Electrochemical Impedance as an Assessment Tool for the Investigation of the Physical and Mechanical Properties of Graphene-Based Cementitious Nanocomposites.

This investigation explores the potential of electrochemical impedance spectroscopy (EIS) in evaluating graphene-based cementitious nanocomposites, focusing on their physical and structural properties, i.e., electrical resistivity, porosity, and fracture toughness. EIS was employed to study cement mixtures with varying graphene nanoplatelet (xGnP) concentrations (0.05-0.40% per dry cement weight), whereas flexural tests assessed fracture toughness and porosimetry analyses investigated the structural characteristics. The research demonstrated that the electrical resistivity initially decreased with increasing xGnP content, leveling off at higher concentrations. The inclusion of xGnPs correlated with an increase in the total porosity of the cement mixtures, which was indicated by both EIS and porosimetry measurements. Finally, a linear correlation emerged between fracture toughness and electrical resistivity, contributing also to underscore the use of EIS as a potent non-destructive tool for evaluating the physical and mechanical properties of conductive nano-reinforced cementitious nanocomposites.

Piezoresistive Properties of Natural Hydraulic Lime Binary Pastes with Incorporated Carbon-Based Nanomaterials under Cyclic Compressive Loadings.

Natural Hydraulic Limes (NHL) are extensively used for the restoration of Monuments of Cultural Heritage, often combined with pozzolanic materials, such as natural pozzolans and metakaolin etc. In the present study, five (5) different cases of binary lime-based pastes composed of a specific type of NHL (NHL5) and metakaolin as pozzolanic addition were examined, that were reinforced with carbon nanostructures, namely graphene and carbon nanotubes. For the first time in restoration mortars, the incorporation of carbon nanostructures was investigated, aiming to produce materials with adequate piezoresistive response, so that they have the potential to be exploited for in situ structural health monitoring. The compressive strength, flexural strength, electrical resistance and piezoresistive response of the composite pastes was examined. The results showed that all modified carbon nanostructures lead to a significant reduction in electrical resistance. The pastes reinforced with 2D nanostructures (graphene family) displayed up to 30% increase in compressive strength and the pastes reinforced with 1D nanostructures (carbon nanotubes) displayed enhanced flexural strength (up to 100% increase). Piezoresistivity was attained for almost all investigated pastes, nevertheless the graphene oxide (GO) was considered as optimal reinforcement as the sensing ability of such pastes was found to be almost proportional to the applied compressive load level.

Dispersion of Multi-Walled Carbon Nanotubes into White Cement Mortars: The Effect of Concentration and Surfactants.

Multi-wall carbon nanotubes (MWCNTs) exhibit exceptional mechanical and electrical properties and can be used to improve the mechanical and piezoelectric properties of cement-based materials. In the present study, the effect of different MWCNT concentrations as well as different types of surfactants and a superplasticizer were examined to reinforce, at the nanoscale, a white cement mortar typically used for the restoration of monuments of cultural heritage. It was shown that sodium dodecylbenzenesulfonate (SDBS) and Triton X-100 surfactants slightly decreased the white cement mortars' electrical resistivity (by an average of 10%), however, the mechanical properties were essentially decreased by an average of 60%. The most suitable dispersion agent for the MWCNTs proved to be the superplasticizer Ceresit CC198, and its optimal concentration was investigated for different MWCNT concentrations. Carboxylation of the MWCNT surface with nitric acid did not improve the mechanical performance of the white cement nanocomposites. The parametric experimental study showed that the optimum combination of 0.8 wt% of cement superplasticizer and 0.2 wt% of cement MWCNTs resulted in a 60% decrease in the electrical resistivity; additionally, the flexural and compressive strengths were both increased by approximately 25% and 10%, respectively.

Effects of Acute Triiodothyronine Treatment in Patients with Anterior Myocardial Infarction Undergoing Primary Angioplasty: Evidence from a Pilot Randomized Clinical Trial (ThyRepair Study).

