First-in-Human Multicenter Experience of the Newest Generation Supra-Annular Self-Expanding Evolut FX TAVR System.

BACKGROUND: The latest-generation Evolut FX TAVR system (Medtronic) offers several potential design improvements over its predecessors, but early reported experience has been limited. OBJECTIVES: This study sought to report our multicenter, limited market release, first-in-human experience of transcatheter aortic valve replacement (TAVR) with the Evolut FX system and compare it with a single-center PRO+ (Medtronic) experience. METHODS: From June 27 to September 16, 2022, 226 consecutive patients from 9 US centers underwent transfemoral TAVR with the Evolut FX system for native aortic stenosis (89.4%) or prosthetic valve degeneration (10.6%). Commissural alignment was defined as 0° to 30° between native and FX commissures. Patient, anatomical, and procedural characteristics were retrospectively reviewed, and 30-day clinical and echocardiographic outcomes per Valve Academic Research Consortium-3 definitions were reported. RESULTS: Of 226 patients, 34.1% were low risk, 4% had a bicuspid valve, and 11.5% had a horizontal root (≥60°). Direct Inline sheath (Medtronic) was used in 67.6% and Lunderquist stiff wire (Cook Medical) in 35.4% of cases. Optimal hat marker orientation during deployment was achieved in 98.4%, with commissural alignment in 96.5%. At 30 days, 14.3% mild, 0.9% moderate, and no severe paravalvular leak were observed. Compared with the Evolut PRO+ experience from 1 center, FX had a more symmetrical implantation with shallower depth at the left coronary cusp (P < 0.001), fewer device recaptures (26.1% vs 39.5%; P = 0.004), and improved commissural alignment (96.5% vs 80.2%; P < 0.001). CONCLUSIONS: The Evolut FX system demonstrated favorable 30-day outcomes with a significant improvement over PRO+ in achieving commissural alignment, fewer device recaptures, and more symmetrical implantation. These features may benefit younger patients undergoing TAVR with the supra-annular, self-expanding valve, where lifetime management would be important.

Online Sexual Solicitation of Children and Adolescents in a High-Risk Population.

INTRODUCTION: The Internet provides a powerful potential tool for sexual predators. Experiencing trauma, including sexual abuse, can increase child and adolescent risk of experiencing online sexual solicitation. METHOD: A retrospective chart review was conducted for the detailed information of all children and adolescents aged 8-18 years presenting to the Child Advocacy Center of large, tertiary care, Midwestern U.S. pediatric hospital with concerns of sexual abuse. RESULTS: Three-hundred twenty-five children and adolescents were seen in the Child Advocacy Center during the 9 months; 139 (42.8%) denied talking to anyone online that they had not met offline (face to face in real life), 88 (27.1%) reported talking to individuals online that they had not met offline but never talking about sex; 65 (20%) reported online sexual solicitation with individuals they had not met offline; and 33 (10.2%) reported highest-risk behaviors online involving meeting someone offline or having sex with someone offline whom they had met online. DISCUSSION: The number of youth involved in online sexual solicitation illustrates that children who have been sexually abused are at increased risk for sexual solicitation. This study also suggests that young children are vulnerable to online sexual solicitation. Youth engaged in these concerning online behaviors with individuals of all ages.

Evaluation of Tissue Perfusion by Wound Blush and 2D Color-Coded Digital Subtraction Angiography During Endovascular Intervention and Its Impact on Limb Salvage in Critical Limb Ischemia.

