Background: Redo mitral valve surgery is the standard of care for failed mitral bioprostheses or recurrence of mitral regurgitation after repair. Nonetheless, catheterbased valve-in-valve (ViV) or valve-in-ring (ViR)-procedures increasingly become viable alternatives in high risk subpopula-tions. Despite reported good initial results, only little is known about longer-term outcomes. The present series report long-term outcomes of transcatheter mitral ViV- and ViR-procedures. Methods: All consecutive patients (n=54) undergoing transcatheter mitral ViV- or ViR-procedures for failed bioprostheses or recurring regurgitation after mitral repair were retrospectively en-rolled in the time period between 2011 and 2021. The mean age was 76.5 ± 6.5 years, and 30 (55.6%) of the patients were male. The procedures were done using a commercially available balloon-expandable transcatheter heart valve. Clinical and echocardiographic follow-up data were obtained out of the hospital’s database and analyzed. Follow-up reached up to 9.9 years with a total of 164.3 patient-years. Results: A total 25 patients received a ViV- and 29 patients a ViR-procedure. Both groups were at high surgical risk with an STS-PROM of 5.9 ± 3.7 % in ViV- and 8.7 ± 9.0% in ViR-patients, respectively (p<0.01). The procedures itself were mainly unevent-ful with no intraoperative deaths and a low conversion rate (n=2/54; 3.7%). VARC-2 procedural success was low (ViV 20.0% and ViR 10.3%; p=0.45), which was either driven by high rates of transvalvular pressure gradients “>5mmHg” (ViV 92.0% and ViR 27.6%; p<0.01) or residual regurgitation “>trace” (ViV 28.0% and ViR 82.7%; p<0.01). ICU-stay was prolonged in both groups (ViV 3.8 ± 6.8 days and ViR 4.3 ± 6.3 days; p=0.96) with acceptable hospital stay (ViV 9.9 ± 5.9 days and ViR 13.5 ± 8.0 days; p=0.13). Despite 30-days mortality was acceptable (ViV 4.0% and ViR 6.9%; p=1.00), the mean posthospital survival time was disappointingly low (ViV 3.9 ± 2.6 years and ViR 2.3 ± 2.7 years; p<0.01). Overall survival I the entire group was 33.3%.Cardiac reasons for death were frequent in both groups (ViV 38.5% and ViR 52.2%). Cox-regression analysis identified ViR-procedures as a predictor of mortality (HR 2.36, CI 1.19 - 4.67, p=0.01). Conclusions: Despite acceptable immediate outcomes in this high-risk subpopulation, long-terms results are discouraging. Transvalvular pressure gradients as well as residual regurgitations remained drawbacks in this real-world population. The indication for catheterbased mitral ViV- or ViR-procedures thoughtfully must be made in consideration of conventional redo-surgery or conservative treatment.

There is increasing evidence that some adult mitral valve pathologies may have developmental origins involving errors in cell signaling and protein deposition during valvulogenesis. While early and late gestational stages are well-documented in zebrafish and small mammalian models, longitudinal studies in large mammals with a similar gestational period to humans are lacking. Further, the mechanism of chordae tendineae formation and multiplication remains unclear. This current study presents a comprehensive examination of mitral anterior leaflet and chordae tendineae development in a bovine model (with a gestational period of 9 months). Remarkably distinct from small mammals, bovine development displayed early branched chordae, with increasing attachments only until birth, while the anterior leaflet grew both during gestation and postnatally. Chordae also exhibited accelerated collagen deposition, maturation, and crimp development during gestation. These findings suggest that the bovine anterior leaflet and chordae tendineae possess unique compartmentalized processes of development despite being a continuous collagenous structure.

The Australian tropical montane cloud forest (TMCF) is home to approximately 18 percent of the nation’s total vascular plant species. Over the past century, human activity and industrial development have caused global climate changes, posing a severe and irreversible danger to the entire land-based ecosystem, and WTWHA is no exception. The current average annual temperature of WTWHA in FNQ is 24 °C. However, in the coming years (by 2030), the average annual temperature increase is estimated to be between 0.5 and 1.4 °C compared to the climate observed between 1986 and 2005. Looking further ahead to 2070, the anticipated temperature rise is projected to be between 1.0 and 3.2 °C, with the exact range depending on future emissions. We identified 84 plant species endemic to the WTWHA in FNQ, which are already experiencing climate change threats. Few of these plants are used in herbal medicines. This study comprehensively reviewed metabolomics studies conducted on these 84 plant species until now toward understanding their physiological and metabolomics responses to global climate change. This review also discusses: i) recent developments in plant metabolomics studies that can be applied to study and understand the interactions of wet tropical plants with climatic stress, ii) medicinal plants and isolated phytochemicals with structural diversity, and iii) reported biological activities of crude extracts and isolated compounds.

Background: Diabetes mellitus (DM) and osteoporosis are two of the most widespread metabolic disease in the world. The aim of this study is to investigate the prevalence of DM among patients affected by osteoporosis and fragility fractures, and to search differences in clinical features. Methods: 713 patients belonging to CTO Bone Unit because of osteoporosis and fragility fractures were divided into two groups, according to the diagnosis of DM. The clinical and bone characteristics of patients were compared. Results: Prevalence of DM was 10.8%. When compared to patients without DM, the median age at the time of first fracture was similar (72 years ± 14 IQR vs 71 years ± 12 IQR); prevalence of combination of vertebral and hip fractures was higher (p=0.039), as well as prevalence of males, although not significantly (p=0.051). Bone mineral density (BMD) at all sites was higher in DM group; Trabecular Bone Score (TBS), instead, was significantly lower (p&lt;0.001). Conclusions: Patients with fragility fractures and DM more frequently show combination of major fractures with higher BMD levels. In these patients, TBS could be a better indicator of bone health than BMD and therefore should be used as a diagnostic tool in clinical practice.

Digital twins are an emerging technology that could be harnessed for the digitalization of the industry. Steel industry systems contain a large number of electro-hydraulic components, as proportional valves. An input-output model for a novel water proportional cartridge valve is derived from physical modelling based on fluid mechanics, dynamics, and electrical principles. The valve is a two-stage valve with two 2/2-way water proportional valves as the pilot stage and a marginally stable poppet-type cartridge valve as the main valve. The orifice equation, which is based on Bernoulli principles, is approximated by a polynomial which makes parameter estimation easier and makes modelling possible without measuring pressure of the varying control volume situated in the pilot stage part of the valve. Data were collected when the valve was operating as a component in a closed-loop system as part of a press-mill machine in a steel manufacturing plant. Parameter estimation was made by convex optimization with physical constraints to overcome problems caused by poor system excitation. For comparison, a simple linear model was derived and the least squares method used for parameter estimation. A thorough estimation of the parameters relative errors is presented. The model contains 5 parameters related to the design parameters of the valve. The modelled position output is in good agreement with experimental data for training and test data. The model can be used for real time monitoring of the valve’s status by the model parameters. One of the model parameters varies linearly with production cycles. Thus, aging of the valve can be monitored.

Cryptococcus neoformans is a facultative intracellular fungal pathogen. Ten-generation-old (10GEN) C. neoformans cells are more resistant to phagocytosis and killing by macrophages than younger daughter cells. However, mechanisms that mediate this resistance and intracellular parasitism are poorly understood. Here, we identified factors important for the intracellular survival of 10GEN C. neoformans, such as urease activity, capsule synthesis, and DNA content using flow cytometry and fluorescent microscopy techniques. Real-time visualization of time-lapse imaging was applied to determine the phagosomal acidity, membrane permeability, and vomocytosis (non-lytic exocytosis) rate in J774 macrophages that phagocytosed C. neoformans of different generational ages. Our results showed that old C. neoformans exhibited higher urease activity, and enhanced capsule formation, which was supported by an increased Golgi complex. In addition, old C. neoformans were more likely to be arrested in the G2 phase, resulting in the occasional formation of aberrant trimera-like cells. To finish, the advanced generational age of the yeast cells slightly reduced vomocytosis events within host cells, which might be associated with increased phagolysosomal pH and membrane permeability. Altogether our results contribute to a better understanding of the strategies used by old C. neoformans to resist phagosomal killing and suggest that old generation C. neoformans intracellular behavior may be driving cryptococcosis pathogenesis.

Depressions containing partially molten rocks were investigated in Quaternary pebbly sedi-ments in Alpine foreland in Bavaria, Germany. Ruins of limekilns from 18-19th centuries are abundant around Seeshaupt. They are usually associated with earthworks for fuel feeding and protection from wind. Depressions contain partially molten stones from furnace walls, with lime and burnt loam remnants. On the surface of pebbles (typically gneisses), green glass formed with chemical composition possibly affected by moderately volatile components of wood biomass, mainly K and Cu. Thermoplastic deformation of pebbles is limited and the sur-face melt deformation points to slow flow. At Emmerting, on the other hand, two walled circu-lar depressions which lack additional earthworks have been identified as possible impact cra-ters. Thermally affected pebbles show much more intense deformation. Colorless to greenish glass, also K and Cu enriched, usually forms only thin surface coatings, in places covered by younger melt extruded from pebble interior. Burnt loam is missing. At Grabenstätt-Kaltenbach, a depression of unclear origin was investigated. Morphologically, it matches craters rather than limekilns, but anthropogenic contamination (brick-like material) is probable. The rare molten samples do not display extreme deformation features. The thermally affected stones, mainly those from Emmerting, have elevated magnetic susceptibility.

Minimally invasive approaches to the aortic valve have been described since 1993, with great hopes that they would become universal and facilitate day-case cardiac surgery. The literature has shown that these procedures can be undertaken with equivalent mortality, similar operative time, comparative cost and some benefits in hospital length of stay. The competing efforts of the transcatheter aortic valve implantation for these same outcomes have provided an excellent range of treatment options for patients from the Heart Team. We describe the current state of the art, including technical considerations, caveats and complications of minimal access aortic surgery and predict future directions in this space.

Background: Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. Objective: To investigate the characteristics and prognosis of IE according to the affected valves. Material and methods: The study is retrospective, single-center, cross-sectional and includes 270 patients with diagnosis IE, for the period 2005 – 2021, who received treatment at the University Hospital "St. Georgi" in Plovdiv, Bulgaria. Results: Single-valve IE (SIE) was found in 82.6% (n-222), multivalvular IE (MIE) in 16.66% (n=45) and device IE (CDRIE) in 0.74% (n=2) patients. The most commonly affected valve was the aortic 44.8% (n=121). The predominant multivalvular involvement was aortic-mitral valves (AV-MV) – 13.7% (n=37). The patients with tricuspid valve (TV) IE were significantly younger – 39 (30) years and were more frequently male (80.8%). Mortality was higher in MIE than SIE (31.1% vs 23.8%) and highest in multivalve aortic-tricuspid (AV-TV) IE (75%). Early surgery was done most in AV-MV IE 29.7% (n=11). Charlson comorbidity index was significantly higher in MV 4 (4) and AV 3 (3) than TV IE 1 (5) (p=0.048 and p=0.011, respectively). Septic shock occurred most frequently in AV-TV involvement (75%; p=0.0001). The most common causative agent was Staphylococcus group. Staphylococcus aureus affected more often TV alone 46.2% (n=124) vs. AV 9.9% (n=14); p=0.0001 and vs. MV 22.6% (n=17), p=0.022; Staphylococcus coagulase-negative (CNG) was the prevalent cause of MV IE 22.7% (n=17) vs AV-MV 2.7% (n=1); p=0.007. Streptococci were represented in a low percentage and only in left-sided IE, and more frequently in AV-MV 18.9% (n=7); vs. AV 6.6% (n=8); (p=0.025). Conclusion: Aortic valve is the most frequently affected valve, as single valve IE or multivalve AV-MV, with the predominant causative agents Staphylococcus group. The AV-TV IE has the worst prognosis, with the most common complication of septic shock and the highest in-hospital mortality.

Aortic valve stenosis and malignancy frequently coexist and share the same risk factors as atherosclerotic disease. Data reporting the prognosis of patients with severe aortic stenosis and cancer are limited. Tailoring the correct and most optimal care for cancer patients with severe aortic stenosis is complex. Cancer patients may be further disadvantaged by aortic stenosis if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and heart failure (HF). Nowadays, several therapeutic options are available for aortic valve stenosis (surgical valve replacement , transcatheter valve implantation, balloon valvuloplasty, or medical therapy), but in presence of malignancy, the use of one of these versus the others should be decided on a case-by-case approach, depending on cancer stage and associated treatment, expected outcome, comorbidities and after an accurate physical examination and Doppler-echocardiography which are the key tools for diagnosing and evaluating aortic stenosis. The current review considers the available data on the association between aortic stenosis and cancer, and therapeutic options.

(1) Background: To identify the association between the presence or absence of raphe and aortic valve dysfunction as well as the presence of aortopathy in patients with bicuspid aortic valve (BAV); (2) Methods: This retrospective study enrolled 312 participants (mean [SD] age, 52.7 [14.3] years; 227 men [72.8%]) with BAV. The BAVs were divided into those with presence (raphe+) or absence (raphe-) of raphe. Valvular function was classified as normal, aortic regurgitation (AR), or aortic stenosis (AS) using TTE. The pattern of BAV aortopathy was determined by the presence of dilatation at the sinus of Valsalva and the middle ascending aorta using CCT.; (3) Results: BAVs with raphe+ had a higher prevalence of AR (148 [79.5%] vs. 48 [37.8%], P < .001) but a lower prevalence of AS (90 [48.6%] vs. 99 [78.0%], P < .001) compared with those with raphe-. The types of BAV aortopathy were significantly different (P = 0.021) according to those with BAV-raphe+ and BAV-raphe-.; (4) Conclusions: The presence of a raphe was significantly associated with a higher prevalence of AR but a lower prevalence of AS and combined dilatation of the aortic root and middle ascending aorta. The presence of raphe was an independent determinant of AR.

Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several uncertainties have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns are with regards to the longevity of the valves. Several factors have been identified that may predict poor outcomes following TAVI. These include the lesser-used finite element analysis (FEA) to quantify the properties of calcifications that affect TAVI valves. This can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities are now widely available such as Multi-detector row computed tomography(MDCT) which can accurately size the aortic valve annulus.. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention. Structural valve degeneration (SVD) remains a key factor with varying results from current studies. The true incidence of SVD in TAVI compared to SAVR remains unclear with the lack of long term data. It is now widely accepted that both are part of the armamentarium and are not mutually exclusive. Decision-making for the appropriate intervention should be made via shared decision-making involving the heart team.

Background: The association of echocardiographic findings and subsequent risk of left-sided native valve endocarditis (LS-NVE) is undefined. The aim of this study was to determine if transthoracic echocardiographic (TTE) measurements are associated with the subsequent development of LS-NVE in patients without cardiac predisposing conditions. Methods: Institutional databases were evaluated for adults diagnosed with LS-NVE from 2008 to 2020. Patients with prosthetic valves, cardiovascular implantable electronic devices, intracardiac devices, injection drug use, and predisposing cardiac conditions were excluded. Only patients who had a TTE performed 6 months to 3 years before the development of LS-NVE were included as cases. Controls were patients within the same Mayo location with a TTE report and were matched in a 1:3 ratio according to age, gender, Charlson Comorbidity Index, and echocardiography date. Results: There were 148 cases and 431 matched controls. As compared to controls, IE cases had a higher prevalence of diabetes mellitus (46.6% vs. 30.4%) and chronic kidney disease (46.6% vs. 28.1%) (p<0.001). Left ventricular outflow tract velocity (p=0.017), left ventricular ejection fraction (p=0.018), and E: e’ ratio (p=0.050) were associated with LS-NVE. Conclusions: Echocardiographic measurements were associated with subsequent LS-NVE development in this pilot study. A larger cohort of LS-NVE patients, however, is needed to validate these findings.

Caudal regression syndrome (CRS) is a congenital abnormality characterized by an incomplete development of the spinal cord (SC) and other abnormalities. We studied a 9-months old CRS child presenting: interruption of SC at L2-L3 level, sacral agenesis, lack of innervation of the inferior limbs (flaccid paraplegia) and neurogenic bladder and bowel. Given the effects of growth hormone (GH) on the proliferation, differentiation and migration of neural stem cells (NSCs), we treated him with GH and rehabilitation, trying to induce the recovery of main sequelae. GMFM-88 test score was 12.31%. After a blood analysis, GH treatment (0.3 mg/day, 5 days/week, 3 months and then 15 days without GH) and rehabilitation commenced. This protocol was followed during 5 years, being the last GH dose 1 mg/day. Blood analysis and physical exams were performed every 3 months initially and every 6 months later. Six months after commencing the treatment GMFM-88 score increased to 39.48%. Responses to sensitive stimuli appeared in most of the territories explored; 18 months later sensitive innervation was complete and the patient moved any muscle over the knees and controlled his sphincters. Three years later he walked with the help of canes, there was plantar flexion and GMFM-88 score was 78.48%. In summary, GH plus rehabilitation may be useful for innervating distal territories, below the level of the incomplete spinal cord in CRS. Most likely, GH acts on ependymal SC NSCs, as the hormone does in the neurogenic niches in the brain.

Background and Objectives: Trichomonas tenax is a protozoan, participating in the human oral microflora. It is considered as a potential paradontopathogen. This microorganism is also reported in the respiratory tract. We aimed to analyze the available literature about the prevalence of Trichomonas tenax in the population affected by periodontal disease. Materials and Methods: Тhe searching with keywords: ,,Trichomonas tenax” and “periodontal diseases’’ in Scopus, PubMed and ScienceDirect databases was able to identify several systematic reviews and original articles until July 2023. All studies with suffering from periodontal disease people, mentioned year of publication, country, specified detection methods, total number of tested samples as well as the percentage of those infected with Trichomonas tenax were included. Irrelevant articles were excluded. Results: We found 137 studies, but only 64 studies about distribution of Trichomonas tenax in patients with gum disease underwent qualitative analysis. The highest number of studies have been conducted in Iran, Poland and Iraq. Different methods have been used to detect the unicellular organism, each with different specificity and sensitivity. Conclusions: Interest in Trichomonas tenax has grown considerably since 2000. Because of its association with periodontal disease, Trichomonas tenax role in the inflammatory process shouldn’t be overlooked.

In new Guideline for the Management of Patients with Valvular Heart Disease for tricuspid regurgitation (TR) is focused the importance of measurement of right-sided diastolic pressures and right ventriculography, pulmonary artery pressures, and pulmonary vascular resistance. Assessment of right ventricular (RV) dimensions and function is pivotal to select patients with severe tricuspid regurgitation who may benefit from tricuspid valve intervention. However, with the exception of tricuspid valve annulus diameter, there is no other cut-off value that defines severe RV dysfunction or dilation for this specific group of patients. It may be difficult, if not impossible, to establish a cut-off value of RV dysfunction since the RV may be exposed to pressure and volume overload, myocardial ischemia, intrinsic myocardial disease or pericardial constraint. Furthermore, the response of the RV to tricuspid valve intervention may vary according to each aetiology and the time course of the disease (acute or chronic). Comprehensive assessment of RV function should address in shape remodelling; functional remodelling; tissue remodelling. This assessment should be performed in optimal loading conditions and after euvolemia has been achieved. It’s now that there is no other cut-off value that defines severe RV dysfunction or dilation for patients with severe TR with the exception of tricuspid valve annulus diameter. It may be difficult, if not impossible, to establish a cut-off value of RV dysfunction since the RV may be exposed to pressure and volume overload, myocardial ischemia, intrinsic myocardial disease or pericardial constraint. In this review we analyze the relationship between right ventricular (RV) and TR in term of outcomes and mortality predictor in patients undergoing percutaneous or invasive treatment for severe TR.

To evaluate whether the extent of cardiac damage in severe aortic stenosis (AS) might be associated with the occurrence of conduction system disorders after TAVI. A total of 153 symptomatic patients with severe AS who had a TAVI were categorized before the procedure according to the extent of cardiac damage: stage 1 (13.5%): no or LV damage; stage 2 (58.8%): left atrial/mitral valve damage, atrial fibrillation (AF); stage 3 (27.7%): low-flow state, pulmonary vasculature/tricuspid valve/RV damage. After TAVI, 34% of patients exhibited LBBB and 10% high-degree atrioventricular block (HD-AVB). No patient in group 1 developed HD-AVD whereas new LBBB was frequent in groups 2 and 3. Twenty-one patients presented with resolutive paroxysmal AF with a higher rate for each group increment (group 1: n=0, 0%; group 2: n=11,15.7%; group 3: n=10, 30.3%) (p = 0.012). Patients in group 3 had the higher rate of permanent pacemaker implantation (PPMI) (group 1: n=1, 6.3%; group 2: n=7,10%; group 3: n=9, 27.3%) (p=0.012). No patient in group 1 died during the hospital stay. In conclusion, cardiac damage staging of AS might help identify patients at higher risk of conduction disorders and PPMI requirement after TAVI.

Background/Objectives: Infectious Endocarditis often requires surgical intervention, with postoperative acute kidney injury (AKI) posing a significant concern. This retrospective study aimed to investigate AKI incidence, its impact on short-term mortality, and identify modifiable factors in patients with endocarditis scheduled for valve surgery. Methods: This single center study enrolled 130 consecutive endocarditis patients from 2013 to 2021 undergoing valve surgery. Creatinine levels were monitored pre- and postoperatively, and AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient demographics, comorbidities, procedural details, and complications were recorded. Primary outcomes included AKI incidence, the relevance of creatinine levels for AKI detection, and the association of AKI with 30-, 60- and 180-day mortality. Modifiable factors contributing to AKI were explored as secondary outcomes. Results: Postoperatively, 35.4% developed AKI. The highest creatinine elevation occurred on the 2nd postoperative day. Best predictive value for AKI was a creatinine level of 1.35 mg/dl on the 2nd day (AUC: 0.901; sensitivity: 0.89, specificity: 0.79). Elevated creatinine levels on the 2nd day were robust predictors for short-term mortality at 30, 60 and 180 days postoperatively (AUC ranging from 0.708 to 0.789). CK-MB levels at 24 hours postoperatively and minimum hemoglobin during surgery were identified as independent predictors for AKI in logistic regression. Conclusions: This study highlights the crucial role of creatinine levels in predicting short-term mortality in surgical endocarditis patients. A specific threshold (1.35 mg/dl) provides a practical marker for risk stratification, offering insights for refining perioperative strategies and optimizing outcomes in this challenging patient population.

Introduction. Recent studies revealed that differentiation of valvular interstitial cell into myofibroblasts played an important role in pathological valve remodeling in rheumatic valvular disease. Objective. To investigate effects of atorvastatin, olmesartan, and resveratrol on Transforming Growth Factor β1-induced fibrosis. Methods. Valvular interstitial cell was isolated from 12-weeks male New Zealand rabbit (Oryctolagus cuniculus). Culture cells was divided into 4 groups, control group, group I (0.5 mg/mL Atorvastatin), group II (100 nmol/L Olmesartan), group III (50 μM/L Resveratrol) and group IV (combinations). All group were exposed to 100 nM Transforming Growth Factor β1 for 24 hours. Results. Immunochemical staining demonstrated that cells were completely differentiated into myofibroblasts with mean expression of α-smooth muscle actin 24522.64±4566.994. Atorvastatin, olmesartan, resveratrol, and its combination significantly reduced α-smooth muscle actin expression (6823±1735.3, 6942.7±2455.9, 14176.2±3343.3, 5051.8±1612.2 respectively (p<0.001). Conclusion. Our data showed atorvastatin, olmesartan, resveratrol, and its combination significantly reduce Transforming Growth Factor β1-induced valvular fibrosis.

: Inflammation may mediate the association of mitral valve prolapse (MVP) with ventricular scarring and arrhythmia. The purpose of this study is to investigate the association of neutrophil- and platelet-to-lymphocyte ratios (NLR, PLR) with ventricular arrhythmia in MVP. Clinical and demographic data were extracted from electronic medical records for all patients aged 18-90 years with MVP on echocardiography between 2016-19 at our institution. We studied 65 patients who had a differential blood count within six months prior to ambulatory ECG (A- ECG) (medi-an age [IQR] 70 [61-77] years; 62% female; 12% African American). Patients with surgery or in-fection within six months prior to CBC were excluded. Complex or frequent ventricular ectopy (cfVE) was defined as the presence of two or more premature ventricular contractions (PVCs) on a 10-second ECG tracing or greater than 1% PVC burden or NSVT on ambulatory ECG monitoring. Logistic and bivariate regression was used to analyze clinical, electrocardiographic and echo-cardiographic factors associated with NLR and PLR. Factors associated with higher NLR were congestive heart failure (p=0.005), male sex (p=0.01), age (p=0.003), and bileaflet MVP (p=0.04). NLR was associated with higher absolute PVC burden (rs=0.28, p=0.03) and cfVE (median NLR [IQR] 3.0 [1.6 – 6.3]) with cfVE versus (2.4 [1.4-3.4], p=0.04) without cfVE. An NLR of 5.6 yielded 50% sensitivity and 90% specificity for PVC burden >1% (AUC 0.69). No significant association was found between PLR and PVC burden or cfVE. NLR is associated with PVC burden and com-plex ventricular ectopy in MVP, suggesting that inflammation is a significant factor in the patho-genesis of ventricular arrhythmia in this condition.

The Tesla valve (TV), a valvular conduit invented by Nicola Tesla over a decade ago, has recently gained significant attention and application in various fields due to the growing interest in microfluidics and nanofluidics. The unique architecture of TV characterized by an asymmetrical design and an arc-shaped channel, has long been an intriguing yet underrated design for building a passive component in a microfluidic system. While previously regarded as a technology without significant use, TV structures have been implemented in wearable devices, thermal manipulation fluidics, micromixers, micropumps, and fuel cell devices. This article presents the first comprehensive review of TV structures in the literature, which has seen significant growth in the last two years. The review discusses typical TV structures, including single-stage TV (STV), multistage TV (MSTV), and TV derivatives (TVD), along with their characteristics and potential applications. The designs of these structures vary based on their intended applications, but all are constructed based on the fundamental principle of the TV structure. Finally, future trends and potential applications of TV structures are summarized and discussed. This review provides a valuable reference for students, early-career scientists, and practitioners in the field of fluidic devices, particularly those interested in using TV structures as passive components.

Nowadays energy saving is a topical issue due to increasing fuel costs and this aspect is amplified by more stringent emissions regulations that impact on vehicle development. A recent study conducted by the U.S. Department of Energy shows that about five percent of the U.S. energy consumption is transmitted by fluid power equipment. Nevertheless, this study also shows that the efficiency of fluid power averages 21 percent. This offers a huge opportunity to improve the current state-of-the-art of fluid power machines, in particular to improve the energy consumption of current applications. These facts dictate a continuous strive toward improvements and more efficient solutions: to accomplish this objective a strong reduction of hydraulic losses and better control strategies of the hydraulic systems are needed. In fluid power, there exist many techniques to reduce/recover energy losses of the conventional layouts, e.g. load sensing, electrohydraulic flow matching, independent metering, etc. One of the most efficient ways to analyze these different layouts and identify the best hydraulic solution is done through virtual simulations instead of prototyping, since the latter involves higher investment costs to deliver the product into the market. However, to build a fluid power machine virtual model, some problems arise relative to different aspects, for instance: loads on actuators (both linear and rotational) are not constant and pumps are driven by a real engine whose speed depends on required torque. Furthermore, it is important to achieve higher level of detail to simulate each component in the circuit: the greater detail, the better the machine behavior is portrayed, but it obviously entails heavy impact on simulation time and computational resources. Therefore, there is a need to create mathematical model of components and systems with sufficient level of detail to easily acquire all those phenomena necessary to correctly evaluate machine performance and make modifications to the fluid power component design. In this context, a hydraulic proportional valve PVG 32 by Danfoss is taken as an object of study, its performance is analyzed with suitable mathematical model and simulation is done to observe closeness of a model to the laboratory experiment.

