No abstract

Approximately 1 in 5 patients admitted to the hospital with aortic stenosis have life-threatening complications due to their disorder. More than half of such patients are actively monitored for aortic stenosis before admission, exposing shortcomings of the watchful waiting management strategy. Measures to identify symptomatic patients earlier and shorten the time between symptom onset and surgery have the potential to substantially reduce morbidity and mortality.

The association between serum calcium and subsequent mortality from aortic stenosis is of potential preventive significance. If confirmed quantitatively in other similar cohort studies, the results suggest that a very small reduction in serum calcium (about 5%) could translate into a large (about one-third) reduction in aortic stenosis.

No abstract

In this study, nano-cerium dioxide doped titanium-dioxide (CeO2-TiO2) Nanocomposites (NCs) was used for the photocatalytic degradation of pollutant parameters (color, polyphenols, polyaromatics) from a textile industry wastewater (TI ww) treatment plant located in Izmir, Turkey, at different operational conditions such as at increasing photocatalytic time (0, 10, 15, 20, 30, 60, 90 and 120 min), at different CeO2-TiO2 mass ratios (1%, 3%, 5%, 10%, 15%, 16%, 25%, 30%, 50%), at the different amounts of CeO2 (1, 3, 5, 8, 10, 15, 20 and 25 mg/L) under 130 W Ultraviolet (UV) and 35 W sun lights irradiations, respectively. Color, polyphenols (quercetin, fisetin, ellargic acid, carminic acid, luteolin, and curcumin) and polyaromatics [2,6-dimethylaniline (2,6-DMA), 2-aminoanisole (MOA), 2,4-toluenediamine (TDA), 2-naphthylamine (NA), 4,40-thiobisbenzenamine (TOA), 3,3-dichlorobenzidine (DCB) and 3,30-dimethoxybenzidine (DMOB)] removal efficiencies were observed between 78% and 99% during photocatalytic experiments, under 130 W UV light, at 15% CeO2-TiO2 NCs, at 21°C, after 30 min irradiation time. 15% CeO2-TiO2 NCs shows the highest photodegradation yield of color under both UV and visible-light irradiation, with maximum photo-degradation rates of 99% and 98.5%, respectively, after 30 min irradiation time. 94.44% maximum Microtox acute toxicity yield was found in CeO2-TiO2 NCs = 20 mg/L, at 5% CeO2 mass ratio, after 150 min photodegradation time at 60oC. 90% maximum Daphnia magna acute toxicity removal was obtained in CeO2-TiO2 NCs = 20 mg/L, at 5% CeO2 mass ratio, after 150 min photodegradation time at 60°C. The results show that the CeO2-TiO2 NCs has a high photocatalytic activity to remove the pollutants from TI ww.

A novel LDL-receptor gene variant was found responsible for previously undetected familial hypercholesterolaemia and acute myocardial infarction in a young man.

Heart failure (HF) affects an estimated 90 000 people within the UK. As a consequence of ventricular remodelling, mitral regurgitation (MR) is common in patients with HF, further contributing to poor prognosis, frequent hospitalisation, and higher rates of mortality. Conventional treatment options include medical therapy, cardiac resynchronisation and conventional mitral valve surgery, with transcatheter mitral valve repair (TMVR) reserved for symptomatic patients with left ventricular dysfunction and multiple comorbidities, considered high surgical risk. Aim Our objectives were to determine: (1) the proportion of patients with an acute HF admission, ejection fraction (EF) of <50% and moderate or more MR; (2) the effectiveness of optimal medical therapy (OMT) in reducing the severity of MR and symptoms; (3) the number of patients with moderate or more MR, EF <50% and symptoms despite OMT. Method We performed a retrospective analysis of patients who presented with acute HF to two large tertiary centres over a five-year period. Based on a combination of electronic care records, and national registry and mortality data, we determined baseline symptoms, symptom progression, and co-morbidities. Echocardiography data was used to assess the degree of MR and EF. Where patients underwent a subsequent echocardiogram on OMT, the change in the degree of MR, EF and symptoms (NYHA class) was examined. Results Over a five-year period (Jan 2012–Dec 2017), 1884 patients presented with acute HF. Of this cohort, 302 (16%) had moderate or more MR and EF of <50%. Mortality amongst patients with moderate or more MR was 29.9% at one year (compared to 26.9% for those with less than moderate MR, p=0.058). Of this cohort, 45% had sufficient clinical and echocardiographic paired follow up data to enable assessment of the effects of OMT (Age 78±20.78; Male n=76 (56.3%). This analysis showed, despite OMT, all 135 patients still had moderate or more MR. When compared with previous echocardiography data, 11 (8%) patients showed a reduction in the severity of MR which meant 92% (124) of patient with MR either saw no improvement or worsening of their MR severity. Of those with severe MR, 23% (7) demonstrated an improvement in the degree of MR following OMT. Clinically 70 (51.4%) patients had an improvement in symptoms. There was significant improvement in the NYHA class pre and post optimisation of medical therapy (p<0.001) across all grades of MR. Despite OMT, 124 (92%) patients with moderate or more MR and EF <50% remained symptomatic. Conclusions A large portion of patients who present with acute HF have moderate or more MR. Although medical therapy is effective in providing some relief from symptoms, the large majority of patients continue to have moderate or more MR. We propose a portion of these patients are potential candidates for TMVR, and should be considered for further intervention. Funding Acknowledgement Type of funding source: None

There was a fall in PCr/ATP ratio on GTN, while flux through creatine kinase (indicating rate of generation of ATP from Phosphocreatine) rose and the first order rate constant of the creatine kinase enzyme (CKkf , the rate limiting step in this process) rose by over 50%. Conclusions The rise in CKkf and CK flux confirm the increased energy demand of the vasoplegic state. What is novel here is that we show a fall in PCr/ATP ratio: as ATP concentrations in the cell are strictly maintained, this suggests phosphocreatine pool depletion occurs when preload is lost and cardiac output is maintained by an increase in inotropy and chronotropy.Progressive energetic depletion during high demand may give rise to contractile dysfunction over time as the heart is unable to keep up with increased requirements for ATP, which could be a mechanism of cardiac dysfunction during vasoplegia. We hypothesize this could be a contributing factor explaining cardiac dysfunction in sepsis and other conditions of distributive shock.