Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach.

Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.

The Role of Autochthonous Levilactobacillus brevis B1 Starter Culture in Improving the Technological and Nutritional Quality of Cow's Milk Acid-Rennet Cheeses-Industrial Model Study.

In the study, an attempt was made to develop an innovative technology for cheese manufacturing. It was hypothesized that selected autochthonous lactic acid bacteria as a starter culture are more suitable for the production of acid-rennet cheeses of good technological and sensory quality. The study aimed to assess the possibility of using the strain Levilactobacillus brevis B1 (L. brevis B1) as a starter culture to produce acid-rennet cheeses using raw cow's milk. Two variants of cheese were manufactured. The control variant (R) was coagulated with microbial rennet and buttermilk, and the other variant (B1) was inoculated with rennet and L. brevis B1 starter culture. The effect of the addition of these autochthonous lactic acid bacteria on selected physicochemical characteristics, durability, the composition of fatty acids, cholesterol, Iipid Quality Indices, and microbiological and sensory quality of acid-rennet cheeses was determined during a 3-month period of storage. The dominant fatty acids observed in the tested cheeses were saturated fatty acids (SFA) (68.43-69.70%) and monounsaturated fatty acids (MUFA) (25.85-26.55%). Significantly higher polyunsaturated fatty acid (PUFA) content during storage was observed for B1 cheeses. The B1 cheeses were characterized by lower cholesterol content compared to cheese R and showed better indexes, including the Index of atherogenicity, Index of thrombogenicity, DFA, OFA, H/H, and HPI indexes, than the R cheese. No effect of the tested L. brevis B1 on sensory quality was observed in relation to the control cheeses during 3 months of storage. The results of the research indicate the possibility of using the L. brevis B1 strain for the production of high-quality, potentially probiotic acid-rennet cheeses.

Inclusion of functional measures and frailty in the development and evaluation of medicines for older adults.

The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) E7, the guidance for the conduct of clinical trials in people older than age 65 years, dates from 1994. Since then, the inclusion of older people in clinical trials has hardly improved, particularly for the oldest old age group (individuals older than age 75 years), which is the fastest growing demographic bracket in the EU. Even though most medications are taken by this group, relevant endpoints and safety outcomes for this cohort are rarely included and reported, both in clinical trials and regulatory approval documents. To improve the critical appraisal and the regulatory review of medicines taken by frail older adults, eight recommendations are presented and discussed in this Health Policy. These recommendations are brought together from different perspectives and experience of the treatment of older patients. On one side, the perspective of medical practitioners from various clinical disciplines, with their direct experience of clinical decision making; on the other, the perspective of regulators assessing the data submitted in medicine registration dossiers, their relevance to the risk-benefit balance for older patients, and the communication of the findings in the product information. Efforts to improve the participation of older people in clinical trials have been in place for more than a decade, with little success. The recommendations presented here are relevant for stakeholders, authorities, pharmaceutical companies, and researchers alike, as the implementation of these measures is not under the capacity of a single entity. Improving the inclusion of frail older adults requires awareness, focus, and action on the part of those who can effect a much needed change.

The Use of Apple Vinegar from Natural Fermentation in the Technology Production of Raw-Ripened Wild Boar Loins.

Wild boar meat is difficult to process, mainly due to its hardness and stringiness. Three types of raw-ripened wild boar loins were produced (C-control treatment, R1 and R2-treatments with the addition of apple vinegar in various production variants). The research aimed to develop a new innovative technology for the production of wild boar loin using apple vinegar for marinating and to determine the impact of apple vinegar on the microbiological and sensory quality, and physico-chemical parameters of the product. As part of the research, a technology for the production of ripened wild boar products was developed and the composition of fatty acids, cholesterol content, pH value, oxidation-reduction potential, thiobarbituric acid reactive substances (TBARS) index, color, microbiological, sensory, and statistical analysis were determined. It was found that the loins were characterized by a high content of saturated, monounsaturated, and polyunsaturated fatty acids (20.18-43.37%), a low content of trans fatty acids (0.30-0.57%), and a high cholesterol content (75.13-85.28 mg/100 g of the product). Samples with apple vinegar (R1 and R2) were characterized by a lower pH value (5.10-5.70; p < 0.05), a comparable oxidation-reduction potential (409.75-498.57 mV), and a low TBARS index (0.461-1.294 mg malondialdehyde/kg of product). Their color was lighter (L* 38.25-40.65). All the tested loins were characterized by appropriate microbiological quality guaranteeing the storage durability of the product. R1 and R2 treatments were characterized by the greatest juiciness. The highest overall quality was achieved by R1 loins (7.36-7.76 c.u.). The apple vinegar used to marinate the loins had a positive effect on their microbiological and sensory quality as well as physico-chemical parameters. Moreover, the technology guarantees the appropriate quality and health safety of the products.

