Control of physical properties in BiFeO3nanoparticles via Sm3+and Co2+ion doping.

Highly crystalline BiFeO3(BFO), Bi0.97Sm0.03FeO3(Sm-BFO) and BiFe0.97Co0.03O3(Co-BFO) nanoparticles (NPs) were utilized as potential magnetic hyperthermia agents at two different frequencies in the radiofrequency (RF) range, and the effect of Sm3+and Co2+ion doping on the physical properties of the material was examined. The thermal behaviour of the as-prepared powders disclosed that the crystallization temperature of the powders is affected by the incorporation of the dopants into the BFO lattice and the Curie transition temperature is decreased upon doping. Vibrational analysis confirmed the formation of the R3c phase in all compounds through the characteristic FT-IR absorbance bands assigned to O-Fe-O bending vibration and Fe-O stretching of the octahedral FeO6group in the perovskite, as well as through Raman spectroscopy. The shift of the Raman-active phonon modes in Sm-BFO and Co-BFO NPs indicated structural distortion of the BFO lattice, which resulted in increased local polarization and enhanced visible light absorption. The aqueous dispersion of Co-BFO NPs showed the highest magnetic hyperthermia performance at 30 mT/765 kHz, entering the therapeutic temperature window for cancer treatment, whereas the heating efficiency of all samples was increased with increasing frequency from 375 to 765 kHz, making our doped nanoparticles to be suitable candidates for potential biomedical applications.

Anomalous circumflex artery: a benign variant generating a malignant potential after valve surgery.

Coronary artery anomalies are a diverse group of congenital disorders presenting with highly variable clinical manifestations. The anomalous origin of left circumflex artery from the right coronary sinus following a retro-aortic trajectory is a well-recognized anatomic variation. Despite its benign course, it can prove lethal in association with valvular surgery. When single aortic valve replacement or combined with mitral valve replacement is performed, the aberrant coronary vessel may be compressed by or between the prosthetic rings triggering postoperative lateral myocardial ischemia. If left untreated, the patient is at risk of sudden death or myocardial infarction with its detrimental complications. Skeletonization and mobilization of the aberrant coronary artery is the most widely accepted intervention, but valve downsizing or concomitant surgical or transcatheter revascularization have also been described. However, large series are lacking from the literature. Therefore, no guidelines exist. This study is a thorough review of the literature concerning the aforementioned anomaly in association with valvular surgery.

Toward the Separation of Different Heating Mechanisms in Magnetic Particle Hyperthermia.

Magnetic particle hyperthermia (MPH) is a promising method for cancer treatment using magnetic nanoparticles (MNPs), which are subjected to an alternating magnetic field for local heating to the therapeutic range of 41-45 °C. In this window, the malignant regions (i.e., cancer cells) undergo a severe thermal shock while healthy tissues sustain this thermal regime with significantly milder side effects. Since the heating efficiency is directly associated with nanoparticle size, MNPs should acquire the appropriate size to maximize heating together with minimum toxicity. Herein, we report on facile synthetic controls to synthesize MNPs by an aqueous precipitation method, whereby tuning the pH values of the solution (9.0-13.5) results in a wide range of average MNP diameters from 16 to 76 nm. With respect to their size, the structural and magnetic properties of the MNPs are evaluated by adjusting the most important parameters, i.e. the MNP surrounding medium (water/agarose), the MNP concentration (1-4 mg mL-1), and the field amplitude (20-50 mT) and frequency (103, 375, 765 kHz). Consequently, the maximum heating efficiency is determined for each MNP size and set of parameters, outlining the optimum MNPs for MPH treatment. In this way, we can address the different heat generation mechanisms (Brownian, Néel, and hysteresis losses) to different sizes and separate Brownian and hysteresis losses for optimized sizes by studying the heat generation as a function of the medium viscosity. Finally, MNPs immobilized into agarose solution are studied under low-field MPH treatment to find the optimum conditions for clinical applications.

Long-Range Ordering Effects in Magnetic Nanoparticles.

The challenge for synthesizing magnetic nanoparticle chains may be achieved under the application of fixation fields, which are the externally applied fields, enhancing collective magnetic features due to adequate control of dipolar interactions among magnetic nanoparticles. However, relatively little attention has been devoted to how size, concentration of magnetic nanoparticles, and intensity of an external magnetic field affect the evolution of chain structures and collective magnetic features. Here, iron oxide nanoparticles are developed by the coprecipitation method at diameters below (10 and 20 nm) and above (50 and 80 nm) their superparamagnetic limit (at about 25 nm) and then are subjected to a tunable fixation field (40-400 mT). Eventually, the fixation field dictates smaller particles to form chain structures in two steps, first forming clusters and then guiding chain formation via "cluster-cluster" interactions, whereas larger particles readily form chains via "particle-particle" interactions. In both cases, dipolar interactions between the neighboring nanoparticles augment, leading to a substantial increase in their collective magnetic features which in turn results in magnetic particle hyperthermia efficiency enhancement of up to one order of magnitude. This study provides new perspectives for magnetic nanoparticles by arranging them in chain formulations as enhanced performance magnetic actors in magnetically driven magnetic applications.

Secondary tracheal distortion in an adult patient after therapy for diphtheria at childhood.

We report a rare case of difficult intubation because of trachea deformation after therapy for diphtheria and subsequent tracheostomy at childhood. The patient was admitted to be subjected to a Bentall procedure, because of ascending aorta dilatation. With a detailed preanesthetic assessment and simulation for intubation by using three-dimensional technology, he was successfully intubated and the operation was accomplished uneventfully. 3D-printed models of the difficult airway enhance imaging of difficult anatomy, assist in simulation and management of potentially problematic intubation, and can be a valuable tool when dealing with airways with potential anatomical malformations.

Perioperative use of iloprost in cardiac surgery patients diagnosed with heparin-induced thrombocytopenia-reactive antibodies or with true HIT (HIT-reactive antibodies plus thrombocytopenia): An 11-year experience.

Thrombocytopenia and thromboembolism(s) may develop in heparin immune-mediated thrombocytopenia (HIT) patients after reexposure to heparin. At the Onassis Cardiac Surgery Center, 530 out of 17,000 patients requiring heart surgery over an 11-year period underwent preoperative HIT assessment by ELISA and a three-point heparin-induced platelet aggregation assay (HIPAG). The screening identified 110 patients with HIT-reactive antibodies, out of which 46 were also thrombocytopenic (true HIT). Cardiac surgery was performed in HIT-positive patients under heparin anticoagulation and iloprost infusion. A control group of 118 HIT-negative patients received heparin but no iloprost during surgery. For the first 20 patients, the dose of iloprost diminishing the HIPAG test to ≤5% was determined prior to surgery by in vitro titration using the patients' own plasma and donor platelets. In parallel, the iloprost "target dose" was also established for each patient intraoperatively, but before heparin administration. Iloprost was infused initially at 3 ng/kg/mL and further adjusted intraoperatively, until ex vivo aggregation reached ≤5%. As a close correlation was observed between the "target dose" identified before surgery and that established intraoperatively, the remaining 90 patients were administered iloprost starting at the presurgery identified "target dose." This process significantly reduced the number of intraoperative HIPAG reassessments needed to determine the iloprost target dose, and reduced surgical time, while maintaining similar primary clinical outcomes to controls. Therefore, infusion of iloprost throughout surgery, under continuous titration, allows cardiac surgery to be undertaken safely using heparin, while avoiding life-threatening iloprost-induced hypotension in patients diagnosed with HIT-reactive antibodies or true HIT.