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This study presents the synthesis and characterization of alginate-based nanocomposite peelable films, reinforced by carbon nanofibers (CNFs) decorated with nanoparticles that possess remarkable antimicrobial properties. These materials are suitable for immediate decontamination applications, being designed as fluid formulations that can be applied on contaminated surfaces, and subsequently, they can rapidly form a peelable film via divalent ion crosslinking and can be easily peeled and disposed of. Silver, copper, and zinc oxide nanoparticles (NPs) were synthesized using superficial oxidized carbon nanofibers (CNF-ox) as support. To obtain the decontaminating formulations, sodium alginate (ALG) was further incorporated into the colloidal solutions containing the antimicrobial nanoparticles. The properties of the initial CNF-ox-NP-ALG solutions and the resulting peelable nanocomposite hydrogels (obtained by crosslinking with zinc acetate) were assessed by rheological measurements, and mechanical investigations, respectively. The evaluation of Minimal Inhibitory Concentration (MIC) and Minimal Bactericidal Concentration (MBC) for the synthesized nanoparticles (silver, copper, and zinc oxide) was performed. The best values for MIC and MBC were obtained for CNF-ox decorated with AgNPs for both types of bacterial strains: Gram-negative (MIC and MBC values (mg/L): E. coli -3 and 108; P. aeruginosa -3 and 54) and Gram-positive (MIC and MBC values (mg/L): S. aureus -13 and 27). The film-forming decontaminating formulations were also subjected to a microbiology assay consisting of the time-kill test, MIC and MBC estimations, and evaluation of the efficacity of peelable coatings in removing the biological agents from the contaminated surfaces. The best decontamination efficiencies against Staphylococcus aureus , Escherichia coli , and Pseudomonas aeruginosa varied between 97.40% and 99.95% when employing silver-decorated CNF-ox in the decontaminating formulations. These results reveal an enhanced antimicrobial activity brought about by the synergistic effect of silver and CNF-ox, coupled with an efficient incorporation of the contaminants inside the peelable films.

In this study, novel materials have been obtained via a dual covalent and ionic crosslinking strategies, leading to the formation of a fully interpenetrated polymeric network with remarkable mechanical performances as drug delivery platforms for dermal patches. The polymeric network was obtained by the free-radical photopolymerization of N-vinylpyrrolidone using tri(ethylene glycol) divinyl ether as crosslinker in the presence of sodium alginate (1%, weight%). The ionic crosslinking was achieved by the addition of Zn 2+ , ions which were coordinated by the alginate chains. Bentonite nanoclay was incorporated in hydrogel formulations to capitalize on its mechanical reinforcement and adsorptive capacity. TiO 2 and ZnO nanoparticles were also included in two of the samples to evaluate their influence on the morphology, mechanical properties and/or the antimicrobial activity of the hydrogels. The double-crosslinked nanocomposite hydrogels presented a good tensile resistance (1.5 MPa at 70% strain) and compression resistance (12.5 MPa at a strain of 70%). Nafcillin was loaded into nanocomposite hydrogel films with a loading efficiency of up to 30%. The drug release characteristics were evaluated, and the profile was fitted by mathematical models that describe the physical processes taking place during the drug transfer from the polymer to a PBS (phosphate-buffered saline) solution. Depending on the design of the polymeric network and the nanofillers included, it was demonstrated that the nafcillin loaded into the nanocomposite hydrogel films ensured a high to moderate activity against S. aureus and S. pyogenes and no activity against E. coli . Furthermore, it was demonstrated that the presence of zinc ions in these polymeric matrices can be correlated with the inactivation of E. coli .

EUDONORGAN, a European Union-funded project to improve organ and tissue donation, included a blended-based "Train the Trainers" program, which was implemented with the support of an international consortium from Croatia, Italy, Slovenia, and Spain. The web-based training included seven modules for which medical aspects, educational tips, and practical activities were scored using a 5-point Likert scale. The overall mean scores of satisfaction were higher than 4 for each module, without significant differences between HCPs and OKPs. In the face-to-face training survey similar scores above 4 were obtained for most items. Knowledge acquisition improved significantly in both HCPs and OKPs, as well as in transplant/donor coordinators, medical doctors, registered nurses, anesthesiologists/intensivists, and intensive care nurses. Improvements in attitudes and perceptions regarding organ donation were also observed, particularly among HCPs. In the accomplishment of the learning process, a successful pass mark of 95% was obtained. The "Train the Trainers" program was associated with an improvement in learning and attitudes of healthcare and non-healthcare professionals for the benefit of organ and tissue donation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Peralta, Istrate, Ballesté, Manyalich, Valero and the EUDONORGAN Consortium.)

