Adult Congenital Heart Disease Transplantation: Does Univentricle Physiology Impact Early Mortality?

BACKGROUND: With patients with congenital heart disease increasingly living into adulthood, there is a growing population of patients with adult congenital heart disease (ACHD) who have heart failure. Limited data exist on evaluating heart transplantation in this population. METHODS: A retrospective review was performed of patients with ACHD who underwent heart transplantation from November 1990 to January 2023. Kaplan-Meier, cumulative incidence accounting for competing risk of death, and subgroup analyses comparing those patients with biventricular (BiV) and univentricular (UniV) physiology were performed. Data are presented as median (interquartile range [IQR]) or counts (%). RESULTS: A total of 77 patients with a median age of 36 years (IQR, 27-45 years) were identified, including 57 (74%) BiV and 20 (26%) UniV patients. Preoperatively, UniV patients were more likely to have cirrhosis (9 of 20 [45.0%] vs 4 of 57 [7.0%]; P < .001) and protein losing enteropathy (4 of 20 [20.0%] vs 1 of 57 [1.8%]; P = .015). Multiorgan transplantation was performed in 23 patients (30%) and more frequently in UniV patients (10 [50%] vs 13 [23%]; P = .04). Operative mortality was 6.5%, 2 of 20 (10%) among UniV patients and 2 of 57 (4%) among BiV patients (P = .276). Median clinical follow-up was 6.0 years (IQR, 1.4-13.1 years). Survival tended to be lower among UniV patients compared with BiV patients, particularly within the first year (P = .09), but it was similar for survivors beyond 1 year. At 5 years, the incidence of rejection was 28% (IQR, 17%-38%) and that of coronary allograft vasculopathy was 16% (IQR, 7%-24%). CONCLUSIONS: Underlying liver disease and the need for heart-liver transplantation were significantly higher among UniV patients. Survival tended to be lower among UniV patients, particularly within the first year, but it was similar for survivors beyond 1 year.

Solid state engineering of Bi2S3/rGO nanostrips: an excellent electrode material for energy storage applications.

The study presents a novel, one-pot, and scalable solid-state reaction scheme to prepare bismuth sulphide (Bi2S3)-reduced graphene oxide (rGO) nanocomposites using bismuth oxide (Bi2O3), thiourea (TU), and graphene oxide (GO) as starting materials for energy storage applications. The impact of GO loading concentration on the electrochemical performance of the nanocomposites was investigated. The reaction follows a diffusion substitution pathway, gradually transforming Bi2O3 powder into Bi2S3 nanostrips, concurrently converting GO into rGO. Enhanced specific capacitances were observed across all nanocomposite samples, with the Bi2S3@0.2rGO exhibiting the highest specific capacitance of 705 F g-1 at a current density of 1 A g-1 and maintaining a capacitance retention of 82% after 1000 cycles. The superior specific capacitance is attributed to the excellent homogeneity and synergistic relation between rGO and Bi2S3 nanostrips. This methodology holds promise for extending the synthesis of other chalcogenides-rGO nanocomposites.

A cold case of hemolytic disease of the fetus and newborn resolved by genomic sequencing and population studies to define a new antigen in the Rh system.

BACKGROUND: We report an obstetric case involving an RhD-positive woman who had developed a red blood cell (RBC) antibody that was not detected until after delivery of a newborn, who presented with a positive direct antiglobulin test result. Immunohematology studies suggested that the maternal antibody was directed against a low-prevalence antigen on the paternal and newborn RBCs. RESULTS: Comprehensive blood group profiling by targeted exome sequencing revealed a novel nonsynonymous single nucleotide variant (SNV) RHCE c.486C>G (GenBank MZ326705) on the RHCE*Ce allele, for both the father and newborn. A subsequent genomic-based study to profile blood groups in an Indigenous Australian population revealed the same SNV in 2 of 247 individuals. Serology testing showed that the maternal antibody reacted specifically with RBCs from these two individuals. DISCUSSION: The maternal antibody was directed against a novel antigen in the Rh blood group system arising from an RHCE c.486C>G variant on the RHCE*Ce allele linked to RHD*01. The variant predicts a p.Asn162Lys change on the RhCE protein and has been registered as the 56th antigen in the Rh system, ISBT RH 004063. CONCLUSION: This antibody was of clinical significance, resulting in a mild to moderate hemolytic disease of the fetus and newborn (HDFN). In the past, the cause of such HDFN cases may have remained unresolved. Genomic sequencing combined with population studies now assists in resolving such cases. Further population studies have potential to inform the need to design population-specific red cell antibody typing panels for antibody screening in the Australian population.

