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1.
Clin Transplant ; 38(7): e15401, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39023081

RESUMEN

BACKGROUND: The use of glucagon-like-peptide 1 receptor agonists (GLP1-RA) has dramatically increased over the past 5 years for diabetes mellitus type 2 (T2DM) and obesity. These comorbidities are prevalent in adult heart transplant (HT) recipients. However, there are limited data evaluating the efficacy of this drug class in this population. The aim of the current study was to describe cardiometabolic changes in HT recipients prescribed GLP1-RA at a large-volume transplant center. METHODS: We retrospectively reviewed all adult HT recipients who received GLP1-RA after HT for a minimum of 1-month. Cardiometabolic parameters including body mass index (BMI), lipid panel, hemoglobin A1C, estimated glomerular filtration rate (eGFR), and NT-proBNP were compared prior to initiation of the drug and at most recent follow-up. We also evaluated for significant dose adjustments to immunosuppression after drug initiation and adverse effects leading to drug discontinuation. RESULTS: Seventy-four patients were included (28% female, 53% White, 20% Hispanic) and followed for a median of 383 days [IQR 209, 613] on a GLP1-RA. The majority of patients (n = 56, 76%) were prescribed semaglutide. The most common indication for prescription was T2DM alone (n = 33, 45%), followed by combined T2DM and obesity (n = 26, 35%). At most recent follow-up, mean BMI decreased from 33.3 to 31.5 kg/m2 (p < 0.0001), HbA1C from 7.3% to 6.7% (p = 0.005), LDL from 78.6 to 70.3 mg/dL (p = 0.018) and basal insulin daily dose from 32.6 to 24.8 units (p = 0.0002). CONCLUSION: HT recipients prescribed GLP1-RA therapy showed improved glycemic control, weight loss, and cholesterol levels during the study follow-up period. GLP1-RA were well tolerated and were rarely associated with changes in immunosuppression dosing.


Asunto(s)
Receptor del Péptido 1 Similar al Glucagón , Trasplante de Corazón , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Receptor del Péptido 1 Similar al Glucagón/agonistas , Trasplante de Corazón/efectos adversos , Estudios de Seguimiento , Pronóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Tasa de Filtración Glomerular , Hipoglucemiantes/uso terapéutico , Pruebas de Función Renal , Adulto , Complicaciones Posoperatorias/tratamiento farmacológico , Rechazo de Injerto/etiología , Rechazo de Injerto/prevención & control , Rechazo de Injerto/tratamiento farmacológico , Agonistas Receptor de Péptidos Similares al Glucagón
2.
Artículo en Inglés | MEDLINE | ID: mdl-39023496

RESUMEN

OBJECTIVE: The HeartMate 3 survival risk score was recently validated in the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 to predict patient-specific survival in HeartMate 3 left ventricular assist device candidates. The HeartMate 3 survival risk score stratifies individuals into tertiles according to survival probability. METHODS: We performed a single-center retrospective review of all HeartMate 3 left ventricular assist device recipients between September 2017 and August 2022. Baseline characteristics were collected from the electronic medical records. HeartMate 3 survival risk scores were calculated for all eligible patients. One- and 2-year Kaplan-Meier survival analyses were conducted. A univariate and multivariable Cox regression model was used to identify predictors. RESULTS: A total of 181 patients were included in this final analysis. The median age was 62 years, 83% were male, and 26% were Interagency Registry for Mechanically Assisted Circulatory Support Profile 1. The mean HeartMate 3 survival risk score for the entire cohort was 2.66 ± 0.66. Two-year survivals in the high, average, and low survival groups were 93.5% ± 3.2%, 81.6% ± 7.4%, and 82.0% ± 6.6%, respectively. As a continuous variable, the unadjusted HeartMate 3 survival risk score was a significant predictor of mortality (hazard ratio, 2.20; 95% CI, 1.08-4.45; P = .029). The areas under the curve were 0.70 and 0.66 at 1 and 2 years, respectively. We were unable to demonstrate the discriminatory ability of the HeartMate 3 survival risk score using the original stratification, but we found significantly increased survival in the high survival group using a binary cutoff (hazard ratio, 4.8; 95% CI, 1.01-20.9; P = .038). CONCLUSIONS: The unadjusted HeartMate 3 survival risk score was associated with postimplant survival in patients outside of the Multicenter study Of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 but did not remain an independent predictor after adjusting for ischemic etiology and severe diabetes. The HeartMate 3 survival risk score was able to identify patients at high survival using a binary cutoff, but we were unable to demonstrate its discriminatory ability among the previously published risk tertiles.

