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Chronic subdural hematoma (CSDH) is a frequently encountered neurosurgical disease among the elderly. The mainstay treatment involves surgical evacuation, but recurrence rates of approximately 13% pose complications. Adjuvant treatments, including tranexamic acid (TXA), have been explored, yet consensus on their efficacy and safety in elderly patients remains uncertain. The study aims to examine the role of TXA as adjunctive therapy in reducing CSDH recurrence and explore any potential association between TXA use and thrombotic events in this patient population. The systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook standards, searching databases up to July 2023 for randomized controlled trials and propensity-matched cohorts evaluating adjuvant TXA. The primary outcome was CSDH recurrence, and the secondary outcome was thrombosis risk, measured as relative risks. A total of 6 studies were included, comprising 1403 patients with CSDH who underwent surgical treatment. Four studies were randomized controlled trials, while the other 2 were propensity-matched cohorts. The overall pooled relative risk for CSDH recurrence in the TXA group compared to the control group was 0.41 (95% confidence interval [0.29–0.59], P < 0.01), indicating a significant reduction in recurrence with TXA treatment. In conclusion, our study indicates that adjuvant TXA may help reduce CSDH recurrence in elderly patients undergoing surgical treatment. However, the study has limitations and there is a need for further research to validate these findings. [ABSTRACT FROM AUTHOR]

Retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with lower success and higher complication rates when compared with the antegrade approach. This study sought to assess contemporary techniques and outcomes of retrograde CTO PCI. We examined the baseline characteristics, procedural techniques and outcomes of 4,058 retrograde CTO PCIs performed at 44 centers between 2012 and 2023. Major adverse cardiac events (MACE) included any of the following in-hospital events: death, myocardial infarction, repeat target vessel revascularization, pericardiocentesis, cardiac surgery, and stroke. The average J-CTO (Multicenter CTO Registry in Japan) score was 3.1 ± 1.1. Retrograde crossing was successful in 60.5% and lesion crossing in 81.6% of cases. The collaterals pathways successfully used were septals in 62.0%, saphenous vein grafts in 17.4%, and epicardials in 19.1%. The technical and procedural success rates were 78.7% and 76.6%, respectively. When retrograde crossing failed, technical success was achieved in 50.3% of cases using the antegrade approach. In-hospital MACE was 3.5%. The clinical coronary perforation rate was 5.8%. The incidence of in-hospital MACE with retrograde true lumen crossing, just marker antegrade crossing, conventional reverse controlled antegrade and retrograde tracking (CART), contemporary reverse CART, extended reverse CART, guide-extension reverse CART, and CART was 2.1%, 0.8%, 5.5%, 3.0%, 2.1%, 3.2%, and 4.1%, respectively; P = 0.01). Retrograde CTO PCI is utilized in highly complex cases and yields moderate success rates with 5.8% perforation and 3.5% periprocedural MACE rates. Among retrograde crossing strategies, retrograde true lumen puncture was the safest. There is need for improvement of the efficacy and safety of retrograde CTO PCI. [Display omitted] [ABSTRACT FROM AUTHOR]

Distal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. The study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. We examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. A total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). A poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose. [Display omitted] [ABSTRACT FROM AUTHOR]

The search for sustainable but environmentally friendly medium of harnessing energy for the automotive industry has led to the evolution of various energy generating and converting devices. One of such energy converting device is fuel cells. Despite the merits associated to the performance of proton exchange membrane (PEM) fuel cells, issues relating to the cost and remaining useful life prediction still persist hence impeding their further commercialization especially in the automotive industry. In spite of the progress made by the research community in developing various predictive models in order to mitigate these challenges, the accuracy of these developed models has lately become active research direction. The current study explored the accuracy of recurrent neural network, bi recurrent neural network, combined convolutional neural network and bi recurrent neural network in predicting the remaining useful life of a PEM fuel cell. The presence of the convolutional neural network was mainly to ensure pre – processing of the bi recurrent neural network for the extraction of high level features. To reduce the possibility of overfitting, a dropout approach coupled with callback technique is adopted. Validation of the model was executed based on an experimental data. The outcome of the investigation highlighted the key role of the convolutional neural network in improving the accuracy of the recurrent neural network. Comparing the root mean square error (RMSE) and mean absolute percentage error (MAPE) of the present model with other models, the developed model yielded the least values indicating a higher accuracy. For instance, the relative error showed a least value of 0.12 for the combined convolutional neural network and bi recurrent neural network compared to the long short term memory with 2.61 reported in previous studies. • Evaluation of various existing predictive models for PEM fuel cells is studied. • Convolutional neural network accuracy in predicting the rate of degradation for PEM fuel cell is captured. • The developed predictive model have higher accuracy compared to other models. • Future studies should explore further combination of various predictive models and the effect on the accuracy. [ABSTRACT FROM AUTHOR]

