Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report.

Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by femoral access. In the echocardiography follow-up, an aorta-right ventricular (Ao-RV) fistula was noted with restrictive flow and no significant shunt and it was treated conservatively. Three years after TAVI, the patient underwent cardiac surgery because of worsening heart failure due to a severe degenerative mitral regurgitation with tethering of P2 due to left ventricular remodelling, a posterior jet of severe regurgitation, and left ventricular dilatation. Surgical replacement of the TAVI and aortic root with a bioprosthesis (Medtronic Freestyle) and direct closure of the fistula was performed along with the mitral valve replacement. The patient was discharged with a good clinical result and no evidence of remaining Ao-RV fistula at transthoracic echocardiography. Aorta-right ventricular fistula is a rare entity. Most reported cases arise after rupture of a congenital coronary sinus aneurism, endocarditis, trauma, and aortic valve or aortic root surgery. This is the 10th reported case after TAVI (9 after an Edwards Sapiens TAVI). Non-significant shunt can be treated conservatively but development of heart failure and death are described in significant shunts. Balloon post-dilatation and the absence of surgical calcium debridement inherent to TAVI may theoretically contribute to the development of the fistula. Surgical replacement and closure of the fistula is a therapeutic option for this entity even in high-risk patients

The little finger ulnar palmar digital artery perforator flap: anatomical basis

PURPOSE: The aim of this study was to explore the cutaneous vascularization of the hypothenar region and investigate the anatomical basis for perforator propeller flaps for coverage of the flexor aspect of the little finger. METHODS: The area between the pisiform and the base of the little finger was studied in 14 hands of fresh cadavers injected with red latex. An oval flap 1.5 cm large was raised along the axis between these two points. Perforators going into the flap were dissected up to their origin from the ulnar palmar digital artery of the little finger, and their distance from the proximal edge of the A1 pulley was recorded. RESULTS: The mean number of perforator arteries entering the flap was 5.8 (range 4-8). A constant sizeable perforator was identified within 0.7 cm from the proximal margin of the A1 pulley in all 14 specimens. In the majority of cases (64 %), the most distal perforator was located at this level. Dissection of the flap was carried out suprafascially on the most distal perforator and 180° rotation allowed the flap to reach the flexor surface of the fifth finger. The donor site was closed primarily. CONCLUSION: Distal perforators of the ulnar palmar digital artery of the little finger are constantly found. Our anatomical findings support the possibility of raising a propeller perforator flap from the hypothenar region for coverage of the flexor aspect of the little finger. Its clinical application could provide a quick and straightforward single-stage option with a negligible donor-site morbidity for reconstruction of such defects

Treatment of esophageal achalasia in children: Today and tomorrow

Esophageal achalasia (EA) is a rare esophageal motility disorder in children. Laparoscopic Heller myotomy (LHM) represents the treatment of choice in young patients. Peroral endoscopic myotomy (POEM) is becoming an alternative to LHM. The aim of this study is to evaluate the effectiveness, safety, and outcomes of POEM vs LHM in treatment of children with EA. Data of pediatric patients with EA, who underwent LHM and POEM from February 2009 to December 2013 in two centers, were collected. Eighteen patients (9 male, mean age: 11.6 years; range: 2-17 years) were included. Nine patients (6 male, mean age: 10.7 years; range: 2-16 years) underwent LHM, and the other 9 (3 males, mean age: 12.2 years; range: 6-17 years) underwent POEM procedure. Mean operation time was shorter in POEM group compared with LHM group (62/149 minutes). Myotomy was longer in POEM group than in LHM group (11/7 cm). One major complication occurred after LHM (esophageal perforation). No clinical and manometric differences were observed between LHM and POEM in follow-up. The incidence of iatrogenic gastroesophageal reflux disease was low (1 patient in both groups). Results of a midterm follow-up show that LHM and POEM are safe and effective treatments also in children. Besides, POEM is a mini-invasive technique with an inferior execution timing compared to LHM. A skilled endoscopic team is mandatory to perform this procedur

Epilepsy, Behavioral Abnormalities, and Physiological Comorbidities in Syntaxin-Binding Protein 1 (STXBP1) Mutant Zebrafish.

Mutations in the synaptic machinery gene syntaxin-binding protein 1, STXBP1 (also known as MUNC18-1), are linked to childhood epilepsies and other neurodevelopmental disorders. Zebrafish STXBP1 homologs (stxbp1a and stxbp1b) have highly conserved sequence and are prominently expressed in the larval zebrafish brain. To understand the functions of stxbp1a and stxbp1b, we generated loss-of-function mutations using CRISPR/Cas9 gene editing and studied brain electrical activity, behavior, development, heart physiology, metabolism, and survival in larval zebrafish. Homozygous stxbp1a mutants exhibited a profound lack of movement, low electrical brain activity, low heart rate, decreased glucose and mitochondrial metabolism, and early fatality compared to controls. On the other hand, homozygous stxbp1b mutants had spontaneous electrographic seizures, and reduced locomotor activity response to a movement-inducing "dark-flash" visual stimulus, despite showing normal metabolism, heart rate, survival, and baseline locomotor activity. Our findings in these newly generated mutant lines of zebrafish suggest that zebrafish recapitulate clinical phenotypes associated with human syntaxin-binding protein 1 mutations