3.
Nanomaterials (Basel) ; 14(11)2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38869607

RESUMEN

Perfluorododecyl iodide (I-PFC12) is of interest for area-selective deposition (ASD) applications as it exhibits intriguing properties such as ultralow surface energy, the ability to modify silicon's band gap, low surface friction, and suitability for micro-contact patterning. Traditional photolithography is struggling to reach the required critical dimensions. This study investigates the potential of using I-PFC12 as a way to produce contrast between the growth area and non-growth areas of a surface subsequent to extreme ultraviolet (EUV) exposure. Once exposed to EUV, the I-PFC12 molecule should degrade with the help of the photocatalytic substrate, allowing for the subsequent selective deposition of the hard mask. The stability of a vapor-deposited I-PFC12 self-assembled monolayer (SAM) was examined when exposed to ambient light for extended periods of time by using X-ray photoelectron spectroscopy (XPS). Two substrates, SiO2 and TiO2, are investigated to ascertain the suitability of using TiO2 as a photocatalytic active substrate. Following one month of exposure to light, the atomic concentrations showed a more substantial fluorine loss of 10.2% on the TiO2 in comparison to a 6.2% loss on the SiO2 substrate. This more pronounced defluorination seen on the TiO2 is attributed to its photocatalytic nature. Interestingly, different routes to degradation were observed for each substrate. Reference samples preserved in dark conditions with no light exposure for up to three months show little degradation on the SiO2 substrate, while no change is observed on the TiO2 substrate. The results reveal that the I-PFC12 SAM is an ideal candidate for resistless EUV lithography.

4.
ACS Appl Mater Interfaces ; 16(23): 30485-30495, 2024 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-38815005

RESUMEN

Two dimensional (2D) imine-based covalent organic framework (COF), 2D-COF, is a newly emerging molecular 2D polymer with potential applications in thin film electronics, sensing, and catalysis. It is considered an ideal candidate due to its robust 2D nature and precise tunability of the electronic and functional properties. Herein, we report a scalable facile synthesis of 2D imine-COF with control over film thickness (ranging from 100 nm to a few monolayers) and film dimension reaching up to 2 cm on a dielectric (glass) substrate. Highly crystalline 2D imine polymer films are formed by maintaining a quasi-equilibrium (very slow, ∼15 h) in Schiff base condensation reaction between p-phenylenediamine (PDA) and benzene-1,3,5-tricarboxaldehyde (TCA) molecules. Free-standing thin and ultrathin films of imine-COF are obtained using sonication exfoliation of 2D-COF polymer. Insights into the microstructure of thin/ultrathin imine-COF are obtained using scanning and transmission electron microscopy (SEM and TEM) and atomic force microscopy (AFM), which shows high crystallinity and 2D layered structure in both thin and ultrathin films. The chemical nature of the 2D polymer was established using X-ray photoelectron spectroscopy (XPS). Optical band gap measurements also reveal a semiconducting gap. This is further established by electronic structure calculation using density functional theory (DFT), which reveals a semiconductor-like band structure with strong dispersion in bands near conduction and valence band edges. The structural characteristics (layered morphology and microscopic structure) of 2D imine-COF show significant potential for its application in thin film device fabrication. In addition, the electronic structure shows strong dispersion in the frontier bands, making it a potential semiconducting material for charge carrier transportation in electronic devices.

