Stent Graft Using Kilt Technique for an Abdominal Aortic Aneurysm with a Severely Angulated Neck.

Endovascular aneurysm repair has become a standard treatment for abdominal aortic aneurysm (AAA). However a severely angulated aneurysmal neck is one of the most common anatomical limitations of endovascular repair, and is associated with poor outcomes. We successfully treated a patient who had an abdominal aortic aneurysm with a severely angulated aortic neck using kilt technique with thoracic stent graft. The technique might be an excellent alternative strategy to overcome anatomical obstacles like a hostile aortic neck.

Increased variability of the coupling interval of premature ventricular contractions as a predictor of cardiac mortality in patients with left ventricular dysfunction.

BACKGROUND: The characteristics and prognostic value of the variability of premature ventricular contraction (PVC) coupling intervals (CIs) for cardiac mortality are not yet decisive. METHODS AND RESULTS: In 133 consecutive patients (58±14 years old, 53 women) who had left ventricular dysfunction (LVD: ejection fraction <50%) and frequent PVCs (≥10/h) who underwent 24-h ambulatory electrocardiography (AECG) recording and (123)I-metaiodobenzylguanidine myocardial single-photon emission computed tomography simultaneously, the heart rate turbulence onset, slope, and T-wave alternans were analyzed from the 24-h AECG. The CI of the PVCs (MEANNV), standard deviation of the CI of the PVCs (SDNV) as an index of the variability of the PVC CI, and their ratio to the preceding N-N intervals (SDNV/SDNN) were calculated from constructed Poincaré plots using the annotated 24-h AECG QRS data. The primary endpoint was cardiac mortality. The mean follow-up period was 63 months. Among 133 patients, 114 survived (group 1) and 19 (14%, group 2) died during the follow-up. The MEANNVand SDNVwere higher in group 2 (539±104 vs. 599±114 ms, P=0.021; 64±34 vs. 83±37 ms, P=0.022, respectively). The SDNV, PVC count, and delayed heart/mediastinum ratio remained as significant predictors of cardiac mortality in the binary logistic regression analysis. CONCLUSIONS: These results suggest that the SDNVcould be another adjunctive parameter for predicting cardiac mortality in LVD.

One-pot synthesis of CeO2-supported Pd-Cu-alloy nanocubes with high catalytic activity.

Cerium and nanocubes: CeO2-supported Pd-Cu-alloy nanocubes (Pd-Cu NCs/CeO2) with high content and good dispersion of the Pd-Cu NCs were prepared in high yields by heating a solution containing Pd, Cu, and Ce precursors. The prepared Pd-Cu NCs/CeO2 have excellent catalytic activity and stability toward formic acid electro-oxidation due to the synergism between the Pd-Cu-alloy catalysts and the CeO2 support.

Synthesis and photocatalytic properties of Cu2S-Pd4S hybrid nanoplates.

Hex appeal! Cu(2)S-Pd(4)S hybrid nanocrystals with a novel hexagonal nanoplate structure were prepared in high yield by a simple one-pot synthetic method (see figure). Successful synthesis of this unique structure was achieved through a consecutive thermolysis process. The Cu(2)S-Pd(4)S hybrid nanoplates exhibited substantially higher photocatalytic activities than pure Cu(2)S nanoplates.

Analysis of cancer cell lipids using matrix-assisted laser desorption/ionization 15-T Fourier transform ion cyclotron resonance mass spectrometry.

A combination of methodologies using the extremely high mass accuracy and resolution of 15-T Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry (MS) was introduced for the identification of intact cancer cell phospholipids. Lipids from a malignant glioma cell line were initially analyzed at a resolution of >200,000 and identified by setting the mass tolerance to ±1 mDa using matrix-assisted laser desorption/ionization (MALDI) 15-T FT-ICR MS in positive ion mode. In most cases, a database search of potential lipid candidates using the exact masses of the lipids yielded only one possible chemical composition. Extremely high mass accuracy (<0.1 ppm) was then attained by using previously identified lipids as internal standards. This, combined with an extremely high resolution (>800,000), yielded well-resolved isotopic fine structures allowing for the identification of lipids by MALDI 15-T FT-ICR MS without using tandem mass spectrometric (MS/MS) analysis. Using this method, a total of 38 unique lipids were successfully identified.

Understanding the Influence of Gypsum upon a Hybrid Flame Retardant Coating on Expanded Polystyrene Beads.