Background: Thyroid hormone has a differential action on healthy and ischemic heart. Triiodothyronine (T3) administration improved postischemic cardiac function while it limited apoptosis in experimentally induced ischemia. Thus, the present study investigated the potential effects of acute liothyronine (LT3) treatment in patients with anterior myocardial infarction. Methods: This study is a pilot, randomized, double-blind, placebo-controlled trial (ThyRepair study). We randomized 52 patients and analyzed data from 37 patients (n = 16 placebo and n = 21 LT3), per prespecified per protocol analysis. We excluded three patients who had died of cardiovascular causes (one in placebo and two in LT3 arm), four with small infarct size below a pre-specified threshold (in the placebo arm), and the rest, who lacked follow-up data. LT3 treatment started after stenting as an intravenous (i.v.) bolus injection of 0.8 µg/kg of LT3 followed by a constant infusion of 0.113 µg/kg/h i.v. for 48 hours. All patients had cardiac magnetic resonance (CMR) at hospital discharge and 6 months follow-up. The primary end point was CMR left ventricular (LV) ejection fraction (LVEF) and secondary endpoints were LV volumes, infarct volume (IV), and safety. Results: The CMR LVEF% at 6 months was 53.6 ± 9.5 for the LT3-treated group and 48.6 ± 11 for placebo, p = 0.15. Acute LT3 treatment resulted in a significantly lower LV end-diastolic volume index (92.2 ± 16.8 mL/m2 vs. 107.5 ± 22.2, p = 0.022) and LV systolic volume index (47.5 ± 13.9 mL/m2 vs. 61.3 ± 21.7, p = 0.024) at hospital discharge, but not at 6 months. There was no statistically significant difference in CMR IV at hospital discharge between the groups (p = 0.24). CMR IV tended to be lower in the LT3-treated group at 6 months (18.7 ± 9.5 vs. 25.9 ± 11.7, in placebo, p = 0.05). Serious, life-threatening events related to LT3 treatment were not observed. A tendency for an increased incidence of atrial fibrillation (AF) was found in the LT3 group during the first 48 hours (19% for T3 group vs. 5% for placebo, p = 0.13). Conclusion: This pilot randomized, placebo-controlled trial study suggests potential favorable effects (acute cardiac dilatation and 6-month IV) as well as potential concerns regarding a higher risk of AF after LT3 administration early after myocardial infarction, which should be tested in a larger scale study.

The prognostic role of late gadolinium enhancement on cardiac magnetic resonance in patients with nonischemic cardiomyopathy and reduced ejection fraction, implanted with cardioverter defibrillators for primary prevention. A systematic review and meta-analysis.

BACKGROUND: Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic events in patients with nonischemic cardiomyopathy (NICM), while others have questioned the role of left ventricular ejection fraction (LVEF) as a sole predictor of future events. OBJECTIVES: To evaluate the role of LGE on CMR in identifying patients with NICM and reduced LVEF for whom a benefit from defibrillator implantation for primary prevention is not anticipated, thus they are mainly exposed to potential risks. METHODS: Major electronic databases were searched for studies reporting the incidence of appropriate device therapy (ADT), sudden cardiac death (SCD), and cardiac death based on the presence of LGE on CMR, among patients with NICM and reduced LVEF, implanted with a cardioverter defibrillator for primary prevention. RESULTS: Eleven studies (1652 patients, 947 with LGE) were included in the final analysis. LGE presence was strongly associated with ADT (logOR: 1.95, 95%CI: 1.21-2.69) and cardiac death (logOR: 0.91, 95%CI: 0.14-1.68), but not with SCD (logOR: 0.26, 95%CI: -1.09-1.6). Diagnostic accuracy analysis demonstrated that contrast enhancement is a sensitive marker of future ADT and cardiac death (93%, 95%CI: 85.8-96.7%; 82.9%, 95%CI: 70.6-90.7%; respectively), with moderate specificity ( 44%, 95%CI: 27.2-62.6%; 37.7%, 95%CI: 23.4-54.6%; respectively). CONCLUSION: LGE is a highly sensitive predictor of ADT and cardiac death in NICM patients implanted with a defibrillator for primary prevention. However, due to moderate specificity, derivation of a cutoff with adequate predictive values and probably a multifactorial approach are needed to improve discrimination of patients who will not benefit from ICDs.

