Comparative Data of Procedural and Midterm Outcomes in Patients Who Underwent Percutaneous Left Atrial Appendage Closure Between the WATCHMAN FLX and WATCHMAN 2.5 Devices　- Insight From the OCEAN-LAAC Registry.

BACKGROUND: Limited data are available regarding clinical outcomes after percutaneous left atrial appendage closure using WATCHMAN FLX (WM-FLX) and WATCHMAN-2.5 (WM2.5) devices in Asian patients.Methods and Results: Data of 1,464 consecutive patients (WM-FLX, n=909; WM2.5, n=555) were extracted from a Japanese multicenter registry, and clinical data were compared between the 2 groups. No in-hospital deaths, periprocedural stroke, or device embolization occurred. Procedural success was significantly higher in the WM-FLX than WM2.5 group (95.8% vs. 91.9%; P=0.002) owing to the lower incidence of periprocedural pericardial effusion (0.55% vs. 1.8%; P=0.021). No significant differences in all-cause death, postprocedural stroke, and device-related thrombus were observed between the 2 groups. However, the cumulative bleeding rate at 1 year was substantially lower in the WM-FLX group (7.8% vs. 16.4%; P<0.001). Landmark analysis of bleeding events highlighted lower bleeding rates in the WM-FLX than WM2.5 group within the first 6 months (6.4% vs. 14.8%; P<0.001), with comparable bleeding rates over the 6- to 12-month period (1.5% vs. 3.2%, respectively; P=0.065). CONCLUSIONS: This study demonstrated higher early safety and lower 1-year bleeding rates in the WM-FLX than WM2.5 group. The lower bleeding events with WM-FLX are likely due to multiple factors other than purely difference in devices, such as postprocedural drug regimen.

Quantifying annual microplastic emissions of an urban catchment: Surface runoff vs wastewater sources.

Urban clusters are recognized as hotspots of microplastic pollution, and the associated urban rivers convey microplastics into the global oceans. Despite this knowledge, the relative contributions of various sources to the annual microplastic emissions from urban catchments remain scarcely quantified. Here, we quantified microplastic emissions from a riverine urban catchment in Japan. The total microplastics (size range: 10-5000 µm) released from the catchment amounted to 269.1 tons/annum, of which 78.1% is contributed by surface runoff and other uncontrolled emissions (UCE), and 21.1% emerges from the regulated wastewater (controlled emissions; CE), implying that approximately one-fifth is intercepted and removed by the wastewater treatment plants (WWTPs). This further indicated higher microplastic pollution by unmanaged surface runoff compared to untreated wastewater. In the dry season, WWTPs contributed significantly to the reduction of total microplastic emissions (95%) compared to wet periods (8%). On an annual scale, the treated effluent occupies only 0.1% of the total microplastics released to the river network (212.4 tons/annum), while the remaining portion is dominated by UCE, i.e., primarily surface runoff emissions (98.9%), and trivially by the background microplastic inputs that are potentially derived through atmospheric depositions in dry days (1.0%). It was shown that moderate and heavy rainfall events which occur during 18% of the year (within the context of Japan), leading to 95% of the annual microplastic emissions, are crucial for pollution control of urban rivers. Furthermore, our study demonstrated that surface area-normalized microplastic emissions from an urban catchment (∼0.8 tons/km2/annum) is globally relevant, especially for planning microplastic interventions for developed cities.

Effects of flusulfamide on spore germination of Plasmodiophora brassicae.

Flusulfamide inhibits germination of Plasmodiophora brassicae resting spores to suppress clubroot disease, but its mechanism of action on the germination of P. brassicae resting spores remains unclear. In this study, P. brassicae resting spores were treated with flusulfamide and visualized using transmission electron microscopy (TEM). The gene expression of P. brassicae resting spores was analyzed using RT-PCR, followed by immunoblotting analysis. TEM results revealed that flusulfamide suppressed the primary zoosporogenesis of P. brassicae resting spores during the early phase, and RT-PCR results revealed that flusulfamide affected the gene expression during the germination of the resting spores. Immunoblot and RT-qPCR analyses revealed that PbCyp3, an immunophilin (peptidyl-prolyl-isomerase) gene, was highly expressed, resulting in the unusual accumulation of PbCYP3 protein in P. brassicae resting spores immediately after treatment with flusulfamide. This suggests that flusulfamide may cause aberrant folding of proteins involved in primary zoosporogenesis, thereby inhibiting germination.

Prognostic impact of residual pulmonary congestion assessed by remote dielectric sensing system in patients admitted for heart failure.

AIMS: Remote dielectric sensing (ReDS) represents a contemporary non-invasive technique reliant on electromagnetic energy to quantify pulmonary congestion. Its prognostic significance within the context of heart failure (HF) patients remains elusive. This study aimed to assess the prognostic implications of residual pulmonary congestion, as gauged by the ReDS system, among patients admitted due to congestive HF. METHODS AND RESULTS: We enrolled hospitalized HF patients who underwent ReDS assessments upon admission and discharge in a blinded manner, independent of attending physicians. We evaluated the prognostic impact of the ReDS ratio between admission and discharge on the primary outcome, which encompassed all-cause mortality and HF-related re-hospitalizations. A cohort of 133 patients (median age 78 [72, 84] years, 78 male [59%]) was included. Over a median observation period of 363 days post-index discharge, an escalated ReDS group (ReDS ratio > 100%), determined through statistical calculation, emerged as an independent predictor of the primary outcome, exhibiting an adjusted hazard ratio of 4.37 (95% confidence interval 1.13-16.81, P = 0.032). The cumulative incidence of the primary outcome was notably higher in the increased ReDS group compared with the decreased ReDS group (50.1% vs. 8.5%, P = 0.034). CONCLUSIONS: Elevated ReDS ratios detected during the index hospitalization could serve as a promising prognostic indicator in HF patients admitted for treatment. The clinical ramifications of ReDS-guided HF management warrant validation in subsequent studies.

Predictive Factors of Cardiac Mortality Following TEER in Patients with Secondary Mitral Regurgitation.

Background: Transcatheter edge-to-edge mitral valve repair (TEER) has emerged as a viable approach to addressing substantial secondary mitral regurgitation. In the contemporary landscape where ultimate heart failure-specific therapies, such as cardiac replacement modalities, are available, prognosticating a high-risk cohort susceptible to early cardiac mortality post-TEER is pivotal for formulating an effective therapeutic regimen. Methods: Our study encompassed individuals with secondary mitral regurgitation and chronic heart failure enlisted in the multi-center (Optimized CathEter vAlvular iNtervention (OCEAN)-Mitral registry. We conducted an assessment of baseline variables associated with cardiac death within one year following TEER. Results: Amongst the 1517 patients (median age: 78 years, 899 males), 101 experienced cardiac mortality during the 1-year observation period after undergoing TEER. Notably, a history of heart failure-related admissions within the preceding year, utilization of intravenous inotropes, and elevated plasma B-type natriuretic peptide levels emerged as independent prognosticators for the primary outcome (p < 0.05 for all). Subsequently, we devised a novel risk-scoring system encompassing these variables, which significantly stratified the cumulative incidence of the 1-year primary outcome (16%, 8%, and 4%, p < 0.001). Conclusions: Our study culminated in the development of a new risk-scoring system aimed at predicting 1-year cardiac mortality post-TEER.

Left Atrial Stiffness Increases after Trans-Catheter Atrial Septal Closure.

BACKGROUND: Transcatheter atrial septal closures for secundum atrial septal defects (ASD) have demonstrated favorable clinical outcomes. However, the impact of device implantation on the stiffness of the left atrium remains unclear. METHOD: Patients with secundum ASD undergoing transcatheter closure and follow-up right heart catheterization at six months were included. We investigated the relationship between post-procedural (E/e' ratio)/(LAs strain) ratio, an index of left atrial stiffness, and baseline characteristics, including echocardiographic and hemodynamic parameters. RESULTS: Forty patients were included (median 69 (56, 75) years, 12 men, and pulmonary systemic flow ratio 2.27 (1.96, 2.86)). Trans-catheter ASD closure was successfully performed without any major complications, accompanying a significant reduction in right ventricular to left ventricular size ratio from 1.04 (0.87, 1.13) to 0.74 (0.66, 0.86) (p < 0.01). The (E/e' ratio)/(LAs strain) ratio was markedly elevated the day after the procedure and was further increased 6 months later (before: 0.25 (0.17, 0.34), 1 day later: 0.34 (0.27, 0.50), 6 months later: 0.43 (0.27, 0.76), p < 0.01). The groups with higher (E/e' ratio)/(LAs strain) ratios at 6 months had significantly more severe heart failure conditions including lower cardiac output and higher plasma B-type natriuretic peptides. CONCLUSIONS: Patients undergoing transcatheter ASD closure experienced improvement in hemodynamics and clinical symptoms but an elevation in left atrial stiffness post-procedure. The clinical ramifications of this finding, particularly during the longer-term observation period subsequent to ASD closure, warrant further investigation.

The quantification of the airborne plastic particles of 0.43-11 µm: Procedure development and application to atmospheric environment.

The environmental degradation of microplastics results in ultrafine particles that may incur severe biological concerns. Despite this, the atmospheric existence of plastics of less than a few microns has barely been investigated due to the particle size limit of conventional analytical methods. This study develops a procedure to quantify and characterize plastic particles (including nanoplastics; less than 1 µm) in the air through fractional sampling, a simple pretreatment method, and pyrolysis-gas chromatography-mass spectrometry (pyr-GC/MS). We targeted 11 major polymers, namely, polyethylene, polypropylene, polystyrene, acrylonitrile-butadiene-styrene resin, styrene-butadiene rubber, polymethylmethacrylate, polycarbonate, polyvinyl chloride, polyethylene terephthalate (PET), polyamide 6, and polyamide 66 (PA66). The average spike and recovery rate of each polymer in the aerosol collected on the roof of a four-story building near a major road in Kyoto, Japan, amounted to 78-130%, with a coefficient of variation of less than 15%. By coupling pyr-GC/MS analysis with fractional sampling of particles within the size range of >11 µm, 11-7.0 µm, 7.0-4.7 µm, 4.7-3.3 µm, 3.3-2.1 µm, 2.1-1.1 µm, 1.1-0.65 µm, 0.65-0.43 µm, it was possible to quantify airborne nano- and microplastics by particle size. Polyethylene, polystyrene, PET, and PA66 were detected in the air, and the total mass concentration of tiny plastic particles (0.43-11 µm) amounted to 1.20 µg/m3. This translates into total particle numbers of 3.05 × 106 particles/m3 (assuming spheres), revealing a substantial number of particles under 1 µm. These results will contribute to future studies to understand the atmospheric behaviors of ultrafine plastic particles and their flow-on effects on the respiratory system.

Inter-event and intra-event dynamics of microplastic emissions in an urban river during rainfall episodes.

Urban rivers represent the major conduits for land-sourced microplastics in the global oceans, yet the real-time dynamics of their emissions in rivers during rainfall (and runoff) events are poorly understood. Herein, we report the results of high-frequency sampling of microplastic particles (MPs) and fibers (MPFs) in the surface water of an urban river in Japan over the course of three rainfall events (i.e., light, moderate, and heavy rainfalls). The event mean concentrations (EMCs) of MPs amounted to 35,000 items/m3, 929,000 items/m3, and 331,000 items/m3; and the corresponding total loads were 0.5 kg, 19.8 kg, and 35.0 kg for light, moderate and heavy rainfalls, respectively. The inter-event total loads of MPs correlate well with the total rainfall, while the concentrations were linked with the number of antecedent dry days. The dynamic trends show that <2000 µm MPs displayed first flush effects during light to moderate rainfall events (>50% mass discharged with the initial 20-40% of flow). Small-sized MPs (10-40 µm) mobilized rapidly at lower rainfall intensities, whereas MPs over 2000 µm discharged immediately after the peak rainfall intensity. Moreover, <70 µm MPs depicted a surge following heavy rainfall events due to turbulent flow conditions reverting the deposited MPs into suspension. Overall, the three events increased the loads by 4-110 folds, and EMCs by 10-350 folds compared to the concentrations during dry weather while portraying a significant impact on 300-1000 µm MPs. The dynamics of MPs were correlated with those of suspended solids in river water, and the characteristics were comparable to the same of road dust sampled in Japan. Although the dynamic trends between MPs and MPFs in river water were comparable, MPFs were relatively less impacted by rain, likely due to the intervention of separate sewer systems in the study area.

Trajectory of pulmonary congestion during TAVR.