Introduction: Balloon-expandable (BE) and self-expandable (SE) prostheses are the main types of devices currently used in transcatheter aortic valve implantation (TAVI). Despite the different designs, clinical practice guidelines do not make any specific recommendation on the selection of one device over the other. Most operators are trained in using both BE and SE prostheses, but operator experience with each of the two designs might influence patient outcomes. The aim of this study was to compare the immediate and mid-term clinical outcomes during the learning curve in BE versus SE TAVI., Methods: The transfemoral TAVI procedures performed in a single center between July 2017 and March 2021 were grouped according to the type of implanted prosthesis. The procedures in each group were ordered according to the case sequence number. For each patient, a minimum follow-up time of 12 months was required for inclusion in the analysis. The outcomes of the BE TAVI procedures were compared with the outcomes of the SE TAVI procedures. Clinical endpoints were defined according to the Valve Academic Research Consortium 3 (VARC-3)., Results: The median follow-up time was 28 months. Each device group included 128 patients. In the BE group, case sequence number predicted mid-term all-cause mortality at an optimal cutoff value ≤58 procedures (AUC 0.730; 95% CI: 0.644-0.805; p < 0.001), while in the SE group, the cutoff value was ≤85 procedures (AUC 0.625; 95% CI: 0.535-0.710; p = 0.04). A direct comparison of the AUC showed that case sequence number was equally adequate in predicting mid-term mortality, irrespective of prosthesis type (p = 0.11). A low case sequence number was associated with an increased rate of VARC-3 major cardiac and vascular complications (OR 0.98 95% CI: 0.96-0.99; p = 0.03) in the BE device group, and with an increased rate of post-TAVI aortic regurgitation ≥ grade II (OR 0.98; 95% CI: 0.97-0.99; p = 0.03) in the SE device group., Conclusions: In transfemoral TAVI, case sequence number influenced mid-term mortality irrespective of prosthesis type, but the learning curve was longer in the case of SE devices., (© 2023 S. Karger AG, Basel.)

Background/aim: The aim of this study was to determine the safety and efficacy of a direct-acting antiviral treatment, ombitasvir/paritaprevir/ritonavir and dasabuvir, without ribavirin, in a real-life setting., Patients and Methods: We performed a prospective observational study including 108 patients undergoing hemodialysis for end-stage kidney disease, referred to our clinic for antiviral therapy for chronic hepatitis C virus infection. Patients received treatment with ombitasvir/paritaprevir/ritonavir and dasabuvir, for 12 weeks. Sustained virologic response (SVR) was defined as undetectable viremia at 12 weeks after the end of therapy. For safety analysis, we monitored serum levels of hemoglobin, albumin, total bilirubin, alanine-aminotransferase and aspartate- aminotransferase at the beginning and end of therapy, as well as at SVR. Verbal Numeric Rating Scale was used to assess the presence of nausea, headaches and fatigue., Results: We noted a high prevalence of diabetic and hypertensive nephropathy as the underlying cause of chronic kidney disease. Most of the patients had F2 and F3 liver fibrosis (32.40% and 34.25%, respectively). The SVR rate was 96.2% (103/107 patients). We recorded an unrelated death after the completion of antiviral therapy. We found increased levels of nausea, headaches and fatigue at the end of therapy compared to at initiation, The presence and degree of symptoms did not correlate with the underlying cause of renal disease (p=0.72) nor with the degree of fibrosis (p=0.08). Minimal increases in transaminases and bilirubin were recorded at the end of treatment, with no statistical significance., Conclusion: Oral antiviral therapy with ombitasvir/paritaprevir/ritonavir and dasabuvir can be safely used in hemodialysis patients, with similar response rates compared to the general population., (Copyright © 2022, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