In situcontrol of graphene oxide dispersions with a small impedance sensor.

Carbon-based nanomaterials (CBNs), such as graphene and carbon nanotubes, display advanced physical and chemical properties, which has led to their widespread applications. One of these applications includes the incorporation of CBNs into cementitious materials in the form of aqueous dispersions. The main issue that arises in this context is that currently no established protocol exists as far as characterizing the dispersions. In the present article, an innovative method for quick evaluation and quantification of graphene oxide (GO) dispersions is proposed. The proposed method is electrical impedance spectroscopy (EIS) with an impedance sensor. The novelty lies on the exploitation of a small sensor for on-site (field) direct dielectric measurements with the application of alternating current. Five different concentrations of GO dispersions were studied by applying EIS and for various accumulated ultrasonic energies. The low GO concentration leads to high impedance values due to low formed current network. Two opposing mechanisms were revealed during the accumulation of ultrasonic energy, that are taking place simultaneously: breakage of the agglomerates that facilitates the flow of the electric current due to the formation of a better dispersed network, nevertheless the surface hydrophilic structure of the GO is damaged with the high accumulated ultrasonic energy. The dielectric measurements were exploited to express an appropriate quantitative 'quality index' to facilitate with the dispersion control of the nanostructures. An intermediate concentration of GO is suggested (about 0.15 wt% of the binder materials) to be optimal for the specific engineering application, ultrasonicated at approximately 30 to 65 kJ. The investigated methodology is highly novel and displays a high potential to be applied in-field applications where CBNs must be incorporated in building materials.

Lessons of the month: Reemergence of rheumatic fever after a systemic streptococcal A infection: The role of cardiac MRI on the diagnosis of subclinical rheumatic carditis.

A 42-year-old man presented with fever, sore throat, rash and painful right knee swelling, preceded by self-medication with oral steroids. Blood and knee cultures yielded group A Streptococcus After 2 weeks of intravenous antibiotics and two arthroscopic knee debridements, he continued to experience spiking fevers, and electrocardiographic changes developed. We postulate that the patient suffered from the first presentation of acute rheumatic fever, following an invasive group A bacteraemic streptococcal infection. The possible role of cardiac magnetic resonance imaging in the diagnosis of rheumatic carditis is discussed.

Epicardial Adipose Tissue: Another Tassel in the Complex Fabric of Atherosclerosis.

Atherosclerosis affects the majority of adult individuals in industrialized nations and it is beginning to affect even traditionally spared populations. The classic view has been that the precipitating events are intraluminal. However, good evidence supports the possibility that at least part of the atherosclerosis burden may be the consequence of extra-luminal noxious stimuli. Additionally, the epidemic of obesity, insulin resistance and diabetes mellitus has generated a strong interest in the potential role of visceral adipose tissue as an extra-luminal promoter of atherosclerosis. The epicardial space is filled with adipose tissue with an embryological origin similar to that of abdominal visceral fat. Both fats are highly inflamed in obese patients, patients with the metabolic syndrome and in those with established coronary artery disease. Additionally they are capable of secreting large quantities of pro-inflammatory cytokines and free fatty acids but also anti-inflammatory adipokines like adiponectin. In this manuscript we review the current evidence supporting the role of epicardial adipose tissue in the development of atherosclerosis and its complications.

Detecting human coronary inflammation by imaging perivascular fat.