Prognostic Relevance of the Lung Ultrasound Score: A Multioutcome Study in Infants with Respiratory Distress Syndrome.

OBJECTIVE: There is growing evidence for the usefulness of the lung ultrasound score (LUS) in neonatal intensive care. We evaluated whether the LUS is predictive of outcomes in infants with respiratory distress syndrome (RDS). STUDY DESIGN: Neonates less than 34 weeks of gestational age were eligible for this prospective, multicenter cohort study. The outcomes of interest were the need for mechanical ventilation (MV) at <72 hours of life, the need for surfactant (SF), successful weaning from continuous positive airway pressure (CPAP), extubation readiness, and bronchopulmonary dysplasia. Lung scans were taken at 0 to 6 hours of life (Day 1), on Days 2, 3, and 7, and before CPAP withdrawal or extubation. Sonograms were scored (range 0-16) by a blinded expert sonographer. The area under the receiver operating characteristic curve (AUC) was used to estimate the prediction accuracy of the LUS. RESULTS: A total of 647 scans were obtained from 155 newborns with a median gestational age of 32 weeks. On Day 1, a cutoff LUS of 6 had a sensitivity (Se) of 88% and a specificity (Sp) of 79% to predict the need for SF (AUC = 0.86), while a cutoff LUS of 7 predicted the need for MV at <72 hours of life (Se = 89%, Sp = 65%, AUC = 0.80). LUS acquired prior to weaning off CPAP was an excellent predictor of successful CPAP withdrawal, with a cutoff level of 1 (Se = 67%, Sp = 100%, AUC = 0.86). CONCLUSION: The LUS has significant predictive ability for important outcomes in neonatal RDS. KEY POINTS: · Lung ultrasound has significant prognostic abilities in neonatal RDS.. · Early sonograms (0-6 h of life) accurately predict the requirement for SF and ventilation.. · Weaning off CPAP is effective when the LUS (range 0-16) is less than or equal to 1..

Position of the Polish Cardiac Society on therapeutic targets for LDL cholesterol concentrations in secondary prevention of myocardial infarctions.

Cardiovascular diseases account for 43% of deaths in Poland. The COVID-19 pandemic increased the number of cardiovascular deaths by as much as 16.7%. Lipid metabolism disorders are observed in about 20 million Poles. Lipid disorders are usually asymptomatic, they cause a significant increase in the risk of cardiovascular diseases. Up to 20% of patients who experience an acute coronary syndrome (ACS) may experience a recurrence of a cardiovascular event within a year, and up to 40% of these patients may be re-hospitalized. Within 5 years after a myocardial infarction, 18% of patients suffer a second ACS and 13% have got a stroke. Lipid-lowering therapy is an extremely important element of comprehensive management, both in primary and secondary prevention, and its main goal is to prevent or extend the time to the onset of heart or vascular disease and reduce the risk of cardiovascular events. A patient with a history of ACS belongs to the group of a very high risk of a cardiovascular event due to atherosclerosis. In this group of patients, low-density lipoprotein cholesterol levels should be aimed below 55 mg/dl (1.4 mmol/l). Many scientific guidelines define the extreme risk group, which includes not only patients with two cardiovascular events within two years, but also patients with a history of ACS and additional clinical factors: peripheral vascular disease, multivessel disease (multilevel atherosclerosis), or multivessel coronary disease, or familial hypercholesterolemia, or diabetes with at least one additional risk factor: elevated Lp(a) >50 mg/dl or hsCRP >3 mg/l, or chronic kidney disease (eGFR <60 ml/min/1.73 m²). In this group of patients, the LDL-C level should be aimed at below 40 mg/dl (1.0 mmol/l). Achieving therapeutic goals in patients after ACS should occur as soon as possible. For this purpose, a high-dose potent statin should be added to the therapy at the time of diagnosis, and ezetimibe should be added if the goal is not achieved after 4-6 weeks. Combination therapy may be considered in selected patients from the beginning. After 4-6 weeks of combination therapy, if the goal is still not achieved, adding a proprotein convertase subtilisin/kexin type 9 protein inhibitor or inclisiran should be considered. In order to increase compliance with the recommendations, Polish Cardiac Society and Polish Lipid Society propose to attach in the patient's discharge letter a statement clearly specifying what drugs should be used and what LDL-C values should be achieved. It is necessary to cooperate between the patient and the doctor, to follow the recommendations and take medicines regularly, to achieve and maintain therapeutic goals.

