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Currently, the symptomatic status and left ventricular ejection fraction (LVEF) play a crucial role in aortic stenosis (AS) assessment. However, the symptoms are often subjective, and LVEF is not a sensitive marker of left ventricle (LV) decompensation. Over the past years, the cardiac structure and function research on AS has increased due to advanced imaging modalities and potential therapies. New imaging parameters emerged as predictors of disease progression in AS. LV global longitudinal strain has proved useful for risk stratification in asymptomatic severe AS patients with preserved LVEF. The assessment of myocardial fibrosis by cardiac magnetic resonance is the most studied application and offers prognostic information on AS. Moreover, the usage of biomarkers in AS as objective measures of LV decompensation has recently gained more interest. The present review focuses on the transition from compensatory LV hypertrophy (H) to LV dysfunction and the biomarkers associated with myocardial wall stress, fibrosis, and myocyte death. Moreover, we discuss the potential impact of non-invasive imaging parameters for optimizing the timing of aortic valve replacement and provide insight into novel biomarkers for possible prognostic use in AS. However, data from randomized clinical trials are necessary to define their utility in daily practice. [ABSTRACT FROM AUTHOR]

The objectives that we wanted to achieve are the knowledge of the legislation in the issue of the intellectual property right of artificial intelligence and in that of the civil liability of robots, as well as the interpretation in a personal note of the already existing norms. The concepts that were the basis of the study are both philosophical ideas and legal provisions, but also specialized doctrine, which completes the ideas we wanted to express. The latter we redrawn up with the help of the descriptive method, the logical and the comparative method and, last but notleast, the sociological method. The results obtained are the observation of the direction in which AI is heading, based on the union provisions, which were analyzed with arguments. We considered that the topic presented is not sufficiently researched and studied, due to its importance in contemporary society. Precisely for this reason, we believe that our study can be an interesting read for both legal specialists and novices. [ABSTRACT FROM AUTHOR]

This review focuses on the available data regarding the utility of advanced left ventricular (LV) imaging in aortic stenosis (AS) and its potential impact for optimising the timing of aortic valve replacement. Ejection fraction is currently the only LV parameter recommended to guide intervention in AS. The cut-off value of 50%, recommended for decision-making in asymptomatic patients with AS, is currently under debate. Several imaging parameters have emerged as predictors of disease progression and clinical outcomes in this setting. Global longitudinal LV strain by speckle tracking echocardiography is useful for risk stratification of asymptomatic patients with severe AS and preserved LV ejection fraction. Its prognostic value was demonstrated in these patients, but further work is required to define the best thresholds to aid the decision-making process. The assessment of myocardial fibrosis is the most studied application of cardiac magnetic resonance in AS. The detection of replacement fibrosis by late gadolinium enhancement offers incremental prognostic information in these patients. Clinical implementation of this technique to optimise the timing of aortic valve intervention in asymptomatic patients is currently tested in a randomised trial. The use of T1 mapping techniques can provide an assessment of interstitial myocardial fibrosis and represents an expanding field of interest. However, convincing data in patients with AS is still lacking. All these imaging parameters have substantial potential to influence the management decision in patients with AS in the future, but data from randomised clinical trials are awaited to define their utility in daily practice. [ABSTRACT FROM AUTHOR]

Serum uric acid (UA) has been shown to be a predictor of cardiovascular (CV) morbidity and mortality, and it may play a role in the pathogenesis of CV disease affecting vascular structure and function. However, there is limited evidence of its specific association with carotid artery stiffness and structure. The aim of our study was to evaluate whether UA is associated with early signs of atherosclerosis, namely local carotid arterial stiffness and intimamedia thickening. We evaluated 698 consecutive asymptomatic patients, referred to the Cardiovascular Department for risk factors evaluation and treatment. All patients underwent carotid artery ultrasonography with measurement of common carotid intimamedia thickness (IMT) and echo-tracking carotid artery stiffness index Beta. Patients with hyperuricemia (defined as serum uric acid ≥7 mg/dL in men and ≥6 mg/dL in women) had higher IMT (0.97±0.22 vs 0.91±0.18, p<0.001) and stiffness index Beta (8.3±3.2 vs 7.5±2.7, p=0.005). UA levels correlated with both IMT (r=0.225; p<0.001) and stiffness index Beta (r=0.154; p<0.001); the correlations were statistically significant in males and females. In a multivariate model which included age, arterial pressure, serum glucose and LDL-cholesterol, serum UA emerged as an independent explanatory variable of IMT and stiffness index Beta. Carotid IMT and local arterial stiffness are related to UA independently of established CV risk factors; UA may play a role in the early development of atherosclerosis. [ABSTRACT FROM AUTHOR]

