A novel layered topology of auxetic materials based on the tetrachiral honeycomb microstructure

Microstructured honeycomb materials may exhibit exotic, extreme and tailorable mechanical properties, suited for innovative technological applications in a variety of modern engineering fields. The paper is focused on analysing the directional auxeticity of tetrachiral materials, through analytical, numerical and experimental methods. Theoretical predictions about the global elastic properties have been successfully validated by performing tensile laboratory tests on tetrachiral samples, realized with high precision 3D printing technologies. Inspired by the kinematic behaviour of the tetrachiral material, a newly-design bi-layered topology, referred to as bi-tetrachiral material, has been theoretically conceived and mechanically modelled. The novel topology virtuously exploits the mutual collaboration between two tetrachiral layers with opposite chiralities. The bi-tetrachiral material has been verified to outperform the tetrachiral material in terms of global Young modulus and, as major achievement, to exhibit a remarkable auxetic behaviour. Specifically, experimental results, confirmed by parametric analytical and computational analyses, have highlighted the effective possibility to attain strongly negative Poisson ratios, identified as a peculiar global elastic property of the novel bi-layered topology

SUBCLINICAL RENAL DAMAGE IS ASSOCIATED WITH A REDUCED CHOROIDAL THICKNESS IN PATIENTS WITH PRIMARY HYPERTENSION

Objective: The retina is considered the easiest accessible window to study the state of the systemic microcirculation, even if the choroid is the most important vascular layer of the eye. Our understanding of the choroid has been greatly increased in last years since the introduction of advanced techniques of optical coherence tomography (OCT). Our study was aimed to assess choroidal thickness by using Swept-Source OCT (SS-OCT) in essential hypertensive patients (EHs) with and without subclinical renal damage (SRD). Design and method: We enrolled 100 EHs of which 65 without kidney damage and 35 with SRD. In all the participants SS-OCT and a routine biochemical work-up were performed. Glomerular filtration rate (GFR) was estimated by the CKD-EPI equation (eGFR). SRD was defined, by the presence of microalbuminuria or eGFR between 30 and 60\u200amL/min/1.73 m2. OCT measurements were performed according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, that divides the macula into 9 subfields. The circular grid consists of 3 concentric rings. The inner and outer rings are further divided into quadrants: temporal, nasal, superior, and inferior. Design and method: Furthermore, we calculated the average of the individuals values of the four quadrants separately for the inner and the outer ring. The average of all the 9 regions of the ETRDS grid (including the inner, the outer and the central rings) was also calculated. Results: EHs with SRD showed thinner choroidal thicknesses than those without kidney damage (all p\u200a<\u200a0.05), even after adjustment for age (figure). Overall choroidal thickness correlated significantly and directly with eGFR (r\u200a=\u200a0.36) and negatively with urinary albumin excretion (r\u200a=\u200a- 0.39). The association of choroidal thickness with SRD was confirmed in multiple logistic regression analyses once the effect of age, anti-hypertensive therapy and triglycerides was accounted for. The odds ratio of having SRD associated with a standard deviation increase of overall choroidal thickness was 0.43 (0.24\u20130.75, 95% confidence interval; p\u200a=\u200a0.007). Conclusions: Our study confirms the close relationships between changes in ocular microcirculation and renal dysfunction

Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients and during the first year after transplantation. For these reasons, and due to the shortage of organs available for transplant, it is of utmost importance to identify patients with a good life expectancy after transplant and minimize the transplant peri-operative risk. Various conditions, such as severe pulmonary diseases, recent myocardial infarction or stroke, and severe aorto-iliac atherosclerosis, need to be ruled out before adding a patient to the transplant waiting list. The effectiveness of systematic coronary artery disease (CAD) treatment before kidney transplant is still debated, and there is no universal screening protocol, not to mention that a nontailored screening could lead to unnecessary invasive procedures and delay or exclude some patients from transplantation. Despite the different clinical guidelines on CAD screening in kidney transplant candidates that exist, up to today, there is no worldwide universal protocol. This review summarizes the key points of cardiovascular risk assessment in renal transplant candidates and faces the role of noninvasive cardiovascular imaging tools and the impact of coronary revascularization versus best medical therapy before kidney transplant on a patient’s cardiovascular outcome

Relationship of choroidal thickness with pulsatile hemodynamics in essential hypertensive patients

Controversy exists about the association of choroidal thickness (CTh) with blood pressure (BP) values. There is some evidence suggesting that central hemodynamics changes are associated with microvascular disease. Our study was aimed to assess the relationships between CTh and clinic and 24-h BP and between CTh and estimated 24-h aortic pulse pressure (aPP), 24-h aortic systolic BP (aSBP), and 24-h aortic augmentation index (aAIx) in a group of hypertensive patients. We enrolled 158 hypertensive subjects (mean age 48&nbsp;±&nbsp;13&nbsp;years) all of which underwent evaluation of the choroidal district by Swept-Source optical coherence tomography (SS-OCT) and 24-h BP monitoring, in order to measure peripheral BP and to estimate central hemodynamic parameters. Inverse significant correlations of clinic PP, 24-h aPP, 24-h aSBP, and 24-h aAIx with thicknesses of central ring, inner ring, and outer ring of the choroid and its overall average were found. The strongest of these correlations was that relating 24-h aPP with overall average choroidal thickness (r&nbsp;=&nbsp;−.531; P&nbsp;&lt;.001). When we divided the study population in subjects with 24-h aPP above and below the median value (35&nbsp;mm Hg), CTh were thinner in subjects with higher values of 24-aPP as compared to those with lower ones, even after adjustment for age, and other potential confounders. The relationships of CTh with 24-h aPP remained significant also taking into account the effects of various covariates in linear multiple regression analyses. Our findings support the concept of a cross-talk between macro- and microcirculation

