Short term clinical outcomes and analysis of risk factors for pacemaker implantation: a single center experience of self-expandable TAVI valves.

OBJECTIVES: Transcatheter aortic valve implantation is a recognized treatment for patients with severe aortic stenosis at all risk groups. However, permanent pacemaker rates remain high for self expandable transcatheter valves and permanent pacemaker implantation has been associated with increased morbidity. In this analysis we aim to evaluate short term clinical outcomes post self expandable transcatheter aortic valve implantation and determine risk factors for permanent pacemaker implantation. METHODS: 88 patients with severe aortic stenosis with transcatheter aortic valve implantation performed between the year 2016-2018 were retrospectively analyzed. Outcomes of interest included 1- year all cause mortality, 30-day major adverse cardiovascular events, permanent pacemaker and paravalvular leak rates. Survival analysis was performed with Kaplan Meier analysis and risk factors for survival and permanent pacemaker rates were identified with log rank test and regression analysis. RESULTS: The mean age of the cohort was 80.3 +/- 6.9 years. The mean STS score was 9.25. The 30 day all-cause mortality was 5.7% and 1-year all cause mortality was 16.7%. 80 patients had transfemoral transcatheter aortic valve implantation, and a majority of the patients (85.2%) were implanted with Corevalve Evolut R device. The device success rate was 88.6%. Multivariate analysis identified concomitant severe coronary artery disease (OR = 18.2 +/- 0.9; P = 0.002), pre transcatheter aortic valve implantation atrial fibrillation (OR = 8.6 +/- 0.91; P = 0.02) and post procedural disabling stroke (OR = 32.6 +/- 1.35; P = 0.01) as risk factors for 1-year mortality. The 30-day pacemaker rate was 17.6%. The presence of right bundle branch block (OR 11.1 +/- 0.86; P = 0.005), non-coronary cusp implantation depth (OR = 1.34 +/- 0.15; P = 0.05) and a non coronary cusp implantation depth / membranous septal length ratio of more than 50% were associated with post procedural pacemaker implantation (OR = 29.9 +/- 1.72; P = 0.05). Among the 15 patients with post procedural pacemaker implantation, 40% were found to be non-pacemaker dependent at 1 year. CONCLUSION: Short term outcomes of transcatheter aortic valve implantation in severe aortic stenosis patients are promising. Pacemaker rates remain high. More studies are needed to evaluate the factors that influence pacemaker rates and dependence to further improve transcatheter aortic valve implantation outcomes.

Improving health communication with photographic images that increase identification in three minority populations.

The homophily principle, that perceived similarities among people produce positive reactions, is a cross-cultural, global phenomenon. This study aimed to test the prediction that photographs that depict models similar to the target population improve health communication by increasing perceived identification in three racial/ethnic populations. Three separate nationally representative stratified samples (n = 1638) of African American, Hispanic and Native American adults were drawn from GfK's Knowledge Panel�. Participants read a message advocating increased physical activity and improved diets and completed measures on behavioral intentions, outcome and self-efficacy expectations and identification. The message contained photographs from a stock photograph service or photographs created for the research project to match the three minority populations, Real Health Photos (RHP). Structural equation modeling confirmed the theoretical hypothesis that RHP which matched the minority population increased behavioral intentions and was mediated by identification (P < 0.05) in all three racial/ethnic minority samples. Messages with only half of the matched RHP images had these same positive indirect effects among African Americans and Hispanics (P < 0.05). The impact of matching visual images in health messages to recipients derived from identification with the characters in images. Homophily and identification are hardwired, evolutionary, biological phenomena that should be capitalized on health educators with minority populations.

Injection of sodium chloride, sodium tripolyphosphate, and sodium lactate improves Warner-Bratzler shear and sensory characteristics of pre-cooked inside round roasts.

Paired inside rounds (n=30 pairs) were removed from randomly selected USDA Select quality grade carcasses to examine the effects of injecting a solution of sodium lactate, sodium tripolyphosphate, and sodium chloride on Warner-Bratzler shear force, cooking loss, lipid oxidation, and sensory characteristics of pre-cooked beef. Injected treatments were more tender (P<0.05) than control products, as measured by Warner-Bratzler shear force and consumer sensory panel ratings. Injected treatments had lower (P<0.01) cooking and re-heating loss percentages when compared to control samples. Lipid oxidation in injected treated samples was significantly reduced as compared to control meat samples. Results of lipid oxidation also revealed that 14-day samples were less (P<0.01) than 0-day samples. Results of this experiment have shown that injection of this solution enhanced sensory panel characteristics, and decreased WBS values and cooking loss.

Metabolic complications of total parenteral nutrition: effects of a nutrition support service.

BACKGROUND: The effectiveness of Nutrition Support Services in optimizing parenteral nutrition has not been evaluated since the 1980s. METHODS: We prospectively monitored medical and surgical patients on total parenteral nutrition (TPN) in a university hospital who did not receive Nutrition Support Service recommendations to compare the incidence of metabolic complications in 1979 (group 1, n = 100) with that in 1992 (group 2, n = 106). The Service provided automatic recommendations on a subsequent group of medical service patients (group 3, n = 128) and compared them with the patients in group 2 who were on the medical service (group 2B, n = 29). RESULTS: Statistically significant changes between 1979 and 1992 included a decline in the incidence of hyperglycemia from 47% to 22% and in hypokalemia from 12% to 3% of surgical patients and an increase in hypomagnesemia from 0% to 23% of surgical patients and from 2% to 14% of medical patients. The incidence of hypophosphatemia remained > 20% in both medical and surgical patients. Within 1992, the addition of automatic recommendations had little impact on metabolic abnormalities and was associated with slightly but insignificantly lower TPN costs (not counting Service personnel costs). CONCLUSIONS: Factors such as the general integration of parenteral nutrition into tertiary medical care, standard protocols and order forms, automatic Nutrition Support Service consultations in an affiliated hospital, and nutrition curricula may be responsible for the improvements seen since 1979. However, the addition of automatic Service consultation in 1992 had only a marginal effect on metabolic complications and costs of parenteral nutrition.

Continuous recombinant bacterial fermentations utilizing selective flocculation and recycle.

Selective recycle has successfully been used to maintain an unstable plasmid-bearing bacterial strain as dominant in a continuous reactor, whereas the culture reverts to 100% segregant cells when selective recycle is not used. The plasmid-bearing strain is slower growing and flocculent; however, when the cells lose their plasmid, the resulting segregant cells are nonflocculent and grow at a faster rate due to their decreased metabolic burden. Both types of cells exit a chemostat and enter an inclined settler where the flocculent plasmid-bearing cells are separated from the nonflocculent segregant cells by differential sedimentation. The underflow from the cell separator, which is enriched with plasmid-bearing cells, is recycled back to the chemostat, while the segregant cells are withdrawn off the top of the settler and discarded. The experimental results agree well with selective recycle reactor theory. On the basis of the theory, a criterion is presented that has been shown to successfully predict whether or not a selective recycle reactor can maintain a plasmid-bearing strain.