PURPOSE: Critical limb ischemia (CLI) is an entity with high mortality if not properly treated. The primary aim of CLI revascularization is to enhance wound healing, which greatly depends on microvascular circulation. The available tools for assessment of revascularization success are deficient in the evaluation of local microvascular tissue perfusion, that wound blush (WB) reflects. A reliable technique that assesses capillary flow to foot lesions is needed. This study aims to assess WB angiographically at sites of interest in the foot after revascularization and its impact on limb salvage in CLI. MATERIALS AND METHODS: 198 CLI patients (Rutherford category 5/6) with infrainguinal atherosclerotic lesions amenable for endovascular revascularization (EVR) were included. Limbs were directly or indirectly revascularized by EVR. Direct revascularization meant that successful revascularization of the area of interest according to the angiosome concept was achieved. A completion angiographic run was taken to assess WB. Patients were divided into 2 groups; positive and negative WB groups. In the event of a disagreement between the observational investigators, the digital subtraction angiography (DSA) series was analyzed for hemodynamic changes with a computerized 2D color-coded DSA (Syngo iFlow). RESULTS: 176 limbs had successful revascularization in 157 patients. The successful revascularization rate was 88.9% (176/198), with technical failure encountered in 22 limbs. 121 patients had positive WB and 55 patients had negative WB. Direct revascularization of target areas was obtained in 98 limbs (55.7%). There was a significant difference in the rate of achieving direct flow to the lesion between the positive WB and negative WB groups (36.4% vs 19.3%, p≤0.001). We noticed a nonsignificant difference between patients who had direct revascularization of the foot lesion(s) and those who had indirect revascularization as regards limb salvage. Patients were followed up for 25.2 ± 12.7 months. By the end of the first year, limb salvage rate was significantly higher in patients who had positive WB (98% vs 63%, p<0.001, after 2 years (97% vs 58%, p<0.001) and after 3 years (94% vs 51.5%, p<0.001). CONCLUSIONS: WB is an important predictor and a prognostic factor for wound healing in CLI patients with soft tissue lesions.

Comprehensive Study of Lithium Adsorption and Diffusion on Janus Mo/WXY (X, Y = S, Se, Te) Using First-Principles and Machine Learning Approaches.

The structural asymmetry of two-dimensional (2D) Janus transition-metal dichalcogenides (TMDs) produces internal dipole moments that result in interesting electronic properties. These properties differ from the regular (symmetric) TMD structures that the Janus structures are derived from. In this study, we, first, examine adsorption and diffusion of a single Li atom on regular MX2 and Janus MXY (M = Mo, W; XY = S, Se, Te) TMD structures at various concentrations using first-principles calculations within density functional theory. Lithium adsorption energy and mobility differ on the top and bottom sides of each Janus material. The correlation between Li adsorption energy, charge transfer, and bond lengths at different coverage densities is carefully examined. To gain more physical insight and prepare for future investigations into regular TMD and Janus materials, we applied a supervised machine learning (ML) model that uses clusterwise linear regression to predict the adsorption energies of Li on top of 2D TMDs. We developed a universal representation with a few descriptors that take into account the intrinsic dipole moment and the electronic structure of regular and Janus 2D layers, the side where the adsorption takes place, and the concentration dependence of adatom doping. This representation can easily be generalized to be used for other impurities and 2D layer combinations, including alloys as well. At last, we focus on analyzing these structures as possible anodes in battery applications. We conducted Li diffusion, open-circuit voltage, and storage capacity simulations. We report that lithium atoms are found to easily migrate between transition-metal (Mo, W) top sites for each considered case, and in these respects, many of the examined Janus materials are comparable or superior to graphene and regular TMDs. In addition, we report that the side with higher electronegative chalcogen atoms is suitable for Li adsorption and only MoSSe and MoSeTe can be suitable for full coverage of Li atoms on the surface. Bilayer Li adsorption was hindered due to negative open-circuit voltage. Bilayer Janus structures are better suited for battery applications due to less volumetric expansion/contraction during the discharge/charge process and having higher storage capacity. Janus monolayers undergo a transition from semiconducting to metallic upon adsorption of a single Li ion, which would improve anode conductivity. The results imply that the examined Janus structures should perform well as electrodes in Li-ion batteries.

Acacia honey from different altitudes: total phenols and flavonoids, laser-induced fluorescence (LIF) spectra, and anticancer activity.

