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.

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.

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.

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.

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.

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.

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.

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.

Innovative antibacterial electrospun nanofibers mats depending on piezoelectric generation.

This paper introduces a new approach of testing piezoelectric nanofibers as antibacterial mat. In this work, both Polyvinylidene fluoride (PVDF) and PVDF embedded with thermoplastic polyurethane nanofibers are synthesized as nanofibers mat via electrospinning technique. Then, such mat is analyzed as piezoelectric material to generate electric voltage under different mechanical excitations. Furthermore, morphological and chemical characteristics have been operated to prove the existence of beta sheets piezoelectricity of the synthesized nanofibers mats. Then, the synthesized nanofibers surfaces have been cyclically stretched and exposed to bacteria specimen. It has been noticed that the generated voltage and the corresponding localized electric field positively affect the growth of bacteria and reduces the formation of K. penomenue samples bacteria colonies. In addition, the effect of both stretching frequency and pulses numbers have been studied on the bacteria count, growth kinetics, and protein leakage. Our contribution here is to introduce an innovative way of the direct impact of the generated electric field from piezoelectric nanofibers on the reduction of bacteria growth, without depending on traditional anti-bacterial nanoparticles. This work can open a new trend of the usability of piezoelectric nanofibers through masks, filters, and wound curing mats within anti-bacterial biological applications.

In-Hospital Outcome In Patients With Acyanotic Congenital Heart Disease Undergoing Transcatheter Aortic Valve Replacement.

The purpose of the study was to determine the in-hospital outcome and resource utilization in patients with acyanotic congenital heart disease (ACHD) undergoing transcatheter aortic valve replacement (TAVR). Current guidelines from professional societies do not support TAVR in patients with ACHD, likely from a lack of supportive evidence. Temporal trends in patients with ACHD undergoing TAVR were determined using the 2016-2018 National Inpatient Sample database appropriate ICS-10-PCS code. Stata 16.0 was used for statistical analysis. 0.87% of patients undergoing TAVR had concomitant ACHD, with ASD being the most common (78%). After matching, there was no increased risk of mortality in ACHD patients undergoing TAVR compared to patients without ACHD (OR 1.43, P = 0.59). Additionally, no difference was found in the incidence of overall cardiac complications between patients with ACHD and patients without ACHD, except STEMI (OR 4.16, 95% CI, 1.08-16.00, P = 0.038), which is likely due to more comorbidity burden in the later cohort. Complications such as acute kidney injury, ischemic stroke, and bleeding were similar. Hospital resource utilization was higher in the ACHD group in the form of increased length of stay and higher mean total cost. The comparable in-hospital all-cause mortality and complication rate in ACHD patients undergoing TAVR compared to patients without ACHD is encouraging and will be helpful to design future randomized controlled trials.

Silver/Snail Mucous PVA Nanofibers: Electrospun Synthesis and Antibacterial and Wound Healing Activities.

Healthcare textiles are gaining great attention in the textile industry. Electrospun nanofibers are considered the golden soldiers due to their strength, flexibility, and eco-friendly properties. The present study aimed to evaluate the potency of polyvinyl alcohol (PVA) nanofibers loaded with newly biosynthesized silver nanoparticles (Ag-NPs) as a wound healing dressing. Chocolate-band snail (Eobania vermiculata) mucus (which is part of the Mollusca defense system) was used as a novel reducing and stabilizing agent. Data indicated the effectiveness of Eobania vermiculata's mucus in silver nanoparticle synthesis after a 24 h incubation time. The biosynthesized AgNPs-SM showed a 13.15 nm particle size, -22.5 mV ζ potential, and 0.37 PDI, which proved the stability of the synthesized nanoparticles. Eobania vermiculata mucus and AgNPs-SM showed potent antibacterial activity, especially against Pseudomonas aeruginosa. The electrospinning technique was applied in the fabrication of PVA/AgNPs-SM nanofibers, which were homogenous with a fine diameter of about 100-170 nm and showed a significantly high antimicrobial activity. In vitro and in vivo studies revealed that PVA/AgNPs-SM nanofibers were safe and efficiently enhanced the wound healing process (typical histological picture of the proliferative phase with compact and well aligned collagen fibers in the dermal tissue after 12 days) together with bacterial growth inhibition in the infected skin area.

Stretchable nanofibers of polyvinylidenefluoride (PVDF)/thermoplastic polyurethane (TPU) nanocomposite to support piezoelectric response via mechanical elasticity.

Interest in piezoelectric nanocomposites has been vastly growing in the energy harvesting field. They are applied in wearable electronics, mechanical actuators, and electromechanical membranes. In this research work, nanocomposite membranes of different blend ratios from PVDF and TPU have been synthesized. The PVDF is responsible for piezoelectric performance where it is one of the promising polymeric organic materials containing ß-sheets, to convert applied mechanical stress into electric voltage. In addition, the TPU is widely used in the plastic industry due to its superior elasticity. Our work investigates the piezoresponse analysis for different blending ratios of PVDF/TPU. It has been found that TPU blending ratios of 15-17.5% give higher output voltage at different stresses conditions along with higher piezosensitivity. Then, TPU addition with its superior mechanical elasticity can partially compensate PVDF to enhance the piezoelectric response of the PVDF/TPU nanocomposite mats. This work can help reducing the amount of added PVDF in piezoelectric membranes with enhanced piezo sensitivity and mechanical elasticity.

Simultaneous Real-Time Intravascular Ultrasound-Guided Transcatheter Pulmonary Embolectomy Improves Procedural Accuracy, Efficacy, and Safety.

Percutaneous catheter-directed interventions for pulmonary embolism is a rapidly evolving field. We present the first case report of simultaneous intravascular ultrasound (IVUS) use during transcatheter pulmonary embolectomy. Real-time IVUS guidance offers the advantage of better clot visualization and precise suction catheter localization while minimizing contrast medium exposure and wire exchanges. (Level of Difficulty: Advanced.).