Artificial Intelligence, Computational Simulations, and Extended Reality in Cardiovascular Interventions.

Artificial intelligence, computational simulations, and extended reality, among other 21st century computational technologies, are changing the health care system. To collectively highlight the most recent advances and benefits of artificial intelligence, computational simulations, and extended reality in cardiovascular therapies, we coined the abbreviation AISER. The review particularly focuses on the following applications of AISER: 1) preprocedural planning and clinical decision making; 2) virtual clinical trials, and cardiovascular device research, development, and regulatory approval; and 3) education and training of interventional health care professionals and medical technology innovators. We also discuss the obstacles and constraints associated with the application of AISER technologies, as well as the proposed solutions. Interventional health care professionals, computer scientists, biomedical engineers, experts in bioinformatics and visualization, the device industry, ethics committees, and regulatory agencies are expected to streamline the use of AISER technologies in cardiovascular interventions and medicine in general.

Canine eosinophilic pulmonary granulomatosis: case report and literature review.

We describe and illustrate herein a case of eosinophilic pulmonary granulomatosis (EPG) in a 16-mo-old, castrated male, Great Pyrenees crossbred dog. EPG appears to differ from eosinophilic pneumonias and eosinophilic bronchopneumopathy in dogs by the presence of nodules and masses in the lungs composed of eosinophils, macrophages, and various combinations of lymphocytes, plasma cells, neutrophils, and mast cells within fibrous tissue. Specific information from this dog was added to the information from the limited number of other dogs diagnosed with EPG reported in the veterinary literature, and the information analyzed. EPG appears to have no breed or sex predilection and tends to be a disease of younger dogs, often ≤ 3 y of age. Antemortem imaging of nodules and masses in the lungs, combined with cytologic evidence of eosinophils in the lesions, is highly suggestive of EPG, and the diagnosis can be confirmed postmortem. Concurrent eosinophilia and basophilia can be features of EPG, but their diagnostic value requires further investigation, as does the possible causal association with Dirofilaria immitis infection.

The influence of indigestible protein on broiler digestive tract morphology and caecal protein fermentation metabolites.

Indigestible dietary protein fermentation products have been suggested to negatively influence broiler performance due to their impact on health and digestive tract morphology. This study evaluated the digestive tract morphology and caecal protein fermentation metabolites of broiler fed 3 dietary protein levels (24%, 26% and 28%) with low or high indigestible protein (LIP, HIP). Two completely randomized 3 × 2 factorial trials were conducted with protein level (PL) and indigestible protein (IDP) as the main factors. In both trials, birds received six diets (24-LIP, 24-HIP, 26-LIP, 26-HIP, 28-LIP and 28 HIP) formulated with no medication. On day 5, trial 1 birds were vaccinated with Coccivac-B52, while trial 2 received no vaccine. Tissue and caecal samples were collected and caecal contents analysed for fermentation metabolites. Differences were considered significant when p ≤ .05. The LIP treatment caecal content in trial 1 at 14 days had greater histamine, agmatine and cadaverine levels, while HIP diets resulted in increased serotonin, tryptamine and spermidine. Histamine, serotonin and tryptamine at day 28 were not affected by IDP, and ammonia was not affected by treatments at day 14 or day 28. At day 14, HIP birds had lower total short-chain fatty acids, higher caecal pH and heavier pancreas, proventriculus, gizzard, jejunum and ileum weights. The same effects of IDP found in trial 1 were observed for histamine, agmatine, cadaverine, serotonin, tryptamine and spermidine at day 21 in trial 2. Trial 2 had a PL-by-IDP interaction influencing tyramine, spermidine (28-LIP > 24-LIP) and spermine with values increasing with PL for LIP diets and remaining constant for HIP diets. An interaction between PL and IDP was found for ammonia level and was similar to interactions for biogenic amines. In conclusion, dietary PL and IDP influence broiler caecal protein fermentation metabolites and those effects varied with coccidiosis vaccination and rearing environment.

