Hemodynamically balanced congenitally corrected transposition of the great arteries with a large ventricular septal defect, and subvalvular pulmonic stenosis: a case report

Background Adults with unoperated congenitally corrected transposition of the great arteries are rare but form a distinct group among adults with congenital heart disease. Patients with congenitally corrected transposition of the great arteries often have one or more associated cardiac anomalies that dictate the need for, and timing of, surgical intervention in childhood. However, in a proportion of patients, the hemodynamics does not require surgical attention during childhood, and, in some patients, a correct diagnosis is not established until adulthood. Here we report an adult case of unoperated congenitally corrected transposition of the great arteries with a large ventricular septal defect and probable pulmonary arterial hypertension. Case presentation Our patient was a 46-year-old Korean man. Transthoracic echocardiography and cardiac catheterization demonstrated hemodynamically balanced ventricles with a non-regurgitant systemic atrioventricular valve, normal pulmonary arterial pressure, and a reasonable difference between the oxygen saturation values of the aorta and pulmonary trunk, even with the presence of a large ventricular septal defect. Further morphological assessments using cardiac computed tomography and three-dimensional modeling/printing of his heart revealed that the mitral valve was straddling over the posteriorly positioned ventricular septal defect, which could explain the functional and anatomical subvalvular pulmonary stenosis and a small amount of shunt flow through the large ventricular septal defect. We interpreted this combination of cardiac defects as able to sustain his stable cardiac function. Thus, we decided to maintain his unoperated status. Conclusion A detailed anatomical understanding based on transthoracic echocardiography, cardiac computed tomography, and three-dimensional printing can justify a decision to not operate in cases of congenitally corrected transposition of the great arteries with hemodynamically balanced pulmonary stenosis and a ventricular septal defect, as observed in the present case

Long-term survival benefits of intrathecal autologous bone marrow-derived mesenchymal stem cells (Neuronata-R®: lenzumestrocel) treatment in ALS: Propensity-score-matched control, surveillance study

ObjectiveNeuronata-R® (lenzumestrocel) is an autologous bone marrow-derived mesenchymal stem cell (BM-MSC) product, which was conditionally approved by the Korean Ministry of Food and Drug Safety (KMFDS, Republic of Korea) in 2013 for the treatment of amyotrophic lateral sclerosis (ALS). In the present study, we aimed to investigate the long-term survival benefits of treatment with intrathecal lenzumestrocel.MethodsA total of 157 participants who received lenzumestrocel and whose symptom duration was less than 2 years were included in the analysis (BM-MSC group). The survival data of placebo participants from the Pooled-Resource Open-Access ALS Clinical Trials (PROACT) database were used as the external control, and propensity score matching (PSM) was used to reduce confounding biases in baseline characteristics. Adverse events were recorded during the entire follow-up period after the first treatment.ResultsSurvival probability was significantly higher in the BM-MSC group compared to the external control group from the PROACT database (log-rank, p < 0.001). Multivariate Cox proportional hazard analysis showed a significantly lower hazard ratio for death in the BM-MSC group and indicated that multiple injections were more effective. Additionally, there were no serious adverse drug reactions found during the safety assessment, lasting a year after the first administration.ConclusionThe results of the present study showed that lenzumestrocel treatment had a long-term survival benefit in real-world ALS patients

Antibacterial activity of varying UMF-graded Manuka honeys.

Honey has been used as a traditional remedy for skin and soft tissue infections due to its ability to promote wound healing. Manuka honey is recognized for its unusually abundant content of the antibacterial compound, methylglyoxal (MGO). The Unique Manuka Factor (UMF) grading system reflects the MGO concentration in Manuka honey sold commercially. Our objective was to observe if UMF values correlated with the antibacterial activity of Manuka honey against a variety of pathogens purchased over the counter. The antibacterial effect of Manuka honey with UMF values of 5+, 10+, and 15+ from the same manufacturer was assessed by the broth microdilution method. Minimum inhibitory concentration (MIC) values were determined against 128 isolates from wound cultures representing gram-positive, gram-negative, drug-susceptible, and multi-drug resistant (MDR) organisms. Lower MICs were observed with UMF 5+ honey for staphylococci (n = 73, including 25 methicillin-resistant S. aureus) and Pseudomonas aeruginosa (n = 22, including 10 MDR) compared to UMF 10+ honey (p<0.05) and with UMF 10+ compared to UMF 15+ (p = 0.01). For Enterobacteriaceae (n = 33, including 14 MDR), MIC values were significantly lower for UMF 5+ or UMF 10+ compared to UMF 15+ honey (p<0.01). MIC50 for UMF 5+, UMF 10+, and UMF 15+ honey against staphylococci was 6%, 7%, and 15%, and for Enterobacteriaceae was 21%, 21%, and 27%, respectively. For Pseudomonas aeruginosa MIC50 was 21% and MIC90 was 21-27% for all UMFs. Manuka honey exhibited antimicrobial activity against a spectrum of organisms including those with multi-drug resistance, with more potent activity overall against gram-positive than gram-negative bacteria. Manuka honey with lower UMF values, in our limited sampling, paradoxically demonstrated increased antimicrobial activity among the limited samples tested, presumably due to changes in MGO content of honey over time. The UMF value by itself may not be a reliable indicator of antibacterial effect

Channel Selectivity of Satellite Transponders with the Antenna Combined with a Size-Reduced Metallic Waveguide Bandpass Filter Having Thin Metamaterial Resonators

Global and intercontinental networking relies on satellite communication. Its wireless communication system always has antennas and their feed assembly comprising waveguides. This makes the satellite payload heavy and costly. In this paper, a novel method is proposed to effectively reduce the size of a waveguide bandpass filter (BPF). Because the metallic cavities make the conventional waveguide end up with a large geometry, especially for high-order BPFs, very compact waveguide-type resonators having metamaterial zeroth-order resonance (WG-ZOR) are designed on the cross-section of the waveguide and substituted for the cavities. While the cavities are half-wavelength resonators, the WG-ZOR is shorter than one eighth of a wavelength. A substantial reduction in size and weight of the waveguide filter is observed as the resonators are cascaded in series through coupling elements in the X-band much longer than K- or Ka-band. An X-band of 7.25~7.75 GHz is chosen to verify the method as the passband with attenuation of 40 dB at 7.00 GHz and 8.00 GHz as the roll-off in the stopband. The BPF is manufactured using the CNC milling technique. The design is carried out with geometrical parameters, not of the level of 10 μm, but the level of 100 μm, which is good for manufacturers but a big challenge for component designers. The measurement of the manufactured metal waveguide filter reveals that the passband has about ≤1 dB and ≤−15 dB as insertion loss and reflection coefficient and the stopband has ≤−40 dB as attenuation, which are in good agreement with the results of the circuit and simulation. The proposed filter has a length of 3.5 λg as the eighth-order BPF, but the conventional waveguide is 5 λg as the seventh-order BPF for the same area of the cross-section. This metamaterial BPF is combined with a horn antenna. The filter enables the wide-band antenna to distinguish the band of transmission from that of noise suppression. This channel selectivity is obviously observed by the filter integrated antenna test

ChartSense: Interactive Data Extraction from Chart Images

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Effect of Activating a Nickel–Molybdenum Catalyst in an Anion Exchange Membrane Water Electrolyzer

Water electrolysis using anion exchange membranes is promising for hydrogen production, and Ni–Mo catalysts have shown high activity for alkaline hydrogen evolution reaction (HER). However, their performance has been mostly tested in a half-cell setup and rarely studied in a single-cell setup with a membrane electrode assembly (MEA) structure, which is used for practical applications. With Ni3Mo as the cathode, a single cell was fabricated using non-noble metal catalysts exclusively. Interestingly, the activation procedure significantly affected the cell performance. The single cell performed better than that with the Pt/C catalyst when the Ni3Mo catalyst was mildly activated. The distribution of Mo in electrodes, membrane, and electrolytes was estimated, confirming Mo dissolution from the cathode. Once the cell was activated, the cell performance was stable without degradation in long-term chronopotentiometry operation, but the performance was degraded by sudden voltage change such as imposing open circuit voltage (OCV). The surface structure and reaction mechanism were studied with density functional theory: the Mo-dissolved Ni3Mo(101) surface could promote H2O dissociation, while MoO3 stably adsorbed on the surface weakened H* adsorption, promoting HER. This study provides important insights into the development of efficient catalysts for large-scale hydrogen production

Hypointense signal lesion on susceptibility-weighted imaging as a potential indicator of vertebral artery dissection in medullary infarction

Abstract Vertebral artery dissection (VAD) is often associated with medullary infarction; however, an underlying cause may be underestimated. This study aimed to assess the diagnostic potential of hypointense signal lesions along the arterial pathways using susceptibility-weighted imaging (SWI) as a feasible indicator of VAD in medullary infarction. A retrospective analysis was conducted using clinical data, brain magnetic resonance imaging, and angiography records of 79 patients diagnosed with medullary infarction between January 2014 and December 2021. Patients were categorized into an angiography-confirmed dissection group and a non-dissection group based on imaging findings. A new possible dissection group was identified using SWI, including cases with hypointense signals along the arteries without calcification or cardioembolism. We compared the clinical characteristics of the two groups before and after the addition of the hypointense signal as a marker of VAD. The angiography-confirmed dissection group included 12 patients (15%). Among patients lacking angiographic VAD evidence, 14 subjects displayed hypointense signals on SWI: nine patients along the vertebral artery and five subjects at the posterior inferior cerebellar artery without calcification or cardioembolism. The newly classified dissection group was younger, had a lower prevalence of diabetes mellitus and stroke history, and revealed increased headaches compared to the non-dissection group. Hypointense signal detection on SWI in medullary infarctions shows promise as a diagnostic indicator for VAD. Suspicion of VAD is needed when the hypointense signal on SWI is noted, and considering different treatment strategies with angiographic follow-up will be helpful

Long‐term mortality and cardiovascular events of seven angiotensin receptor blockers in hypertensive patients: Analysis of a national real‐world database: A retrospective cohort study

Abstract Background and Aims Although many angiotensin receptor blockers (ARBs) are widely used, comparative data regarding their impact on clinical outcomes are limited. We aimed to compare the clinical effectiveness of seven ARBs on long‐term cardiovascular outcomes in Korean patients with hypertension. Methods Using the Korean National Health Insurance Service database, the data of 780,785 patients with hypertension without cardiovascular disease (CVD) who initiated ARB treatment (candesartan, fimasartan, irbesartan, losartan, olmesartan, telmisartan, or valsartan) in 2014 and underwent this treatment for more than 6 months, were analyzed. Cox‐regression analysis was performed using Losartan as a comparator, as it was the most widely used drug, by adjusting age, sex, diabetes, dyslipidemia, smoking, alcohol drinking, exercise, body mass index, systolic blood pressure, albuminuria, estimated glomerular filtration rate, and concomitant medications. The occurrence of mortality and the rate of major adverse cardiovascular events (MACEs) of the six ARBs was compared with that of losartan. Results The median follow‐up duration was 5.94 (interquartile range, 5.87–5.97) years. In the crude analysis of all‐cause mortality and MACEs, fimasartan exhibited the lowest event rates. In the Cox‐regression analysis with adjustment, there was no significant difference in all‐cause mortality among ARBs. The risk of MACEs with ARBs was similar to that with losartan, although the risks with irbesartan (hazard ratio [HR], 1.079; 95% confidence interval [CI], 1.033–1.127; p = 0.007) and candesartan (HR: 1.066; 95% CI, 1.028–1.106; p = 0.015) were slightly higher. Conclusion In a Korean population of patients with hypertension without CVD, six different ARBs showed similar efficacy to losartan in terms of long‐term mortality and MACEs. Further well‐designed prospective studies are required to confirm our findings

Orthogonal Dual Photocatalysis of Single Atoms on Carbon Nitrides for One-Pot Relay Organic Transformation

Single-atom photocatalysis has shown potential in various single-step organic transformations, but its use in multistep organic transformations in one reaction systems has rarely been achieved. Herein, we demonstrate atomic site orthogonality in the M1/C3N4 system (where M = Pd or Ni), enabling a cascade photoredox reaction involving oxidative and reductive reactions in a single system. The system utilizes visible-light-generated holes and electrons from C3N4, driving redox reactions (e.g., oxidation and fluorination) at the surface of C3N4 and facilitating cross-coupling reactions (e.g., C-C and C-O bond formation) at the metal site. The concept is generalized to different systems of Pd and Ni, thus making the catalytic site-orthogonal M1/C3N4 system an ideal photocatalyst for improving the efficiency and selectivity of multistep organic transformations. © 2023 American Chemical Society11Nsciescopu

Predictors of SARS-CoV-2 Infection in Youth at a Large, Urban Healthcare Center in California, March–September 2020

Objective: To understand which social, epidemiologic, and clinical risk factors are associated with SARS-CoV-2 infection in youth accessing care in a large, urban academic institution. Methods: We conducted a prospective cohort study with case-control analyses in youth who received testing for SARS-CoV-2 at our academic institution in Los Angeles during the first wave of the COVID-19 pandemic (March-September 2020). Results: A total of 27,976 SARS-CoV-2 assays among 11,922 youth aged 0-24 years were performed, including 475 youth with positive SARS-CoV-2 results. Positivity rate was higher among older, African American, and Hispanic/Latinx youth. Cases were more likely to be from non-English-speaking households and have safety-net insurance. Zip codes with higher proportion of Hispanic/Latinx and residents living under the poverty line were associated with increased SARS-CoV-2 cases. Youth were more likely to have positive results if tested for exposure (OR 21.5, 95% CI 14.6-32.1) or recent travel (OR 1.5, 95% CI 1.0-2.3). Students were less likely to have positive results than essential worker youth (OR 0.5, 95% CI 0.3-0.8). Patterns of symptom presentation varied significantly by age group; number of symptoms correlated significantly with age in SARS-CoV-2 cases (r = 0.030, p &lt; 0.001). SARS-CoV-2 viral load did not vary by symptom severity, but asymptomatic youth had lower median viral load than those with symptoms (21.5 vs. 26.7, p = 0.009). Conclusions: Socioeconomic factors are important drivers of SARS-CoV-2 infection in youth. Presence of symptoms, exposure, and travel can be used to drive testing in older youth. Policies for school reopening and infection prevention should be tailored differently for elementary schools and universities