Synthesis of 1,3,5-Triazepines and Benzo[f][1,3,5]triazepines and Their Biological Activity: Recent Advances and New Approaches.

This review article discusses the recent progress in synthesizing seven-membered ring 1,3,5-triazepine and benzo[f][1,3,5]triazepine derivatives. These derivatives can be either unsaturated, saturated, fused, or separated. This review covers strategies and procedures developed over the past two decades, including cyclo-condensation, cyclization, methylation, chlorination, alkylation, addition, cross-coupling, ring expansions, and ring-closing metathesis. This review discusses the synthesis of 1,3,5-triazepine derivatives using nucleophilic or electrophilic substitution reactions with various reagents such as o-phenylenediamine, 2-aminobenzamide, isothiocyanates, pyrazoles, thiazoles, oxadiazoles, oxadiazepines, and hydrazonoyl chloride. This article systematically presents new approaches and techniques for preparing these compounds. It also highlights the biological importance of benzo[f][1,3,5]triazepine derivatives, which have been used as drugs for treating nervous system diseases. This review aims to provide researchers with the necessary information to create and develop new derivatives of these compounds as quickly as possible.

RNA landscapes of brain and brain-derived extracellular vesicles in simian immunodeficiency virus (SIV) infection and central nervous system pathology.

INTRODUCTION: Brain tissue-derived extracellular vesicles (bdEVs) act locally in the central nervous system (CNS) and may indicate molecular mechanisms in HIV CNS pathology. Using brain homogenate (BH) and bdEVs from a simian immunodeficiency virus (SIV) model of HIV disease, we identified RNA networks in SIV infection and neuroinflammation. METHODS: Postmortem occipital cortex samples were obtained from uninfected controls and SIV-infected subjects (acute and chronic phases with or without CNS pathology (SIV encephalitis). bdEVs were separated and characterized per international consensus guidelines. RNAs from bdEVs and BH were sequenced and qPCR-amplified to detect levels of small RNAs (sRNAs, including microRNAs (miRNAs)) and longer RNAs including messenger RNAs (mRNAs) and circular RNAs (circRNAs). RESULTS: Dysregulated RNAs in BH and bdEVs were identified in acute and chronic infection with pathology groups, including mRNAs, miRNAs, and circRNAs. Most dysregulated mRNAs in bdEVs reflected dysregulation in source BH. These mRNAs are disproportionately involved in inflammation and immune responses. Based on target prediction, several circRNAs that were differentially abundant in source tissue might be responsible for specific differences in sRNA levels in bdEVs during SIV infection. CONCLUSIONS: RNA profiling of bdEVs and source tissues reveals potential regulatory networks in SIV infection and SIV-related CNS pathology.

Microbial-induced Redox Imbalance in the Neonatal Lung Is Ameliorated by Live Biotherapeutics.

Bronchopulmonary dysplasia (BPD) is a common lung disease of premature infants. Hyperoxia exposure and microbial dysbiosis are contributors to BPD development. However, the mechanisms linking pulmonary microbial dysbiosis to worsening lung injury are unknown. Nrf2 (nuclear factor erythroid 2-related factor 2) is a transcription factor that regulates oxidative stress responses and modulates hyperoxia-induced lung injury. We hypothesized that airway dysbiosis would attenuate Nrf2-dependent antioxidant function, resulting in a more severe phenotype of BPD. Here, we show that preterm infants with a Gammaproteobacteria-predominant dysbiosis have increased endotoxin in tracheal aspirates, and mice monocolonized with the representative Gammaproteobacteria Escherichia coli show increased tissue damage compared with germ-free (GF) control mice. Furthermore, we show Nrf2-deficient mice have worse lung structure and function after exposure to hyperoxia when the airway microbiome is augmented with E. coli. To confirm the disease-initiating potential of airway dysbiosis, we developed a novel humanized mouse model by colonizing GF mice with tracheal aspirates from human infants with or without severe BPD, producing gnotobiotic mice with BPD-associated and non-BPD-associated lung microbiomes. After hyperoxia exposure, BPD-associated mice demonstrated a more severe BPD phenotype and increased expression of Nrf2-regulated genes, compared with GF and non-BPD-associated mice. Furthermore, augmenting Nrf2-mediated antioxidant activity by supporting colonization with Lactobacillus species improved dysbiotic-augmented lung injury. Our results demonstrate that a lack of protective pulmonary microbiome signature attenuates an Nrf2-mediated antioxidant response, which is augmented by a respiratory probiotic blend. We anticipate antioxidant pathways will be major targets of future microbiome-based therapeutics for respiratory disease.