Reversibility of precapillary pulmonary hypertension and outcomes after heart transplantation bridged with left ventricular assist devices: Insight from the United Network for Organ Sharing.

BACKGROUND: In light of the updated lowered threshold for diagnosing pulmonary hypertension (PH), the reversibility of precapillary PH with left ventricular assist device (LVAD) and the associated post-heart transplantation (HT) outcomes remain unclear. METHODS: Using data from the United Network for Organ Sharing database, we aimed to investigate predictors of persistent precapillary PH in HT recipients bridged with LVAD and examine the interrelated post-HT survival using the updated pulmonary vascular resistance (PVR) cutoff of >2 Wood units for precapillary PH. RESULTS: Among 2169 HT recipients bridged with LVAD, 1299 had PVR >2 at baseline; 551 (42.4%) of whom normalized their PVR ≤2 and 748 (57.6%) remained with elevated PVR >2 after LVAD implantation. Female sex (adjusted odds ratio [aOR]; 2.22, 95% confidence interval [CI], 1.61-3.07; P < .001) and inotrope treatment at listing (aOR, 1.31; 95% CI, 1.03-1.66; P = .028) were associated with persistently elevated PVR after LVAD. Conversely, longer duration of LVAD support (aOR, 0.74; 95% CI, 0.65-0.84; P < .001) and use of HeartMate II (aOR, 0.74; CI, 0.59-0.93; P = .011) were found to be protective against persistently elevated PVR after LVAD. Persistently elevated PVR >2 after LVAD was associated with increased risk of death compared with those who normalized their PVR (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.01-1.57; P = .037). However, the normalized PVR post-LVAD group had comparable survival with those with PVR ≤2 at baseline (aHR, 0.76; 95% CI, 0.57-1.02; P = .07). CONCLUSIONS: Many recipients of HT bridged with LVAD remain with PVR >2 after LVAD implantation, which is associated with increased risk of death after HT compared with patients with normalized PVR after LVAD.

Exploring sustainable management by using green nano-silver to combat three post-harvest pathogenic fungi in crops.

Global crop protection and food security have become critical issues to achieve the 'Zero Hunger' goal in recent years, as significant crop damage is primarily caused by biotic factors. Applying nanoparticles in agriculture could enhance crop yield. Nano-silver, or AgNPs, have colossal importance in many fields like biomedical, agriculture, and the environment due to their antimicrobial potential. In this context, nano-silver was fabricated by Citrus medica L. (Cm) fruit juice, detected visually and by UV-Vis spectrophotometric analysis. Further, AgNPs were characterized by advanced techniques. UV-Vis spectroscopic analysis revealed absorbance spectra at around 487 nm. The zeta potential measurement value was noted as -23.7 mV. Spectral analysis by FT-IR proved the capping of the acidic groups. In contrast, the XRD analysis showed the Miller indices like the face-centered cubic (fcc) crystalline structure. NTA revealed a mean size of 35 nm for nano-silver with a 2.4 × 108 particles mL-1 concentration. TEM analysis demonstrated spherical Cm-AgNPs with 20-30 nm sizes. The focus of this research was to evaluate the antifungal activity of biogenic AgNPs against post-harvest pathogenic fungi, including Aspergillus niger, A. flavus, and Alternaria alternata. The Cm-AgNPs showed significant antifungal activity in the order of A. niger > A. flavus > A. alternata. The biogenic Cm-AgNPs can be used for the inhibition of toxigenic fungi.

Using PAH-SYMPACT to assess quality of life in patients with pulmonary hypertension associated with chronic lung disease.