Background: Current studies show similar in-hospital outcomes following percutaneous coronary intervention (PCI) between Black and White patients. Long-term outcomes and the role of individual and community-level socioeconomic factors in differential risk are less understood.Methods: We linked clinical registry data from PCIs performed between January, 2013 and March, 2018 at 48 Michigan hospitals to Medicare Fee-for-service claims. We analyzed patients of Black and White race. We used propensity score matching and logistic regression models to estimate the odds of 90-day readmission and Cox regression to evaluate the risk of postdischarge mortality. We used mediation analysis to evaluate the proportion of association mediated by socioeconomic factors.Results: Of the 29,317 patients included in this study, 10.28% were Black and 89.72% were White. There were minimal differences between groups regarding post-PCI in-hospital outcomes. Compared with White patients, Black patients were more likely to be readmitted within 90-days of discharge (adjusted OR 1.62, 95% CI [1.32-2.00]) and had significantly higher risk of all-cause mortality (adjusted HR 1.45, 95% CI 1.30-1.61) when adjusting for age and gender. These associations were significantly mediated by dual eligibility (proportion mediated [PM] for readmission: 11.0%; mortality: 21.1%); dual eligibility and economic well-being of the patient's community (PM for readmission: 22.3%; mortality: 43.0%); and dual eligibility, economic well-being of the community, and baseline clinical characteristics (PM for readmission: 45.0%; mortality: 87.8%).Conclusions: Black patients had a higher risk of 90-day readmission and cumulative mortality following PCI compared with White patients. Associations were mediated by dual eligibility, community economic well-being, and traditional cardiovascular risk factors. Our study highlights the need for improved upstream care and streamlined postdischarge care pathways as potential strategies to improve health care disparities in cardiovascular disease. [ABSTRACT FROM AUTHOR]

There are limited data on the limited antegrade subintimal tracking (LAST) technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The aim of this study was to analyze the frequency of use and outcomes of the LAST technique for CTO PCI. We analyzed 2,177 CTO PCIs performed using antegrade dissection and re-entry (ADR) in the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) registry between 2012 and January 2022 at 39 centers. ADR was attempted in 1,465 cases (67.3%). Among antegrade re-entry cases, LAST was used in 163 (11.1%) (primary LAST in 127 [8.7%] and secondary LAST [LAST after other ADR approaches failed] in 36 [2.5%]), the Stingray system (Boston Scientific) in 980 (66.9%), subintimal tracking and re-entry in 387 (26.4%), and contrast-guided subintimal tracking and re-entry in 29 (2.0%). The mean patient age was 65.2 ± 10 years, and 85.8% were men. There was no significant difference in technical (71.8% vs 77.8%; P = 0.080) and procedural (69.9% vs 75.3%; P = 0.127) success and major cardiac adverse events (1.84% vs 3.53%; P = 0.254) between LAST and non-LAST cases. However, on multivariable analysis, the use of LAST was associated with lower procedural success (OR: 0.61; 95% CI: 0.41-0.91). Primary LAST was associated with higher technical (76.4% vs 55.6%; P = 0.014) and procedural (75.6% vs 50.0%; P = 0.003) success and similar major adverse cardiac event (1.57% vs 2.78%; P = 0.636) rates compared with secondary LAST. LAST was used in 11.1% of antegrade re-entry CTO PCI cases and was associated with lower procedural success on multivariable analysis, suggesting a limited role of LAST in contemporary CTO PCI. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Contemporary practices for hemodynamically supported high-risk percutaneous coronary intervention have evolved over the last decade. This study sought to compare outcomes of the prospective, multicenter, PROTECT III study to historic patients treated with Impella in the PROTECT II randomized controlled trial.Methods: Of 1,134 patients enrolled in PROTECT III from March 2017 to March 2020, 504 were "PROTECT II-like" (met eligibility for PROTECT II randomized controlled trial) and are referred to as PROTECT III for comparative analysis. Major adverse cardiac and cerebrovascular events (MACCE), comprising all-cause mortality, stroke/transient ischemic attack, myocardial infarction, and repeat revascularization, were compared at hospital discharge and 90 days.Results: Compared with PROTECT II (N = 216), PROTECT III patients were less often Caucasian (77.1% vs 83.8%, P = .045), with less prior CABG (13.7% vs 39.4%; P < .001) and prior myocardial infarction (40.7% vs 69.3%; P < .001). More PROTECT III patients underwent rotational atherectomy (37.1% vs 14.8%, P < .001) and duration of support was longer (median 1.6 vs 1.3 hours; p<0.001), with greater improvement achieved in myocardial ischemia jeopardy scores (7.0±2.4 vs 4.4±2.9; P < .001) and SYNTAX scores (21.4±10.8 vs 15.7±9.5; P < .001). In-hospital bleeding requiring transfusion was significantly lower in PROTECT III (1.8% vs 9.3%; P < .001), as was procedural hypotension (2.2% vs 10.1%; P < .001) and cardiopulmonary resuscitation or ventricular arrhythmia (1.6% vs 6.9%; P < .001). At 90 days, MACCE was 15.1% and 21.9% in PROTECT III and PROTECT II, respectively (p=0.037). Following propensity score matching, Kaplan-Meier analysis showed improved 90-day MACCE rates in PROTECT III (10.4% vs 16.9%, P = .048).Conclusions: The PROTECT III study demonstrates improved completeness of revascularization, less bleeding, and improved 90-day clinical outcomes compared to PROTECT II for Impella-supported high-risk percutaneous coronary intervention among patients with severely depressed LVEF. [ABSTRACT FROM AUTHOR]

