Optimizing Thermoelectric Properties through Compositional Engineering in Ag-Deficient AgSbTe2 Synthesized by Arc Melting.

Thermoelectric materials offer a promising avenue for energy management, directly converting heat into electrical energy. Among them, AgSbTe2 has gained significant attention and continues to be a subject of research at further improving its thermoelectric performance and expanding its practical applications. This study focuses on Ag-deficient Ag0.7Sb1.12Te2 and Ag0.7Sb1.12Te1.95Se0.05 materials, examining the impact of compositional engineering within the AgSbTe2 thermoelectric system. These materials have been rapidly synthesized using an arc-melting technique, resulting in the production of dense nanostructured pellets. Detailed analysis through scanning electron microscopy (SEM) reveals the presence of a layered nanostructure, which significantly influences the thermoelectric properties of these materials. Synchrotron X-ray diffraction reveals significant changes in the lattice parameters and atomic displacement parameters (ADPs) that suggest a weakening of bond order in the structure. The thermoelectric characterization highlights the enhanced power factor of Ag-deficient materials that, combined with the low glass-like thermal conductivity, results in a significant improvement in the figure of merit, achieving zT values of 1.25 in Ag0.7Sb1.12Te2 and 1.01 in Ag0.7Sb1.12Te1.95Se0.05 at 750 K.

Multiscale Length Structural Investigation and Thermoelectric Performance of Double-Filled Sr0.2Yb0.2Co4Sb12: An Exceptional Thermal Conductivity Reduction by Filler Segregation to the Grain Boundaries.

Among thermoelectric materials, skutterudites are the most prominent candidates in the mid-temperature range applications. In the multiple-filled Sr0.2Yb0.2Co4Sb12 skutterudite, with Sr and Yb as fillers, we have enhanced the thermoelectric performance of CoSb3 through the reduction of lattice thermal conductivity and the optimization of carrier concentration and electrical conductivity. The high-pressure synthesis of the double-filled derivative promotes filling fraction fluctuation. This is observed by high angular resolution synchrotron X-ray diffraction, showing a phase segregation that corresponds to an inhomogeneous distribution of the filler atoms, located at the 2a positions of the cubic space group Im3̅. In addition, scanning transmission electron microscopy (STEM) combined with EELS spectroscopy clearly shows a segregation of Sr atoms from the surface of the grains, which is compatible with the synchrotron X-ray powder diffraction results. Mean square displacement parameters analysis results in Einstein temperatures of ∼94 and ∼67 K for Sr and Yb, respectively, and a Debye temperature of ∼250 K. The strong effect on resonant and disorder scattering yields a significantly lower lattice thermal conductivity of 2.5 W m-1 K-1 at 773 K. Still, good weighed-mobility values were obtained, with high filling fraction of the Yb and Sr elements. This drives a reduced electrical resistivity of 2.1 × 10-5 Ω m, which leads to a peak zT of 0.26 at 773 K. The analysis and results performed for the synthesized (Sr,Yb)-double filled CoSb3, shed light on skutterudites for potential waste-heat recovery applications.

Magnetoelastic Coupling Evidence by Anisotropic Crossed Thermal Expansion in Magnetocaloric RSrCoFeO6 (R = Sm, Eu) Double Perovskites.