This study presents the functionalization and characterization of graphene and electromagnetic interference (EMI) attenuation capacity in epoxy-nanocomposites. The modification of graphene involved both small molecules and polymers for compatibilization with epoxy resin components to provide EMI shielding. The TGA and RAMAN analyses confirmed the synthesis of graphene with a different layer thickness of the graphene sheets. Graphene samples with different layer thicknesses (monolayer, few layers, and multilayer) were selected and further employed for epoxy coating formulation. The obtained nanocomposites were characterized in terms of EMI shielding effectiveness, SEM, micro-CT, magnetic properties, and stress-strain resistance. The EMI shielding effectiveness results indicated that the unmodified graphene and hexamethylene diamine (HMDA) modified graphene displayed the best EMI shielding properties at 11 GHz. However, the epoxy nanocomposites based on HMDA modified graphene displayed better flexibility with an identical EMI shielding effectiveness compared to the unmodified graphene despite the formation of aggregates. The improved flexibility of the epoxy nanocomposites and EMI shielding characteristics of HMDA functionalized graphene offers a practical solution for textile coatings with microwave absorbing (MA) capacity.

The pathogeneses of age-related macular degeneration (AMD) and age-related hearing impairment are not yet fully understood. If AMD and age-related hearing impairment are correlated, the cause of both may be a result of a common vulnerability. The aim of this study was to assess the interrelation between age-related macular degeneration and age-related hearing loss., Material and Methods: In our case-control analysis, the hearing conditions of 40 subjects with AMD were compared with 40 age-matched healthy controls. In all patients, retinal changes were certified by clinical examinations, optical coherence tomography (OCT), and fluorescein angiography (FA). All subjects were inspected with pure tone audiometry (PTA), impedance audiometry, and speech audiometry., Results: A significant correlation ( p < 0.001) was identified between age-related macular degeneration and age-related hearing impairment. The predominant hearing impairment in this case was sensorineural (SNHL). Of the patients diagnosed with AMD, SNHL was found in 88.89% of those with exudative macular degeneration and in 67.74% of those with atrophic macular degeneration. In contrast, we found that a significant proportion of the control group had normal hearing., Conclusion: One possible explanation for the association between retinal and cochlear impairment may be due to a melanin disorder.

Objective: Paravalvular aortic regurgitation is an important independent mortality predictor in transcatheter aortic valve implantation (TAVI). Our study evaluated the association between paravalvular aortic regurgitation and mid-term mortality in relation with the learning curve, in patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program., Methods: Patients with severe aortic stenosis who underwent transfemoral TAVI between 2017 and 2020 were included in the analysis. Paravalvular aortic regurgitation was assessed by transthoracic echocardiography at 48 hours after the procedure. All-cause mortality was evaluated after 30 days and at mid-term follow-up., Results: Paravalvular aortic regurgitation ≥grade II was associated with mid-term all-cause mortality (OR 4.4; 95%CI 1.82-11.55; p < 0.001), their prevalence declining after the first 60 cases. Baseline characteristics did not significantly differ in the first 60 patients from the rest of the cohort. Male sex (p = 0.006), advanced age (p = 0.04), coronary artery disease (p = 0.003), or elevated STS Score (p = 0.02) influenced mid-term survival. When adjusting for the presence of these factors, only age (OR 1.1; 95%CI 1.0-1.2), paravalvular aortic regurgitation ≥grade II (OR 3.9; 95%CI 1.3-12.9), and the number of days spent in the intensive care unit (OR 1.4; 95%CI 1.1-1.8) were independent predictors of mid-term all-cause mortality., Conclusions: In a group of patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program, paravalvular aortic regurgitation ≥grade II was associated with mid-term mortality, both declining after the first 60 cases., (© 2022 Wiley Periodicals LLC.)

The findings and recommendations of the 2019 consensus conference in organ donation, held in Kunming, China, are here reported. The main objective of the conference was to gather relevant information from experts involved in the field. The data and opinions provided allowed to propose a series of recommendations for "One Belt & One Road Countries" on how to achieve self-sufficiency in organ donation. Leadership in organ donation should be results-oriented and goal-driven based on the principles of excellence, empowerment, and engagement, providing the means, resources, and strategies necessary to reach the goal in earnest. Management includes good governance and transparency of a national registry of patients in the waiting list, donors, transplants, transplant teams, quality, and safety programs with continuous educational training of health care professionals. Mandatory monitoring, auditing and evaluation of quality must be incorporated into donation practices as relevant points in innovation, as well as the adoption of already established and novel processes and technologies. Achievement of self-sufficiency in organ donation is a crucial step to fight against transplant tourism and to prevent organ trafficking. Based on recommendations arising from the conference, each country could review and develop individualized action plans adjusted to its own circumstances and reality., (© 2021 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)

