Prothrombin complex concentrates or recombinant factor VIIa are more effective than fresh-frozen plasma at lowering INR in patients with liver disease

A critical appraisal and clinical application of Kwon JO, MacLaren R. Comparison of fresh-frozen plasma, four-factor prothrombin complex concentrates, and recombinant factor VIIa to facilitate procedures in critically ill patients with coagulopathy from liver disease: a retrospective cohort study. Pharmacotherapy. 2016;36(10):1047-1054. doi: 10.1002/phar.182

Conservative Management of Spontaneous Coronary Artery Dissection: A Case Report

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare but fatal cause of acute coronary syndrome (ACS), often seen in young healthy women without any significant cardiovascular disease. If not treated early, it can lead to sudden cardiac death. We report an interesting case of ACS due to SCAD. Case Presentation: A 40-year-old woman presented to the emergency department with retrosternal chest pain at rest, associated with diaphoresis, palpitations, and nausea. Her past medical history was significant for hypertension and type 2 diabetes. On presentation, blood pressure was elevated to 150/81 mmHg, remaining vitals were normal. Initial electrocardiogram (ECG) showed normal sinus rhythm with no ischemic changes. Laboratory tests revealed an elevated high sensitivity troponin level to 104 ng/L (ref:/L). Given her clinical picture and biomarker elevation, there was concern for acute coronary syndrome. Echocardiography displayed an ejection fraction of 60% and no regional wall motion abnormalities. Coronary angiography was performed, which revealed non-obstructive coronary artery disease (CAD) with dissection of the mid-to-distal right posterolateral branch of the right coronary artery (RCA). No intervention was performed given mild extension of dissection and location. Of note, she did have recurrent chest pain with subsequent resolution. Given her overall symptomatic improvement, she was eventually discharged on metoprolol succinate, aspirin, and a moderate dose statin. Discussion: SCAD involves dissection of an epicardial coronary artery that is not secondary to atherosclerosis, trauma, or iatrogenic causes. It is the cause of up to 1-4% of ACS cases, occurs mostly in women, and is the most common cause of pregnancy-associated myocardial infarction (MI). The left anterior descending (LAD) artery is the most common artery affected, although it can affect any artery. The pathogenesis of SCAD involves the sudden disruption of the intimal layer, leading to dissection of the tunica media and subsequent formation of an intramural hematoma within a false lumen, and eventual compression of the true lumen. This leads to reduced coronary blood flow and MI. Acute coronary syndrome is the most common presentation, though clinical manifestations of SCAD can range from stable angina, to cardiogenic shock and life-threatening arrhythmias. When diagnosing SCAD, coronary angiography should be the first-line diagnostic imaging study. Other modalities including intravascular ultrasonography and optical coherence tomography allow for more detailed visualization of the artery wall and can be used to aid diagnosis. Management of SCAD varies depending on the case presentation and the severity of the condition. Patients with extensive dissections resulting in recurring symptoms and myocardial ischemia usually require percutaneous coronary intervention (PCI), while surgery is preferred for multi-vessel disease. Medical therapy is indicated for cases with mild involvement, and may include aspirin, P2Y12 inhibitors, beta blockers, and nitrates. Generally, patients with SCAD have a good prognosis especially with early detection and treatment. Recurrence of SCAD occurs in a minority of cases.https://scholarlycommons.henryford.com/merf2020caserpt/1052/thumbnail.jp

TCT-378 Not Every TEE Is a “Standard of Care” TEE

Background: Intraprocedural structural heart imaging is more challenging and has unique differences from standard of care (SOC) imaging. However, the variations in time and complexity of different types of SOC transesophageal echocardiographs (TEEs) versus interventional TEEs is not well studied. In this study, we aim to compare the complexity of SOC nonvalvular indication TEE with SOC valvular TEE studies and interventional TEEs performed in the guidance of transcatheter edge-to-edge repair (TEER) MitraClip (Abbott Vascular) procedures. Methods: A retrospective case-control analysis was performed on 200 patients who underwent TEE in the Henry Ford Health System. One hundred cases of interventional TEE-guided TEER were compared with 73 nonvalvular (endocarditis and stroke evaluation) SOC TEEs and 27 valvular (preprocedural mitral, aortic, and tricuspid valve evaluations) SOC TEEs. Complexity was quantified by the total procedure duration, the total number of images, and the number of 3-dimensional (3D) clips captured. The mean, median, and SD were compared between these groups. The Kruskal-Wallis test was used to evaluate statistical significance. Results: The mean duration of TEE procedures, the number of images, and the number of 3D clips were all significantly higher in the interventional imaging TEER group compared with the noninterventional groups (P \u3c 0.0001) (Table 1). The duration and number of images were also significantly higher among valvular compared with nonvalvular SOC TEE groups (P \u3c 0.0002) as well as number of 3D clips (P \u3c 0.0012). Conclusion: Interventional TEE was more complicated and time-consuming compared with SOC TEE performed for both nonvalvular and valvular indications. The latter was also more complex than SOC nonvalvular TEE. This is the first study of its kind demonstrating objective differences between interventional and 2 SOC TEE groups. These results emphasize the need of dedicated training for intraprocedural imaging as well as restructuring of reimbursement codes. Categories: STRUCTURAL: Valvular Disease: Mitra