Interfacial Engineering of Porous Pd/M (M = Au, Cu, Mn) Sponge-like Nanocrystals with a Clean Surface for Enhanced Alkaline Electrochemical Oxidation of Ethanol.

The interfacial engineering of Pd-based alloys (i.e., PdM with distinct morphologies, compositions, and strain defects) is an efficient way for enhanced catalytic activity; however, it remains a grand challenge to fabricate such alloys in aqueous solutions without heating, organic solvents, and multiple reaction steps. Herein, we present a simple, aqueous-phase, one-step, and ultrafast approach for the interfacial engineering of surfactant-free porous PdM (M = Cu, Au, and Mn) nanocrystals with well-controlled spongy-like morphology and compositions. The electronic interaction in PdM nanocrystals and their effect on the alkaline electrochemical ethanol oxidation reaction (EOR) are investigated using XRD, XPS, and electrochemical tests. Notably, integrating M metals into Pd atoms results in upshifting the d-band center of Pd and subsequently modulating the EOR activity and stability substantially. The EOR mass activity (10.78 A/mgPd (6.93 A/mgPdCu)) of PdCu was 1.83, 3.09, 4.51, and 53.90 times higher than those of AuPd (5.90 A/mgPd (3.27 A/mgAuPd)), PdMn (3.48 A/mgPd (3.19 A/mgPdMn)), Pd (2.39 A/mgPd), and Pd/C (0.20 A/mgPd), respectively, besides substantial durability after 1000 cycles. This is due to the porous two-dimensional morphology, a low synergetic effect, higher interfacial interaction, and greater active surface area of PdCu, besides a high Cu content with more oxophilicity that facilitates activation/dissociation of H2O to generate -OH species needed for quick EOR electrocatalysis. The electrochemical impedance spectroscopy (EIS) reveals better electrolyte/electrode interfacial interaction and lower charge transfer resistance on PdCu. The EOR activity of PdCu porous sponge-like nanocrystals was superior to all previously reported Pd-based alloys for electrochemical EOR. This study indicates that binary Pd-based catalysts with less synergetic effect are preferred for boosting the EOR activity, which could help in manipulating the surface properties of Pd-based alloys to optimize EOR performance.

Brain-derived neurotrophic factor and neuroimaging in pediatric patients with sickle cell disease.

BACKGROUND: The risk of neurological complications is increased in children with sickle cell disease (SCD), such as silent cerebral infarction (SCI) and stroke. Brain-Derived Neurotrophic Factor (BDNF) is a nerve growth factor associated with elevated transcranial Doppler (TCD) velocities and increased risk of stroke in SCD patients. So, we assessed the BDNF level in children with SCD and its relation to neurological complication as silent stroke. METHODS: A comparative cross-sectional study was conducted on 40 patients with SCD, recruited from the Hematology Unit, Pediatric Department, Menoufia University Hospital, and 40 healthy children as controls. Laboratory investigations including BDNF were done. TCD was done for all patients and Magnetic Resonance Imaging (MRI) was done on high-risk patients. RESULTS: BDNF levels were significantly higher in children with SCD than in controls with a significant relation to TCD findings. There was a statistically significant diagnostic ability of BDNF in the prediction of SCD complications as its sensitivity was 89.5%, specificity (95% CI) was 80% with a cut-off point >0.69, AUC = 0.702, and p = 0.004). CONCLUSION: Serum BDNF levels were higher in sickle disease patients who had abnormal transcranial Doppler. BDNF had a significant diagnostic ability in the detection of SCD complications. IMPACT: Silent stroke is a very serious complication in children with sickle cell disease, so regular follow up should be every six months. BDNF is considered a potential biomarker for stroke risk prediction in patients unable to receive TCD.

Comparative outcomes among inlay grafted incised plate, onlay preputial flap and tubularized incised plate urethroplasty for the repair of distal penile hypospadias with a narrow urethral plate.