Background: Atherosclerotic renal artery stenosis is a risk factor for cardiovascular death. Observational studies support the benefit of renal revascularization on outcomes in patients with high-risk clinical manifestations. In this context, we evaluated the factors associated with long-term mortality after renal artery stenting in patients with severe renal artery stenosis, impaired kidney function, and/or uncontrolled hypertension., Methods: The medical records of patients undergoing renal artery stenting between 2004 and 2014 were extracted. Blood pressure and creatinine were recorded at baseline, 24 hours poststenting and in the 1-month to 1-year interval that followed revascularization. Long-term follow-up was performed in March 2020., Results: The cohort consisted of 65 patients. Median follow-up was 120 months. In the first year after stenting, less patients had chronic kidney disease (CKD) class 3b-5 as compared with baseline (35.3% vs. 56.9%, P = 0.01). The number of patients with controlled blood pressure after revascularization increased with 69.2% (P < 0.001). Long-term all-cause mortality reached 44.6%. Age (odds ratio (OR) 1.1; 95% confidence interval (CI) 1.0-1.2; P = 0.01), male gender (OR 7.9; 95% CI 1.9-43.5; P = 0.008), poststenting CKD class 3b-5 (OR 5.8; 95% CI 1.5-27.9; P = 0.01), and postrevascularization uncontrolled hypertension (OR 8.9; 95% CI 1.7-63.5; P = 0.01) were associated with long-term mortality independent of diabetes mellitus and coronary artery disease., Conclusions: Improved CKD class and blood pressure were recorded in the first year after renal artery stenting in patients with severe renal artery stenosis and high-risk clinical manifestations. The lack of improvement in kidney function and blood pressure was independently associated with long-term mortality., (© American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Introduction: Cigarette smoking has been causally associated with various diseases, and among the numerous harmful effects of smoking is included its impact on the senses of vision and hearing. The purpose of this study is to evaluate the impact of cigarette smoking on the visual and auditory functions., Methods: In this analytic study, hearing and smoking status of 40 patients with agerelated macular degeneration (AMD) were analyzed with 40 age-matched control subjects without AMD. In all subjects (n=80), retinal status was investigated by optical coherence tomography (OCT), with analyses of thickness central subfield (TCS) and thickness average cube (TAC) of the macula. All participants were examined with pure tone audiometry. Audiometric trials comprised pure tone bone and air conduction. The smoking history of all the subjects was recorded in detail., Results: A significant correlation was found between smoking status and visual (p<0.001) and hearing impairment (p<0.05). Cigarette smoking was found to be highly correlated with sensorineural hearing impairment and exudative macular degeneration., Conclusions: Cigarette smoking damage anti-oxidative systems and tissue metabolism. We have underlined a clear correlation between the risk of sensorineural hearing impairment, exudative macular degeneration and cigarette smoking. Our findings may result in future screening of smokers to identify any hearing and vision impairment and for improving smoking cessation interventions., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2021 Istrate M. et al.)

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries., (© 2021 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT.)

The human eye is made up of multiple layers of pigmented tissues that have in componence melanin. In the eye, one can separate melanosomes from various embryonic origins. The pigment-producing cells in the stroma of the iris, ciliary body and the choroid (uveal melanocytes) are neural crest derivatives. On the other hand, ciliary, iris and retinal pigment epithelial cells are developed from the neural ectoderm. One universally accepted role of melanin is to react as neutral-density filter in scattering light. Melanin acts as a free radical stabilizer and has the ability to absorb near-infrared, visible light and UV radiation. This paper reviews the current knowledge on ocular melanin, including ocular melanogenesis, roles of melanin in retinal metabolic processes and some imaging techniques that identify melanin in the retina., (©Romanian Society of Ophthalmology.)

