Sutureless bioprosthesis for aortic valve replacement: surgical and clinical outcomes

© 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Background: Aortic valve stenosis is the most common adult valve disease in industrialized countries. The aging population and the increase in comorbidities urge the development of safer alternatives to the current surgical treatment. Sutureless bioprosthesis has shown promising results, especially in complex procedures and in patients requiring concomitant surgeries. Objectives: Assess the clinical and hemodynamic performance, safety, and durability of the Perceval® prosthetic valve. Methods: This single-center retrospective longitudinal cohort study collected data from all adult patients with aortic valve disease who underwent aortic valve replacement with a Perceval® prosthetic valve between February 2015 and October 2020. Of the 196 patients included (mean age 77.20 ± 5.08 years; 45.4% female; mean EuroSCORE II 2.91 ± 2.20%), the majority had aortic stenosis. Results: Overall mean cross-clamp and cardiopulmonary bypass times were 33.31 ± 14.09 min and 45.55 ± 19.04 min, respectively. Mean intensive care unit and hospital stay were 3.32 ± 3.24 days and 7.70 ± 5.82 days, respectively. Procedural success was 98.99%, as two explants occurred. Four valves were reimplanted due to intraoperative misplacement. Mean transvalvular gradients were 7.82 ± 3.62 mmHg. Pacemaker implantation occurred in 12.8% of patients, new-onset atrial fibrillation in 21.9% and renal replacement support was necessary for 3.1%. Early mortality was 2.0%. We report no structural valve deterioration, strokes, or endocarditis, and one successfully treated valve thrombosis. Conclusions: Our study confirms the excellent clinical and hemodynamic performance and safety of a truly sutureless aortic valve, up to a 5-year follow-up. These results were consistent in isolated and concomitant interventions, solidifying this device as a viable option for the treatment of isolated aortic valve disease.info:eu-repo/semantics/publishedVersio

(2E)-N-(3,5-Dibromo-4-methoxy­phen­yl)-2-(hydroxy­imino)acetamide

The title compound, C9H8Br2N2O3, is planar (r.m.s. deviation = 0.030 Å) with the exception of the terminal methyl group which lies out of the plane [1.219 (3) Å]. The conformation about the C=N double bond [1.268 (3) Å] is E. An intra­molecular N—H⋯N hydrogen bond occurs. Linear supra­molecular chains along the b axis mediated by O—H⋯O hydrogen-bonding inter­actions feature in the crystal structure. These chains are also stabilized by weak C—H⋯N contacts

Plantas medicinais na Amazônia Ocidental.

Os estudos com plantas medicinais, aromáticas e condimentares na Embrapa Amazônia Ocidental iniciaram-se, em 1996, com o pesquisador Antônio Franco de Sá Sobrinho. Posteriormente, houve a incorporação do pesquisador Antônio Nascim Kalil Filho na equipe, com a introdução de sacaca (Croton cajucara) tipos branca e vermelha, provenientes de várias localidades, tanto do Estado do Amazonas como de outros da região Norte, como: sacaca branca (Rio Preto da Eva, Presidente Figueiredo, Iranduba, Manaus, no Amazonas); sacaca vermelha (Belém, Santarém e Belterra, no Pará, e Rio Branco, no Acre)

Role of omega-6 fatty acid metabolism in cardiac surgery postoperative bleeding risk

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Cardiac surgery is frequently associated with significant postoperative bleeding. Platelet-dysfunction is the main cardiopulmonary bypass (CPB)-induced hemostatic defect. Not only the number of platelets decreases, but also the remaining are functionally impaired. Although lipid metabolism is crucial for platelet function, little is known regarding platelet metabolic changes associated with CPB-dysfunction. Our aim is to explore possible contribution of metabolic perturbations for platelet dysfunction after cardiac surgery. Design: Prospective cohort study. Setting: Tertiary academic cardiothoracic-surgery ICU. Patients: Thirty-three patients submitted to elective surgical aortic valve replacement. Interventions: Samples from patients were collected at three time points (preoperative, 6- and 24-hr postoperative). Untargeted metabolic analysis using high-performance liquid chromatography-tandem mass spectrometry was performed to compare patients with significant postoperative bleeding with patients without hemorrhage. Principal component analyses, Wilcoxon matched-pairs signed-rank tests, adjusted to FDR, and pairwise comparison were used to identify pathways of interest. Enrichment and pathway metabolomic complemented the analyses. Measurements and main results: We identified a platelet-related signature based on an overrepresentation of changes in known fatty acid metabolism pathways involved in platelet function. We observed that arachidonic acid (AA) levels and other metabolites from the pathway were reduced at 6 and 24 hours, independently from antiagreggation therapy and platelet count. Concentrations of preoperative AA were inversely correlated with postoperative chest tube blood loss but were not correlated with platelet count in the preoperative, at 6 or at 24 hours. Patients with significant postoperative blood-loss had considerably lower values of AA and higher transfusion rates. Values of postoperative interleukin-6 were strongly correlated with AA variability. Conclusions and relevance: Our observations suggest that an inflammatory-related perturbation of AA metabolism is a signature of cardiac surgery with CPB and that preoperative levels of AA may be more relevant than platelet count to anticipate and prevent postoperative blood loss in patients submitted to cardiac surgery with CPB.info:eu-repo/semantics/publishedVersio