This study sought to evaluate the differences in cardiogenic shock patient characteristics in trial patients and real-life patients. Cardiogenic shock (CS) is a leading cause of mortality in patients presenting with acute myocardial infarction (AMI). However, the enrollment of patients into clinical trials is challenging and may not be representative of real-world patients. We performed a systematic review of studies in patients presenting with AMI-related CS and compared patient characteristics of those enrolled into randomized controlled trials (RCTs) with those in registries. We included 14 RCTs (n = 2,154) and 12 registries (n = 133,617). RCTs included more men (73% vs 67.7%, P < 0.001) compared with registries. Patients enrolled in RCTs had fewer comorbidities, including less hypertension (61.6% vs 65.9%, P < 0.001), dyslipidemia (36.4% vs 53.6%, P < 0.001), a history of stroke or transient ischemic attack (7.1% vs 10.7%, P < 0.001), and prior coronary artery bypass graft surgery (5.4% vs 7.5%, P < 0.001). Patients enrolled in RCTs also had lower lactate levels (4.7 ± 2.3 mmol/L vs 5.9 ± 1.9 mmol/L, P < 0.001) and higher mean arterial pressure (73.0 ± 8.8 mm Hg vs 62.5 ± 12.2 mm Hg, P < 0.001). Percutaneous coronary intervention (97.5% vs 58.4%, P < 0.001) and extracorporeal membrane oxygenation (11.6% vs 3.4%, P < 0.001) were used more often in RCTs. The in-hospital mortality (23.9% vs 38.4%, P < 0.001) and 30-day mortality (39.9% vs 45.9%, P < 0.001) were lower in RCT patients. RCTs in AMI-related CS tend to enroll fewer women and lower-risk patients compared with registries. Patients enrolled in RCTs are more likely to receive aggressive treatment with percutaneous coronary intervention and extracorporeal membrane oxygenation and have lower in-hospital and 30-day mortality. [Display omitted] [ABSTRACT FROM AUTHOR]

