Combinatorial biosynthesis in yeast leads to over 200 diterpenoids.

Diterpenoids form a diverse group of natural products, many of which are or could become pharmaceuticals or industrial chemicals. The modular character of diterpene biosynthesis and the promiscuity of the enzymes involved make combinatorial biosynthesis a promising approach to generate libraries of diverse diterpenoids. Here, we report on the combinatorial assembly in yeast of ten diterpene synthases producing (+)-copalyl diphosphate-derived backbones and four cytochrome P450 oxygenases (CYPs) in diverse combinations. This resulted in the production of over 200 diterpenoids. Based on literature and chemical database searches, 162 of these compounds can be considered new-to-Nature. The CYPs accepted most substrates they were given but remained regioselective with few exceptions. Our results provide the basis for the systematic exploration of the diterpenoid chemical space in yeast using sequence databases.

Penile Elastography Versus Penile Duplex Ultrasonography in Diagnosing Non-Responders to Intracavernosal Injection: A Prospective Cohort Study.

OBJECTIVES: The current study aims to investigate the value of penile elastography in assessing the fibrotic changes in the corpora cavernosa. PATIENTS AND METHODS: Eighty participants were included in the study. These were divided into two equal groups: a study group (group 1) included patients with ED who did not respond to intracavernosal injection (ICI), and an age-matched control group (group 2) included age-matched subjects with normal erection. All subjects answered an International Index of Erectile Function-5 (IIEF-5) questionnaire. The first group was evaluated by two ICI trials of 1 mL Quadmix, each took place 1 week apart, followed by a color duplex/Doppler ultrasonography (CDDU) scan using also a 1 mL Quadmix. All the above was done a week before the penile shear wave elastography (SWE) scan. It comprised a 12-section scan of both corpora cavernosa. Each corpus was scanned in three different segments (proximal, mid-shaft, and distal), and in both longitudinal and transverse axes. RESULTS: Comparisons of the laboratory data were non-significant, apart from the glycosylated hemoglobin which proved significant (P value <.001) in both groups. Also, the IIEF-5 scores were significantly lower in the study group (P value <.001). Significantly higher SWE readings (indicating higher fibrotic) were found in the study group compared with the control group in almost all of the scanned segments and their combinations (P value <.05). CONCLUSION: SWE can effectively assess the fibrotic changes occurring in the corpora cavernosa. Hence, SWE could be utilized as a modality that helps diagnose patients with ED.

The Promise and Perils of Transcatheter Aortic Valve Replacement (TAVR) in Low Surgical Risk Patients with Severe Aortic Stenosis in the Current Era.

PURPOSE OF REVIEW: Transcatheter Aortic Valve Replacement (TAVR) has become the preferred treatment approach for many patients with symptomatic severe aortic valve stenosis (SsAS), particularly those who are deemed at high surgical risk. However, in low-risk surgical patients (LSRP) with SsAS, the choice between TAVR and surgical aortic valve replacement (SAVR) is often a matter of debate and depends on several clinical and anatomical considerations. RECENT FINDINGS: Midterm data show similar clinical outcomes and durability of TAVR and SAVR bioprosthetic valves in LRSP. Data on long term durability and outcomes of TAVR in LRSP remains scarce. Both TAVR and SAVR are reasonable options in LRSP with SsAS. Nevertheless, many of these LRSP are expected to outlive their bioprosthetic valves and planning for the second aortic valve replacement should begin at the time of the index procedure with special consideration for coronary re-access, risk for coronary obstruction, and prothesis patient mismatch.

Nano-Enriched Self-Powered Wireless Body Area Network for Sustainable Health Monitoring Services.

Advances in nanotechnology have enabled the creation of novel materials with specific electrical and physical characteristics. This leads to a significant development in the industry of electronics that can be applied in various fields. In this paper, we propose a fabrication of nanotechnology-based materials that can be used to design stretchy piezoelectric nanofibers for energy harvesting to power connected bio-nanosensors in a Wireless Body Area Network (WBAN). The bio-nanosensors are powered based on harvested energy from mechanical movements of the body, specifically the arms, joints, and heartbeats. A suite of these nano-enriched bio-nanosensors can be used to form microgrids for a self-powered wireless body area network (SpWBAN), which can be used in various sustainable health monitoring services. A system model for an SpWBAN with an energy harvesting-based medium access control protocol is presented and analyzed based on fabricated nanofibers with specific characteristics. The simulation results show that the SpWBAN outperforms and has a longer lifetime than contemporary WBAN system designs without self-powering capability.