Patients with severe aortic stenosis often experience pulmonary congestion due to incremental afterload. The trajectory of pulmonary fluid volume during transcatheter aortic valve replacement (TAVR) remains uncertain. Remote dielectric sensing (ReDS) is a recently introduced device for non-invasive quantification of lung fluid volume without expert techniques. We evaluated the trajectory of ReDS values during TAVR and its prognostic implications. Patients with severe aortic stenosis who underwent ReDS measurements upon admission and at the index discharge after TAVR between 2021 and 2022 were eligible. They were followed up until August 2023. The primary focus was on the trajectory of ReDS values during TAVR, with secondary consideration given to its impact on the composite of death or all-cause readmission after TAVR. A total of 57 patients were included. Median age was 84 years and 24 were male. ReDS value remained unchanged after TAVR, changing from 27% (IQR 24%, 29%) to 26% (IQR 24%, 30%) (p = 0.65). ReDS value did not decrease in 23 (40%) patients. The presence of coronary artery disease and atrial fibrillation were associated with no decrease in ReDS value. This lack of decrease in ReDS value was linked to death or all-cause readmission after TAVR, with an age-adjusted hazard ratio of 3.40 (95% confidence interval 1.01-11.4, p = 0.048). The degree of lung fluid amount did not decrease in 40% of TAVR candidates during the procedure. The lack of decrease in lung fluid amount was associated with mortality and morbidity after TAVR. The next concern is to establish therapeutic strategy for patients with residual pulmonary congestion after TAVR.

Prognostic Implication of Intestinal Wall Edema in Patients with Aortic Stenosis Receiving Trans-Catheter Aortic Valve Replacement.

BACKGROUND: A recently proposed mechanism, the intestinal-cardiovascular relationship, serves as a framework to elucidate the interplay between these two systems. In our investigation, we assessed the prognostic implications of colon wall thickness, a marker correlated with intestinal congestion and dysfunction, in patients diagnosed with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). METHODS: Patients diagnosed with severe aortic stenosis who underwent TAVR at our institution during the period spanning 2015 to 2022 were retrospectively enrolled. As part of the institutional protocol, patients underwent abdominal computed tomography upon admission, preceding TAVR. Our analysis aimed to assess the influence of colon wall thickness on the occurrence of either all-cause mortality or readmission due to heart failure within a two-year period. RESULTS: A total of 345 patients were included. The median age was 85 (82, 88) years, and 99 patients were male. Baseline colon wall thickness was distributed widely, with a median value of 2.2 (2.0, 2.5) mm. Patients with thicker colon walls tended to have lower pulmonary artery pulsatility index values, indicating more impaired right ventricular function and more advanced malnutrition. A thicker colon wall was independently associated with 2-year death or heart failure readmission with a hazard ratio of 2.02 (95% confidence interval 1.01-14.07), adjusted for hemoglobin, age, and plasma B-type natriuretic peptide levels (p = 0.049), and significantly stratified the primary endpoint at a cutoff of 2.7 mm (25% versus 10%, p = 0.005). CONCLUSIONS: Our initial observation revealed that a thicker baseline colon wall correlated with increased rates of mid-term mortality and readmission due to heart failure subsequent to TAVR. Developing a comprehensive understanding of the underlying causality necessitates further in-depth investigations through subsequent studies.

Occurrence and distribution of plastic particles (10-25,000 µm) and microfibers in the surface water of an urban river network in Japan.

Urban rivers remain the key conduits conveying land-sourced plastics into the ocean. However, detailed information is limited on the concurrent evaluation over a wide array of particle size-specific abundances, characteristics, and distribution patterns of plastics in riverine environments. Therefore, this study provides a comprehensive assessment of plastic pollution in an urban river network in Japan by analyzing mesoplastics (5000-25,000 µm), large microplastics (300-5000 µm), small microplastics (SMPs, 10-300 µm), and microplastic-fibers (MPFs, 10-5000 µm) concurrently, for the first time. Sampling was conducted at seven stations in the Kamo and Katsura Rivers flowing across metropolitan Kyoto City. The analytical procedures involved infrared spectroscopy and fluorescence-staining microscopy. The concentrations of plastics were moderate compared to the global reports and gradually increased along the river flow (3550-15,840 items/m3; 180-13,180 µg/m3), mostly due to urban discharges via non-point sources. The number concentrations increased with decreasing particle size, marking 99.94% of SMPs, including 50% smaller than 40 µm. Conversely, mass concentrations decreased, exhibiting 96% larger than 1000 µm (64% mesoplastics including 20% around 5000 µm), along with 2% SMPs. Polyethylene (PE) and polyvinyl alcohol were distinct among SMPs, with PE indicating higher susceptibility to fragmentation compared to polypropylene and other polymer types. MPF concentrations were homogeneous throughout the watershed (1470-3600 items/m3; 520-1060 µg/m3), with a higher proportion of fibers smaller than 1000 µm (86%), apparently originating from polyethylene terephthalate/nylon/acrylic-like textile fibers. The proportion of MPFs surpassed particles within 100-3000 µm and was considerably high around 300 µm (> 98%). The river network of Kyoto conveys billions of tiny microplastics to the Yodo River, the primary water resource downstream, within a dry day.

