Valve in valve implantation of the CoreValve Evolut R in degenerated surgical aortic valves

Background: The new CoreValve Evolut R has an improved design to minimize paravalvular leak­age and allows repositioning of the valve. For patients with degenerated bioprosthetic aortic valves, transcatheter aortic valve implantation (TAVI) represents a less invasive option. Herein reported are valve-in-valve (ViV) implantations of this new valve. Methods: A total of 26 patients (mean age 79.4 ± 6.1 years, 17 males and 9 females) were treated for severe prosthesis stenosis (n = 9), severe regurgitation (n = 8) or severe combination of stenosis and regurgitation (n = 9). All patients underwent transthoracic echocardiography before and after ViV implantation. Results: Valve-in-valve implantation of a CoreValve Evolut R was performed successfully in all pa­tients. The mean transaortic gradient for stenotic valves determined by transthoracic echocardiography was reduced significantly from 37.5 ± 15.3 mmHg in patients with prosthesis stenosis to 16.3 ± 8.2 mmHg (p < 0.001). In all cases with severe prosthesis regurgitation, regurgitation was reduced to none or mild. All-cause mortality after 30 days was 0%. Conclusions: It was concluded that CoreValve Evolut R is well suited for ViV implantation

Renal and hepatic function of patients with severe tricuspid regurgitation undergoing inferior caval valve implantation

Due to progressive abdominal-venous congestion severe tricuspid regurgitation (TR) is a common cause of cardiorenal and cardiohepatic syndrome. We initiated the TRICAVAL study to compare interventional valve implantation into the inferior vena cava (CAVI) versus optimal medical therapy (OMT) in severe TR. In the present subanalysis, we aimed to evaluate the effects of CAVI on clinical signs of congestion, renal and hepatic function. TRICAVAL was an investigator-initiated, randomized trial. Twenty-eight patients with severe TR were randomized to OMT or CAVI using an Edwards Sapien XT valve. Probands who completed the 3-month follow-up (CAVI [n = 8], OMT [n = 10]) were evaluated by medical history, clinical examination, and laboratory testing at baseline, 3 and 12 months. After 3 months, the CAVI group exhibited a significant reduction of body weight (from 80.7 [69.0-87.7] kg to 75.5 [63.8-84.6] kg, p < 0.05) and abdominal circumference (from 101.5 +/- 13.8 cm to 96.3 +/- 15.4 cm, p <= 0.01) and a trend to lower doses of diuretics compared to OMT. Renal and hepatic function parameters did not change significantly. Within a short-term follow-up, CAVI led to an improvement of clinical signs of venous congestion and a non-significant reduction of diuretic doses compared to OMT

Impact of inferior caval valve implantation on severity of tricuspid regurgitation and right heart function

Aims: Severe tricuspid regurgitation (TR) is a common finding in heart failure patients and associated with increased mortality. New interventional therapeutic options are needed as many heart failure patients are unfit for surgery. The TRICAVAL study compared valve implantation into the inferior vena cava (CAVI) with optimal medical therapy (OMT) in patients with severe TR. Here, we report details on the impact of CAVI on TR severity as well as right heart function and morphology. Methods and results: We randomized 28 patients with severe TR to CAVI (n = 14) with transfemoral implantation of an Edwards Sapien XT valve into the inferior vena cava or OMT (n = 14). Inclusion and exclusion criteria were based on anatomical and clinical parameters. Echocardiographic measurements were performed at baseline, at the first postoperative day and one, three, and twelve months after randomization. As proof of concept of an effective sealing of the inferior vena cava, we detected a significant decrease in systolic hepatic vein reflux volume (11.0 [6.2-21.9] mL vs 3.5 [0.6-8.5] mL,P = .016) and hepatic vein diameter (11.5 [10.0-14.8] mm vs 10.0 [9.3-11.8] mm,P = .034) at thirty-day follow-up. However, CAVI had no significant impact on TR, cardiac function, and morphology. Conclusions: Caval valve implantation significantly reduced systolic reflux into the hepatic veins but was not associated with an improvement in cardiac function, morphology, or TR severity