PURPOSE: We conducted this study, comparing the outcomes among Transverse Onlay Island Flap, inlay grafted incised plate and our previous records of tubularized incised plate urethroplasty (TIPU) in patients with narrow urethral plates, aiming to determine which method of repair provides a good outcome. METHODS: This hybrid study included two datasets. The first from a prospective randomized study evaluating outcomes of two treatment modalities; Inlay graft and only flap for distal hypospadias with shallow urethral plate with 80 patients (40 patients in each group) included, the second based on our previous records of TIPU in 40 patients with distal primary hypospadias with narrow urethral plate. RESULTS: The success rate in inlay graft urethroplasty group (n = 40) was 87.5%; glandular dehiscence occurred in one case (2.5%), fistulas occurred in 2 cases (5%), and narrow meatus occurred in two cases (5%). Success rate in onlay flap urethroplasty group (n = 40) was 82.5%; glandular dehiscence occurred in two cases (5%), fistulas occurred in two cases (5%), and narrow meatus occurred in three cases (7.5%). TIPU group (n = 40) had success rate of 62.5%; glandular dehiscence occurred in eight cases (20%), fistulas occurred in five cases (12.5%), and narrow meatus occurred in seven cases (17.5%), with five cases exhibiting both narrow meatus with fistula. CONCLUSION: Inlay graft and onlay flap urethroplasty for repair of distal penile hypospadias with narrow urethral plate had higher success rate and fewer complications than traditional TIPU. Moreover, operative time was shorter in TIPU.

Octopus: A Novel Approach for Health Data Masking and Retrieving Using Physical Unclonable Functions and Machine Learning.

Health equipment are used to keep track of significant health indicators, automate health interventions, and analyze health indicators. People have begun using mobile applications to track health characteristics and medical demands because devices are now linked to high-speed internet and mobile phones. Such a combination of smart devices, the internet, and mobile applications expands the usage of remote health monitoring through the Internet of Medical Things (IoMT). The accessibility and unpredictable aspects of IoMT create massive security and confidentiality threats in IoMT systems. In this paper, Octopus and Physically Unclonable Functions (PUFs) are used to provide privacy to the healthcare device by masking the data, and machine learning (ML) techniques are used to retrieve the health data back and reduce security breaches on networks. This technique has exhibited 99.45% accuracy, which proves that this technique could be used to secure health data with masking.

24-nt phasiRNAs move from tapetal to meiotic cells in maize anthers.

In maize, 24-nt phased, secondary small interfering RNAs (phasiRNAs) are abundant in meiotic stage anthers, but their distribution and functions are not precisely known. Using laser capture microdissection, we analyzed tapetal cells, meiocytes and other somatic cells at several stages of anther development to establish the timing of 24-PHAS precursor transcripts and the 24-nt phasiRNA products. By integrating RNA and small RNA profiling plus single-molecule and small RNA FISH (smFISH or sRNA-FISH) spatial detection, we demonstrate that the tapetum is the primary site of 24-PHAS precursor and Dcl5 transcripts and the resulting 24-nt phasiRNAs. Interestingly, 24-nt phasiRNAs accumulate in all cell types, with the highest levels in meiocytes, followed by tapetum. Our data support the conclusion that 24-nt phasiRNAs are mobile from tapetum to meiocytes and to other somatic cells. We discuss possible roles for 24-nt phasiRNAs in anther cell types.

Comprehensive Performance Analysis of Zigbee Communication: An Experimental Approach with XBee S2C Module.

The recent development of wireless communications has prompted many diversified applications in both industrial and medical sectors. Zigbee is a short-range wireless communication standard that is based on IEEE 802.15.4 and is vastly used in both indoor and outdoor applications. Its performance depends on networking parameters, such as baud rates, transmission power, data encryption, hopping, deployment environment, and transmission distances. For optimized network deployment, an extensive performance analysis is necessary. This would facilitate a clear understanding of the trade-offs of the network performance metrics, such as the packet delivery ratio (PDR), power consumption, network life, link quality, latency, and throughput. This work presents an extensive performance analysis of both the encrypted and unencrypted Zigbee with the stated metrics in a real-world testbed, deployed in both indoor and outdoor scenarios. The major contributions of this work include (i) evaluating the most optimized transmission power level of Zigbee, considering packet delivery ratio and network lifetime; (ii) formulating an algorithm to find the network lifetime from the measured current consumption of packet transmission; and (iii) identifying and quantizing the trade-offs of the multi-hop communication and data encryption with latency, transmission range, and throughput.