A low-cost and effective flame retarding expanded polystyrene (EPS) foam was prepared herein by using a hybrid flame retardant (HFR) system, and the influence of gypsum was studied. The surface morphology and flame retardant properties of the synthesized flame retardant EPS were characterized using scanning electron microscopy (SEM) and cone calorimetry testing (CCT). The SEM micrographs revealed the uniform coating of the gypsum-based HFR on the EPS microspheres. The CCT and thermal conductivity study demonstrated that the incorporation of gypsum greatly decreases the peak heat release rate (PHRR) and total heat release (THR) of the flame retarding EPS samples with acceptable thermal insulation performance. The EPS/HFR with a uniform coating and the optimum amount of gypsum provides excellent flame retardant performance, with a THR of 8 MJ/m2, a PHRR of 53.1 kW/m2, and a fire growth rate (FIGRA) of 1682.95 W/m2s. However, an excessive amount of gypsum weakens the flame retardant performance. The CCT results demonstrate that a moderate gypsum content in the EPS/HFR sample provides appropriate flame retarding properties to meet the fire safety standards.

Identification of trimethylation at C-terminal lysine of pilin in the cyanobacterium Synechocystis PCC 6803.

Various post-translational modifications (PTMs) of pilin in Synechocystis sp. PCC 6803 have been proposed. In this study, we investigated previously unidentified PTMs of pilin by mass spectrometry (MS). MALDI-TOF MS and TOF/TOF MS showed that the molecular mass of the C-terminal lysine of pilin was increased by 42Da, which could represent acetylation (ΔM=42.0470) or trimethylation (ΔM=42.0106). To discriminate between these isobaric modifications, the molecular mass of the C-terminal tryptic peptide was measured using 15T Fourier transform ion cyclotron resonance (FT-ICR) MS. The high magnetic field FT-ICR provided sub-ppm mass accuracy, revealing that the C-terminal lysine was modified by trimethylation. We could also detect the existence of mono- and di-methylation of the C-terminal lysine. Cells expressing a pilin point mutant with glutamine replacing the C-terminal lysine showed dramatically reduced motility and short pili. These findings suggest that trimethylation of pilin at the C-terminal lysine may be essential for the biogenesis of functional pili.

Compression Molding of Thermoplastic Polyurethane Foam Sheets with Beads Expanded by Supercritical CO2 Foaming.

Expanded thermoplastic polyurethane (ETPU) beads were prepared by a supercritical CO2 foaming process and compression molded to manufacture foam sheets. The effect of the cell structure of the foamed beads on the properties of the foam sheets was studied. Higher foaming pressure resulted in a greater number of cells and thus, smaller cell size, while increasing the foaming temperature at a fixed pressure lowered the viscosity to result in fewer cells and a larger cell size, increasing the expansion ratio of the ETPU. Although the processing window in which the cell structure of the ETPU beads can be maintained was very limited compared to that of steam chest molding, compression molding of ETPU beads to produce foam sheets was possible by controlling the compression pressure and temperature to obtain sintering of the bead surfaces. Properties of the foam sheets are influenced by the expansion ratio of the beads and the increase in the expansion ratio increased the foam resilience, decreased the hardness, and increased the tensile strength and elongation at break.

Expanded Polystyrene Beads Coated with Intumescent Flame Retardant Material to Achieve Fire Safety Standards.

The compatibility and coating ratio between flame retardant materials and expanded polystyrene (EPS) foam is a major impediment to achieving satisfactory flame retardant performance. In this study, we prepared a water-based intumescent flame retardant system and methylene diphenyl diisocyanate (MDI)-coated expandable polystyrene microspheres by a simple coating approach. We investigated the compatibility, coating ratio, and fire performance of EPS- and MDI-coated EPS foam using a water-based intumescent flame retardant system. The microscopic study revealed that the water-based intumescent flame retardant materials were successfully incorporated with and without MDI-coated EPS microspheres. The cone calorimeter tests (CCTs) of the MDI-coated EPS containing water-based intumescent flame retardant materials exhibited better flame retardant performance with a lower total heat release (THR) 7.3 MJ/m2, peak heat release rate (PHRR) 57.6 kW/m2, fire growth rate (FIGRA) 2027.067 W/m2.s, and total smoke production (TSP) 0.133 m2. Our results demonstrated that the MDI-coated EPS containing water-based intumescent flame retardant materials achieved flame retarding properties as per fire safety standards.

Electrocardiographic Manifestations in Patients with COVID-19: Daegu in South Korea.

BACKGROUND AND OBJECTIVES: As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients. METHODS: Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]). RESULTS: Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746-42.306). CONCLUSIONS: COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.

