Early and Long-Term Results of Simultaneous and Staged Revascularization of Coronary and Carotid Arteries.

BACKGROUND: Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus on the optimal choice of surgical treatment tactics for patients with significant stenoses in both carotid and coronary arteries. The aim of the current study was to compare the 30-day and long-term outcomes of coronary and carotid artery revascularization surgery based on the simultaneous or staged surgical tactics. MATERIAL AND METHODS: This single-center retrospective study involved 192 patients with concurrent coronary artery disease and carotid artery stenosis ≥ 70%, of whom 106 patients underwent simultaneous intervention (CABG + CEA) and 86 patients underwent staged CABG/CEA. The mean time between stages ranged from 1 to 4 months (mean 1.88 ± 0.9 months). The endpoints included death from any cause, non-fatal stroke, non-fatal myocardial infarction (MI), and major adverse cardiovascular events (MACEs) (death + non-fatal MI + non-fatal stroke) within 30 days after the last intervention and in the long-term follow-up period (median follow-up-6 years). RESULTS: The 30-day all-cause mortality, incidence of postoperative non-fatal MI, non-fatal stroke, and MACEs did not exhibit differences between the groups after single-stage and staged interventions. However, the overall risk of postoperative complications (adjusted for the risk of any complication per patient) (OR 2.214, 95% CI 1.048-4.674, p = 0.035), as well as the duration of ventilatory support (p = 0.004), was elevated in the group after simultaneous interventions compared with the staged intervention group. This difference did not result in an increased incidence of death and MACEs in the group after simultaneous interventions. In the long-term follow-up period, there were no significant differences observed when comparing simultaneous or staged surgical tactics in terms of overall survival (54.9% and 62.6% in Groups 1 and 2, respectively, P log-rank = 0.068), non-fatal stroke-free survival (45.6% and 33.6% in Groups 1 and 2, respectively, P log-rank = 0.364), non-fatal MI-survival (57.6% and 73.5% in Groups 1 and 2, respectively, P log-rank = 0.169), and MACE-free survival (7.1% and 30.2% in Groups 1 and 2, respectively, P log-rank = 0.060). The risk factors associated with an unfavorable outcome included age, smoking, BMI, LV EF, and atherosclerosis of the lower extremity arteries. CONCLUSIONS: This study revealed no significant difference in the impact of simultaneous CABG + CEA or staged CABG/CEA on the incidence of death, stroke, MI, and MACEs over a 30-day and long-term follow-up period. Although the immediate results indicated an increased risk of a complicated course (attributable to overall complications) and more prolonged ventilation after simultaneous CABG + CEA compared with staged CABG/CEA, this did not lead to an increase in fatal complications. Therefore, the implementation of either tactic is considered eligible and appropriate following a thorough operative risk assessment.

Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis.

AIM OF THE STUDY: The aim of this study was to perform a comparative analysis of severity of discordant aortic stenosis (AS) assessment using multiposition scanning and the standard apical window. MATERIALS AND METHODS: All patients (n = 104) underwent preoperative transthoracic echocardiography (TTE) and were ranked according to the degree of AS severity. The reproducibility feasibility of the right parasternal window (RPW) was 75.0% (n = 78). The mean age of the patients was 64 years, and 40 (51.3%) were female. In 25 cases, low gradients were identified from the apical window not corresponding to the visual structural changes in the aortic valve, or disagreement between the velocity and calculated parameters was detected. Patients were divided into two groups: concordant AS (n = 56; 71.8%) and discordant AS (n = 22; 28.2%). Three individuals were excluded from the discordant AS group due to the presence of moderate stenosis. RESULTS: Based on the comparative analysis of transvalvular flow velocities obtained from multiposition scanning, the concordance group showed agreement between the velocity and calculated parameters. We observed an increase in the mean transvalvular pressure gradient (ΔPmean) and peak aortic jet velocity (Vmax), ΔPmean in 95.5% of patients, velocity time integral of transvalvular flow (VTI AV) in 90.9% of patients, and a decrease in aortic valve area (AVA) and indexed AVA in 90.9% of patients after applying RPW in all patients with discordant AS. The use of RPW allowed the reclassification of AS severity from discordant to concordant high-gradient AS in 88% of low-gradient AS cases. CONCLUSION: Underestimation of flow velocity and overestimation of AVA using the apical window may lead to misclassification of AS. The use of RPW helps to match the degree of AS severity with the velocity characteristics and reduce the number of low-gradient AS cases.

Photonic Dirac cavities with spatially varying mass term.

In recent years, photonics has proven itself as an excellent platform for emulation of relativistic phenomena. Here, we show an example of relativistic-like trapping in photonic system that realizes Dirac-like dispersion with spatially inhomogeneous mass term. The modes trapped by such cavities, their energy levels, and corresponding orbitals are then characterized through optical imaging in real and momentum space. The fabricated cavities host a hierarchy of photonic modes with distinct radiation profiles directly analogous to various atomic orbitals endowed with unique characteristics, such as pseudo-particle-hall symmetry and spin degeneracy, and they carry topological charge which gives rise to radiative profiles with angular momentum. We demonstrate that these modes can be directionally excited by pseudo-spin-polarized boundary states. In addition to the fundamental interest in the structure of these pseudo-relativistic orbitals, the proposed system offers a route for designing new types of nanophotonic devices, spin-full resonators and topological light sources compatible with integrated photonics platforms.

Transthoracic Echocardiography-Based Prediction Model of Adverse Event Risk in Patients with COVID-19.

