Ultrasound-guided deployment of ProGlide™ device in transfemoral transcatheter aortic valve implantation and risk reduction of vascular complications: A propensity-matched cohort study.

BACKGROUND: ProGlide is a percutaneous suture-mediated closure device used in arterial and venous closure following percutaneous intervention. Risk of vascular complications from use, particularly related to failure in hemostasis, or acute vessel closure, remains significant and often related to improper suture deployment. We describe a technique of ultrasound-guided ProGlide deployment in transfemoral transcatheter aortic valve implantation (TF-TAVI). AIMS: The aim of this study is to assess vascular outcomes for ultrasound-guided deployment of ProGlide vascular closure devices in patients undergoing TF-TAVI. METHODS: We collected relevant clinical data of patients undergoing TAVI in a large volume centre. PRIMARY OUTCOME: main access Valve Academic Research Consortium 3 (VARC-3) major vascular complication. SECONDARY OUTCOME: any major/minor VARC-3 vascular complication, its type (bleed or ischemia), and treatment required (medical, percutaneous, or surgical). We performed inverse weighting propensity score analysis to compare the population undergoing ultrasound-guided versus conventional ProGlide deployment for main TAVI access. Ultrasound technique for ProGlide insertion was performed as described below. RESULTS: Five hundred and seventeen patients undergoing TF-TAVI were included. PRIMARY OUTCOME: In 126 (ultrasound-guided) and 391 (conventional ProGlide insertion), 0% versus 1.8% (p < 0.001) had a major VARC-3 vascular complication, respectively. SECONDARY OUTCOME: 0.8% (one minor VARC-3 bleed) vs 4.1% (13 bleeds and three occlusions) had any VARC-3 vascular complication (major and minor) (p < 0.001). Surgical treatment of vascular complication was required in 0.8% versus 1.3% (p = NS). CONCLUSIONS: Ultrasound-guided deployment of ProGlide for vascular closure reduced the risk of major vascular complications in a large population undergoing TAVI.

Phytoremediation potential modulated by structural and functional traits in a saline desert halophyte Fagonia indica Burm. f.

Using halophytes for phytoremediation is an environmentally friendly technique, now gaining importance all over the world. Fagonia indica Burm. f. (Indian Fagonia) is primarily distributed in salt-affected lands of the Cholistan Desert and surrounding habitats. Four populations with three replications from salt-affected habitats were collected from natural habitats to evaluate structural and functional adaptation for salinity tolerance and phytoremediation of hypersaline habitats. The populations collected from the highest saline sites Pati Sir (PS) and Ladam Sir (LS) had restricted growth habit, increased accumulation of K+ and Ca2+ along Na+ and Cl-, more excretion of Na+ and Cl-, increased cross-sectional area of root and stem, larger exodermal and endodermal cells in roots, and broad metaxylem area. Sclerification in stem was high in population. Specific modifications in leaves were reduced stomatal area and increased adaxial epidermal cell area. Important traits associated with phytoremediation potential of F. indica populations (Pati Sir and Ladam Sir) were deeper roots and taller plants, increased density of salt glands on leaf surface, and high excretion of Na+. Additionally, higher bio-concentration factor, translocation factor, and dilution factor for Na and Cl- in same Ladam Sir and Pati Sir population were identified as key phytoremediation attributes. The plants of F. indica colonizing high salinities (Pati Sir and Ladam Sir) were, therefore, more efficient in phytoremediation of saline soils as these populations accumulated and/or excrete toxic salts. Density of salt glands remarkably increased in the Pati Sir population collected from the highest salinity. This population accumulated and excreted the highest amount of Na+ and Cl-. The dilution factor of Na+ and Cl- ions was also the highest in this population. Anatomical modifications such as root and stem cross-sectional areas, proportion of storage parenchyma, and broad metaxylem vessels were the maximum in Pati Sir population. These modifications indicate not only better salt tolerance of the Pati Sir population but also better in accumulation and excretion of toxic salts. This population can potentially rehabilitate hypersaline uncultivated lands through green reclamation.

Isolation, characterization and in-vitro antigenicity studies of outer membrane proteins (OMPs) of Salmonella gallinarum coated gold nanoparticles (AuNPs).