Preeclampsia (PE), a pathological entity characterized by hypertension and pregnancy-related proteinuria, is a medical condition of incompletely known etiopathogenesis. Placental defects and placental angiogenesis may be a cause of this condition. The main factor that controls angiogenesis in the early stages of placental development is vascular endothelial growth factor A (VEGF-A) and its two receptors, namely VEGFR-1 and VEGFR-2. This study analyzed the immunohistochemical (IHC) expression of the two VEGF receptors, R1 and R2, in pregnancies complicated by PE compared to pregnancies with a normal evolution. The pregnancies included into the study for the harvesting of placental tissue to be microscopically analyzed were divided into two groups: the group of physiological pregnancies (22 pregnancies) and the group of pregnancies complicated by preeclampsia (13 pregnancies). For the microscopic analysis, we used the Hematoxylin-Eosin (HE), Masson's trichrome and IHC stainings. The microscopic aspects of HE and Masson's trichrome stainings most commonly found in normal development pregnancies underlie the normal process of placental senescence. In the case of pregnancies complicated by PE, the microscopic analysis of the placentas revealed fibrinoid necrosis of the vascular wall, lipid-loaded endothelial cells, diffuse trophoblastic hypertrophy, microinfarctions, calcification areas, fibrin deposits, vascular-syncytial membrane surface reduction, basement membrane thickening. According to the established marker intensity score, the VEGFR-1 and VEGFR-2 receptors were more pronounced in the placentas resulting from pregnancies complicated by preeclampsia. The present study brings arguments that support the major regulatory role of VEGF-A and of the two receptors in the normal or pathological angiogenesis in the placenta, and implicitly in the pathogenesis of preeclampsia. Further studies are needed for a more comprehensive analysis of the stages in which these factors cause alteration of the placental angiogenesis and vasculogenesis processes, so that they can intervene effectively in the treatment or prevention of this disease.

Vascular endothelial growth factor (VEGF) represents a growth factor with important pro-angiogenic activity, having a mitogenic and an anti-apoptotic effect on endothelial cells, increasing the vascular permeability, promoting cell migration, etc. Due to these effects, it actively contributes in regulating the normal and pathological angiogenic processes. In humans, the VEGF family is composed of several members: VEGF-A (which has different isoforms), VEGF-B, VEGF-C, VEGF-D, VEGF-E (viral VEGF), VEGF-F (snake venom VEGF), placenta growth factor (PlGF), and, recently, to this family has been added endocrine gland-derived vascular endothelial growth factor (EG-VEGF). VEGF binds to tyrosine kinase cell receptors (VEGFRs): VEGFR-1 [Fms-like tyrosine kinase 1 (Flt-1)], VEGFR-2 [kinase insert domain receptor (KDR) in human; fetal liver kinase 1 (Flk-1) in mouse] and VEGFR-3 [Fms-like tyrosine kinase 4 (Flt-4)]. While VEGFR-1 and VEGFR-2 are expressed predominantly on vascular endothelial cells, VEGFR-3 is expressed especially on lymphatic endothelial cells. VEGFR-2 has the strongest pro-angiogenic activity and a higher tyrosine kinase activity than VEGFR-1. Endothelial cells also express co-receptors, such as neuropilin-1 (NP-1) and neuropilin-2 (NP-2), which modulate tyrosine kinase receptor activity. Both VEGF and VEGFRs are expressed not only on endothelial cells, but also on non-endothelial cells. This article aims to highlight the most recent data referring to the VEGF family and its receptors, as well as its implications in the angiogenesis process. At present, blocking angiogenesis in cancer or in other pathological processes, using anti-VEGF and anti-VEGFRs therapies, is considered to be extremely important.

Advanced training of healthcare professionals active in organ donation is highlighted as a major means to overcome organ shortage. The objective of this study was to improve donation rates in the selected European target areas (TAs) by providing an advanced training program. A prospective intervention study was conducted in 25 TAs with active donor programs from 17 European countries, between 2007 and 2009. A training program based on collaborative methodology was designed at three different professional levels (health workers awareness, junior transplant coordinators, managers). Courses evaluation scores and donation figures in each TA were collected and compared before and after intervention. Courses with new developed training tools were implemented reaching out 3286 healthcare professionals. Feed-back questionnaires revealed a high degree of satisfaction among participants (average of 4.35 on a 1-5 scale). The number of utilized donors in the TAs increased from 15.7 ± 14.3 (95% CI: 9.8-21.6) to 20.0 ± 17.1 (95% CI: 13-27.1) (P = 0.014) and the number of organs recovered increased from 49.7 ± 48.5 (95% CI: 29.6-69.7) to 59.3 ± 52.1 (95% CI: 37.8-80.8) (P = 0.044). The European Training Program on Organ Donation is a successful training program, achieving a significant increase in organ donation figures., (© 2012 The Authors Transplant International © 2012 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.)