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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]

This article, titled "Management of Brain Stem Cavernomas in the Setting of Multiple Intracranial Cavernomas: A Retrospective Analysis of Single Institutional Experience," explores the impact of multiple cerebral cavernomas on the management of brain stem cavernomas. The study analyzed electronic records from 2007 to 2023 and selected patients with multiple intracranial cavernomas, dividing them into two groups: those with only brain stem cavernomas and those with both brain stem and non-brain stem cavernomas. The study found that the risk of brain stem cavernoma bleeding was higher in the group with multiple cavernomas compared to the group with only brain stem cavernomas. However, there was no significant difference in outcomes between the two groups after a two-year follow-up period. [Extracted from the article]

Background: The nucleoside transport capabilities of the human equilibrative nucleoside transporter-3 (hENT3) are disrupted by mutations in SLC29A3 (10q22.2), which are genes for the nucleoside transporter and are the cause of the unusual autosomal recessive disease known as H syndrome. As a result, histiocytic cells invade a number of organs. Case presentation: A 17-year-old Syrian male was admitted to the internal medicine department with a one-month history of polyuria, polydipsia, general weakness, and pallor. He had a history of progressive bilateral sensorineural hearing loss and failure to gain weight for three years. Physical examination revealed various abnormalities, including scrotal mass, small penis and testicles, absence of pubic and axillary hair, joint abnormalities, short stature, hallux valgus, fibrous protrusion near the navel, and hyperpigmented non-itchy painful skin plaques. Clinical signs along with laboratory test results confirmed hyperglycemia, primary hypogonadism, osteopenia, and growth hormone deficiency. After a review of the relevant medical literature, this patient's presentation of hyperglycemia with hypogonadism, hyperpigmentation, hallux valgus, hearing loss, hematological abnormalities, and short stature suggested the diagnosis of H syndrome. The patient received treatment with insulin and testosterone, leading to a significant improvement in his presenting symptoms. Conclusions: H syndrome is a very rare condition, and the fact that the first case has only recently been reported in Syria serves to emphasize how rare it is. H Syndrome should be suspected if a patient has short stature with signs of hyperglycemia and other endocrine and cutaneous abnormalities. We are reporting this case to increase physicians' awareness of this exceedingly rare and unique syndrome. [ABSTRACT FROM AUTHOR]

Background: Malignant mesotheliomas are rare, yet highly malignant tumors. Mesotheliomas are tumors that develop from mesothelial surfaces, with the pleura being the most common, followed by the peritoneum. The diagnosis of malignant peritoneal mesothelioma (MPM) is usually established when the disease is advanced, owing to the nonspecific clinical appearance and abdominal symptoms. Initially, MPM was treated with palliative systemic chemotherapy, with or without palliative surgery. However, cytoreductive surgery (CRS) combined with bidirectional intraoperative chemotherapy (BDIC) has recently emerged as a treatment option for MPM. BDIC creates a bidirectional chemotherapy gradient in the peritoneal tumor cells through the simultaneous use of intraperitoneal and intravenous chemotherapy. CRS, combined with BDIC (CRS-BDIC), allows the complete elimination of residual tiny tumor cells after complete removal of the visible tumor nodules. Case Report: Herein, we present a case of a 51-year-old woman with MPM and chronic kidney disease (CKD) stage 3b. Her treatment consisted of neoadjuvant chemotherapy and immunotherapy, followed by CRS-BDIC using intraperitoneal cisplatin and doxorubicin, and intravenous ifosfamide. The surgery was successful, with no immediate complications or decline in the patient's kidney function. On follow up 2 months later, the patient denies suffering any chemotherapy-related adverse effects, and her kidney profile remains stable. Conclusions: In conclusion, nephrotoxicity, a known adverse effect of cisplatin and ifosfamide, might not be a contraindication for the use of these potentially nephrotoxic drugs in CRS-BDIC in patients with renal impairment. [ABSTRACT FROM AUTHOR]

Estrogen receptor (ER) α expression and associated signaling is a major driver of over two-thirds of all breast cancers (BC). ER targeting strategies are typically used as a first-line therapy in patients with steroid receptor positive (SR+) disease. Secondary resistance to anti-estrogenic agents may occur with clonal expansion and disease progression. Mechanisms underlying hormone resistance are an expanding field of significant translational importance. Cross-talk with other nuclear hormones, receptors, and signaling pathways, including thyroid hormones (TH) and their receptors (THRs), have been shown to promote endocrine therapy resistance in some studies. We have shown that TH replacement therapy (THRT) was independently and significantly associated with higher rates of relapse and mortality in SR positive (+), node-negative (LN-) BC patients, whereas it showed no association with outcomes in SR negative (-) patients. LN-, SR+ patients receiving THRT and tamoxifen had the worst outcomes, suggesting a pro-carcinogenic interaction that significantly and independently shortened survival and increased mortality. Using in vivo and in vitro models, we previously showed hormonal cross-talk, altered gene signaling, target gene activation, and resistance to tamoxifen in the presence of TH. In this report, we show TH ± E2 ± tamoxifen inhibits cell cycle control signaling, reduces apoptosis, and enhances cell proliferation, tumor growth, tamoxifen resistance, and clonal expansion. Mechanistically these changes involve numerous genes and pathways, including critical cell cycle regulatory proteins and genes identified using various molecular methods. These studies facilitate a greater mechanistic understanding of the biological and molecular impact of TH on SR+ BC. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the anti-sickling activity of Senna alexandrina, Aerva javanica, and Ficus palmate extracts. Methods: The leaves were extracted with water and methanol. The anti-sickling effect of extracts was determined using blood from 20 sickle cell disease (SCD) patients by mixing it with 500 and 1000 μg/mL of extract. The treated blood samples were then examined under a light microscope. The osmotic fragility of erythrocytes was determined using 4 mL (0 – 0.9 %) buffered saline mixed with 1 mL extract (500 μg/mL) and 0.05 mL sickled red blood cells (RBCs). Results: Aerva javanica extract significantly (p < 0.0001) reduced the percentage of sickle cells compared to control. The sickle-shaped cells were 29.47 % when treated with 125 μg/mL concentration of methanol extract of A. javanica that was further decreased to 0.35 % on increasing the concentration to 500 μg/mL. A similar trend was also observed with extracts of F. palmata. Extracts had protective effect on erythrocyte osmotic fragility. Results of comet assay suggested that extracts did not damage DNA. Conclusion: These plant extracts have promising anti-sickling activity and protect erythrocyte osmotic fragility. However, in vivo studies are required to validate these results and for further development of the extracts for therapeutic use. [ABSTRACT FROM AUTHOR]

The objective of this paper is to study and define some algebraic curves with neutrosophic variables in neutrosophic real field R(I), where we study what are the relationships between classical algebraic curves and neutrosophic algebraic curves depending on the geometric isometry (AH-Isometry). [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]

The rising significance of the field of biopolymers has driven the rapid progress of this distinctive class of polymeric materials in the past decades. Biodegradable polymers have acquired much attention because they play an essential role in humans' lives due to their specific tunable electrical conductivity and biodegradability characteristics, making them fascinating in many applications. Herein, we debated the recent progress in developing biodegradable polymers and their applications. Initially, we introduce the basics of conducting and biodegradable polymers, trailed by debates about the effective strategies currently used to develop biopolymers. Special importance will focus on the uses of biodegradable polymers in drug delivery and tissue engineering, as well as wound healing, demonstrating the recent findings, and uses of several biodegradable polymers in modern biological uses. In this review, we have provided comprehensive viewpoints on the latest progress of the challenges and future prospects involving biodegradable polymers' advancement and commercial applications. [ABSTRACT FROM AUTHOR]

Parathyromatosis is a rare cause of recurrent primary hyperparathyroidism that often follows surgical removal of the parathyroid gland. Foci of parathyromatosis are most commonly found in the neck, mediastinum, and sites of autotransplantation. A 36-year-old male with renal failure and prior parathyroidectomy presented with generalized bone pain, for which laboratory investigations revealed hyperparathyroidism. Preoperative coil localization was utilized followed by thoracoscopy using fluoroscopy for resection of ectopic parathyroid tissue. The specimen was sent to histopathology, which revealed multiple nodules of hypercellular parathyroid tissue, consistent with the diagnosis of parathyromatosis. Parathyromatosis is a rare cause of recurrent hyperparathyroidism, with surgical removal being the only curative option. Follow-up is essential as it can commonly recur. [ABSTRACT FROM AUTHOR]

Background: Ventilator Associated Pneumonia (VAP) is a common hospital acquired infection that occurs as complication in patients who are connected to Mechanical Ventilation (MV). Nurses in intensive care unit (ICU) should be updated with the latest evidence-based practice to prevent such complication. This study aimed to assess improvement of the nurses' awareness toward ventilator-associated pneumonia based on latest evidence guidelines. Methods: A quantitative pretest-posttest design has been conducted. Using a convenience sample of 58 nurses who are working in the ICU were recruited. Tools: A self-administrative questionnaire was adapted to assess the nurse's knowledge about VAP and VAP prevention bundle. Results: The results highlighted that all ICU nurses had improvement of knowledge level pre-post regarding VAP (p <0.001), VAP prevention (p <0.001), and the overall knowledge score improvement revealed significantly higher after the educational program (p <0.001). Conclusion: Periodic refreshing on-services education program should be provided to nurses in ICU to improve their knowledge and to maintain high level of information, moreover hospital policies should include updated guidelines for VAP prevention bundle and protocol from international evidence. [ABSTRACT FROM AUTHOR]

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]

[Display omitted] • Novel nanocatalysts with oxygen vacancies were synthesized using carbothermal reduction. • Various techniques characterized catalyst structure and morphology. • Oxygen vacancies and doping reduce gaps, improve mobility, and suppress recombination. • The results showed improved degradation of pollutants and high stability for the photocatalysts. Nanostructured photocatalysts based on cobalt and molybdenum-doped TiO 2 composite materials were developed to enhance photocatalytic performance. The creation of defects through partial carbothermal reduction resulted in materials with lower band gaps, improving efficiency. The carbon lattice facilitated electron movement and inhibited electron-hole recombination, while the large surface area of the nanosheets enhanced catalyst effectiveness. The materials were characterized using XRD, FTIR, Raman spectroscopy, FESEM, and UV–Vis spectroscopy. The degradation of arsenazo 3 dye was used to evaluate the catalysts, with all three showing efficient degradation. The TiO 2 -Mo-C catalyst exhibited the highest degradation rate (99.8%). Kinetic data indicated that the photodegradation followed pseudo-first-order and Langmuir-Hinshelwood kinetics. Remarkably, the reaction rate constant (k C = 41.61 mg L-1 min−1) and adsorption equilibrium constant (K LH = 1.26 × 10-3 L mg−1) of the TiO 2 -Mo-C catalyst were significantly superior to other catalysts. These photocatalysts demonstrated excellent stability and reusability over six cycles. [ABSTRACT FROM AUTHOR]

Key Clinical Message: However, it is noteworthy that certain patients with minor functional limitations in their hand may have experienced undiagnosed thumb hypoplasia during their childhood years. These individuals may have successfully adapted to their condition without seeking medical intervention and may express a preference for nonintervention (as in this case). Thumb hypoplasia is a congenital underdevelopment of the thumb, accounting for 5%–15% of congenital hand disorders. It occurs equally among both genders and can affect both thumbs. The condition is categorized using Blauth's classification with Type I being the mildest form. We report a 23‐year‐old Syrian male presented with a bilateral restriction in opposition movement when using a pen or razor. Clinical examination and x‐ray imaging revealed a bilateral Type I hypoplastic thumb with bilateral minimal hypoplasia of the toes. Despite the surgical treatment options available, the patient opted not to undergo surgery due to his adaptation to his condition. Hypoplastic thumb Type I is a congenital condition characterized by underdevelopment of the thumb. Bilateral thumb hypoplasia with toes hypoplasia is extremely rare. A full systemic evaluation should be done due to its associations with other syndromic manifestations and treatment options are discussed concerning the best functional outcomes and patient preferences. [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]

Biodiesel represents a promising solution for sustainable energy needs, offering an eco-friendly alternative to conventional fossil fuels. In this research, we investigate the use of a catalyst derived from mussel shells to facilitate biodiesel production from Jatropha curcas oil. Our findings from X-ray Fluorescence (XRF) analysis emphasize the importance of carefully selecting calcination temperatures for mussel shell-based catalysts, with 1100 °C identified as optimal for maximizing CaO content. We identify a reaction time of 6 h as potentially optimal, with a reaction temperature of approximately 110 °C yielding the desired methyl ester composition. Notably, a methanol-to-oil ratio of 18:1 is the most favorable condition, and the optimal methyl ester composition is achieved at a calcined catalyst temperature of 900 °C. We also assess the stability of the catalyst, demonstrating its potential for reuse up to five times. Additionally, a thorough analysis of J. curcas Methyl Ester (JCME) biodiesel properties confirmed compliance with industry standards, with variations attributed to the unique characteristics of JCME. Comparing homogeneous (NaOH) and heterogeneous (CaO) catalysts highlights the potential of environmentally sourced heterogeneous catalysts to replace their homogeneous counterparts while maintaining efficiency. Our study presents a novel approach to sustainable biodiesel production, outlining optimal conditions and catalyst stability and highlighting additional benefits compared with NaOH catalysts. Therefore, utilizing mussel shell waste for catalyst synthesis can efficiently eliminate waste and produce cost-effective catalysts. [ABSTRACT FROM AUTHOR]

Key clinical Message: This case highlights the significance of maintaining clinical suspicion for CPBs in adults presenting with SBO. Early surgical intervention, offering both diagnosis and treatment, is essential for managing this rare cause of SBO. Increased clinical awareness of CPBs will help ensure they are considered in the differential diagnosis of adult patients with bowel obstruction. [ABSTRACT FROM AUTHOR]

Peri-stent contrast staining (PSS), defined as contrast staining around the stent struts, has been identified as an indicator of future stent failure in first generation, sirolimus-eluting coronary stents. 1 PSS has been associated with in-stent restenosis, stent thrombosis, stent fracture, and the development of coronary aneurysm. As the frequency of patients with first generation sirolimus-eluting coronary stents becomes infrequent; PSS may go unrecognized. Herein, we present a patient with a decade of longitudinal follow-up, who developed PSS identified on coronary angiogram with recurrent stent failure. [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]

This study introduces an innovative approach to sustainable biodiesel production using mussel shell-derived calcium oxide (CaO) as a catalyst for converting Jatropha curcas oil into biodiesel. By repurposing waste mussel shells, the research aims to provide an eco-friendly and cost-effective solution for environmentally responsible biodiesel production, aligning with global standards. The study involves characterizing the catalyst, optimizing reaction conditions, and achieving a remarkable 99.36% Fatty Acid Methyl Ester (FAME) yield, marking a significant step toward cleaner and more economically viable energy sources. Biodiesel, recognized for its lower emissions, is produced through transesterification using mussel shell-derived CaO as a sustainable catalyst. This research contributes to cleaner and economically viable energy sources, emphasizing the importance of sustainable energy solutions and responsible catalytic processes. This research bridges the gap between waste management, catalyst development, and sustainable energy production, contributing to the ongoing global shift towards cleaner and more economically viable energy sources. [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]

Key Clinical Message: A novel radiologic sign in patients with renal failure and uremic encephalopathy (UE) with metabolic acidosis has recently been identified as the lentiform fork sign. On magnetic resonance imaging (MRI), the "lentiform fork sign" has been described as bilateral symmetrical hyperintensities in the basal ganglia encircled by a hyperintese rim delineating the lentiform nucleus. Changes in uremic solute retention, aberrant blood–brain barrier transport, disordered vascular reactivity, altered electrolyte and acid–base balance, and altered hormone metabolism are the most likely causes of the condition. A 56‐year‐old male with end‐stage renal disease was brought to the emergency room for a progressive change in mental status and involuntary arm movements over the previous 5 days, which were accompanied by mild dyspnea. A brain MRI was performed, and it revealed hyperintensity on T2/FLAIR in the white matter surrounding the basal ganglia. the patient was treated with dialysis and improved greatly. Intensified hemodialysis and glycemic control are the cornerstones of treating diabetic uremic syndrome (DUS) with likely reversible clinical symptoms and remission of imaging abnormalities. [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]

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with a considerable risk of complications, and risk stratification is of utmost importance. To assess the clinical usefulness of the recently developed PROGRESS-CTO (NCT02061436) complication risk scores in an independent cohort. Individual patient data pooled analysis of 3 registries was performed. Of the 4569 patients who underwent CTO PCI, 102 (2.2%) had major adverse cardiovascular events (MACE). Patients with MACE were older (69 ± 11 vs. 65 ± 10, p < 0.001), more likely to have a history of prior coronary artery bypass graft surgery, and unfavorable angiographic characteristics J-CTO score (2.4 ± 1.2 vs. 2.1 ± 1.3, p = 0.007), including blunt stump (59% vs. 49%, p = 0.047). Technical success was lower in patients with MACE (59% vs. 86%, p < 0.001). The area under the receiver operating characteristic curve of the PROGRESS-CTO complication risk models were as follows: MACE 0.72 (95% confidence interval [CI], 0.67–0.76), mortality 0.73 (95% CI, 0.61–0.85), and pericardiocentesis 0.69 (95% CI, 0.62–0.77) in the validation dataset. The observed complication rates increased with higher PROGRESS-CTO complication scores. The PROGRESS-CTO MACE score showed good calibration in this external cohort, with MACE rates similar to the original study: 0.7% (score 0–1), 1.5% (score 2), 2.2% (score 3), 3.8% (score 4), 4.9% (score 5), 5.8% (score 6–7). Given the good discriminative performance, calibration, and ease of calculation, the PROGRESS-CTO complication scores could help assess the risk of complications in patients undergoing CTO PCI. • We evaluated the PROGRESS-CTO complication risk scores in an individual patient data pooled analysis of 3 CTO PCI registries. • The c-statistic of the models were 0.72, 0.73, and 0.69 for MACE, mortality, and pericardiocentesis, respectively. • The use of the PROGRESS-CTO complication risk should be considered to facilitate risk-benefit assessment in CTO PCI. [ABSTRACT FROM AUTHOR]

Objective: Unknown etiology Background: Gastric antral vascular ectasia (GAVE) is a rare clinical entity that presents with acute upper-gastrointestinal bleeding or chronic anemia. It is characterized by endoscopic watermelon appearance of the stomach. It is usually associated with other comorbidities; however, few articles have previously described GAVE in patients with end-stage renal disease. Its management is controversial, and endoscopic management is considered the treatment of choice. Case Report: A middle-age female patient, on regular hemodialysis for ESRD, was referred to the surgical out-patient clinic as a refractory GAVE after failure of endoscopic management as she became blood transfusion-dependent. She underwent laparoscopic subtotal gastrectomy with a Billroth II reconstruction of gastrojejunostomy. She had a smooth postoperative course and was followed up in the clinic for 12 months with no complications. Her hemoglobin level was stable at 9.4 g/dL without further blood transfusion. Conclusions: Gastric antral vascular ectasia is usually associated with other comorbidities; however, an association between GAVE and CKD is rare. Its management is controversial, and endoscopic management is considered the preferred method of treatment. Laparoscopic subtotal gastrectomy is an effective management modality for GAVE, with dramatic improvement and good outcomes in terms of bleeding, blood transfusion requirements, and nutritional status. [ABSTRACT FROM AUTHOR]

Mango fruit is well known for its nutritional and health benefits due to the presence of a plethora of phytochemical classes. The quality of mango fruit and its biological activities may change depending upon the variation in geographical factors. For the first time, this study comprehensively screened the biological activities of all four parts of the mango fruit from twelve different origins. Various cell lines (MCF7, HCT116, HepG2, MRC5) were used to screen the extracts for their cytotoxicity, glucose uptake, glutathione peroxidase activity, and α-amylase inhibition. MTT assays were carried out to calculate the IC50 values for the most effective extracts. The seed part from Kenya and Sri Lanka origins exhibited an IC50 value of 14.44 ± 3.61 (HCT116) and 17.19 ± 1.60 (MCF7). The seed part for Yemen Badami (119 ± 0.08) and epicarp part of Thailand (119 ± 0.11) mango fruit showed a significant increase in glucose utilization (50 μg/mL) as compared to the standard drug metformin (123 ± 0.07). The seed extracts of Yemen Taimoor seed (0.46 ± 0.05) and Yemen Badami (0.62 ± 0.13) produced a significant reduction in GPx activity (50 μg/mL) compared to the control cells (100 μg/mL). For α-amylase inhibition, the lowest IC50 value was observed for the endocarp part of Yemen Kalabathoor (108.8 ± 0.70 μg/mL). PCA, ANOVA, and Pearson's statistical models revealed a significant correlation for the fruit part vs. biological activities, and seed part vs. cytotoxicity and α-amylase activity (p = 0.05). The seed of mango fruit exhibited significant biological activities; hence, further in-depth metabolomic and in vivo studies are essential to effectively utilize the seed part for the treatment of various diseases. [ABSTRACT FROM AUTHOR]

Introduction: Children with Special Healthcare Needs (CSHCN) are considered difficult to maintain oral hygiene and challenging for caregivers and dentists to attain cooperation in dental treatment under general anaesthesia. Family Impact Scale (FIS) and Parental-Caregiver Perceptions Questionnaire (P-CPQ) are useful tools to assess patient's oral health quality of life and caregivers perception. Aim: To assess the impact of dental treatment under general anaesthesia on the quality of life and oral hygiene of CSHCNs, as perceived by caregivers. Materials and Methods: This prospective follow-up survey study was carried out at Dammam Medical Complex, Saudi Arabia, from December 5th, 2019 to December 15th, 2021. The CSHCN of either gender, aged 12 years, and falling within the American Academy of Pediatric Dentistry (AAPD) definition of special-needs patients referred for invasive procedures under general anaesthesia (American Society of Anaesthesiologists (ASA) class I or II), were included. The baseline and, after a one-year follow-up, information obtained from two surveys that were altered from Thompson's P-CPQ and FIS were decoded into the numeric ordinal scales Never ("0"), Once or Twice ("1"), Sometime ("2"), Always ("3"), and Daily ("4"). Analysis of the collected data was done by Statistical Package for Social Sciences (SPSS) version 20.0. Results: A total of 84 participants were caregivers of CSHCN who underwent dental procedures under General Anaesthesia (GA), of whom 77 (91.7%) were mothers and 7 (8.3%) were fathers of the CSHCN. The mean age of children was 8.29±2.14 years (Range= 3-12 years); 38 (45.2%) were males and 46 (54.8%) were females. The median FIS after treatment was zero, compared to the median before treatment which was 2, revealing a significant impact on being absent from work, a child requiring more care, the impact of presence, sleeping disturbances, feeling angry, feeling guilty, and a child disputing or blaming either parent (p<0.001). Following the pattern of one year post-treatment FIS, median was 0 (Never) for all items including halitosis, pain, food trapped in palate and teeth, swallow, breath, time, sleep, irritable, frustrating, nervous, shy, absent, laugh, and continue school (p<0.001). Conclusion: The modified FIS and P-CPQ evaluations before and after dental treatment under GA revealed a significant improvement in the oral health quality of life for those CSHCN, as well as the impact on their caregivers. Regular check-ups would be useful for early and non invasive intervention without GA. [ABSTRACT FROM AUTHOR]

Background: Balloon uncrossable lesions are defined as lesions that cannot be crossed with a balloon after successful guidewire crossing. Methods: We analyzed the association between balloon uncrossable lesions and procedural outcomes of 8671 chronic total occlusions (CTOs) percutaneous coronary interventions (PCIs) performed between 2012 and 2022 at 41 centers. Results: The prevalence of balloon uncrossable lesions was 9.2%. The mean patient age was 64.2 ± 10 years and 80% were men. Patients with balloon uncrossable lesions were older (67.3 ± 9 vs. 63.9 ± 10, p < 0.001) and more likely to have prior coronary artery bypass graft surgery (40% vs. 25%, p < 0.001) and diabetes mellitus (50% vs. 42%, p < 0.001) compared with patients who had balloon crossable lesions. In-stent restenosis (23% vs. 16%. p < 0.001), moderate/severe calcification (68% vs. 40%, p < 0.001), and moderate/severe proximal vessel tortuosity (36% vs. 25%, p < 0.001) were more common in balloon uncrossable lesions. Procedure time (132 (90, 197) vs. 109 (71, 160) min, p < 0.001) was longer and the air kerma radiation dose (2.55 (1.41, 4.23) vs. 1.97 (1.10, 3.40) min, p < 0.001) was higher in balloon uncrossable lesions, while these lesions displayed lower technical (91% vs. 99%, p < 0.001) and procedural (88% vs. 96%, p < 0.001) success rates and higher major adverse cardiac event (MACE) rates (3.14% vs. 1.49%, p < 0.001). Several techniques were required for balloon uncrossable lesions. Conclusion: In a contemporary, multicenter registry, 9.2% of the successfully crossed CTOs were initially balloon uncrossable. Balloon uncrossable lesions exhibited lower technical and procedural success rates and a higher risk of complications compared with balloon crossable lesions. [ABSTRACT FROM AUTHOR]

The DNA Damage Response (DDR) pathways sense DNA damage and coordinate robust DNA repair and bypass mechanisms. A series of repair proteins are recruited depending on the type of breaks and lesions to ensure overall survival. An increase in glucose levels was shown to induce genome instability, yet the links between DDR and glucose are still not well investigated. In this study, we aimed to identify dysregulation in the transcriptome of normal and cancerous breast cell lines upon changing glucose levels. We first performed bioinformatics analysis using a microarray dataset containing the triple-negative breast cancer (TNBC) MDA-MB-231 and the normal human mammary epithelium MCF10A cell lines grown in high glucose (HG) or in the presence of the glycolysis inhibitor 2-deoxyglucose (2DG). Interestingly, multiple DDR genes were significantly upregulated in both cell lines grown in HG. In the wet lab, we remarkably found that HG results in severe DNA damage to TNBC cells as observed using the comet assay. In addition, several DDR genes were confirmed to be upregulated using qPCR analysis in the same cell line. Our results propose a strong need for DDR pathways in the presence of HG to oppose the severe DNA damage induced in cells. [ABSTRACT FROM AUTHOR]

Preprocedural coronary computed tomography angiography (CCTA) can be useful in procedural planning for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical, angiographic and procedural characteristics and outcomes of cases with vs. without preprocedural CCTA in PROGRESS-CTO (NCT02061436). Multivariable logistic regression was used to adjust for confounding factors. Of 7034 CTO PCI cases, preprocedural CCTA was used in 375 (5.3%) with increasing frequency over time. Patients with preprocedural CCTA had a higher prevalence of prior coronary artery bypass graft surgery (39% vs. 27%, p < 0.001) and angiographically unfavorable characteristics including higher prevalence of proximal cap ambiguity (52% vs. 33%, p < 0.001) and moderate/severe calcification (59% vs. 41%, p < 0.001) compared with those without CCTA. CCTA helped resolve proximal cap ambiguity in 27%, identified significant calcium not seen on diagnostic angiography in 18%, changed estimated CTO length by >5 mm in 10%, and was performed as part of initial coronary artery disease work up in 19%. CCTA cases had higher J-CTO (2.6 ± 1.2 vs. 2.3 ± 1.3, p < 0.001) and PROGRESS-CTO (1.3 ± 1.0 vs. 1.2 ± 1.0 p = 0.027) scores. After adjusting for potential confounders, cases with preprocedural CCTA had similar technical success (odds ratio [OR]: 1.18, 95% confidence interval [CI], 0.83–1.67) and incidence of major adverse cardiovascular events (OR: 1.47, 95% CI, 0.72–3.00). Preprocedural CCTA was used in ~5% of CTO PCI cases. While CCTA may help with procedural planning, especially in complex cases, technical success and MACE were similar with or without CCTA. • Of the 7,034 CTO PCI procedures performed between 2012-2022, preprocedural CCTA was used in 375 (5.3%). • CCTA helped resolve proximal cap ambiguity in 27%, identified calcium in 18%, and changed the estimated CTO length in 10%. • On multivariable analysis preprocedural CCTA was not associated with technical success or major adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

This paper studies the technical, economic, and environmental feasibility of a standalone adsorption cooling system thermally driven by biomass combustion and solar thermal energy. The developed cooling package was benchmarked against a baseline vapour compression refrigeration system, driven by grid electricity and the widely investigated adsorption cooling system driven by solar heat. TRNSYS was utilised to imitate the integrated systems, investigate their year-round performance, and optimise their designs by employing the meteorological data for Rwanda and an existing cold room (13 m2 floor area × 2.9 m height) as a case study. The optimisation study for the system revealed that maximum chiller performance (COP = 0.62), minimum biomass daily consumption (36 kg), and desired cold room setting temperature (10 °C) throughout the year can be achieved if the boiler setting temperature, heat storage size, and heating water flow rate are 95.13 °C, 0.01 m3 and 601.25 kg/h. An optimal PV area/battery size combination of 12 modules/16 kWh was obtained from the economic, environmental, and technical viewpoints. [Display omitted] • A standalone bio-driven adsorption cooling system was developed. • A PV solar system was integrated to drive the system's auxiliaries. • The system's variables were optimised to minimise the cost and environmental impact. • The system's technical, economic, and environmental feasibility were analysed. [ABSTRACT FROM AUTHOR]

Antibiotics are essential medications for human and animal health, as they are used to battle urinary infections and bacterial diseases. Therefore, the rapid determination of antibiotic drugs in biological samples is necessary to address the current clinical challenge. Here, we developed a heterojunction ternary composite of BiOCl/BiVO 4 nanosheets enriched with graphene oxide (BiOCl/BiVO 4 @GO) for accurate and minimal-level detection of an antihistamine (promethazine hydrochloride, PMZ) in urine samples. The BiOCl/BiVO 4 nanosheets were prepared by a wet chemical approach using a deep eutectic green solvent. The spectroscopic and analytical methods verified the formation and interaction of the BiOCl/BiVO 4 @GO composite. Our results showed that the thoroughly exfoliated BiOCl/BiVO 4 @GO composite retained good electrical conductivity and fast charge transfer toward the electrode–electrolyte interface in neutral aqueous media. In addition, the experimental conditions were accurately optimized, and the BiOCl/BiVO 4 @GO composite showed excellent electrocatalytic activity toward the oxidation of PMZ. Indeed, the BiOCl/BiVO 4 @GO composite demonstrated a good linear response range (0.01–124.7 μM) and a detection level of 3.3 nM with a sensitivity of 1.586 μA μM−1 cm−2. In addition, the BiOCl/BiVO 4 @GO composite had excellent storage stability, good reproducibility, and reliable selectivity. Finally, the BiOCl/BiVO 4 @GO displayed a desirable recovery level of PMZ in urine samples for real-time monitoring. • A heterojunction composite of BiOCl/BiVO 4 @GO was prepared via green synthesis. • BiOCl/BiVO 4 @GO showed excellent electrocatalytic activity towards PMZ detection. • BiOCl/BiVO 4 @GO showed much lower detection limit of PMZ with good stability. • BiOCl/BiVO 4 @GO was applied to real time analysis of PMZ in urine samples. [ABSTRACT FROM AUTHOR]

The prevalence, treatment, and outcomes of balloon undilatable lesions encountered in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We examined the clinical characteristics and procedural outcomes of balloon undilatable lesions in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). Of 6535 CTO PCIs performed between 2012 and 2022, 558 (8.5%) lesions were balloon undilatable. In this subset, patients were older (mean age 67 ± 10 vs. 64 ± 10, p < 0.001) and had higher prevalence of comorbidities: diabetes mellitus (54% vs. 40%, p < 0.001), prior PCI (71% vs. 59%, p < 0.001), prior myocardial infarction (52% vs. 45%, p = 0.003), and prior coronary artery bypass graft surgery (44% vs. 25%, p < 0.001). The CTO lesion length was estimated to be 34 ± 23 mm, mean J-CTO score was 2.9 ± 1.1 and mean PROGRESS-CTO score was 1.4 ± 1.0. A cutting balloon was used in 27%, a scoring balloon in 15%, laser in 14%, rotational atherectomy in 28%, orbital atherectomy in 10%, intravascular lithotripsy in 1% and other modalities/approaches in 5%. Balloon undilatable lesions had lower technical success (90.9% vs. 93.8%, p = 0.007) and higher incidence of major adverse cardiovascular events (MACE) (composite of in-hospital death, acute myocardial infarction, stroke, re-PCI, emergency CABG, and pericardiocentesis) (5.0% versus 1.3%, p < 0.001). Approximately 1 in 12 CTO (8.5%) lesions are balloon undilatable. Treatment of balloon undilatable lesions is associated with lower technical success and higher in-hospital MACE. • Approximately 1/12 chronic total occlusion (8.5%) lesions are balloon undilatable • Balloon undilatable lesions had lower technical success (90.9% vs. 93.8%, p = 0.007) • Balloon undilatable lesions had higher MACE (5.0% versus 1.3%, p < 0.001) [ABSTRACT FROM AUTHOR]

Biomarkers to identify ICU COVID-19 patients at high risk for mortality are urgently needed for therapeutic care and management. Here we found plasma levels of the glycolysis byproduct methylglyoxal (MG) were 4.4-fold higher in ICU patients upon admission that later died (n = 33), and 1.7-fold higher in ICU patients that survived (n = 32),compared to uninfected controls (n = 30). The increased MG in patients that died correlated inversely with the levels of the MG-degrading enzyme glyoxalase-1 (r2 = − 0.50), and its co-factor glutathione (r2 = − 0.63), and positively with monocytes (r2 = 0.29). The inflammation markers, SSAO (r2 = 0.52), TNF-α (r2 = 0.41), IL-1β (r2 = 0.25), CRP (r2 = 0.26) also correlated positively with MG. Logistic regression analysis provides evidence of a significant relationship between the elevated MG upon admission into ICU and death (P < 0.0001), with 42% of the death variability explained. From these data we conclude that elevated plasma MG on admission is a novel independent biomarker that predicts mortality in ICU COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: The modes of failure of coronary polymer-jacketed guidewires have received limited study.Methods: We queried the Manufacturer and User Facility Device Experience (MAUDE) database between January 2011 and December 2020 for reports on coronary polymer-jacketed guidewires and retrieved 254 reports.Results: The most common failure mode was failure of the guidewire to cross (36.2%), followed by guidewire fracture (35%), peeling of the polymer jacket (13.8%), failure to retrieve the guidewire (13.8%), and guidewire unraveling (4.7%). Guidewire fracture was more common with soft (37.3%) compared with stiff (23.8%) guidewires. Failure of retrieval was only reported with soft guidewires (9%). Coronary perforation and dissection occurred in 19.7% and 7.9% of the reports, with more reports with stiff as compared with soft guidewires (45.2% vs. 14.6% for perforation and 21.4% vs. 5.3% for dissection).Conclusions: The most common failure modes of polymer-jacketed guidewires during percutaneous coronary intervention are failure to cross the lesion, guidewire fracture, and peeling of the polymer jacket. Coronary perforations were more common with stiff whereas wire fracture was more common with soft polymer-jacketed guidewires. [ABSTRACT FROM AUTHOR]

Background: To describe the national trends and outcomes of contemporary thrombectomy use for primary percutaneous coronary intervention (PCI) from 2016 to 2018.Methods: We queried the Nationwide Readmission Database (NRD) from January 2016 to December 2018 to identify patients who underwent primary PCI and thrombectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality and stroke in patients undergoing primary PCI and those who underwent thrombectomy.Results: We identified 409,910 total hospitalizations who underwent primary PCI. Thrombectomy was used in 62,446 records (15.2%) with no change in the trend over the study period (p trend = 0.52). Thrombectomy was more utilized in patients who had more cardiogenic shock and use of mechanical circulatory devices. The overall incidence of in-hospital mortality and stroke were 5.6% and 1.1%, respectively. The incidence of in-hospital mortality (6.7% vs. 5.4%, p < 0.001) and strokes (1.3% vs. 1.0%, p < 0.001) were higher in the thrombectomy group. On multivariable regression analysis adjusting for high-risk features, thrombectomy was not independently associated with in-hospital mortality [1.036, 95% CI (0.993-1.080), p = 0.100], but was associated with a higher risk of stroke [OR 1.186, 95% CI (1.097-1.283), p < 0.001].Conclusion: During primary PCI, thrombectomy was used in 1 of 6 cases, and its use has been stable over 2016-2018. The use of thrombectomy was associated with a higher risk of stroke, but not in-hospital death. [ABSTRACT FROM AUTHOR]

Background: Data on the mechanisms of failure of covered coronary stents [Graftmaster, PK Papyrus] are limited.Methods: We queried the "Manufacturer and User Facility Device Experience" (MAUDE) database between August 2018 (when the PK Papyrus stent was FDA approved) and December 2020 for reports on covered coronary stents.Results: We identified 299 reports in the MAUDE database (after excluding duplicates, peripheral vascular reports, and incomplete records) (Graftmaster n = 225, PK Papyrus n = 74). The most common mechanism of failure of covered stents was failure to deliver the stent (46.2%), followed by stent dislodgement (22.4%) and failure to seal the perforation (19.7%). Failure to deliver the stent was more often reported with Graftmaster compared with PK Papyrus (59.1% vs. 6.8%, p < 0.001). Stent dislodgement was more often reported with PK Papyrus compared with Graftmaster (75.7% vs. 4.9%, p < 0.001) and was managed by device retrieval or by crushing the stent.Conclusions: The most common failure mechanisms of covered stents are failure of delivery, stent dislodgement, and failure to seal the perforation. Failure of delivery was more common with Graftmaster, while stent dislodgement was more common with PK Papyrus. Further improvements in covered stent design are needed to optimize deliverability and minimize the risk of complications. [ABSTRACT FROM AUTHOR]