Caracterização e ocorrência do distúrbio do amolecimento precoce em mamões 'Golden'

The occurrence of green skin and soft pulp in 'Golden' papaya fruit during certain seasons has been reported by farmers in the northern of the state of Espirito Santo, Brazil. The objective of this study was to characterize and determine the occurrence of this disorder, which was referred as "early softening disorder". Fruits were harvested weekly for 11 months (from September to July). The fruits were stored at 10°C, and then fruit flesh firmness and skin color were analyzed. The results of the firmness test were submitted to regression analysis assuming a linear trendline. The slope of the curve was called the 'softening index' (SI). Fruits with early softening are characterized by a loss of firmness in less than 10 days, even when stored under refrigeration. Although softened, the skin of the fruit remains partially green. Fruits with the disorder occurred more frequently from mid-summer to mid-autumn (February to May). It is not possible to distinguish early softening disorder fruits from those without the disorder by skin color and flesh firmness analysis at the time of the harvest.Tem sido relatado por produtores da região norte do Espírito Santo a ocorrência de mamões 'Golden' com casca verde e polpa mole, em determinadas épocas do ano. O objetivo deste trabalho foi caracterizar e determinar a ocorrência deste distúrbio denominado de amolecimento precoce. Foram realizadas coletas semanais durante 11 meses (período de setembro a julho). Os frutos foram armazenados a 10°C e analisados quanto à firmeza da polpa e à cor da casca. Os resultados de firmeza da polpa foram submetidos à análise de regressão, assumindo-se que a equação é do tipo linear, e o ângulo de inclinação da curva foi chamado Índice de Amolecimento (IA). Frutos com o distúrbio caracterizaram-se pela perda da firmeza em menos de 10 dias, mesmo quando armazenados sob refrigeração. Embora amolecidos, a coloração da casca manteve-se parcialmente verde. A maior frequência de frutos com o distúrbio ocorreu de meados de verão a meados de outono (fevereiro a maio). Não é possível distinguir frutos com o distúrbio do amolecimento precoce daqueles normais pela análise da cor da casca e da firmeza da polpa, no momento da colheita

Perceptions of HIV Risk and Explanations of Sexual Risk Behavior Offered by Heterosexual Black Male Barbershop Patrons in Brooklyn, NY

Objective: To describe HIV risk factors among adult heterosexual Black men recruited from four barbershops located in high HIV seroprevalent neighborhoods of Brooklyn, NY. Methods: Data on HIV-risk related behaviors and other characteristics were collected from barbershop clients. All participants (n=60) completed brief risk assessments; and a subset (n=22) also completed focus groups and/or individual interviews. Results: Of the subset of 22 men, 68% were US born, 59% had been in jail/prison, 32% were unemployed; and during the 3 months before the interviews, 68% reported at least two partners and 45% reported unprotected vaginal or anal sex with two or more women. Emergent themes included: 1) the psychological function of multiple partnerships; 2) calculated risk taking regarding condom use; 3) the role of emotional attachment and partner trust in condom use; 4) low perceived HIV risk and community awareness; and 5) lack of relationship between HIV testing and safer sex practices. Conclusions: Interventions among heterosexual Black men should focus not only on increasing HIV awareness and reducing sexual risk, but also on contextual and interpersonal factors that influence sexual risk

D\u27Amico Risk Stratification Correlates with Degree of Suspicion of Prostate Cancer on Multiparametric Magnetic Resonance Imaging.