Recent Progress in Beam-Based Metal Additive Manufacturing from a Materials Perspective: A Review of Patents

Over the last decade, the enormous potential of metal additive manufacturing (AM) processes has led these technologies to establish their position in many industries. Much effort is being made toward their widespread application; however, much remains to be done to achieve full industrialization of these processes. Therefore, many companies, research centers and universities are investing in comprehensive research and development activities in order to further promote the industrialization of metal AM. This review traces the progress of metal AM technologies through an investigation of patents. In the present study, beam-based metal AM patents were searched through the Orbit Intelligence database. First, the number of patents per year was studied, indicating that, as expected, there is strong growth in AM patenting activities. The patents were afterward examined in order to highlight the key players in the field, and it was found that the main players investing in this market are: multidisciplinary companies, AM machine producers, end users working, especially in the aerospace sector, universities and research centers. The patents were then analyzed to understand the technology domains covered by each key player and their trend of investments. Finally, the patents in the field of Materials and Metallurgy were studied individually to identify the main topics faced by the most used alloy classes: Al-, Ni- and Ti-based alloys and steels. The extensive study of these patents clearly indicated that the main gaps to fill in metal AM are strongly material dependent and that it is possible to find correlations between the alloy classes, their main industrial applications and their specific AM processability issues. The current study provides insights into global trends that can help industrial markets to identify the right investment direction and research to identify topics for future investigation

Morphology and structure of ABS membranes filled with two different activated carbons

Mixed matrix-composite membranes (MMCM) for gas separation are prepared and characterized in this work. Acrylonitrile-butadiene-styrene (ABS) copolymer was used for the continuum phase of the membrane filled with two different activated carbons (AC). The so-obtained membranes have been characterized by gas permeability, optical microscopy, electronic microscopy and atomic force microscopy. The membranes have different roughness on both their surfaces but are always recovered by the polymeric material. Better ABS-AC adhesion has been always reached giving high selectivity and permeability for CO2 / CH4. Such intimate contact can be attributed to the rubber properties of the butadiene-styrene chains in ABS. The morphological characteristics and the increase in both permeability and selectivity with the volume fraction of the filler are explained in terms of the properties of pure activated carbons.Fil: Marchese, Jose. Universidad Nacional de San Luis; Argentina. Universidad Nacional de San Luis. Facultad de Ciencias Fisico Matematicas y Naturales. Departamento de Fisica. Laboratorio de Ciencias de Superficies y Medios Porosos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Anson, M.. Universidad Nacional de San Luis; Argentina. Universidad Nacional de San Luis. Facultad de Ciencias Fisico Matematicas y Naturales. Departamento de Fisica. Laboratorio de Ciencias de Superficies y Medios Porosos; ArgentinaFil: Ochoa, Nelio Ariel. Universidad Nacional de San Luis; Argentina. Universidad Nacional de San Luis. Facultad de Ciencias Fisico Matematicas y Naturales. Departamento de Fisica. Laboratorio de Ciencias de Superficies y Medios Porosos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Prádanos, P.. Universidad de Valladolid; EspañaFil: Palacio, L.. Universidad de Valladolid; EspañaFil: Hernández, A.. Universidad de Valladolid; Españ

A critical analysis of the hydrino model

Recently, spectroscopic and calorimetric observations of hydrogen plasmas and chemical reactions with them have been interpreted as evidence for the existence of electronic states of the hydrogen atom with a binding energy of more than 13.6 eV. The theoretical basis for such states, that have been dubbed hydrinos, is investigated. We discuss both, the novel deterministic model of the hydrogen atom, in which the existence of hydrinos was predicted, and standard quantum mechanics. Severe inconsistencies in the deterministic model are pointed out and the incompatibility of hydrino states with quantum mechanics is reviewed.Comment: 9 page

Productivity Enhancement in Directed Energy Deposition: The Oscillating Scanning Strategy Approach

Directed Energy Deposition (DED) is an additive manufacturing process that enables the production of large metal components by melting the feedstock material while being deposited. An improvement of the production speed of this process would further increase its applicability in many industrial fields. The DED building rate is strictly related to the building parameters adopted, in particular to the laser spot diameter, which also affects the build accuracy and the surface quality of the components. The possibility of using a variable laser spot would result in a significant increase in the production rate in bulky zones, while also providing a good surface quality where needed. In the present work, an oscillating scanning strategy was used to create a large apparent laser spot (+ 170% of the nominal value) to produce 316L stainless steel samples via DED. The optimisation of the DED parameters with the oscillating strategy was performed using the single scan tracks (SSTs) approach. The morphologies of the SSTs obtained with different process parameters were assessed and the geometrical features related to the melt pools were analysed in order to select the most suitable X and Z displacements for the production of the cubic samples. The analyses of the cubes revealed that, if the correct overlap among nearby scans is selected, it is possible to obtain dense samples with all the oscillating diameters tested. Finally, comparing the building rate and powder efficiency values confirmed that this method can accelerate the building process and improve its overall performance