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Severe diaphragm dysfunction can lead to respiratory failure and to the need for permanent mechanical ventilation. Yet permanent tethering to a mechanical ventilator through the mouth or via tracheostomy can hinder a patient’s speech, swallowing ability and mobility. Here we show, in a porcine model of varied respiratory insufficiency, that a contractile soft robotic actuator implanted above the diaphragm augments its motion during inspiration. Synchronized actuation of the diaphragm-assist implant with the native respiratory effort increased tidal volumes and maintained ventilation flow rates within the normal range. Robotic implants that intervene at the diaphragm rather than at the upper airway and that augment physiological metrics of ventilation may restore respiratory performance without sacrificing quality of life.

OBJECTIVES We have previously shown in experimental settings that a leaflet foldoplasty device reduces redundant leaflet area to re-establish mitral valve (MV) coaptation. The current study investigates the in vivo device retention and functional durability following foldoplasty. METHODS The prototype is of superelastic nitinol formed into a 3-dimensional shape. It is unfolded to engage a specified area of leaflet tissue and then folded to exclude this tissue from the coaptation surface. Design modifications were made and tested in benchtop studies to determine the optimal design for durable retention within the leaflet. To evaluate in vivo performance, posterior leaflet chordae were severed in Yorkshire pigs to produce complete posterior leaflet prolapse and severe mitral regurgitation. Design modifications were then used for MV repair. Five animals that underwent repair using the optimal design were observed for 2 weeks postoperative to evaluate the functional result and implant retention. RESULTS Device position and orientation were maintained at 2 weeks while preserving the functional MV repair in all 5 animals. Coaptation height was 5.5 ± 1.5 mm, which was not significantly different from a baseline of 4.9 ± 0.8 mm. The degree of leaflet excursion was 41.0 ± 16.0 compared to a baseline of 58.7 ± 27.5. CONCLUSIONS Device foldoplasty is a new concept for MV repair based on the reduction of redundant leaflet tissue area. This study demonstrates the feasibility of safe maintenance of this repair without early dislodgement or embolization.

Purpose In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload. Methods In nine Yorkshire swine of 65–80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV. The SRVAD was actuated in synchrony with the ventricle to augment native RV output for up to one hour. Hemodynamic parameters during SRVAD actuation were compared to baseline and RHF levels. Results Median RV cardiac index (CI) was 1.43 (IQR, 1.37–1.80) L/min/m2 and 1.26 (IQR 1.05–1.57) L/min/m2 at first and second baseline. Upon PA banding RV CI fell to a median of 0.79 (IQR 0.63–1.04) L/min/m2. Device actuation improved RV CI to a median of 0.87 (IQR 0.78–1.01), 0.85 (IQR 0.64–1.59) and 1.11 (IQR 0.67–1.48) L/min/m2 at 5 min (p = 0.114), 30 min (p = 0.013) and 60 (p = 0.033) minutes respectively. Statistical GEE analysis showed that lower grade of tricuspid regurgitation at time of RHF (p = 0.046), a lower diastolic pressure at RHF (p = 0.019) and lower mean arterial pressure at RHF (p = 0.024) were significantly associated with higher SRVAD effectiveness. Conclusions Short-term augmentation of RV function using SRVAD is feasible even in cases of elevated RV afterload. Moderate or severe tricuspid regurgitation were associated with reduced device effectiveness.

Objectives: This work aimed to study the clinical, angiographic profiles and in-hospital outcomes of NSTEMI cases in Duhok, Iraq. Methods: This prospective study involved 283 patients with NSTEMI who were admitted to Azadi teaching hospital/Azadi heart center in Duhok, Kurdistan region of Iraq, between 2021 and 2022. The patient's demographic variables, major cardiovascular risk factors (smoking, hypertension, diabetes mellitus, hyperlipidemia and family history of coronary artery disease), clinical presentation, past history of myocardial infarction/ previous percutaneous coronary intervention (PCI) and drug history were collected. The GRACE risk score was calculated for each patient. Patients were followed up regarding the management strategies (whether conservative or invasive approach), and in-hospital complications and outcomes. Results: The mean GRACE score was 142±26. 70% of cases underwent coronary angiography/ angioplasty, with a mean time to the coronary intervention of 8 days. 17% of the sample had developed different cardiovascular complications, with heart failure being the most common. The mortality rate was 7.4%. Conclusion: The study demonstrated higher complications and mortality rates, especially among patients with higher GRACE scores, compared to rates found in most available studies, particularly in western countries. This finding could be secondary to a suboptimal coronary intervention for NSTEMI in terms of time to intervention and the proportion of patients who underwent it.

Kynurenic acid (KynA) is tissue protective in cardiac, cerebral, renal, and retinal ischemia models, but the mechanism is unknown. KynA can bind to multiple receptors, including the aryl hydrocarbon receptor, the a7 nicotinic acetylcholine receptor (a7nAChR), multiple ionotropic glutamate receptors, and the orphan G protein–coupled receptor GPR35. Here, we show that GPR35 activation was necessary and sufficient for ischemic protection by KynA. When bound by KynA, GPR35 activated G i - and G 12/13 -coupled signaling and trafficked to the outer mitochondria membrane, where it bound, apparantly indirectly, to ATP synthase inhibitory factor subunit 1 (ATPIF1). Activated GPR35, in an ATPIF1-dependent and pertussis toxin–sensitive manner, induced ATP synthase dimerization, which prevented ATP loss upon ischemia. These findings provide a rationale for the development of specific GPR35 agonists for the treatment of ischemic diseases.