Meat Microflora and the Quality of Meat Products.

Meat and meat products are not only a source of nutrients for humans [...].

Synergistic Effect of Combination of Various Microbial Hurdles in the Biopreservation of Meat and Meat Products-Systematic Review.

The control of spoilage microorganisms and foodborne pathogens in meat and meat products is a challenge for food producers, which potentially can be overcome through the combined use of biopreservatives, in the form of a mix of various microbial hurdles. The objective of this work is to systematically review the available knowledge to reveal whether various microbial hurdles applied in combination can pose an effective decontamination strategy for meat and meat products. PubMed, Web of Science, and Scopus were utilized to identify and evaluate studies through February 2023. Search results yielded 45 articles that met the inclusion criteria. The most common meat biopreservatives were combinations of various starter cultures (24 studies), and the use of mixtures of non-starter protective cultures (13 studies). In addition, studies evaluating antimicrobial combinations of bacteriocins with other bacteriocins, BLIS (bacteriocin-like inhibitory substance), non-starter protective cultures, reuterin, and S-layer protein were included in the review (7 studies). In one study, a biopreservative mixture comprised antifungal protein PgAFP and protective cultures. The literature search revealed a positive effect, in most of the included studies, of the combination of various bacterial antimicrobials in inhibiting the growth of pathogenic and spoilage bacteria in meat products. The main advantages of the synergistic effect achieved were: (1) the induction of a stronger antimicrobial effect, (2) the extension of the spectrum of antibacterial action, and (3) the prevention of the regrowth of undesirable microorganisms. Although further research is required in this area, the combination of various microbial hurdles can pose a green and valuable biopreservation approach for maintaining the safety and quality of meat products.

The Influence of the Apple Vinegar Marination Process on the Technological, Microbiological and Sensory Quality of Organic Smoked Pork Hams.

The effect of marinating pork hams in apple vinegar on the technological, microbiological, and sensory quality was verified. Three variants of pork hams were produced: S1-ham with curing salt, without apple vinegar; S2-ham with curing salt and 5% apple vinegar; S3-ham with salt and 5% apple vinegar. The tests were carried out immediately after production, after 7 and 14 days of storage. The products did not differ significantly in their chemical composition, salt content, fatty acid composition, and water activity (p > 0.05). During storage, a significant increase in the cholesterol content was observed (64.88-72.38 mg/100 g of the product). The lowest levels of nitrites and nitrates were recorded for treatment S3 (<0.10 and 4.73 mg/kg of product, respectively). The samples with the addition of apple vinegar (S2 and S3) were characterized by a lower pH value, higher oxidation-reduction potential, and TBARS (thiobarbituric acid reactive substances). Hams S3 were significantly brighter (L* 68.89) and less red (a* 12.98). All of the tested pork hams were characterized by very good microbiological quality (total number of microorganisms, number of lactic acid bacteria, number of acetic bacteria, number or presence of pathogenic bacteria). Significantly the lowest TVC (total viable counts) was found in the ham S3 (2.29 log CFU/g after 14 days). The S3 hams during storage were characterized by greater juiciness (6.94 c.u.) and overall quality (7.88 c.u.), but a lower intensity of smell and taste than the cured ham (S1). To sum up, it is possible to produce pork hams without the addition of curing salt, using natural apple vinegar as a marinade. Apple vinegar has a positive effect on the storage stability of the products, without losing their sensory properties.

Real world evidence: Perspectives from a European Society of Cardiology Cardiovascular Round Table with contribution from the European Medicines Agency.

Real world data (RWD) refers to healthcare information that is routinely collected in electronic healthcare records (EHR), hospital and pharmacy records, patient and disease registries, and health insurance databases. The collection and analysis of this vast amount of data is an important complement to that obtained from conventional randomised controlled trials (RCT). Real world data has been used for healthcare quality improvements, to conduct clinical trials, to support drug and device development, and to inform medical guidelines. The utility of RWD may be facilitated by common data models, which standardise format and content, and allow data from different health systems to be analysed together. The European Society of Cardiology (ESC) supports the use of RWD in collaboration with national cardiac societies, regulatory authorities, and industry to encourage continuous quality of care improvements at the hospital and country level, to conduct registry-based randomised clinical trials (R-RCT) and to facilitate safety surveillance of novel drugs and devices. The European Medicines Agency (EMA) is developing systems and processes to enable the use of RWD that can help in trial planning, defining clinical contexts, and enhancing outcome assessments. RWD can also contribute to the measurement of the impact of regulatory actions, such as contraindications or restriction of indications by looking at medicines use patterns over time across European Member States. A number of other initiatives from the European Commission and the EMA are underway to strengthen the EU's health security framework, and foster the collection and utilisation of RWD.

