Predictors of 30-day and 12-month mortality in left main stem percutaneous coronary intervention 2016-2020: A study from two UK centers.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Generating a Topological Anomalous Hall Effect in a Nonmagnetic Conductor: An In-Plane Magnetic Field as a Direct Probe of the Berry Curvature.

We demonstrate that the Berry curvature monopole of nonmagnetic two-dimensional spin-3/2 holes leads to a novel Hall effect linear in an applied in-plane magnetic field B_{∥}. Remarkably, all scalar and spin-dependent disorder contributions vanish to leading order in B_{∥}, while there is no Lorentz force and hence no ordinary Hall effect. This purely intrinsic phenomenon, which we term the anomalous planar Hall effect (APHE), provides a direct transport probe of the Berry curvature accessible in all p-type semiconductors. We discuss experimental setups for its measurement.

Indocyanine green fluorescence video angiography reduces vascular injury-related morbidity during micro-neurosurgical clipping of ruptured cerebral aneurysms: a retrospective observational study.

BACKGROUND: Specific procedural complications in aneurysm surgery are broadly related to vascular territory compromise and brain/nerve retraction; vascular complications account for about half of this. Intraoperative indocyanine green video angiography (ICG-VA) provides real-time high spatial resolution imaging of the cerebrovascular architecture, allowing immediate quality assurance of aneurysm occlusion and vessel integrity. The aim of this study was to examine whether the routine use of ICG-VA reduced early procedural complications related to vascular compromise or injury during micro-neurosurgical clipping of ruptured cerebral aneurysms. METHODS: Retrospective comparative observational study of 412 adult good-grade (WFNS 1 or 2) SAH patients who had undergone microsurgical clipping without (n = 200, 2001-2004) or with (n = 212, 2009-2015) ICG-VA in a high-volume neurosurgical centre. RESULTS: The ICG-VA group had a significantly lower incidence of procedural vascular complications (7/212; 3.3%) compared with the non-ICG-VA group (19/200; 9.5%) (Fisher's exact test p = 0.0137). CONCLUSIONS: ICG-VA is a straightforward, easy-to-use, intraoperative adjunct which significantly reduces avoidable 'technical error' related morbidity.

Ocular manifestations and the clinical course of carotid cavernous sinus fistulas in Asian patients.

PURPOSE: To study the clinical course with regard to both the angiographic and visual outcomes of carotid cavernous fistulas (CCFs). BACKGROUND: Carotid cavernous sinus fistulas (CCFs) are conditions which often present with ocular signs and symptoms. The clinical presentation of CCFs is varied according to the anatomy, haemodynamics and size of the CCF. CCFs causing significant symptoms or vision loss should be treated with embolization. METHODS: This is a retrospective review of the medical records of all CCF cases seen in the Singapore National Eye Centre from September 2002 to December 2011. RESULTS: 45 patients who had confirmed CCF on conventional cerebral angiography were included. Anterior draining CCFs presented with orbital congestion while posterior draining CCFs presented with pain, diplopia and cranial nerve palsies. Mild residual symptoms were still present in 85% of treated direct CCFs despite complete angiographic closure however 52% of treated dural CCFs had complete resolution of symptoms despite only half of those achieving angiographic closure. Treated and untreated dural CCFs had similar outcomes (87% versus 76% recovered or improved (p > 0.05)). Poor outcomes can result from residual diplopia or vision loss from complications of the CCF itself (e.g. compressive optic neuropathy, glaucoma, retinopathy) or complications from CCF embolization treatment (e.g. central retinal artery occlusion). CONCLUSION: Presenting symptoms and signs are related to the angiographic drainage of CCFs. Angiographic outcomes after embolization treatment may not always correlate with clinical outcomes.

Spin-orbit torques due to topological insulator surface states: an in-plane magnetization as a probe of extrinsic spin-orbit scattering.

Topological insulator (TI) surface states exert strong spin-orbit torques. When the magnetization is in the plane its interaction with the TI conduction electrons is non-trivial, and is influenced by extrinsic spin-orbit scattering. This is expected to be strong in TIs but is difficult to calculate and to measure unambiguously. Here we show that extrinsic spin-orbit scattering sizably renormalizes the surface state spin-orbit torque resulting in a strong density dependence. The magnitude of the renormalization of the spin torque and the effect of spin-orbit scattering on the relative sizes of the in-plane and out-of-plane field-like torques have strong implications for experiment: We propose two separate experimental signatures for the measurement of its presence.