Double perovskite oxides, characterized by their tunable magnetic properties and robust interconnection between the lattice and magnetic degrees of freedom, present an enticing foundation for advanced magnetic refrigeration materials. Herein, we delve into the influence of rare-earth elements on RSrCoFeO6 (R = Sm, Eu) disordered double perovskites by examining their structural, electronic, magnetic, and magnetocaloric properties. Temperature-dependent synchrotron X-ray diffraction analysis confirmed the stability of the orthorhombic phase (Pnma) across a wide temperature range. X-ray photoemission spectroscopy revealed that both Sm and Eu are in the 3+ state, whereas multiple states for Co2+/3+ and Fe3+/4+ are identified. The magnetic investigation and magnetocaloric effect (MCE) analysis brought to light the presence of a long-range antiferromagnetic (AFM) order with a second-order phase transition (SOPT) in both samples. The maximum magnetic entropy change ΔSMmax was approximately 0.9 J/kg K for both samples at applied field 0-7 T, manifesting prominently above Neel temperatures TN ≈ 93 K (Sm) and 84 K (Eu). Nevertheless, different relative cooling powers (RCP) of 112.6 J/kg (Sm) and 95.5 J/kg (Eu) were observed. A detailed analysis of the temperature-dependent lattice parameters shed light on a distinct magnetocaloric effect across the magnetic transition temperature, unveiling an anisotropic thermal expansion [αV = 1.41 × 10-5 K-1 (Sm) and αV = 1.54 × 10-5 K-1 (Eu)] wherein the thermal expansion axial ratio αbSm/αbEu = 0.61 became lower with increasing temperature, which suggests that the Eu sample experiences a greater thermal expansion in the b-axis direction. At the atomic bonding level, the evidence for magnetoelastic coupling around the magnetic transition temperatures TN was found through the anomalies along the average Co/Fe-O bond distance, formal valence, octahedral distortion, as well as an anisotropic lattice expansion.

SrMo0.9O3-δ Perovskite with Segregated Ru Nanoparticles Performing as Anode in Solid Oxide Fuel Cells.

A new anode material, Ru-SrMo0.9O3-δ, with a perovskite structure and segregated metallic Ru, has been tested in an intermediate-temperature solid oxide fuel cell (IT-SOFC) in an electrolyte-supported configuration giving substantial power densities as high as 840 mW/cm2 at 850 °C using pure H2 as fuel. This material has been prepared by the citrate method and structurally and microstructurally characterized at room temperature by different techniques such as X-ray diffraction (XRD), neutron powder diffraction (NPD), scanning electron microscopy (SEM), and scanning transmission electron microscopy (STEM). NPD was very useful to determine oxygen positions and vacancies, unveiling a cubic and oxygen-deficient perovskite SrMo0.9O3-δ oxide with a Pm-3m space group and potential ionic mobility. On the other hand, SEM and STEM studies have allowed to identify metallic segregated Ru nanoparticles providing the material with an excellent catalytic activity. Other properties such as the thermal expansion coefficient (TEC) and chemical compatibility with other cell components or electrical conductivity have also been studied to understand the excellent performance of this material as anode in IT-SOFC and correlate it with the crystallographic structure.

Structural and Electrical Characterization of LaSrAl1-xMgxO4-δ Layered Perovskites Obtained by Mechanical Synthesis.

This work presents the structural and electrical characterization of K2NiF4-type layered perovskites of LaSrAl1-xMgxO4-δ composition to be used as oxide-ion electrolytes for a solid-oxide fuel cell (SOFC). These perovskites were prepared by mechano-chemical synthesis (ball milling), an alternative to traditional synthesis methods such as citrate-nitrates and solid-state reaction. With these methods, two things are avoided: first, the use of nitrate salts, which are more environmentally harmful than oxide precursors, and second, it saves the series of long thermal treatments associated with solid-state reactions. After grinding the precursors, nanometric particles were obtained with a combination of crystalline regions and amorphous regions; this effect was determined by XRD and TEM, showing that Mg has a positive effect on the phase formation by only mechanical synthesis. R2C4: After sintering, it was found by XRD that the sample x = 0.1 only presents the diffraction peaks corresponding to the desired phase, which shows a phase purity greater than 97%, even higher than that of the standard undoped sample. For x = 0.2 and 0.3, there was a segregation of impurities, possibly by the local migration of La and Sr heavy cations; this was determined by SEM and EDS. The electrical characterization of the sintered pellets was carried out by electrochemical impedance spectroscopy, which determined that the incorporation of Mg in the structure improves the ionic conductivity by three orders of magnitude, obtaining conductivities of 1.6 mS/cm at 900 °C for x = 0.2. Although the improvement in conductivity is considerable, many challenges such as densification, the segregation of impurities, and the study of mechanical and thermal properties must be carried out on these materials to endorse them as solid electrolytes in SOFC.