Aurivillius Na0.5Bi4.5Ti4O15 and Bi4Ti3O12 compounds were synthesized via solid-state reaction technique. X-ray powder diffraction study confirmed monophasic four-layered Na0.5Bi4.5Ti4O15 and three-layered Bi4Ti3O12 ceramics. Dielectric relaxation and conduction behaviors of Na-contained Na0.5Bi4.5Ti4O15 ceramics were thoroughly investigated in a large scale of temperature of 30–650 °C and frequency of 40 Hz–1 MHz. In addition, comparative studies of both the compounds were discussed. Impedance and modulus analyses revealed a single relaxation behavior in Na0.5Bi4.5Ti4O15 compound which was originated from the grain’s interior with grain resistance of 2.189 × 105 Ω and capacitance of 4.268 × 10−10 F at 570 °C. While in Bi4Ti3O12 ceramic the relaxation was due to the contributions of grain and grain boundaries. Alternating current (AC) conductivity analysis revealed the presence of two different conduction regions in both the compounds. Activation energies for the two different conduction mechanisms, i.e., in low-temperature region and in high-temperature region were calculated to be ~ 0.23 and ~ 1.27 eV at 1 kHz for Na0.5Bi4.5Ti4O15 compound and ~ 0.43 eV and ~ 0.97 eV at 1 kHz for Bi4Ti3O12 compound, respectively. The present study of dielectric relaxation and conduction behaviors would be helpful for further investigations of Na0.5Bi4.5Ti4O15-related Aurivillius compounds.

Using first-principles calculations, the geometry, electronic structure, optical and photocatalytic performance of blueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers and their corresponding van der Waal heterostructures in three possible stacking patterns, are investigated. BlueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers are indirect bandgap semiconductors. A tensile strain of 8(10)% leads to TiSeO(ZrSeO) monolayers transitioning to a direct bandgap of 1.30(1.61) eV. The calculated binding energy and AIMD simulation show that unstrained(strained) blueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers and their heterostructures are thermodynamically stable. Similar to the corresponding monolayers, blueP-XYO (X = Ti, Zr, Hf: Y = S, Se) vdW heterostructures in three possible stacking patterns are indirect bandgap semiconductors with staggered band alignment, except blueP-TiSeO vdW heterostructure, which signifies straddling band alignment. Absorption spectra show that optical transitions are dominated by excitons for blueP and XYO (X = Ti, Zr, Hf; Y = S, Se) monolayers and the corresponding vdW heterostructures. Both EVB and ECB in TiSO, ZrSO, ZrSeO and HfSO monolayers achieve energetically favorable positions, and therefore, are suitable for water splitting at pH = 0, while TiSeO and HfSeO monolayers showed good response for reduction and fail to oxidise water. All studied vdW heterostructures also show good response to any produced O2, while specific stacking reduces H+ to H2.

Purpose Many cytokines have been implicated in the pathogenesis of psoriasis, among these the transforming growth factor-beta 1 (TGF-β1) can be endorsed by different mechanisms besides inhibiting keratinocytes proliferation. The role of genetic polymorphisms of TGF-β1 has been studied in various inflammatory diseases. Our aim is to study the correlation of TGF-β1 gene polymorphism at codon 10 and 25 with the expression of serum level of TGF-β1 in a sample of Iraqi psoriatic patients compared to the control group. Materials and methods A cross-sectional study involved 100 patients with psoriasis vulgaris and 50 sex- and age-matched healthy volunteers as control group. Serum and genomic DNA were prepared from peripheral blood samples. Amplification refractory mutation system-polymerase chain reaction technique (ARMS-PCR) had been applied for genotyping TGF-β1 codon 10 [rs1982073] and codon 25 [rs1800471] genetic polymorphisms. Enzyme-linked immunosorbent assay technique (ELISA) based on the sandwich principle was used for quantification of serum TGF-β1 level. Psoriasis Area and Severity Index (PASI) scoring was applied for determining the severity in psoriatic patients and classified accordingly to mild (PASI 12) groups. Results Statistically significant difference was found in TGF-β1 gene polymorphism between psoriatic patients and control group at codon 10 (T869C) polymorphism (p=0.021) and codon 25 (G915C) polymorphism (p=0.040). No significant association was detected with the mean serum TGF-β1 level, severity of the disease, disease onset, gender, history of psoriatic arthritis, and smoking in both codons. Significant lower mean serum TGF-β1 level was found among psoriatic group (192.17 ± 531.12 ng/L) compared with controls (565.89 ± 1372.30 ng/L) (p = 0.018). Relation of mean serum TGF-β1 level with the onset of the disease was statistically significant (p = 0.004), early-onset disease group was lower (105.92 ± 68.02 ng/L) compared with the late-onset disease group (450.92 ±1027.79 ng/L). The mean serum TGF-β1 level showed no significant differences with the severity of psoriasis, gender, history of psoriatic arthritis, and smoking. Conclusion Iraqi population showed a significant association between TGF-β1 gene polymorphism at codon 10 and 25 were with psoriasis susceptibility, and a significantly lower mean serum TGF-β1 level was detected in psoriatic patients.

Purpose Donation after circulatory death (DCD) offers an additional source of cardiac allografts, potentially allowing expansion of the donor pool. In this study, we investigated the efficacy of mitochondrial transplantation to improve myocardial function in DCD hearts. Methods Cardiocirculatory death was induced in Yorkshire pigs (40-50 kg, n=22) by cessation of mechanical ventilation. After 20 minutes of warm ischemia, cardioplegia was administered. The hearts were then reperfused on an ex-situ blood perfusion system for 240 minutes. Following 15 minutes of ex-situ perfusion, mitochondria (5 × 109 in respiration buffer, Mitochondria, n=8) or respiration buffer alone (Vehicle, n=8) were delivered as a single bolus to the coronary arteries. A control group (Sham, n=6) was not subjected to warm ischemia. Hearts were perfused in a resting mode for 120 minutes before converting the system to a continuous isovolumic loading mode. Left ventricular (LV) global function, myocardial oxygen consumption, and arterial lactates were compared by two-way repeated-measures analysis of variance (ANOVA) with Bonferroni adjustment. Results At the end of 240 minutes of reperfusion, LV peak developed pressure (LVdevP) and dP/dt max were significantly higher in the Sham group than in Vehicle (p 0.05), which was significantly lower in Vehicle (p=0.004). No differences were found in arterial lactate levels (Figure D) (p> 0.05). Conclusion Mitochondrial transplantation significantly preserves myocardial function and oxygen consumption in DCD hearts, thus providing an additional possible benefit for expanding heart donor pool.

