Clinical Efficacy of Percutaneous Vegetectomy in Tricuspid and Right-Heart Indwelling Device Infective Endocarditis.

Several studies have analyzed the efficacy of AngioVac for percutaneous intracardiac vegetectomy, but impact on surgical candidacy or clinical efficacy for infectious endocarditis (IE) is currently unknown. This is a single-arm, retrospective study on IE vegetectomy with impact on surgical risk scores. Analysis included 32 patients who underwent AngioVac vegetectomy for right heart IE at a single institution. The primary endpoint was improvement in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) scores. Secondary endpoints included technical success, improved leukocytosis, procedural safety, 30-day mortality, and 60-day mortality. Findings demonstrate 90.6% (n = 29) technically successful debulking. There was improvement in mean NSQIP scores from 34.6 to 27.9 (P = .007). Zero cases of 30-day all-cause mortality. One patient experienced a major post-procedural complication of pneumothorax, a Class D Adverse Event. 20.5% (n = 5) of valvular vegetation patients went on to have surgical tricuspid valve repair. All indwelling intracardiac devices were removed. Findings suggest that percutaneous vegetectomy improves surgical candidacy, as measured by ACS NSQIP scores, in patients with IE and right heart vegetations and is associated with low complication rates.

Early adverse life events and post-traumatic stress disorder in patients with constipation and suspected disordered defecation.

BACKGROUND: Early adverse life events (EALs) and post-traumatic stress disorder (PTSD) are associated with irritable bowel syndrome (IBS). Disordered defecation (DD) presents with symptoms of IBS or functional constipation (FC) and is associated with psychological distress. However, the role of trauma and stress in chronic constipation is poorly defined. We aimed to examine EALS, PTSD, and psychological symptoms in patients with constipation and suspected DD. METHODS: We conducted a survey study among adults with constipation who completed anorectal manometry (ARM) and balloon expulsion testing (BET). Data were collected on socio-demographics, EALs, PTSD, bowel symptoms, quality of life, and anxiety and depression. We performed comparisons between individuals with normal versus abnormal ARM or BET, subgroup analysis by detailed ARM and BET findings, and latent class analysis using individual EAL domains. KEY RESULTS: Among 712 eligible patients, 69 completed the study. EALs and provisional PTSD were present in 75.4% and 27.5%, respectively; rates did not differ between those with normal versus abnormal ARM or BET. Normal testing was associated with higher rates of specific EAL domains (emotional abuse and mental illness), higher depression scores, and poorer mental component scores in both primary and subgroup comparisons (all p < 0.05). Normal testing was associated with a lower likelihood of high-EAL latent class (p = 0.01) membership. Presence of IBS or FC did not influence associations. CONCLUSIONS & INFERENCES: Early adverse life events and PTSD are prevalent in patients with constipation and suspected DD. Those with normal ARM and BET have higher rates of prior emotional abuse and poorer mental health.

Evaluation of Exfoliated Graphite to Graphene in Polyamide 66 Using Novel High Shear Elongational Flow.

Graphene has been publicized as the game changing material of this millennium. To this day, scalable production leading to exceptional material properties has been difficult to attain. Most methods require harsh chemicals, which result in destroying the graphene surface. A method was developed, exploiting high speed elongational flow in a novel designed batch mixer; creating a distribution of pristine few to many layer graphene flakes. The method focuses on exfoliating in a molten polyamide 66 (PA66) matrix, creating a graphene reinforced polymer matrix composite (G-PMC). The process revealed that high speed elongational flow was able to create few layer graphene. Graphite exfoliation was found driven in part by diffusion, leading to intercalation of PA66 in graphite. The intercalated structure lead to increases in the hydrogen bonding domain, creating anisotropic crystal domains. The thermal stability of the G-PMC was found to be dependent to the degree of exfoliation, PA66 crystal structure and composite morphology. The aim of this research is to characterize uniquely produced graphene containing polymer matrix composites using a newly created elongational flow field. Using elongational flow, graphite will be directly exfoliated into graphene within a molten polymer.