Concomitant vs. Staged Treatment of Varicose Tributaries as an Adjunct to Endovenous Ablation: A Systematic Review and Meta-Analysis.

OBJECTIVE: This review compares the outcomes of both concomitant and staged superficial varicose tributary (SVT) interventions as an adjunct to endovenous truncal ablation. METHODS: A systematic search of Medline through Pubmed, Embase, and the Cochrane Central Register of Controlled Trials was last performed in November 2019. All studies comparing the outcomes of both concomitant and staged treatments for SVT as an adjunct to endovenous truncal ablation were included. Each included study was subject to an evaluation of methodological quality using the Downs and Black assessment tool. Outcomes assessed included rates of re-intervention, complications, and thrombotic events. Quality of life (QOL) and disease severity were also analysed. Data were pooled with a random effects model. RESULTS: Fifteen studies (6 915 limbs) were included for analysis. Included studies were of reasonable methodological quality. Re-intervention rates were significantly lower in the concomitant group (6.3% vs. 36.1%) when compared with staged intervention (relative risk [RR] 0.21 [95% CI 0.07-0.62], p = .004, I2 = 90%, p ≤ .001). Reported complications (RR 1.14 [95% CI 0.67-1.93], p = .64) and rates of deep venous thrombosis (RR 1.41 [95% CI 0.72-2.77] p = .31) were similar in each group. Overall disease severity (Venous Clinical Severity Score) was lower in the concomitant group (-1.16 [95% CI, -1.97- -0.35] p = .005), while QOL, assessed using the Aberdeen Varicose Vein Questionnaire, favoured concomitant treatment when measured at less than three months (weighted mean difference [WMD] -3.6 [95% CI, -7.17- -0.03] p = .050) and between three and 12 months (WMD -1.61 [95% CI, -2.99- -0.23] p = .020). CONCLUSION: Concomitant and staged treatments are safe and effective. Improvements in early disease severity and QOL scores were better in the concomitant group. While meta-analysis suggests that concomitant intervention offers significantly lower rates of re-intervention, studies assessing its merits are subject to some biases. This benefit was not reflected by the randomised trial subgroup analysis, which identified no difference in re-intervention.

Free-standing interconnected carbon nanofiber electrodes: new structural designs for supercapacitor application.

This work aims to develop and characterize a new design of free-standing interconnected carbon nanofiber electrodes for supercapacitor application. The fibers are obtained via carbonization of three components of electrospun nanofiber mats based on a polyacrylonitrile polymer (as a carbon backbone precursor), polyvinylalcohol (as a sacrificial copolymer), and 0-1.0 wt% multi-walled carbon nanotubes. Carbonizing these ternary composites results in fibers with about twice as large in surface area and one order of magnitude higher in electrical conductivity than those obtained by the carbonization of neat polyacrylonitrile and/or binary polyacrylonitrile-0-1.0 wt% carbon nanotube mats. The carbonized polyacrylonitrile-polyvinylalcohol-0.3 wt% carbon nanotube mat reveals the highest surface area and electrical conductivity and best capacitive performance. It exhibits energy and power densities of 27.8 Wh kg-1 and 110.59 kW kg-1, respectively, and cyclic stability of 95% after 2000 charge-discharge cycles at a charging current of 1.0 Ag-1. The nanotubes' alignment along the fiber's axis, the formation of fiber-fiber interconnected morphology with more mesopore pollution, and changes in the graphitization degree and defect features of fiber crystallites are the reasons for the observed increase in the electrical conductivity, surface area, and capacitive performance of the carbon fibers. Therefore, the new design represents a potential free-standing carbon nanofiber electrode for future electrochemical double layer capacitor (EDLC) device fabrication.

High-performance asymmetric supercapacitor based hierarchical NiCo2O4@ carbon nanofibers//Activated multichannel carbon nanofibers.