Dietary proteins modulate high-density lipoprotein characteristics in a sex-specific way in Apoe-deficient mice.

OBJECTIVES: The type and amount of dietary protein have become a topic of renewed interest, considering their involvement in several diseases. However, little attention has been devoted to the effect of avian proteins despite their wide human consumption. In a previous study, we saw that compared with soybean protein, the consumption of avian proteins, depending on sex, resulted in similar or lower atherosclerosis with a higher paraoxonase 1 activity, an antioxidant enzyme carried by high-density lipoproteins (HDL). This suggests that under these conditions, the HDL lipoproteins may undergo important changes. The aim of this research was to study the influence of soybean, chicken, and turkey proteins on the characteristics of HDL. METHODS: Male and female Apoe-deficient mice were fed purified Western diets based on the AIN-93 diet, differing only in the protein source, for 12 wk. After this period, blood and liver samples were taken for analysis of HDL composition and hepatic expression of genes related to HDL metabolism (Abca1, Lcat, Pltp, Pon1, and Scarb1). Depending on sex, these genes define a different network of interactions. Females consuming the turkey protein-containing diet showed decreased atherosclerotic foci, which can be due to larger very-low-density lipoproteins (VLDLs) calculated by molar ratio triacylglycerols/VLDL cholesterol and higher expression of Lcat. In contrast, in males, a higher ratio of paraoxonase1 to apolipoprotein A1 decreased the oxidative status of the different lipoproteins, and augmented Abca1 expression was observed. CONCLUSIONS: The source of protein has an effect on the development of atherosclerosis depending on sex by modifying HDL characteristics and the expression of genes involved in their properties.

The Path Towards Effective Respiratory Syncytial Virus Immunization Policies: Recommended Actions

The respiratory syncytial virus (RSV) causes a substantial burden worldwide. After over six decades of research, there is finally a licensed immunization option that can protect the broad infant population, and other will follow soon. RSV immunization should be in place from season 2023/2024 onwards. Doing so requires thoughtful but swift steps. This paper reflects the view of four immunization experts on the efforts being made across the globe to accommodate the new immunization options and provides recommendations organized around five priorities: (I) documenting the burden of RSV in specific populations; (II) expanding RSV diagnostic capacity in clinical practice; (III) strengthening RSV surveillance; (IV) planning for the new preventive options; (V) achieving immunization targets. Overall, Spain has been a notable example of converting RSV prevention into a national desideratum and has pioneered the inclusion of RSV in some of the regional immunization calendars for infants facing their first RSV season. (AU)

Structural Features and Optical Properties of All-Inorganic Zero-Dimensional Halides Cs4PbBr6-xIx Obtained by Mechanochemistry.

Despite the great success of hybrid CH3NH3PbI3 perovskite in photovoltaics, ascribed to its excellent optical absorption properties, its instability toward moisture is still an insurmountable drawback. All-inorganic perovskites are much less sensitive to humidity and have potential interest for solar cell applications. Alternative strategies have been developed to design novel materials with appealing properties, which include different topologies for the octahedral arrangements from three-dimensional (3D, e.g., CsPbBr3 perovskite) or two-dimensional (2D, e.g., CsPb2Br5) to zero-dimensional (0D, i.e., without connection between octahedra), as the case of Cs4PbX6 (X = Br, I) halides. The crystal structure of these materials is complex, and their thermal evolution is unexplored. In this work, we describe the synthesis of Cs4PbBr6-xIx (x = 0, 2, 4, 6) halides by mechanochemical procedures with green credentials; these specimens display excellent crystallinity enabling a detailed structural investigation from synchrotron X-ray powder diffraction (SXRD) data, essential to revisit some features in the temperature range of 90-298 K. In all this regime, the structure is defined in the trigonal R3̅c space group (#167). The presence of Cs and X vacancies suggests some ionic mobility into the crystal structure of these 0D halides. Bond valence maps (BVMs) are useful in determining isovalent surfaces for both Cs4PbBr6 and Cs4PbI6 phases, unveiling the likely ionic pathways for cesium and bromide ions and showing a full 3D connection in the bromide phase, in contrast to the iodide one. On the other hand, the evolution of the anisotropic displacement parameters is useful to evaluate the Debye temperatures, confirming that Cs atoms have more freedom to move, while Pb is more confined at its site, likely due to a higher covalency degree in Pb-X bonds than that in Cs-X bonds. Diffuse reflectance ultraviolet-visible (UV-vis) spectroscopy shows that the optical band gap can be tuned depending on iodine content (x) in the range of 3.6-3.06 eV. From density functional theory (DFT) simulations, the general trend of reducing the band gap when Br is replaced by I is well reproduced.

