Shifting perspectives in coronary involvement of polyarteritis nodosa: case of 3-vessel occlusion treated with 4-vessel CABG and review of literature.

BACKGROUND: Polyarteritis Nodosa (PAN) is a systemic vasculitis (SV) historically thought to spare the coronary arteries. Coronary angiography and contemporary imaging reveal coronary stenosis and dilation, which are associated with significant morbidity and mortality. Coronary arteries in PAN are burdened with accelerated atherosclerosis from generalized inflammation adding to an inherent arteritic process. Traditional atherosclerotic risk factors fail to approximate risk. Few reports document coronary pathology and optimal therapy has been guarded. METHODS: Database publication query of English literature from 1990-2022. RESULTS: Severity of coronary involvement eludes laboratory monitoring, but coronary disease associates with several clinical symptoms. Framingham risk factors inadequately approximate disease burden. Separating atherosclerosis from arteritis requires advanced angiographic methods. Therapy includes anticoagulation, immunosuppression and revascularization. PCI has been the mainstay, though stenting is confounded by vagarious alteration in luminal diameter and reports of neointimization soon after placement. CONCLUSIONS: When graft selection avoids the vascular territory of SV's, CABG offers definitive therapy. We have contributed report of a novel CABG configuration in addition to reviewing, updating and discussing the literature. Accumulating evidence suggests discrete clinical symptoms warrant suspicion for coronary involvement.

Synthesis of Water-Dispersible Poly(dimethylsiloxane) and Its Potential Application in the Paper Coating Industry as an Alternative for PFAS-Coated Paper and Single-Use Plastics.

Polyethylene-, polyvinylidene chloride-, and per- and polyfluoroalkyl substance-coated paper generate microplastics or fluorochemicals in the environment. Here, we report an approach for the development of oil-resistant papers using an environmentally friendly, fluorine-free, water-dispersible poly(dimethylsiloxane) (PDMS) coating on kraft paper. Carboxylic-functionalized PDMS (PDMS-COOH) was synthesized and subsequently neutralized with ammonium bicarbonate to obtain a waterborne emulsion, which was then coated onto kraft paper. The water resistance of the coated paper was determined via Cobb60 measurements. The Cobb60 value was reduced to 2.70 ± 0.14 g/m2 as compared to 87.6 ± 5.1 g/m2 for uncoated paper, suggesting a remarkable improvement in water resistance. Similarly, oil resistance was found to be 12/12 on the kit test scale versus 0/12 for uncoated paper. In addition, the coated paper retained 70-90% of its inherent mechanical properties, and more importantly, the coated paper was recycled via pulp recovery using a standard protocol with a 91.1% yield.

Successful Transcatheter Closure of a Rare Malaligned Atrial Septal Defect With a Membranous Chord.

Atrial septal defect (ASD) is a common congenital defect that leads to various hemodynamic complications if untreated. Transcatheter closure (TCC) of isolated secundum ASD is the preferred treatment. Herein we describe a unique malaligned ASD secondary to a membranous chord. With balloon sizing and intracardiac echocardiography (ICE), TCC was successfully pursued. (Level of Difficulty: Beginner.).

Real-time noninvasive estimation of intrapleural pressure in mechanically ventilated patients: a feasibility study.

A method for real-time noninvasive estimation of intrapleural pressure in mechanically ventilated patients is proposed. The method employs a simple first-order lung mechanics model that is fitted in real-time to flow and pressure signals acquired non-invasively at the opening of the patient airways, in order to estimate lung resistance (RL), lung compliance (CL) and intrapleural pressure (Ppl) continuously in time. Estimation is achieved by minimizing the sum of squared residuals between measured and model predicted airway pressure using a modified Recursive Least Squares (RLS) approach. Particularly, two different RLS algorithms, namely the conventional RLS with Exponential Forgetting (EF-RLS) and the RLS with Vector-type Forgetting Factor (VFF-RLS), are considered in this study and their performances are first evaluated using simulated data. Simulations suggest that the conventional EF-RLS algorithm is not suitable for our purposes, whereas the VFF-RLS method provides satisfactory results. The potential of the VFF-RLS based method is then proved on experimental data collected from a mechanically ventilated pig. Results show that the method provides continuous estimated lung resistance and compliance in normal physiological ranges and pleural pressure in good agreement with invasive esophageal pressure measurements.