Aims The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP). Method and results A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (<50%), 77 (64%) were in NYHA ≥ II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (≤15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (≥ 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68). Conclusion The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP noninvasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP. [ABSTRACT FROM AUTHOR]

Aims - We studied the clinical and echocardiographic characteristics of patients (pts) with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), according to the flow-gradient classification. Methods and results - We enrolled 165 pts (66±11 years, 95 men) with aortic valve area (AVA) <1 cm2 (indexed AVA <0.6 cm2/m2) and preserved LVEF (62±6%). Patients were stratified by LV stroke volume index (<35 mL/m2 [low flow, LF] and ≥35 mL/ m2 [normal flow, NF]) and mean aortic gradient (<40 mmHg [low gradient, LG] and ≥40 mmHg [high gradient, HG]) into 4 groups: NF/HG, NF/LG, LF/HG, and LF/LG. LV global longitudinal strain (GLS) was measured in 133 pts. Paradoxical LF/LG AS was present in 4 pts (2.4%). Most pts with LG severe AS had a normal flow (18.2%). Compared to NF/HG (121 pts, 73.3%), NF/LG pts had a lower NYHA class and serum BNP, larger AVAs, lower LV mass index, relative wall thickness and smaller LV volumes when compared to NF/HG pts. Worse parameters of LV longitudinal and diastolic function were found in NF/HG pts compared to NF/LG pts: lower GLS (p<0.001), larger left atrial volumes (p=0.03) and higher E/e’ ratios (p=0.009). Conclusion - We found a low prevalence of paradoxical LF/LG severe AS in pts with severe AS and preserved LVEF. According to the proposed criteria, most pts with LG severe AS have a normal transvalvular flow. These pts have a better clinical and echocardiographic profile when compared to pts with NF/HG severe AS. [ABSTRACT FROM AUTHOR]

Aortic stenosis has an increasing prevalence in the context of aging population. In these patients non-invasive imaging allows not only the grading of valve stenosis severity, but also the assessment of left ventricular function. These two goals play a key role in clinical decision-making. Although left ventricular ejection fraction is currently the only left ventricular function parameter that guides intervention, current imaging techniques are able to detect early changes in LV structure and function even in asymptomatic patients with significant aortic stenosis and preserved ejection fraction. Moreover, new imaging parameters emerged as predictors of disease progression in patients with aortic stenosis. Although proper standardization and confirmatory data from large prospective studies are needed, these novel parameters have the potential of becoming useful tools in guiding intervention in asymptomatic patients with aortic stenosis and stratify risk in symptomatic patients undergoing aortic valve replacement. This review focuses on the mechanisms of transition from compensatory left ventricular hypertrophy to left ventricular dysfunction and heart failure in aortic stenosis and the role of non-invasive imaging assessment of the left ventricular geometry and function in these patients. [ABSTRACT FROM AUTHOR]

Pulmonary embolism is a multifactorial disease that carries a high risk of mortality. Although venous thromboembolism may occur in patients without any identifi able predisposing risk factors, one or more of them are usually identifi ed. It has been reported that approximately 5% of patients with acute pulmonary embolism present with right heart thrombus which occasionally straddles the interatrial septum, posing a threat to the pulmonary arteries and systemic circulation. Despite the high prevalence of patent foramen ovale in the general population, paradoxical embolism is a rare event. The treatment of pulmonary embolism in patients with impending systemic embolism remains controversial. According to a statement from the American Heart Association, surgical thrombectomy in patients with an intracardiac thrombus might reduce the incidence of stroke, whereas thrombolysis might be associated with higher mortality. The ESC guidelines on the diagnosis and management of acute pulmonary embolism concludes that both thrombolysis and embolectomy are effective whereas anticoagulation alone appears less effective. [ABSTRACT FROM AUTHOR]