Synthesis of rational nanostructure design of hybrid materials including uniformly growing, stable and highly porous structures have received a great deal of attention for many energy storage applications. In this study, the positive electrode of the uniform distribution of NiCo2O4 nanorods anchored on carbon nanofibers has been successfully prepared by in-situ growth under the hydrothermal process. Whereas, the activated multichannel carbon nanofibers (AMCNFs) have been fabricated via electrospinning followed by alkaline activation as the negative electrode. The crystal phase, morphological structure for the proposed electrode materials were characterized by x-ray diffraction (XRD), Raman spectroscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Moreover, the electrochemical behaviors were investigated using cyclic voltammetry (CV), galvanostatic charge and discharge (GCD) and electrochemical impedance spectroscopy (EIS) measurements. Compared to the neat CNFs and the pristine NiCo2O4, the NiCo2O4@CNFs hybrid electrodes showed better electrochemical performance and achieved a high specific capacitance up to 649 F g-1 at a current density of 3 A g-1. The optimized NiCo2O4@CNFs//AMCNFs asymmetric device achieved a high energy density of 38.5 Wh kg-1 with a power density of 1.6 kW kg-1 and possessed excellent recyclability with 93.1% capacitance retention over 6000 charging/discharging cycles. Overall, the proposed study introduces a facile strategy for the robust design of hybrid structured as effective nanomaterials based electrode for high-performance electrochemical supercapacitors.

Acoustic Energy Harvesting and Sensing via Electrospun PVDF Nanofiber Membrane.

This paper introduces a new usage of piezoelectric poly (vinylidene fluoride) (PVDF) electrospun nanofiber (NF) membrane as a sensing unit for acoustic signals. In this work, an NF mat has been used as a transducer to convert acoustic signals into electric voltage outcomes. The detected voltage has been analyzed as a function of both frequency and amplitude of the excitation acoustic signal. Additionally, the detected AC signal can be retraced as a function of both frequency and amplitude with some wave distortion at relatively higher amplitudes and within a certain acoustic spectrum region. Meanwhile, the NFs have been characterized through piezoelectric responses, beta sheet calculations and surface morphology. This work is promising as a low-cost and innovative solution to harvest acoustic signals coming from wide resources of sound and noise.

A Study of the Impact of the Commonly Used Female Contraceptive Methods in Egypt on Female Sexual Function.

Temporary methods of female contraception are commonly practiced in Egypt, but an increased total fertility rate was recently reported. Impaired female sexual function (FSF) due to contraceptive use can be a reason for irregular use/discontinuation. This study aimed at identifying the type(s) of the commonly used contraceptive method(s) in Egypt that can impair FSF. The sexual function of women on some form of temporary contraceptive was compared to that of women not using contraceptives. All participants answered the Arabic translation of the 19-item Female Sexual Function Index questionnaire. Furthermore, participants on contraceptives answered a global question: Did the use of the contraceptive impact your sexual function? Participants on contraceptives were subgrouped into Copper-T intrauterine devices (IUDs), progestin injectable (medroxyprogesterone 400 mg), combined oral pills (COP; 30 µg ethinylestradiol and 150 µg levonorgestrel), and progestin-only pills (POP; 750 µg levonorgestrel). According to this study, neither the IUDs nor the COP impaired FSF. However, the progestin-only contraceptives were associated with impairment of FSF; the injectable was worse than the POP. Accordingly, counseling about the potential sexual risks of the available contraceptive methods is recommended. Impaired FSF due to contraceptive use can be addressed by a trial of an alternative method to avoid discontinuation.

A new technique, combined plication-incision (CPI), for correction of penile curvature.