TCT-374 Structural Heart Intraprocedural Versus Nonprocedural Transesophageal Echocardiography: A Quantitative Analysis of Complexity

Background: Transesophageal echocardiography (TEE) is an essential tool in many structural heart procedures, such as transcatheter mitral valve edge-to-edge repair (TEER). Interventional procedural TEE requires a unique skill set. This study aims to evaluate the complexity of interventional structural heart TEE used to guide TEER compared with standard of care (SOC) TEE studies performed at a single center. Methods: A retrospective case-control analysis was performed of 200 patients who underwent TEE in the Henry Ford Health System. One hundred cases of interventional TEE-guided TEER were compared with 100 controls of SOC TEE. Complexity was quantified by the total duration of the procedure, the total number of images, and the number of 3-dimensional clips captured. The mean, median, and SD were compared between these 2 groups. Wilcoxon rank sum tests were used to evaluate statistical significance. Results: One hundred intraprocedural TEE studies to guide TEER and 100 SOC TEE studies were analyzed. The mean duration of TEE procedures, the number of images, and the number of 3-dimensional clips were all significantly higher in the TEER group (P \u3c 0.0001) (Table 1). Conclusion: Interventional TEE guidance for TEER is significantly more complex and more time-consuming than SOC TEE. This is the first large-scale study demonstrating objective differences between interventional and SOC TEE. This conclusion implicates the necessity of dedicated training programs for interventional imaging, in addition to the necessity of reviewing the current reimbursement codes to account for such a difference. Categories: STRUCTURAL: Valvular Disease: Mitra

Effect of pre-existing baryon inhomogeneities on the dynamics of quark-hadron transition

Baryon number inhomogeneities may be generated during the epoch when the baryon asymmetry of the universe is produced, e.g. at the electroweak phase transition. The regions with excess baryon number will have a lower temperature than the background temperature of the universe. Also the value of the quark hadron transition temperature $T_c$ will be different in these regions as compared to the background region. Since a first-order quark hadron transition is very susceptible to small changes in temperature, we investigate the effect of the presence of such baryonic lumps on the dynamics of quark-hadron transition. We find that the phase transition is delayed in these lumps for significant overdensities. Consequently, we argue that baryon concentration in these regions grows by the end of the transition. We briefly discuss some models which may give rise to such high overdensities at the onset of the quark-hadron transition.Comment: 16 pages, no figures, minor changes, version to appear in Phys. Rev.

Additive Value of Preprocedural Computed Tomography Planning Versus Stand-Alone Transesophageal Echocardiogram Guidance to Left Atrial Appendage Occlusion: Comparison of Real-World Practice

Background: Transesophageal echocardiogram is currently the standard preprocedural imaging for left atrial appendage occlusion. This study aimed to assess the additive value of preprocedural computed tomography (CT) planning versus stand-alone transesophageal echocardiogram imaging guidance to left atrial appendage occlusion. Methods and Results: We retrospectively reviewed 485 Watchman implantations at a single center to compare the outcomes of using additional CT preprocedural planning (n=328, 67.6%) versus stand-alone transesophageal echocardiogram guidance (n=157, 32.4%) for left atrial appendage occlusion. The primary end point was the rate of successful device implantation without major peri-device leak (\u3e5 mm). Secondary end points included major adverse events, total procedural time, delivery sheath and devices used, risk of major peri-device leak and device-related thrombus at follow-up imaging. A single/anterior-curve delivery sheath was used more commonly in those who underwent CT imaging (35.9% versus 18.8%; P\u3c0.001). Additional preprocedural CT planning was associated with a significantly higher successful device implantation rate (98.5% versus 94.9%; P=0.02), a shorter procedural time (median, 45.5 minutes versus 51.0 minutes; P=0.03) and a less frequent change of device size (5.6% versus 12.1%; P=0.01), particularly device upsize (4% versus 9.4%; P=0.02). However, there was no significant difference in the risk of major adverse events (2.1% versus 1.9%; P=0.87). Only 1 significant peri-device leak (0.2%) and 5 device-related thrombi were detected in follow-up (1.2%) with no intergroup difference. Conclusions: Additional preprocedural planning using CT in Watchman implantation was associated with a higher successful device implantation rate, a shorter total procedural time, and a less frequent change of device sizes

Secluded Dark Matter Coupled to a Hidden CFT

Models of secluded dark matter offer a variant on the standard WIMP picture and can modify our expectations for hidden sector phenomenology and detection. In this work we extend a minimal model of secluded dark matter, comprised of a U(1)'-charged dark matter candidate, to include a confining hidden-sector CFT. This provides a technically natural explanation for the hierarchically small mediator-scale, with hidden-sector confinement generating m_{gamma'}>0. Furthermore, the thermal history of the universe can differ markedly from the WIMP picture due to (i) new annihilation channels, (ii) a (potentially) large number of hidden-sector degrees of freedom, and (iii) a hidden-sector phase transition at temperatures T << M_{dm} after freeze out. The mediator allows both the dark matter and the Standard Model to communicate with the CFT, thus modifying the low-energy phenomenology and cosmic-ray signals from the secluded sector.Comment: ~50p, 8 figs; v2 JHEP versio

