Adult Congenital Heart Disease Transplantation: Does Univentricle Physiology Impact Early Mortality?

BACKGROUND: With congenital heart disease patients increasingly living into adulthood, there is a growing population of adult congenital heart disease (ACHD) patients suffering from heart failure. Limited data exist evaluating heart transplant in this population. METHODS: Retrospective review was performed of ACHD patients undergoing heart transplantation 11/1990-1/2023. Kaplan-Meier, cumulative incidence accounting for competing risk of death, and subgroup analyses comparing those with biventricular (BiV) and univentricular (UniV) physiology were performed. Data are presented as median (interquartile range) or counts (%). RESULTS: 77 patients with a median age of 36 years (27, 45) were identified, including 57 (74%) BiV and 20 (26%) UniV. Preoperatively, UniV patients were more likely to have cirrhosis (9/20 [45.0%] vs 4/57 [7.0%], p<0.001) and protein losing enteropathy (4/20 [20.0%] vs 1/57 [1.8%], p=0.015). Multiorgan transplantation was performed in 23 patients (30%) and more frequently in UniV patients (10 [50%] vs. 13[23%], p=0.04). Operative mortality was 6.5%, 2/20 (10%) among UniV and 2/57 (4%) among BiV patients, p=0.276. Median clinical follow-up was 6.0 (1.4, 13.1) years. Survival tended to be lower among UniV patients compared to BiV patients, particularly within the first year (p=0.09), but was similar for survivors beyond one year. At 5 years, incidence of rejection was 28% (17%, 38%) and coronary allograft vasculopathy was 16% (7%, 24%). CONCLUSIONS: Underlying liver disease and need for heart/liver transplantation were significantly higher among UniV patients. Survival tended to be lower among UniV, particularly within the first year, but was similar for survivors beyond one year.

Nylon fiber waste as a prominent adsorbent for Congo red dye removal.

In this research nylon fibers wastes (NF) were fabricated into porous sheet using a phase inversion technique to be utilized as an adsorbent materials for Congo red dye (CR). The fabricated sheet denoted as NS was characterized using FTIR and XRD. The surface studies of the adsorbent materials using SEM and BET analysis reveals a highly pores structure with an average pore volume 0.61 cc/g and BET surface area of 767 m2/g. The adsorption studies of fabricated NS were employed into CR at different parameters as pH, effect of time and dye concentration. The adsorption isotherm and kinetic studies were more fit to Langmuir and pseudo second order models. The maximum adsorption capacity qmax reached 188 mg/g with removal percentage of 95 for CR concentration of 400 mg/L at pH 6 and 0.025 g NS dose for 10 ml CR solution. The regeneration study reveals a prominent adsorption behavior of NS with removal % of 88.6 for CR (300 mg/L) after four adsorption desorption cycles. Effect of incorporation of NaonFil Clay to NS was studied using Response Surface Methodology (RSM) modeling and reveals that 98.4% removal of CR could be achieved by using 19.35% wt. of fiber with 8.2 g/L dose and zero clay, thus at a predetermined parameters studies of NanoFil clay embedded into NS, there are no significant effect for %R for CR.

How the COVID-19 Pandemic Contributed to Diagnostic Bias.

Diagnosis bias in the medical field is a recognized entity that can contribute to misdiagnoses and incorrect management. It remains a constant challenge that must be recognized and addressed. Several factors play a role in the formation of preconceptions which influence the physicians' decision-making process. The aim of this paper is to present a case that was misdiagnosed and mistakenly managed due to diagnosis bias during the coronavirus disease 2019 (COVID-19) pandemic. We also suggest two ways to reduce the risk of diagnosis bias. Multi-inflammatory syndrome of children (MIS-C) was described during the COVID-19 pandemic. The rise in the incidence of MIS-C masked the diagnosis of other diseases that present in a similar fashion. In this paper, we describe the case of a seven-year-old girl, who presented in 2020, with acute onset respiratory distress. Her chest images were suggestive of COVID-19 pneumonitis which prompted the physicians to complete the MIS-C workup by performing an echocardiogram. A large aneurysm of the left main artery was seen which led to a preliminary diagnosis of MIS-C. A repeat echocardiography, 48 hours after the initiation of MIS-C treatment, was suggestive of a large coronary fistula complicated by infective endocarditis and multiple septic pulmonary emboli. It can be inferred that the misdiagnosis occurred as a result of availability and premature-closure biases. Efforts to decrease such biases include group decision-making and using checklists during the assessment of a patient.