INTRODUCTION: Penile curvature (PC) can be surgically corrected by either corporoplasty or plication techniques. These techniques can be complicated by post-operative: penile shortening, recurrent PC, painful/palpable suture knots and erectile dysfunction. OBJECTIVE: To avoid the complications of corporoplasty and plication techniques using a new technique: combined plication-incision (CPI). MATERIALS AND METHODS: Two groups (1&2) were operated upon: group 1 using CPI and group 2 using the 16-dot technique. In CPI, dots were first marked as in 16 dot technique. In each group of 4 dots the superficial layer of tunica albuginea was transversely incised (3-6mm) at the first and last dots. Ethibond 2/0, passed through the interior edge of the first incision plicating the intermediate 2 dots and passed out of the interior edge of the last incision, was tightened and ligated. Vicryle 4/0, passed through the exterior edges of the incisions, was tightened and ligated to cover the ethibond knot. RESULTS: Twelve (57.1 %) participants in group 2 complained of a bothering palpable knot compared to none in group 1 with statistically significant difference (P=0.005). Postoperative shortening (5mm) of erect penis, encountered in 9 participants, was doubled in group 2 but with insignificant difference (P>0.05). Post-operative recurrence of PC, was encountered in only 1 (4.8%) participant in group 2, compared to none in group 1, with insignificant difference (P>0.05). Post-operative erectile rigidity was normally maintained in all participants. CONCLUSION: The new technique was superior to the 16-dot technique for correction of PC.

Intracardiac Echocardiography-Guided Percutaneous Mitral Balloon Commissurotomy: Technique and Early Experience.

Background: Percutaneous mitral balloon commissurotomy (PMBC) is the gold standard for the treatment of patients with symptomatic rheumatic mitral valve (MV) stenosis and favorable valve morphology. Intracardiac ultrasound (ICE)-guided PMBC is an attractive alternative to standard transesophageal echocardiography guidance for simplification of procedure and avoiding general anesthesia. Methods: We conducted a retrospective analysis of all ICE-guided PMBC cases at our institution between July 2020 and November 2023. Procedural success was defined as post-PMBC MV area ≥1.5 cm2; or an increase of ≥0.5 cm2 in MV area associated with echocardiographic mitral regurgitation (MR) that is ≤moderate post-PMBC. Six-month follow-up data were collected. Results: We identified 11 subjects for whom ICE-guided PMBC was attempted. The mean age of the subjects was 61.7 (±12.1) years. All, but one, were females. Out of the 11 subjects, 2 did not undergo PMBC; one had baseline severe MV regurgitation identified on ICE, and the other developed a pericardial effusion following transeptal puncture that needed an urgent pericardial window. The protocol-defined procedural success was achieved in all nine patients who underwent PMBC. Post-PMBC mean MV gradient was 4.4 (±2.0) as compared to 11.1 (±2.9) mmHg at baseline. At 6-month follow-up, 8 of the 9 patients had ≤New York Heart Association class II symptoms. Conclusions: ICE-guided PMBC appears to be feasible and safe. ICE-guided PMBC offers several advantages over transesophageal echocardiography guidance including improving patient comfort and eliminating the need for patient intubation and general anesthesia.

Cellulose acetate nanofiber modified with polydopamine polymerized MOFs for efficient removal of noxious organic dyes.

The need to effectively remove toxic organic dyes from aquatic systems has become an increasingly critical issue in the recent years. In pursuit of this objective, polydopamine (PDA)-binary ZIF-8/UiO-66 (MOFs) was synthesized and incorporated into cellulose acetate (CA), producing ZIF-8/UiO-66/PDA@CA composite nanofibers under meticulously optimized conditions. The potential of fabricated nanofibers to remove cationic methylene blue (MB) dye was investigated. Various analysis tools including FTIR, XRD, SEM, zeta potential, BET, tensile strength testing, and XPS were employed. Results revealed a substantial leap in tensile strength, with ZIF-8/UiO-66/PDA@CA registering an impressive 2.8 MPa, as a marked improvement over the neat CA nanofibers (1.1 MPa). ZIF-8/UiO-66/PDA@CA nanofibers exhibit an outstanding adsorption capacity of 82 mg/g, notably outperforming the 22.4 mg/g capacity of neat CA nanofibers. In binary dye systems, these nanofibers exhibit a striking maximum adsorption capacity of 108 mg/g, establishing their eminence in addressing the complexities of wastewater treatment. Furthermore, the adsorption data fitted to the Langmuir isotherm, and the pseudo-second-order kinetic model. The fabricated nanofiber demonstrates good reproducibility and durability, consistently upholding its performance over five cycles. This suite of remarkable attributes collectively underscores its potential as a robust, durable, and highly promising solution for the effective and efficient removal of pernicious MB dye, in the context of both water quality improvement and environmental preservation.