Hydrogel films have been used extensively in the preparationofbiosensors and biomedical devices. The characteristics of the aqueousinterface of the polymer layer are significant for the biosensor ordevice function; likewise, the changing mechanical properties of thermoresponsivepolymers are an important feature that affects the polymer behavior.Atomic force microscopy was used here to characterize both the surfaceand the mechanical properties of polymeric hydrogel films preparedfrom a thermoresponsive terpolymer of N-isopropylacrylamideand acrylic acid with benzophenonemethacrylate as a photoreactivecross-linker comonomer. The force–distance curves thus obtainedwere analyzed to assess both the surface forces and the mechanicalresponse that were associated with the hydrogel. These propertieswere investigated as a function of temperature, in water and in Trisbuffer, for different degrees of polymer cross-linking. For samplesin water, the distance over which the surface forces were effectivewas found to remain constant as the temperature was increased from26 to 42 °C, even though the mechanical response indicated thatthe samples had been heated past the lower critical solution temperature,or LCST. The bulk of the polymer becomes less soluble above the LCST,although this does not seem to affect the surface properties. Thismay be due to the segregation of the acrylic acid-rich polymer segmentsnear the gel surface, which is in agreement with reports for relatedsystems. [ABSTRACT FROM AUTHOR]

Hydrogel materials consisting of water-swollen polymer networks exhibit a large number of specific properties highly attractive for a variety of optical biosensor applications. This properties profile embraces the aqueous swelling medium as the basis of biocompatibility, non-fouling behavior, and being not cell toxic, while providing high optical quality and transparency. The present review focuses on some of the most interesting aspects of surface-attached hydrogel films as active binding matrices in optical biosensors based on surface plasmon resonance and optical waveguide mode spectroscopy. In particular, the chemical nature, specific properties, and applications of such hydrogel surface architectures for highly sensitive affinity biosensors based on evanescent wave optics are discussed. The specific class of responsive hydrogel systems, which can change their physical state in response to externally applied stimuli, have found large interest as sophisticated materials that provide a complex behavior to hydrogel-based sensing devices. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 33-year-old man with a persistent ductus arteriosus (PDA) during childhood was referred for cardiac examination due to fatigue and progressively worsening dyspnoea on exertion over the past 3 months. He underwent transthoracic and transesophageal echocardiography and determined the presence of a large PDA with a continuous systolic-diastolic flow signal. It notes that bacterial endocarditis is the most severe potential of PDA.

pH-responsive surfaces, reversibly switching between superhydrophilicity and superhydrophobicity/water repellency, are developed by “grafting from” a pH-sensitive polymer onto a hierarchically micro/nano-structured substrate. We quantify the water repellency by investigating the restitution coefficient of water droplets bouncing off the surfaces. The water repellent state requires appropriate hydrophobicity of the functionalizing polymer as well as very low values of contact angle hysteresis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 59 year-old male patient who experienced surgical mitral valve for severe mitral regurgitation due to flail of the anterior mitral leaflet.

The article presents a case study of a 42-year-old woman who was experiencing chest pain and systolic and diastolic murmur in precordium. Among the tests and treatment methods that the patient had undergone were physical examination, electrocardiography (ECG), and coronary angiography. It mentions the diagnosis of coronary artery fistula (CAF).

The article discusses the case study of a 66-year-old woman with atrial septal defect (ASD) diagnosed in childhood. The woman was admitted for fatigue at small effort and palpitations. On conducting the transesophageal echocardiogram (TEE), the ostium secundum ASD with left-to-right shunt was confirmed.

During the past 10 years, transcatheter aortic valve replacement (TAVR) has emerged as a valuable alternative treatment option for patients with severe symptomatic aortic stenosis at high surgical risk. We present the case of a 69 year-old man with symptomatic severe aortic stenosis deemed to be inoperable because of severe biventricular systolic dysfunction. TAVR was successfully performed as a last-resort option within a recently launched national programme covering such procedures in the public healthcare system. [ABSTRACT FROM AUTHOR]