This paper proposes a position control method for low cost EGR valve system in automotive application. Generally, position control system using in automotive application has many restrictions such as cost and space, the mechanical structure of actuator implies high friction and large difference between static friction and coulomb friction. This large friction difference occurs the vibrated position control result when the controller uses conventional linear controller such as P, PI. In this paper, low cost position control method which can apply under the condition of high difference friction mechanical system. Proposed method is verified by comparing conventional control result of experiments.

During the Renaissance, Leonardo Da Vinci was the first person to successfully detail the anatomy of the aortic root and its adjacent structures. Ever since, novel insights into morphology, function and their interplay have accumulated resulting in advanced knowledge on complex functional characteristics of the aortic valve (AV) and root. This shifted the vision from the AV as being a static structure towards that of a dynamic interconnected apparatus within the aortic root as a functional unit, exhibiting a complex interplay with adjacent structures via both humoral and mechanical stimuli. This paradigm shift has stimulated surgical treatment strategies of valvular disease that seek to recapitulate healthy AV function, whereby AV disease can no longer be seen as an isolated morphological pathology which needs to be replaced. As prostheses still cannot reproduce the complexity of human nature, treatment of diseased AVs, whether stenotic or insufficient, has tremendously evolved with a similar shift towards treatments options that are more hemodynamically centered such as the Ross procedure and valve-conserving surgery. Native AV and root components allow for an efficient Venturi effect over the valve to allow for optimal opening during the cardiac cycle, while also alleviating the left ventricle. Next to that, several receptors are present on native AV leaflets, enabling messenger pathways based on their interaction with blood and other shear-stress related stimuli. Many of these physiological and hemodynamical processes are under acknowledged but may hold important clues for innovative treatment strategies, or as potential novel targets for therapeutic agents that halt or reverse the process of valve degeneration. A structured overview of these pathways and their implications for cardiothoracic surgeons and cardiologists is lacking. As such, we provide an overview on embryology, hemodynamics, and messenger pathways of the healthy and diseased AV and its implications for clinical practice, by relating this knowledge to current treatment alternatives and clinical decision-making.

In the current study, a two-dimensional numerical study is carried out to investigate the performance of a novel Double-chamber Parallel Flexible Valves micropump, which utilized the electrowetting-on-dielectrics (EWOD) effect to drive the microfluid flow. By observing the flow fields, the internal circulations are seen on both the left and right side of the pump. The generation of the backflow is discussed by tracking the movement of the vortices. Only slight flow fluctuation is seen in the micropump. Based on the simulation outcomes, the structural parameters including the width of the inlet/outlet, the width of the pumping channel and the diverging angle in the micropump are analyzed, the influence of these parameters on the pumping volume and the maximum pressure have been discussed. Eventually, a group of optimal parameter combinations is given according to the results to extend the operating potential of the micropump.

Transcatheter Aortic Valve Implantation (TAVI) now represents the mainstay in the treatment of severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as a cornerstone. Leveraging data from multiple randomized controlled trials, current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without, or with atrial fibrillation respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual-patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.

This study describes the development of an automated bag valve mask (BVM) compression system, which, during acute shortages and supply chain disruptions can serve as a temporary emergency ventilator. The resuscitation system is based on the Arduino controller with a real-time operating system installed on a largely RepRap 3-D printable parametric component-based structure. The cost of the system is under $170, which makes it affordable for replication by makers around the world. The device provides a controlled breathing mode with tidal volumes from 100 to 800 milliliters, breathing rates from 5 to 40 breaths/minute, and inspiratory-to-expiratory ratio from 1:1 to 1:4. The system is designed for reliability and scalability of measurement circuits through the use of the serial peripheral interface and has the ability to connect additional hardware due to the object-oriented algorithmic approach. Experimental results demonstrate repeatability and accuracy exceeding human capabilities in BVM-based manual ventilation. Future work is necessary to further develop and test the system to make it acceptable for deployment outside of emergencies in clinical environments, however, the nature of the design is such that desired features are relatively easy to add with the test using protocols and parametric design files provided.

Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications including young patients. However, as for SAVR, TAVR is also associated with a risk of infectious complications, namely prosthetic valve endocarditis (PVE). As the number of performed TAVR procedure increases, and despite the low incidence of PVE post TAVR, clinicians should be familiar with the associated risk factors and the clinical presentation. Whereas the diagnosis of native valve endocarditis can be straightforward applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, lower sensitivity of the criteria, and low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as S. aureus, coagulase negative staphylococci, Enterococcus spp. and Streptococcus spp. (particularly the viridans group) and, less likely Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.

Chronic kidney disease (CKD) affects approximately 12% of the global population posing a significant health threat. Inflammation plays a crucial role in the uremic phenotype of CKD contributing to elevated cardiovascular and overall mortality in affected individuals. This study aimed to explore novel metabolic pathways in non-dialysis dependent stage 5 CKD patients using semitargeted metabolomics. In a prospective observational design involving 50 patients, blood samples collected before the initial hemodialysis session underwent liquid chromatography and high resolution mass spectrometer analysis. Univariate (Mann-Whitney test) and multivariate (logistic regression with LASSO regularization) methods identified metabolomic variables associated with inflammation. Notably, adenosine-5’-phosphosulfate (APS), dimethylglycine, pyruvate, lactate, and 2-ketobutyric acid exhibited significant differences in the presence of inflammation. Cholic acid, homogentisic acid, and 2-phenylpropionic acid displayed opposing patterns. Multivariate analysis indicated increased inflammation risk with certain metabolites (N-Butyrylglycine, dimethylglycine, 2-Oxoisopentanoic acid, and pyruvate), while others (homogentisic acid, 2-Phenylpropionic acid, and 2-Methylglutaric acid) suggested decreased probability. These findings unveil potential inflammation-associated biomarkers related to defective mitochondrial fatty acid beta oxidation and branched-chain amino acid breakdown in CKD, shedding light on cellular energy production and offering insights for further clinical validation.

Studies on crop response to light quality [red (R) to far-red (FR) light ratio] often recommend early weed removal to reduce the effects of shade avoidance responses on crop yield. However, it is unclear whether crops are able to distinguish reflected light quality of kin from that of non-kin. We evaluated the response of sugarbeet (Beta vulgaris L.) to reflected FR light from sugarbeet, common lambsquarters (Chenopodium album L.), Kentucky bluegrass (Poa pratensis L.), alfalfa (Medicago sativa L.), and bare soil (control) under outdoor conditions in 2016 and 2017. Treatments were completely randomized with 10 replications per treatment. The study methods ensured there was no direct resource competition. The reflected R:FR of plant species ranged from 0.06 (common lambsquarters) to 0.24 (sugarbeet) compared to 0.7 for the bare soil. In both 2016 and 2017, there were 2 to 4 more leaves in the sugarbeet surrounded by soil compared to sugarbeet surrounded by neighboring species. There was up to 47, 57, 43, and 23% reduction in sugarbeet leaf area, shoot dry weight, root diameter, and root dry weight, respectively, due to reflected R:FR light from neighboring species. Sugarbeet did not respond differently to reflected light quality of kin compared to non-kin.

This study is aimed at demonstrating application of vegetation spectral techniques for detection and monitoring of impact of oil spills on vegetation. Vegetation spectral reflectance from Landsat 8 data were used in the calculation of five vegetation indices (normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), adjusted resistant vegetation index 2 (ARVI2), green-infrared index (G/NIR) and green-shortwave infrared (G/SWIR) from the spill sites (SS) and non-spill (NSS) sites in 2013 (pre-oil spill), 2014 (oil spill date) and 2015 (post-oil spill) for statistical comparison. The result shows that NDVI, SAVI, ARVI2, G/NIR and G/SWIR indicated certain level difference between vegetation condition at the SS and the NSS were significant with p-value <0.5 in December 2013. In December 2014 vegetation conditions indicated higher level of significant difference between the vegetation at the SS and NSS as follows where NDVI, SAVI and ARVI2 with p-value 0.005, G/NIR - p-value 0.01 and GSWIR p-value 0.05. Similarly, in January 2015 a very significant difference with p-value <0.005. Three indices NDVI, ARVI2 and G/NIR indicated highly significant difference in vegetation conditions with p-value <0.005 between December 2013 and December 2014 at the same sites. Post—spill analysis show that NDVI and ARVI2 indicated low level of significance difference p-value <0.05 suggesting subtle change in vegetation conditions between December 2014 and January 2015. This technique is essential for real time detection, response and monitoring of oil spills from pipelines for mitigation of pollution at the affected sites in the mangrove forest.

The valve controlled cylinder drive system is the most common type among hydraulic applications. The nonlinear behaviour in such system is inevitable when the valve spool around its null position [1] , Leaney [2] utilised component linking method to investigate the nonlinearities in a Moog valve controlled asymmetric cylinder drive system by simulation in Fortran, in which a generalised concept is introduced and validated by comparing to the experimental results. An factor is proposed in the generalised concepts to describe the asymmetric cylinder state, which is a constant when the cylinder in extending or retracting, but numerically calculated when the valve spool in the underlap region [2]. This paper utilises the component linking method to simulate the Moog valve controlled asymmetric cylinder drive system in Matlab Simulink, and proposed an analytical solution for factor when the valve spool in the underlap region.

Spin valves with a synthetic antiferromagnet were fabricated by magnetron sputtering. It was shown that the fabricated spin valves had perfect microstructure of layers and smooth interfaces, therefore RKKY interaction dominates in coupling of ferromagnetic layers separated by a copper spacer. Rhombus-shaped microobjects were fabricated from a single spin valve film. The thermomagnetic treatment procedure was found, to form unidirectional anisotropy in the microobject so, that the values of the exchange bias fields in the rhombus’ nonparallel sides were opposite in sign. For the synthetic antiferromagnet CoFeNi/Ru/CoFeNi the difference between ferromagnetic layers thicknesses was found, at which the thermomagnetic treatment forms the same exchange bias all over the rhombus’ side. The sensor element was fabricated in which each side of the rhombus was a shoulder of a Wheatstone bridge. After the thermomagnetic treatment procedure each shoulder worked as an active magnetosensitive element, thus the device operated as the full Wheatstone bridge. The sensor output has the shape of a step, high sensitivity to field change and significant magnetic hysteresis. Such characteristics are suitable for switching devices.

Background. Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize the surgical trauma, promote an earlier postoperative recovery and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods. Prospectically collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based upon clinical history and anatomy for the allocation to the most appropriate surgical strategy. Selection for the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results. During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and 23 patients, respectively, underwent early surgery (75%) or were operated on after the completion of targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. Causes of death were refractory heart or multiorgan failure and/or septic shock. New onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions. The present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular and echocardiographic screening represent the key points to select the optimal approach and allow the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis.

Background: In America, vaccine-related deaths constitute a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: This study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the Diphtheria, Tetanus, and Pertussis Vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a JoinPoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CI) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of -1.4 (95% CI -1.8.; -1.0). This trend varied across regions. In North America, the decrease was negligible (-0.1% APC). South America showed the steepest decrease, with an APC of -2.5%. Central America also signif-icantly declined, with an APC of -1.3%. Our findings suggest a concerning trend of declining DTP vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was -4 % between 2019 and 2022, with the most significant drop observed in Central America (-7 %). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being -7.37%. This decline poses a significant challenge to achieving the WHO's target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intraabdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy.

Agricultural expansion is altering the provision of ecosystem services and seriously affecting the well-being of the indigenous communities still living in forests. In this paper, we evaluate the impact of forest loss and degradation on the indigenous forest dependent communities of Eastern Salta, Argentina, between 2001 and 2015. First, we identified the demand area of ten final ecosystem services for 202 indigenous communities using participatory mapping data. Second, we calculated the remaining usage area using a deforestation geodatabase based on Landsat images. Third, we analyzed the significance of trends in forest productivity processing vegetation spectral indices from MODIS products. By last, we detected changes in the growing season length by evaluating monthly trends in spectral indices. Our results show a reduction of 21% in the area used by indigenous communities for capturing final ecosystem services, and significant negative trends in forest productivity for the demand area of 64% of the communities, indicating that the area of use is not only being reduced, but also remnant forest area is being degraded and the growing season is being shortened. These aspects indicate an important loss in the provision of ecosystem services that deeply affects the wellbeing of indigenous communities.

Purpose: To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A). Method: A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was surgical success, defined as intraocular pressure (IOP) > 5 mmHg, ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline at two consecutive visits after three months, no reoperation for glaucoma. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 70% in AT, and 65% in A (p=0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p= 0.001). The corresponding numbers for A were 28.8 ± 10.2 and 16.7 ± 4.9, respectively (p= 0.001). The final IOP was significantly lower in AT (p= 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p=0.851). Corresponding number at 1 year visit was 1.2±2 in AT and 2.8±1.8 in A (p=0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p=0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3% and 28.5%, respectively, p=0.67). Conclusion: Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma medications.

We discuss the optimal control formulation for enhancement and denoising of satellite multiband images and propose to take it in the form of an L1-control problem for quasi-linear parabolic equation with non-local p[u]-Laplacian and with a cost functional of a tracking type. The main characteristic feature of the considered class of parabolic problems is the fact that the variable exponent p(t,x) and the anisotropic diffusion tensor D(t,x) are not well predefined a priori, but instead these characteristic non-locally depend on a solution of this problem, i.e., pu=p(t,x,u) and Du=D(t,x,u). We prove the existence of optimal pairs with sparse L1-controls using for that the indirect approach and a special family of approximation problems.