Implication of amino acid metabolism and cell surface integrity for the thermotolerance mechanism in the thermally adapted acetic acid bacterium Acetobacter pasteurianus TH-3.

IMPORTANCE: Acetobacter pasteurianus, an industrial vinegar-producing strain, is suffered by fermentation stress such as fermentation heat and/or high concentrations of acetic acid. By an experimental evolution approach, we have obtained a stress-tolerant strain, exhibiting significantly increased growth and acetic acid fermentation ability at higher temperatures. In this study, we report that only the three gene mutations of ones accumulated during the adaptation process, ansP, dctD, and glnD, were sufficient to reproduce the increased thermotolerance of A. pasteurianus. These mutations resulted in cell envelope modification, including increased phospholipid and lipopolysaccharide synthesis, increased respiratory activity, and cell size reduction. The phenotypic changes may cooperatively work to make the adapted cell thermotolerant by enhancing cell surface integrity, nutrient or oxygen availability, and energy generation.

Association Between Remote Dielectric Sensing and Body Mass Index.

Remote dielectric sensing (ReDS) is a non-invasive, electromagnetic energy-based technology to quantify pulmonary congestion. However, the accuracy of ReDS values in patients with a variety of physiques has not been fully validated.Prospective successive measurements of ReDS values and body mass index (BMI) were performed on admission in consecutive hospitalized patients with cardiovascular diseases. Patients were stratified into 4 groups according to the WHO classification: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 24.9), pre-obese (25.0 ≤ BMI < 29.9), and obese (30.0 ≤ BMI). The indexed ReDS value was defined as a ReDS value divided by the modified congestion score index (the severity of pulmonary congestion on chest X-ray). The indexed ReDS values were compared among the 4 stratified groups.A total of 436 patients (76 [69, 82] years old and 254 men) were included. The median indexed ReDS values were 21.3 (19.1, 23.8), 25.7 (21.0, 29.5), 25.7 (20.3, 31.0), and 28.0 (21.1, 34.0) in underweight, normal weight, pre-obese, and obese patients, respectively, highlighting the underweight group had the lowest values (P < 0.001).ReDS values may be underestimated and specific caution should be paid in its interpretation in underweight patients.

Mid-Term Feasibility of Percutaneous Left Atrial Appendage Occlusion in Elderly Patients with Non-Valvular Atrial Fibrillation.

BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) therapy using the WATCHMAN system has been introduced to prevent thrombosis and minimize the use of anticoagulants in patients with non-valvular atrial fibrillation. Given the high risk of bleeding and stroke in elderly patients, these patients would be good candidates for this therapy. However, the efficacy and feasibility of LAAO therapy in elderly patients remains uncertain. METHODS: Consecutive patients who underwent LAAO therapy using the WATCHMAN system in a large academic center between June 2020 and March 2023 were included. The safety and efficacy of LAAO therapy during the 1-year observation period in patients aged ≥85 years old were compared with those in the younger cohort. RESULTS: A total of 188 patients (78.4 ± 6.9 years old, 133 male patients) were included. 34 patients were ≥85 years old, 96 were between 75 and 84 years old, and 58 were <75 years old. The elderly group had a higher CHA2DS2-VASc score and were at greater risk of falling-related bleeding compared with the younger cohort. The device implantations were successful in all patients except for one. During the 1-year observation period, one patient had a peri-device leak >5 mm and there were 6 device-related cases of thrombosis, whose incidence was not significantly different between the groups (p = 0.98). The cumulative incidences of bleeding and thrombotic events in the elderly group were as low as in the younger cohort (p > 0.05 for both). Most anticoagulants were terminated regardless of age. CONCLUSION: The mid-term feasibility and efficacy of percutaneous LAAO therapy using the WATCHMAN system in elderly patients aged ≥85 years were as acceptable as in the younger cohort.