The Path Towards Effective Respiratory Syncytial Virus Immunization Policies: Recommended Actions.

The respiratory syncytial virus (RSV) causes a substantial burden worldwide. After over six decades of research, there is finally a licensed immunization option that can protect the broad infant population, and other will follow soon. RSV immunization should be in place from season 2023/2024 onwards. Doing so requires thoughtful but swift steps. This paper reflects the view of four immunization experts on the efforts being made across the globe to accommodate the new immunization options and provides recommendations organized around five priorities: (I) documenting the burden of RSV in specific populations; (II) expanding RSV diagnostic capacity in clinical practice; (III) strengthening RSV surveillance; (IV) planning for the new preventive options; (V) achieving immunization targets. Overall, Spain has been a notable example of converting RSV prevention into a national desideratum and has pioneered the inclusion of RSV in some of the regional immunization calendars for infants facing their first RSV season.

Immunization technologies: Time to consider new preventative solutions for respiratory syncytial virus infections.

New technologies for the prevention of infectious diseases are emerging to address unmet medical needs, in particular, the use of long-acting monoclonal antibodies (mAb) to prevent Respiratory Syncytial Virus (RSV) lower respiratory tract disease in infants during their first RSV season. The lack of precedent for mAbs for broad population protection creates challenges in the assessment of upcoming prophylactic long-acting mAbs for RSV, with associated consequences in legislative and registration categorization, as well as in recommendation, funding, and implementation pathways. We suggest that the legislative and regulatory categorization of preventative solutions should be decided by the effect of the product in terms of its impact on the population and health-care systems rather than by the technology used or its mechanism of action. Immunization can be passive and active, both having the same objective of prevention of infectious diseases. Long-acting prophylactic mAbs work as passive immunization, as such, their recommendations for use should fall under the remit of National Immunization Technical Advisory Groups or other relevant recommending bodies for inclusion into National Immunization Programs. Current regulations, policy, and legislative frameworks need to evolve to embrace such innovative preventative technologies and acknowledge them as one of key immunization and public health tools.

Active and durable R2MnRuO7 pyrochlores with low Ru content for acidic oxygen evolution.

The production of green hydrogen in water electrolyzers is limited by the oxygen evolution reaction (OER). State-of-the-art electrocatalysts are based on Ir. Ru electrocatalysts are a suitable alternative provided their performance is improved. Here we show that low-Ru-content pyrochlores (R2MnRuO7, R = Y, Tb and Dy) display high activity and durability for the OER in acidic media. Y2MnRuO7 is the most stable catalyst, displaying 1.5 V at 10 mA cm-2 for 40 h, or 5000 cycles up to 1.7 V. Computational and experimental results show that the high performance is owed to Ru sites embedded in RuMnOx surface layers. A water electrolyser with Y2MnRuO7 (with only 0.2 mgRu cm-2) reaches 1 A cm-2 at 1.75 V, remaining stable at 200 mA cm-2 for more than 24 h. These results encourage further investigation on Ru catalysts in which a partial replacement of Ru by inexpensive cations can enhance the OER performance.

Highly active and stable OER electrocatalysts derived from Sr2MIrO6 for proton exchange membrane water electrolyzers.