Towards equitable climate-compatible transport pathways in Kenya : modelling co-created scenarios using a socio-technical approach

Through the co-development of a set of Kenyan transport pathways and a transport-energy systems model, TEAMKenya, we present a decision-support tool to assist policymakers at regional, national and international levels. The tool can help create policy, project and finance pipelines to support the realisation of climate compatible development objectives in the transport-energy sector. We quantify the impacts of pathways on transport-energy system outcomes including vehicle stock, Summary energy consumption, emissions, fiscal implications of changing fuel tax revenues and grid implications of e-mobility uptake. It was found that Kenya can vastly expand transport services to a growing population in a manner compatible with improving equitable access to mobility and limiting future emissions to comply with its nationally determined contribution (NDC) to the Paris Agreement. This transition is only possible if policy recommendations, applicable to both Kenyan and international policymakers, are met

How can emerging economies meet development and climate goals in the transport-energy system? : Modelling co-developed scenarios in Kenya using a socio-technical approach

Transport-energy transitions pose complex challenges that have been extensively studied in high-income countries in response to national mandates for climate action. Low- and middle-income countries, however, have low but rapidly growing motorisation rates and face very different challenges in adopting new technologies to foster economic development and ensure equitable access to clean transportation. Here, we present a set of narrative scenarios for the future of the Kenyan transport-energy system co-developed through engagement with 41 local experts and decision-makers. Through the co-development of a Kenyan transport-energy system model, we present a decision-support tool, populated with those scenarios, to assist policymakers at regional, national and international levels in building policy and investment pipelines to support low-carbon economic growth. We find that Kenya’s transport-energy system can meet both development and climate goals, but this demands strong policy support for efficient public transport and targeted support for road vehicle electrification. Increased support for non-motorised transport is essential to provide equitable access to services and economic opportunities. Favourable pathways result in significant e-mobility uptake, which is anticipated to increase electricity demand by 5-56% from 2023 to 2040, relative to the IEA Kenya Energy Outlook’s Stated Policies scenario, representing a 2.7-3.9x increase in Kenya’s total electricity demand over the same period. From a macro-fiscal perspective, results show that e-mobility has two important consequences for Kenya. Firstly, under high e-mobility scenarios, there is a negative fiscal impact that taxation revenues from the sale of transport fuels reduce by up to 41% relative to the low e-mobility scenario (though, notably, they still increase marginally from the 2023 level because of increasing transport demand). Secondly, high e-mobility scenarios have a positive impact on balance of payments by reducing the fuel import bill by up to 69% relative to the low e-mobility baseline. This corresponds to a reduction in foreign exchange requirement of up to $4.2bn annually by 2050

Optimization of Pre-hydrolysis Conditions for the Production of Biogas

Hydrolysis and solubilisation of organic material is known to be the rate limiting step during anaerobic digestion. In this study, the effect of pre-hydrolysis was investigated. The substrate had a composition of the following wastes streams: fish and slaughterhouse waste, cleaning waste, doggy meat, doggy sludge, doggy dry food, mink (fur), Norway slurry, SOR2-Industrial waste, and municipal solid waste (MSW) from households in Borås community.Analyses were made on two batches of experiments performed at two different mesophilic temperature conditions; 34 0C and 42 0C and with or without the addition of mesophilic sludge obtained from a waste water treatment plant. One of the substrate maintained the original carbon/nitrogen (C/N) ratio, and for the other substrate the carbon nitrogen ratio was then slightly increased by adding 7.98g of special shredded paper which contains 82% volatile solids (VS). The experiments were run for 7days with samples collected regularly after 0 day, 4 days, 5 days, 6 days and 7 days retention time. Chemical oxygen demand (COD), pH, total nitrogen, and volatile fatty acids (VFAs) as process indicators were analyzed.The results showed that at 42 0C the rate of hydrolysis was faster with a higher COD release and removal. The optimum retention time for hydrolysis was 4 days and any longer time caused some of the carbon to be lost to carbon dioxide. The effect of adding mesophilic sludge had no significant effect. An increased C/N ratio resulted in a balanced system with lower VFAs produced compared with that from the original substrate mixture.Acknowledgements: The authors are heartily thankful to their supervisor Ilona Sárvári Horváth whose guidance and support from the initial to the final level of this thesis work enabled us to gain a deeper understanding of the project.We equally extend our sincere gratitude to the following persons who never ceased in helping until this work was complete.Solmaz Aslanzadeh: For sharing her precious time and positive insight in coping with associated challenges of the project.Hanson Jonas: Your assistance and patience over our laboratory experiments given the limited resources vis-a-vis students demand is quite reminding and saluted.The support team at Sobacken Biogas plant: Your concern and timely assistance beginning from the supply of the substrate and the opportunity granted us to use your laboratory station greatly ensured results validation.Program: MSc in Resource Recovery - Sustainable EngineeringProgram: MSc in Resource Recovery - Industrial Biotechnology</p