Internet of Things: Security and Solutions Survey.

The overwhelming acceptance and growing need for Internet of Things (IoT) products in each aspect of everyday living is creating a promising prospect for the involvement of humans, data, and procedures. The vast areas create opportunities from home to industry to make an automated lifecycle. Human life is involved in enormous applications such as intelligent transportation, intelligent healthcare, smart grid, smart city, etc. A thriving surface is created that can affect society, the economy, the environment, politics, and health through diverse security threats. Generally, IoT devices are susceptible to security breaches, and the development of industrial systems could pose devastating security vulnerabilities. To build a reliable security shield, the challenges encountered must be embraced. Therefore, this survey paper is primarily aimed to assist researchers by classifying attacks/vulnerabilities based on objects. The method of attacks and relevant countermeasures are provided for each kind of attack in this work. Case studies of the most important applications of the IoT are highlighted concerning security solutions. The survey of security solutions is not limited to traditional secret key-based cryptographic solutions, moreover physical unclonable functions (PUF)-based solutions and blockchain are illustrated. The pros and cons of each security solution are also discussed here. Furthermore, challenges and recommendations are presented in this work.

Prospect of Internet of Medical Things: A Review on Security Requirements and Solutions.

With the widespread and increasing use of Internet-of-Things (IoT) devices in all aspects of daily life, a hopeful future for people, data, and processes is emerging. Extensive spans allow for an integrated life cycle to be created from home to enterprise. The Internet of Medical things (IoMT) forms a flourishing surface that incorporates the sensitive information of human life being sent to doctors or hospitals. These open an enormous space for hackers to utilize flaws of the IoMT network to make a profit. This creates a demand for standardizing regulations and a secure system. Though many authorities are making standards, there are some lacking in the system which makes the product vulnerable. Although many established mechanisms are present for the IoT network, there are a number of obstacles preventing its general implementation in the IoMT network. One of the adoption challenges is the IoMT devices itself, because many IoMT networks consist of battery-powered devices with constrained processing capability. A general overview of the different security integrations with IoT applications has been presented in several papers. Therefore, this paper aims to provide an overview of the IoMT ecosystem, regulations, challenges of standards, security mechanisms using cryptographic solutions, physical unclonable functions (PUF)-based solutions, blockchain, and named data networking (NDN) as well, with pros and cons.

Non-Metal-Doped Porous Carbon Nitride Nanostructures for Photocatalytic Green Hydrogen Production.

Photocatalytic green hydrogen (H2) production through water electrolysis is deemed as green, efficient, and renewable fuel or energy carrier due to its great energy density and zero greenhouse emissions. However, developing efficient and low-cost noble-metal-free photocatalysts remains one of the daunting challenges in low-cost H2 production. Porous graphitic carbon nitride (gCN) nanostructures have drawn broad multidisciplinary attention as metal-free photocatalysts in the arena of H2 production and other environmental remediation. This is due to their impressive catalytic/photocatalytic properties (i.e., high surface area, narrow bandgap, and visible light absorption), unique physicochemical durability, tunable electronic properties, and feasibility to synthesize in high yield from inexpensive and earth-abundant resources. The physicochemical and photocatalytic properties of porous gCNs can be easily optimized via the integration of earth-abundant heteroatoms. Although there are various reviews on porous gCN-based photocatalysts for various applications, to the best of our knowledge, there are no reviews on heteroatom-doped porous gCN nanostructures for the photocatalytic H2 evolution reaction (HER). It is essential to provide timely updates in this research area to highlight the research related to fabrication of novel gCNs for large-scale applications and address the current barriers in this field. This review emphasizes a panorama of recent advances in the rational design of heteroatom (i.e., P, O, S, N, and B)-doped porous gCN nanostructures including mono, binary, and ternary dopants for photocatalytic HERs and their optimized parameters. This is in addition to H2 energy storage, non-metal configuration, HER fundamental, mechanism, and calculations. This review is expected to inspire a new research entryway to the fabrication of porous gCN-based photocatalysts with ameliorated activity and durability for practical H2 production.