Optimization of isotropic MoS2/PES membranes for efficient treatment of industrial oily wastewater.

Elimination of tiny oil droplets nearly miscible with wastewater can be realized using membrane technology through ultrafiltration. The novelty of this work was to blend different phases of molybdenum disulfide (MoS2) in isotropic polyethersulfone (PES). We prepared isotropic PES membranes by optimizing nonsolvent vapour-induced phase separation (VIPS). Membranes were blended with MoS2 nanosheets of different phases to promote separation performance and antifouling resistance. FE-SEM revealed the flower-like surface morphology of MoS2 nanosheets. HR-TEM of MoS2 revealed 2H domains in the monolayer, flakes of a few layers and a d-spacing of 0.22 nm. Raman spectroscopy could be used to distinguish mixed-phase MoS2 from single-phase MoS2. Isotropic PES membranes modified with 70% 1T/2H MoS2 had a significantly high permeance to pure water (6911 kg m-2 h bar). The same membrane possessed a high efficiency of oil rejection of 98.78%, 97.85%, 99.83% for emulsions of industrial crude oil at 100, 1000 and 10 000 mg L-1, respectively. Removal of oil droplets from wastewater was dominated by a mechanism based on size exclusion. Isotropic PES modified with 2H MoS2 possessed superior oleophilicity, which resulted in low rejection of crude oil. Modified membranes showed excellent fouling resistance for three successive filtration cycles, as evidenced by enhanced antifouling parameters. Our study reveals how the phase composition of MoS2 nanosheets can significantly affect the performance of isotropic PES membranes during the ultrafiltration of oily wastewater.

Percutaneous pericardiocentesis using the apical approach: case series and review of the literature.

BACKGROUND: Pericardiocentesis offers a definitive diagnostic and a life-saving therapeutic modality through removal of pericardial fluid and relief of high intrapericardial pressure. Percutaneous pericardiocentesis has been performed via different approaches depending on different institutional experiences. In this paper, we present our institutional experience and review the current literature of the different approaches for performing percutaneous pericardiocentesis. MATERIALS AND METHODS: We evaluated consecutive patients who underwent echocardiographic-guided pericardiocentesis via the apical approach for pericardial effusion between the period of April 1st, 2022, and April 1st, 2023, at University of Arkansas for Medical Sciences (UAMS). Health records were reviewed for clinical presentations, available imaging findings, procedural outcomes, and short-term follow up. RESULTS: A total of eight consecutive cases of pericardiocentesis via the apical approach were found. Seven were successful. No complications were reported. Six patients had evidence of tamponade physiology on echocardiogram. CONCLUSION: Historically, pericardiocentesis has been most performed via the subxiphoid approach. However, an ultrasound-guided apical approach offers a safe and effective alternative and may be preferable in patients with challenging anatomies.

The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry.

BACKGROUND: Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. RESULTS: We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P < 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival. CONCLUSIONS: Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality.

Infective Endocarditis After Transcatheter Aortic Valve Implantation: A Systematic Review.

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but potentially fatal event. In this systematic review, we searched PubMed and Embase for large TAVI studies and registries to identify the incidence, presentation, microbiology, risk factors, and outcomes of IE in this population. After application of the selection criteria and quality assessment, 8 studies representing 255,310 TAVR cases and 4218 cases of IE qualified for this review. IE following TAVI is uncommon with an incidence of 0.87 to 1.7 events per 100 person-years. Most events occur in the first year following valve implantation. Staphylococcus , Enterococcus , and Streptococcus species are the most common pathogens. Risk factors include age, sex, concomitant comorbidities, and procedural factors. Outcomes are dismal, and surgical intervention is rare in this population.

Nano-Chitosan/Eucalyptus Oil/Cellulose Acetate Nanofibers: Manufacturing, Antibacterial and Wound Healing Activities.