The development of biomimetic nanoparticles by combining the natural cellular material with synthetic nanoparticles has inspired innovative therapeutic strategies as compared to traditional line of therapeutics. Therefore, the research was conducted to prepare the outer membrane proteins (OMPs) from Salmonella gallinarum and coated on to the surface of synthetic gold nanoparticles (AuNPs). The size of the final product was characterized by Zeta sizer and Zeta potential. The coating of outer membrane proteins onto the gold nanoparticles (AuNPs) was confirmed by transmission electron microscopy (TEM). The sterility, stability and safety of the prepared antigen was confirmed by standard culture media, in biological buffer solution and in-vitro pyrogenic testing, respectively. In-vitro antigenicity of outer membrane protein alone and coated with gold nanoparticles were observed through macrophage phagocytosis assay. On the basis of results, it was anticipated that bacterial outer membrane protein has immunogenic antigenic properties and coating of bacterial outer membrane protein on the surfaces of synthetic gold nanoparticles not only preserved the complex biological characteristics of bacteria but also provided greater immune responses as compared to outer membrane protein alone. So, it was concluded that the coating of bacterial outer membrane proteins on the surface of synthetic gold nanoparticles have synergistic effects to induce the immune responses and promising potential to develop the effective antibacterial vaccine against salmonellosis in poultry birds.

Outer Membrane Protein-Coated Nanoparticles as Antibacterial Vaccine Candidates.

Nanoformulations are novel therapeutic strategies as compared to traditional treatments. The development of biomimetic nanoparticles by combining the natural cellular material with synthetic nanoparticles has inspired innovative vaccine strategies for modifying the antibacterial immunity. A lot of work has been done in which synthetic nanoparticles are coated with biomimetic cellular membranes for enhancement of biological functions and treatments. Outer membrane protein of bacteria not only act as adjuvant but also contain a large number of immunogenic antigens that play an important role in motivating the native immunity and stimulating the immune responses of the body. Outer membrane protein coating onto the surfaces of synthetic nanoparticles has synergistic effects to produce antibacterial responses. This article reviews the recent improvements related to the bacterial membrane-coated nanoparticles for antibacterial immunization.

A rare cause of myocardial infarction with non-obstructive coronary arteries-case report of ST-segment elevation myocardial infarction caused by a mediastinal mass.

INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is attributable to an occluded coronary artery in almost 90% of patients. Accordingly, restoration of coronary perfusion as early as possible, preferably with primary percutaneous coronary intervention, is the recommended treatment by the European Society of Cardiology, to maximise myocardial salvage. However, not all cases of STEMI are because of coronary artery occlusion. ST-segment elevation myocardial infarction that occurs in the absence of obstructive coronary artery disease on angiography has been termed myocardial infarction with non-obstructive coronary arteries (MINOCA). CASE PRESENTATION: A 44-year-old man was admitted with retrosternal chest pain radiating to the left arm and jaw, and electrocardiography showed extensive anterior ST-segment elevation. Emergency coronary angiography showed all three coronary arteries were patent with Thrombolysis in Myocardial Infarction-3 flow and no evidence of dissection or thrombus. The ST-elevation and pain resolved spontaneously. Troponin-T level rose from <3 ng/L on arrival to 549 ng/L at 12 h. Subsequent cardiac magnetic resonance imaging (MRI) showed a structurally normal heart (without late gadolinium enhancement) but detected an incidental large, lobulated (90 × 31 × 71 mm) mediastinal mass containing multiple cysts in the anterior mediastinum with inflammation and oedema of the parietal pericardium. Tissue biopsy confirmed Hodgkin's lymphoma and the patient was initiated on chemotherapy. DISCUSSION: Some 3% of ST-segment myocardial infarctions occur in the absence of obstructive coronary disease (MINOCA), is more frequent in younger patients. Cardiac MRI is a useful tool to both identify some of the potential causes of MINOCA and also to confirm the diagnosis of infarction. Some 26% of MINOCA patients have significant biochemical evidence of myocardial injury but have a normal cardiac MRI. This case illustrates a very rare cause of myocardial infarction in a young patient with unobstructed coronary arteries, and highlights the need in such cases for further detailed imaging of the myocardium and thorax to establish the diagnosis and initiate appropriate treatment.