Pheochromocytomas are rare catecholamine-secreting tumors with a high potential for recurrence post-surgery, necessitating prolonged follow-up. This case highlights the diagnostic and therapeutic challenges in managing recurrent pheochromocytoma. A 25-year-old female, with a history of left pheochromocytoma treated with adrenalectomy a decade earlier, presented with a right adrenal mass. Despite controlled hypertension, elevated urine metanephrines suggested recurrence. Imaging showed a right adrenal mass and suspicious left paraaortic lymph nodes, confirming the diagnosis of recurrent malignant pheochromocytoma in the left adrenal bed and right adrenal gland, with metastasis to the paraaortic lymph nodes. The patient underwent right adrenalectomy coupled with cytoreductive surgery (CRS) in the form of excision of left-sided adrenal bed recurrence and left paraaortic lymph node dissection, intraoperative radiation therapy (IORT), and hyperthermic intraperitoneal chemotherapy (HIPEC). On follow-up six years later, the patient remains free from recurrence. This case illustrates the importance of continued surveillance in pheochromocytoma patients, even those with a low-risk profile. The recurrence in this case, despite a smaller initial tumor size and no genetic predispositions, underscores the unpredictable nature of pheochromocytomas. The successful management with CRS, IORT, and HIPEC emphasizes the need for a personalized and multifaceted treatment approach. Pheochromocytoma patients, including those initially considered low risk, require long-term monitoring due to the risk of recurrence. The utilization of CRS, IORT, and HIPEC in this case was pivotal in managing the recurrent and metastatic malignant disease effectively, demonstrating the significance of a comprehensive, multidisciplinary treatment strategy in such complex cases. • Low risk pheochromocytoma patients require at least a 10-year follow-up. • Malignant pheochromocytoma is defined by the presence of extra-adrenal metastasis. • Recurrence of pheochromocytoma can be masked by controlled hypertension. • CRS, HIPEC, and IORT, a novel approach, was successful in treating pheochromocytoma. • HIPEC and IORT help achieve better local control and limit peritoneal spread. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) remains the leading cause of death globally, including the Middle East and North Africa (MENA) region. However, limited research has been conducted on the burden of CVD in this region. Our study aims to investigate the burden of CVD and related risk factors in the MENA. We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 21 MENA countries. Prevalence and mortality were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and risk factors were evaluated under the GBD's comparative risk assessment framework. Between 1990 and 2019, CVD raw accounts in the MENA increased by 140.9%, while age standardized prevalence slightly decreased (-1.3%). CVD raw mortality counts rose by 78.3%, but age standardized death rates fell by 28%. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of CVA. Age standardized DALYs decreased by 32.54%. DALY rates varied across countries and were consistently higher in males. Leading risk factors included hypertension, high LDL-C, dietary risks, and elevated BMI. The countries with the three highest DALYs in 2019 were Afghanistan, Egypt, and Yemen. While strides have been made in lessening the CVD burden in the MENA region, the toll on mortality and morbidity, particularly from ischemic heart disease, remains significant. Country-specific variations call for tailored interventions addressing socio-economic factors, healthcare infrastructure, and political stability. [ABSTRACT FROM AUTHOR]

A hemoglobin (Hb) level goal of 7-8 g/dL is a standard care threshold, prompting blood transfusion. The debate over whether acute myocardial infarction (MI) patients benefit from a more liberal transfusion strategy prompted a meta-analysis of relevant trials. We performed a meta-analysis of randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in anemic MI patients. Primary outcomes were recurrent MI and death/MI, while secondary outcomes included stroke, revascularization, heart failure, and all-cause mortality. Due to the limited trials, we utilized the Paul-Mendele method with Hartung Knapp adjustment. Involving 2155 patients with liberal transfusion and 2170 with conservative transfusion across four RCTs, liberal transfusion did not significantly reduce MI (relative risk [RR] 0.85; 95 % CI 0.72 - 1.02, p = 0.07) or death/MI (RR 0.88; 95 % CI 0.45 - 1.71, p = 0.57). No significant differences were observed in all-cause mortality (RR 0.82; 95 % CI 0.25 – 2.68, p = 0.63), stroke (RR 0.89; 95 % CI 0.48 - 1.64, p = 0.50), revascularization (RR 0.93; 95 % CI 0.48 - 1.80, p = 0.68), or heart failure (RR 1.14; 95 % CI 0.04 – 28.84, p = 0.88). Our meta-analysis supports current medical guidelines, reinforcing the practice of limiting transfusions in acute MI patients to those with an Hb level of 7 or 8 g/dL. Liberal transfusion strategies did not show improved clinical outcomes. [ABSTRACT FROM AUTHOR]