Morphotropic phase boundaries in ferromagnets: Tb(1-x)Dy(x)Fe2 alloys.

The structure and properties of the ferromagnet Tb(1-x)Dy(x)Fe(2) are explored through the morphotropic phase boundary (MPB) separating ferroic phases of differing symmetry. Our synchrotron data support a first order structural transition, with a broadening MPB width at higher temperatures. The optimal point for magnetomechanical applications is not centered on the MPB but lies on the rhombohedral side, where the high striction of the rhombohedral majority phase combines with the softened anisotropy of the MPB. We compare our findings with single ion crystal field theory and with ferroelectric MPBs, where the controlling energies are different.

Spin transfer torques due to the bulk states of topological insulators.

Spin torques at topological insulator (TI)/ferromagnet interfaces have received considerable attention in recent years with a view towards achieving full electrical manipulation of magnetic degrees of freedom. The most important question in this field concerns the relative contributions of bulk and surface states to the spin torque, a matter that remains incompletely understood. Whereas the surface state contribution has been extensively studied, the contribution due to the bulk states has received comparatively little attention. Here we study spin torques due to TI bulk states and show that: (i) there is no spin-orbit torque due to the bulk states on a homogeneous magnetisation, in contrast to the surface states, which give rise to a spin-orbit torque via the well-known Edelstein effect. (ii) The bulk states give rise to a spin transfer torque (STT) due to the inhomogeneity of the magnetisation in the vicinity of the interface. This spin transfer torque, which has not been considered in TIs in the past, is somewhat unconventional since it arises from the interplay of the bulk TI spin-orbit coupling and the gradient of the monotonically decaying magnetisation inside the TI. Whereas we consider an idealised model in which the magnetisation gradient is small and the spin transfer torque is correspondingly small, we argue that in real samples the spin transfer torque should be sizable and may provide the dominant contribution due to the bulk states. We show that an experimental smoking gun for identifying the bulk states is the fact that the field-like component of the spin transfer torque generates a spin density with the same size but opposite sign for in-plane and out-of-plane magnetisations. This distinguishes them from the surface states, which are expected to give a spin density of a similar size and the same sign for both an in-plane and out-of-plane magnetisations.

Maternal and/or post-weaning supplementation with Bacillus altitudinis spores modulates the microbial composition of colostrum, digesta and faeces in pigs.

This study examined the effects of maternal and/or post-weaning Bacillus altitudinis supplementation on the microbiota in sow colostrum and faeces, and offspring digesta and faeces. Sows (n = 12/group) were assigned to: (1) standard diet (CON), or (2) CON supplemented with probiotic B. altitudinis spores (PRO) from day (d)100 of gestation to weaning (d26 of lactation). At weaning, offspring were assigned to CON or PRO for 28d, resulting in: (1) CON/CON, (2) CON/PRO, (3) PRO/CON, and (4) PRO/PRO, after which all received CON. Samples were collected from sows and selected offspring (n = 10/group) for 16S rRNA gene sequencing. Rothia was more abundant in PRO sow colostrum. Sow faeces were not impacted but differences were identified in offspring faeces and digesta. Most were in the ileal digesta between PRO/CON and CON/CON on d8 post-weaning; i.e. Bacteroidota, Alloprevotella, Prevotella, Prevotellaceae, Turicibacter, Catenibacterium and Blautia were more abundant in PRO/CON, with Firmicutes and Blautia more abundant in PRO/PRO compared with CON/CON. Lactobacillus was more abundant in PRO/CON faeces on d118 post-weaning. This increased abundance of polysaccharide-fermenters (Prevotella, Alloprevotella, Prevotellaceae), butyrate-producers (Blautia) and Lactobacillus likely contributed to previously reported improvements in growth performance. Overall, maternal, rather than post-weaning, probiotic supplementation had the greatest impact on intestinal microbiota.

Glare in a Case of a Craniopharyngioma.