5.
ACS Appl Mater Interfaces ; 16(10): 12437-12445, 2024 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-38436945

RESUMEN

Rising global energy demand, accompanied by environmental concerns linked to conventional fossil fuels, necessitates a shift toward cleaner and sustainable alternatives. This study focuses on the machine-learning (ML)-driven high-throughput screening of transition-metal (TM) atom intercalated g-C3N4/MX2 (M = Mo, W; X = S, Se, Te) heterostructures to unravel the rich landscape of possibilities for enhancing the hydrogen evolution reaction (HER) activity. The stability of the heterostructures and the intercalation within the substrates are verified through adhesion and binding energies, showcasing the significant impact of chalcogenide selection on the interaction properties. Based on hydrogen adsorption Gibbs free energy (ΔGH) computed via density functional theory (DFT) calculations, several ML models were evaluated, particularly random forest regression (RFR) emerges as a robust tool in predicting HER activity with a low mean absolute error (MAE) of 0.118 eV, thereby paving the way for accelerated catalyst screening. The Shapley Additive exPlanation (SHAP) analysis elucidates pivotal descriptors that influence the HER activity, including hydrogen adsorption on the C site (HC), MX layer (HMX), S site (HS), and intercalation of TM atoms at the N site (IN). Overall, our integrated approach utilizing DFT and ML effectively identifies hydrogen adsorption on the N site (site-3) of g-C3N4 as a pivotal active site, showcasing exceptional HER activity in heterostructures intercalated with Sc and Ti, underscoring their potential for advancing catalytic performance.

6.
Clin Transplant ; 38(3): e15251, 2024 03.
Artículo en Inglés | MEDLINE | ID: mdl-38504576

RESUMEN

BACKGROUND: Belatacept (BTC), a fusion protein, selectively inhibits T-cell co-stimulation by binding to the CD80 and CD86 receptors on antigen-presenting cells (APCs) and has been used as immunosuppression in adult renal transplant recipients. However, data regarding its use in heart transplant (HT) recipients are limited. This retrospective cohort study aimed to delineate BTC's application in HT, focusing on efficacy, safety, and associated complications at a high-volume HT center. METHODS: A retrospective cohort study was conducted of patients who underwent HT between January 2017 and December 2021 and subsequently received BTC as part of their immunosuppressive regimen. Twenty-one HT recipients were identified. Baseline characteristics, history of rejection, and indication for BTC use were collected. Outcomes included renal function, graft function, allograft rejection and mortality. Follow-up data were collected through December 2023. RESULTS: Among 776 patients monitored from January 2017 to December 2021 21 (2.7%) received BTC treatment. Average age at transplantation was 53 years (± 12 years), and 38% were women. BTC administration began, on average, 689 [483, 1830] days post-HT. The primary indications for BTC were elevated pre-formed donor-specific antibodies in highly sensitized patients (66.6%) and renal sparing (23.8%), in conjunction with reduced calcineurin inhibitor dosage. Only one (4.8%) patient encountered rejection within a year of starting BTC. Graft function by echocardiography remained stable at 6 and 12 months posttreatment. An improvement was observed in serum creatinine levels (76.2% of patients), decreasing from a median of 1.58 to 1.45 (IQR [1.0-2.1] to [1.1-1.9]) over 12 months (p = .054). eGFR improved at 3 and 6 months compared with 3 months pre- BTC levels; however, this was not statistically significant (p = .24). Treatment discontinuation occurred in seven patients (33.3%) of whom four (19%) were switched back to full dose CNI. Infections occurred in 11 patients (52.4%), leading to BTC discontinuation in 4 patients (19%). CONCLUSION: In this cohort, BTC therapy was used as alternative immunosuppression for management of highly sensitized patients or for renal sparing. BTC therapy when combined with CNI dose reduction resulted in stabilization in renal function as measured through renal surrogate markers, which did not, however, reach statistical significance. Patients on BTC maintained a low rejection rate and preserved graft function. Infections were common during BTC therapy and were associated with medication pause/discontinuation in 19% of patients. Further randomized studies are needed to assess the efficacy and safety of BTC in HT recipients.


Asunto(s)
Trasplante de Corazón , Trasplante de Riñón , Adulto , Humanos , Femenino , Persona de Mediana Edad , Masculino , Abatacept , Estudios Retrospectivos , Trasplante de Riñón/efectos adversos , Inmunosupresores , Inhibidores de la Calcineurina/uso terapéutico , Linfocitos T , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/etiología , Receptores de Trasplantes , Supervivencia de Injerto
7.
Cureus ; 16(1): e51727, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38318587