OBJECTIVE: To investigate Acacia honey from different altitudes regarding total phenols and flavonoids, laser-induced fluorescence (LIF) spectra and anticancer activity against human cancer cell lines. METHODS: Anticancer activity was investigated using sulforhodamine B cytotoxicity assays in the following human cancer cell lines: HCT116 (colon); MCF7 (breast), and HepG2 (liver). Total phenols and flavonoids were measured using spectrophotometric methods and LIF was used to differentiate between low and high-altitude honey. RESULTS: The LIF spectra differed between low and high-altitude Acacia honey. High altitude Acacia honey was characterized by significantly lower total phenol content (81.47 ± 1.25 mg gallic acid equivalent [GAE]/100 g) and increased total flavonoids (10.63 ± 0.53 mg quercetin equivalent [QE]/100 g) versus low altitude Acacia honey (91.33 ± 0.96 mg GAE/100 g and 8.78 ± 0.23 mg QE/100 g, respectively). Low altitude Acacia honey displayed increased IC50 values against HCT116 and MCF7 cells (264.17 ± 10.5 and 482.65 ± 20.3 µg/ml, respectively) versus high altitude Acacia honey (117.99 ± 12.7 and 189.82 ± 15.8 µg/ml, respectively). CONCLUSIONS: High altitude Acacia honey had significantly more effective anticancer activity against HCT116 and MCF7 cells compared with low altitude honey.

Outcomes Following Shock Aortic Valve Replacement: Transcatheter Versus Surgical Approaches.

OBJECTIVES: To compare transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients in shock. BACKGROUND: There are minimal data on the clinical and echocardiographic outcomes for patients in shock that undergo TAVR and no data comparing these outcomes to similar patients undergoing SAVR. METHODS: This is a single center, retrospective cohort study of patients having Society of Thoracic Surgeons (STS)-defined urgent or emergent AVR for aortic stenosis with clinical signs and symptoms of shock. Inclusion criteria were based on the Society of Cardiovascular Angiography & Interventions (SCAI) shock consensus statement and included: the need for inotropic or vasopressor agents, mechanical ventilation, continuous renal replacement therapy or newly initiated hemodialysis, and/or utilization of mechanical hemodynamic support. Clinical and echocardiographic outcomes for TAVR and SAVR were compared. RESULTS: Thirty-seven patients met the inclusion criteria for this study (17 TAVR, 20 SAVR). TAVR patients had a higher STS Predicted Risk of Mortality (PROM) score of 22.3% compared to 11.8% for SAVR patients (p = 0.001). No significant differences were found in baseline echocardiographic results. TAVR procedures required less procedure room time (185.9 min TAVR, 348.5 min SAVR, p < 0.001) and fewer intraoperative packed red blood cell (pRBC) transfusions (0.2 units TAVR, 3.4 units SAVR, p < 0.001). TAVR patients also had lower rates of prolonged postoperative ventilation compared to SAVR patients (38.5% TAVR, 75.0% SAVR, p = 0.047). TAVR and SAVR had similar rates of mortality at discharge (2 TAVR, 1 SAVR, p = 0.584), 30-days (2 TAVR, 1 SAVR, p = 0.584), and 1-year (8 TAVR, 5 SAVR, p = 0.149). CONCLUSIONS: Despite a higher risk TAVR group, patients in shock undergoing either TAVR or SAVR have similar 30-day mortality. At one year, SAVR patients have a numerically better, though not statistically significant, survival. These findings support the use of TAVR for patients in shock with aortic stenosis.

Sonochemical assisted synthesis of RGO/ZnO nanowire arrays for photoelectrochemical water splitting.

This article presented the synthesis of a hybrid nanoarchitecture material composed of reduced graphene oxide (RGO) multiple sheets and ZnO nanowire arrays (NWAs) formed on an arbitrary ZnO coated fluorine doped tin oxide (FTO) substrates via pulse sonication and hydrothermal approach. The NWAs have high aspect-ratio, high density, apt positioning and well-ordered formation. FESEM images demonstrated that RGO layers have been effectively intercalated between and on the accessible surfaces of the ZnO NWAs. The diameter of ZnO nanowires is 80-150nm and length about 1-2µm. Raman spectrum of hybrid material exhibited characteristic D and suppressed G peaks for graphene and E2 mode at 437cm-1 for ZnO NWAs. UV-visible spectrum indicated slight red shift towards visible range after formation of RGO/ZnO NWAs heterostructure. The Photoelectrochemical results indicated higher current densities for RGO/ZnO NWAs heterostructure due to water oxidation reaction at the working electrode compared to pristine ZnO NWAs.