Chronic lung disease (CLD) is the second leading cause of pulmonary hypertension (PH) and is associated with significant morbidity and mortality. Although PH associated with CLD (PH-CLD) leads to impaired health-related quality of life (HRQOL), there are no validated tools to assess HRQOL in PH-CLD. The Pulmonary Arterial Hypertension-Symptoms and Impact Questionnaire (PAH-SYMPACT) is an HRQOL instrument aimed at assessing the symptoms and impact of PH on overall function and well-being. We performed a single-center prospective cohort study using PAH-SYMPACT scores to compare symptoms, exercise capacity and HRQOL in patients with PAH and PH-CLD. One hundred and twenty-five patients (99 patients with idiopathic/heritable PAH and 26 with PH-CLD) completed the PAH-SYMPACT questionnaire which consists of 22 questions that assess HRQOL across four domains: cardiopulmonary (CP) symptoms, cardiovascular (CV) symptoms, physical impact (PI), and cognitive/emotional (CE) impact. Higher scores indicate worse HRQOL. We compared patients with PAH and PH-CLD using a Wilcoxon rank sum or chi-squared test as appropriate. Multivariate linear regression analysis was used to assess the relationship between PH classification and SYMPACT scores. Compared to PAH, patients with PH-CLD were older, more likely to use oxygen and had worse functional class and exercise capacity. While there was no significant difference between the two groups in CP, CV, or CE domain scores, patients with PH-CLD had significantly worse PI scores by univariate (1.79 vs. 1.13, p < 0.001) and multivariate analysis (1.61 vs. 1.17, p = 0.02) and overall worse SYMPACT scores (1.19 vs. 0.91, p = 0.03). In conclusion, patients with PH-CLD have worse HRQOL as assessed by the PAH-SYMPACT questionnaire versus patients with PAH. Although PAH-SYMPACT has not been validated in PH-CLD, the results of this study can guide clinicians in understanding the symptoms and impact of PH-CLD relative to PAH.

Application of X-ray based modern instrumental techniques to determine the heavy metals in soils, minerals and organic media.

To evaluate the environmental concerns associated with heavy metals (HMs) during their translocations in food chains, it is crucial to gather data on the types of HMs present in soils in order to ascertain their toxicity and potential to migrate. An overview of the findings from several physical techniques used to determine and identify the HMs, sediments, individual minerals, and organic components in contaminated agricultural and industrial soils, is provided in this review article. These studies cover a variety of X-ray-based analytical techniques, including most widely used ones like X-ray absorption near edge structure, extended X-ray absorption fine structure, X-ray diffraction, and less popular ones X-ray fluorescence, etc. When compared to techniques that rely on laboratory radiation sources, synchrotron radiation offers more precision and efficiency. These methods could pinpoint the primary mechanisms influencing the soil's ability to transport contaminants and track their subsequent migration up the food chain.

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support.

BACKGROUND: Gastrointestinal bleeding (GIB) in patients with continuous flow left ventricular assist devices (CF-LVADs) is often related to GI angiodysplasia (GIAD). We previously reported data on VEGF inhibition with IV bevacizumab in the treatment of LVAD-associated GIAD bleeding, and now present follow-up data on patients treated with IV bevacizumab and/or low-dose oral pazopanib. METHODS: All consecutive adult patients with LVAD-associated GIB from GIAD treated with bevacizumab or pazopanib, from July 20, 2017 to June 22, 2022, were included in the analysis. Data on hospitalizations, GI endoscopic procedures, and blood transfusions were obtained from first admission for GIB up to a median of 35.7 months following treatment initiation (range 1.3-59.8 months). RESULTS: Eleven patients (91% male, mean 69.5 ± 8.9 years) were included. Eight patients (73%) received IV bevacizumab, two patients (18%) received oral pazopanib, and one patient (9%) received bevacizumab followed by pazopanib therapy. We observed a significantly decreased number of annualized hospitalizations for GIB (median difference - 2.87, p = 0.002), blood transfusions (median difference - 20.9, p = 0.01), and endoscopies (median difference - 6.95, p = 0.007) in patients pre- and post-anti-angiogenic therapy (bevacizumab and/or pazopanib). Similarly, a significant improvement in these clinical outcomes was noted in the bevacizumab group with decreased annualized hospitalizations (median difference - 2.75, p = 0.014), blood transfusions (median difference - 24.5, p = 0.047), and number of endoscopies (median differences -6.88, p = 0.006). CONCLUSION: Anti-angiogenic therapy with IV bevacizumab and/or low-dose oral pazopanib appears to provide benefits in patients with LVAD-associated GIB with reduced hospitalizations, blood transfusions, and need for GI endoscopic procedures.

In situ synthesis of g-C3N4/Ti3C2Tx nano-heterostructures for enhanced photocatalytic H2 generation via water splitting.

Herein, we demonstrated the in situ synthesis of g-C3N4/Ti3C2Tx nano-heterostructures for hydrogen generation under UV visible light irradiation. The formation of the g-C3N4/Ti3C2Tx nano-heterostructures was confirmed via powder X-ray diffraction and supported by XPS. The FE-SEM images indicated the formation of layered structures of MXene and g-C3N4. HR-TEM images and SAED patterns confirmed the presence of g-C3N4 together with Ti3C2Tx nanosheets, i.e., the formation of nano-heterostructures of g-C3N4/Ti3C2Tx. The absorption spectra clearly showed the distinct band gaps of g-C3N4 and Ti3C2Tx in the nano-heterostructure. The increase in PL intensity and broadening of the peak with an increase in g-C3N4 indicated the suppression of electron-hole recombination. Furthermore, the nano-heterostructure was used as a photocatalyst for H2 generation from water and methylene blue dye degradation. The highest H2 evolution (1912.25 µmol/0.1 g) with good apparent quantum yield (3.1%) and an efficient degradation of MB were obtained for gCT-0.75, which was much higher compared to that of the pristine materials. The gCT-0.75 nano-heterostructure possessed a high surface area and abundant vacancy defects, facilitating the separation of charge carriers, which was ultimately responsible for this high photocatalytic activity. Additionally, TRPL clearly showed a higher decay time, which supports the enhancement in the photocatalytic activity of the gCT-0.75 nano-heterostructure. The nano-heterostructure with the optimum concentration of g-C3N4 formed a hetero-junction with the linked catalytic system, which facilitated efficient charge carrier separation also responsible for the enhanced photocatalytic activity.

Cell free extract-mediated biogenic synthesis of ZnONPs and their application with kanamycin as a bactericidal combination.

Antimicrobial resistance (AMR) is a main public health issue and a challenge for the scientific community all over the globe. Hence, there is a burning need to build new bactericides that resist the AMR. The ZnONPs were produced by cell free extract of mint (Mentha piperita L.) leaves. Antibiotics that are ineffective against resistant bacteria like Escherichia coli and Staphylococcus aureus were treated. The antibiotics were first screened, and then antibacterial activity was checked by disk diffusion, and MIC of Mp-ZnONPs individually and using Kanamycin (KAN) were determined against these pathogens by broth microdilution method. The synergism between Mp-ZnONPs and KAN was confirmed by checkerboard assay. The MIC showed robust antibacterial activity against the tested pathogens. The combination of KAN and Mp-ZnONPs reduces the MIC of KAN as it efficiently inhibits E. coli's growth, and KAN significantly enhances the antibacterial activity of Mp-ZnONPs. Taken together, Mp-ZnONPs have strong antimicrobial activity, and KAN significantly improves it against the tested pathogens, which would offer an effective, novel, and benign therapeutic methodology to regulate the incidence. The combination of Mp-ZnONPs and KAN would lead to the development of novel bactericides, that could be used in the formulation of pharmaceutical products.

Cardiac Transplantation: Physiology and Natural History of the Transplanted Heart.

Heart transplantation (HT) is one of the prodigious achievements in modern medicine and remains the cornerstone in the treatment of patients with advanced heart failure. Advances in surgical techniques, immunosuppression, organ preservation, infection control, and allograft surveillance have improved short- and long-term outcomes thereby contributing to greater clinical success of HT. However, prolonged allograft and patient survival following HT are still largely restricted by the development of late complications, including allograft rejection, infection, cardiac allograft vasculopathy (CAV), and malignancy. The introduction of mTOR inhibitors early after HT has demonstrated multiple protective effects against CAV progression, renal dysfunction, and tumorigenesis. Therefore, several HT programs increasingly use mTOR inhibitors with partial or complete withdrawal of calcineurin inhibitor (CNI) in stable HT patients to reduce complications risk and improve long-term outcomes. Furthermore, despite a substantial improvement in exercise capacity and health-related quality of life after HT as compared to advanced heart failure patients, most HT recipients remain with a 30% to 50% lower peak oxygen consumption (Vo 2 ) than that of age-matched healthy subjects. Several factors, including alterations in central hemodynamics, HT-related complications and alterations in the musculoskeletal system, and peripheral physiological abnormalities, presumably contribute to the reduced exercise capacity following HT. Cardiac denervation and subsequent loss of sympathetic and parasympathetic regulation are responsible for various physiological alterations in the cardiovascular system, which contributes to restricted exercise tolerance. Restoration of cardiac innervation may improve exercise capacity and quality of life, but the reinnervation process is only partial even several years after HT. Multiple studies have shown that aerobic and strengthening exercise interventions improve exercise capacity by increasing maximal heart rate, chronotropic response, and peak Vo 2 after HT. Novel exercise modalities, such as high-intensity interval training (HIT), have been proven as safe and effective for further improvement in exercise capacity, including among de novo HT recipients. Further developments have recently emerged, including donor heart preservation techniques, noninvasive CAV and rejection surveillance methods, and improvements in immunosuppressive therapies, all aiming at increasing donor availability and improving late survival after HT. © 2023 American Physiological Society. Compr Physiol 13:4719-4765, 2023.