RESUMEN

Background Cancer of the oral cavity is very common in Eastern India. This is due to the lack of awareness that chewing tobacco causes oral cancer. Because of poor economic condition and lack of access to healthcare, patients in this region often present at an advanced stage of the disease when they become symptomatic. A retrospective study was conducted at Tata Main Hospital, Jamshedpur, India, to know the epidemiology and recurrence of oral cavity cancer in this region. Materials and methods We conducted a retrospective study of oral cavity cancer patients operated at Tata Main Hospital, Jamshedpur, from January 2018 to June 2023. Data were collected from the surgical register, operation theatre notes, case sheets and hospital online data. The following parameters were observed in this study: a) age, b) gender, c) site of cancer, d) histology, e) stage of disease at presentation, f) type of neck dissection, g) margin status on the final histopathology report, h) node positivity, i) presence of perineural invasion or lymphovascular invasion and j) recurrence.  Results A total of 218 patients were operated between January 2018 and June 2023. The most common site for oral cavity cancer was the buccal mucosa with the involvement of the lower alveolus (168 patients, 77.06%), followed by the tongue (27 patients, 12.38%). Two-hundred seventeen patients were diagnosed with squamous cell carcinoma (SCC), and one patient had epithelioid sarcoma on the biopsy report. The most common stage of presentation was stage IVa (180 patients, 82.56%), followed by stage III (16 patients, 7.34%). The most frequent neck dissection performed was modified radical neck dissection (MRND) sacrificing the sternocleidomastoid muscle (SCM) and preserving the internal juglar vein (IJV) and spinal accessory nerve (SAN) (176 patients, 80%). The margin was positive for 10 patients. Node positivity on the final histopathology report grouped according to the clinical stage are as follows: stage I (33.33%), stage II (60%), stage III (75%) and stage IV (86.67%). Similarly, the presence of lymphovascular or perineural invasion on the final histopathology report grouped according to the clinical stage is as follows: stage I (0%), stage II (20%), stage III (25%) and stage IV (55.55 %). Fifteen patients lost to follow-up. Recurrence was noted in 11 patients (5.04%). Patients presenting with stages I and II had no recurrence, whereas three out of 16 patients in stage III (1.1%) and eight out of 180 patients in stage IV (4.44%) had recurrence. Conclusion SCC is the most common type of oral cavity cancer in Eastern India. It is strongly related to tobacco chewing habit. Since most of the patients in this part of the country present with an advanced stage of the disease, awareness regarding cessation of tobacco use and screening can be beneficial to the general population.

8.
ASAIO J ; 2024 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-38373176

RESUMEN

In patients supported by the HeartMate 3 left ventricular assist device (HM3 LVAD), pump speed adjustments may improve hemodynamics. We investigated the hemodynamic implications of speed adjustments in HM3 recipients undergoing hemodynamic ramp tests. Clinically stable HM3 recipients who underwent routine invasive hemodynamic ramp tests between 2015 and 2022 at our center were included. Filling pressure optimization, defined as central venous pressure (CVP) <12 mm Hg and pulmonary capillary wedge pressure (PCWP) <18 mm Hg, was assessed at baseline and final pump speeds. Patients with optimized pressures were compared to nonoptimized patients. Overall 60 HM3 recipients with a median age of 62 years (56, 71) and time from LVAD implantation of 187 days (124, 476) were included. Optimized filling pressures were found in 35 patients (58%) at baseline speed. Speed was adjusted in 84% of the nonoptimized patients. Consequently, 39 patients (65%) had optimized pressures at final speed. There were no significant differences in hemodynamic findings between baseline and final speeds (p > 0.05 for all). Six and 12 month readmission-free rates were higher in optimized compared with nonoptimized patients (p = 0.03 for both), predominantly due to lower cardiac readmission-free rates (p = 0.052). In stable outpatients supported with HM3 who underwent routine ramp tests, optimized hemodynamics were achieved in only 2 of 3 of the patients. Patients with optimized pressures had lower all-cause readmission rates, primarily driven by fewer cardiac-related hospitalizations.