Ultra-high dynamic range electro-optic sampling for detecting millimeter and sub-millimeter radiation.

Time-domain spectroscopy using coherent millimeter and sub-millimeter radiation (also known as terahertz radiation) is rapidly expanding its application, owing greatly to the remarkable advances in generating and detecting such radiation. However, many current techniques for coherent terahertz detection have limited dynamic range, thus making it difficult to perform some basic experiments that need to directly compare strong and weak terahertz signals. Here, we propose and demonstrate a novel technique based on cross-polarized spectral-domain interferometry to achieve ultra-high dynamic range electro-optic sampling measurement of coherent millimeter and sub-millimeter radiation. In our scheme, we exploit the birefringence in a single-mode polarization maintaining fiber in order to measure the phase change induced by the electric field of terahertz radiation in the detection crystal. With our new technique, we have achieved a dynamic range of 7 × 10(6), which is 4 orders of magnitude higher than conventional electro-optic sampling techniques, while maintaining comparable signal-to-noise ratio. The present technique is foreseen to have great impact on experiments such as linear terahertz spectroscopy of optically thick materials (such as aqueous samples) and nonlinear terahertz spectroscopy, where the higher dynamic range is crucial for proper interpretation of experimentally obtained results.

Cerebral Oximetry as a Real-Time Monitoring Tool to Assess Quality of In-Hospital Cardiopulmonary Resuscitation and Post Cardiac Arrest Care.

BACKGROUND: Regional cerebral oxygen saturation (rSO2) as assessed by near infrared frontal cerebral spectroscopy decreases in circulatory arrest and increases with high-quality cardiopulmonary resuscitation. We hypothesized that higher rSO2 during cardiopulmonary resuscitation and after return of spontaneous circulation (ROSC) would predict survival to discharge and neurological recovery. METHODS AND RESULTS: This prospective case series included patients experiencing in-hospital cardiac arrest. Cerebral oximetry was recorded continuously from initiation of resuscitation until ROSC and up to 48 hours post-arrest. Relationships between oximetry data during these time periods and outcomes of resuscitation survival and survival to discharge were analyzed. The cohort included 27 patients. Nineteen (70.3%) achieved ROSC, and 8 (29.6%) survived to discharge. Median arrest duration was 20.8 minutes (range=8 to 74). There was a significant difference in rSO2 between resuscitation survivors and resuscitation nonsurvivors at initiation of the resuscitative efforts (35% versus 17.5%, P=0.03) and during resuscitation (36% versus 15%, P=0.0008). No significant association was observed between rSO2 at ROSC or during the post-arrest period and survival to discharge. Among patients who survived to discharge, there was no association between cerebral performance category and rSO2 at ROSC, during resuscitation, or post-arrest. CONCLUSIONS: Higher rSO2 levels at initiation of resuscitation and during resuscitation are associated with resuscitation survival and may reflect high-quality cardiopulmonary resuscitation. However, in this small series, rSO2 was not predictive of good neurological outcome. Larger studies are needed to determine whether this monitoring modality can be used to improve clinical outcomes.

Acute myocardial infarction.

This article discusses the approach to the management of myocardial infarction (MI) in the intensive care unit setting. It includes an overview of the definition, classification, and underlying pathologic conditions of acute MI and specifically discusses the diagnosis and management of unstable angina, non-ST elevation MI, and ST-segment elevation MI. Diagnosis and treatment of the acute complications of MI are also reviewed.

Self-referenced spectral domain interferometry for improved signal-to-noise measurement of terahertz radiation.

In this work, we demonstrate self-referenced spectral domain interferometry for the electro-optic sampling of terahertz (THz) electric fields. This technique allows reduction of the phase noise of the measurement, thus increasing the signal-to-noise ratio (SNR). Using the proposed technique, we achieve a more than sixfold improvement in the SNR of the detected THz electric field.