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There is limited information on use of laser in complex percutaneous coronary interventions (PCI). We examined the impact of laser on the outcomes of balloon uncrossable and balloon undilatable chronic total occlusion (CTO) PCI. We reviewed baseline clinical and angiographic characteristics and procedural outcomes of 4845 CTO PCIs performed between 2012 and 2020 at 32 centers. Of the 4845 CTO lesions, 752 (15.5%) were balloon uncrossable (523 cases) or balloon undilatable (356 cases) and were included in this analysis. Mean patient age was 66.9 ± 10 years and 83% were men. Laser was used in 20.3% of the lesions. Compared with cases in which laser was not used, laser was more commonly used in longer length occlusions (33 [21, 50] vs. 25 [15, 40] mm, p = 0.0004) and in-stent restenotic lesions (41% vs. 20%, p < 0.0001). Laser use was associated with higher technical (91.5% vs. 83.1%, p = 0.010) and procedural (88.9% vs. 81.6%, p = 0.033) success rates and similar incidence of major adverse cardiac events (3.92% vs. 3.51%, p = 0.805). Laser use was associated with longer procedural (169 [109, 231] vs. 130 [87, 199], p < 0.0001) and fluoroscopy time (64 [40, 94] vs. 50 [31, 81], p = 0.003). In a contemporary, multicenter registry balloon uncrossable and balloon undilatable lesions represented 15.5% of all CTO PCIs. Laser was used in approximately one-fifth of these cases and was associated with high technical and procedural success and similar major complication rates. [Display omitted] • Information on laser use in complex percutaneous coronary interventions is limited. • Balloon uncrossable/undilatable lesions represented 15% of chronic total occlusions. • Laser was used in approximately one-fifth of these cases. • Laser was associated with higher technical and procedural success rates. • Laser was associated with similar major cardiac complication rates. [ABSTRACT FROM AUTHOR]

Bacillus Calmette-Guérin (BCG) vaccination is a prototype model for the study of trained immunity (TI) in humans, and results in a more effective response of innate immune cells upon stimulation with heterologous stimuli. Here, we investigate the heterogeneity of TI induction by single-cell RNA sequencing of immune cells collected from 156 samples. We observe that both monocytes and CD8+ T cells show heterologous transcriptional responses to lipopolysaccharide, with an active crosstalk between these two cell types. Furthermore, the interferon-γ pathway is crucial in BCG-induced TI, and it is upregulated in functional high responders. Data-driven analyses and functional experiments reveal STAT1 to be one of the important transcription factors for TI shared in all identified monocyte subpopulations. Finally, we report the role of type I interferon-related and neutrophil-related TI transcriptional programs in patients with sepsis. These findings provide comprehensive insights into the importance of monocyte heterogeneity during TI in humans. [Display omitted] • IFN-γ plays an important role in amplifying trained immunity response • Monocytes show heterogeneous trained immunity capacity after in vivo BCG vaccination • Trained monocytes are regulated by different transcription factors including STAT1 • A developed tool for user to test trained immunity signatures in transcriptome data Li et al. show that BCG vaccination induces an enhanced antimicrobial response upon secondary stimulation, and this effect is heterogeneous at single-cell level. These findings provide comprehensive insights into the molecular mechanism of trained immunity and its role in immune-mediated diseases. [ABSTRACT FROM AUTHOR]

Polymer matrix composites are excellent materials for a variety of industrial applications. They have superior mechanical, thermal and electrical properties, making them preferable to traditional materials such as metal. To make polymer matrix composite materials, thermosetting, elastomers and thermoplastic polymers are mainly the three types of polymers that can be utilized as matrices. In comparison to thermosetting and elastomers polymers, carbon fiber reinforced thermoplastic (CFRTP), is the subject of this research, are gaining popularity in many industrial sectors due to its recyclability, simplicity of processing, good characteristics, flexibility, and less production time. This review covers conventional and state-of-the-art manufacturing techniques of CFRTP. Moreover, the potential and existing of CFRTP's application as well as the techniques of carbon fiber recovery and recycling methods of such materials were also examined. Overall, this study considers the research and development on manufacturing CFRTP and recycling techniques of polymer composites to recover carbon fiber materials. [Display omitted] • Conventional and state-of-the-art manufacturing techniques of carbon fiber reinforced thermoplastic were investigated. • The potential and existing of carbon fiber reinforced thermoplastic application were reviewed. • Techniques of carbon fiber recovery and recycling methods of polymer composites materials were examined. [ABSTRACT FROM AUTHOR]