Trends in Cardiovascular Disease Mortality by County-Level Social Vulnerability Index in the United States.

Background Although cardiovascular mortality (CVM) rates in the United States have been declining overall, our study evaluated whether this holds true for areas with increased social deprivation. Methods and Results We used county-level cross-sectional age-adjusted CVM rates (aa-CVM) (2000-2019) linked to the Centers for Disease Control and Prevention Social Vulnerability Index (SVI-2010). We grouped counties as per SVI (Groups I 0-0.2, II 0.21-0.4, III 0.41-0.6, IV 0.61-0.8, and V 0.81-1) and calculated the relative change in the aa-CVM between 2000 to 2003 and 2016 to 2019. We used adjusted linear regression analyses to explore the association between a higher SVI and temporal aa-CVM improvement; we studied this temporal change in aa-CVM across subgroups of race, sex, and location. The median aa-CVM rate (per 100 000) was 272.6 (interquartile range [IQR]: 237.5-311.7). The aa-CVM was higher in men (315.6 [IQR: 273.4-363.9]) than women (221.3 [IQR: 189.6-256.7]), and in Black residents (347.2 [IQR: 301.1-391.1]; P<0.001) than White residents (258.9 [IQR: 226-299.1]; P<0.001). The aa-CVM for SVI I (233.6 [IQR: 214.8-257.0]) was significantly lower than that of group V (323.6 [IQR: 277.2-359.2]; P<0.001). The relative reduction in CVM was significantly higher for SVI group I (32.2% [IQR: 24.2-38.4]) than group V (27.2% [IQR: 19-34.1]) counties. After multivariable adjustment, a higher SVI index was associated with lower relative improvement in the age-adjusted CVM (model coefficient -3.11 [95% CI, -5.66 to -1.22]; P<0.001). Conclusions Socially deprived counties in the United States had higher aa-CVM rates, and the improvement in aa-CVM over the past 20 years was lower in these counties.

Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

PURPOSE: We aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome. MATERIALS AND METHODS: We retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients' demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more. RESULTS: The urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively. CONCLUSIONS: Unfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

The Impact of Bacteriospermia on Semen Parameters Among Infertile Egyptian Men: A Case-Control Study.

This study aimed to detect the impact of bacteriospermia on semen parameters and sperm DNA fragmentation. This prospective case-control study was conducted over a period of 9 months. Samples were collected from andrology outpatient clinic attendants of Cairo University Hospitals. We enrolled 68 semen samples divided into two groups: a study group (34 semen samples with bacteriospermia) and a control group (34 semen samples without bacteriospermia). The characteristics of the semen, including morphology, motility, count, liquefaction, viscosity, pH, volume, and appearance, were evaluated according to the standard protocols. Patients with and without bacteriospermia had a comparable liquefaction time (p = .343), semen appearance and color (p = 1.00), semen pH (p = 1.00), velocity (p = .163), and total sperm count (p = .451). Patients with bacteriospermia were associated with lower progressive motility (p = .001), nonprogressive motility (p = .032), total motility (p = .001), and normal forms (p = .001). The prevalence of abnormal semen analysis was 64.71% in the study group compared with 35.29% in the control group. Staphylococcus aureus (67.6%) and Escherichia coli (14.7%) were the most commonly detected organisms. Samples from which Methicilin-resistant Staphylococcus aureus was isolated showed significant abnormalities in both progressive motility and normal morphology of sperm. Bacteriospermia has deteriorative effects on sperm quality parameters, such as semen volume, sperm motility, and sperm normal morphology.

The presentation and outcomes of penile fracture with associated urethral injury: A systematic literature review.

