Surgical Treatment of Native Valve Aspergillus Endocarditis and Fungemic Vascular Complications

Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromoembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge

Post-transcriptional microRNA repression of PMP22 dose in severe Charcot-Marie-Tooth disease type 1

Copy number variation (CNV) may lead to pathological traits, and Charcot-Marie-Tooth disease type 1A (CMT1A), the commonest inherited peripheral neuropathy, is due to a genomic duplication encompassing the dosage-sensitive PMP22 gene. MicroRNAs act as repressors on post-transcriptional regulation of gene expression and in rodent models of CMT1A, overexpression of one such microRNA (miR-29a) has been shown to reduce the PMP22 transcript and protein level. Here we present genomic and functional evidence, for the first time in a human CNV-associated phenotype, of the 3' untranslated region (3'-UTR)-mediated role of microRNA repression on gene expression. The proband of the family presented with an early-onset, severe sensorimotor demyelinating neuropathy and harboured a novel de novo deletion in the PMP22 3'-UTR. The deletion is predicted to include the miR-29a seed binding site and transcript analysis of dermal myelinated nerve fibres using a novel platform, revealed a marked increase in PMP22 transcript levels. Functional evidence from Schwann cell lines harbouring the wildtype and mutant 3'-UTR showed significantly increased reporter assay activity in the latter which was not ameliorated by overexpression of a miR-29a mimic. This shows the importance of miR-29a in regulating PMP22 expression and opens an avenue for therapeutic drug development

Removal of Chalk River unidentified deposit (CRUD) radioactive waste by enhanced electrokinetic process

Decontamination techniques proposed and used to remove Chalk River unidentified deposit (CRUD) in radioactive waste management. In cases of huge volumes of metal or radionuclides contaminated by CRUD, removal of CRUD by mechanical or chemical decontamination is difficult. An advanced electrokinetic process combined with chemical decontamination was applied to remove CRUD and experimentally evaluated. Oxalic acid was used for CRUD removal, and cobalt (Co) released from the CRUD was transferred to the cathode in an electrokinetic reactor. Results indicate that the combined system is efficient for CRUD removal with enhanced, efficiency by use of the cation exchange membrane and zeolite. (c) 2017 The Korean Society of Industrial and Engineering Chemistry.11Nsciescopuskc

Fracture flow of radionuclides in unsaturated conditions at LILW Disposal Facility

Adsorption experiments for radionuclides such as 3H, 90Sr and 99Tc were conducted using fractured rock collected in unsaturated zone. The released radionuclide through artificial barrier from the near surface repository can be transported by the flow of rainfall or pore water through fractures in unsaturated zone and reach to groundwater flow. Therefore, it is important to investigate transport behavior (retardation) of radionuclides through fractured rock for the safety assessment and long-term performance of repository. Fractured rock samples were collected and characterized by X-ray microtomography (XMT) analysis, which can be used to develop a more robust unsaturated fracture transport model. When fracture-filling materials are exist, distribution coefficient of 90Sr is higher than without fracture-filling materials. In this study, batch sorption distribution coefficient (Kd) of radionuclide was determined and used to increase our understanding of radionuclide retardtion through fracture-filling materials.22Nkc

Interpretation of high-temperature tensile properties by thermodynamically calculated equilibrium phase diagrams of heat-resistant austenitic cast steels

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Effects of Cr and Nb addition on high-temperature tensile properties in austenitic cast steels used for turbo-charger application

In automotive turbo-chargers, excellent high-temperature properties are needed for retaining their structures at extremely high temperature of exhausted gas, and thus austenitic cast steels have been actively developed. In this study, high-temperature tensile properties of austenitic cast steels containing different W, Nb, and Cr were interpreted by deformation and fracture mechanisms related with carbides and austenite matrix. Replacement effects of W by Nb or Cr were also investigated because of expensive alloying cost of W. The high-temperature tensile test results revealed that the Cr-added steel containing many M7C3 carbides showed the higher strength than the Nb-added steel containing hard MC carbides. This was because the strength could be enhanced by distributing carbides having slightly lower hardness such as M7C3 carbides in the strengthened matrix as it could hold hard carbides, like in the Cr-added steel. The Cr-added steel (1 wt% W) also showed the higher strength and elongation at 900 degrees C than the basic-composition steel (2 wt% W), which indicated that the partly replacement of W by Cr was successfully achieved. (C) 2016 Elsevier B.V. All rights reserved.11Nsciescopu

The risk of stroke/systemic embolism and major bleeding in Asian patients with non-valvular atrial fibrillation treated with non-vitamin K oral anticoagulants compared to warfarin: Results from a real-world data analysis.

BackgroundAlthough randomized trials provide a high level of evidence regarding the efficacy of non-vitamin K oral anticoagulants (NOACs), the results of such trials may differ from those observed in day-to-day clinical practice.AimsTo compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between NOAC and warfarin in clinical practice.MethodsPatients with non-valvular atrial fibrillation (NVAF) who started warfarin/NOACs between January 2015 and November 2016 were retrospectively identified from Korea's nationwide health insurance claims database. Using inpatient diagnosis and imaging records, the Cox models with inverse probability of treatment weighting using propensity scores were used to estimate hazard ratios (HRs) for NOACs relative to warfarin.ResultsOf the 48,389 patients, 10,548, 11,414, 17,779 and 8,648 were administered apixaban, dabigatran, rivaroxaban and warfarin, respectively. Many patients had suffered prior strokes (36.7%, 37.7%, 31.4%, and 32.2% in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively), exhibited high CHA2DS2-VASc (4.8, 4.6, 4.6, and 4.1 in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively) and HAS-BLED (3.7, 3.6, 3.6, and 3.3 in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively) scores, had received antiplatelet therapy (75.4%, 75.7%, 76.8%, and 70.1% in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively), or were administered reduced doses of NOACs (49.8%, 52.9%, and 42.8% in apixaban, dabigatran, and rivaroxaban group, respectively). Apixaban, dabigatran and rivaroxaban showed a significantly lower S/SE risk [HR, 95% confidence intervals (CI): 0.62, 0.54-0.71; 0.60, 0.53-0.69; and 0.71, 0.56-0.88, respectively] than warfarin. Apixaban and dabigatran (HR, 95% CI: 0.58, 0.51-0.66 and 0.75, 0.60-0.95, respectively), but not rivaroxaban (HR, 95% CI: 0.84, 0.69-1.04), showed a significantly lower MB risk than warfarin.ConclusionsAmong Asian patients who were associated with higher bleeding risk, low adherence, and receiving reduced NOAC dose than that provided in randomised controlled trials, all NOACs were associated with a significantly lower S/SE risk and apixaban and dabigatran with a significantly lower MB risk than warfarin