Acute kidney injury is a common clinical disorder and one of the major causes of morbidity and mortality in the postoperative period. In this study, the safety and efficacy of autologous mitochondrial transplantation by intra-arterial injection for renal protection in a swine model of bilateral renal ischemia-reperfusion injury were investigated. Female Yorkshire pigs underwent percutaneous bilateral temporary occlusion of the renal arteries with balloon catheters. Following 60 min of ischemia, the balloon catheters were deflated and animals received either autologous mitochondria suspended in vehicle or vehicle alone, delivered as a single bolus to the renal arteries. The injected mitochondria were rapidly taken up by the kidney and were distributed throughout the tubular epithelium of the cortex and medulla. There were no safety-related issues detected with mitochondrial transplantation. Following 24 h of reperfusion, estimated glomerular filtration rate and urine output were significantly increased while serum creatinine and blood urea nitrogen were significantly decreased in swine that received mitochondria compared with those that received vehicle. Gross anatomy, histopathological analysis, acute tubular necrosis scoring, and transmission electron microscopy showed that the renal cortex of the vehicle-treated group had extensive coagulative necrosis of primarily proximal tubules, while the mitochondrial transplanted kidney showed only patchy mild acute tubular injury. Renal cortex IL-6 expression was significantly increased in vehicle-treated kidneys compared with the kidneys that received mitochondrial transplantation. These results demonstrate that mitochondrial transplantation by intra-arterial injection provides renal protection from ischemia-reperfusion injury, significantly enhancing renal function and reducing renal damage.

Objective: This registry aims to clarify the characteristics and 6-weeks outcomes of patients with STEMI after PPCI in the region. Methods: Data from a total of 151 STEMI patients undergoing PPCI at Duhok heart center, Iraq from 2020 to 2021 was collected. Patient’s demographic, clinical and PPCI profiles were recorded. The major adverse cardiac events (MACE) and left ventricle ejection fraction (LVEF%) outcomes for 6 weeks period was registered. Results: Of the 151 consecutive patients with STEMI who underwent PPCI, 46 (30.4%) were

Background: Dextro transposition of the great arteries (d-TGA) is the most common critical congenital cardiac defect surgically treated in the neonatal period by arterial switch operation (ASO). Major aortopulmonary collaterals (MAPCAs) can be present in this population and may complicate the early postoperative period. Our aim was to review our institutional data and systematically review the available literature to provide further insight on the clinical significance of MAPCAs during the early postoperative course after ASO. Methods: This is a retrospective study of patients with simple d-TGA who underwent ASO between March 1998 and September 2020 at Boston Children's Hospital. The MEDLINE, Embase, and Cochrane databases were searched from inception to June 2020. Results: Of the 671 d-TGA patients who underwent ASO at our center, 13 (1.9%) were diagnosed with MAPCAs. Five were diagnosed before ASO, while eight were diagnosed after ASO. Of these, two patients required catheterization for MAPCAs coiling during the same hospitalization on the 2nd and 11th postoperative days. The systematic review retrieved a total of 34 articles after duplicates were removed. Finally, nine studies reporting on 23 patients were deemed eligible for our analysis. The average time to MAPCAs coiling was 12 days, while the mean hospital stay was 36 days. Conclusions: MAPCAs should be included in the differential diagnosis of ASO complicated by cardiac or respiratory failure, or pulmonary hemorrhage acutely postoperatively. Once managed, recovery of these patients is predictable, and mortality is low. Further studies investigating the diagnostic value of echocardiography and the long-term outcomes of these MAPCAs are necessary.

Severe diaphragm dysfunction can lead to respiratory failure and to the need for permanent mechanical ventilation. Yet permanent tethering to a mechanical ventilator through the mouth or via tracheostomy can hinder a patient's speech, swallowing ability and mobility. Here we show, in a porcine model of varied respiratory insufficiency, that a contractile soft robotic actuator implanted above the diaphragm augments its motion during inspiration. Synchronized actuation of the diaphragm-assist implant with the native respiratory effort increased tidal volumes and maintained ventilation flow rates within the normal range. Robotic implants that intervene at the diaphragm rather than at the upper airway and that augment physiological metrics of ventilation may restore respiratory performance without sacrificing quality of life.

In order to probe the band gap engineering to tune optical properties in YAuPb1-xSix (x = 0, 0.25, 0.50, 0.75 and 1) alloys, we used all electron full-potential linearized augmented plane wave (FP-LAPW+lo) method within the frame work of the density functional theory. The optimized structural parameters were in good agreement with other theoretical and experimental results. The calculated results of elastic constant satisfy the condition for mechanical stability at each composition for cubic symmetry. In addition, the study of elastic parameters are summarized for the calculation bulk modulus, Young’s modulus, shear modulus, Kleinman parameters, Poisson’s ratio and Lame’s co-efficient. To predict the brittle (ductile) nature of this composition, the Cauchy pressure, Poisson’s ratio and B/G ratio were also calculated. Using modified Becke and Johnson GGA, the band gap values of each composition were computed precisely. Further, it was observed that for 0.25 < x < 0.75, band gap structure revealed a direct band gap configuration. In order to analyze the electronic structure of each composition, the total and partial densities of states have been investigated in detail. Furthermore, the investigation of optical parameters in terms of dielectric functions revealed the potential of these alloys for optoelectronic devices.

Aurivillius single-phase Na0.5Bi4La0.5Ti4O15 ceramics was prepared via solid state mixed oxide sintering technique. The ac data in terms of dielectric and impedance were collected to investigate the electrical properties and dielectric relaxation behaviors in the ceramics. The detailed frequency spectrum analysis demonstrates the existence of single dielectric relaxation behavior in the material, which is due to the grains contribution. A phase transition was observed to take place at ~570 °C. Ar-annealing study showed that above ∼280 °C, relaxation and conduction of the ceramics was assigned to the motion of ionized oxygen vacancies. The kinetic analysis was performed to probe the conduction-relaxation mechanisms in the ceramics. The present results could be significant for deep understanding of electrical properties and defect-relaxation behaviors in Na0.5Bi4La0.5Ti4O15 related ceramics.