Background. Recent studies revealed that differentiation of valvular interstitial cell into myofibroblasts played an important role in pathological valve remodeling in rheumatic valvular disease. Objective. To investigate effects of atorvastatin, olmesartan, and resveratrol on Transforming Growth Factor β1-induced fibrosis. Methods. Valvular interstitial cell was isolated from 12-weeks male New Zealand rabbit (Oryctolagus cuniculus). Culture cells was divided into 4 groups, control group, group I (0.5 mg/mL Atorvastatin), group II (100 nmol/L Olmesartan), group III (50 μM/L Resveratrol) and group IV (combinations). All group were exposed to 100 nM Transforming Growth Factor β1 for 24 hours. Results. Immunochemical staining demonstrated that cells were completely differentiated into myofibroblasts with mean expression of α-smooth muscle actin 24522.64±4566.994. Atorvastatin, olmesartan, resveratrol, and its combination significantly reduced α-smooth muscle actin expression (6823±1735.3, 6942.7±2455.9, 14176.2±3343.3, 5051.8±1612.2 respectively (p&lt;0.001). Conclusion. Our data showed atorvastatin, olmesartan, resveratrol, and its combination significantly reduce Transforming Growth Factor β1-induced valvular fibrosis.

Diesel engines, as power equipment, are widely used in the fields of automobile industry, ship and power equipment. Due to wear or faulty adjustment, the valve train clearance abnormal fault is a typical failure of diesel engines, which may result in the performance degradation, even valve fracture and cylinder hit fault. However, the failure mechanism features mainly in time domain and angular domain, on which the current diagnosis methods based, are easily affected by working conditions or hard to extract accurate enough, as the diesel engine keeps running in transient and non-stationary process. This work arms at diagnosing this fault mainly based on frequency band features which would change when the valve clearance fault occurs. For the purpose of extracting a series of frequency band features adaptively，a decomposition technique based on improved variational mode decomposition is investigated in this work. As the connection between the features and the fault is fuzzy, the random forest algorithm is used to analyze the correspondence between features and faults. In addition, the feature dimension is reduced to improve the operation efficiency according to importance score. The experimental results under variable speed condition show that the method based on variational mode decomposition and random forest is capable to detect valve clearance fault effectively.

Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder characterized by a variety of both signs and symptoms; it mainly affects women of childbearing age, with an estimated prevalence of 24/100,000 people in Europe and North America. SLE is often described as an antibodies-driven disease as its clinical manifestations are usually associated with the presence or the absence of specific antibodies. Objectives To evaluate clinical manifestations in patients with SLE and to assess the relationship with the presence of specific antibodies by using real-world data. Methods A retrospective study was performed; the 2019 EULAR/ACR Classification Criteria for Systemic Lupus Erythematosus were used to classify patients with SLE. Data concerning serological profiles (which included Antinuclear antibodies – ANA, anti dsDNA, anti-Ro/SS-A, anti-La/SS-B, anti-Sm) were gathered along with medical records of clinical manifestations. Complement levels were also tested for possible clinical correlations. χ² or Fisher's exact tests were utilized to establish associations between autoantibodies and symptoms. The odds ratios (OR) and their 95% confidence intervals (CI) were computed. No correction was made for multiple testing; only a p-value 0.01 ≤ was considered significant. Results One-hundred and twenty-seven patients (n=127, mean age 53.43 ±14.02) were enrolled in this study. Anti-dsDNA antibodies were found to be statistically significant for both malar rash and proteinuria; anti-Ro/SSA antibodies showed an association with photosensitivity and pericarditis; furthermore, a strong association was found between anti-Ro antibodies and proteinuria, but only if anti-dsDNA antibodies were present as well. Patients who tested positive for anti-La/SSB antibodies correlated with a threefold increase in the risk of developing pericarditis. Lastly, anti-Smith appeared to be associated with NPSLE as well as an increased risk for both autoimmune haemolytic anemia and thrombocytopenia. Conclusions In our study, many associations confirmed those found in previous studies; however, new relationships between antibodies and clinical manifestations were found thus indicating the need for additional evaluations to assess these correlations further.

Saline soil from the coast is a valuable resource that is readily available. It is also a valuable resource for reserving arable land. It has been demonstrated that adding organic fertilizers to salinized soils can effectively enhance them. However, since the improvement of saline soils cannot be achieved by a single measure, the effects of compound measures of organic fertilizers combined with mineral elements, humic acid, are significant and might be examined in depth. In order to explore the effects of various measures on the features of pH, electrical conductivity (EC), and nutrient changes in coastal salinized soils in Yancheng, Jiangsu Province, a ryegrass-alfalfa rotation with organic fertilizer as well as compound measures was designed. The findings indicated that the total nitrogen (TN) content of the soil increased and that all organic fertilizer composites decreased the electrical conductivity of the surface soil. However, the organic fertilizer with microbial fertilizer and humic acid was especially effective at regulating the pH and electrical conductivity of the surface soil during the time when salts were prone to accumulating. In conclusion, our findings point to new approaches to lowering salinity and boosting fertility in coastal saline soils: organic fertilizer with microbial fertilizers and humic acid, as well as organic fertilizer with Attapulgite clay.

Drainage divide is a dynamic feature that migrates in response to tectonic activity. The asymmetric uplift between two adjacent basins causes the divide migration from a slower to faster uplift area. Sado Island, Japan, has been affected by southeastward tilting uplift since ca. 300k years. Despite the faster uplift on the northwest, the main divides have existed on the southeast side of the geometric center of the island, with no other feature suggesting tectonic inversion of the tilting direction. In this study, we conducted a DEM-based investigation that focused on divide migration. A spectrum from very inactive to active divide migration in the northwest. Regardless of their position, actively migrating divides are comprehensible, but inactive divides located in a relatively slow uplift area remain unclear. We concluded that some divides slowed down owing to the local balance of erosion rates across the divides, not implying the balance between uplift and river erosion at the basin scale, reflecting disequilibrium in river longitudinal profiles. The main divides of Sado have presumably continued to slowly migrate toward the faster uplift area; however, they are most likely to have never overcome the moving geometric center owing to land expansion at the seacoast due to asymmetric uplift.

The change in both streamflow and baseflow in urban catchments has received significant attention in the latest decades as a result of their drastic variability. In this research, effects of climate variation and dynamics of land use are measured separately and in combination on streamflow and baseflow in the Little Eagle Creek (LEC) watershed (Indianapolis, Indiana). These effects are examined using land use maps, statistical tests, and hydrological modeling. Transition matrix analysis was used to investigate the change in land use between 1992 and 2011. Temporal trends and changes in meteorological data were evaluated from 1980-2017 using the Mann-Kendall test. Changes in streamflow and baseflow were assessed using the Soil and Water Assessment Tool (SWAT) hydrological model using multiple scenarios that varied in land use and climate change. Evaluation of the model outputs showed streamflow and baseflow in LEC are well represented using SWAT; however, comparing the calibration and validation period showed SWAT performs better for the calibration. During 1992-2011, roughly 30% of the watershed experienced change, typically cultivated agricultural areas became urbanized. Baseflow is significantly affected by the observed urbanization; however, the combination of land and climate variability has a larger effect on the baseflow in LEC. Generally, the variability in the baseflow and streamflow appears to be heavily driven by the response to climate change in comparison to variability due to altered land use. The results reported herein expand the current understanding of variation in hydrological components, and provides useful information for management planning regarding water resources, as well as water and soil conservation in urban watersheds in Indiana and beyond.

The four-way reversing valve is a key component determining whether a heat pump air conditioning system can work. Studying the four-way reversing valve is of great significance for improving the performance of the heat pump air conditioning system. In this paper, the control equation of the sliding block movement process is constructed to simulate the reversing process of the four-way reversing valve in fluid mechanics, and a detailed study is carried out from the sliding block speed, sliding block acceleration, sliding block force, refrigerant leakage, and other aspects. Research has shown that optimizing the structure of the slider can greatly improve the working performance of the four-way reversing valve. Increasing the height of the slider not only improves the pressure relief ability of the four-way reversing valve and prevents the slider from being damaged by high-pressure gas impact, but also reduces the leakage of refrigerant during the directional process; When reducing the length of the slider, although it will improve the pressure relief capacity of the four-way reversing valve, it also increases the amount of refrigerant leakage. The research results provide a theoretical basis and improvement direction for designers to improve the performance of four-way reversing valves.

Based on the textured controllable interface effect, the dynamic performances of the textured and ordinary pilot valve are analyzed experimentally, and the influence of the textured controllable interface on the response of pilot valve is studied. Results show that when Pin is small, the textured surface shortens the reciprocating time of valve core, increasing the flow rate, and speeds up the piston stroke of oil cylinder. The valve core actions much more stable and sensitivity. Meanwhile, combined with the theoretical calculation, the operation mechanism of texturing the pilot valve is analyzed. It is concluded that the stress of textured valve core sealing surface is greater than that of ordinary one, and the pressure difference gradually decreases with the increase of Pin, and the flow difference is basically the same as the force on the sealing surface. This indicates that the textured surface improves lubrication characteristics, reduces the friction between components. The textured valve makes the velocity changes gently, and enhances the responsiveness and stability of the valve. Those related results provide a new idea for enhancing the response design of the pilot valve.

Reliability assessment is an important component and tool used for process plants since the facility consists of many loops and instruments attached and operates based on each other availability, thus it requires a statistical method to visualize the reliability. The paper focuses on reliability assessment and prediction based on available statistical models such as normal, log-normal, exponential, and Weibull distribution. This paper also visualizes, which model fits best for assessment and prediction and also considers failure modes caused during a simulation mode process control operation. A simulation model is designed in this paper to observe the failure of the control valve causing stiction to visualize the failure modes and predict the best-fit model for reliability assessment.

Mitral regurgitation (MR) is a broadly diffuse valvular heart disease (VHD) with a significant impact on healthcare system and patient’s prognosis. Transcatheter mitral valve interventions (TMVI) are now well-established techniques included in the therapeutic armamentarium for managing patients with mitral regurgitation, either primary or functional MR. Even if guidelines give indications regarding the correct management of this VHD, the wide heterogeneity of patient’s clinical background, valvular and heart’s anatomy make each patient a unique case, in which the appropriate device’s selection requires a multimodality imaging evaluation and a multidisciplinary discussion. Proper pre-procedural evaluation plays a pivotal role to judge the feasibility of TMVI, as well as a cooperative works between imagers and interventionalist is crucial for procedural success. This manuscript aims to provide an exhaustive overview of the main parameters that need to be evaluated for appropriate device selection, pre-procedural planning, intraprocedural guidance and post-operative assessment in the setting of TMVI. In addition, it tries to give some insights about next perspective of structural cardiovascular imaging.

Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscess due to this agent with left heart endocarditis. We describe the case of a 40-year-old man with a brain abscess due to S. intermedius and concomitant lung abscess and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.

The complex and interconnected challenges of climate change, water stress, disasters, and health crises have far-reaching implications for sustainable development and global sustainability agendas, such as the Sustainable Development Goals (SDGs). However, one critical issue that has been overlooked is the nexus between climate change impacts and mental health (CCMH). Recognizing and addressing the negative emotions associated with this global phenomenon is essential to fostering a holistic approach to climate action planning and building long-term resilience. In this assessment, we present a set of narratives to argue that CCMH research requires a collaborative, transdisciplinary approach that integrates socio-economic and socio-cultural complexities. For this assessment, we used a case study approach to elucidate that the mental health impacts of climate change are unequally distributed, disproportionately affecting vulnerable groups based on age, gender, race, and socioeconomic status. The assessment presented in this study concluded that adequate mental health support programs are limited due to sociocultural stigmas and limited socioeconomic resources in some regions. Existing climate-related mental health services mechanisms lack coordination and specific action plans, leaving affected populations underserved. Unlike traditional understandings of the climate-health nexus, this research calls for experts from multiple fields to work together and for enhanced attention to and investment in CCMH research to bridge the gap between scientific knowledge and practical solutions. Such solutions will lead to scalable and lasting change as communities can implement research findings to support those in need and enhance disaster resilience. Furthermore, by collectively recognizing the climate and mental health nexus, global commitments such as the SDGs and the Paris Declaration can advance awareness and action in climate-related mental health, ultimately promoting a healthier relationship between humanity and nature.

Transcatheter aortic valve replacement (TAVI) improves event-free survival in patients with severe aortic stenosis, but patients’ exercise capacity remains poor after the procedure. Therefore, we sought to compare the effects of supervised centre-based exercise training program and unsupervised exercise routine on exercise capacity and vascular function in patients after TAVI. Patients were randomised to either centre-based exercise training (12-24 sessions of combined aerobic and low-weight resistance training twice weekly for 8-12 weeks) or unsupervised home-based exercise routine (initial appraisal with detailed recommendations and monthly follow-up). Exercise capacity (cardiopulmonary testing) and vascular function (ultrasonographic measurement of flow-mediated vasodilation [FMD] and arterial stiffness) were assessed at baseline and after the study period. We included 23 patients (mean age 81 years, 61% women), with higher-than-expected drop-out rates (41%) because of the coronavirus-19 pandemic outbreak. Exercise capacity improved over time, irrespective of intervention group: 0.09 ml/min/kg increase in peak oxygen uptake (95%CI [0.01-0.16]; p=0.02), 8.2 Watts increase in workload (95%CI [0.6-15.8]; p=0.034), and 47 seconds increase in cumulative exercise time (95% CI [5.0-89.6]; p=0.029). A between-group difference in change over time (treatment effect) was detected only for FMD (4.49%; 95% CI [2.35; 6.63], p &lt; 0.001), but not for other outcome variables. Both supervised and unsupervised exercise training improve exercise capacity and vascular function in patients after TAVI, with supervised exercise training possibly yielding larger improvements in vascular function, as determined by FMD.