Accelerated wound healing in infected skin is still one of the areas where current therapeutic tactics fall short, which highlights the critical necessity for the exploration of new therapeutic approaches. The present study aimed to encapsulate Eucalyptus oil in a nano-drug carrier to enhance its antimicrobial activity. Furthermore, in vitro, and in vivo wound healing studies of the novel nano-chitosan/Eucalyptus oil/cellulose acetate electrospun nanofibers were investigated. Eucalyptus oil showed a potent antimicrobial activity against the tested pathogens and the highest inhibition zone diameter, MIC, and MBC (15.3 mm, 16.0 µg/mL, and 256 µg/mL, respectively) were recorded against Staphylococcus aureus. Data indicated a three-fold increase in the antimicrobial activity of Eucalyptus oil encapsulated chitosan nanoparticle (43 mm inhibition zone diameter against S. aureus). The biosynthesized nanoparticles had a 48.26 nm particle size, 19.0 mV zeta potential, and 0.45 PDI. Electrospinning of nano-chitosan/Eucalyptus oil/cellulose acetate nanofibers was conducted, and the physico-chemical and biological properties revealed that the synthesized nanofibers were homogenous, with a thin diameter (98.0 nm) and a significantly high antimicrobial activity. The in vitro cytotoxic effect in a human normal melanocyte cell line (HFB4) proved an 80% cell viability using 1.5 mg/mL of nano-chitosan/Eucalyptus oil/cellulose acetate nanofibers. In vitro and in vivo wound healing studies revealed that nano-chitosan/Eucalyptus oil/cellulose acetate nanofibers were safe and efficiently enhanced the wound-healing process through enhancing TGF-ß, type I and type III collagen production. As a conclusion, the manufactured nano-chitosan/Eucalyptus oil/cellulose acetate nanofiber showed effective potentiality for its use as a wound healing dressing.

Inverted balloon vaginoplasty: an obstructed upper vaginal pouch was pulled downward to form a neovagina.

Inverted balloon vaginoplasty technique was performed for a case with segmental vaginal aplasia and upper hematocolpos within 50 min operative time without any complications. The neovagina was naturally covered, 11 cm in depth and communicated with dimple at hymen's site. Regular painless menstruations were reported.

Direct infusion of fenoldopam into the renal arteries to protect against contrast-induced nephropathy in patients at increased risk.

1. Fenoldopam is a dopamine-like receptor agonist that selectively increases renal medullary blood flow. Despite promising pathophysiology, randomized controlled trials have failed to show a benefit with intravenous infusion of fenoldopam in preventing contrast-induced nephropathy (CIN). 2. The aims of the present study were to examine the efficacy of intrarenal (i.r.) fenoldopam in preventing CIN in high-risk patients undergoing coronary angiograms and percutaneous revascularization. 3. The present study was a single centre, retrospective observational matched cohort study that included 52 patients at risk of developing CIN to whom i.r. fenoldopam was given during catheter-based coronary procedures. For each patient treated, a control patient was identified on basis of an identical Mehran score. Observed rates of CIN and in-hospital dialysis were compared between the i.r. fenoldopam and control groups. 4. Direct comparison of the 52 patients treated with i.r. fenoldopam and the 52 matched controls revealed that the two groups had similar baseline clinical characteristics and creatinine levels (2.4 ± 0.7 vs. 2.2 ± 0.6 mg/dL; P = 0.12). In the i.r. fenoldopam group, six patients (11.5%) developed CIN, compared with 16 patients in the control group (30.8%; risk ratio 0.38; 95% confidence interval 0.16-0.88; P = 0.012). 5. None of the patients in the fenoldopam group needed in-hospital dialysis, compared with three patients in the control group. 6. A larger prospective randomized study is needed to prove the effectiveness of this protective approach.

Carotid endarterectomy for symptomatic carotid artery stenosis in a patient who presented with psychosis.

Acute psychosis is an unusual presentation of stroke particularly in a patient with no history of psychiatric illness. We report a case where an elderly male patient with self-inflicted injuries caused by acute psychosis. The investigation confirmed an acute left hemispherical stroke associated with a high-grade left internal carotid artery stenosis. The patient underwent a successful left carotid endarterectomy. His psychotic symptoms resolved and he was discharged home without the need for neuroleptic medication.