Proton exchange membrane water electrolysis is a promising technology to produce green hydrogen from renewables, as it can efficiently achieve high current densities. Lowering iridium amount in oxygen evolution reaction electrocatalysts is critical for achieving cost-effective production of green hydrogen. In this work, we develop catalysts from Ir double perovskites. Sr2CaIrO6 achieves 10 mA cm-2 at only 1.48 V. The surface of the perovskite reconstructs when immersed in an acidic electrolyte and during the first catalytic cycles, resulting in a stable surface conformed by short-range order edge-sharing IrO6 octahedra arranged in an open structure responsible for the high performance. A proton exchange membrane water electrolysis cell is developed with Sr2CaIrO6 as anode and low Ir loading (0.4 mgIr cm-2). The cell achieves 2.40 V at 6 A cm-2 (overload) and no loss in performance at a constant 2 A cm-2 (nominal load). Thus, reducing Ir use without compromising efficiency and lifetime.

Stroke prevention during and after transcatheter aortic valve implantation: From cerebral protection devices to antithrombotic management.

Since its conception, transcatheter aortic valve implantation (TAVI) has undergone important improvements both in the implantation technique and in transcatheter devices, allowing an enthusiastic adoption of this therapeutic approach in a wide population of patients previously without a surgical option and managed conservatively. Nowadays, patients with severe symptomatic aortic stenosis are typically managed with TAVI, regardless of their risk to surgery, improving the prognosis of patients and thus achieving an exponential global expansion of its use. However, thromboembolic and hemorrhagic complications remain a latent concern in TAVI recipients. Both complications can appear simultaneously in the periprocedural period or during the follow-up, and when minor, they resolved without apparent sequelae, but in a relevant percentage of cases, they are devastating, overshadowing the benefit achieved with TAVI. Our review outlines the etiology and incidence of thromboembolic complications associated with TAVI, the main current strategies for their prevention, and the implications of its pharmacological management at the follow-up in a TAVI population, mostly frail and predisposed to bleeding complications.

Reduced Thermal Conductivity in Nanostructured AgSbTe2 Thermoelectric Material, Obtained by Arc-Melting.

AgSbTe2 intermetallic compound is a promising thermoelectric material. It has also been described as necessary to obtain LAST and TAGS alloys, some of the best performing thermoelectrics of the last decades. Due to the random location of Ag and Sb atoms in the crystal structure, the electronic structure is highly influenced by the atomic ordering of these atoms and makes the accurate determination of the Ag/Sb occupancy of paramount importance. We report on the synthesis of polycrystalline AgSbTe2 by arc-melting, yielding nanostructured dense pellets. SEM images show a conspicuous layered nanostructuration, with a layer thickness of 25-30 nm. Neutron powder diffraction data show that AgSbTe2 crystalizes in the cubic Pm-3m space group, with a slight deficiency of Te, probably due to volatilization during the arc-melting process. The transport properties show some anomalies at ~600 K, which can be related to the onset temperature for atomic ordering. The average thermoelectric figure of merit remains around ~0.6 from ~550 up to ~680 K.

Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: A review.

Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) because of papillary muscle dysfunction or rupture. Severe acute MR in this scenario is a life-threatening complication associated with hemodynamic instability and pulmonary edema, and has been linked to a worse prognosis even after reperfusion. Patients treated solely with medical therapy have the highest mortality rates. Surgery has been the only treatment strategy until recently, but the results of the technique are hindered by high rates of morbidity and mortality. Therefore, the development of less invasive interventions for correcting MR would be ideal. We aimed to review the current role of transcatheter interventions in this clinical setting.

[Analysis of vaccination strategy against COVID-19 in Spain. The scientific basics (may 2022).] / Análisis de las estrategias de vacunación frente a la COVID-19 en España y las bases científicas sobre las que se han sustentado (mayo 2022).

After about a year and a half (at the moment these lines are being written) since the start of the massive vaccination campaign in which, thanks to the high coverage achieved in all groups eligible for vaccination, it has been possible to significantly reduce the morbidity and mortality due to COVID-19, it is important to review the scientific basics that have supported the recommendations implemented to date and those that could be adopted in the near future taking into consideration the epidemiological situation. The objective of this article is, therefore, to address the foundations of some of the technical decisions proposed by the Committee on Programme and Registry of Vaccinations (National Immunization Technical Advisory Group in Spain) and the Technical Working Group on Vaccination against COVID-19. Throughout the eleven updates of the Vaccination Strategy against COVID-19 in Spain, several issues pose intense debate as the vaccination intervals between doses, the convenience of using different types of vaccines, the use of heterologous schemes of vaccination, the benefits of hybrid immunity and the use of a fourth dose (second booster dose) for selected populations. All this without forgetting essential aspects of safety of vaccines. This article is divided into the following sections: Vaccination intervals; Heterologous or mixed scheme; Hybrid immunity (vaccination after infection and infection after vaccination [breakthrough]); Second booster dose.