Type I Interferons Enhance the Repair of Ultraviolet Radiation-Induced DNA Damage and Regulate Cutaneous Immune Suppression.

Type I interferons (IFNs) are important enhancers of immune responses which are downregulated in human cancers, including skin cancer. Solar ultraviolet (UV) B radiation is a proven environmental carcinogen, and its exposure contributes to the high prevalence of skin cancer. The carcinogenic effects of UV light can be attributed to the formation of cyclobutane pyrimidine dimers (CPD) and errors in the repair and replication of DNA. Treatment with a single dose of UVB (100 mJ/cm2) upregulated IFNα and IFNß in the skin of C57BL/6 mice. IFNα and IFNß were predominantly produced by CD11b+ cells. In mice lacking the type I IFN receptor 1 (IFNAR1), the repair of CPD following cutaneous exposure to a single dose of UVB (100 mJ/cm2) was decreased. UVB induced the expression of the DNA repair gene xeroderma pigmentosum A (XPA) in wild-type (WT) mice. In contrast, such treatment in IFNAR1 (IFNAR1-/-) mice downregulated XPA. A local UVB regimen consisting of UVB radiation (150 mJ/cm2) for 4 days followed by sensitization with hapten 2,4, dinitrofluorobenzene (DNFB) resulted in significant suppression of immune responses in both WT and IFNAR1-/- mice. However, there were significantly higher CD4+CD25+Foxp3+ regulatory T-cells in the draining lymph nodes of IFNAR1-/- mice in comparison to WT mice. Overall, our studies reveal a previously unknown action of type I IFNs in the repair of photodamage and the prevention of UVB-induced immune suppression.

Pt-Based Nanostructures for Electrochemical Oxidation of CO: Unveiling the Effect of Shapes and Electrolytes.

Direct alcohol fuel cells are deemed as green and sustainable energy resources; however, CO-poisoning of Pt-based catalysts is a critical barrier to their commercialization. Thus, investigation of the electrochemical CO oxidation activity (COOxid) of Pt-based catalyst over pH ranges as a function of Pt-shape is necessary and is not yet reported. Herein, porous Pt nanodendrites (Pt NDs) were synthesized via the ultrasonic irradiation method, and its CO oxidation performance was benchmarked in different electrolytes relative to 1-D Pt chains nanostructure (Pt NCs) and commercial Pt/C catalyst under the same condition. This is a trial to confirm the effect of the size and shape of Pt as well as the pH of electrolytes on the COOxid. The COOxid activity and durability of Pt NDs are substantially superior to Pt NCs and Pt/C in HClO4, KOH, and NaHCO3 electrolytes, respectively, owing to the porous branched structure with a high surface area, which maximizes Pt utilization. Notably, the COOxid performance of Pt NPs in HClO4 is higher than that in NaHCO3, and KOH under the same reaction conditions. This study may open the way for understanding the COOxid activities of Pt-based catalysts and avoiding CO-poisoning in fuel cells.

The severity and atypical presentations of COVID-19 infection in pediatrics.

BACKGROUND: Emergence of 2019-nCoV attracted global attention and WHO declared COVID-19 a public health emergency of international concern. Therefore we aimed to explore the severity and atypical manifestations of COVID-19 among children. METHODS: This is an observational cohort study conducted on 398 children with confirmed COVID-19 by using real-time reverse transcriptase polymerase chain reaction assay for detection of 2019-nCoV nucleic acid during the period from March to November 2020. Patients were subdivided regarding the severity of COVID-19 presentation into Group I (Non-severe COVID-19) was admitted into wards and Group II (Severe COVID-19) admitted into the PICU. RESULTS: Non- severe cases were 295cases (74.1%) and 103cases (25.9%) of severe cases. There was a significant difference between age groups of the affected children (P < 0.001) with a median (0-15 years). Boys (52%) are more affected than girls (48%) with significant differences (P < 0.001). 68.6%of confirmed cases had contact history to family members infected with COVID-19. 41.7% of severe patients needed mechanical ventilation. Death of 20.4% of severe cases. In COVID-19 patients, fever, headache, fatigue and shock were the most prominent presentations (95, 60.3, 57.8, and 21.8% respectively). 3.5% of children were manifested with atypical presentations; 1.25% manifested by pictures of acute pancreatitis, 1.25% presented by manifestations of deep venous thrombosis and 1.0% had multisystem inflammatory syndrome (MIS-C). Multivariate regression analysis showed that COVID-19 severity in children was significantly higher among children with higher levels of D-dimer, hypoxia, shock and mechanical ventilation. CONCLUSION: Most children had a non-severe type of COVID-19 and children with severe type had higher levels of D-dimer, hypoxia, shock and mechanical ventilation.