As part of a plethora of global efforts to minimize the negative effects of the SARS-CoV2 (COVID-19) pandemic, we developed two different mechanisms that, after further development, could potentially be of use in the future in order to increase the capacity of ventilators with low-cost devices based on single-use-bag-valve mask systems. We describe the concept behind the devices and report a characterization of them. Finally, we make a description of the solved and unsolved challenges and propose a series of measures in order to better cope with future contingencies.

In order to create a smart mine, it is necessary to digitize the existing emulsion pumping station. Existing research does not achieve this task, this paper designs and manufactures a high-pressure, high-flow, high-water-based mining digital controlled unloading valve (abbreviated as HLHMDCUV), which achieves good results in both theoretical analysis and experimental testing. In order to obtain the accurate dynamic characteristics, this valve was analyzed by simulation using AMESim. Based on the dynamic performance analysis and the flow field analysis inside the valve body, the structure has been optimized to improve the performance of HLHMDCUV. The results show that the HLHMDCUV has a better dynamic characteristics, which were also demonstrated in the experiment. At the same time, the HLHMDCUV is easy to disassemble and maintain. This paper provides a theoretical basis for the design of such valves, which is conducive to the subsequent promotion of intelligent mine transformation.

Degenerative mitral valve disease (DMVD) consists of progressive degeneration of the mitral valve that can occur either in isolation or in association with the tricuspid valve, leading to incomplete coaptation of its leaflets and subsequent valve regurgitation. It's the most common cardiac condition in small animals, accounting for about 75% of cases of heart disease in dogs, mainly affecting elderly small-breed dogs. Breeds with a genetic predisposition such as Cavalier King Charles Spaniels and Bull Terriers tend to develop the disease early. It can be classified into 4 stages: A, B, C, and D, with B having subdivisions (B1 and B2). Animals in stages A, B1, and B2 are asymptomatic, showing clinical signs only from stage C onwards. The report details the case of a 13-year-old Fox Terrier diagnosed at stage B2 of the disease, progressing to stage C within two years. A cardiologist conducted annual monitoring.

: Kentucky is one of the largest coal producing states and surface coal mining has led to changes in natural land cover, soil loss, and water quality. This study explored relationships between actively mined and reclaimed areas and vegetation change and water quality parameters. The study site evaluated 58 watersheds with Landsat-derived variables (reclamation age, mining percentage, reclaimed forest percentage, and reclaimed woods percentage) as well as topographic variables (such as elevation, slope, drainage density, and infiltration). Water samples were collected in spring (n=9), summer (n=14), and fall (n=58) 2017 to study changes in water quality variables (SO42-, alkalinity, conductivity, Ca2+, Mg2+, Mn2+, Al3+, and Fe2+,Fe3+) in response to changes in land cover. Pearson correlation analyses indicated conductivity has strong to very strong relationships with other variables of water quality variables related to coal mining (except Al3+, Fe2+,Fe3+, Mn2+, elevation, slope, and drainage density) and land cover variables. In addition, separate multivariate regression analyses were performed with conductivity values based on samples collected in the fall. First, conductivity response to mining percentage, reclamation age and topographic variables were examined (adjusted R2=0.818, p &lt; 0.01). Next, vegetation cover change parameters were added to the same model, which yielded slightly improved R2 (adjusted R2 = 0.826, p &lt; 0.01). Finally, reclamation age and mining percentage were used to explain the quantity of reclaimed forested areas as a percentage of watersheds. The model was significant (p &lt; 0.01) with an adjusted R2 value of 0.641. Results suggest that the quantity (area as a percentage) of reclaimed forests may be a predictor of mining percentage and reclamation age. This study indicated that conductivity is a predictable water quality indicator that is highly associated with Coal Mine Related Stream Chemistry in areas where agriculture and urban development are limited. These findings may help the scientific community and key state and federal agencies improve their understanding of water quality attributes in watersheds affected by coal mining as well as refining land reclamation practices.

The purpose of this study was to evaluate the morpho-functional change of the patellar ligament in dogs affected by cranial cruciate ligament rupture. The hypothesis is that it may show increased thickening and stiffness with increasing days from trauma to diagnosis. Understanding this aspect have implications on the choice of timing to treat patients suffering from cranial cruciate ligament rupture, and also in the contextualization of patellar ligament desmitis pictures after surgical treatment with tibial plateau levelling osteotomy or tibial tuberosity advanced. Thirty-three dogs were affected affected by unilateral cranial cruciate rupture were examined and divided into three groups based on the time elapsed from the onset of lameness to diagnosis: Group 1 (from 1 to 15 days), Group 2 (from 16 to 60 days), Group 3 (over 60 days). Conventional B-mode ultrasonographic and elastosonographic examinations of patellar ligament were performed without sedation for each dog. At the ultrasonographic examination, all dogs showed alterations in the echostructure of the patellar ligament. In addition, the patellar ligament tended to become harder and less soft with increasing days after rupture, although there were not significant differences between groups. Our results showed that as time increases between the onset of cranial cruciate ligament rupture and diagnosis and treatment, the patellar ligament progressively thickens and loses its elasticity.

Tillage has been reported to induce seasonal changes of organic carbon (Сmicro) and nitrogen (Nmicro) in biomass of microorganisms. Soil microorganisms execute such ecosystem functions as: it is an immediate sink of labile biophil elements; it is an agent of a conversion, catalysis and synthesis of humus substances; it transforms soil contaminants into non-hazardous wastes; it participates in soil aggregation and pedogenesis as a whole. However, the seasonal turnover of microorganisms on arable lands in temperate ecosystems has not been investigated on a relevant level. Hence, we aimed to study the dynamics of such soil microbial biomass patterns as: Сmicro, Nmicro, microbial index (MI = (Сmicro/CTOC)·100, %) and CO2-C emission on the background of 9 years of tillage and 22 years of abandoned (Ab) and fallow (F) usage. Our study was conducted on a long-term experimental site on a Mollisol in the northeast China. The maximum Сmicro and Nmicro content was found: at the beginning of the growing season – in 0-10-; in mid-July – in 20-40 cm layers, while the minimum – in August-October. The Сmicro content ranged from 577.79- and 381.79 mg-1 kg-1 under Ab in spring to 229.53- and 272.86 mg-1 kg-1 in autumn under CT (conventional tillage) and F in 0-10- and 10-20 cm layers, respectively. The amplitude of Nmicro content changes was several times lower comparatively to Сmicro. The smallest quartile range (IQR0.25-0.75) of such changes was under: no-till (NT) and Ab in 0-10-, NT and F – in 10-20- and CT - in 20-40 cm layers. The widest Сmicro : Nmicro ratio was found at F and CT – in 0-20- and CT and rotational tillage (Rot) – in 20-40 cm layers. MI dynamics resembled the trends of Сmicro and Nmicro and changed from 0.72  0.168- tо 2.00  0,030 %. The highest part of Сmicro in CTOC was at Ab (1.82  1.85 %) and NT (1.66  1.52 %) – in 0-10-; Ab (1.23  1.27 %) and NT (1.29  1.32 %) – in 10-20- and – Ab (1.19  1.09 %) and F (1.11  1.077 %) – in 20-40 cm layers, correspondingly. The Pearson’s correlation coefficient between Сmicro and CTOC increased from the upper 0-10- to the lower 20-40 cm layer, it was "strong" and "high" between Сmicro and CTOC. Different use of Mollisol affected the amplitude of Сmicro and Nmicro seasonal changes, but it didn’t change their trend. Our results suggest the key role of Ab and NT technologies in Сmicro accumulation in total organic carbon (TOC).

With the increasing societal expectation that animals are afforded greater protection in emergencies, the legal process from entering a property to rescue a companion animal, through to how to dispose of such animals if they remain unclaimed has not been well examined in New Zealand. It is hypothesised that the legal framework for such response is flawed. In this study, each phase of animal disaster rescue is evaluated against four key statues that may apply in each phase, in that does any statute provide clear end to end provisions with clear legal authority to do so. The study found that all statutes evaluated contained flaws and that the current legal provisions are insufficient to provide clear authority for the sequential process of undertaking rescue of animals during emergencies. A major flaw was discovered in the Civil Defence Emergency Management Act 2002 a key statute, that provided for the seizure of property and animals but omitted a procedure for the disposal of such seized things leaving them all in legal limbo. It is recommended that animal disaster laws are updated to be more animal inclusive. The method also may be applicable to assist evaluating animal disaster management legal frameworks in other countries.

Soil salinity is seen as a major restriction for crop production, and with water scarcity this problem becomes more complicated. Mulching is crucial to salinity dynamics management by decreasing evaporation with improving the soil’s characteristics. Using chitosan as an eco-friendly biostimulant can enhance plant defense genes during different abiotic stresses. Recently, agricultural research has recognized nanoparticles as a pioneer material due to their distinctive physicochemical features. Therefore, a lysimeter experiment was conducted to investigate the interactive effects of mulching (UNM: un-mulched, WPM: white plastic, RSM: rice straw and SDM: sawdust) and chitosan foliar application (Ch0: control, Ch1: 250 mg chitosan L-1, Ch2: 125 mg nano chitosan L-1, and Ch3: 62.5 mg nano chitosan L-1) on the biochemical soil characteristics and common beans productivity under salt affected soil conditions. Organic mulching (RSM and SDM) treatments significantly improved the soil's organic carbon, available nutrient content, and total count of bacteria. WPM treatment lowered soil EC to 6.63 dS m-1 and increased soil water content to 34.13%. The application of Ch3 caused considerable increases in the plant height, shoot dry weight, root dry weight, grain yield, and nutrient content in the seed. The total fungi count in the soil and Na% in the seed was significantly decreased due to chitosan foliar applications. Moreover, the interactive effect of different mulch materials plus foliar by chitosan applications gave a statistically similar seed yield in both seasons. Overall, this study revealed the potential of the mulching treatments and foliar application of nano chitosan in improved biochemical soil characteristics and common bean productivity under saline soil conditions.

In Nitrate Vulnerable Zones (NVZ) site-specific techniques are needed to match N availability with durum wheat (Triticum turgidum subsp. durum Desf.) requirements. Enhanced-efficiency fertilizers (EEF) can improve efficient N supply and reduce leaching, thus contributing to sustainable agriculture. To study the effects of rates, sources and timings of nitrogen application, two-year field experiments were carried out at two Mediterranean NVZs of Central Italy (Pisa and Arezzo). The trial compared: i) two N rates: one based on the crop N requirements (NO), the other on the Action Programmes’ prescriptions of the two NVZ (NAP); ii) three N sources (urea, methylene urea (MU), and nitrification inhibitor (NI) 3,4-Dimethylpyrazole phosphate (DMPP); and two top-dressing timings (1st tiller visible and 1st node detectable). Grain yield and yield components were determined, together with N uptake. Results showed that: i) grain and biomass production were reduced with NAP at both locations; ii) urea performed better than slow-release fertilizers; iii) the best application time varied depending on N source and location: at Pisa enhanced-efficiency fertilizers achieved higher yields when applied earliest, while for urea the contrary was true; at Arezzo different N fertilizers showed similar performances between the two application timings. Different behaviors of top-dressing fertilizers at the two localities could be related to the diverse patterns of temperatures and rainfall. Therefore, optimal fertilization strategies vary according to environmental conditions.

In our exploration of percutaneous mitral valve repair (PMVR) alongside conditions like atrial fibrillation (AF), we uncover a fascinating and complex relationship that significantly impacts patient outcomes. Our journey through various studies, including patient registries, meta-analyses, and cohort investigations, reveals the intricate interplay between AF and PMVR. Despite the advancements in PMVR techniques, AF adds layers of complexity, influencing procedural success rates, long-term clinical outcomes, and post-operative complications. While some studies suggest that AF may not heavily affect short-term results, others highlight its association with increased risks of mortality, heart failure hospitalization, and post-PMVR adverse events. Our exploration also delves into the anatomical and remodeling changes induced by PMVR, shedding light on the importance of understanding how AF interacts with cardiac chamber remodeling. Along the way, we acknowledge the limitations inherent in such research, including data variability, publication bias, and potential confounding factors, urging a cautious approach to interpreting findings. Through this review, we offer valuable insights into the challenges and considerations surrounding AF in the context of PMVR. Our hope is that these insights will guide clinicians and researchers as they navigate this complex landscape, ultimately enhancing patient care and outcomes in the realm of mitral valve repair

Recent research efforts in bone tissue engineering have been primarily directed towards manufacture-viable synthesis of biomaterials that can significantly enhance the biocompatibilities and osteogenic capabilities on the new biomaterials. This paper presents a straightforward, cost-effective, optimized, and well-controlled hydrothermal synthesis of Nb-doped potassium titanate nanofibers in high-purity. Characterization data revealed that the Nb-doping potassium titanate maintained the crystal structure, showing great promise for applications in bone tissue engineering.

Background: COVID-19 pneumonia caused by SARS-Cov-2 virus induces alveolar collapse and hypoxia that may become severe. The aim of the study is to analyze the effects of chest physiotherapy using a threshold valve in patients with acute respiratory failure due to COVID-19 pneumonia. Methods; Retrospective observational study, in hospitalized patients from March to May 2020. Breathing exercises were performed with a threshold valve of 10 cmH2O. Fraction of inspired oxygen, oxygen saturation, heart rate, respiratory rate and dyspnea were collected before and after the first session and at the end of the 5th day of chest physiotherapy treatment. Results: The final sample included 125 patients. Significant differences (p&lt;0.01) were found in the pre-post intervention SpO2/FiO2 ratio (250±88.4 vs 275.6±97.5, p&lt;0.001), reaching 354.4±110.2 after 5 days of therapy (p&lt;0.001 with respect to baseline). Mean baseline respiratory, heart rate and level of dyspnea measure by the Borg scale did not change during the technique performance. In patient maneuvers with FiO2&gt;0.4, the SaO2/FiO2 ratio increase was higher than in patients with milder severity (46.85 ± 77.69, p&lt;0.01). Conclusions: Chest physiotherapy with a 10 cmH2O threshold valve is a safe and tolerated intervention with short-term improvement in oxygenation in patients with COVID-19 pneumonia.