9.
ACS Appl Mater Interfaces ; 16(6): 6971-6987, 2024 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-38289235

RESUMEN

Cryogenic distillation, a currently employed method for C2H4/C2H6 and C3H6/C3H8 mixture separation, is energy-intensive, prompting the research toward alternative technologies, including adsorbent-based separation. In this work, we combine machine learning (ML) technique with high-throughput screening to screen ∼23,000 hypothetical metal-organic frameworks (MOFs) for paraffin (C2H6 and C3H8) selective adsorbent separation. First, structure-based prescreening was employed to remove MOFs with undesired geometric properties. Further, a random forest model built upon the multicomponent grand canonical Monte Carlo (m-GCMC) simulation data of training set MOFs was found to be the most successful in learning the relationship between MOF features and olefin/paraffin mixture separation. Using this technique, the separation performance of the remaining (test set) MOFs was predicted, and the top-performing MOFs were identified. We also employed active learning (AL) to evaluate its effectiveness in improving the prediction of olefin/paraffin selectivity. AL was discovered to be ∼29 times more efficient than the best-supervised ML model, as it was able to identify the top materials in limited training data and at a fraction of computational cost and time as compared to ML techniques. Among the top selected materials, framework chemistry was found to be the most important parameter. Nickel and copper (as a metal node) in a tfzd and hms topological arrangement respectively, were discovered to be a prevalent attribute in high-performing MOFs, further demonstrating the prominent significance of framework chemistry. Additionally, the top MOFs discovered were studied in detail and further compared to the previously reported MOFs. These MOFs show the highest selectivity for C2H4/C2H6 and C3H6/C3H8 mixture separation, as reported until date. The hierarchical strategy devised in this study will facilitate the quick screening of MOFs across multiple databases toward industrially significant separation processes by leveraging molecular simulations and AL.

10.
J Card Fail ; 30(1): 95-99, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37625582

RESUMEN

BACKGROUND: Aortic regurgitation (AR) is a common complication following left ventricular assist device (LVAD) implantation. We evaluated the hemodynamic implications of AR in patients with HeartMate 3 (HM3) LVAD at baseline and in response to speed changes. METHODS AND RESULTS: Clinically stable outpatients supported by HM3 who underwent a routine hemodynamic ramp test were retrospectively enrolled in this analysis. Patients were stratified based on the presence of at least mild AR at baseline speed. Hemodynamic and echocardiographic parameters were compared between the AR and non-AR groups. Sixty-two patients were identified. At the baseline LVAD speed, 29 patients (47%) had AR, while 33 patients (53%) did not. Patients with AR were older and supported on HM3 for a longer duration. At baseline speed, all hemodynamic parameters were similar between the groups including central venous pressure, pulmonary capillary wedge pressure, pulmonary arterial pressures, cardiac output and index, and pulmonary artery pulsatility index (p > 0.05 for all). During the subacute assessment, AR worsened in some, but not all, patients, with increases in LVAD speed. There were no significant differences in 1-year mortality or hospitalization rates between the groups, however, at 1-year, ≥ moderate AR and right ventricular failure (RVF) were detected in higher rates among the AR group compared to the non-AR group (45% vs. 0%; p < 0.01, and 75% vs. 36.8%; p = 0.02, respectively). CONCLUSIONS: In a cohort of stable outpatients supported with HM3 who underwent a routine hemodynamic ramp test, the presence of mild or greater AR did not impact the ability of HM3 LVADs to effectively unload the left ventricle during early subacute assessment. Although the presence of AR did not affect mortality and hospitalization rates, it resulted in higher rates of late hemodynamic-related events in the form of progressive AR and RVF.


Asunto(s)
Insuficiencia de la Válvula Aórtica , Insuficiencia Cardíaca , Corazón Auxiliar , Humanos , Estudios Retrospectivos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/efectos adversos , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/etiología , Hemodinámica/fisiología
11.
Ann Med Surg (Lond) ; 85(12): 6144-6147, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38098606

RESUMEN

Introduction and importance: Foreign body ingestion leading to luminal obstruction in both the small and large bowels is rare, especially in children. The authors present a case of a 7-year-old patient who presented with a small bowel obstruction caused by an ingested radiolucent foreign body. The previous herniotomy surgery 1 year back led to initial diagnostic confusion, highlighting the need for a broad differential diagnosis. Case presentation: A 7-year-old child with a history of herniotomy presented with symptoms of small bowel obstruction. Radiological imaging revealed a soft tissue mass mimicking a polyp or cystic lesion. During exploratory laparotomy, a cystic structure was discovered in the terminal ileum. The foreign body, identified as a fluid-filled balloon, was inaccessible to endoscopy and was gently maneuvered into the ascending colon. It was punctured and removed during on-table colonoscopy. Clinical discussion: This case underscores the challenges of diagnosing and managing luminal obstruction caused by radiolucent foreign bodies in children. The presence of previous surgery can mislead clinicians, necessitating a broad differential diagnosis. Radiological imaging played a crucial role in identifying the foreign body. Surgical intervention guided by an on-table colonoscopy allowed successful removal. Conclusion: Foreign body ingestion leading to luminal obstruction should be considered, even in cases with previous abdominal surgery. Radiological imaging aids in identification, and timely surgical intervention, guided by on-table colonoscopy, facilitates foreign body removal. Awareness of such cases is essential for optimal care in pediatric patients with luminal obstruction caused by foreign body ingestion.