Degradation and lifetime prediction of plastics in subsea and offshore infrastructures.

Engineering and civil developments have relied on synthetic polymers and plastics (including polyethylene, polypropylene, polyamide, etc.) for decades, especially where their durability protects engineering structures against corrosion and other environmental stimuli. Offshore oil and gas infrastructure and renewable energy platforms are typical examples, where these plastics (100,000 s of metric tonnes worldwide) are used primarily as functional material to protect metallic flowlines and subsea equipment against seawater corrosion. Despite this, the current literature on polymers is limited to sea-surface environments, and a model for subsea degradation of plastics is needed. In this review, we collate relevant studies on the degradation of plastics and synthetic polymers in marine environments to gain insight into the fate of these materials when left in subsea conditions. We present a new mathematical model that accounts for various physicochemical changes in the oceanic environment as a function of depth to predict the lifespan of synthetic plastics and the possible formation of plastic debris, e.g., microplastics. We found that the degradation rate of the plastics decreases significantly as a function of water depth and can be estimated quantitatively by the mathematical model that accounts for the effect (and sensitivity) of geographical location, temperature, light intensity, hydrostatic pressure, and marine sediments. For instance, it takes a subsea polyethylene coating about 800 years to degrade on ocean floor (as opposed to <400 years in shallow coastal waters), generating 1000s of particles per g of degradation under certain conditions. Our results demonstrate how suspended sediments in the water column are likely to compensate for the decreasing depth-corrected degradation rates, resulting in surface abrasion and the formation of plastic debris such as microplastics. This review, and the complementing data, will be significant for the environmental impact assessment of plastics in subsea infrastructures. Moreover, as these infrastructures reach the end of their service life, the management of the plastic components becomes of great interest to environmental regulators, industry, and the community, considering the known sizeable impacts of plastics on global biogeochemical cycles.

Prognostic Impact of Modified H2FPEF Score in Patients Receiving Trans-Catheter Aortic Valve Replacement.

BACKGROUND: H2FPEF is a recently introduced score for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Many patients with severe aortic stenosis have clinical/subclinical HFpEF and have worsening heart failure even after trans-catheter aortic valve replacement (TAVR). We investigated the prognostic impact of the H2FPEF score in TAVR candidates. METHODS: Patients undergoing TAVR procedures at a single academic center between 2015 and 2022 were included. The H2FPEF score was calculated using baseline characteristics before TAVR. The prognostic impact of the score on the post-TAVR composite endpoint, consisting of all-cause death and heart failure readmissions during the 2-year observation period, was evaluated. RESULTS: A total of 244 patients (median age 86 years, 70 males) were included. The median value of H2FPEF score was 3 (2, 4). The score was significantly associated with the primary outcome with a hazard ratio of 1.33 (95% confidence interval 1.02-1.74, p = 0.036). We constructed a modified H2FPEF score by adjusting cutoffs of several items for better prognostic stratification (i.e., age and body mass index). A modified score had a higher area under the curve than the original one (0.65 vs. 0.59, p = 0.028) and was independently associated with the primary outcome with an adjusted hazard ratio of 1.22 (95% confidence interval 1.01-1.49, p = 0.047). CONCLUSIONS: A modified H2FPEF score, which was originally developed to diagnose the presence of HFpEF, could be used to risk-stratify elderly patients receiving TAVR. The clinical utility of this score should be validated in future studies.

Prognostic impact of remote dielectric sensing value following TAVR.