Sludge Accumulation Rates in Pour-Flush Latrines

In 1983 the United Nations Development Programme Technology Advisory Group (UNDP/TAG) decided to sponsor a research project to investigate sludge accumulation rates in pour-flush waterseal latrines. A grant was given to the Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina at Chapel Hill, to conduct this project. The project objectives were 1) to determine accumulation rates in a number of pour-flush latrines and 2) to try to explain how these rates had been affected by choice of pit design and local socio-cultural and environmental conditions. A field study of pour-flush latrines was conducted in Patna and Singur, India. Sludge accumulation rates in thirty latrines were measured. Soil type, user population size, hydrogeological conditions and other factors thought to affect the accumulation rate were also evaluated. Specific tests were conducted to examine decomposition and drainage processes. A large variation in sludge accumulation rates was observed. The "normal" range of accumulation rates was found to be between 0.010 and 0.060 m[3]/capita-yr. The "average" accumulation rate was found to be 0.025 m[3]/capita-yr. A theoretical model was developed to analyze the relationship between the sludge accumulation rate and design, socio-cultural and environmental factors. The model was designed to describe liquid loading and loss from a latrine. Model evaluation indicated that the sludge accumulation rate is dependent on five factors - per capita loading rate, pit radius, amount of pit lining, soil hydraulic conductivity, and latrine age. Use of model accumulation rates led to better estimations of sludge accumulation than use of an "average" rate when the field data were examined. Based on the conclusions drawn from the data analysis, recommendations have been made concerning latrine design in terms of 1) a practical guide for determination of pit capacity requirements, and 2) suggested changes in pit design in order to reduce sludge accumulation rates.Master of Science in Environmental Engineerin

Development of a Web Based Monitoring System for a Distributed and Modern Production

AbstractWeb technologies have experienced a rapid development in recent years. In particular web browsers enhanced their abilities because of the improvement of JavaScript, CSS3 and HTML5. Hence, richer web-based software solutions with an increasing range of functions are available. By using responsive web design (RWD), a technology to display content without resizing on different screens, developers are able to support a diverse range of devices with small effort.In order to enable a monitoring of the current status of a production system, signals of many different sensors, machine and production data are required. Combining microcontrollers with sensors to embedded sensors enables an efficient way to communicate with web services. Due to the strong decline of prices for semiconductor technologies, companies are able to set up production machines with these technologies at low costs.This paper presents a way to set up a distributed manufacturing control system by using common web technologies like RWD and embedded systems. We discuss advantages and drawbacks of web-based software solutions and show a methodical approach for the use in a modern production system. Finally, the functionality of the method is proven within an application example

Role of Kozak sequence polymorphism of platelet glycoprotein Ibα as a risk factor for coronary artery disease and catheter interventions

AbstractOBJECTIVESWe sought to determine the role of the −5T/C polymorphism of the platelet glycoprotein (GP) Ibα as a potential risk factor for coronary artery disease (CAD) and adverse events complicating a coronary catheter intervention.BACKGROUNDThe platelet GP Ib-IX-V receptor complex plays a crucial role in arterial thrombus formation. The −5T/C polymorphism of GP Ibα is associated with increased receptor density.METHODSWe genotyped 1,000 patients with angiographically confirmed CAD, as well as 1,000 age- and gender-matched control subjects, for this polymorphism by polymerase chain reaction/restriction fragment length polymorphism. Among the patients with CAD, 269 underwent percutaneous transluminal coronary angioplasty (PTCA), 103 underwent directional coronary atherectomy and 278 underwent stenting. This intervention group was followed for a 30-day composite end point of target vessel revascularization, myocardial infarction or death.RESULTSCarriers of the −5C allele were significantly over-represented in the group of patients developing acute coronary syndromes (relative risk [RR] 1.43, 95% confidence interval [CI] 1.05 to 1.95, p = 0.02). The −5C allele furthermore predicted an increased risk for developing complications after PTCA (RR 3.75, 95% CI 1.15 to 12.27, p = 0.029).CONCLUSIONSThe −5C allele of the GP Ibα Kozak polymorphism may represent a risk factor in clinical conditions in which thrombosis plays an important role, such as in acute coronary syndromes and in complications after PTCA

Estimating food ingredient compositions based on mandatory product labeling

Having a specific understanding of the actual ingredient composition of products helps to calculate additional nutritional information, such as containing fatty and amino acids, minerals and vitamins, as well as to determine its environmental impacts. Unfortunately, producers rarely provide information on how much of each ingredient is in a product. Food manufacturers are, however, required to declare their products in terms of a label comprising an ingredient list (in descending order) and Big7 nutrient values. In this paper, we propose an automated approach for estimating ingredient contents in food products. First, we parse product labels to extract declared ingredients. Next, we exert mathematical formulations on the assumption that the weighted sum of Big7 ingredients as available from food compositional tables should resemble the product’s declared overall Big7 composition. We apply mathematical optimization techniques to find the best fitting ingredient composition estimate. We apply the proposed method to a dataset of 1804 food products spanning 11 product categories. We find that 76% of these products could be analyzed by our approach, and a composition within the prescribed nutrient tolerances could be calculated, using 20% of the allowed tolerances per Big7 ingredient on average. The remaining 24% of the food products could still be estimated when relaxing one or multiple nutrient tolerances. A study with known ingredient compositions shows that estimates are within a 0.9% difference of products’ actual recipes. Hence, the automated approach presented here allows for further analysis of large product quantities and provides possibilities for more intensive nutritional and ecological evaluations of food