Assessing the effect of rate and extent of starch digestion on laying hen performance.

The inclusion of starch with a lower rate and extent of digestion has proven to be beneficial in broiler production. However, less is known about its effect on laying hen performance. Therefore, 6 diets were formulated to produce differing ratios (0:100, 20:80, 40:60, 60:40, 80:20, and 100:0) of semi-purified wheat starch (rapidly digested) and pea starch (PS; slowly digested). Each diet was fed to 120 conventionally caged Lohmann LSL lite hens in groups of 12, from 27 to 46 wk of age, and its effects on performance and feather covering were assessed. Data were analyzed by regression analysis, and the significance level was chosen at P ≤ 0.05. Hen-day egg production (HDP) was high (97.05%) and unaffected by PS concentration for 0 to 10 wk of the trial, followed by a quadratic-shaped HDP, with an estimated maximum at 67% PS concentration, for the 10 to 20 wk period of the trial. Overall (0 to 20 wk), HDP increased linearly with PS. No effect on egg weight was found (average weight = 59.6±2.1 g), but eggshells were thickest at the 55% PS concentration. Body weight gain was affected by PS concentration and maximized at 49% PS. Body weight uniformity and mortality were not affected by dietary treatment. Feed intake increased linearly with PS from 102 to 109 g/hen/d, while feed: egg mass ratio was minimal at 26% PS. Using a scale from 1 to 4 per body part (neck, wings, back, vent and breast), only neck feather cover increased linearly with PS, from 3.0 (0% PS) to 3.2/4 (100% PS). However, back and total feather coverage showed a trend (P = 0.054 and P = 0.079 respectively) to increase linearly with PS as well (from 3.7 to 3.9/4 and 15.6 to 16.6/20, respectively). In summary, feeding PS at low to intermediate concentrations improved laying hen performance. Further research should focus on the mechanisms involved in this effect.

Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.

AIMS: Patients undergoing transcatheter aortic valve replacement (TAVR) possess a higher risk of recurrent healthcare resource utilisation due to multiple comorbidities, frailty, and advanced age. We sought to devise a simple tool to identify TAVR patients at increased risk of 30-day readmission. METHODS AND RESULTS: We used the Nationwide Readmissions Database from January 2013 to September 2015. Complex survey methods and hierarchical regression in R were implemented to create a prediction tool to determine probability of 30-day readmission. Boot-strapped internal validation and cross-validation were performed to assess model accuracy. External validation was performed using a single-centre data set. Of 39,305 patients who underwent endovascular TAVR, 6,380 (16.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: chronic kidney disease, end-stage renal disease on dialysis (ESRD), anaemia, chronic lung disease, chronic liver disease, atrial fibrillation, length of stay, acute kidney injury, and discharge disposition. ESRD (OR 2.11, 95% CI: 1.7-2.63), length of stay ≥5 days (OR 1.64, 95% CI: 1.50-1.79), and short-term hospital discharge disposition (OR 1.81, 95% CI: 1.2-2.7) were the strongest predictors. The c-statistic of the prediction model was 0.63. The c-statistic in the external validation cohort was 0.69. On internal calibration, the tool was extremely accurate in predicting readmissions up to 25%. CONCLUSIONS: A simple and easy-to-use risk prediction tool utilising standard clinical parameters identifies TAVR patients at increased risk of 30-day readmission. The tool may consequently inform hospital discharge planning, optimise transitions of care, and reduce resource utilisation.

Effect of rate and extent of starch digestion on broiler chicken performance.