Background: This study discerns surgeons’ attitudes and practices in the determination of heart valve replacement for patients with endocarditis due to intravenous drug use (IVDU-IE). We aimed to identify factors contributing to surgeons’ decision-making process for initial and recurrent surgical heart valves, and the availability of institutional guidance. Methods: An IRB approved, anonymous mixed-methods survey instrument was designed and validated with 24 questions. Cardiothoracic surgeons in the U.S. and globally were recruited with a total of 220 enrolling in the study with 176 completing every question on the survey. Results: A cluster analysis revealed that although surgeons can be divided into sub-groups based on their previous experience with valve replacements, these groups are not perfectly homogenous, and the number of identified clusters is dependent on technique used. ANOVA analysis revealed that the variables that most clearly divided the surgeons into subgroups were, in order of importance, years of practice, number of valve replacements, and geography. Conclusions: Our analysis showed heterogeneity among cardiothoracic surgeons regarding how they make clinical decisions regarding re-operative valve replacement related to IVDU-IE Therefore, an opportunity exists for an interprofessional team to develop guidelines to decrease variability in surgical decision-making regarding valve replacement associated with IVDU-IE

Dementia is a major issue for healthcare systems worldwide, necessitating the development of creative and effective strategies for its management. This paper examines the use of Artificial Intelligence (AI) technologies in caring for and managing people with dementia. AI-driven solutions can improve diagnosis, personalize care, optimize medication management, and reduce the burden on caregivers. This paper discusses the implementation of an AI-based framework for creating videos related to people’s memories to support train-therapy or travel- therapy, a non-pharmacological intervention for Alzheimer’s disease patients

Social enterprises are very common in Birmingham having the largest concentrations of social enterprises in the United Kingdom. With the emergence of the Covid-19 pandemic, the operations and management of social enterprises in Birmingham has been greatly affected. This study seeks to analyse the impact of the Covid-19 pandemic on the operations and funding of social enterprises in Birmingham UK. In order to achieve this, the study is going to carry out a qualitative methodology in order to analyse the impact Covid-19 has had on social enterprises. The research is going to select relevant stakeholders through a non-purposive sampling criteria identifying individuals who have direct interest in the functioning of social enterprises. The relevant stakeholders will be expected to respond to semi structured interviews that are structured to evoke responses relevant to this area of research. The research realized that Social enterprises in Birmingham are a critical player in the economy of UK with many individuals depending on the social enterprise industry. In addition to that, the study realised that the Covid-19 pandemic exposed social enterprises to various financial and market risks. Moreover, social enterprises were forced to make a change in their organizational structure through cost management changes and offering alternative services. However, the government came in support through provision of grants and funding to boost the social enterprise economy.

A rational decision is a systematic and logical way of making a resolution. It is needed in critical situation, especially the unavoidable ones such as annual floods. People affected by this natural disaster, continue living their lives if good rational decisions are made. The current research consists of two studies. The first identifies rational decisions based on age, education, socio-economic and gender, while the second is based on decisions associated with resilience, coping strategies and age. A total number of 354 participants from various cities in East Java were used as participants of the study. The results in the first study, 58% of the people made good rational decisions, with the remaining 42% making low decisions. Furthermore, education was found to significantly influence the decision making process. The second study found a significant relationship between the resilience, coping strategies, age with the rational decisions. Conclusion of the study will be used make better decisions for the community in order to minimize physical and psychological impacts.

WNT10B belongs to the family of WNT proteins that are implicated in a range of phenomena that are affected by the Wnt signaling pathway. Recent studies have shown that WNT10B plays a role in colorectal cancer. WNTs have been found to directly affect the stemness of the tumor cells via regulation of ASCL2. Switching off the ASCL2 literally blocks the stemness process of the tumor cells and vice versa. Furthermore, recent findings suggest BVES to be highly suppressed in malignancies and in vitro deletions of BVES show higher Wnt signaling activity to induce stem- ness. WNT10B was found to be highly expressed in such cases. Often, in biology, we are faced with the problem of exploring relevant unknown biological hypotheses in the form of myriads of combination of factors that might be affecting the pathway under certain conditions. For example, WNT10B-ASCL2 is one such 2^nd order combination whose relation needs to be tested under the influence of recently developed porcupine-WNT inhibitor ETC-1922159. The inhibitor is known to suppress PORCN (porcupine) and thus inhibit a range of oncogenes known to be directly or indirectly affected by the Wnts. In a recent unpublished work in bioRxiv, Sinha 1, we had the opportunity to rank these unknown biological hypotheses for down regulated genes at 2^nd order level after the drug was administered. The in silico observations showed that the combination of WNT10B-ASCL2 was assigned a relatively lower rank, thus validating the pipeline’s efficacy with the confirmed wet lab experiment that indicate that both WNT10B and ASCL2 were down regulated after treatment in cancer cells. Here, we take one step further by in silico analysis of the 3rd order combinations of WNT10B-X-X (X can be known or unknown factor), from a range of 100 randomly picked down regulated genes after ETC-1922159 treatment. The pipeline uses the density based HSIC (Hilbert Schmidt Information Criterion) sensitivity index with an rbf (ra- dial basis function) kernel, which is known to be highly effective in sensitivity analysis. Various unknown/unexplored/untested 3^rd order biological hypotheses emerge some of which are con- firmed in wet lab, while others need to be tested. The potential of such ranking is indispensable in the current era of search in a vast combinatorial forest.

Currently, aortic valve (AV) disease is the most common reason for heart valve surgery. The gold standard of care for people with aortic pathology is thought to be AV replacement. The issue of prosthesis selection has always been important. Although mechanical prosthesis are robust, lifelong anticoagulation medication is necessary due to the significant risk of thromboembolic consequences. Biological prostheses have a flow structure that is similar to the physiological one, and as malfunction gradually sets in, scheduled recurrent surgery can be carried out. The purpose of this study is to evaluate the short- and long-term effects of biological prosthetic aortic valve replacement (AVR) in elderly individuals. The study included 198 patients with AV pathology [85 men (42.9%)/113 women (57.1%)]. The median age was 70 [66–73] years. There were 175 (88.4%) patients with degenerative AV, 5 (2.5%) with infective endocarditis, and 30 patients (15.2%) had bicuspid AV. The median follow-up period was 26.3±1.4 months. Hospital mortality was 4.5%. No wound complications were detected. Thirty-one patients died in the long-term period. The causes of lethality were: cardiovascular disease (13 patients), malignant neoplasm (5 patients), gastrointestinal disease (2 patients), urinary system disease (1 patient), COVID-19 (1 patient), unknown cause (9 patients). Thus, the five-year postoperative survival rate was 63%, respectively. Throughout the observation period, two patients (2.9%) underwent reoperation on AV. 97.1% of patients were free of reoperation after five years. The five-year survival rate was 63% due to the history of severe concomitant pathology and mean age of the patients of 70 years.

This study proposes a 3D particle-base (discrete) multiphysics approach for modelling calcification in the aortic valve. Different stages of calcification (from mild to severe) were simulated, and their effect on the cardiac output assessed. The cardiac flow rate decreases with the level of calcification. In particular, there is a critical level of calcification below which the flow rate decreases dramatically. Mechanical stress on the membrane is also calculated. The results show that, as calcification progresses, spots of high mechanical stress appear. Firstly, they concentrate in the regions connecting two leaflets; when severe calcification is reached, then they extend to the area at the basis of the valve.

Inorganic polymeric materials react slowly at room temperature and as a result usually require high-temperature curing. This study used the Arrhenius equation to analyze the correlation between curing temperature and curing duration during high-temperature curing. The test results show that optimal values exist for each alkali equivalent of the activator (weight ratio of Na2O/glass powder), curing temperature, and curing duration. Extending the curing duration and increasing the curing temperature have positive effects when the alkali equivalent is lower than the optimal value. However, over-curing results in invisible cracking in the specimens. Furthermore, despite exhibiting high strength initially, the strength of specimens gradually diminishes after standing in air. To ensure the durability of glass-based geopolymer, the curing temperature should not exceed 70℃, and the curing duration should be less than one day.

It is widely discussed that growth of GDP has a vague impact on environmental pollution due to the emissions of carbon dioxide from consumed fossil fuels in production, transportation and power generation, and creation of required instruments to control environmental pollution as well. Due to the fact that environmental pollution can be a reason of mortality increase in a society, the main purpose of this study is to investigate the relationship between economic growth, fossil fuel consumption, mortality (from cardiovascular disease, cancer, diabetes and chronic respiratory disease) and environmental pollution using Generalized Method of Moments (GMM) estimation technique in the case of CIS member states over the period of 1993-2018. The major results revealed CO2 emissions in in the region of CIS have a positive effect on increase of mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease. In regards to fossil fuel consumption, the estimation proved that this variable affects mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease positively. In addition, we found effect of economic growth, population growth and inflation rate positively, while any improvement in human development index (HDI) has a negative effect on increase of mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease in the CIS region. It is recommended that the CIS member states carry out different policies to improve energy transition indicating movement from fossil fuel energy sources to renewable ones. Moreover, we recommend the CIS member states to enhance various policies for easy access to the electricity from green sources and increase of renewable supply through improved technologies, sustainable economic growth, and increase of using green source in daily social life.

Critical aortic valve stenosis (CAVS) is a life-threatening cardiac disease of the newborn requiring urgent treatment. First-line therapy is still controversial. The aim of our study was (1) to analyze retrospectively the patients of our institution who underwent balloon aortic valvuloplasty (BAV) due to CAVS, and (2) to describe techniques for improved feasibility of the intervention using microcatheters and retrieval loops. Twelve patients underwent 23 BAVs: 1 BAV was performed in 3 patients, 2 BAVs in 7 patients, and 3 BAVs in 2 patients. Trans-valvular pressure gradient (Δp) and left ventricular shortening fraction (LVSF) improved significantly in the first two interventions; first BAV: Δp from 73.7 ±34.5 mmHg to 39.8 ±11.9 mmHg (p=0.003) and LVSF from 22.3 ± 13.5 % to 31.6 ±10.2 % (p=0.001); second BAV: Δp from 73.2 ±33.3 mmHg to 35.0 ± 20.2 mmHg (p&lt;0.001) and LVSF from 26.7 ±9.6 % to 33.3 ±7.4 % (p=0.004). Cardiac surgery during the neonatal period was avoided for all children; median time to valve surgery was 5.75 years. Few complications occurred: mild to moderate aortic regurgitation, one remediable air embolism, and one intimal injury of the ascending aorta. We conclude that BAV is a successful primary treatment for CAVS resulting in left ventricular relief, stabilization of the neonate, and a time gain until cardiac surgery.

Unsmooth reversing is one of the most common faults in the four-way reversing valve of air conditioning system, and the airflow in the valve chamber and the shape of the slider of the reversing valve are the main factors in unsmooth reversing. In order to study the influence of the airflow in the chamber and the slider shape on the reversing process, the fluid flow in the valve chamber of a four-way reversing valve is obtained using computational fluid dynamics (CFD) simulations, and the influence of slider structure on slider thrust and resistance of the four-way reversing valve is analyzed. Four-way reversing valves with no-cutting, straight-cutting and arc-cutting sliders are employed to evaluate the reversing characteristics. A pressure measuring device for a four-way reversing valve chamber is designed, which is performed to test the chamber pressure of three different types of sliders of four-way reversing valves. The maximum error of experimental tests and simulations is within 5% of engineering tolerance, so as to verify the reliability of numerical simulation. The results indicate that the chamber pressure and resistance-thrust ratio with the cutting slider are reduced, which is beneficial to the reversing of the four-way reversing valve. Compared with the straight cutting structure, the arc cutting slider four-way reversing valve has a more stable reversing process and better comprehensive reversing performance. The results can provide a theoretical basis for engineers to improve the performance of four-way reversing valves.

Background Limited data are available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and with follow-up >2 years. Objective In this large, population-based cohort study, long-term mortality and morbidity were investigated in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis using a surgically implanted bioprosthesis (sB-AVR) or TAVR. Methods Individual data from the Austrian Insurance funds from 2010 through 2020 were analysed. The primary outcome was all-cause mortality, assessed in the overall and propensity score–matched populations. Secondary outcomes included reoperation and cardiovascular events. Results From January 2010 through December 2020, a total of 18 882 patients underwent sB-AVR (n=11 749; 62.2%) or TAVR (n=7133; 37.8%); median follow-up was 4.0 (interquartile range 2.1–6.5) years (maximum 12.3 years). The risk of all-cause mortality was higher with TAVR compared with sB-AVR: hazard ratio (HR) 1.552, 95% confidence interval (CI) 1.469–1.640, p<0.001; propensity score–matched HR 1.510, 1.403–1.625, p<0.001. Estimated median survival was 8.8 years (95% CI 8.6–9.1) with sB-AVR vs 5 years (4.9–5.2) with TAVR. Estimated 5-year survival probability was 0.664 (0.664–0.686) with sB-AVR vs 0.409 (0.378–0.444) with TAVR overall, and 0.690 (0.674–0.707) and 0.560 (0.540–0.582), respectively, with propensity score matching. Other predictors of mortality were age, sex, previous heart failure, diabetes, and chronic kidney disease. Conclusions In >2-year follow-up, selection for TAVR was significantly associated with higher all-cause mortality compared with sB-AVR in patients ≥65 years with severe, symptomatic aortic stenosis.