Vertical axis wind turbines (VAWTs) have gained popularity in the last few decades due to their numerous advantages when deployed in urban areas. Despite this, Vertical axis wind turbines have complex aerodynamics, dynamic stall, hence lower performance. Low/zero starting torque, noise, visual impact, as well as blade safeness are further hurdles when they are fitted into the physical environment. Due to these pertinent issues that comes to play in a vertical axis wind turbine, the current investigation explores an augmented vertical axis wind turbine (AVAWT) having a rotor and a stator. The outcome of the study highlighted the effect of mesh density and the type of turbulence model selected in the determination of the forces being exerted on the blade using computational fluid dynamics. Investigation into the effect of time steps showed lesser effect of this parameter on the performance of the blade computationally. The newly developed augmented turbine blades improved the output power by 1.35 times in comparison to an open rotor. The shape for the conical surface and the stator blade impacted the performance as well. Furthermore, it was deduced that there was higher dynamic stall for scenarios where the tip speed ratios were lower. The study showed the importance of the stator in a vertical axis wind turbine in ensuring that the incoming wind attains some acceleration as well as creating a lower pressure outlet but overall aids in the improvement of the power and torque coefficients by more than 36%. • Effect of mesh density on vertical axis turbine blade design using CFD is presented. • Power and torque coefficient increased by more than 36%. • The speed of the wind has direct correlation to the stator design. [ABSTRACT FROM AUTHOR]

• Soybean with higher protein and better nutritional composition has been developed. • The protein content of seeds ranged from 41.3 %–47.7 %. • Elevated levels of cysteine and elemental sulfur were found in these seeds. • Bowman-Birk protease inhibitor and lunasin were elevated in these seeds. Soybean is the preferred protein source for both poultry and swine feed. However, this preferred status is being challenged due to competition from alternative feed ingredients. To overcome this, it becomes necessary for breeders to develop soybean cultivars that contain higher protein and better nutritional composition. In this study, we have developed experimental soybean lines that not only contain significantly higher amounts of protein but also improved sulfur amino acid content. This objective was achieved by crossing a O-acetylserine sulfhydrylase (OASS) overexpressing transgenic soybean line with elevated levels of sulfur amino acid content (CS) with a high protein Korean soybean cultivar (Lee 5). Introgression of high protein and overexpression of OASS was monitored in the experimental lines at each successive generation (F2-F6) by measuring protein content and OASS activity. The average protein content of transgenic CS and Lee 5 seeds were 34.8 % and 44.7 %, while in the experimental soybean lines the protein content ranged from 41.3 %–47.7 %, respectively. HPLC and inductively coupled plasma-mass spectrometry analyses revealed that all the experimental lines developed in this study contained significantly higher amounts of sulfur containing amino acids and elemental sulfur in the seeds. The sulfur amino acid (cysteine + methionine) content of the experimental lines ranged from 1.1 % to 1.26 % while the parents Lee 5 and CS had 0.79 % and 1.1 %, respectively. SDS-PAGE and western blot analysis demonstrated that the accumulation of Bowman-Birk protease inhibitor and lunasin, two sulfur amino acid rich peptides, were elevated in experimental soybean lines. High-resolution 2D-gel electrophoresis and Delta2D gel analysis validated that an overall increase in the different subunits of 7S β-conglycinin and 11S glycinin were mainly responsible for the observed increase in the total amount of protein in experimental lines. [ABSTRACT FROM AUTHOR]

