitous 180°-domain walls in the archetypical ferroelectric, tetragonal Pb(Zr,Ti)O3. These electrically erasable/rewritable channels show tens of nanoamperes (200-400nA/μm) at voltages ≤2V and metallic-like non thermally-activated transport properties down to 4K, as confirmed by nanoscopic mapping. The domain structure analysis and phase-field simulations reveal complex switching dynamics, in which the extraordinary conductivity in strained Pb(Zr,Ti)O3 films is explained by an interplay between ferroelastic 90°-domains and 180°-domains. This work demonstrates the potential of accessible and stable arrangements of nominally uncharged domain walls for nanoelectronics.

Identifying certain serum biomarkers associated with the degree of rheumatoid arthritis (RA) activity can provide us with a more accurate view of the evolution, prognosis, and future quality of life for these patients. Our aim was to analyze the presence and clinical use of matrix metalloproteinase-13 (MMP-13), along with vascular endothelial growth factor (VEGF) and well-known cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) for patients with RA. We also wanted to identify the possible correlations between MMP-13 and these serological markers, as well as their relationship with disease activity indices, quality of life, and ultrasonographic evaluation. For this purpose, we analyzed serum samples of 34 RA patients and 12 controls. In order to assess serum concentrations for MMP-13, VEGF, TNF-α, and IL-6, we used the enzyme-linked immunosorbent assay (ELISA) technique. Our results concluded that higher levels of MMP-13, VEGF, TNF-α, and IL-6 were present in the serum of RA patients compared to controls, with statistical significance. We furthermore identified moderately positive correlations between VEGF, MMP-13, and disease activity indices, as well as with the ultrasound findings. We also observed that VEGF had the best accuracy (97.80%), for differentiating patients with moderate disease activity. According to the data obtained in our study, that although MMP-13, TNF-α and C-reactive protein (CRP) have the same sensitivity (55.56%), MMP-13 has a better specificity (86.67%) in the diagnosis of patients with DAS28(4v) CRP values corresponding to moderate disease activity. Thus, MMP-13 can be used as a biomarker that can differentiate patients with moderate or low disease activity. VEGF and MMP-13 can be used as additional parameters, along with TNF-α and IL-6, that can provide the clinician a better picture of the inflammatory process, disease activity, and structural damage in patients with RA. Our data can certainly constitute a start point for future research and extended studies with multicenter involvement, to support the selection of individualized and accurate therapeutic management strategies for our patients.

Complete aortic occlusion is a rare pathology with various possible etiologies. According to current data, it is most frequently caused by atherosclerosis. However, thrombosis or vasculitis could also be involved. We present the case of a 42-year-old female with chronic complete distal aortic occlusion, associated pulmonary embolism and positive antiphospholipid antibodies. The patient had an obstetric history suggestive of antiphospholipid syndrome (APS). She presented with typical intermittent claudication symptoms persisting for approximately five years at the time of admission. Arteriography revealed complete infrarenal aortic occlusion and the presence of collateral arteries. Aortoiliac bypass surgery was performed. This case emphasizes an unusual, yet possible, etiology of chronic aortic occlusion—most probably, combining atherosclerosis and chronic thrombosis—in a relatively young patient, in which the diagnosis was significantly delayed due to the peculiar association of traits.

Background: Since the beginning of the COVID-19 pandemic, empiric antibiotics (ATBs) have been prescribed on a large scale in both in- and outpatients. We aimed to assess the impact of antibiotic treatment on the outcomes of hospitalised patients with moderate and severe coronavirus disease 2019 (COVID-19). Methods: We conducted a prospective multicentre cohort study in six clinical hospitals, between January 2021 and May 2021. Results: We included 553 hospitalised COVID-19 patients, of whom 58% (311/553) were prescribed antibiotics, while bacteriological tests were performed in 57% (178/311) of them. Death was the outcome in 48 patients—39 from the ATBs group and 9 from the non-ATBs group. The patients who received antibiotics during hospitalisation had a higher mortality (RR = 3.37, CI 95%: 1.7–6.8), and this association was stronger in the subgroup of patients without reasons for antimicrobial treatment (RR = 6.1, CI 95%: 1.9–19.1), while in the subgroup with reasons for antimicrobial therapy the association was not statistically significant (OR = 2.33, CI 95%: 0.76–7.17). After adjusting for the confounders, receiving antibiotics remained associated with a higher mortality only in the subgroup of patients without criteria for antibiotic prescription (OR = 10.3, CI 95%: 2–52). Conclusions: In our study, antibiotic treatment did not decrease the risk of death in the patients with mild and severe COVID-19, but was associated with a higher risk of death in the subgroup of patients without reasons for it.