12.
ASAIO J ; 2023 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-37934714

RESUMEN

This review discusses the challenges and outcomes associated with pregnancy during left ventricular assist device (LVAD) support. Women account for a third of the heart failure population in the United States. Left ventricular assist devices have emerged as a safe and effective treatment option for patients with advanced heart failure. Pregnancy during LVAD support can occur, and it presents significant risks to both mother and fetus, including hemodynamic stress, thrombotic events, medication-associated teratogenicity, and uterine impingement. This literature review identified 10 cases of confirmed pregnancy during LVAD support, of which eight resulted in successful births. Maternal and fetal mortality occurred in one case, and there was a spontaneous abortion in one case. The review highlights the importance of a multidisciplinary approach, promotion of shared decision-making, thoughtful anticoagulation, adjustment of LVAD speed, and medication optimization to maintain hemodynamic support during pregnancy. Hemodynamic changes during pregnancy include increased cardiac output, heart rate, and plasma volume, as well as decreased systemic vascular resistance, which can impact LVAD support. Despite reduced pulsatility in LVAD-supported patients, ovulation and reproductive capacity might be preserved, and viable pregnancies may be achieved with appropriate management. The review provides insights into the risks and considerations for a viable pregnancy during LVAD support, including the need for ongoing research to inform joined decision-making.

13.
Clin Transplant ; 37(12): e15131, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37897211

RESUMEN

INTRODUCTION: Monitoring for graft rejection is a fundamental tenet of post-transplant follow-up. In heart transplantation (HT) in particular, rejection has been traditionally assessed with endomyocardial biopsy (EMB). EMB has potential complications and noted limitations, including interobserver variability in interpretation. Additional tests, such as basic cardiac biomarkers, cardiac imaging, gene expression profiling (GEP) scores, donor-derived cell-free DNA (dd-cfDNA) and the novel molecular microscope diagnostic system (MMDx) have become critical tools in rejection surveillance beyond standard EMB. METHODS: This paper describes an illustrative case followed by a review of MMDx within the context of other noninvasive screening modalities for rejection. CONCLUSIONS: We suggest MMDx be used to assist with early detection of rejection in cases of discordance between EMB and other noninvasive studies.


Asunto(s)
Trasplante de Corazón , Miocardio , Humanos , Miocardio/patología , Trasplante de Corazón/efectos adversos , Biopsia , Perfilación de la Expresión Génica , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/etiología , Rechazo de Injerto/epidemiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-37739242

RESUMEN

BACKGROUND: Aortic root thrombosis(ART) is a complication of continuous-flow left ventricular assist device therapy. However, the incidence and related complications of ART in HeartMate 3 (HM3) patients remain unknown. METHODS: Patients who underwent HM3 implantation from November 2014 to August 2020 at a quaternary academic medical center were included. Demographics and outcomes were abstracted from the medical record. Echocardiograms and contrast-enhanced computed tomography studies were reviewed to identify patients who developed ART and/or moderate or greater aortic insufficiency (AI) on HM3 support. RESULTS: The study cohort included 197 HM3 patients with a median postimplant follow-up of 17.5 months. Nineteen patients (9.6%) developed ART during HM3 support, and 15 patients (7.6%) developed moderate or greater AI. Baseline age, gender, race, implantation strategy, and INTERMACS classification were similar between the ART and no-ART groups. ART was associated with an increased risk of death, stroke, or aortic valve (AV) intervention (subhazard ratio [SHR] 3.60 [95% confidence interval (CI) 1.71-7.56]; p = 0.001) and moderate or greater AI (SHR 11.1 [CI 3.60-34.1]; p < 0.001) but was not associated with a statistically significantly increased risk of death or stroke on HM3 support (2.12 [0.86-5.22]; p = 0.10). Of the 19 patients with ART, 6 (31.6%) developed moderate or greater AI, necessitating more frequent AV interventions (ART: 5 AV interventions [3 surgical repairs, 1 surgical replacement, 1 transcatheter replacement; 26.3%]; no-ART: 0). CONCLUSIONS: Nearly 10% of HM3 patients developed ART during device support. ART was associated with increased risk of a composite end-point of death, stroke, or AV intervention as well as moderate or greater AI.