Glare is commonly encountered in patients with corneal disease, uveitis, or retinal problems. Rarely, it may be a presenting manifestation of more sinister conditions such as chiasmal lesions. We present the case of a 42-year-old male who complained of glare for 2-3 months. There was neither headache nor blurring of vision. His neuro-ophthalmological examination was within normal limits except for slight decrease in colour contrast of the upper temporal dots of the red-dot perimetry chart. Automated visual fields showed a central scotoma on the right eye and a temporal-inferior field defect on the left. He underwent neuro-imaging, which revealed a suprasellar cystic mass, most likely a craniopharyngioma. Referral to the neurosurgeon was made who performed supraorbital keyhole surgery. Intraoperative findings showed a cystic mass stuck bilaterally on the optic nerves, carotids, and optic chiasm with the pituitary stalk deviated to the right side. Histopathology report revealed a craniopharyngioma, adamantinomatous variant. One month post excision, the patient showed improvement in his visual functions.

Microbial Quality of Liquid Feed for Pigs and Its Impact on the Porcine Gut Microbiome.

There is evidence that spontaneous fermentation frequently occurs in liquid pig feed that is intended to be delivered as fresh liquid feed, often with a resultant deterioration in the microbial and nutritional quality of the feed, which can negatively affect pig health and growth. Strategies including controlled fermentation with microbial inoculants, pre-fermentation or soaking of the cereal fraction of the diet, enzyme supplementation and dietary acidification have been employed to inhibit pathogens and prevent deterioration of feed nutritional quality, with promising results obtained in many cases. This review evaluates the impact of these strategies on the microbial quality of liquid feed and discusses how they can be further improved. It also investigates if/how these strategies impact the pig gut microbiota and growth performance of liquid-fed pigs. Finally, we review liquid feed system sanitisation practices, which are highly variable from farm to farm and discuss the impact of these practices and whether they are beneficial or detrimental to liquid feed microbial quality. Overall, we provide a comprehensive review of the current state of knowledge on liquid feed for pigs, focusing on factors affecting microbial quality and strategies for its optimisation, as well as its impact on the pig gut microbiome.

An Ace Angiographic Diagnosis.

Interventional cardiologists should maintain awareness of extracardiac structures when undertaking cardiac catheterization, as pathology outside of the coronary arteries may be identified.

Image report: Extensive disseminated thoracolumbosacral myxopapillary ependymoma.

BACKGROUND: Myxopapillary ependymoma occurs more frequently in adults, but is found in the first two decades of life in around 8-20% of patients. Tumors are usually benign with low likelihood for dissemination. CASE DESCRIPTION: We describe a case of a 13-year-old boy who presented with progressive kyphosis and bilateral weakness of the lower limbs. MRI shows a thoracolumbosacral intradural tumor with invasion of sacral neural foramina and dissemination to the cervicothoracic region. The patient received T10-L5 laminectomy with subtotal tumor resection. Pathological examination revealed myxopapillary ependymoma. After surgical resection, the patient underwent physical therapy with whole spinal radiotherapy for disease control. CONCLUSION: Spinal myxopapillary ependymomas are usually benign and slow-growing tumors. This case illustrates an extensive and disseminated myxopapillary ependymoma.

Effect of cereal fermentation and carbohydrase supplementation on growth, nutrient digestibility and intestinal microbiota in liquid-fed grow-finishing pigs.

This study aimed to determine the impact of fermenting the cereal fraction of the diet (Cferm) and enzyme supplementation (ENZ) on the bacterial composition of the feed, nutrient digestibility, pig growth, feed efficiency (FE), intestinal volatile fatty acid (VFA) concentrations and intestinal microbiota composition. A total of 252 grow-finisher pigs (~ 40.4 kg; 7 pigs/pen) were randomly allocated to 4 diets in a 2 × 2 factorial arrangement for 55d. The diets were: (1) fresh liquid feed (Fresh); (2) Cferm liquid feed (Ferm); (3) Fresh + ENZ and (4) Ferm + ENZ. Cferm increased total tract nutrient digestibility, reduced caecal butyrate and propionate concentrations, and increased average daily gain (ADG). ENZ increased ileal and total tract nutrient digestibility, reduced caecal isobutyrate and propionate concentrations, and improved FE. Bacterial taxa positively correlated with pig growth (Lactobacillus kisonensis in the ileum and Roseburia faecis in the caecum) were more abundant in pigs fed ENZ diets, whereas most of the ileal bacterial taxa negatively correlated with growth (Megasphaera, Bifidobacterium and Streptococcus) had lower abundance in pigs fed Cferm diets. In conclusion, Cferm increased ADG and ENZ improved FE, with these improvements possibly mediated by increased nutrient digestibility, and beneficial modulation of the intestinal microbiota.