Early detection of vascular inflammation would allow deployment of targeted strategies for the prevention or treatment of multiple disease states. Because vascular inflammation is not detectable with commonly used imaging modalities, we hypothesized that phenotypic changes in perivascular adipose tissue (PVAT) induced by vascular inflammation could be quantified using a new computerized tomography (CT) angiography methodology. We show that inflamed human vessels release cytokines that prevent lipid accumulation in PVAT-derived preadipocytes in vitro, ex vivo, and in vivo. We developed a three-dimensional PVAT analysis method and studied CT images of human adipose tissue explants from 453 patients undergoing cardiac surgery, relating the ex vivo images with in vivo CT scan information on the biology of the explants. We developed an imaging metric, the CT fat attenuation index (FAI), that describes adipocyte lipid content and size. The FAI has excellent sensitivity and specificity for detecting tissue inflammation as assessed by tissue uptake of 18F-fluorodeoxyglucose in positron emission tomography. In a validation cohort of 273 subjects, the FAI gradient around human coronary arteries identified early subclinical coronary artery disease in vivo, as well as detected dynamic changes of PVAT in response to variations of vascular inflammation, and inflamed, vulnerable atherosclerotic plaques during acute coronary syndromes. Our study revealed that human vessels exert paracrine effects on the surrounding PVAT, affecting local intracellular lipid accumulation in preadipocytes, which can be monitored using a CT imaging approach. This methodology can be implemented in clinical practice to noninvasively detect plaque instability in the human coronary vasculature.

Cardiac Imaging in Chronic Kidney Disease Patients.

Cardiovascular disease is highly prevalent and it is associated with high morbidity and mortality rates in patients with chronic kidney disease (CKD). The implementation of various imaging modalities may help to risk stratify these patients with a potential ease on the burden of complications and the rising costs of care. In this article we review some of the modern imaging techniques to diagnose cardiac disease in patients affected by CKD.

The Tree of Sirtuins and the Garden of Cardiovascular Youth.

Sirtuins (SIRTs) are a class of nicotine adenine dinucleotide (NAD+)-dependent proteins which participate in numerous molecular pathways involved in various age-related human diseases, such as type II diabetes, cardiovascular (CV) diseases and cancer. They have a major role in apoptosis, inflammation, oxidative stress and metabolism regulation, traits that have a great impact on CV physiology and pathology. Their unique profile of NAD+ energy dependency makes them an appealing target for human intervention in cellular and metabolic processes. This review focuses on the recent advances of SIRTs research aiming to shed light on the emerging roles of SIRTs in the pathophysiology of CV and metabolic diseases.

Aortic Flow Patterns After Simulated Implantation of Transcatheter Aortic Valves.

INTRODUCTION: The functional behavior and hemodynamic characteristics of percutaneously implanted bioprosthetic valves are not known. METHODS: We created aortic models after the simulated implantation of two of the most widely used bioprosthetic valves: the Edwards SAPIEN, and the Medtronic CoreValve. By using computational fluid dynamics analysis we sought to investigate variations in the aortic flow patterns induced by the two valve designs and their association with detrimental phenomena such as vascular remodeling, vascular wall damage and thrombosis. RESULTS: The simulated implantation of models that resemble the two valves resulted in different aortic flow conditions. Vortex formation in the upper ascending aorta was more persistent in the case of the simulated Medtronic valve. The ranges of average wall shear stress (WSS) values were 2.4-3.5 Pa for Edwards and 3.0-5.3 Pa for Medtronic; the calculated WSS values induced endothelial quiescence and an atheroprotective setting in both valves. The average shear stress on the simulated valve leaflets was low; however, hotspots were present in both valves (155.0 Pa for Edwards and 250.0 Pa for Medtronic) which would in theory be able to cause platelet activation and thus promote thrombosis. The pressure drops along the aorta were slightly lower for the Edwards compared to the Medtronic valve (198.0 Pa versus 218.0 Pa). CONCLUSIONS: The presented method allows the assessment of aortic flow conditions following the implantation of bioprosthetic valves. It may be useful in predicting detrimental flow phenomena, thus facilitating the selection of appropriate valve designs.