Remote dielectric sensing (ReDS) system non-invasively quantifies pulmonary congestion. Re-admission following trans-catheter aortic valve replacement (TAVR) remains an unsolved matter. Residual pulmonary congestion is a strong risk factor of worse clinical outcomes in patients with heart failure. ReDS system may have a prognostic impact in patients undergoing TAVR. Patients who received TAVR and ReDS measurements during index hospitalization between 2021 and 2022 were included. The prognostic impact of ReDS value on the composite endpoint of death or re-admission following index discharge was investigated. Totally, 42 patients (median 84 years, 14 men) were included. Median ReDS value at index discharge was 27% (24%, 30%) and 10 patients had ReDS values > 30%. During a median of 316 (282, 354) days following index discharge, a higher ReDS value at baseline was independently associated with the incidence of composite endpoint with an adjusted hazard ratio of 1.32 (95% confidence interval between 1.10 and 1.58) with a calculated cutoff of 30%, which significantly stratified the cumulative incidence of the composite endpoint (78% in the high ReDS group [N = 10] and 36% in the normal ReDS group [N = 32], p = 0.002). ReDS technology may be a promising tool to predict future clinical outcomes following TAVR by quantifying residual pulmonary congestion. The clinical implication of ReDS-guided aggressive intervention following TAVR remains the next concern.

Quantification of microplastic by particle size down to 1.1 µm in surface road dust in an urban city, Japan.

The impact of microplastics (MPs, plastic particles ≤5 mm) on ecosystems is of great concern. Road surfaces represent a significant source of MPs where plastic fragments are physically and chemically reduced to MPs. However, the literature lacks information on fragmentation tendencies below 11 µm. This study aimed to characterize the occurrence of MPs in road dust in different size fractions down to 1.1 µm. Road dust was collected at five sites near a major road in Kusatsu city, Japan, and partitioned by size into 13 fractions (1.1-850 µm). The coarser fractions accounted for a greater proportion of the dust. The percentage of organic matter, determined by loss on ignition, increased as the fractions became finer. Pyrolysis-gas chromatography-mass spectrometry was used to quantify 12 types of polymers in each fraction. The dust was found to contain nine types of MP, namely, polyethylene (PE), polypropylene (PP), polyvinylchloride (PVC), polystyrene (PS), styrene/butadiene rubber (SBR), acrylonitrile/butadiene/styrene resin (ABS), polycarbonate (PC), polymethylmethacrylate (PMMA), and polyamide 66 (PA66). The total MP concentration in road dust particles by particle size fraction (concentrationf) began to increase from the 125-250 µm fraction and remained elevated in finer fractions down to 1.1 µm, indicating that MPs in the road dust micronized to at least 1.1 µm. However, for individual polymer types, the tendency for concentrationf to increase or decrease with particle size fraction varied: the concentrationf of some polymers, such as PE and PVC, remained elevated in fractions down to 1.1 µm; the concentrationf of SBR, a rubber-MP, showed a stable or decreasing trend in fractions of 7.0-11 µm and finer. Particles of PE, PVC, and some other plastics might become increasingly finer, even down to 1.1 µm. Further research is needed to understand the comminution limits of these polymers under pertinent environmental conditions.

Negative Prognostic Impact of Mineralocorticoid Receptor Antagonist in Elderly Patients Receiving TAVR.

Background: Morbidity and mortality following trans-catheter aortic valve replacement (TAVR) remain high. Renin-angiotensin system inhibitors improve clinical outcomes in the cohort studied in this work. However, post-TAVR prognostic impact of mineralocorticoid receptor antagonist (MRA), another neuro-hormonal blocker, remains uncertain. Here, we hypothesized that MRA was associated with improved clinical outcomes in elderly patients with severe aortic stenosis receiving TAVR. METHODS: Consecutive patients who received TAVR at our institute between 2015 and 2022 were considered for inclusion. Propensity score matching analysis was performed to match pre-procedural baseline characteristics between those with and without MRA. The prognostic impact of MRA use on the composite primary endpoint consisting of all-cause death and heart failure during the 2-year observational period following index discharge was evaluated. RESULTS: Among 352 patients who received TAVR, 112 patients (median 86 years, 31 men) were included, consisting of baseline-matched 56 patients with MRA and 56 patients without MRA. Following TAVR, patients with MRA had more impaired renal function compared with no MRA group. Following index discharge, serum potassium tended to increase, and renal function tended to decline in patients with MRA. Patients with MRA had a higher cumulative incidence of the primary endpoints during a two-year observational period (30% versus 8%, p = 0.022). CONCLUSIONS: Routine prescription of MRA might not be recommended in elderly patients with severe aortic stenosis receiving TAVR, given its negative prognostic impact. Optimal patient selection for MRA administration in this cohort needs further study.