Cardiopulmonary disorders cause a significant increase in the risk of adverse events in patients with COVID-19. Therefore, the development of new diagnostic and treatment methods for comorbid disorders in COVID-19 patients is one of the main public health challenges. The aim of the study was to analyze patient survival and to develop a predictive model of survival in adults with COVID-19 infection based on transthoracic echocardiography (TTE) parameters. We conducted a prospective, single-center, temporary hospital-based study of 110 patients with moderate to severe COVID-19. All patients underwent TTE evaluation. The predictors of mortality we identified in univariate and multivariable models and the predictive performance of the model were assessed using receiver operating characteristic (ROC) analysis and area under the curve (AUC). The predictive model included three factors: right ventricle (RV)/left ventricle (LV) area (odds ratio (OR) = 1.048 per 1/100 increase, p = 0.03), systolic pulmonary artery pressure (sPAP) (OR = 1.209 per 1 mm Hg increase, p < 0.001), and right ventricle free wall longitudinal strain (RV FW LS) (OR = 0.873 per 1% increase, p = 0.036). The AUC-ROC of the obtained model was 0.925 ± 0.031 (95% confidence interval (95% CI): 0.863−0.986). The sensitivity (Se) and specificity (Sp) measures of the models at the cut-off point of 0.129 were 93.8% and 81.9%, respectively. A binary logistic regression method resulted in the development of a prognostic model of mortality in patients with moderate and severe COVID-19 based on TTE data. It may also have additional implications for early risk stratification and clinical decision making in patients with COVID-19.

Enhanced Nonlinear Light Generation in Oligomers of Silicon Nanoparticles under Vector Beam Illumination.

All-dielectric nanoparticle oligomers have recently emerged as promising candidates for nonlinear optical applications. Their highly resonant collective modes, however, are difficult to access by linearly polarized beams due to symmetry restraints. In this paper, we propose a new way to increase the efficiency of nonlinear processes in all-dielectric oligomers by tightly focused azimuthally polarized cylindrical vector beam illumination. We demonstrate two orders enhancement of the third-harmonic generation signal, governed by a collective optical mode represented by out-of-plane magnetic dipoles. Crucially, the collective mode is characterized by strong electromagnetic field localization in the bulk of the nonlinear material. For comparison, we measure third-harmonic generation in the same oligomer pumped with linearly and radially polarized fundamental beams, which both show significantly lower harmonic output. We also provide numerical analysis to describe and characterize the observed effect. Our findings open a new route to enhance and modulate the third-harmonic generation efficiency of Mie-resonant isolated nanostructures by tailoring the polarization of the pump beam.

Forward and Backward Switching of Nonlinear Unidirectional Emission from GaAs Nanoantennas.

High-index III-V semiconductor nanoantennas have gained great attention for enhanced nonlinear light-matter interactions, in the past few years. However, the complexity of nonlinear emission profiles imposes severe constraints on practical applications, such as in optical communications and integrated optoelectronic devices. These complexities include the lack of unidirectional nonlinear emission and the severe challenges in switching between forward and backward emissions, due to the structure of the susceptibility tensor of the III-V nanoantennas. Here, we propose a solution to both issues via engineering the nonlinear tensor of the nanoantennas. The special nonlinear tensorial properties of zinc-blende material can be used to engineer the nonlinear characteristics via growing the nanoantennas along different crystalline orientations. Based on the nonlinear multipolar effect, we have designed and fabricated (110)-grown GaAs nanoantennas, with engineered tensorial properties, embedded in a transparent low-index material. Our technique provides an approach not only for unidirectional second-harmonic generation (SHG) forward or backward emission but also for switching from one to another. Importantly, switching the SHG emission directionality is obtained only by rotating the polarization of the incident light, without the need for physical variation of the antennas or the environment. This characteristic is an advantage, as compared to other nonlinear nanoantennas, including (100)- and (111)-grown III-V counterparts or silicon and germanium nanoantennas. Indeed, (110)-GaAs nanoantennas allow for engineering the nonlinear nanophotonic systems including nonlinear "Huygens metasurfaces" and offer exciting opportunities for various nonlinear nanophotonics technologies, such as nanoscale light routing and light sources, as well as multifunctional flat optical elements.

Tailoring Second-Harmonic Emission from (111)-GaAs Nanoantennas.

Second-harmonic generation (SHG) in resonant dielectric Mie-scattering nanoparticles has been hailed as a powerful platform for nonlinear light sources. While bulk-SHG is suppressed in elemental semiconductors, for example, silicon and germanium due to their centrosymmetry, the group of zincblende III-V compound semiconductors, especially (100)-grown AlGaAs and GaAs, have recently been presented as promising alternatives. However, major obstacles to push the technology toward practical applications are the limited control over directionality of the SH emission and especially zero forward/backward radiation, resulting from the peculiar nature of the second-order nonlinear susceptibility of this otherwise highly promising group of semiconductors. Furthermore, the generated SH signal for (100)-GaAs nanoparticles depends strongly on the polarization of the pump. In this work, we provide both theoretically and experimentally a solution to these problems by presenting the first SHG nanoantennas made from (111)-GaAs embedded in a low index material. These nanoantennas show superior forward directionality compared to their (100)-counterparts. Most importantly, based on the special symmetry of the crystalline structure, it is possible to manipulate the SHG radiation pattern of the nanoantennas by changing the pump polarization without affecting the linear properties and the total nonlinear conversion efficiency, hence paving the way for efficient and flexible nonlinear beam-shaping devices.