PURPOSES: Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to address the current literature concerning the etiology, presentations, intra-operative findings, site of injury, and complications of PF with associated urethral injury, Materials and Methods: The present systematic review was limited to human-based studies published in English language, and reporting clinical data on PF cases with associated urethral injuries. A comprehensive search of the literature was conducted on five electronic databases from their inception to May 2022: Medline via PubMed, Web of Science, Google Scholar, Scopus, and EBSCO host. RESULTS: A total of 15 studies were included encompassing 1671 patients with PF. Out of 1665 patients with PF retrieved from the case series studies, 65 patients had associated urethral injuries giving a point prevalence of 3.9%. The vast majority of the patients had blood on the meatus and hematuria suggestive of urethral injury (57/59; 96.6%). Forty patients had partial urethral disruption and the rest of the patients had a complete rupture. All patients received primary urethroplasty as the main modality of treatment. The median hospital stay was two days and the median duration of transurethral catheterization was 21 days. Five patients (8.5%) developed urethral stricture; other complications included penile curvature (6.7%), palpable fibrosis (6.7%), and erectile dysfunction (3.4%). CONCLUSIONS: Urethral injuries are uncommon, but serious findings, in patients with PF. Primary urethroplasty appears to achieve satisfactory outcomes with a low incidence of short and long-term complications.

Spectrum and classification of megameatus anomalies.

OBJECTIVE: To define and classify megameatus anomalies, the parameters of a considerable number of cases were investigated and compared with those of normal children. METHODS: A total of 1150 normal babies were examined during routine nonmedical circumcision, and another 750 boys referred with hypospadias were examined during the previous 3 years. All patients were evaluated and assessed for the size, location, and configuration of the urinary meatus, and penile length and girth were measured. Children with normal size and location of the meatus were considered control group A, and 42 cases of different forms of megameatus were considered group B. Other penoscrotal, urinary, and general anomalies were examined and investigated accordingly. All data were analyzed by the SPSS 9.0.1 statistical package and compared by paired t tests. RESULTS: Forty-two uncircumcised patients aged from 1 month to 4 years (mean 18 months) were diagnosed with a urinary meatus that engrossed the whole ventral or dorsal aspects of the glans, exceeding half the width of the glans or penile girth with the complete vanishing of the glans closure in most cases. Megameatus is usually associated with the abnormal meatal position as hypospadiac, orthotopic, or epispadic. Additionally, megameatus may be associated with a normally intact or deficient prepuce. Consequently, we had four categories of megameatus, and the intact prepuce orthotopic megameatus subcategory has not been described before. Megameatus was also detected with deficient prepuce, and this was considered a hypospadiac variant. CONCLUSION: Megameatus is diagnosed precisely with penile biometry and is classified into 4 groups: hypospadiac, epispadic, and orthotopic or central, either with or without intact prepuce. This classification is applicable for expansion to other centers.

Intraoperative hydrodissection and Doppler ultrasound during magnified varicocelectomy: A comparative study.

METHODS: We performed a non-randomized comparative trial that recruited infertile men with varicocele who were scheduled to undergo MSV. Eligible patients were allocated by the investigators in a 1:1 ratio to receive intraoperative Doppler (group I) or intraoperative Doppler plus hydrodissection (group II). RESULTS: Sixty men were included in each group. The two study groups showed a comparable number of ligated veins on the right (4.22 ±1.57 versus 4.42 ± 1.65; p = 0.49) and left side (6.77 ± 2.14 versus 6.98 ± 2.29; p = 0.59). On the contrary, group II showed a significantly higher number of preserved arteries on the right (2.42 ± 0.56 versus 1.47 ±0.5 in group I) and left side (2.6 ± 0.53 versus 1.63 ± 0.55 in group I), with p-value < 0.001. The sperm motility was significantly higher in group II than in group I (21.25 ± 13.73 versus 13.85 ± 12.25, respectively; p = 0.002). In both groups, the sperm motility increased significantly at the end of follow-up compared to the preoperative period. The postoperative sperm mortality remained significantly higher in group II than in group I (p = 0.008). CONCLUSIONS: Intraoperative Doppler plus hydrodissection (D+IH-MSV) has advantages in preserving more arteries and enhancing the motility of sperms. Based on these findings, we strongly recommend D+IH-MSV when treating infertile men with varicocele.