We are presenting the case of a woman, 37 years old, former smoker, who was admitted for palpitations lasting a few seconds, accompanied by shortness of breath and dry cough. The patient complained about shortness of breath induced by ordinary physical activity, paroxysmal nocturnal dyspnoea and chest pain that occurred at rest and disappeared in approximately 5 minutes after its onset. She had been diagnosed a year previously with rheumatic mitral valve disease consisting of moderate stenosis and mild regurgitation. The young woman had a normal menstrual cycle and three children aged between 7 and 12 years old (all the pregnancies were full-term). When taking the social history, the patient revealed that she had grown up in an orphanage and at the age of 18, soon after leaving it, she was diagnosed with acute rheumatic fever. The patient's treatment before admission consisted of an anti-vitamin K anticoagulant, and antiarrhythmic drugs - amiodarone and a beta blocker. On physical examination, the patient was afebrile and had a normal Body Mass Index. The auscultation revealed rhythmic heart sounds, an early diastolic opening snap and a mitral diastolic rumble near the apex. There were no signs of systemic or pulmonary congestion. The blood tests detected elevated erythrocyte sedimentation rate (ESR) and creatine kinase -MB (CK-MB); the rest of the laboratory values were normal, including that of the B-type natriuretic peptide (BNP). The ECG showed sinus rhythm and left atrial enlargement which was visible on the otherwise normal chest x-ray. Transthoracic echocardiography revealed mitral valve disease with moderate stenosis (mitral valve area, MVA, estimation by PHT: 1.4 cm2 - Figure 1, mean gradient: 6 mmHg - Figure 2) and mild regurgitation with an eccentric jet towards the posterior left atrial wall. The dimensions and the systolic function of both ventricles were normal (LVEF 65%), but the left atrium was severely enlarged (Figure 3). Transoesophageal echocardiography confirmed the mitral valve disease with significant mitral stenosis (MVA by planimetry: 1.1 cm2, MVA by PHT: 1.3 cm2) and mild regurgitation. It also allowed a better appraisal of the mitral valve morphology: fusion of the commissures (Figure 4), small calcified nodules on the anterior mitral leaflet, a dome-like opening of the valve and also an assessment of the Wilkins score of 7 (leaflet mobility: 2, subvalvular apparatus involvement: 2, leaflet thickening: 2, valve calcification: 1). There was no evidence of thrombi either in the enlarged left atrium or in the left atrial appendage. Both echographic examinations revealed mild aortic regurgitation and the lack of diagnostic criteria for pulmonary hypertension (estimated PASP: 31 mmHg). After discussing the therapeutic options with the patient, we decided for a percutaneous balloon mitral valvuloplasty in the case of a young symptomatic patient with a significant mitral stenosis, with favourable valve characteristics both hemodynamically and morphologically. During the two months preceding the intervention, the patient was prescribed a beta blocker, an anti-vitamin K anticoagulant, a loop diuretic. As this was the case of a young woman with long-term necessity of antiarrhythmic therapy, considering the possible side effects of amiodarone, it was replaced with propafenone. After the balloon valvuloplasty, the area of the mitral valve was 1.9 cm2. A week after the intervention, the transthoracic echocardiography revealed an estimated MVA of 1.8 cm2 by planimetry (Figure 6) and 1.6 cm2 by PHT, a mean gradient of 4 mmHg (Figure 7) and a slight decrease in the volume of the left atrium, which remained nevertheless severely enlarged. The mitral regurgitation was mild and the estimated PASP receded to 17 mmHg. The patient did not tolerate the propafenone therapy, complaining about dyspnoea at rest after taking the drug. At discharge, the patient claimed amelioration of the symptoms and was prescribed a beta blocker, anti-vitamin K anticoagulant, low dose loop diuretic and secondary prophylaxis for rheumatic fever - penicillin V. At the following examinations, the necessity of an antiarrhythmic therapy remains to be reassessed. [ABSTRACT FROM AUTHOR]

Introduction - Since apical rotation is a key determinant of left ventricular (LV) performance we hypothesized that the worse outcome observed in pts with anterior myocardial infarction (Ml) may beat least partly, a consequence of LV apical involvement. Methods - We analyzed retrospectively from our database 245 echocardiographic studies of pts with documented history of LV Ml. Pts with either apical or basal akinetic segments, (between 2 and 5 segments) were included in our study and two groups were formed: 30 pts with apical and 30 pts with basal wall motion abnormalities (WMA). Results - A higher NYHA class was found in pts with apical W MA as compared to pts with basal W M A despite similar echocardiographic parameters of LV function. Wall motion score index (WMSI) was significantly higher in patients with apical dysfunction and emerged as the only predictor of functional NYHA class in the whole study population. No further statistical difference was observed between groups after correcting fo r WMSI. Conclusions - In our study the poorer functional status of post-MI patients with apical W M A as compared to patients with basal ischemic involvement was rather related to a more extensive ischemic area than to the actual location of akinetic segments. [ABSTRACT FROM AUTHOR]