PURPOSE: We determined whether there is a correlation between D\u27Amico risk stratification and the degree of suspicion of prostate cancer on multiparametric magnetic resonance imaging based on targeted biopsies done with our electromagnetically tracked magnetic resonance imaging/ultrasound fusion platform. MATERIALS AND METHODS: A total of 101 patients underwent 3 Tesla multiparametric magnetic resonance imaging of the prostate, consisting of T2, dynamic contrast enhanced, diffusion weighted and spectroscopy images in cases suspicious for or with a diagnosis of prostate cancer. All prostate magnetic resonance imaging lesions were then identified and graded by the number of positive modalities, including low-2 or fewer, moderate-3 and high-4 showing suspicion on multiparametric magnetic resonance imaging. The biopsy protocol included standard 12-core biopsy, followed by real-time magnetic resonance imaging/ultrasound fusion targeted biopsies of the suspicious magnetic resonance lesions. Cases and lesions were stratified by the D\u27Amico risk stratification. RESULTS: In this screening population 90.1% of men had a negative digital rectal examination. Mean±SD age was 62.7±8.3 years and median prostate specific antigen was 5.8 ng/ml. Of the cases 54.5% were positive for cancer on protocol biopsy. Chi-square analysis revealed a statistically significant correlation between magnetic resonance suspicion and D\u27Amico risk stratification (p CONCLUSIONS: Our data support the notion that using multiparametric magnetic resonance prostate imaging one may assess the degree of risk associated with magnetic resonance visible lesions in the prostate

Green and roasted arabica coffees differentiated by ripeness, process and cup quality via electrospray ionization mass spectrometry fingerprinting

Direct infusion electrospray ionization mass spectrometry in both the negative ESI(-)-MS and positive ESI(+)-MS ion modes are investigated to differentiate green and roasted Arabica coffees with different stages of ripeness (green, ripe and overripe), post-harvesting process (dry, wet and semi-wet) and coffees with different cup qualities. In the ESI(-)-MS of green coffees, ions from deprotonated fatty acids and chlorogenic acids are the most important for ripeness discrimination. In the ESI(+)-MS, maturity is differentiated by ions from protonated caffeine, chlorogenic acids and K+ adducts of fatty acids. To differentiate between post-harvesting process in both ionization modes, ions from fatty acids, chlorogenic acids, sugars and carboxylic acids generated in the fermentation process are the most representative. Roasted Arabica coffees are also well discriminated: in the ESI(-)-MS, ions from chlorogenic acids and short-chain organic acids derived from sugars are important. In the ESI(+)-MS, discrimination are mainly performed by low m/z ions such as protonated pyridine and alkylpiridines formed via trigonelline degradation. Both ESI(+)-MS and ESI(-)-MS are able to differentiate cup quality for Arabica roasted coffees and the ions used to perform discrimination are the same ones described in ripeness and post-harvesting processes.A habilidade da técnica de espectrometria de massas com infusão direta e ionização por eletronebulização (IES-EM), nos modos de íons positivos e negativos, foi avaliada na diferenciação de cafés Arábica verdes e torrados e com diferentes estágios de amadurecimento (verde, maduro e passado), processo pós-colheita (seco, úmido e semi-úmido) e cafés classificados por prova de xícara. No modo negativo, a análise dos cafés verdes mostrou que os íons correspondentes aos ácidos graxos e ácidos clorogênicos desprotonados são os mais importantes para a discriminação da maturidade. No modo positivo, a maturidade é diferenciada através de íons correspondentes a cafeína, ácidos clorogênicos protonados e adutos de K+ de ácidos graxos. Na diferenciação da pós-colheita, em ambos os modos de ionização, são mais importantes os íons correspondentes aos ácidos graxos, ácidos clorogênicos, açúcares e ácidos carboxílicos formados da fermentação. Cafés Arábica torrados também são discriminados com eficiência. No modo negativo, são importantes os íons correspondentes aos ácidos clorogênicos e ácidos orgânicos de cadeia curta, derivados de açúcares. No modo positivo, a discriminação é realizada por íons de baixa m/z tais como piridina e alquil piridinas protonadas, formadas através da degradação da trigonelina. Ambos os IES(+)-EM e IES(-)-EM são capazes de discriminar diferentes cafés Arábica torrados classificados por prova de xícara e os íons que permitem esta diferenciação são os mesmos descritos para a maturidade e processos pós-colheita.313321Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES