Transcatheter Aortic Valve Replacement for Aortic Regurgitation – A Review

Transcatheter aortic valve replacement (TAVR) is currently a widely used option for patients with severe symptomatic aortic stenosis with high to low surgical risk. However, aortic regurgitation (AR) remains an “off-label” indication for TAVR, particularly for patients with mild or absent leaflet calcification or aortic annulus dimensions beyond the size of the bioprosthesis, which increase the risk of dislocation. With advances in transcatheter heart valve devices, the safety and efficacy of TAVR in treating patients with severe pure native AR has gained acceptance. This review examines current evidence and clinical practice, and presents technological advancements in devices for AR

Preferential flow in the understory soil of Hippophae rhamnoides at different stump heights

This study aimed to clarify the effects of stumping on preferential flow in the understory soils of Hippophae rhamnoides and to assess appropriate stumping height for optimization of preferential flow. Root properties, soil properties, and preferential flow for different H. rhamnoides stump heights (0, 10, 15, 20 cm, and no-stumping, labeled conditions S1, S2, S3, S4, and CK, respectively) were studied using in situ dye-tracing and laboratory analysis. The results showed that stumping significantly increased preferential flow development. This effect was maximized in condition S3, with dye-tracing coverage (DC) of 36.77%, maximum dye depth (MaxD) of 40.02 cm, uniform infiltration depth (Unifr) of 14.28 cm, preferential flow ratio (PFfr) of 23.85%, and length index (LI) of 96.72%. In terms of root length density (RLD), root mass density (RMD), root surface area density (RSAD), soil water content (SWC), soil total porosity (TP), mean weight diameter (MWD), and soil organic matter (SOM), the conditions were ranked S3>S2>S1>S3>CK; for root average diameter (RAD), they were ranked S3<S2<S1<S4<CK. Structural equation modeling showed that DC was affected directly by TP, MWD, and SWC and indirectly by RAD, RLD, RMD, RSAD, and SOM, explaining up to 89.1% of the variance. Thus, stumping of H. rhamnoides affected soil properties through the mechanism of root development, thereby improving preferential flow development in the soil and soil infiltration. The optimal stump height was 15 cm. These findings are critical for vegetation recovery and for prevention and control of soil erosion in feldspathic sandstone areas

A Combined Risk Score Model to Assess Prognostic Value in Patients with Soft Tissue Sarcomas

A study by Tsvetkov et al. recently published a proposed novel form of copper-induced cell death in Science; however, few studies have looked into the possible mechanism in soft tissue sarcoma (STS). Herein, this study sought to investigate the function of cuproptosis-related genes (CRGs) in the development of tumor-associated immune cells and the prognosis of sarcoma. Herein, this study aimed to explore the role of cuproptosis-related genes (CRGs) in the development, tumor-associated immune cells, and the prognosis of sarcoma. Methods: The prognostic model was established via the least absolute shrinkage and selection operator (LASSO) algorithm as well as multivariate Cox regression analysis. The stromal scores, immune scores, ESTIMA scores, and tumor purity of sarcoma patients were evaluated by the ESTIMATE algorithm. Functional analyses were performed to investigate the underlying mechanisms of immune cell infiltration and the prognosis of CRGs in sarcoma. Results: Two molecular subgroups with different CRG expression patterns were recognized, which showed that patients with a higher immune score and more active immune status were prone to have better prognostic survival. Moreover, GO and KEGG analyses showed that these differentially expressed CRGs were mainly enriched in metabolic/ions-related signaling pathways, indicating that CRGs may have impacts on the immune cell infiltration and prognosis of sarcoma via regulating the bioprocess of mitochondria and consequently affecting the immune microenvironment. The expression levels of CRGs were closely correlated to the immunity condition and prognostic survival of sarcoma patients. Conclusions: The interaction between cuproptosis and immunity in sarcoma may provide a novel insight into the study of molecular mechanisms and candidate biomarkers for the prognosis, resulting in effective treatments for sarcoma patients

Constraints on the spacetime metric around seven "bare" AGNs using X-ray reflection spectroscopy

We present the study of a sample of seven "bare" active galactic nuclei (AGN) observed with Suzaku. We interpret the spectrum of these sources with a relativistic reflection component and we employ our model RELXILL_NK to test the Kerr nature of their supermassive black holes. We constrain the Johannsen deformation parameters $\alpha_{13}$ and $\alpha_{22}$, in which the Kerr metric is recovered when $\alpha_{13} = \alpha_{22} = 0$. All our measurements are consistent with the hypothesis that the spacetime geometry around these supermassive objects is described by the Kerr solution. For some sources, we obtain quite strong constraints on $\alpha_{13}$ and $\alpha_{22}$ when compared to those found in our previous studies. We discuss the systematic uncertainties in our tests and the implications of our results.Comment: 15 pages, 12 figures. v2: refereed versio

Single femoral artery access is safe and feasible during transcatheter aortic valve replacement: a propensity score matched analysis

BackgroundTranscatheter aortic valve replacement (TAVR) potentially may be significantly simplified by using the single artery access (SA) technique, which does not require a secondary artery access. Nevertheless, the safety and efficacy of this technique remains unclear. Our goal was to determine if single artery access TAVR (without upgrading the sheath size) is a feasible, minimally invasive procedure.MethodsPatients with symptomatic severe aortic stenosis who underwent TAVR via the femoral artery were consecutively enrolled in this study. Eligible individuals were divided into 2 groups: the SA group and the dual artery access (DA) group. The primary end point was device success (defined by the valve academic research consortium 3, VARC 3). A 6-month follow-up and propensity score matching analyses were performed.ResultsAfter propensity score matching analysis, a total of 130 patients were included: 65 in the SA group and 65 in the DA group. The SA procedure achieved similar device success (95.4% vs. 87.7%; P = 0.115) compared with the DA procedure. The SA procedure shortened the operating time (102 min vs. 125 min; P = 0.001) but did not increase the x-ray time or dose. Both a 20 Fr and a 22 Fr sheath (without upgrading the sheath size) could be used for the SA procedure. There was no major vascular complication occurred in both groups. The incidence of minor main vascular and access complications in the SA group was comparable to those of the DA procedure (0.0% vs. 3.1%; P = 0.156).ConclusionsThe SA access procedure is a promising minimally invasive TAVR technique with a low incidence of vascular complications and a high incidence of device success. It is safe and possibly applicable in all TAVR procedures

Pharmacoeconomic evaluation of anti-obesity drugs for chronic weight management: a systematic review of literature

IntroductionPharmacological therapy is recommended as a second-line alternative to reverse obesity. Currently, five anti-obesity drugs (AODs) have been approved by the U.S. Food and Drug Administration (FDA) for chronic weight management. The aim of this paper is to investigate the pharmacoeconomic evaluation of AODs through a systematic review with a special focus on methodological considerations.MethodsWe searched the general and specific databases to identify the primary pharmacoeconomic evaluation of AODs.ResultsA total of 18 full-text articles and three conference abstracts were included in this review. Most of the economic assessments were still about Orlistat. And the observations we could make were consistent with the previous systematic review. A few studies were on the combined therapies (i.e. PHEN/TPM ER and NB ER) compared to different comparators, which could hardly lead to a generalized summary of the cost-effectiveness. Most recently, pharmacoeconomic evidence on the newest GLP 1 RA approved for the indication of obesity or obesity with at least one comorbidity emerged gradually. Modelling-based cost-utility analysis is the major type of assessment method. In the modelling studies, a manageable number of the key health states and the state transitions were structured to capture the disease progression. In particular, the principal structure of the decision model adopted in the three studies on the newly approved drug was nearly the same, which enables more in-depth comparisons and generalizations of the findings.ConclusionThis study provided an up-to-date overview of the strengths and areas for improvement in the methodological design of the pharmacoeconomic evaluation of the licensed drugs for chronic weight management. Future modelling evaluations would benefit from a better understanding of the long-term weight loss effects of the current therapeutic options and the weight rebound process after the discontinuation of treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302648, identifier CRD42022302648

Prevalence and Characterization of Staphylococcus aureus Isolated From Women and Children in Guangzhou, China

The prevalent Staphylococcus aureus clones and antibiotic susceptibility profiles are known to change dynamically and geographically; however, recent S. aureus strains causing infections in women and children in China have not been characterized. In this study, we analyzed the molecular epidemiology and antimicrobial resistance of S. aureus isolated from patients in four centers for women and children in Guangzhou, China. In total, 131 S. aureus isolates (100 from children and 31 from women) were analyzed by spa typing, multi-locus sequence typing, virulence gene and antimicrobial resistance profiling, staphylococcal chromosomal cassette mec typing, and mutation analyses of rpoB. A total of 58 spa types, 27 sequence types (STs), and 10 clonal complexes (CCs) were identified. While CC59 (ST59-IV, 48.8%; ST338-III, 35.7%) and CC45 (ST45-IV, 100%) were the major clones (84.4%) among MRSA isolates, CC5 (ST188, 24.3%; ST1, 21.6%) and CC398 (ST398, 70%) were the major ones (70.1%) among MSSA isolates. ST338-MRSA-III mostly found in pus but hardly in respiratory tract samples while ST45-MRSA-IV was on the opposite, even though they both found in blood and cerebrospinal fluid sample frequently. Staphylococcal enterotoxin genes seb-seq-sek were strongly associated with ST59 and ST338, while sec was associated with ST45, ST121, ST22, and ST30. All ST338, ST1232, and SCCmec III isolates carried lukF/S-PV genes. A total of 80% of ST338 isolates were resistant to erythromycin, clindamycin, and tetracycline. All ST45 isolates exhibited intermediate or complete resistance to rifampicin. In total, 481 HIS/ASN mutations in rpoB were found in rifampicin-resistant or intermediate-resistant isolates. ST338-III and ST45-IV emerged as two of three major clones in MRSA isolates from women and children in Guangzhou, China, though ST59-MRSA-IV remained the most prevalent MRSA clone. Clonal distribution of S. aureus varied, depending on the specimen source. Virulence genes and antibiograms were closely associated with the clonal lineage. These results clarified the molecular epidemiology of S. aureus from women and children in Guangzhou, China, and provide critical information for the control and treatment of S. aureus infections

Feasibility study of temporary permanent pacemaker in patients with conduction block after TAVR

BackgroundLimited data exist on the use of temporary permanent pacemaker (TPPM) to reduce unnecessary PPM in patients with high-degree atrioventricular block (HAVB) after transcatheter aortic valve replacement (TAVR).ObjectivesThis study aims to determine the feasibility of TPPM in patients with HAVB after TAVR to provide prolonged pacing as a bridge.Materials and methodsOne hundred and eleven consecutive patients undergoing TAVR were screened from August 2021 to June 2022. Patients with HAVB eligible for PPM were included. TPPM were used in these patients instead of conventional temporary pacing or early PPM. Patients were followed up for 1 month. Holter and pacemaker interrogation were used to determine whether to implant PPM.ResultsTwenty one patients met the inclusion criteria for TPPM, of which 14 patients were third-degree AVB, 1 patient was second-degree AVB, 6 patients were first degree AVB with PR interval > 240 ms and LBBB with QRS duration > 150 ms. TPPM were placed on the 21 patients for 35 ± 7 days. Among 15 patients with HAVB, 26.7% of them (n = 4) recovered to sinus rhythm; 46.7% (n = 7) recovered to sinus rhythm with bundle branch block. The remains of 26.7% patients (n = 4) still had third-degree AVB and received PPM. For patients with first-degree AVB and LBBB, PR interval shortened to < 200 ms in all 6 patients and LBBB recovered in 2 patients. TPPM were successfully removed from all patients and no procedure-related adverse events occurred.ConclusionTPPM is reliable and safe in the small sample of patients with conduction block after TAVR to provide certain buffer time to distinguish whether a PPM is necessary. Future studies with larger sample are needed for further validation of the current results