LoRa Architecture for V2X Communication: An Experimental Evaluation with Vehicles on the Move.

The industrial development of the last few decades has prompted an increase in the number of vehicles by multiple folds. With the increased number of vehicles on the road, safety has become one of the primary concerns. Inter vehicular communication, specially Vehicle to Everything (V2X) communication can address these pressing issues including autonomous traffic systems and autonomous driving. The reliability and effectiveness of V2X communication greatly depends on communication architecture and the associated wireless technology. Addressing this challenge, a device-to-device (D2D)-based reliable, robust, and energy-efficient V2X communication architecture is proposed with LoRa wireless technology. The proposed system takes a D2D communication approach to reduce the latency by offering direct vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communication, rather than routing the data via the LoRa WAN server. Additionally, the proposed architecture offers modularity and compact design, making it ideal for legacy systems without requiring any additional hardware. Testing and analysis suggest the proposed system can communicate reliably with roadside infrastructures and other vehicles at speeds ranging from 15-50 km per hour (kmph). The data packet consists of 12 bytes of metadata and 28 bytes of payload. At 15 kmph, a vehicle sends one data packet every 25.9 m, and at 50 kmph, it sends the same data packet every 53.34 m with reliable transitions.

Analysis of membrane permeability due to synergistic effect of controlled shock wave and electric field application.

Controlled shock wave has its application in drug delivery via induced membrane permeability. The magnitude of the impulse force to influence the membrane permeability can be abridged via communion effect of shock wave and external applied electric field of reduced threshold. Controlled shock wave have application at targeting membrane site and are used in drug delivery. Electric field influences the phospholipid bilayer structure by creating transient nanometer-sized pores and has application in targeted chemotherapeutic drug delivery. The synergistic input compensates for increased membrane permeability, reduced threshold magnitude and time for transient poration. The hypothesis is analyzed via Molecular Dynamic (MD) simulation. MARTINI coarse grain force field is used to evaluate the changes in the permeability region of the Dipalmitoyl phosphatidylcholine (DPPC) bilayers during the effect. DPPC has been used in the previous literature to model biological membranes. The hydrophobic DPPC region showed an increased permeability during the synergistic effect via transient nanopores formed due to the perturbation. The study of the time-variant synergistic effect will allow molecular-level understanding of the dynamics of the cell membrane permeability for future drug delivery procedure.

Psycho-demographic and clinical predictors of medication adherence in patients with bipolar I disorder in a university hospital in Egypt.

BACKGROUND: Poor adherence to treatment is one of the main challenges to symptom control and preventing recurrence in bipolar disorder (BD). Numerous studies have established an association between patients' poor adherence and an increased risk of recurrence, relapse of the symptoms and admission to hospital. AIM: To study the socio-demographic and clinical factors associated with medication nonadherence in patients with BD who were admitted to the hospital. SETTING: The study was conducted at the Institute of Psychiatry, Ain Shams University. METHODS: A 1-year longitudinal prospective study of 110 patients, aged 18-60 years, with BD-I. Young Mania Rating Scale, Clinical Global Impression, Global Assessment of Functioning, Sheehan Disability Scale and Insight and Treatment Attitude Questionnaire were applied before and 6 months after discharge. Adherence was measured using the Morisky 8-Item Medication Adherence Scale. Sociodemographic data and level of functioning were studied in relation to adherence. RESULTS: Higher adherence was noticed in female, married and older patients and those with a higher level of education. However, low adherence was more common in male, non-married and less educated patients. Follow-up after 6 months revealed that the high adherence group scored the lowest in terms of disability. Meanwhile, the low adherence group scored the highest scores in disability. CONCLUSION: Several socio-demographic and clinical variables were found to be associated with a low adherence rate to the prescribed medication in patients with BD-I. Age and impaired insight were found to be significant predictive factors for non-adherence.