Dietary starch with lower rate and extent of digestion improves broiler feed efficiency, but previous results might have been confounded by non-starch components of the grains. Therefore, the objective of this research was to study the effects of starch digestion on broilers using semi-purified starch. Semi-purified wheat (WS, rapidly digested) and pea (PS, slowly digested) starch were combined to create 6 WS:PS ratios (100:0, 80:20, 60:40, 40:60, 20:80, and 0:100) in starter, grower and finisher diets. Each treatment was fed to Ross 308 male (2,124) and female (2,376) broilers housed in 72 L floor pens from 0 to 31 d of age to measure performance and meat yield relative to live weight. On day 33, the effects of diet on 8 h feed withdrawal was assessed in 20 males per treatment. Data were analyzed with ANOVA and linear and quadratic regression analyses using SAS 9.4. Significance was accepted at P ≤ 0.050. Body weight gain declined linearly with increasing PS. Male feed intake decreased with increasing PS, but PS did not affect female feed intake. Mortality corrected gain:feed ratio was quadratically influenced by diet (estimated maximum at 25% PS). Breast meat increased linearly with PS, while fat pad and breast and thigh skin decreased linearly. Quadratic responses were found for thigh meat and whole drum (estimated maximum values at 56 and 54% PS, respectively). Males grew faster, ate more, and had higher mortality than females. They also had heavier pectoralis major, thigh bone, and whole drum, while females had heavier pectoralis minor and more breast and thigh skin. After feed withdrawal, digesta content decreased linearly with time in all sections, except for the crop and duodenum, which declined quadratically. Ileal digesta pH increased linearly with time, while crop and caecal pH decreased for 2 h before steadily increasing. Diet did not affect digestive tract emptying or digesta pH. In conclusion, dietary PS maximized feed efficiency at 25% PS and linearly improved breast meat yield, but did not affect digesta clearance after feed withdrawal.

Effect of protein sources on performance characteristics of turkeys in the first three weeks of life.

The effect of nutrition during the early life of turkey poults has a long-lasting impact on bird performance. This study assessed the digestibility of 5 high protein feed ingredients (soybean meal [SBM], corn gluten meal [CGM], canola protein concentrate [CPC], fish meal [FM], and porcine meal [PCM]) in broiler chickens, as well as their use in turkey pre-starter diets fed to 21 d of age. The first experiment (5 × 2 factorial arrangement) determined nitrogen corrected apparent metabolizable energy (AMEn) and apparent ileal amino acid digestibility (AIAAD) of each ingredient in broiler chickens at 5 and 21 d of age, using 6 replications of 30 and 8 chicks, respectively. In the second experiment (completely randomized design), 4 replication pens, containing 23 d-old poults, were randomly assigned to one of 5 dietary treatments. The diets were formulated based on the AMEn and AIAAD values derived in the first experiment, and consisted of a high SBM control diet, and 4 additional diets with either CPC, FM, PCM or CGM replacing 25% of the protein supplied by SBM in the control diet. Statistical analysis was completed using Proc Mixed in SAS 9.3. Planned contrasts were used to compare treatments in the second experiment. Trends were identified at P < 0.10 and significant differences identified at P ≤ 0.05. Bird age did not affect CPC, FM, CGM, and SBM AMEn, but the PCM value at d 5 was higher than that at d 21. Apparent ileal amino acid digestibility increased with age for most amino acids (AA), but the response was AA and protein source dependent. The largest average increase in AIAAD between 5 and 21 d of age was observed for CGM. Inclusion of CPC, FM, PCM, or CGM increased body weight up to 14 d, in comparison to poults fed the SBM diet, but feed efficiency and water consumption were not affected. Terminal ileum digesta moisture values were higher for birds fed SBM when compared to those fed PCM. These results demonstrate that combining SBM with CPC, FM, PCM, or CGM improves poult performance during the first 14 d of life in comparison to feeding SBM alone.

Development of an in vitro protein digestibility assay mimicking the chicken digestive tract.