Una vez transcurrido alrededor de un año y medio (en el momento de escribir estas líneas) desde el inicio de la campaña masiva de vacunación en la que, gracias a las altas coberturas alcanzadas en todos los grupos diana para vacunación, se ha conseguido reducir de manera muy significativa la morbimortalidad por la COVID-19, es importante revisar las bases científicas que han sustentado las recomendaciones implantadas hasta la fecha y aquellas que podrían adoptarse en un futuro próximo según la situación epidemiológica. El objetivo del presente artículo fue, por tanto, abordar los fundamentos de algunas de las decisiones técnicas propuestas desde la Ponencia de Programa y Registro de Vacunaciones y el Grupo de Trabajo Técnico de Vacunación frente a la COVID-19. A lo largo de once actualizaciones de la Estrategia de Vacunación frente a la COVID-19 en España, han sido objeto de intenso debate varias cuestiones relativas a los intervalos de vacunación entre dosis, la conveniencia del uso de diferentes tipos de vacunas, las combinaciones de las mismas, los beneficios de la inmunidad híbrida y el uso de una cuarta dosis (segunda dosis de recuerdo) para poblaciones seleccionadas. Todo ello sin olvidar aspectos esenciales de su seguridad. Este artículo se divide en los siguientes apartados: Intervalos de vacunación; Pauta heteróloga o mixta; Inmunidad híbrida (vacunación tras la infección e infección tras vacunación [breakthrough]); Segunda dosis de recuerdo.

Análisis de las estrategias de vacunación frente a la COVID-19 en España y las bases científicas sobre las que se han sustentado (mayo 2022) / Analysis of vaccination strategy against COVID-19 in Spain. The scientific basics (may 2022)

Una vez transcurrido alrededor de un año y medio (en el momento de escribir estas líneas) desde el inicio de la campaña masiva de vacunación en la que, gracias a las altas coberturas alcanzadas en todos los grupos diana para vacunación, se ha conseguido reducir de manera muy significativa la morbimortalidad por la COVID-19, es importante revisar las bases científicas que han sustentado las recomendaciones implantadas hasta la fecha y aquellas que podrían adoptarse en un futuro próximo según la situación epidemiológica. El objetivo del presente artículo fue, por tanto, abordar los fundamentos de algunas de las decisiones técnicas propuestas desde la Ponencia de Programa y Registro de Vacunaciones y el Grupo de Trabajo Técnico de Vacunación frente a la COVID-19. A lo largo de once actualizaciones de la Estrategia de Vacunación frente a la COVID-19 en España, han sido objeto de intenso debate varias cuestiones relativas a los intervalos de vacunación entre dosis, la conveniencia del uso de diferentes tipos de vacunas, las combinaciones de las mismas, los beneficios de la inmunidad híbrida y el uso de una cuarta dosis (segunda dosis de recuerdo) para poblaciones seleccionadas. Todo ello sin olvidar aspectos esenciales de su seguridad. Este artículo se divide en los siguientes apartados: Intervalos de vacunación; Pauta heteróloga o mixta; Inmunidad híbrida (vacunación tras la infección e infección tras vacunación [breakthrough]); Segunda dosis de recuerdo.(AU)