Self-assembly kinetics of debranched short-chain glucans from waxy maize starch to form spherical microparticles and its applications.

Starch microparticles (SMPs) of well-defined size and morphology were synthesized through pullulanase-mediated debranching of waxy maize starch followed by spontaneous re-assembly of the resulting short-chain glucan molecules in aqueous solution. Enzymatic debranching of amylopectins from native starch generated two major fractions corresponding to a smaller glucan and partially digested larger amylopectin molecules. The ratio of short-chain glucan (SCG) over partially digested amylopectin (PDAp) turned out to be the deterministic factors for the size and crystallinity of SMPs, of which the ratio could be controlled by the concentration of debranching enzyme. The PDAp fraction was closely associated with the creation of nuclei, determining the growth kinetics of SMPs which led to the formation of SMPs with a diameter ranging from 0.52.5 µm. In addition, we demonstrated that iron oxide nanoparticles (IONPs) were successfully incorporated into the starch microstructure by introducing them during the self-assembly reaction, conferring desired functionality onto the final SMPs. The incorporated IONPs rendered the SMPs an excellent magnetic sensitivity, which were successfully applied for the separation and concentration of target bacteria upon conjugation of specific antibody on the surface of SMPs. The simple processes and biocompatible nature of starch would make this approach attractive for many applications in the area of food, medicine and other related materials sciences.

Late complication of the Nuss procedure: recurrent cardiac tamponade.

Pectus excavatum (PE) is known as one of the most common congenital deformities of the anterior chest wall. The Nuss procedure is an effective surgical therapy to correct PE. Here, we report a case of recurrent cardiac tamponade due to hemopericardium that occurred after 16 months following the Nuss procedure. The cause of recurrent hemopericardium was thought to be local, repetitive irritation of the pericardium by the Nuss steel bar. We should keep in mind that this serious complication can occur after the Nuss procedure, even in the late phase.

Microbial Biosynthesis of Silver Nanoparticles in Different Culture Media.

Microbial biosynthesis of metal nanoparticles has been extensively studied for the applications in biomedical sciences and engineering. However, the mechanism for their synthesis through microorganism is not completely understood. In this study, several culture media were investigated for their roles in the microbial biosynthesis of silver nanoparticles (AgNPs). The size and morphology of the synthesized AgNPs were analyzed by UV-vis spectroscopy, Fourier-transform-infrared (FT-IR), transmission electron microscopy (TEM), and dynamic light scattering (DLS). The results demonstrated that nutrient broth (NB) and Mueller-Hinton broth (MHB) among tested media effectively reduced silver ions to form AgNPs with different particle size and shape. Although the involved microorganism enhanced the reduction of silver ions, the size and shape of the particles were shown to mainly depend on the culture media. Our findings suggest that the growth media of bacterial culture play an important role in the synthesis of metallic nanoparticles with regard to their size and shape. We believe our findings would provide useful information for further exploration of microbial biosynthesis of AgNPs and their biomedical applications.

Hemorheologic Alterations in Patients with Type 2 Diabetes Mellitus Presented with an Acute Myocardial Infarction.

BACKGROUND: Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. METHODS: A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n=77) and control group (AMI-, n=118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. RESULTS: The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI-, P<0.001) but the level of CSS was higher (316.13±108.20 mPa in AMI+ and 286.80±85.34 mPa in AMI-, P=0.040) in the AMI+. The CSS was significantly related to the erythrocyte sedimentation rate (R²=0.497, P<0.001) and use of dipeptidyl peptidase-4 inhibitors (R²=0.574, P=0.048). CONCLUSION: Diabetics with AMI resulted in adverse hemorheologic changes with lower EI and higher CSS compared to diabetic subjects without AMI. Evaluation of the hemorheologic parameters may provide valuable supplementary information for managing patients with AMI and T2DM.

Corrigendum: Hemorheologic Alterations in Patients with Type 2 Diabetes Mellitus Presented with an Acute Myocardial Infarction.

This corrects the article on p. 155 in vol. 42, PMID: 29676545.

Discordant Relationships between Systemic Inflammatory Markers and Burden of Oxidative Stress in Patients with Atrial Fibrillation.