It is difficult to obtain in vivo digestion kinetics data of high protein ingredients using chickens. Collecting kinetics data requires repeated sampling of digesta from the small intestine during the digestion process, which is not easily accomplished due to the anatomical structure of chicken digestive tract. An in vitro technique is proposed for measuring the digestion kinetics of protein sources fed to chickens. The method has a 30 min gastric and 3 h intestinal phase. Five hundred milligram crude protein (CP) equivalent of each meal sample (CP = % N × 6.25) was digested with pepsin (28,260 units) in 50 mL polyethylene centrifuge tubes for 30 min in a shaking water bath (150 strokes/min; 30 mm stroke length) at 41 °C. The 6.5 mL pancreatin was selected as the enzyme concentration for the intestinal phase, during which time 500 µL aliquots were collected at 0, 15, 30, 45, 60, 90, 120, 150, 180 and 240 min. Samples were diluted 1:820 with HCl and sodium acetate buffer, and then mixed with ninhydrin reagent (2:1) at 100 ± 2 °C for 15 min and spectrometric readings taken at 568 nm. To validate the assay, 5 replications of soybean meal (SBM), corn gluten meal (CGM), corn distillers dried grains with solubles (CDDGS), porcine meal (PCM), fish meal (FM) and casein (CA) were digested. The digestion data were modeled with PROC NLIN procedure, and the intra coefficient of variation (CV) assessed using PROC MEANS of SAS 9.4. The digestion values at 180 min were SBM 95 ± 4, FM 93 ± 3, PCM 68 ± 4, CGM 82 ± 3 and CDDGS 70 ± 2. Intra CV for SBM, CGM, CDDGS, PCM and FM were 5%, 5%, 12%, 10% and 2%, respectively. The estimated fractional digestion rates for SBM, CGM, CDDGS, FM and PCM were 0.023, 0.013, 0.009, 0.024 and 0.013, respectively. In conclusion, the proposed in vitro technique estimated the rate and extent of the digestion of CP for the meals with low intra CV.

Valvular Heart Disease in Patients ≥80 Years of Age.

In the United States, the octogenarian population is projected to triple by 2050. With this aging population, the prevalence of valvular heart disease (VHD) is on the rise. The etiology, approach to treatment, and expected outcomes of VHD are different in the elderly compared with younger patients. Both stenotic and regurgitant lesions are associated with unfavorable outcomes if left untreated. Surgical mortality remains high due to multiple co-morbidities, and long-term survival benefit is dependent on many variables including valvular pathology. Quality of life is an important consideration in treatment decisions in this age group. Increasingly, octogenarian patients are receiving transcatheter therapies, with transcatheter aortic valve replacement having the greatest momentum. Numerous transcatheter devices for management of other valve lesions are currently in early clinical trials. This review will describe the epidemiology, etiology, diagnosis, and therapeutic options for VHD in the oldest old, with a focus on transcatheter technologies.

Comparison of drug-eluting and bare metal stents in large coronary arteries: findings from the NHLBI dynamic registry.

OBJECTIVES: This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels. BACKGROUND: Randomized trials have demonstrated that DES reduce the risk of target vessel revascularization (TVR) compared to BMS. This benefit is less pronounced as artery diameter increases. Whether DES are superior to BMS for larger coronary arteries in the setting of routine clinical practice is unknown. METHODS: We analyzed data from 869 patients undergoing de novo lesion PCI with reference vessel diameter greater than or equal to 3.5 mm in the NHLBI Dynamic Registry according to whether they were treated with DES or BMS. Patients were followed for 3 years for the occurrence of cardiovascular events. RESULTS: At 3-year follow-up, rates of TVR at 3 years were similar and low in both groups (4.4% vs. 3.7%, P = 0.62). After adjustment for differences in baseline characteristics, the adjusted hazard ratio for 3-year MI for DES was 1.85 (95% CI 0.93-3.7, P = 0.08), for TVR at 3 years 1.14 (95% CI 0.52-2.49, P = 0.75) and for mortality 0.89 (95%CI 0.49-1.62, P = 0.71). CONCLUSIONS: In our study of the unrestricted use of DES for patients with lesions in larger diameter coronary arteries, first generation DES did not reduce 3-year risk of TVR. Our findings do not support the preferred use of DES over BMS for patients with lesions located in arteries >3.5 mm. It is unknown whether secondary generation DES can offer better outcome compared to BMS in large coronary vessels. Further study on this issue is warranted.