Hippocampal Subfield Volumes in Middle-Aged Adults at Risk of Dementia.

BACKGROUND: Alzheimer's disease (AD) begins decades before the onset of dementia. There is a need to investigate biomarkers of early AD for use in clinical trials and to facilitate early intervention. OBJECTIVE: We aimed to determine whether changes in hippocampal subfield volumes in healthy middle-aged adults were associated with risk of future dementia. METHODS: We included 150 participants from the PREVENT-Dementia cohort, which recruited subjects aged 40-59 with or without a family history of dementia (FHD; included here were 81 with FHD and 69 without). Hippocampal subfield volumes were segmented from high resolution T2-weighted 3T MRI images taken at baseline and 2-year follow-up. RESULTS: FHD and greater 20 year-risk of dementia due to cardiovascular risk factors were both associated with lower CA1 volume. FHD was also associated with a relative increase in combined CA3, CA4, and dentate gyrus volume between baseline and follow-up. CONCLUSION: CA1 atrophy may commence as early as middle-age in those with a high risk of future dementia, while increases in CA3, CA4, and dentate gyrus volume may be a response to early AD in the form of inflammation or neurogenesis.

Quantitative and qualitative analysis of platelet-rich plasma collection using the Haemonetics Cell Saver 5 in open heart surgery.

Many traditional autologous blood recovery systems (ABRSs) have undergone modifications to enable them to collect platelet-rich plasma (PRP). Because of the growing demand for autologous platelet gel (APG) in cardiac surgery, many open heart teams are faced with the choice of using their existing ABRS or purchasing a dedicated PRP device. This study was conducted to address the issues we had about our use of the Haemonetics Cell Saver 5 (CS5) to collect PRP during open heart surgery at our institution. PRP and platelet-poor plasma (PPP) were collected on 20 "first-time" elective open heart surgical patients. Baseline, PRP, and PPP platelet counts, as well as modified thrombelastograms (TEGs), were performed on all study patients. The mean baseline, PRP, and PPP platelet counts were 232,450, 1,348,850, and 18,100/mm3, respectively. We found a strong positive correlation (r = +0.7142) between the maximum amplitude (MA) of our modified PRP TEG and the platelet count of the PRP. Using the CS5, we achieved a mean platelet multiple of greater than six times baseline, which compares favorably with the multiple produced using dedicated PRP devices. These data support the conclusion that we achieved a high platelet multiple with the CS5, and our use of a modified TEG showed that platelet function of the collected PRP was preserved.

The effect of 8.25% sodium hypochlorite on dental pulp dissolution and dentin flexural strength and modulus.

INTRODUCTION: The purpose of this study was to evaluate the effect of various concentrations of sodium hypochlorite (NaOCl), including 8.25%, on dental pulp dissolution and dentin flexural strength and modulus. METHODS: Sixty dental pulp samples and 55 plane parallel dentin bars were retrieved from extracted human teeth. Five test groups (n = 10) were formed consisting of a pulp sample and dentin bar immersed in various NaOCl solutions. The negative control group (n = 5) consisted of pulp samples and dentin bars immersed in saline. The positive control group (n = 5) consisted of pulp samples immersed in 8.25% NaOCl without a dentin bar. Every 6 minutes for 1 hour, the solutions were refreshed. The dentin bars were tested for flexural strength and modulus with a 3-point bend test. The time until total pulp dissolution and any changes in dentin bar flexural strength and modulus for the different NaOCl solutions were statistically analyzed. RESULTS: An increase in NaOCl concentration showed a highly significant decrease in pulp dissolution time. The pulp dissolution property of 8.25% NaOCl was significantly faster than any other tested concentration of NaOCl. The presence of dentin did not have a significant effect on the dissolution capacity of NaOCl if the solutions were refreshed. NaOCl concentration did not have a statistically significant effect on dentin flexural strength or modulus. CONCLUSIONS: Dilution of NaOCl decreases its pulp dissolution capacity. Refreshing the solution is essential to counteract the effects of dentin. In this study, NaOCl did not have a significant effect on dentin flexural strength or modulus.