Semen Parameters Changes in Adolescents With Clinical Varicocele after Magnified Subinguinal Varicocelectomy: A Prospective Controlled Study.

BACKGROUND: Previously, we highlighted the benefits of magnified subinguinal varicocelectomy over conservative treatment on the semen of a small group of adolescents with varicoceles. In this report, we presented changes of semen parameters of 47 adolescents who underwent magnified subinguinal varicocelectomy (MSV) and followed-up for 6 months. METHODS: The present prospective controlled study was conducted on 47 adolescents with varicocele who underwent MSV and were followed up for 6 months. In addition, age and sex-matched patients were added as control group. The primary outcome of this study was to assess the postoperative change in semen analysis parameters. RESULTS: A significant increase in sperm volume from 2.5 (1.9-3) to 3.2 (2.6-4) mL at the end of the sixth month of follow-up. Likewise, the sperm count increased from 10.8 (3.51-21.6) to 20.3 (9.6-35) million. Notably, the percentage of rapid and slow sperms increased significantly from a median of 5% (0%-10%) and 15% (10 -20%) to a median of 10% (5%-15%) and 17.5% (15%-25%), respectively. The percentage of sperm with progressive movement increased from 35% (30%-40%) to 59% (45%-69%). The vitality of the sperms increased significantly as well. While the percentage of sperms with abnormal morphology decreased significantly at the end of follow-up. CONCLUSION: Our findings support the safety and efficacy of MSV in patients with clinically detectable varicocele. MSV has improved the semen parameters of the included patients, including sperm motility, volume, count, and total progressive motility, which may positively impact their fertility potential.

Nano-Restoration for Sustaining Soil Fertility: A Pictorial and Diagrammatic Review Article.

Soil is a real treasure that humans cannot live without. Therefore, it is very important to sustain and conserve soils to guarantee food, fiber, fuel, and other human necessities. Healthy or high-quality soils that include adequate fertility, diverse ecosystems, and good physical properties are important to allow soil to produce healthy food in support of human health. When a soil suffers from degradation, the soil's productivity decreases. Soil restoration refers to the reversal of degradational processes. This study is a pictorial review on the nano-restoration of soil to return its fertility. Restoring soil fertility for zero hunger and restoration of degraded soils are also discussed. Sustainable production of nanoparticles using plants and microbes is part of the process of soil nano-restoration. The nexus of nanoparticle-plant-microbe (NPM) is a crucial issue for soil fertility. This nexus itself has several internal interactions or relationships, which control the bioavailability of nutrients, agrochemicals, or pollutants for cultivated plants. The NPM nexus is also controlled by many factors that are related to soil fertility and its restoration. This is the first photographic review on nano-restoration to return and sustain soil fertility. However, several additional open questions need to be answered and will be discussed in this work.

Cementitious Grouts for Semi-Flexible Pavement Surfaces-A Review.

The hybrid type of pavement called semi-flexible or grouted macadam has gained popularity over the last few decades in various countries, as it provides significant advantages over both rigid and conventional flexible pavements. The semi-flexible pavement surface consists of an open-graded asphalt mixture with high percentage voids into which flowable cementitious slurry is allowed to penetrate due to gravitational effect. Several researchers have conducted laboratory, as well as field, experiments on evaluating the performance of semi-flexible layers using different compositions of cementitious grouts. The composition of grouts (i.e., water/cement ratio, superplasticizer, polymers, admixtures, and other supplementary materials) has a significant effect on the performance of grouts and semi-flexible mixtures. A comprehensive review of cementitious grouts and their effect on the performance of semi-flexible layers are presented and summarized in this review study. The effect of byproducts and other admixtures/additives on the mechanical properties of grouts are also discussed. Finally, recommendations on the composition of cementitious grouts have been suggested.

Buccal versus skin graft for two-stage repair of complex hypospadias: an Egyptian center experience.