BACKGROUND AND OBJECTIVES: Oxidative stress (OS) plays an important role in the pathophysiology of atrial fibrillation (AF) by amplifying the inflammatory cascade, wherein augmented inflammation facilitates the atrial electrical remodeling process. Few studies have investigated the possible link between systemic inflammation and OS in AF. SUBJECTS AND METHODS: A total of 220 consecutive patients with AF (117 patients) or healthy controls (103 patients) were enrolled. Among the 117 AF patients, 65 paroxysmal AF (PaAF) and 52 persistent AF (PeAF) patients were included. The level of 8-iso-prostaglandin F2α (8-iso-PGF2α) was measured as a marker of OS burden. We evaluated the correlations between 3 systemic inflammatory markers, high-sensitivity C-reactive protein (hsCRP), neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW), and 8-iso-PGF2α. RESULTS: The 8-iso-PGF2α concentration in both PaAF and PeAF patients was higher than that of controls (p<0.001 and p=0.024, respectively). The NLR and RDW of PeAF patients were higher than those of both control and PaAF patients (p=0.041 and p=0.031 for NLR, p=0.057 and p=0.031 for RDW, respectively). There were no correlations between specific inflammatory markers and the 8-iso-PGF2α in AF. The 8-iso-PGF2α level decreased gradually with an increase in AF duration (p=0.008), contrary to the graded increase in hsCRP. Multiple regression analysis indicated that AF duration persisted as a significant determinant of 8-iso-PGF2α (ß=-0.249, p=0.044). CONCLUSION: Systemic inflammatory marker levels were not proportional to the levels of 8-iso-PGF2α, an OS marker, in AF.

Effectiveness of Implantable Cardioverter-Defibrillator Therapy for Heart Failure Patients according to Ischemic or Non-Ischemic Etiology in Korea.

BACKGROUND AND OBJECTIVES: This study was performed to describe clinical characteristics of patients with left ventriculars (LV) dysfunction and implantable cardioverter-defibrillator (ICD), and to evaluate the effect of ICD therapy on survival in Yeongnam province of Korea. SUBJECTS AND METHODS: From a community-based device registry (9 centers, Yeongnam province, from November 1999 to September 2012), 146 patients with LV dysfunction and an ICD implanted for primary or secondary prophylaxis, were analyzed. The patients were divided into two groups, based on the etiology (73 with ischemic cardiomyopathy and 73 with non-ischemic cardiomyopathy), and indication for the device implantation (36 for primary prevention and 110 for secondary prevention). The cumulative first shock rate, all cause death, and type and mode of death, were determined according to the etiology and indication. RESULTS: Over a mean follow-up of 3.5 years, the overall ICD shock rate was about 39.0%. ICD shock therapy was significantly more frequent in the secondary prevention group (46.4% vs. 16.7%, p=0.002). The cumulative probability of a first appropriate shock was higher in the secondary prevention group (p=0.015). There was no significant difference in the all-cause death, cardiac death, and mode of death between the groups according to the etiology and indication. CONCLUSION: Studies from this multicenter regional registry data shows that in both ischemic and non-ischemic cardiomyopathy patients, the ICD shock therapy rate was higher in the secondary prevention group than primary prevention group.

Five-year clinical outcomes of drug-eluting stents according to on-label and off-label use.

BACKGROUND/AIMS: To compare the clinical outcomes of 'on-label' and 'off-label' drug-eluting stents (DESs) over a 5-year follow-up period. METHODS: A total of 929 patients that underwent percutaneous coronary intervention with DESs were enrolled. Patients were divided into two groups according to on-label (n = 449) and off-label (n = 480) indications. Off-label use was defined as implantation of DESs for acute myocardial infarction (MI), very small vessel, a long stenotic lesion, chronic total occlusion, a bifurcation lesion, an ostial lesion, left main coronary artery disease, multivessel disease, a saphenous vein graft lesion, and a lesion with thrombus. Endpoints were composite of major adverse cardiac events (MACEs), which included all-cause death, ischemic-driven target vessel revascularization (Id-TVR), MI, and stent thrombosis (ST). Clinical outcomes in the two groups were compared for up to 5 years postimplantation. RESULTS: At 1 year postimplantation, the off-label group had higher incidences of total MACEs (8.2% vs. 3.7%, p = 0.005), Id-TVR (5.0% vs. 1.6%, p = 0.004), and ST (1.7% vs. 0.3%, p = 0.042), and at 5 years postimplantation, the off-label group continued to have higher incidences of total MACEs (17.5% vs. 9.4%, p < 0.001), Id-TVR (13.1% vs. 5.8%, p = 0.024), and ST (2.1% vs. 0.3%, p = 0.021). Multivessel disease and diabetes were found to be independent risk factors of MACE in patients with an off-label indication. CONCLUSIONS: Patients treated with an on-label DES had better long-term clinical outcomes than those treated with an off-label DES.