The switched inertance hydraulic system (SIHS) is a novel high-bandwidth and energy-efficient digital device which can adjust or control flow and pressure by a means that does not rely on throttling the flow and dissipation of power. An SIHS can provide an efficient step-up or step-down of pressure or flow rate by using a digital control signal. In this article, analytical models of an SIHS in a four-port high-speed switching valve configuration are proposed, and the system dynamics and performance are investigated theoretically and experimentally. The flow responses, system characteristics and power consumption can be predicted effectively and accurately by using the proposed models, which were validated by comparing with experiments and with numerical simulation. The four-port configuration is compared with the three-port configuration, and it is concluded that the former one is less efficient for valves of the same size, but provides a bi-direction control capability. As bi-direction control is a common requirement, this constitutes an important contribution to the development of efficient digital hydraulics.

The therapeutic management of acquired thrombotic thrombocytopenic purpura (aTTP) has recently benefited from the introduction of caplacizumab, an agent directed to inhibition of platelet aggregation. This real-world analysis investigated the epidemiology, the demographic and clinical characteristics of aTTP patients in Italy before and after caplacizumab introduction in 2020. Hospitalized adults with aTTP were included using the administrative databases of healthcare entities covering 17 million residents. Epidemiological estimates of aTTP considered the 3-year period before and after caplacizumab introduction. After stratification by treatment or not with caplacizumab, aTTP patients were characterized for their demographic and clinical features. The annual incidence before and after 2020 was estimated in the range 4.3-5.8 cases/million and 3.6-4.6/million, respectively. From 2018 to 2022, 393 patients with aTTP were included, 42 of them treated with caplacizumab. Caplacizumab-treated patients were aged on average 46.8 years, 31% were males, and showed tendentially better clinical outcomes: no treated patients died at either 1 month or 3 months after caplacizumab treatment initiation, compared to 10.5% (1 month) and 11.1% (3 months) mortality among the untreated. Caplacizumab treatment was associated with a trend towards shorter hospital stays. These findings suggest that caplacizumab advent provided clinical and survival benefits for patients with aTTP.

One of the most important problems, which public health is called to face, is obesity. The World Health Organization (WHO) underlines that worldwide more than 380 million of overweight or obese children and adolescents exist. Although obesity is a multifactorial disease, excessive use of the screen seems to act in a way that affects obesity. The purpose of this systematic literature review is to study of the major problem, obesity in teenagers and its association with the hours of entertainment(referring to excessive hours of television use and viewing, video games and social media).In the present systematic literature review was carried out search for sources, through the scientific databases PubMed, ScienceDirect, and Scopus for the period from 2010 to 2022.This systematic review provides public health evidence regarding the positive association of excessive screen time and of obesity and overweight in adolescents.

Background: Primary lymphedema is a chronic condition caused by a developmental abnormality of the lymphatic system and its malfunction. Different surgical options such as physiologic and excisional procedures have been proposed. The aim of this study was to present a complete algorithm for the treatment of primary lower extremity lymphedema: Primary LYmphedema Multidisciplinary Approach (P-LYMA). Methods: Nineteen patients were treated according to the P-LYMA. Patients underwent pre- and post-operative complex decongestive therapy (CDT). Different physiologic and excisional procedures were performed independently or in combination. The primary outcome was the circumferential reduction rate (CRR). The Lymphedema Quality of Life Score (LeQOLiS), reduction in the number of episodes of cellulitis, length of stay, and complications were recorded. Results: The mean CRR calculated was 72.8±19.6% after twelve months. The episodes of cellulitis per year decreased from a mean of 1.9±0.8 preoperative to 0.4± 0.6 throughtout follow-up. Two patients experienced minor complications. Mean hospitalization time was 5 days. Patients’ quality of life (LeQOLi score) drastically improved from 70.4±11.6 to 24.2 ±13.9 at twelve months post-op. Conclusion: The P-LYMA algorithm allows to maximize surgical results and improve the quality-of life in patients who suffer from primary lymphedema. CDT is mandatory to optimize results.

In celIs, microtubule location, length, and dynamics are regulated by a host of microtubule-associated proteins and enzymes that read where to bind and act based on the microtubule “tubulin code,” which is predominantly encoded in the tubulin carboxy-terminal tail (CTT). Katanin is a highly conserved AAA ATPase enzyme that binds to the tubulin CTTs to remove dimers and sever microtubules. We have previously demonstrated that short CTT peptides are able to inhibit katanin severing. Here, we examine effects of CTT sequences on this inhibition activity. Specifically, we examine CTT sequences found in nature, alpha1A (TUBA1A), detyrosinated alpha1A, Δ2 alpha1A, beta5 (TUBB/TUBB5), beta2a (TUBB2A), beta3 (TUBB3), and beta4b (TUBB4b). We find that these natural CTTs have distinct abilities to inhibit, most noticeably beta3 cannot inhibit katanin. Two non-native CTT tail constructs are also unable to inhibit – despite having 94% sequence identity with alpha1 or beta5 sequences. Surprisingly, we demonstrate that poly-E and poly-D peptides are capable of inhibiting katanin significantly. An analysis of the hydrophobicity of the CTT constructs indicates that more hydrophobic polypeptides are less inhibitory than more polar polypeptides. These experiments not only demonstrate inhibition, but also likely interaction and targeting of katanin to these various CTTs when they are part of a polymerized microtubule filament.

Renal Cell Carcinoma (RCC) is generally represented by low-FDG avidity, and [18F]FDG-PET/CT is not recommended to stage the primary tumor. However, its role to assess metastases is still unclear. The aim of this study was to evaluate the diagnostic accuracy of [18F]FDG-PET/CT to correctly identify RCC lung metastases using histology as standard of truth. Records of 350 patients affected by RCC and with CT evidence of at least one lung nodule, were retrospectively analyzed. Inclusion criteria were: a) histologically proven RCC; b) [18F]FDG-PET/CT performed prior to lung surgery; c) lung surgery with histological analysis of surgical specimens; d) complete follow-up available. A per-lesion analysis was performed, and diagnostic accuracy was reported as sensitivity and specificity, using histology as standard of truth. [18F]FDG-PET/CT semiquantitative parameters (Standardized Uptake Value [SUVmax], Metabolic Tumor Volume [MTV] and Total Lesion Glycolysis [TLG]) were collected for each lesion. Sixty-seven (n=67) patients with a total of 107 lesions were included: lung metastases from RCC were detected in 57/107 of cases, while 50/107 lesions were related to others lung malignancies. Applying a cut-off of SUVmax ≥2, the sensitivity and the specificity of [18F]FDG-PET/CT for detect RCC lung metastases were 33.3% (95% CI: 21.4% - 47.1%) and 26% (95%CI: 14.6% - 40.3%), respectively. The analysis demonstrated sub-optimal diagnostic accuracy of [18F]FDG-PET/CT to discriminate between RCC lung metastases versus other malignancies. However, semiquantitative analysis including also volumetric parameters (MTV and TLG) can support [18F]FDG-PET/CT image interpretation.

. Colchicine (C22H25NO6) is a substance used for inducing mutations in order to regulate important agronomic traits. The objective of this study was to investigate the effect of different concentrations (0.0, 0.04, 0.06, 0.08 and 0.1%) and treatment time (6, 12 and 24 h) of colchicine on agronomic traits of proso millet (Panicum miliaceum L.) and to assess the genetic diversity of M2 generations using inter simple sequence repeat markers (ISSR). The experiment was conducted in 2021 for the M1-generation and in 2022 for the M2-generation, from May to September. The percentage of the field germination was decreased with the increasing colchicine concentration and exposure duration. The chlorophyll-defective M1-M2 plants were obtained using various concentrations and exposure periods of colchicine. The highest amount of mutational modifications was attained at 0.08-0.1% concentrations colchicine. A total of 248 plant families with chlorophyll-defective mutations based on the research results were selected from 2214 families. The growing season of M1- and M2 plants were diminished under higher colchicine concentration (0.08-0.1%) combined with soaking time. Thus, the highest indicator of growing season (84 days) was observed at six h treatment time for PI 289324, while the fewest (78 days) was recorded at 12 and 24 h. The possibility of obtaining morphological mutations using colchicine has been confirmed. The ISSR primers amplified a total of 1333 fragments, 1281 bands were found to be polymorphic and 52 bands monomorphic. The percentage of polymorphism varied from 80 to 100 % with an average of 96.11%. Our results showed that most of the bands were found at 0.08% colchicine concentration. These positive variations are a great opportunity to use colchicine as a tool for improving agronomic traits in plant breeding.

Tree decline resulting from climate change results in physiological weaknesses, attack by harmful pests and pathogen, and threatens forest ecosystem stability. In the work described here, the effects of drought on wood density, tree ring width, and variations in vessel morphology were investigated in Persian oak (Quercus brantii) in the forests of the Zagros Mountains, Ilam province, western Iran. Radial discs were cut from trunks of declined and healthy trees and wood blocks cut radially from the sapwood, heartwood, and juvenile core. Observations were made on transverse sections from the blocks using microscopy. In trees with decline symptoms, wood density was greater than the healthy trees. Furthermore, declining trees had the narrowest ring width, reduced vessel diameter, vessel area, and highest number of vessels and tylose in pith towards bark. It was concluded that changes in anatomical features are associated with the weakening of the trees and are components in declining tree health.

Background: CoronaVirus Disease 2019 (COVID-19) is the main discussed topic world-wide in 2020 and at the beginning of the Italian epidemic, scientists tried to understand the virus diffusion and the epidemic curve of positive cases with controversial findings and numbers. Objectives: In this paper, a data analytics study on the diffusion of COVID-19 in Lombardy Region and Campania Region is developed in order to identify the driver that sparked the second wave in Italy Methods: Starting from all the available official data collected about the diffusion of COVID-19, we analyzed google mobility data, school data and infection data for two big regions in Italy: Lombardy Region and Campania Region, which adopted two different approaches in opening and closing schools. To reinforce our findings, we also extended the analysis to the Emilia Romagna Region. Results: The paper aims at showing how different policies adopted in school opening / closing may have on the impact on the COVID-19 spread. Conclusions: The paper shows that a clear correlation exists between the school contagion and the subsequent temporal overall contagion in a geographical area.

The potential yield of annual crops is affected by management practices and water and energy availabilities throughout the crop season. The current work aimed to assess the effects of plant population and soil covering on yield components of maize. Field experiments were carried out during 2014-15 and 2015-16 growing seasons at areas grown with oat straw, voluntary plants and bare soil, considering five different plant populations (40,000, 60,000, 80,000, 100,000 and 120,000 plants ha-1) and three sowing dates (15 Sep., 30 Oct., 15 Dec.) for the hybrid P30F53YH in Ponta Grossa, State of Parana, Brazil. Non-impacts of soil covering or plant population on plant height at the flowering phenological stage were observed. Significant effects of soil covering on crop physiological and yield components responses throughout the 2014-15 season were detected. Influence of plant populations on yield components was evidenced, suggesting that from 80,000 plants ha-1 the P30F53YH hybrid performs a compensatory effect among assessed yield components in such a way as to not compromise productivity insofar as plant population increases up to 120,000 plants ha-1. It was noticed a positive trend of yield components and crop final yield as a function of plant density increments.

Background: The role of NFATC genes expression in BAV progression is not fully understood. Aim of study is to determine the significance of NFATC1 and NFATC4 gene expression for myocardial changes in children with BAV. Methods: In 47 children with BAV the standard Doppler echocar-digraphic characteristics were detected and the expression of the NFATC1 and NFATC4 genes was studied. Results: PWTd, AoPPG, in BAV patients were significantly higher compared to healthy controls (PWTd median(min-max) 9 (7-10) mm vs 7 (6-8) mm), AoPPG median (min-max) 7,79 (2,98-15,09) mm Hg vs 2,94 (2,42-3,72) mm Hg. Expression of NFATC1 gene in BAV children was significantly higher compared to NFATC4 (NFATC1 median (min-max) 70,88 (8,79-106,51) e.u. vs 7,72 (1,74-22,67) e.u., respectively p<0,05). Significant correlation of NFATC1 expression with Ao found (R=+0,53, p<0,05). In BAV patients with PWTd > 8 mm and Ao> 21 mm the NFATC1 expression was significantly higher compare to those with PWTd< =8 mm and Ao<=21 mm NFATC1 median (min-max) 45,49 (5,01-101,52) e.u. vs 15,53 (2,36-44,40) e.u., p<0.05 and 81.11 (20.27-101.10) e.u. mm vs 12.16 (2,40-45.49) e.u., p<0.05, respectively) Conclusion: in children with BAV the high expression of the NFATC1 calcineurin signalling pathway gene is associated with elevated PWTd and Ao.

Introduction: The effect of halogenated drugs as cardioprotectors in cardiac surgery has been evaluated in several studies. However, the possibility that there is a protective role at renal level, triggered by their use, is currently under study. Aortic valve replacement and coronary revascularization are the most frequent surgeries in cardiac surgery. Our research evaluates the effect of desflurane compared to propofol in aortic valve replacement surgery at renal level; including its administration during extracorporeal circulation. Method: Quasi-experimental prospective study performed on 60 patients, divided into 2 groups according to the drug used in intraoperative aortic valve replacement surgery. In group 1 propofol was used as a hypnotic during surgery, in group 2 desflurane was used. Differences in kidney damage measured through the urinary NGAL marker were evaluated. Other markers of renal function and myocardial damage and the need for inotropic support during the first 48 hours were also measured. Results: There were significant variations in the values ​​of urinary NGAL and creatinine regarding to basal values ​​in the propofol group, but not in the desflurane group, in which there were no differences in the hemodynamic parameters and myocardial damage. Conclusion: the use of desflurane during aortic valve replacement surgery produced better renal preservation than propofol.

A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally classified as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient with an isolated single coronary artery, who underwent successful combined aortic valve replacement and coronary artery bypass grafting surgery, we intend to distinguish casual from causal in this extremely rare clinical and surgical scenario. This is the first-ever case published, combining such underlying pathology, clinical presentation, and surgical treatment.