A Comparative Study of TAVR versus SAVR in Moderate and High-Risk Surgical Patients: Hospital Outcome and Midterm Results.

BACKGROUND: Although the use of transcatheter aortic valve replacement (TAVR) has recently become an attractive strategy in prohibitive surgical high-risk patients undergoing aortic valve replacement (AVR), the most appropriate treatment option in patients with an intermediate- to high-risk profile- whether conventional surgery (SAVR) or TAVR-has been widely debated. METHODS: One hundred and forty-three consecutive patients with intermediate to high risk were prospectively enrolled and selected to undergo SAVR (Group 1 [G1], n = 63) or TAVR (Group 2 [G2], n = 80) following a multidisciplinary evaluation including frailty, anatomy, and degree of atherosclerotic disease of the aorta/peripheral vessels. The mean logistic EuroSCORE (G1 = 20.11 ± 7.144 versus G2 = 23.33 ± 8.97; P = .022), STS score (G1 = 5.722 ± 1.309 versus G2 = 5.958 ± 1.689; P = .347), and preoperative demographics such as sex, left ventricular ejection fraction (LVEF),  body mass index (BMI), peripheral vascular disease, diabetes, atrial fibrillation, renal impairment and syncope were similar. Of note, chronic obstructive pulmonary disease was more frequent in TAVR patients (G2 [46.2%] versus G1 [19.0%]; P = .001), whereas pulmonary hypertension was more frequent in SAVR group (G1 [47.6%] versus G2 [17.5%]; P = .000). The SAVR was performed with either a mechanical or tissue valve; meanwhile, TAVR was performed with either Core valve prosthesis or Edwards-Sapiens XT valve. RESULTS: SAVR group showed higher incidence of some postoperative complications compared to TAVR, namely, postoperative bleeding (4.8% versus 0.0%; P = .048), tamponade (4.8% versus 0.0%; P = .048) and postoperative atrial fibrillation (34.9% versus 10.0%; P = .000), whereas TAVR group had a higher incidence of other sets of postoperative complications, namely, left bundle branch block (58.8% versus 4.8%; P = .000), need for permanent pacemaker implantation (25.0% versus 1.6%; P = .000) and peripheral vascular complications (15.0% versus 0.0%; P = .001). On the contrary, when the two groups were compared they did not show any significant difference regarding anemia requiring more than two units of blood transfusion, postoperative renal failure, stroke, myocardial infarction, and hospital mortality. P = .534, .873, .258, .373 and .072 respectively. Hospital mortality was similar among the two groups (G1 = 0% versus G2 = 5%; P = .072). At the 24-month follow-up, overall mortality, major adverse cardiac and cerebrovascular events were comparable between the two groups but prosthetic regurgitation was better in SAVR group (G2 = 8 patients [10.0%] versus G1 = 1 patient [1.6%] in SAVR group; P = .040). CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis.

Synthesis, characterization and cytotoxic activity of naturally isolated naringin-metal complexes.

High-purity naringin was isolated from the fruit peels of Citrus maxima and characterized by various spectroscopic methods like UV and NMR. The isolated compound ligand (HL) was used as ligand-metal complexes synthesis after using Ag (I), Y (III) and Ru (III) metals. These ligand-metal complexes were characterized by elemental analysis, FT-IR, UV-VIS, TGA, molar conductance and magnetic properties. Cytotoxic activity of the isolated naringin and its metal complexes were investigated against two human cancer cell lines namely, white breast Adenocarcinoma (MCF7) and Lung carcinoma (A549) using cell viability assay. Transition metal increased the cytotoxic activity of naringin when they were conjugated. LC50 of Ag ligand complex demonstrated strong cytotoxicity against MCF-7 and A549 cell line that was found higher active more than three and four times the strength, respectively when compared to LC50 of Adriamycin. While LC50 of Adriamycin compound was slightly more active only about 30% and twice the strength of the Ru ligand complex against MCF-7 and A549 cell line, respectively.