Optimizing Referral Timing of Patients With Fontan Circulatory Failure for Heart Transplant.

BACKGROUND: There are no criteria guiding the timing of heart transplant referral for Fontan patients, nor are there any characteristics of those deferred or declined listing reported. This study examines comprehensive transplant evaluations for Fontan patients of all ages, listing decisions, and outcomes to inform referral practices. METHODS: Retrospective review of 63 Fontan patients formally assessed by the advanced heart failure service and presented at Mayo Clinic transplant selection committee meetings (TSM) January 2006 to April 2021. The study is compliant with the Helsinki Congress and Declaration of Istanbul and included no prisoners. Statistical analysis was performed with Wilcoxon Rank Sum and Fisher's Exact tests. RESULTS: Median age at TSM was 26 years (17.5, 36.5). Most were approved (38/63 [60%]); 9 of 63 (14%) were deferred and 16 of 63 (25%) were declined. Approved patients more commonly were <18 years old at TSM (15/38 [40%] vs 1/25 [4%], P = .002) compared with those deferred/declined. Complications of Fontan circulatory failure were less common in approved vs deferred/declined patients: ascites (15/38 [40%] vs 17/25 [68%], P = .039), cirrhosis (16/38 [42%] vs 19/25 [76%], P = .01), and renal insufficiency (6/38 [16%] vs 11/25 [44%], P = .02). Ejection fraction and atrioventricular valve regurgitation did not differ between groups. Pulmonary artery wedge pressure was overall high normal (12 mm Hg [9,16]) but higher in deferred/declined vs approved patients, 14.5 (11, 19) vs 10 (8, 13.5) mm Hg, P = .015. Overall survival was significantly lower in deferred/declined patients (P = .0018). CONCLUSION: Fontan patient referral for heart transplant at younger age and before the onset of end-organ complications is associated with increased approval for transplant listing.

Interventricular-Septal Output While Supported on Left Ventricular Assist Device Therapy.

The effects of left ventricular unloading on septal function in patients with left ventricular assist devices (LVADs) have not been well characterized in vivo. The purpose of this study was to evaluate the relationship between markers of septal function with echocardiography in relationship to RV dysfunction and late RV failure after LVAD implantation. A retrospective study was conducted of patients supported on centrifugal-flow LVADs implanted over a 10-year period. Echocardiographic data were collected pre-operatively and up to 2 years after implantation. Interventricular septum (IVS) measurements were taken at end-systole and end-diastole. Interventricular-septal output (ISO) was calculated using the formula: (IVSs-IVSd)×heart rate. A total of 110 patients were included. An immediate and sustained reduction in both lateral annulus systolic velocity (RVS') and TAPSE were observed after implant ( p < 0.0001). However, ISO gradually decreased over time ( p < 0.0001). While ISO was not predictive of late RV failure, a decrease in ISO by 25% or greater from pre-implant to hospital discharge was associated with late RV failure (OR 4.8; 95% CI, 1.4-16.5; p = 0.012) even after adjusting for relevant clinical variables ( p ≤ 0.01 for each model). RV function is known to be influenced by mechanical ventricular interdependence and we demonstrate that measurement of ISO may be a useful marker in assessing RV dysfunction and predicting RV failure in patients following LVAD implantation.

Current State and Opportunities with Long-acting Injectables: Industry Perspectives from the Innovation and Quality Consortium "Long-Acting Injectables" Working Group.