Intravitreal Brolucizumab for Pachychoroid Neovasculopathy Associated With Chronic Central Serous Chorioretinopathy

Purpose: To evaluate the anatomical and functional outcomes of intravitreal brolucizumab in eyes with chronic central serous chorioretinopathy complicated by pachychoroid neovasculopathy. Methods: Retrospective analysis of 34 eyes treated with intravitreal brolucizumab. Twenty-five eyes (73.5%) had been treated with other anti-vascular endothelial growth factor agents before switching to brolucizumab, whereas nine eyes were naïve. Outcome measures included the change of central foveal thickness and subfoveal choroidal thickness, evaluation of sub/intraretinal fluid on optical coherence tomography, and change in best-corrected visual acuity. Results: Before starting brolucizumab, 23 eyes showed subretinal fluid, 8 both subretinal and intraretinal fluid, and 3 intraretinal fluid only. At the last visit, 22 eyes (64.7%) showed complete reabsorption of both intraretinal and subretinal fluid, whereas subretinal fluid was still present in 8 eyes (23.5%), and both intraretinal and subretinal fluid in 4 eyes (11.8%). The mean number of brolucizumab injections required to achieve complete fluid reabsorption was 2.8 ± 1.8. central foveal thickness decreased from 317.8 ± 109.3&nbsp;μm to 239.8 ± 74.8&nbsp;μm (P = 0.0005) and subfoveal choroidal thickness decreased from 399.3 ± 86.2&nbsp;μm to 355.5 ± 92.7&nbsp;μm at the end of the follow-up period (P = 0.0008). The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.4 ± 0.2 to 0.3 ± 0.2 at 1 month after the first injection and remained stable at the same values at the end of the follow-up period (P = 0.04). Conclusions: Intravitreal brolucizumab is effective for the treatment of naïve and recalcitrant pachychoroid neovasculopathy. Translational relevance: Intravitreal brolucizumab may represent an option in patients with pachychoroid neovasculopathy complicating chronic central serous chorioretinopathy

Metered Cryospray™: a novel uniform, controlled, and consistent in vivo application of liquid nitrogen cryogenic spray

Typically, wood-based composite materials have been developed through empirical studies. In these products, the constituent wood elements have broad spectrums regarding species, size, and anatomical orientation relative to their own dimensions. To define special strength and stiffness properties during a long-term study, two types of corrugated wood composite panels were developed for possible structural utilization. The constitutional elements of the newly developed products included Appalachian hardwood veneer residues (side clippings) and/or rejected low quality, sliced veneer sheets. The proposed primary usage of these veneer-based panels is in applications where the edgewise loading may cause buckling (e.g., web elements of I-joists, shear-wall and composite beam core materials). This paper describes the development of flat and corrugated panels, including furnish preparations and laboratory-scale manufacturing processes as well as the determination of key mechanical properties. According to the results in parallel to grain direction bending, tension and compression strengths exceeded other structural panels’ similar characteristics, while the rigidities were comparable. Based on the research findings, sliced veneer clipping waste can be transformed into structural panels or used as reinforcement elements in beams and sandwich-type products

Comparative effectiveness of combined IgM-Enriched immunoglobulin and extracorporeal blood purification plus standard care versus standard care for sepsis and septic shock after cardiac surgery

Background: The combination of surgery, bacterial spread-out, and artificial cardiopulmonary bypass surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyper-inflammatory condition frequently associated with compromised hemodynamics and organ dysfunction. A promising approach could be extracorporeal blood purification therapies in combination with IgM enriched immunoglobulin. This approach might perform a balanced control of both hyper and hypo-inflammatory phases as an immune-modulating intervention. Methods: We performed a retrospective observational study of patients with proven infection after cardiac surgery between January 2020 and December 2021. Patients were divided into two groups: (1) the first group (Control Group) followed a standard care approach as recommended by the Surviving Sepsis Campaign Guidelines; The second group (Active Group) underwent extracorporeal blood purification therapy (EBPT) in combination with intravenous administration of IgM enriched immunoglobulin 5 mL/kg die for at least three consecutive days, in conjunction with the standard approach (SSC Guidelines). In addition, ventriculo-arterial (V/A) coupling, Interleukin 6 (IL-6), Endotoxin Activity Assay (EAA), Procalcitonin, White Blood Cells (WBC) counts, Sequential Organ Failure Assessment (SOFA) Score and Inotropic Score were assessed in both two groups at different time points. Results: Fifty-four patients were recruited; 25 were in the Control Group, while 29 participants were in the Active Group. SOFA score significantly improved from baseline [12 (9–16)] until at T3 [8 (3–13)] in the active group; it was associated with a median EAA reduction from 1.03 (0.39–1.20) at T0 to 0.41 (0.2–0.9) at T3 in the active group compared with control group 0.70 (0.50–1.00) at T0 to 0.70 (0.50–1.00) at T3 (p &lt; 0.001). V/A coupling tended to be lower in patients of the active arm ranging from 1.9 (1.2–2.7) at T0 to 0.8 (0.8–2.2) at T3 than in those of the control arm ranging from 2.1 (1.4–2.2) at T0 to 1.75 (1.45–2.1) at T3 (p = 0.099). The hemodynamic improvement over time was associated with evident but no significant decrease in inotropic score in the active group compared with the control group. Changes in EAA value from T0 to T4 were directly and significantly related (r = 0.39, p = 0.006) to those of V/A coupling. Conclusions: EBPT, in combination with IgM enriched immunoglobulin, was associated with a mitigated postoperative response of key cytokines with a significant decrease in IL-6, Procalcitonin, and EAA and was associated with improvement of clinical and metabolic parameters