Radiation protection for healthcare professionals working in catheterisation laboratories during pregnancy: a statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the ESC Regulatory Affairs Committee and Women as One.

The European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology (ESC) Regulatory Affairs Committee and Women as One support continuous review and improvement, not only in the practice of assuring patients a high quality of care but also in providing health professionals with support documents to help them in their career and enhance gender equity. Recent surveys have revealed that radiation exposure is commonly reported as the primary barrier for women pursuing a career in interventional cardiology or cardiac electrophysiology (EP). The fear of foetal exposure to radiation during pregnancy may lead to a prolonged interruption in their career. Accordingly, this joint statement aims to provide a clear statement on radiation risk and the existing data on the experience of radiation-exposed cardiologists who continue to work in catheterisation laboratories (cath labs) throughout their pregnancies. In order to reduce the barrier preventing women from accessing these careers, increased knowledge in the community is warranted. Finally, by going beyond simple observations and review of the literature, our document suggests proposals for improving workplace safety and for encouraging equity.

The effect of the use of Limosilactobacillus fermentum S8 isolated from organic acid whey on nitrosyl pigment concentration and the colour formation of uncured cooked meat products.

This paper studies the application of Limosilactobacillus fermentum S8 from organic whey in meat processing and investigation the effect of bacteria on the concentration of nitrosyl pigments, colour formation, physicochemical characteristics and microbiological quality of uncured cooked meat products. 3 canned meat batters' were produced: control with salt and sodium nitrite (100 mg/ kg), treatment with salt, treatment with salt and L. fermentum S8 (107 cfu/g), then the cans were stored and cooked. The tests were carried out after production, 32 and 56 days of cold storage. It was shown that the use of L. fermentum in the processing of uncured meat caused the increase concentration of nitrosyl pigments and redness (a*) in the products after cooking. The addition of bacteria had a significant impact on the lowering pH value and the redox potential of the cooked products. The product from L. fermentum was characterized by a similar microbiological quality as compared to the traditionally cured and non-cured products (P < 0.05).

Application of Density Measurements for Discrimination and Evaluation of Chemical Composition of Different Types of Mechanically Separated Meat (MSM).

At present, the problem of identifying and controlling different types of Mechanically Separated Meat (MSM) is a very important practical issue in the meat industry. To address this challenge, the authors propose a new, analytical method for the discrimination and characterization of MSM that uses density measurements. The method proposed by the authors, in contrast to the analytical methods existing so far, is rapid, non-destructive, relatively simple and can be computerized. The density measurements of meat samples were conducted with a modified pycnometric method. Statistically significant (p<0.01) differences were found in the evaluated mean values of density for all investigated types of meat. Subsequently, the density measurements were correlated with the physicochemical properties of meat samples. A high correlation coefficient was found between the density of meat samples and the content of protein, sodium and fat. The authors have proven that density measurements allow for rapid discrimination of various types of MSM, and can also be effectively used to determine the chemical composition of MSM samples, e.g., the content of protein, fat and sodium.

Community Heroes and Sleeping Members: Interdependency of the Tenets of Energy Justice.

Energy justice literature generally treats its three tenets, distributional justice, procedural justice and recognition justice, as separate and independent issues. These are seen as separate dimensions by which criteria can be formulated for a just state of affairs. And a just state of affairs regarding energy should fulfill all criteria. However, we show, using empirical research on six European energy communities that the tenets of energy justice are interdependent and negotiated in practice. We show this interdependency using three core concerns of justice-risk, effort and power-which we identified through our empirical work. Our findings reveal that community members are often willing to take risks and put in effort, if they are compensated with more power within the community. Similarly, members are willing to compromise power if no effort or risk-taking is required from them. This demonstrates the interdependency of the tenets "procedural justice" and "distributional justice" within energy communities. We reflect on the need for energy justice theory and policymakers to recognize the significance of this interdependency.

Clinical profile and outcome of recurrent infective endocarditis.

AIMS: Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE). METHODS: Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode. RESULTS: 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE. CONCLUSIONS: In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.