Long-acting injectable (LAI) formulations can provide several advantages over the more traditional oral formulation as drug product opportunities. LAI formulations can achieve sustained drug release for extended periods of time, which results in less frequent dosing requirements leading to higher patient adherence and more optimal therapeutic outcomes. This review article will provide an industry perspective on the development and associated challenges of long-acting injectable formulations. The LAIs described herein include polymer-based formulations, oil-based formulations, and crystalline drug suspensions. The review discusses manufacturing processes, including quality controls, considerations of the Active Pharmaceutical Ingredient (API), biopharmaceutical properties and clinical requirements pertaining to LAI technology selection, and characterization of LAIs through in vitro, in vivo and in silico approaches. Lastly, the article includes a discussion around the current lack of suitable compendial and biorelevant in vitro models for the evaluation of LAIs and its subsequent impact on LAI product development and approval.

Biogenic Synthesis of Fluorescent Carbon Dots (CDs) and Their Application in Bioimaging of Agricultural Crops.

Fluorescent nanoparticles have a transformative potential for advanced sensors and devices for point-of-need diagnostics and bioimaging, bypassing the technical burden of meeting the assay performance requirements. Carbon dots (CDs) are rapidly emerging carbon-based nanomaterials. Regardless of their fate, they will find increasing applications. In this study, a simple approach for synthesizing CDs from fruit peels was developed. The CDs were fabricated from Annona squamosa (L.) peels using a carbonization technique through microwave-assisted hydrothermal digestion at temperatures around 200 °C. Synthesized CDs were detected using a UV transilluminator for the preliminary confirmation of the presence of fluorescence. UV-Vis spectrophotometry (absorbance at 505 nm) analysis, zeta potential measurement (-20.8 mV), nanoparticles tracking analysis (NTA) (average size: 15.4 nm and mode size: 9.26 nm), photoluminescence, and Fourier transform infrared (FT-IR) analysis were used to identify the capping functional groups on the CDs. The total quantum yield exhibited was 8.93%, and the field emission scanning electron microscopy (FESEM) showed the size range up to 40 nm. The germinating mung bean (Vigna radiata (L.)) seeds were incubated with biogenically synthesized CDs to check the absorption of CDs by them. The fluorescence was observed under a UV-transilluminator in the growing parts of seeds, indicating the absorption of CDs during the germination, development, and growth. These fluorescent CDs could be used as a bioimaging agent. This novel method of synthesizing CDs was found to be eco-friendly, rapid, and cost-effective.

Pulsatile Pressure Delivery of Continuous-Flow Left Ventricular Assist Devices Is Markedly Reduced Relative to Heart Failure Patients.

Although continuous-flow left ventricular assist devices (CF-LVADs) provide an augmentation in systemic perfusion, there is a scarcity of in vivo data regarding systemic pulsatility on support. Patients supported on CF-LVAD therapy (n = 71) who underwent combined left/right catheterization ramp study were included. Aortic pulsatility was defined by the pulsatile power index (PPI), which was also calculated in a cohort of high-output heart failure (HOHF, n = 66) and standard HF cohort (n = 44). PPI was drastically lower in CF-LVAD-supported patients with median PPI of 0.006 (interquartile range [IQR], 0.002-0.012) compared with PPI in the HF population at 0.09 (IQR, 0.06-0.17) or HOHF population at 0.25 (IQR, 0.13-0.37; p < 0.0001 among groups). With speed augmentation during ramp, PPI values fell quickly in patients with higher PPI at baseline. PPI correlated poorly with left ventricular ejection fraction (LVEF) in all groups. In CF-LVAD patients, there was a stronger correlation with LV dP/dt (r = 0.41; p = 0.001) than LVEF (r = 0.21; p = 0.08; pint < 0.001). CF-LVAD support is associated with a dramatic reduction in arterial pulsatility as measured by PPI relative to HOHF and HF cohorts and decreases with speed. Further work is needed to determine the applicability to the next generation of device therapy.

Invasive aortic pulse pressure is linked to cardiac allograft vasculopathy after heart transplantation.