15.
Soft Matter ; 19(39): 7570-7579, 2023 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-37751160

RESUMEN

This work investigates the freezing-induced self-assembly (FISA) of polyvinyl alcohol (PVA) and PVA-like polymers using molecular dynamics simulations. In particular, the effect of the degree of supercooling, degree of polymerization, polymer type, and initial local concentration on the FISA was studied. It was found that the preeminent factor responsible for FISA is not the diffusion of the polymers away from the nucleating ice front, but the increase in the polymer's local concentration upon freezing of the solvent (water). At a higher degree of supercooling, the polymers are engulfed by the growing ice front, impeding their diffusion into the supercooled solution and finally inhibiting their self-assembly. Conversely, at a relatively lower degree of supercooling, the rate of diffusion of the polymers into the supercooled solution is higher, which increases their local concentration and results in FISA. FISA was also observed to depend on the polymer-solvent interactions. Strongly favorable solute-solvent interactions hinder the self-assembly, whereas unfavorable solute-solvent interactions promote the self-assembly. The polymer and aggregate morphology were investigated using the radius of gyration, end-to-end distance, and asphericity analysis. This study brings molecular insights into the quintessential factors governing self-assembly via freezing of the solvent, which is a novel self-assembly technique especially suitable for biomedical applications.

16.
Phys Chem Chem Phys ; 25(32): 21528-21537, 2023 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-37545252

RESUMEN

Understanding the nucleation of homogeneous flow systems at high pressures is vital in protein crystallization and cryopreservation, where high pressure prevents the freezing of biological samples. This study examines the behavior of ice nucleation under shear at various pressures and explores the universal nucleation behavior of the sheared systems applied to supercooled water at higher pressures. In this study, the nucleation rates for the TIP4P/Ice model via a seeding method based on extended classical nucleation theory (CNT) are computed at pressures of 1, 100, 500, 700, and 1000 bar and a constant temperature of 240 K. Using extended CNT with explicitly embodying the shear rate, we analyzed the dependence of pressure on the transport and thermodynamic properties. In line with previous studies, we observed that Δµliq-ice and viscosity decrease while diffusivity increases with an increase in pressure. Furthermore, we showed that the dependence of the nucleation rate on shear at higher pressure is non-monotonic, with the maximum at optimal shear rates between 107 and 108 s-1. Our results demonstrate a non-monotonic pressure dependence of the optimal shear rates, which could originate from a violation of the Stokes-Einstein relation.

17.
Dalton Trans ; 52(34): 11886-11896, 2023 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-37561075

RESUMEN

Designing metal-organic framework (MOF)-based solid nanoparticles to stabilize Pickering emulsions by fine-tuning their hydrophobicity and lipophobicity is vital for essential applications and fundamental understanding. We demonstrate in situ grafting of palmitic acid in UiO-66 MOF through its linker defects. Our designed and activated nanoparticles (denoted as UP') stabilized the Pickering emulsions of n-heptane-in-water. Furthermore, we showed how UP' stabilized emulsion droplets disperse in media by covering each tiny droplet with a nanoscale layer made of UP'. To support our claim, we carried out the freeze-drying process to remove the liquid part from the emulsion, leaving behind the solid shell-like microstructures that we further characterized through several microscopic techniques. The stable n-heptane-in-water emulsion was confirmed by dilution (drop test), conductivity, zeta potential, and theoretical surface electrostatic potential measurements. Rheological studies indicate that the Pickering emulsions of n-heptane-in-water stabilized by UP' are much more resistant to deformation and flow imparting higher (mechanical) stability and shelf-life. Pickering emulsions stabilized by UP' emerged as a versatile way to design smart functional materials of UiO-66 through engineering linker defects that may have potential applications in interfacial catalysis, dye or contaminant separation, etc.