Pediatric atlantoaxial instability (AAI) is not common and could be a serious clinical condition. The Goel-Harms technique is one of the most used techniques in adults and needs more evaluation in pediatric populations. This study reports the feasibility and safety of the Goel-Harms technique in the treatment of pediatric reducible AAI. In this retrospective cohort study we reported all pediatric patients who underwent Goel-Harms technique for AAI with a minimum 1-year follow up. Patients were clinically assessed using the Japanese Orthopedic Association (JOA) score and radiologically with plain radiographs, computed tomography scan, and magnetic resonance imaging of the craniocervical region. Postoperatively, patients were followed up according to our clinical and radiographic imaging protocol. The following parameters were recorded: JOA score, construct stability, fusion, and abnormal events. A total of 25 patients have completed a 1-year follow-up and fulfilled our criteria. The mean age was 10.68 ± 4.47 (range, 3–17) years. Fifteen patients were male and 10 were female. The final diagnosis included Down syndrome (DS) in 8, type II dens fracture in 7, os odontoideum in 3, and atlantoaxial rotatory fixation in 7. The mean follow-up was 21.76 ± 8.22 months. The preoperative JOA score improved from 15.96 ± 1.46 to 16.76 ± 1.92 at the last follow-up. Sound bone fusion was reported in 92% of patients. Our data suggest that the Goel-Harms technique is a safe, feasible, and effective procedure in managing pediatric reducible AAI. Special perioperative care should be offered to young AAI patients with DS. [ABSTRACT FROM AUTHOR]

This work discusses the novel application of proton exchange membrane fuel cells (PEMFC) in the transport sector as well as portable applications. This kind of fuel cell produces a considerable quantity of heat while in operation. This quantity of heat is about 45–60% of entire energy composition of the hydrogen that is introduced into the cell. A correctly built cooling system must be used to efficiently eliminate produced heat from the stack to extend the stack's life and preserve its efficiency throughout its entire lifespan. Using appropriate thermal management techniques coupled with exploiting possibilities for fuel cell heat recovery may significantly improve size, cost, etc., while also reducing its total energy consumption. It is possible to collect and utilise the heat produced by PEMFC in other applications. A thorough analysis of heat recovery possibilities in this type of fuel cells is presented in this investigation. Similarly, the study further touched on the need for experimental studies into waste heat recovery from proton exchange membrane fuel cells as most of the recent work being championed are modelling based and does not really present a real life scenario of the system investigated. The need for investigations into the environmental performance of the waste heat recovery unit coupled to the proton exchange fuel cell system is also another important research direction that must be considered in future studies. Finally most of the studies on waste heat recovery from fuel cells have largely employed the use of organic Rankine cycle but other types of thermodynamic cycles like Kalina cycle is however recommended for further investigations due to their range of operation hence making them suitable for low and high temperature proton exchange membrane fuel cells. • Role of PEMFC in the transport sector as well as portable applications was discussed. • PEM Fuel cell in Combine Heat and Power Applications was illustrated. • Waste heat recovery in FCs was summarised. [ABSTRACT FROM AUTHOR]

Alternate means of harnessing energy are currently being researched. However, not all demographics are in a position to switch over to these alternatives while complying with the change in existing infrastructure. The present study aspires to evaluate the effectiveness of ternary fuel blends in existing automotive engines to offer a more flexible mode of operation without demanding any modifications to the existing spark-ignition (SI) engine. It focuses on the compatibility between biofuels and pure gasoline as a flexi-fuel alternative in internal combustion engines (ICE) for improved combustion characteristics. Butanol and Lemon Peel Oil (LPO) are highly competitive renewable biofuels for use in internal combustion engines due to their many advantages. Empirical research is conducted on studying mixtures at different engine speeds and blend concentrations. Accordingly, a combined mixture process design model is developed by virtue of the Design of Experiments (DOEs). ANOVA or analysis of variance method is employed, in addition, to determine the influence of input parameters on output parameters. From the results, it is observed that utilizing pure gasoline or a blend with 90% gasoline produced the least amount of peak cylinder pressure (Pmax) alongside minimum levels of mean gas temperature (MGT), and cumulative heat release rate (CHRR). This indicated a lower efficiency of fuel combustion when using higher proportions of gasoline in the blend. Additionally, engine speed is found to have a significant influence over all the performance parameters where it exhibited an inverse relationship which showed that higher engine speed produced inferior results and vice versa. The desirability matrix yields the most optimal blend, displaying a substantial desirability score of 0.683 running on 50% gasoline, 20% n-butanol, and 30% LPO, at 1523.485 rpm. A comparison between the results of Pmax, CHRR, and MGT between pure gasoline and the optimal blend yields a performance enhancement of 16%, 0.5%, and 6.4%, respectively. Overall, from the research , both butanol and LPO meet the ascribed expectations and are observed to significantly enhance the different combustion parameters. These results can thus be further extrapolated to ascertain the partial replacement of straight gasoline in real-life scenarios with butanol and LPO. [Display omitted] [ABSTRACT FROM AUTHOR]