In this work, we have studied new double perovskite materials, A21+B2+B3+X61−, where A21+ = Cs, B2+ = Li, Na, B3+ = Al, Ga, In, and X61−. We used the all electron full-potential linearized augmented plane wave (FP-LAPW+lo) method within the framework of density functional theory. We used the mBJ approximation and WC-GGA as exchange–correlation functionals. We optimized the lattice constants with WC-GGA. Band structures were calculated with and without spin–orbit coupling (SOC). Further, band structures for Cs2LiGaBr6 and Cs2NaGaBr6 were calculated with SOC + mBJ to correct the band gap values with respect to experimental value. We obtained direct bandgaps at Γ-point of 1.966 eV for Cs2LiGaBr6 and 1.762 eV for Cs2NaGaBr6, which are similar to the parent organic–inorganic perovskite (MAPI) CH3NH3PbI3 (Eg = 1.6 eV). Total and partial density of states were analyzed to understand the orbital contribution of Cs, Na, Li, Ga and Br near the Fermi level. The optical properties in terms of real and imaginary e, refractive index n, extinction coefficient k, optical conduction σ, absorption I, and reflectivity R were calculated. A study of the elastic and mechanical properties shows that both materials are thermodynamically stable. A stable, direct bandgap and a gap value close to those of MAPI make Cs2NaGaBr6 a great competitor in the Pb-free hybrid perovskite solar cells world.

Favorable stacking patterns of two models with alternative orders of chalcogen atoms in SiC-MSSe (M = Mo, W) vdW heterostructures are investigated using density functional theory calculations. Both model-I and model-II of the SiC-MSSe (M = Mo, W) vdW heterostructures show type-II band alignment, while the spin orbit coupling effect causes considerable Rashba spin splitting. Furthermore, the plane-average electrostatic potential is also calculated to investigate the potential drops across the heterostructure and work function. The imaginary part of the dielectric function reveals that the first optical transition is dominated by excitons with high absorption in the visible region for both heterostructures. Appropriate band alignments with standard water redox potentials enable the capability of these heterostructures to dissociate water into H+/H2 and O2/H2O.

OBJECTIVES Among patients with hypoplastic left heart syndrome (HLHS), tricuspid valve regurgitation (TR) portends a poor prognosis. Our goal was to describe the outcomes of tricuspid valve reconstruction (TVR) concomitant with the Norwood operation and using two-dimensional echocardiography and evaluate the structural factors associated with successful functional correction. METHODS We performed a retrospective, single-centre study of patients with HLHS undergoing TVR at the time of the Norwood operation. Structural echocardiographic parameters were compared between patients with successful correction (≤ mild TR) and those with ≥ moderate regurgitation at discharge. Preoperative dimensions of matched HLHS controls with ≤ trivial TR were used as a reference. RESULTS Of 205 patients with HLHS undergoing the Norwood operation, 18 patients had a concomitant TVR. Ten (56%) patients had an improved TR grade postoperatively, 8 (44%) of whom had ≤ mild TR at discharge. Improvement in TR grade (P = 0.001) and having ≤ mild TR at discharge (P = 0.011) were associated with an improved reintervention and TR-free survival. Patients with successful functional correction had smaller preoperative tricuspid annulus lateral dimensions (P = 0.023), tricuspid valve area (P = 0.007) and right ventricle mid-width (P = 0.064). Preoperatively, the successful TVR cases tended to have had higher anterior leaflet excursion (80 ± 20 vs 55 ± 11, P = 0.010), and a higher proportion of anterior leaflet prolapse (63% vs 10%, P = 0.043) compared to cases where TVR was not successful. CONCLUSIONS Patients with HLHS with significant tricuspid regurgitation undergoing the stage 1 operation were more likely to have successful concomitant tricuspid valve repair if they had less tricuspid annular dilation, less-severe RV enlargement and predominantly anterior leaflet prolapse. Successful tricuspid valve repair was associated with improved mid- and long-term outcomes.

Funding Acknowledgements Type of funding sources: None. Introduction Arrhythmias are frequently encountered in adult congenital heart disease (ACHD) and respond poorly to pharmacological therapies. Catheter ablation is challenging due to anatomical variation and complexity of the arrhythmia substrate. High density multi electrode mapping (MEM) with automatic annotation of activation time may aid mapping of arrhythmia, decrease procedure time and improve the accuracy of targeting of ablation therapy. Purpose To compare the acute and long term outcomes and procedural characteristics of catheter ablation in ACHD patients with and without automatic annotation of activation with MEM. Methods Retrospective analysis of the acute and long term outcomes of ACHD patients in a single centre undergoing ablation procedures from 1 Jan 2014 to 18 August 2017 was undertaken. 2 groups were identified. Group 1 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system without the use of automatic signal annotation. Most patients in this group had sequential mapping performed with the ablation catheter (78%), the rest had multi-electrode mapping with the PentaRay 20 pole catheter. Group 2 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system using the automated CONFIDENSE mapping algorithm. Results Group 1: n = 27, mean age 44.6 +/-3 years. Male 46.6%. Group 2: n = 38, mean age 44.0 +/- 1.9 years. Male 56.7%. All patients had CHD of at least moderate complexity. 25% of patients in group 1 and 45% in group 2 were repeat ablations. 45 arrhythmias were induced in group 1 of which 29 were targeted and 74 arrhythmias were induced in group 2 of which 46 were targeted. Acute success rates (after attempts at reinduction) were 96.3% in group 1 and 94.7% in group 2. Recurrences of arrhythmia occurred significantly less in patients in group 2 compared to group 1 (44.7% and 70.4% respectively, p Conclusions The use of multi-electrode mapping with an automatic annotation algorithm was associated with a significantly lower risk of recurrence during the follow up period of this study.

Funding Acknowledgements Type of funding sources: None. Introduction Hydroxychloroquine(HCQ) use alone or in combination with Azithromycin (AZM) in SARS-CoV-2 infection is associated with QTc prolongation and risk of arrhythmias. Objectives To determine changes in QTc interval and factors predictive of extreme QTc prolongation in patients receiving HCQ alone or in azithromycin combination in Pakistani patients. Methodology Retrospective review of records of hospitalized patients with SARS-Cov2 RT-PCR positive result who received HCQ or HCQ/Azithromycin in combination from March-May 2020. Baseline ECGs as well as post drug use ECGs data was recorded. Tisdale score was calculated for predicting risk of QTc prolongation,QTc interval was calculated using Bazett formula. Data entry and analysis was done in SPSS version 23. Results A total of 134 patients were included in the study. 82.1%(110) were males and 17.9%(24) were females, mean age was 54.9 ± 13.7 years. 61.2% (82) had severe disease and 38.8 %(52) had non-severe disease. 14.2%(19) had history of cardiac disease, 35.8%(48) had hypertension and 35.1%(47) had diabetes mellitus. 70.1% (94) patients had received HCQ, AZM, or HCQ/AZM in combination. 40(29.9%) patients had not received any drug. Median baseline QTc among controls and non-control group was 383.5 (IQR 342.25-413.75)msec and 379(IQR 358-402)msec respectively. HCQ alone was administered to 26.9%(36) and HCQ/AZM to 33.6%(45) patients. 55.6% (45/81) developed QTc prolongation(QTc> 480 msec) or delta QTc increase > 60 msec. 6.2%(5/81) had absolute QTc > 500 msec post-drug administration. 55.6%(25/45) and 30.6%(11/36) (p-value 0.024) developed QTc prolongation in combination and HCQ alone groups respectively. Delta QTc increased to >60msec in 42.0% (34/81); 53.3%(24/45) in combination group and in 27.8%(10/36) of those receiving HCQ alone( p-value 0.021). Median delta change was 63( IQR 25-81) and 48.5(IQR 26.25-66.75) msec; Median Day 2 QTc was 413.5 msec (IQR 377.5-436) and 413 msec (IQR361-447); and median maximum QTc was 447(IQR391-471) and 429.8(IQR401.5-45.75) msec in those receiving HCQ/AZM combination and HCQ alone respectively. 9%(12/134) had arrhythmias during hospital stay, in 8.9% (4) and 5.6%(2) patients of those receiving HCQ/AZM combination and HCQ alone respectively, no patient developed torsade de pointes, one patient had non-sustained VT. There was no statistically significant association of QTc prolongation with mortality, acute kidney injury, myocardial injury or severity of disease. Diuretic use was found to be statistically significant association with QTc prolongation(p-value 0.038). There was a weak correlation of baseline QTc with Δ QTc(r = 0.207 and p-value 0.017) Conclusion QTc prolongation was observed in a significant population of patients receiving HCQ and HCQ/AZM combination, however, no significant life threating arrhythmias occurred.

Acute kidney injury (AKI) is associated with higher risk for morbidity and mortality post-operatively. Ischemia-reperfusion injury (IRI) is the most common cause of AKI. To mimic this clinical scenario, this study presents a highly reproducible large animal model of renal IRI in swine using temporary percutaneous bilateral balloon-catheter occlusion of the renal arteries. The renal arteries are occluded for 60 min by introducing the balloon-catheters through the femoral and carotid artery and advancing them into the proximal portion of the arteries. Iodinated contrast is injected in the aorta to assess any opacification of the kidney vessels and confirm the success of the artery occlusion. This is furtherly confirmed by the flattening of the pulse waveform at the tip of the balloon catheters. The balloons are deflated and removed after 60 min of bilateral renal artery occlusion, and the animals are allowed to recover for 24 h. At the end of the study, plasma creatinine and blood urea nitrogen significantly increase, while eGFR and urine output significantly decrease. The need for iodinated contrast is minimal and does not affect renal function. Bilateral renal artery occlusion better mimics the clinical scenario of perioperative renal hypoperfusion, and the percutaneous approach minimizes the impact of the inflammatory response and the risk of infection seen with an open approach, such as a laparotomy. The ability to create and reproduce this clinically relevant swine model eases the clinical translation to humans.

Introduction: Acute kidney injury (AKI) is a common clinical disorder and one of the major causes of morbidity and mortality during the postoperative period. In this study, we investigated the safety and efficacy of autologous mitochondrial transplantation by intra-arterial injection for renal protection in a swine model of bilateral renal ischemia-reperfusion injury (IRI). Methods: Female Yorkshire pigs (n=12) underwent percutaneous bilateral temporary occlusion of the renal arteries with balloon-catheters. Following 60 minutes of ischemia, the balloon catheters were deflated and animals received either autologous mitochondria suspended in vehicle (n=6) or vehicle alone (n=6), delivered as a single bolus to the renal arteries. Results: Injected mitochondria were rapidly taken up by the kidney and were distributed throughout the tubular epithelium of the cortex and the medulla. Evaluation of plasma electrolytes, acid-base status, complete blood count and biochemical analysis did not reveal evidence of any adverse effects associated with mitochondrial transplantation. After 24 hours of reperfusion, eGFR and urine output were significantly increased (p Conclusions: Mitochondrial transplantation by intra-arterial injection provides renal protection from IRI, significantly enhancing renal function and ameliorating AKI.

Introduction Left ventricular thrombus (LVT) formation is a prominent complication of acute myocardial infarction (AMI). Accurate and prompt detection of the condition is important as it poses a high risk for thromboembolic events that can be arrested by systemic anticoagulation. The purpose of our study was to evaluate the frequency of LVT formation in thrombolyzed and non-thrombolyzed patients with AMI to ascertain the current magnitude of the problem in the local population. Methods The study was conducted at the Chaudhry Pervaiz Elahi Institute of Cardiology in Multan, Pakistan. A total of 281 patients of either gender aged between 30-65 years with anterior wall myocardial infarction (AWMI; both thrombolyzed and non-thrombolyzed) were included in the study. Once they were enrolled in the study, all the relevant baseline investigations were performed. A detailed history was taken and examinations were done; serial ECG and echocardiography were performed till discharge from the hospital on the third day of hospitalization to record the final outcome of the study, i.e., LVT formation. Results The mean age of the patients was 55.54 ± 7.26 years. Overall, LVT formation was noted in 65 cases (23.1%), of which 11 (16.9%) were thrombolyzed patients and 54 (83.1.1%) were non-thrombolyzed. A significant association of LVT was noted with age, hypertension, family history, and duration of symptoms. Conclusion We found a high frequency of LVT formation among patients with AWMI who have not undergone thrombolytic therapy. It was observed that LVT was notably associated with advanced age, hypertension, and other comorbidities. Early presentation to the hospital and thrombolysis reduce the risk of developing LVT, which in turn can reduce morbidity and mortality in such patients.

Introduction Non-ST segment elevation myocardial infarction (NSTEMI) is becoming more common than ST segment elevation myocardial infarction (STEMI) and data regarding presence of underlying multivessel coronary artery disease (MVCAD) in these patients is consistent in locoregional population that leads to lethal delays in proper management. Therefore, in the current study, we aimed to evaluate the frequency of MVCAD in NSTEMI with markedly raised troponin T levels. This will help to identify patients that should be labeled as high risk and must be referred for coronary revascularization on priority basis, so that clinical outcomes can be improved in these patients. Methods This cross-sectional research study was carried out at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan over a period of one year. A total of 326 patients with history of chest discomfort within past 48 hours of presentation or angina equivalent symptoms and cardiac troponin T more than 500 ng/l were included in the study. Coronary angiography was done within 72 hours of same hospital admission. The outcome variable i.e. MVCAD was determined. Results Mean age of patients was 50.74 ± 7.75 years with range of 30 to 60 years. MVCAD was found in 107 (32.82%) patients, whilst there was no MVCAD in 219 (67.18%) patients. Moreover, no significant association of MVCAD was noted with age or smoking. Conclusion We found presence of MVCAD in a considerable number of patients presenting with NSTEMI. The key to detect the underlying presence of MVCAD in these patients is lifted troponin T levels. Therefore, we conclude that any patient with elevated troponin T levels, even in the absence of ST segment elevation, should undergo cardiac catheterization to detect presence of MVCAD as this subset of patients can benefit from early revascularization including coronary artery bypass graft (CABG) surgery.

Aurivillius single-phase Bi2.5Nd0.5Nb1.5Fe0.5O9 (BNNF) ceramics was synthesized via solid state mixed oxide sintering method. Electrical properties of the samples were intensely studied in a wide range of temperature (25 °C–650 °C). Dielectric behaviors were investigated by dielectric and impedance spectroscopies in the range (40 Hz−10 MHz) of frequency. Single dielectric relaxation was observed due to the grains contribution. The phase transition temperature (TC) was noticed at ∼270 °C. Kinetic analysis of dielectric data was used to understand the possible relaxation-conduction behaviors in the ceramics. Above ∼250 °C, relaxation and conduction of the ceramics was assigned to the motion of ionized oxygen vacancies. The Aurivillius ceramics has promising industrial applications in dielectric capacitors and piezoelectric transducers due to low leakage below ∼200 °C. The results could be valuable for designing and/or modifying properties of BNNF related materials.

Background Fontan outcomes data from large volume Middle Eastern Centres are lacking. We report our experience after the Fontan operation from a tertiary cardiac centre in Saudi Arabia. Method All 458 consecutive patients who had Fontan surgery 1986 through 2015 at the Prince Sultan Cardiac Centre, Riyadh [PSCC], Saudi Arabia, were evaluated for baseline, early and late post-operative outcomes and their uni and multivariate determinants. Results The mean age at Fontan operation was 7 years [IQR 4.8–9.0]. The most common anatomic diagnoses were tricuspid atresia (104 [23%]) and double-inlet left ventricle (81 [18%]). Only 3 patients in the present series had hypoplastic left heart syndrome [HLHS]. Early mortality [i.e. during Fontan surgical admission] was 3.1%. At late follow-, 35 (8%) patients were lost to follow up. The 1, 5, 10, 20 and 30 year survival was 96%, 94%, 93% and 85%, respectively. In the modern surgical era, 5, 10 and 15 year survival were 96%, 95% and 93% respectively. Univariate determinants of death or transplant were hypoalbuminemia, elevated NtProBNP >500, surgical era prior to 1999, the lack of Fontan fenestration, and prior atriopulmonary Fontan [APF] procedure. On multivariate analysis, surgical era before 1999 and prior APF procedure were independently associated with death or transplant. Conclusions Fontan patients from this large volume Middle Eastern centre have comparable early and late mortality outcomes compared to prior published reports. Rigorous selection criteria at the time of Fontan, and Fontan specific dedicated care teams are likely contributors to this success.

Introduction: The characters of coronary artery disease with its risk factors and coronary angiograms studied elsewhere revealed differences in different populations. We, here, assess the regional characters of coronary artery disease with its major risk factors and coronary angiographic profile in Duhok, Kurdistan region of Iraq. Methods: We conducted this cross sectional study at the Azadi heart center in Duhok, Iraq. A consecutive sampling procedure was used to enroll a total of 300 adult patients with coronary artery disease (145 men and 155 women) who had undergone coronary angiography. Direct interview was used with designed questionnaire to collect demographic, cardiovascular risk factors and angiographic profiles. Results: The mean patient’s age was 55.5 (10.4) years. The most prevalent risk factor was hypertension (55.3%), followed by dyslipidemia (42.7%), type 2 diabetes mellitus (29%), smoking (11%) and ex-smoking (9.3%). Apart from smoking all other risk factors were more frequent in women. Angiographic analysis revealed normal angiograms in (29.3%) versus single vessel disease (23.3%), double vessel disease (14.3%), triple vessel disease (21.3%) and non significant (11.7%). As to the coronary branch involved, the most frequently affected was the left anterior descending artery followed by right coronary artery, left circumflex artery, and left main stem (60.7%, 46.3%, 43.7% and 6% respectively). Conclusion: This study showed that the coronary artery disease tends to occur earlier in our population. Although cardiovascular risk factors were clustered among women, older men showed more aggressive coronary angiographic lesions.

Soft robotic devices have been proposed as an alternative solution for ventricular assistance. Unlike conventional ventricular assist devices (VADs) that pump blood through an artificial lumen, soft robotic VADs (SRVADs) use pneumatic artificial muscles (PAM) to assist native contraction and relaxation of the ventricle. Synchronization of SRVADs is critical to ensure maximized and physiologic cardiac output. We developed a proof-of-concept synchronization algorithm that uses an epicardial electrogram as an input signal and evaluated the approach on adult Yorkshire pigs (n = 2). An SRVAD previously developed by our group was implanted on the right ventricle (RV). We demonstrated an improvement in the synchronization of the SRVAD using an epicardial electrogram signal versus a RV pressure signal of 4 ± 0.5% in heart failure and 3.2 ± 0.5% during actuation for animal 1 and 7.4 ± 0.6% in heart failure and 8.2% ± 0.8% during actuation for animal 2. Results suggest that improved synchronization is translated in greater cardiac output. The pulmonary artery (PA) flow was restored to a 107% and 106% of the healthy baseline during RV electrogram actuation and RV pressure actuation, respectively, in animal 1, and to a 100% and 87% in animal 2. Therefore, the presented system using the RV electrogram signal as a control input has shown to be superior in comparison with the use of the RV pressure signal.

Vertical stacking of two-dimensional materials into layered van der Waals heterostructures has recently been considered as a promising candidate for photocatalytic and optoelectronic devices because it can combine the advantages of the individual 2D materials. Janus transition metal dichalcogenides (JTMDCs) have emerged as an appealing photocatalytic material due to the desirable electronic properties. Hence, in this work, we systematically investigate the geometric features, electronic properties, charge density difference, work function, band alignment and photocatalytic properties of ZnO–JTMDC heterostructures using first-principles calculations. Due to the different kinds of chalcogen atoms on both sides of JTMDC monolayers, two different possible stacking patterns of ZnO–JTMDC heterostructures have been constructed and considered. We find that all these stacking patterns of ZnO–JTMDC heterostructures are dynamically and energetically feasible. Moreover, both ZnO–MoSSe and ZnO–WSSe heterostructures are indirect band gap semiconductors and present type-I and type-II band alignments for model-I and model-II, respectively. The Rashba spin polarization of the ZnO–WSSe heterostructure for model-I is greater than that in the others. Furthermore, valence (conduction) band edge potentials are calculated to understand the photocatalytic behavior of these systems. Energetically favorable band edge positions in ZnO–Janus heterostructures make them suitable for water splitting at zero pH. We found that the ZnO–Janus heterostructures are promising candidates for water splitting with conduction and valence band edges positioned just outside of the redox interval.

Background and objective: Seborrheic dermatitis is chronic skin disease with exacerbation and remission, many topical and systemic therapies were used, including oral antifungal itraconazole, oral isotretinoin efficacy in the treatment of seborrheic dermatitis less studied. This study aimed to compare the efficacy and safety of low dose oral isotretinoin and oral itraconazole in the treatment of patients with seborrheic dermatitis. Methods: A total of 68 patients with seborrheic dermatitis were participating in a randomized, parallel-group study. One group (n = 31) took 200-mg/day oral itraconazole for one week of the first month, followed by 200 mg for the first two days of the next two months. The second group (n = 37) took oral isotretinoin 20 mg twice weekly for three months. Seborrheic dermatitis area severity index and intensity of itching and burning sensation were calculated before, during three months and one month after treatment. Results: Both drugs significantly reduced the severity of seborrheic dermatitis (P

Several studies have been performed internationally to assess the understanding and self-care exercise of people in the direction of sun exposure and sun protection measures, as self-care is an essential pillar of public health. Nevertheless, limited data on these factors are available from the Middle East. The aim of this study was to investigate the students’ awareness of skin aging and sun-protection measures among college students. For this purpose, a cross-sectional questionnaire was specially designed; a random sample of the students in the different college of the University of Sulaimani was selected. Data were collected between January and May 2017. The relationship between the skin cancer awareness and different sociodemographic characteristics was produced by applying multiple logistic regressions. The questionnaires were distributed to 450 college students. A total of 413 questionnaires had been completely responded and covered within the data analysis, with a response rate of 91.7%. 41% of the respondents were females and 61.0% of the participants were aged between 18 and 21 years old. 47% have been privy to the association between sun exposure and skin aging. The respondents had been more likely to be aware of the connection between sun exposure and skin cancer (P < 0.03). The respondents from the third class of undergraduates were more likely to be familiar (P < 0.04). Staying under the shade during the outdoor activity was reported by more than 90% of our participants and is positioned as the most frequently used sun protection method.

Aims: Hepatitis B virus infection is a global health hazard. The virus can be transmitted by both parenteral and non- parenteral methods such as direct contact with mucus membrane. Dental instruments can be the source of infection, therefore this study was conducted to detect HBs Ag in dental instruments used in the different public dental centers and clinics in Duhok governorate. Sampling process was from December 2016 to January 2017. Materials and Methods: A total of 549 samples were collected from five different districts as follow: 238 samples from center of Duhok, 121 samples from Zakho, 87 samples from Amedi, 68 samples from Sumail and 35 samples from Aqre. Four different commonly used dental instruments were chose namely: Scaler tips, curette, sickle and chisele. The samples divided into sterilized and used using capital A letter for sterilized and small a letter for used samples. Results: No HBs Ag was detected in all tested samples both sterilized and non- sterilized samples by ELISA technique. The results of the present study indicated to the proper hygienic precautions implemented in public dental centers and clinics as well as to the effectiveness of anti-HBV vaccine that almost all dentists had been received prior working. Conclusions: Further studies are required to cover private dental instruments as well as dentists and assistant technicians using both ELISA and RT-PCR techniques.