18.
Dalton Trans ; 52(33): 11621-11630, 2023 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-37551528

RESUMEN

A Zn(II)-based metal-organic framework (MOF) was synthesized by the self-assembly of the dicarboxylate ligand terephthalic acid (TPA), 2-aminoterephthalic acid (NH2-TPA) and N-donor auxiliary ligand 1,4-bis(4-pyridinylmethyl)piperazine (bpmp) using Zn(NO3)2·6H2O under hydrothermal conditions. {[Zn(TPA)0.5(NH2TPA)0.5(bpmp)]·DMF·7H2O}n (framework 1) has an sra topology with a BET surface area of 756 m2 g-1. The microporous nature of the framework is apparent from the significant CO2 adsorption capacities observed at various temperatures: 57 cc g-1 at 283 K, 46 cc g-1 at 293 K, 37 cc g-1 at 303 K, and 30 cc g-1 at 313 K. The considerable CO2 adsorption may be caused by the existence of free carboxylate and amine substituents that interact with the gas molecules and micropores. At room temperature, the activated MOF readily converts CO2 into cyclic carbonates when a suspension of the MOF is bubbled with ambient air and different epoxides under solvent-free conditions. The amine groups located within the pores of the MOF interact with CO2 molecules, enhancing their sorption and conversion to cyclic carbonates. However, due to interpenetration within framework 1, only smaller size epoxides can be accommodated and converted to cyclic carbonates in good yields. Additionally, the effectiveness of the catalyst is further confirmed by the positive outcomes obtained from the hot filtration control test. Grand canonical Monte Carlo (GCMC) molecular simulations were utilized to gain a better understanding of molecular interactions. GCMC results are in line with the experiments. The substantial adsorption of CO2 can be ascribed to the strong intermolecular interactions that occur between the amine groups within the framework and the CO2 molecules.

19.
J Chem Phys ; 159(4)2023 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-37493130

RESUMEN

Understanding the nucleation behavior of water in dilute polymeric solutions is quintessential for the development of suitable artificial ice recrystallization inhibition (IRI) agents. Although poly(vinyl alcohol) (PVA) is found to be one of the most potent biomimetic IRI agents, the molecular understanding of the nucleation behavior of water in the presence of PVA is still lacking. Here, we use molecular dynamics to elucidate the role of concentration, degree of supercooling, degree of polymerization, and amphiphilicity of PVA and PVA-like polymers on the homogeneous nucleation of water in dilute polymeric solutions using the seeding method. Using classical nucleation theory (CNT), our simulations indicate an increase in the chemical potential difference between ice and melt that favors ice nucleation. However, it also predicts a significant increase in the ice-melt interfacial energy that impedes nucleation. The relative increase in the interfacial energy dominates the increase in the chemical potential difference, which results in a decrease in the nucleation rate of water with an increase in the solute concentration. This study contradicts the previous simulation study that suggested the promotion of homogeneous ice nucleation by PVA and supports the experimental observations of the heterogeneous origins of ice nucleation. Our results also suggest the non-classical origins of ice nucleation in polymeric solutions and the limitation of the CNT in predicting heterogeneous ice nucleation in polymeric solutions.

20.
ACS Appl Mater Interfaces ; 15(25): 30117-30126, 2023 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-37334697

RESUMEN

Fusing high-throughput quantum mechanical screening techniques with modern artificial intelligence strategies is among the most fundamental ─yet revolutionary─ science activities, capable of opening new horizons in catalyst discovery. Here, we apply this strategy to the process of finding appropriate key descriptors for CO2 activation over two-dimensional transition metal (TM) carbides/nitrides (MXenes). Various machine learning (ML) models are developed to screen over 114 pure and defective MXenes, where the random forest regressor (RFR) ML scheme exhibits the best predictive performance for the CO2 adsorption energy, with a mean absolute error ± standard deviation of 0.16 ± 0.01 and 0.42 ± 0.06 eV for training and test data sets, respectively. Feature importance analysis revealed d-band center (εd), surface metal electronegativity (χM), and valence electron number of metal atoms (MV) as key descriptors for CO2 activation. These findings furnish a fundamental basis for designing novel MXene-based catalysts through the prediction of potential indicators for CO2 activation and their posterior usage.

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