Spontaneous coronary artery dissection (SCAD) is a common cause of myocardial infarction in young and middle-aged women. Patients with SCAD present rarely with hemodynamic collapse and cardiogenic shock, requiring immediate resuscitation and mechanical circulatory support. Percutaneous mechanical circulatory support may serve as a bridge to recovery, decision or heart transplantation. We present a case of a young woman with SCAD of the left main coronary artery, presenting with ST-elevation myocardial infarction, cardiac arrest and cardiogenic shock. She was stabilized emergently with Impella and early escalation with extracorporeal membrane oxygenation (ECPELLA) at a non-surgical community hospital. Despite revascularization with percutaneous coronary intervention (PCI), her left ventricular recovery was poor, and ultimately required cardiac transplantation on day 5 of her presentation. • Mechanical circulatory support is key to stabilize patients with refractory cardiogenic shock in order to perform revascularization • Access to mechanical circulatory support in the community and timely escalation of mechanical circulatory support are fundamental to achieve favorable outcomes in cardiogenic shock. • Early evaluation by advanced heart failure team in a tertiary experienced center is recommended. [ABSTRACT FROM AUTHOR]

Coronary intravascular lithotripsy (IVL) has emerged as a novel technique for the treatment of severely calcified coronary lesions. We evaluated the mechanism and efficacy of IVL in facilitating optimal stent implantation in heavily calcified coronary lesions using intravascular ultrasound (IVUS). Forty-six patients were initially enrolled as a part of the Disrupt CAD III study. Of these, 33 had pre-IVL, 24 had post-IVL, and 44 had post-stent IVUS evaluation. The final analysis was performed on 18 patients who had IVUS images interpretable at all three intervals. The primary endpoint was increase in minimum lumen area (MLA) from pre-IVL to post-IVL treatment to post-stenting. Pre-IVL, MLA was 2.75 ± 0.84 mm2, percent area stenosis was 67.22 % ± 20.95 % with maximum calcium angle of 266.90° ± 78.30°, confirming severely calcified lesions. After IVL, MLA increased to 4.06 ± 1.41 mm2 (p = 0.0003), percent area stenosis decreased to 54.80 % ± 25.71 % (p = 0.0009), and maximum calcium angle decreased to 239.40° ± 76.73° (p = 0.003). There was a further increase in MLA to 6.84 ± 2.18 mm2 (p < 0.0001) and decrease in percent area stenosis to 30.33 % ± 35.08 % (p < 0.0001) post-stenting with minimum stent area of 6.99 ± 2.14 mm2. The success rate of stent delivery, implantation, and post-stent dilation was 100 % post-IVL. In this first study evaluating the mechanism of IVL using IVUS, the primary endpoint of increase in MLA from pre-IVL to post-IVL treatment to post-stenting was successfully achieved. Our study showed that the use of IVL-assisted percutaneous coronary intervention is associated with improved vessel compliance, facilitating optimal stent implantation in de novo severely calcified lesions. • We evaluated mechanism of intravascular lithotripsy using intravascular ultrasound. • Primary endpoint, increase in MLA from pre-IVL to post-stenting, was met. • We showed that the use of IVL-assisted PCI improves vessel compliance. • This facilitates optimal stent implantation in de novo severely calcified lesions. [ABSTRACT FROM AUTHOR]

Following successful retrograde CTO PCI via a degenerating saphenous vein graft, persistent TIMI II flow was noted in the graft. Given increased risk of target vessel failure in the presence of significant competitive flow from a saphenous vein graft, the SVG underwent coil embolization with two 4 mm × 6 cm detachable coils. Follow up angiography with forceful contrast injection resulted in embolization of the coils into the patient's two remaining patent grafts. The coils were then retrieved using a micro-snare. The patient tolerated the procedure with no compromise of flow into the remaining grafts and resolution of angina following CTO PCI. [ABSTRACT FROM AUTHOR]

• Teaching hospitals experience no negative effects on STEMI patients in summer with new residents, fellows, and attendings. • Given the limitations of HCUP databases including the (NRD), a prospective cohort study may be needed to confirm findings. [ABSTRACT FROM AUTHOR]