Objectives During mitral valve repair using the foldoplasty technique, correct judgement of the necessary dimensions and orientation of the leaflet fold is a critical but challenging step that can affect the chances of successful repair. In this study, we investigated whether a leaflet plication clip can be used to guide suture foldoplasty for posterior leaflet prolapse of the mitral valve. Methods Complete posterior leaflet prolapse was created in both in vivo and ex vivo pig hearts by severing the chordae supporting the middle scallop. A plication clip was applied to perform leaflet foldoplasty. Sutures were then placed using the clip as a template and the clip was removed. Leaflet width after flail creation, clip application and suture placement was determined in an ex vivo test. In vivo repair and evaluation was then performed in 7 pigs to determine the repair efficacy under normal physiological loading, at 1 and 6 h after recovery from cardiopulmonary bypass. Results Leaflet width after suture placement was comparable to the clip alone (7.0 ± 1.4 vs 9.0 ± 1.6) and both were significantly less than the flail width 15.7± 2.5 mm. In vivo, average coaptation height following repair was restored to 4.7 ± 1.4 mm and 4.2 ± 1.3 mm at 1 and 6 h, respectively, after recovery compared with the baseline height of 5.5 ± 0.9 mm. Mitral regurgitation was reduced from moderate-severe to mild or less, and addition of a De-Vega annuloplasty in the last 3 animals abolished residual leaks to trivial or none. Conclusions Application of the adjustable leaflet plication clip facilitated accurate determination of the correct position, width, height and orientation of the foldoplasty. Any necessary clip repositioning was made prior to the placement of sutures avoiding the need to redo the sutures. This approach could potentially help improve the ease and reproducibility of the foldoplasty repair.

We introduce an implantable intracardiac soft robotic right ventricular ejection device (RVED) for dynamic approximation of the right ventricular (RV) free wall and the interventricular septum (IVS) in synchrony with the cardiac cycle to augment blood ejection in right heart failure (RHF). The RVED is designed for safe and effective intracardiac operation and consists of an anchoring system deployed across the IVS, an RV free wall anchor, and a pneumatic artificial muscle linear actuator that spans the RV chamber between the two anchors. Using a ventricular simulator and a custom controller, we characterized ventricular volume ejection, linear approximation against different loads and the effect of varying device actuation periods on volume ejection. The RVED was then tested in vivo in adult pigs (n = 5). First, we successfully deployed the device into the beating heart under 3D echocardiography guidance (n = 4). Next, we performed a feasibility study to evaluate the device’s ability to augment RV ejection in an experimental model of RHF (n = 1). RVED actuation augmented RV ejection during RHF; while further chronic animal studies will provide details about the efficacy of this support device. These results demonstrate successful design and implementation of the RVED and its deployment into the beating heart. This soft robotic ejection device has potential to serve as a rapidly deployable system for mechanical circulatory assistance in RHF.

Background Right ventricular hypertrophy and failure are major causes of cardiac morbidity and mortality. A key event in the progression to right ventricular hypertrophy and failure is cardiomyocyte apoptosis due to mitochondrial dysfunction. We sought to determine whether localized intramyocardial injection of autologous mitochondria from healthy muscle treats heart failure. Methods Mitochondria transplanted from different sources were initially tested in cultured hypertrophic cardiomyocytes. A right ventricular hypertrophy/right ventricular failure model created through banding of the pulmonary artery in immature piglets was used for treatment with autologous mitochondria (pulmonary artery banded mitochondria injected/treated n = 6) from calf muscle, versus vehicle (pulmonary artery banded vehicle injected/treated n = 6) injected into the right ventricular free-wall, and compared with sham-operated controls (sham, n = 6). Animals were followed for 8 weeks by echocardiography (free-wall thickness, contractility), and dp/dt max was measured concomitantly with cardiomyocyte hypertrophy, fibrosis, and apoptosis at study end point. Results Internalization of mitochondria and adenosine triphosphate levels did not depend on the source of mitochondria. At 4 weeks, banded animals showed right ventricular hypertrophy (sham: 0.28 ± 0.01 cm vs pulmonary artery banding: 0.4 ± 0.02 cm wall thickness; P = .001), which further increased in pulmonary artery banded mitochondria injected/treated but declined in pulmonary artery banded vehicle injected/treated (0.47 ± 0.02 cm vs 0.348 ± 0.03 cm; P = .01). Baseline contractility was not different but was significantly reduced in pulmonary artery banded vehicle injected/treated compared with pulmonary artery banded mitochondria injected/treated and so was dp/dtmax. There was a significant difference in apoptotic cardiomyocyte loss and fibrosis in sham versus hypertrophied hearts with most apoptosis in pulmonary artery banded vehicle injected/treated hearts (sham: 1 ± 0.4 vs calf muscle vs vehicle: 13 ± 1.7; P = .001 and vs pulmonary artery banded mitochondria injected/treated: 8 ± 1.9, P = .01; pulmonary artery banded vehicle injected/treated vs pulmonary artery banded mitochondria injected/treated, P = .05). Conclusions Mitochondrial transplantation allows for prolonged physiologic adaptation of the pressure-loaded right ventricular and preservation of contractility by reducing apoptotic cardiomyocyte loss.

The complex motion of the beating heart is accomplished by the spatial arrangement of contracting cardiomyocytes with varying orientation across the transmural layers, which is difficult to imitate in organic or synthetic models. High-fidelity testing of intracardiac devices requires anthropomorphic, dynamic cardiac models that represent this complex motion while maintaining the intricate anatomical structures inside the heart. In this work, we introduce a biorobotic hybrid heart that preserves organic intracardiac structures and mimics cardiac motion by replicating the cardiac myofiber architecture of the left ventricle. The heart model is composed of organic endocardial tissue from a preserved explanted heart with intact intracardiac structures and an active synthetic myocardium that drives the motion of the heart. Inspired by the helical ventricular myocardial band theory, we used diffusion tensor magnetic resonance imaging and tractography of an unraveled organic myocardial band to guide the design of individual soft robotic actuators in a synthetic myocardial band. The active soft tissue mimic was adhered to the organic endocardial tissue in a helical fashion using a custom-designed adhesive to form a flexible, conformable, and watertight organosynthetic interface. The resulting biorobotic hybrid heart simulates the contractile motion of the native heart, compared with in vivo and in silico heart models. In summary, we demonstrate a unique approach fabricating a biomimetic heart model with faithful representation of cardiac motion and endocardial tissue anatomy. These innovations represent important advances toward the unmet need for a high-fidelity in vitro cardiac simulator for preclinical testing of intracardiac devices.