Dioscorea remotiflora, a perennial climbing herbaceous plant wild and native to México, bears tubers of important ethnobotanical and nutritional value. However, the information for its production and use is precarious. The objective of this research was to characterize the adaptation habitats of D. remotiflora in order to determine its ecological descriptors and current distribution, as well as to model its potential distribution. A comprehensive database encompassing 481 geo-referenced accessions was assembled. Using the Agroclimatic Information System for México and Central America (SIAMEXCA), 42 environmental variables were formulated. The MaxEnt model within the Kuenm R-package was employed to predict the species distribution. The findings reveal a greater presence of D. remotiflora in harsh environments, characterized by arid to semi-arid conditions, poor soils, and hot climates with long dry periods. The plant's nutritional and medicinal attributes, combined with its ecological adaptability, suggest its viability within evolving regional cropping systems under the influence of climate change. Niche modeling revealed that seven key variables determine the geographical distribution of D. remotiflora: precipitation of the warmest quarter, precipitation of the driest month, minimum temperature of the coldest month, November-April solar radiation, annual mean relative humidity, annual moisture availability index, and May-October mean temperature. Favorable regions for D. remotiflora coincide with its current presence sites, while other suitable areas, such as the Yucatan Peninsula, Northeast region, and Gulf of México, offer potential expansion opportunities for the species distribution. The characterization obtained for D. remotiflora, together with the description of its edaphic and climatic adaptation habitats, will enable an efficient design of strategies for its use and conservation in the near future.

Wash’Em is a process that supports humanitarians in assessing and designing rapid but context-specific hygiene programmes in crises or outbreaks. The process consists of training implementers, using tools to learn from populations, and entering findings into a software which generates contextualised activities. A process evaluation of Wash’Em use was conducted in a drought-affected area in Midland province, Zimbabwe. Data was collected during the programme design and following implementation, using a mix of qualitative methods. Findings were classified against the intended stages of Wash’Em, and the evaluation domains were defined by the UKRI Medical Research Council. The Wash’Em process was not fully implemented as intended. An abridged training was utilised, some of the tools for learning from populations were omitted, many of the recommended activities were not implemented, the delivery modalities were different from intended, the budget available was minimal, and the number of people exposed to activities were fewer than hoped. Despite these ‘on the ground’ challenges and adaptations, the Wash’Em process was considered feasible by implementers and was seen to be less top-down than most programme design approaches. The populations exposed to the intervention found the activities engaging, understood the content, and reportedly took action to improve handwashing behaviour.

The improvement of health and social care needs the introduction of shared solution at transnational level. The SI4CARE (Social Innovation for Integrated Health Care) project is a transnational initiative within the Adriatic-Ionian regions aiming to develop strategies to improve the current status of health and social care. The Municipality of Miglierina, a small rural town in Calabria, which is a member the project, is developing a pilot action related to the use of wearable device for monitoring people affected by dementia with the project partner Ra.Gi.. Ra.Gi. is a non-profit organization dedicated to assisting people with dementia in day care centers and so-called dementia-friendly communities. The pilot is based on the use of smart wearable devices to monitor these patients during their daily lifetime. This paper focuses on the design and implementation of the system discussing the proposed application, the strengths and weaknesses. Finally, the possibility of extending the experiment to the other Adriatic-Ionian region is presented.

Alkali Silica Reaction (ASR) is known to be a serious problem for concrete worldwide, especially in high humidity and high temperature regions. ASR is a slow process that develops over years to decades and it is influenced by changes in environmental and loading conditions of the structure. The problem becomes even more complicated if one recognizes that other phenomena like creep and shrinkage are coupled with ASR. This results in synergistic mechanisms that can not be easily understood without a comprehensive computational model. In this paper, coupling between creep, shrinkage and ASR is modeled within the Lattice Discrete Particle Model (LDPM) framework. In order to achieve this, a multi-physics formulation is used to compute the evolution of temperature, humidity, cement hydration, and ASR in both space and time, which is then used within physics-based formulations of cracking, creep and shrinkage. The overall model is calibrated and validated on the basis of experimental data available in the literature. Results show that even during free expansions (zero macroscopic stress), a significant degree of coupling exists because ASR induced expansions are relaxed by meso-scale creep driven by self-equilibriated stresses at the meso-scale. This explains and highlights the importance of considering ASR and other time dependent aging and deterioration phenomena at an appropriate length scale in coupled modeling approaches.

Rice varieties such as Mahsuri Mutan and Basmati 370 are categorized as specialty rice with kernel elongation ratio exceeding 1.6 and 2.0, respectively. Ageing treatment in rice could affect the physical and chemical properties of rice such as grain size and shape, quality and taste of the cooked rice. The main objective of this study was to determine the effects of ageing treatment on the physicochemical properties of Mahsuri Mutan, Basmati 370 and MR219 rice varieties. The three rice varieties were subjected to heat treatment at 90ºC using the oven for 3 hours. After the heat treatment, the samples were cooled at room temperature (25ºC) for 1 hour. Physicochemical properties such as alkali digestion value, water uptake ratio (WUR), solids in cooking water (SCW), high kernel elongation (HKE) ratio and amylose contents were determined. Data collected on physicochemical traits and ageing vs non-ageing treatments were subjected to analysis of variance (ANOVA) using SAS software version 9.4. Phenotypic correlation coefficient indicated that there was a high positive correlation between HKE and water uptake ratio. The ageing treatment also showed significant difference in all the physicochemical traits of the varieties studied. Observation under electron microscope showed that the ageing samples had more cracks on the tissue structure compared to normal rice samples. The hexagon structure in Mahsuri Mutan gave more elongation effect on its kernel. The findings from this study could be useful to breeders in selection and development of new high kernel elongation rice variety.

Nine crossbred finishing barrows randomly assigned to 3 dietary treatments were used to investigate the effects of dietary lysine on muscle growth related metabolic and signaling pathways. Muscle samples were collected from the longissimus dorsi of individual pigs after feeding the lysine-deficient, lysine-adequate, or lysine-excess diet for 5 weeks, and the total RNA was extracted afterwards. Affymetrix Porcine Gene 1.0 ST Array was used to quantify the expression levels of 19,211 genes. A total of 674 transcripts were differentially expressed (P ≤ 0.05); 60 out of 131 transcripts (P ≤ 0.01) were annotated in the NetAffx database. Ingenuity pathway analysis showed that dietary lysine deficiency may lead to (1) increased muscle protein degradation via the ubiquitination pathway as indicated by the up-regulated DNAJA1, HSP90AB1 and UBE2B mRNA, (2) reduced muscle protein synthesis via the up-regulated RND3 and ZIC1 mRNA, (3) increased serine and glycine synthesis via the up-regulated PHGDH and PSPH mRNA, and (4) increased lipid accumulation via the up-regulated ME1, SCD, and CIDEC mRNA. Dietary lysine excess may lead to (1) decreased muscle protein degradation via the down-regulated DNAJA1, HSP90AA1, HSPH1, and UBE2D3 mRNA, and (2) reduced lipid biosynthesis via the down-regulated CFD and ME1 mRNA.

Both soybean variety and processing affect product characteristics. This study’s objective was to characterize the effect of four extraction methods (variations of soaking and grinding) combined with cooking on the content and composition of phenolic substances, antioxidant and anti-DU145 prostate cancer cell proliferative properties of soymilk prepared from a yellow soybean of the ProSoy variety, which is a high protein variety. Results showed soymilk processing yield was the greatest by Method 4, but Method 2 gave the highest solids and protein yields by about 14 and 12%, respectively. Method 4, a two-step grinding also increased yields (8 and 7%, for solids and protein, respectively), and in all but one instance produced higher total phenolic content (TPC), total flavonoid content (TFC), condensed tannin content (CTC) and total isoflavone content in both raw and cooked soymilk as compared to Method 1. Cooking soymilk reduced 14-17% of total phenolic substances. Cooking reduced anticancer capacity of Method-4-prepared soymilk phenolic extract by increasing IC50 value from about 4.9 mg/mL to 6.8 mg/mL. The increases in phenolic compounds and antioxidants produced in Prosoy soymilk by Methods 2 and 4 with simultaneous increases in product solids yield are significant to benefit the soymilk industry and consumer health. Keywords: ProSoy yellow soybean, soymilk processing, phenolics, isoflavones, antioxidant capacity, anti-DU145 prostate cancer proliferation

Outcome of redo-mitral valve replacement in the small mitral annulus with the use of the chimney technology is not well documented. From 2019 to 2020, 77 consecutive patients underwent redo-mitral valve replacement with the use of the chimney technology because of a small mitral annulus. To evaluate heart structural integrity and clinical outcomes, postoperative clinical data and echocardiograms were examined. Mean age was 56.7 ± 15.98 years. All patients underwent mitral valve surgery of which 62 were mitral valve replacements, 7 mitral valve repairs, and 8 double valve replacements. Preoperative Mitral valve mean gradient was 18.07 ± 9.40 mmHg. Postoperative mitral prosthesis size 28.51 ± 1.22 mm. The median increment of mitral size enlargement was 4 (0, 6) valve sizes. Mean mitral gradient coming out of the operating room was 10.34 ± 2.12 mmHg and at follow-up echocardiogram performed at 3 years after the procedure was 10.36 ± 1.70 mmHg. One-year survival was 93.3%, while 4-year survival was 89.3% with no reoperation. Use of the chimney technology in small mitral valve re-mitral valve replacement results in larger valve sizes. Moreover, the mean gradients over the mitral valve are acceptable intraoperatively and over time.

Background Few data exist on comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided in four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow - low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35ml/m2 and mean gradient (MG) < 40mmHg), (ii) normal flow - low gradient (NF-LG): SVi > 35ml/m2 and MG < 40mmHg, (iii) low flow - high gradient (LF-HG) : SVi ≤ 35ml/m2 and MG ≥ 40mmHg and (iv) normal flow - high gradient (NF-HG): SVi > 35 ml/m2 and MG ≥ 40mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow up was complete for all patients. Results A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80±7 years and the majority of patients (N=138, 50.2%) were women. 62 patients (22.8% of the study population) were distributed in LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, while 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%) and NF-LG patients (58.8%) (log rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918 – 0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645 - 5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456 , 95% C.I.: 1.106 - 1.792 ) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p<0.001) and a lower Svi (p<0.001) at baseline were associated with LVEF improvement at 1 year. Conclusions Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit an exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.

Objective: It was aimed to investigate the cerebral vascular territories in stroke patients with NVAF as an etiologic factor. Material and Methods: A total of 104 patients who were referred to our hospital between January 2015 and September 2016, who were over 55 years of age, identified or documented as having a standard ECG or Holter ECG record on their medical history, and diagnosed with stroke were included. Our study was designed as a retrospective analysis of prospective data. Detailed history, physical examination and electrocardiography (ECG) evaluations of the patients were performed. Descriptive statistics were used in the detection of findings, and t-test, Pearson-square test and Fisher's exact test were used for differences analysis. Results: 53.8% (N = 56) of the patients were male and 46.2% (N = 48) were female. The mean age was 73.5. MCA was the most common site of vascular involvement in NVAF-dependent strokes. In MCA vascular territory, ischemic infarcts were detected most frequently in the upper and lower divisions. SCA and PCA followed MCA. Approximately 64% of the NVAF-related strokes were anterior circulation infarction (ASE) and 22% were posterior circulation infarct (PSE). There was a significant difference in age and past stroke history factors in favor of ASE (p<0.05). There was no significant difference between ASE and PSE in HT, cardiac history and DM factors (p>0.05). Conclusion: It was emphasized that the area of the vessel that underwent ischemia in the acutely displayed infarcts and the etiological factor for this vessel area could be predicted

Artificial insemination (AI) is considered as the most efficient feasible tool to improve the dairy cows’ profitability and productivity. In bovines, AI helps to promote genetic improvement and can positively impact the rural economy. The achievement of education in rural populations was one of the Millennium Development Goals (MDGs), made by the United Nations. During the last World Summit on Sustainable Development (WSSD), it was concluded that most of the world’s poor, illiterate and undernourished population lives in rural areas; therefore, access to education is considered one of the greatest challenges for governments in countries with developing economies. To determine the effects of a theoretical-practical training program related to rural management and leadership, AI, and bovine genetic improvement, on the perception and level of knowledge in a rural Colombian population that has been affected by the armed conflict. Phase 1. Included the practical and theoretical training of undergraduate animal sciences students in three dimensions rural management; leadership (D-ML), AI in bovines (D-AI), and genetic improvement (D-GI) after training students were evaluated and selected according to their skills, characteristics, solidarity skills, and their social sensitivity was identified. Phase 2. Included the socioeconomic characterization and training of rural residents by students and field experts in three dimensions D-ML, D-AI, and D-GI. After training we evaluated the perception and level of knowledge before and after training in 63 rural residents using an evaluative instrument. The data before and after (post-test) of the theoretical-practical training, were analyzed to obtain a statistical significance. The perception of knowledge in rural residents was low for general knowledge (2.48±0.76, p ˂ 0.05), D-ML (2.89±1.18, p ˂ 0.05) and D-AI and D-GI (2.17±0.83, p ˂ 0.05). On the other hand, before the theorical-practical training the level of general knowledge was 45.9%, however, after the training increased at 77.6% (p<0.01), while the level of knowledge for the D-AI was increased from 38.5 % to 80.6 % (p ˂ 0.05) after training. Regarding the level of knowledge for the D-GI pre-training was 50.8 and increased to 73.0% (p<0.01) then after. Finally, the level of knowledge for the D-ML was increased (p<0.01) from 54.8 before training to 75% after training. Altogether, the rural extension programs contribute to the closing of knowledge gaps in relation to the use of reproductive biotechnologies and bovine management in rural areas affected by armed conflict.