Does valve morphological type impact TAVR outcomes?

Appropriate treatment for the bicuspid aortic valve demands attention to detail across the spectrum of bicuspid morphological types. Transcatheter aortic valve replacement outcomes, while encouraging, require in-depth evaluation before generalization to improve the precision of care.

Infected chylopericardium: An unexpected cause of cardiac tamponade.

A 22-year-old immunocompetent female with a history of small pericardial effusion while infant presented with fever and hemodynamic collapse 4 days after facial trauma. She was found to have cardiac tamponade secondary to infected chylopericardium from bacterial translocation. We report this very unusual case and review of the literature on chylopericardium infections.

Functional Crosstalk between PCSK9 Internalization and Pro-Inflammatory Activation in Human Macrophages: Role of Reactive Oxygen Species Release.

Atherosclerosis is a cardiovascular disease caused mainly by dyslipidemia and is characterized by the formation of an atheroma plaque and chronic inflammation. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a protease that induces the degradation of the LDL receptor (LDLR), which contributes to increased levels of LDL cholesterol and the progress of atherosclerosis. Given that macrophages are relevant components of the lipidic and inflammatory environment of atherosclerosis, we studied the effects of PCSK9 treatment on human macrophages. Our data show that human macrophages do not express PCSK9 but rapidly incorporate the circulating protein through the LDLR and also activate the pro-inflammatory TLR4 pathway. Both LDLR and TLR4 are internalized after incubation of macrophages with exogenous PCSK9. PCSK9 uptake increases the production of reactive oxygen species and reduces the expression of genes involved in lipid metabolism and cholesterol efflux, while enhancing the production of pro-inflammatory cytokines through a TLR4-dependent mechanism. Under these conditions, the viability of macrophages is compromised, leading to increased cell death. These results provide novel insights into the role of PCSK9 in the crosstalk of lipids and cholesterol metabolism through the LDLR and on the pro-inflammatory activation of macrophages through TLR4 signaling. These pathways are relevant in the outcome of atherosclerosis and highlight the relevance of PCSK9 as a therapeutic target for the treatment of cardiovascular diseases.

Innovatively processed quinoa (Chenopodium quinoa Willd.) food: chemistry, structure and end-use characteristics.

BACKGROUND: Quinoa (Chenopodium quinoa Willd.) flour and processed traditional Peruvian quinoa breakfast foods were studied to evaluate the effect of extrusion and post-processing on protein properties, morphology and nutritional characteristics (amino acids and dietary fibers). RESULTS: The extrusion increased quinoa protein crosslinking and aggregation observed by size exclusion high-performance liquid chromatography and the amount of soluble fibers, as well as decreasing the amounts of insoluble fibers in the processed foods. The post-processing drying resulted in additional crosslinking of large protein fractions in the quinoa products. The microstructure of the extruded quinoa breakfast flakes and heat-post-processed samples studied by scanning electron microscopy and X-ray tomography differed greatly; post-drying induced formation of aerated protein microstructures in the heat-treated samples. Nanostructures revealed by small-angle and wide-angle X-ray scattering indicated that extrusion imparted morphological changes in the quinoa protein and starch (dominance of V-type). Overall, extrusion processing only reduced the content of most of the essential amino acids to a minor extent; the content of valine and methionine was reduced to a slightly greater extent, but the final products met the requirements of the Food and Drug Organization. CONCLUSION: This study presents innovative examples on how extrusion processing and post-processing heat treatment can be used to produce attractive future food alternatives, such as breakfast cereal flakes and porridge powder, from quinoa grains. Extrusion of quinoa flour into Peruvian foods was shown to be mostly impacted by the processing temperature and processing conditions used. Protein crosslinking increased due to extrusion and post-processing heating. Starch crystallinity decreased most when the product was dried after processing. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Structural properties of cationic surfactant-fatty alcohol bilayers: insights from dissipative particle dynamics.

Bilayers, self-assembled by cationic surfactants and fatty alcohols in water, are the basic units of lamellar gel networks - creamy formulations extensively used in cosmetics and pharmaceutics. Mesoscopic modelling and study of the bilayers formed by single- or double-tail cationic surfactants (CTAC or DHDAC), and fatty alcohols (FAs) in the lamellar fluid and gel phases were employed. Fatty alcohols with alkyl tail equal to or greater than the surfactant alkyl tail, i.e., C16FA or C18FA and C22FA, were considered. A model formulation was explored with the FA concentration greater than that of the surfactant and the structure of the fluid and gel bilayers in tensionless state characterised via the density profiles across the bilayers, orientational order parameters of the surfactant and FA chains, intrinsic analysis of the bilayer interfaces, and bending rigidity. The intrinsic analysis allows identification and quantification of the coexistence of the interdigitated and non-interdigitated phases present within the gel bilayers. The FA chains were found to conform the primary scaffolding of the bilayers while the surfactant chains tessellate bilayer monolayers from their water-hydrophobic interface. Further, the overlap of the FA chains from the apposed monolayers of the fluid bilayers rises with increasing FA length. Finally, the prevalence of the non-interdigitated phase over the interdigitated phase within the gel bilayers becomes enhanced upon the FA length increase with a preference of the surfactant chains to reside in the non-interdigitated phase rather than the interdigitated phase.

Charge-transfer dynamics in van der Waals heterojunctions formed by thiophene-based semiconductor polymers and exfoliated franckeite investigated from resonantly core-excited electrons.

Organic/inorganic van der Waals heterojunctions formed by a combination of 2D materials with semiconductor polymer films enable the fabrication of new device architectures that are interesting for electronic and optoelectronic applications. Here, we investigated the charge-transfer dynamics at the interface between 2D layered franckeite (Fr) and two thiophene-based conjugated polymers (PFO-DBT and P3HT) from the resonantly core-excited electron. The unoccupied electronic states of PFO-DBT/Fr and P3HT/Fr heterojunctions were studied using near-edge X-ray absorption fine structure (NEXAFS) and resonant Auger (RAS) synchrotron-based spectroscopies. We found evidence of ultrafast (subfemtosecond charge-transfer times) interfacial electron delocalization pathways from specific electronic states. For the interface between the PFO-DBT polymer and exfoliated franckeite, the most efficient interfacial electron delocalization pathways were found through π*(S-N) and π*(S-C) electronic states corresponding to the benzothiadiazole and thiophene units. On the other hand, for the P3HT polymer, we found that electrons excited to π-π* and S1s-π*(C-C) electronic states of the P3HT polymer are the most affected by the presence of exfoliated franckeite and consequently are the main interfacial electron-transfer pathways in this heterojunction. Our results have important implications in understanding how ultrafast electron delocalization is taking place in organic/inorganic van der Waals heterojunctions, which is relevant information in designing new devices involving these systems.

Comparative Study of Two Infrared Meibographers in Evaporative Dry Eye Versus Nondry Eye Patients.

OBJECTIVE: To compare the measurement of the meibomian gland (MG) dropout between two infrared meibographers in patients with and without dry eye. METHODS: The right eyelids of each patient were imaged using the Antares and Cobra meibography devices. All images were analyzed using Phoenix software to calculate the percentage of the MG dropout. Lipid layer thickness, eyelid margin characteristics, ocular surface staining, MG secretion, number of expressible glands, and noninvasive tear breakup time were also evaluated. A comparison between nondry eye and evaporative dry eye was performed. RESULTS: Eighty participants (mean age, 36.93 years and 51.3% women) were included, of which 67.5% had nondry eye. A significant difference was observed in the dropout percentage of the superior eyelid between the Antares and Cobra devices (P=0.007) for all participants and when only the nondry eye patients were examined. In patients with dry eye, no significant differences were found in the dropout measurements of both eyelids. CONCLUSIONS: Statistically significant differences in the MG dropout percentage in the upper eyelid of nondry eye patients were obtained from both meibographers. The measurements were similar in patients with dry eye, suggesting that the two instruments can be interchanged.

Right atrial myxoma with peripheral eosinophilia: Eosinophilia in cardiac myxoma.

BACKGROUND: Cardiac myxoma is the most common type of primary cardiac tumors. It is known that inflammatory markers are increased in the setting of myxoma, like C-reactive protein, erythrocyte sedimentation rate, and interleukin-6. The association between cardiac myxoma and abnormal blood cell counts has been scarcely reported. RESULTS: We present a patient with a right atrial myxoma found incidentally, who had hypereosinophilia, which dramatically resolved after resection of the tumor. CONCLUSION: Hypereosinophilia has mostly been found in patients with heart malignancies. It is extremely uncommon in patients with cardiac myxoma; therefore, its presence may signify a distinct biological tumoral behavior with the potential to become a marker of disease activity or recurrence. The true significance of this finding is still unknown and requires further investigation.

Activation of the Extrinsic and Intrinsic Apoptotic Pathways in Cerebellum of Kindled Rats.

The purpose of this study is to determine the activation of the extrinsic and intrinsic apoptotic pathways in the cerebellum of rats exposed to amygdaloid electrical kindling. Western blot analyses were carried out for caspase-8 and caspase-9, Bid, Bax, and Bcl-2 in the cerebellum and immunohistochemistry of Bid, Bax, cytochrome C, and VDAC (voltage-dependent anion channels) in the cerebellar cortex of Wistar male rats with 0, 15, and 45 kindling stimulations. In the experimental group of 45 stimuli, we observed an increase in protein activation of caspase-9 and truncated Bid and Bax, in addition to a decrease in expression of pro-caspase-8 and the anti-apoptotic protein Bcl-2, determined by Western blot. Moreover, we observed a cytosolic immunopositivity for cytochrome C and a mitochondrial immunolocalization for truncated Bid and Bax in the group of 45 stimuli. In this work, we found an increase of caspase-8, a cysteine-protease that can activate caspase-3 triggering extrinsic apoptosis by signaling of death receptors. However, it also can activate the intrinsic pathway releasing Bid, which performs mitochondrial translocation of Bax, inactivating Bcl-2 and allowing the release of cytochrome C through the opening of the mitochondrial permeability transition pore, promoting the activation of caspase-9 which activates caspase-3, the main executor caspase of apoptosis. Therefore, it is concluded that there is an activation of the intrinsic and extrinsic apoptotic pathways in the cerebellum of rats exposed to the kindling model. Apoptosis signaling pathways can be analyzed as an important developing object of research about the epileptic activity. Graphical Abstract.

Species selective charge transfer dynamics in a P3HT/MoS2 van der Waals heterojunction: fluorescence lifetime microscopy and core hole clock spectroscopy approaches.

Hybrid van der Waals heterojunctions based on organic polymers and 2D materials have emerged as a promising solution for developing more efficient optoelectronic devices. Herein, we investigated the charge transfer (CT) dynamics at the interface of the poly[3-hexylthiophene-2,5-diyl] (P3HT) organic polymer and a MoS2 monolayer. A global picture of the charge transfer dynamics of a P3HT/MoS2/SiO2 heterojunction was elucidated from photoluminescence (PL) spectroscopy and the fluorescence lifetime decay profile. Rapid interfacial charge transfer between P3HT and MoS2 was indicated by strong PL quenching and a reduction in the average fluorescence lifetime (τav) of the P3HT/MoS2/SiO2 heterojunction. The role of specific electronic states in the interfacial CT process was investigated by applying the core hole clock approach. CT times (τCT) on femtosecond and sub-femtosecond timescales were estimated using the S1s core-hole lifetime as the internal clock. Sub-femtosecond CT was observed for electrons excited to S3pz (0.34 fs) electronic states of MoS2 and to π* (C-C) (0.45 fs) electronic states of P3HT in the P3HT/MoS2/SiO2 heterojunction. These fast bidirectional CT processes result from strong coupling between these two electronic states in the P3HT/MoS2/SiO2 heterostructure. However, the reduction of the τCT values in the heterojunction compared with those of the isolated films shows that interfacial CT from the P3HT species to MoS2 is more efficient. Interfacial CT was not observed for electrons excited to electronic states S3px,y (MoS2) and σ* (S-C) (P3HT). We conclude that the π* (C-C) electronic state of the P3HT species is the main pathway for interfacial ultrafast CT in a P3HT/MoS2/SiO2 heterojunction.

Transcatheter Intervention for Treatment of Coronary Stenosis After Unroofing of the Anomalous Left Coronary Artery.

Anomalous origin of left coronary artery (LCA) from the right coronary cusp with an intramural course is usually managed with unroofing of the intramural segment. Available literature demonstrates an uneventful course following surgery in most patients. Coronary stenosis following the unroofing procedure treated with percutaneous coronary intervention has not been described in the past. We describe a case where an 11-year-old girl with anomalous origin of the LCA from the right coronary cusp presented with near syncope. Surgical unroofing of the intramural segment was done without any post-operative complications and the patient remained asymptomatic for 9 months. She then presented with chest pain, abnormal troponin levels, and ST-T wave changes on EKG. A CT angiogram done revealed short segment narrowing of the LCA near its origin. Cardiac catheterization with coronary angiography demonstrated short segment narrowing of the LCA just distal to origin. Stenting of the left main coronary artery was done with a drug eluting stent. She underwent the procedure without complications. The patient continued to be asymptomatic 16 months after placement of the stent and there was no residual stenosis seen on a repeat CT angiogram at 3 months after the procedure.

Spatial estimation of surface ozone concentrations in Quito Ecuador with remote sensing data, air pollution measurements and meteorological variables.

Surface ozone is problematic to air pollution. It influences respiratory health. The air quality monitoring stations measure pollutants as surface ozone, but they are sometimes insufficient or do not have an adequate distribution for understanding the spatial distribution of pollutants in an urban area. In recent years, some projects have found a connection between remote sensing, air quality and health data. In this study, we apply an empirical land use regression (LUR) model to retrieve surface ozone in Quito. The model considers remote sensing data, air pollution measurements and meteorological variables. The objective is to use all available Landsat 8 images from 2014 and the air quality monitoring station data during the same dates of image acquisition. Nineteen input variables were considered, selecting by a stepwise regression and modelling with a partial least square (PLS) regression to avoid multicollinearity. The final surface ozone model includes ten independent variables and presents a coefficient of determination (R2) of 0.768. The model proposed help to understand the spatial concentration of surface ozone in Quito with a better spatial resolution.

In-stent thrombosis when switching ticagrelor to clopidogrel after percutaneous coronary intervention.

Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker has been proven to reduce subsequent cardiovascular events and in-stent thrombosis in patients undergoing percutaneous coronary intervention. Newer P2Y12 antagonists with faster onset and greater inhibition of platelet activity have improved cardiovascular outcomes but have created uncertainty with the appropriate dosing when switching between agents. Currently, there are no evidence-based guidelines to aid clinicians when switching between P2Y12 receptor blockers. Here we describe two patients that developed in-stent thrombosis when switching from ticagrelor to clopidogrel using a 300 mg clopidogrel loading dose. Both patients presented with ST elevation myocardial infarction and underwent stent placement but then developed in-stent thrombosis 48 hours after switching from ticagrelor to clopidogrel. These cases illustrate the severe consequences of suboptimal platelet inhibition and the need for prospective trials thoroughly powered to assess clinical outcomes in order to determine the most appropriate strategy when switching from ticagrelor to clopidogrel.