Introduction: Right ventricular (RV) dysfunction and pulmonary hypertension (PH) have been previously associated with unfavorable outcomes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), but little is known about the effect of right ventricle (RV) to pulmonary artery (PA) coupling. Our study aimed to evaluate the determinant factors and the prognostic value of RV-PA coupling in patients undergoing TAVI., Methods: One hundred sixty consecutive patients with severe AS were prospectively enrolled, between September 2018 and May 2020. They underwent a comprehensive echocardiogram before and 30 days after TAVI, including speckle tracking echocardiography (STE) for myocardial deformation analysis of the left ventricle (LV), left atrium (LA), and RV function. Complete data on myocardial deformation was available in 132 patients (76.6 ± 7.5 years, 52.5% men) who formed the final study population. The ratio of RV free wall longitudinal strain (RV-FWLS) to PA systolic pressure (PASP) was used as an estimate of RV-PA coupling. Patients were analyzed according to baseline RV-FWLS/PASP cut-off point, determined through time-dependent ROC curve analysis, as follows: normal RV-PA coupling group (RV-FWLS/PASP ≥0.63, n  = 65) and impaired RV-PA coupling group (RV-FWLS/PASP < 0.63, n  = 67)., Results: A significant improvement of RV-PA coupling was observed early after TAVI (0.75 ± 0.3 vs. 0.64 ± 0.3 before TAVI, p  < 0.001), mainly due to PASP decrease ( p  < 0.001). LA global longitudinal strain (LA-GLS) is an independent predictor of RV-PA coupling impairment before and after TAVI (OR = 0.837, p  < 0.001, OR = 0.848, p  < 0.001, respectively), while RV diameter is an independent predictor of persistent RV-PA coupling impairment after TAVI (OR = 1.174, p  = 0.002). Impaired RV-PA coupling was associated with a worse survival rate (66.3% vs. 94.9%, p -value < 0.001) and emerged as an independent predictor of mortality (HR = 5.97, CI = 1.44-24.8, p  = 0.014) and of the composite endpoint of death and rehospitalization (HR = 4.14, CI = 1.37-12.5, p  = 0.012)., Conclusion: Our results confirm that relief of aortic valve obstruction has beneficial effects on the baseline RV-PA coupling, and they occur early after TAVI. Despite significant improvement in LV, LA, and RV function after TAVI, RV-PA coupling remains impaired in some patients, it is mainly related to persistent pulmonary hypertension and is associated with adverse outcomes., Competing Interests: BAP has received research support and lecture honoraria from GE Healthcare and Hitachi-Aloka. The remaining 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., (© 2023 Parasca, Calin, Cadil, Mateescu, Rosca, Botezatu, Enache, Beladan, Ginghina, Deleanu, Chioncel, Bubenek-Turconi, Iliescu and Popescu.)

Surface decontamination is of general concern in many technical fields including optics, electronics, medical environments, as well as art conservation. In this respect, we developed&nbsp;thin copolymer networks covalently bonded to flexible polyethylene (PE) sheets for hydrogel-based cleaning of varnished paintings. The syntheses of acrylates and methacrylates of the surfactants Triton X-100, Brij 35, and Ecosurf EH-3 or EH-9 and their incorporation into copolymers with acrylamide (PAM) and N -(4-benzoylphenyl)acrylamide are reported. Photocrosslinked polymer networks were prepared from these copolymers on corona-treated PE sheets, which can be swollen with aqueous solution to form hydrogel layers. The cleaning efficacy of these PE-PAM hydrogel systems, when swollen with appropriate cleaning solutions, was evaluated on painting surfaces in dependence of the PAM copolymer composition and degree of crosslinking. Specifically, soil and varnish removal and varnish surface solubilization were assessed on mock-ups as well as on paintings, indicating that even surfactant-free cleaning solutions were effective., Competing Interests: The authors declare no conflict of interest.