Effect of Apheresis for ABO and HLA Desensitization on Anti-Measles Antibody Titers in Renal Transplantation

Desensitization strategies for ABO-incompatible renal transplants with plasma exchange (PE) or specific immunoadsorption (IA) decrease immunoglobulin levels. After recent measles outbreak and decreasing vaccination rates, we studied the impact of apheresis on anti-measles antibodies. Anti-measles antibodies were measured before desensitization, before transplantation and during followup in 12 patients with ABO incompatibility (2x PE only, 8x IA only, and 2x IA and PE) and 3 patients with donor-specific HLA antibodies (all PE). Patients received rituximab, IVIG, and standard immunosuppressive therapy. All patients had detectable anti-measles antibodies before desensitization (mean 3238 mU/l, range 560–8100). After 3–6 PE sessions, titers decreased significantly to 1710 mU/l (P < 0.05), in one patient to nondetectable values, while IA only maintained protective titers. After a median followup of 64 days, anti-measles antibodies returned to baseline in all patients. Immunity against measles was temporarily reduced by apheresis but remained detectable in most patients at time of transplantation. Desensitization maintains long-term protective immunity against measles

Anti-tumor activity of patient-derived NK cells after cell-based immunotherapy – a case report

Background: Membrane-bound heat shock protein 70 (Hsp70) serves as a tumor-specific recognition structure for Hsp70-peptide (TKD) plus IL-2 activated NK cells. A phase I clinical trial has shown that repeated re-infusions of ex vivo TKD/IL-2-activated, autologous leukapheresis product is safe. This study investigated the maintenance of the cytolytic activity of NK cells against K562 cells and autologous tumor after 6 plus 3 infusions of TKD/IL-2-activated effector cells. Methods: A stable tumor cell line was generated from the resected anastomotic relapse of a patient with colon carcinoma (pT3, N2, M0, G2). Two months after surgery, the patient received the first monthly i.v. infusion of his ex vivo TKD/IL-2-activated peripheral blood mononuclear cells (PBMNC). After 6 infusions and a pause of 3 months, the patient received another 3 cell infusions. The phenotypic characteristics and activation status of tumor and effector cells were determined immediately before and at times after each infusion. Results: The NK cell ligands Hsp70, MICA/B, and ULBP-1,2,3 were expressed on the patient's anastomotic relapse. An increased density of activatory NK cell receptors following ex vivo stimulation correlated with an enhanced anti-tumoricidal activity. After 4 re-infusion cycles, the intrinsic cytolytic activity of non-stimulated PBMNC was significantly elevated and this heightened responsiveness persisted for up to 3 months after the last infusion. Another 2 re-stimulations with TKD/IL-2 restored the cytolytic activity after the therapeutic pause. Conclusion: In a patient with colon carcinoma, repeated infusions of ex vivo TKD/IL-2-activated PBMNC initiate an intrinsic NK cell-mediated cytolytic activity against autologous tumor cells

Outcome after Desensitization in HLA or ABO-Incompatible Kidney Transplant Recipients: A Single Center Experience

Background The shortage of deceased donors led to an increase of living donor kidney (LDK) transplantations performed in the presence of donor-specific antibodies (DSA) or ABO incompatibility (ABOi) using various desensitization protocols. Methods We herein analyzed 26 ABOi and 8 Luminex positive DSA patients who were successfully desensitized by anti-CD20, antigen-specific immunoadsorption and/or plasmapheresis to receive an LDK transplant. Twenty LDK recipients with non-donor-specific HLA-antibodies (low risk) and 32 without anti-HLA antibodies (no risk) served as control groups. Results 1-year graft survival rate and renal function was similar in all 4 groups (creatinine: 1.63 +/- 0.5 vs 1.78 +/- 0.6 vs 1.64 +/- 0.5 vs 1.6 +/- 0.3 mg/dl in ABOi, DSA, low risk and no risk group). The incidence of acute T-cell mediated rejections did not differ between the 4 groups (15% vs 12, 5% vs 15% vs 22% in ABOi, DSA, low risk and no risk), while antibody-mediated rejections were only found in the DSA (25%) and ABOi (7.5%) groups. Incidence of BK nephropathy (BKVN) was significantly more frequent after desensitization as compared to controls (5/34 vs 0/52, p = 0.03). Conclusion We demonstrate favorable short-term allograft outcome in LDK transplant recipients after desensitization. However, the desensitization was associated with an increased risk of BKVN