BACKGROUND: Pulse pressure (PP) has been linked to an increased risk of extent of coronary atherosclerosis and cardiovascular events. This study aimed to investigate the contribution of aortic PP on cardiac allograft vasculopathy (CAV) progression, and cardiovascular events after heart transplantation (HTx). METHODS: A total of 330 HTx patients (mean age 49 ± 25 years, 70.0% male) undergoing routine serial coronary intravascular ultrasound (IVUS) studies and had invasive aortic PP were enrolled. The median time from HTx to first IVUS was 13.6 months. CAV progression was assessed by IVUS as the changes (Δ) in plaque volume divided by the segment length (PV/SL), adjusted for the time between IVUS (median, 3.99 years; interquartile range, 1.99-7.20 years), and was defined as ΔPV/SL ≥0.50 mm3/mm/year. Major adverse cardiovascular event (MACE) was defined as any incidence of mortality, myocardial infarction, coronary revascularization, heart failure hospitalization, or re-transplantation. RESULTS: Recipient age, recipient sex, and renal dysfunction were independent determinant of high aortic PP (≥ 50 mmHg). High aortic PP was an independent determinant of CAV progression [odds ratio, 1.72; 95% confidence interval (CI), 1.01-2.93; p = 0.045]. Both high aortic PP (HR 1.46, 95% CI 1.01-2.11, p = 0.044) and high baseline CAV grade on angiogram (≥1, HR 1.50, 95% CI 1.03-2.21, p = 0.037) were independently associated with MACEs over 12 years. CONCLUSION: In post-HTx patients, high aortic PP was significantly associated with plaque progression. Both aortic PP and CAV grade are independently associated with MACE during long-term follow-up. These findings suggest that arterial stiffness and CAV can be important predictors of MACEs.

Chitosan nanoparticles (ChNPs): A versatile growth promoter in modern agricultural production.

Agriculture is a backbone of global economy and most of the population relies on this sector for their livelihood. Chitosan as a biodegradable material thus can be explored for in various fields in its nano form to replace non-biodegradable and toxic compounds. The chitosan has appealing properties like biocompatibility, non-toxicity, biodegradability, and low allergenic, making it useful in several applications including in agriculture sector. Because of their unique properties, chitosan nanoparticles (ChNPs) are extensively applied as a bioagent in various biological and biomedical processes, including wastewater treatment, plant growth promoter, fungicidal agent, wound healing, and scaffold for tissue engineering. Furthermore, the biocompatibility of chitosan nanoparticles (ChNPs) is reported to have other biological properties such as anti-cancerous, antifungal, antioxidant activities, even induces an immune response in the plant, and helps manage biotic and abiotic stresses. Chitosan can also find its application in wastewater treatment, hydrating agents in cosmetics, the food industry, paper, and the textile industry as adhesive, drug-delivering agent in medical as well as for bioimaging. Since chitosan has low toxicity, the nano-formulation of chitosan can be used for the controlled release of fertilizers, pesticides, and plant growth promoters in agriculture fields. The ChNPs applications in precision farming being a novel approach in recent developments. Here we have comprehensively reviewed the major points in this review are; the synthesis of ChNPs by biological resources, their modification and formulation for increasing its applicability, their modified types, and the different agricultural applications of ChNPs.

Assessment of Attachment Level by Laser in Pocket Therapy.

BACKGROUND: Scaling and root planing is the gold standard non-surgical therapy in patients with periodontitis. However, mechanical debridement alone may not eradicate all periopathogens from subgingival niches. Adjunctive use of diode laser in pocket therapy may improve tissue healing by its bactericidal and detoxification effects in subgingival areas. The objective of this study was to evaluate and compare effectiveness of scaling and root planing alone and scaling and root planing along with diode laser in chronic periodontitis patients. METHODS: This is a prospective comparative study conducted in which 30 chronic periodontitis patients with at least one site with clinical attachment loss ?3mm in each contralateral quadrant were included and divided into Site A (control) scaling and root planing only and Site B (test) scaling and root planing with diode laser therapy. Clinical parameters (Plaque Index, Gingival Index, Probing Pocket Depth and Clinical Attachment Level) were recorded at baseline, one month and three months postoperatively and compared. Student's t-test was used to analyze intra and inter site mean variation. RESULTS: Site A and Site B showed significant improvements in clinical parameters at three months postoperatively (p ?0.05) with better improvement observed in Site B (p ?0.05).   Conclusions: The use of diode laser as an adjunct to scaling and root planing can be considered as an effective treatment modality for the management of chronic periodontitis than scaling and root planing alone.