After about a year and a half (at the moment these lines are being written) since the start of the massive vaccination campaign in which, thanks to the high coverage achieved in all groups eligible for vaccination, it has been possible to significantly reduce the morbidity and mortality due to COVID-19, it is important to review the scientific basics that have supported the recommendations implemented to date and those that could be adopted in the near future taking into consideration the epidemiological situation. The objective of this article is, therefore, to address the foundations of some of the technical decisions proposed by the Committee on Programme and Registry of Vaccinations (National Immunization Technical Advisory Group in Spain) and the Technical Working Group on Vaccination against COVID-19. Throughout the eleven updates of the Vaccination Strategy against COVID-19 in Spain, several issues pose intense debate as the vaccination intervals between doses, the convenience of using different types of vaccines, the use of heterologous schemes of vaccination, the benefits of hybrid immunity and the use of a fourth dose (second booster dose) for selected populations. All this without forgetting essential aspects of safety of vaccines. This article is divided into the following sections: Vaccination intervals; Heterologous or mixed scheme; Hybrid immunity (vaccination after infection and infection after vaccination[breakthrough]); Second booster dose.(AU)

Contact pathway in surgical and transcatheter aortic valve replacement.

Background: Aortic valve replacement is the gold standard treatment for severe symptomatic aortic stenosis, but thrombosis of bioprosthetic valves (PVT) remains a concern. Objective: To analyze the factors involved in the contact pathway during aortic valve replacement and to assess their impact on the development of thromboembolic complications. Methods: The study was conducted in 232 consecutive patients who underwent: transcatheter aortic valve replacement (TAVR, N = 155), and surgical valve replacement (SAVR, N = 77) (MUVITAVI project). Demographic and clinical data, outcomes including a combined end point (CEP) of thrombotic events, and imaging controls were recruited. Samples were collected 24 h before and 48 h after valve replacement. FXII, FXI and (pre)kallikrein were evaluated by Western Blot and specific ELISA with nanobodies. Results: The CEP of thrombotic events was reached by 19 patients: 13 patients presented systemic embolic events and 6 patients subclinical PVT. Valve replacement did not cause FXII activation or generation of kallikrein. There was a significant reduction of FXI levels associated with the procedure, which was statistically more pronounced in SAVR than in TAVR. Cases with reductions of FXI below 80% of basal values had a lower incidence of embolic events during the procedure than patients in whom FXI increased above 150%: 2.7 vs. 16.7%; p: 0.04. Conclusion: TAVR or SAVR did not significantly activate the contact pathway. A significant reduction of FXI, was observed, particularly in SAVR, associated with lower incidence of thrombotic events. These results encourage evaluating the usefulness and safety of FXI-directed antithrombotic treatments in these patients.

Clinical Features and Long-Term Outcomes in Very Young Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries.

Background: The main cause of acute coronary syndrome (ACS) is coronary artery obstruction due to atherosclerotic plaque growth or thrombus formation secondary to plaque rupture or erosion. However, there is a subgroup of patients with signs and symptoms suggestive of ACS but without relevant coronary artery obstruction on coronary angiography. This population is defined as myocardial infarction with non-obstructive coronary arteries (MINOCA). The present study analyzes the clinical features and outcomes of very young patients with a diagnosis of MINOCA. Method: Nested case-control study of ≤40-year-old patients referred for coronary angiography due to clinical suspicion of ACS. Patients were divided into three groups: patients with obstructive coronary artery disease (CAD), patients diagnosed with MINOCA, and controls with non-coronary artery disease. Results: Of 19,321 coronary angiographies performed in our center in a period of 10 years, 408 (2.1%) were in patients ≤40 years old, and MINOCA was identified in 32 (21%) patients. The cardiovascular risk factors for obstructive CAD and MINOCA were very similar. The incidence of major adverse cardiovascular events (MACE) at follow-up was significantly higher in the MINOCA (HR 4.13 (95%CI 1.22-13.89) and obstructive CAD (HR 4.59 (95%CI 1.90-10.99) patients compared to controls. Cocaine use HR 14.58 (95%CI 3.08-69.02), family history of CAD HR 6.20 (95%CI 1.40-27.43), and depression HR 5.16 (95%CI 1.06-25.24) were associated with a poor outcome in the MINOCA population. Conclusion: Very young patients with MINOCA had a poor prognosis at long-term follow-up, similar to patients with obstructive CAD. Focusing efforts on secondary prevention is essential in this population.