Background: Data regarding the contribution of left atrial (LA) dysfunction to the occurrence of heart failure in patients with severe aortic stenosis (AS) are scarce. The aim of this study was to assess the relationship between LA deformation and symptomatic status in this clinical setting., Methods: A total of 361 consecutive patients with severe AS (aortic valve area [AVA] index ≤ 0.6 cm 2 /m 2 ) referred to the echocardiography laboratory were prospectively screened. Two hundred forty-eight patients with preserved left ventricular (LV) ejection fraction (≥50%), in sinus rhythm, and with no more than mild aortic or mitral regurgitation (202 symptomatic and 46 asymptomatic) were enrolled. Asymptomatic status was confirmed by exercise echocardiography or electrocardiography, as clinically indicated. All patients underwent comprehensive echocardiography, including speckle-tracking analysis of LV and LA deformation., Results: No significant differences were found between the two groups regarding age and cardiovascular risk factors. LV ejection fraction and geometric parameters were similar between groups despite higher indexed AVA in asymptomatic patients. In symptomatic patients, brain natriuretic peptide values, average E/e' ratio, and LA size were higher, whereas LV global longitudinal strain and peak LA longitudinal strain and strain rate parameters were lower compared with asymptomatic patients. AVA and peak systolic LA longitudinal strain rate were the only independent correlates of heart failure symptoms (P = .04 and P = .01, respectively)., Conclusions: LA systolic strain rate, in addition to AVA, emerged as an independent correlate of the presence of heart failure in patients with severe AS and preserved LV ejection fraction. The echocardiographic evaluation of LA function by speckle-tracking may become useful for risk stratification in patients with asymptomatic AS, but larger prospective studies are needed., (Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Aims: The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP)., Method and Results: A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (<50%), 77 (64%) were in NYHA ≥ II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (≥15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (≥ 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68)., Conclusion: The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP non-invasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.)

We report the case of a rare association of a congenital Gerbode defect with severe mitral regurgitation due to abnormal linear structure of mitral valve, diagnosed in an adult patient. The case highlights the importance of a thorough examination interpreting the echocardiographic findings on a pathophysiological basis. It also underlines the complementary role of different imaging techniques with transesophageal echocardiography, allowing the precise assessment of both structural and functional abnormalities in such a complex case. The patient underwent mitral valve replacement with a bileaflet mechanical prosthesis and repair of the Gerbode defect. The imaging findings were confirmed during the surgical procedure, leading to a good outcome., Competing Interests: The authors have no financial conflicts of interest.

Drugs can be delivered by a temperature change-driven shrinking of the nanocarrier followed by the cargo release. This paper describes a different structural response to temperature, performed by nanoparticles of poly(N-isopropylacrylamide) and hyaluronic acid. Around 35 °C, the hydrophobicity of the vinyl polymer drives a core-shell rearrangement with the acrylamide chains confined in the core and the polysaccharide moiety forming the shell. In this arrangement, the nanoparticles enable the active targeting of tumor cells, due to the specific interaction of hyaluronic acid with the CD44 receptors. When doxorubicin-loaded nanoparticles are up-taken, the polysaccharide part degrades in the cytoplasm and the cytotoxic effect of the anticancer drug in colon adenocarcinoma cells has a 2-fold increase with respect to healthy fibroblasts. These core-shell particles have hyaluronic acid as the key factor for the specific targeting of tumor cells and drug release with poly(N-isopropylacrylamide) driving the transition.

The use of thermoresponsive poly( N -isopropylacrylamide)-based hydrogel (pNIPAAm) for rapid tuning of surface plasmon resonance (SPR) is reported. This approach is implemented by using an SPR layer architecture with an embedded indium tin oxide microheater and pNIPAAm film on its top. It takes advantage of rapid thermally induced swelling and collapse of pNIPAAm that is accompanied by large refractive index changes and leads to high thermo-optical coefficient of d n /d T = 2 × 10 -2 RIU/K. We show that this material is excellently suited for efficient control of refractive index-sensitive SPR and that it can serve simultaneously as a 3D binding matrix in biosensor applications (if modified with biomolecular recognition elements for a specific capture of target analyte). We demonstrate that this approach enables modulating of the output signal in surface plasmon-enhanced fluorescence spectroscopy biosensors and holds potential for simple time-multiplexing of sensing channels for parallelized readout of fluorescence assays.