Spondylatrhritis is a multifaceted disease, primary involving the axial skeleton. But sometimes, the patient present either with articular involvement plus other organ invelovement, or with only extraarticular involvement. As the most frequent, uveitis is the main extraarticular manifestation (EAM) of spondylarthritis. This EAM is very important because it can be the first manifestation of SpA, so it may bring the patient to the doctor, be it an ophthalmologist or a rheumatologist. Diagnosing uveitis in the context of SpA, is of paramount importance also because anterior uveitis is an emergency, because it can lead to blindness. So, knowing the clinical appearance and the treatment of uveitis in the context of SpA is crucial for providing the best care for SpA patients.

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory autoimmune disease with unclear etiology that involves the peripheral joints symmetrically, causing synovial hypertrophy, inflammation and, consequently, erosions of the bone and cartilage. We hereby present the case of a 51-year-old female patient diagnosed with RA in 2009 for which she received treatment with Methotrexate and TNF alpha treatment (Infliximab). Prior to the first dose of Infliximab Quantiferon-TB Gold was performed with a negative result. In 2016 the patient presented with ascites and pleural effusion with a positive repeated test for Quantiferon-TB Gold, the treatment with Infliximab and Methotrexate was stopped and she was started on anti TB standard treatment regimen for 9 months with the remission of the polyserositis. After the completion of the anti TB treatment we reinitiated Methotrexate therapy given a high disease activity (DAS28-CRP of 6.59) which improved the patients complaints; however, 3 months later, given an increase in the patients inflammatory markers we performed a computed tomography (CT) scan that revealed peritoneal thickening, and several omental nodules, the histological examination confirming the diagnosis of peritoneal TB. The patient was reinitiated on the anti-TB treatment.

Cloud object stores such as Amazon S3 are some of the largest and most cost-effective storage systems on the planet, making them an attractive target to store large data warehouses and data lakes. Unfortunately, their implementation as key-value stores makes it difficult to achieve ACID transactions and high performance: metadata operations such as listing objects are expensive, and consistency guarantees are limited. In this paper, we present Delta Lake, an open source ACID table storage layer over cloud object stores initially developed at Databricks. Delta Lake uses a transaction log that is compacted into Apache Parquet format to provide ACID properties, time travel, and significantly faster metadata operations for large tabular datasets (e.g., the ability to quickly search billions of table partitions for those relevant to a query). It also leverages this design to provide high-level features such as automatic data layout optimization, upserts, caching, and audit logs. Delta Lake tables can be accessed from Apache Spark, Hive, Presto, Redshift and other systems. Delta Lake is deployed at thousands of Databricks customers that process exabytes of data per day, with the largest instances managing exabyte-scale datasets and billions of objects.

Availability of biosimilar medicines is rapidly increasing, potentially leading to a wider prescription and a support for healthcare system costs. Despite efforts of patient and physician educational initiatives there still remains a reluctance in prescribing or administering this type of products. A multi-centric survey was conducted on 336 patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) or lupus (SLE) on biologic treatment. Half of the patients stated never hearing of biosimilars and one third feared adverse events (infections, cancer). Another 20% felt insecure on drug tolerability or efficacy. However, the majority declared relying on their rheumatologist if prescribing a biosimilar. Lack of patient information should be accurately addressed by health organizations so that the choice of treatment is done knowingly.

Musculoskeletal ultrasound had gained more and more importance lately and there is no doubt now about its role in the diagnosis and management of rheumatic diseases such as rheumatoid arthritis, spondyloarthritis, osteoarthritis and crystal related arthropathies. We can say that now, US is a widely available, non-invasive, and cost-effective technique suitable for the evaluation of the articular and periarticular structures, such as joints, tendons, muscles, ligaments, and bursa. The real-time capabilities of the US allow continuous observation of those structures during movement and of the needle placement during musculoskeletal interventions. More than this, recently, ultrasonography (US) has gained its rights in the evaluation of Sjogren syndrome and giant cell arteritis. Thus, US can detect changes secondary to both inflammatory joint diseases, like synovitis, tenosynovitis or enthesitis, and to degenerative disease, like osteophytes or tendinosis. US can identify calcium pyrophosphate and urate deposits at the level of the cartilage and tendons and to recognize the changes at the level of the salivary glands in the context of the Sjogren’s syndrome and the ones at the level of the temporal artery, secondary to giant cell arteritis.

The demand for low power, large-scale integration, and novel functionality has been increasing since the emergence of the internet of things (IoT) and Edge Artificial Intelligence (AI) applications requiring real-time energy-efficient information processing. In this work, the integration of doped high-k ferroelectric and linear high-k dielectric gate stacks with 2D material systems is developed as a versatile technological solution for building robust energy-efficient electronic functions. In this context, we report the co-integration of three major types of devices, offering the first 2D hybrid platform supporting the co-design of energy-efficient Von-Neumann and neuromorphic circuits. The negative capacitance (NC) of the ferroelectric layer is used in our platform as a technology booster to achieve significantly improved subthermionic electronic switches. The performance of four types of logic switches on this platform: 2D MOSFET, 2D/2D TFET, NC 2D MOSFET, and NC 2D/2D TFET, are reported, showing superior performance of NC devices compared to their conventional baseline 2D MOSFET and 2D/2D TFET. Importantly, this work shows the first NC 2D/2D TFET integrated with NC 2D MOSFET that achieves an average swing of 50 mV/dec over 2.5 decades of current for TFET and 45 mV/dec over 3 decades of ID for MOSFET. Furthermore, we exploit the same ferroelectric gate stacks on 2D devices to build artificial synapses and our platform demonstrates a good capability to mimic various synapse behaviors including long-term potentiation, long-term depression, and spike-amplitude-dependent plasticity. This prototypical demonstration paves the way toward practical implementations of 2D platforms in emerging Edge AI technologies, enabling energy-efficient operation, high integration density, and excellent scalability while co-integrating for the first time logic switches and neuromorphic devices.

Guidelines for the diagnosis and management of aortic regurgitation (AR) contain recommendations that do not always match. We systematically reviewed clinical practice guidelines and summarized similarities and differences in the recommendations as well as gaps in evidence on the management of AR. We searched MEDLINE and Embase (1 January 2011 to 1 September 2021), Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed as assessed by the Appraisal of Guidelines for Research and Evaluation II tool. Three guidelines met our inclusion criteria. There was consensus on the definition of severe AR and use of echocardiography and of multimodality imaging for diagnosis, with emphasis on comprehensive assessment by the heart valve team to assess suitability and choice of intervention. Surgery is indicated in all symptomatic patients and aortic valve replacement is the cornerstone of treatment. There is consistency in the frequency of follow-up of patients, and safety of non-cardiac surgery in patients without indications for surgery. Discrepancies exist in recommendations for 3D imaging and the use of global longitudinal strain and biomarkers. Cut-offs for left ventricular ejection fraction and size for recommending surgery in severe asymptomatic AR also vary. There are no specific AR cut-offs for high-risk surgery and the role of percutaneous intervention is yet undefined. Recommendations on the treatment of mixed valvular disease are sparse and lack robust prospective data.

We report an unusual case where "stuck" bileaflet aortic prosthetic valve occluders were partly released by performing emergency balloon dilatation with 2 noncompliant balloons by a percutaneous femoral approach. (

Coronary lesions with marked mismatch between the vessel diameters proximal and distal to the stenosis pose the challenge of determining the correct stent size. Under-sizing and under expansion/malapposition can lead to restenosis and stent thrombosis, while oversizing can result in coronary dissection/perforation. Stentys self-apposing stents was introduced to address such challenging lesions. In addition, they’ve also shown promising results in bifurcation lesions, vein graft intervention and ectatic vessels. However, their use in the treatment of in-stent restenosis (ISR) is unknown.

Psoriasis is an immune-mediated chronic inflammatory skin disease with extracutaneous manifestations, that affects about 1–3% of the world’s population. The disease is not life-threatening, but the disability which comes with it is comparable to the disability caused by other serious chronic diseases, such as oncologic or cardiovascular disease. Several risk factors, such as infections, stress, smoking, excessive alcohol consumption and genetic predisposition have been involved in inducing psoriasis. Smoking status is a risk factor for many chronic diseases, including psoriasis. Moreover, recent studies have tried to answer the question of whether smoking also influences the response to biologic therapy in patients with psoriasis. Through the current study, our intention is to find out how smoking affects the response to biologic treatment. A hospital-based cross-sectional, observational, non-interventional, retrospective study of moderate and severe psoriasis patients receiving biologic treatment was developed. Two groups were defined based on smoking status: group 1 included smokers (more than 10 cigarettes/day) and former smokers, and group 2 included non-smokers. The data that resulted from the analysis of the cohort of patients demonstrate that smoking status does not affect the response of biologic therapy in patients with moderate and severe psoriasis.