BACKGROUND: Urethral reconstruction in complex hypospadias poses a significant challenge. We report our 10-year experience with buccal mucosa graft (BMG) in the two-stage repair of complex hypospadias and compare its results to the skin graft. METHODS: We retrieved the data of 15 patients with complex hypospadias who underwent two-stage repair using the BMG at our institution. The data were compared to 13 patients who underwent skin graft during the same period. RESULTS: The median follow-up duration was 14 (12-17) months in the BMG group and 16 (13.5-22.5) months in the skin graft group. Patients in the BMG had a numerically lower incidence of the diverticulum, wound dehiscence, fistula, and infection than the skin graft group, however, without statistically significant difference (p > 0.05). On the other hand, the incidence of meatal stenosis and urethral stricture was significantly lower in the BMG group (0% each) compared to the skin graft group (30.8% each; p = 0.02). At the same time, there were no reported cases of graft contracture. The frequency of donor site morbidity was significantly higher in the skin graft group compared to the BMG group (p = 0.003). The BMG led to a lower incidence of postoperative straining than the skin graft (0% vs. 38.5%, p = 0.03). Only one patient needed revision surgery after skin graft, compared to no case in the BMG (p = 0.27). CONCLUSION: The present study demonstrates the feasibility and durable outcomes of the BMG in the setting of two-stage repair of complex hypospadias.

Preoperative anxiety after face-to-face patient assessment versus preanaesthesia telemedicine (PANTEM) in adults: a randomised clinical trial.

Preanaesthesia consultation is performed to assess and optimise patient-specific risk factors before surgery, to inform patients about anaesthesia techniques and to obtain consent. Aside from face-to-face visits, telephone consultation is increasingly being used clinically. Concentration on the content and avoidance of confounding factors could lead to improved patient preparation. We hypothesised that patients receiving a telemedical intervention have less anxiety. Patients scheduled for elective surgery were randomised into two groups according to the consultation performed face-to-face (FTF) or via telephone (TEL). Before consultation (< 48 h) and 1-2 h prior to surgery, both groups had to fill in the State-Trait Anxiety Inventory (STAI). A total of 271 patients were randomised and 130 were analysed. There were no significant intergroup differences in mean state anxiety (STAI-S) before and after the intervention. Patients' positive feedback on telemedical consultation urges future studies on its effect on satisfaction and quality of life.

FOLFIRI plus ramucirumab versus paclitaxel plus ramucirumab as second-line therapy for patients with advanced or metastatic gastroesophageal adenocarcinoma with or without prior docetaxel - results from the phase II RAMIRIS Study of the German Gastric Cancer Study Group at AIO.

BACKGROUND: Ramucirumab and paclitaxel is the standard second-line therapy in patients with metastatic gastroesophageal adenocarcinoma. We report the efficacy and safety analyses of FOLFIRI and ramucirumab versus paclitaxel and ramucirumab after the failure of a platinum- and fluoropyrimidine-containing chemotherapy. METHODS: This multicenter, investigator initiated, phase II trial randomised patients with gastroesophageal adenocarcinoma to either FOLFIRI plus ramucirumab (RAM) (arm A) or paclitaxel plus RAM (arm B). The primary end-point was 6-month overall survival (OS) rate, with a proportion of ≥65% in arm A considered a positive signal for further investigation. RESULTS: 111 patients (65% of patients had prior docetaxel) were enrolled and 110 patients qualified for ITT population (arm A, 72; arm B, 38). The study did not meet the primary end-point for the comparison with historical control, as 6-month OS rate in the FOLFIRI plus RAM arm was 54% (95% CI 44-67). In between arm comparison, OS was similar (hazard ratio, HR 0.97 [95% CI 0.62-1.52]), while objective response rates (ORRs) and PFS were numerically better in arm A versus arm B (HR for PFS 0.73; ORR, 22% versus 11%). These differences were largely attributed to favourable efficacy results for arm A in docetaxel-pretreated patients (HR, 0.49; ORR, 25% versus 8%). In the safety population (n = 106), grade 3-5 adverse events were similar between arms (arm A, 75%; arm B, 68%). CONCLUSION: The RAMIRIS trial demonstrated feasibility of FOLFIRI plus RAM. While the study was formally negative, it provided a signal to further investigate this combination for the group of patients with previous docetaxel therapy. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03081143.

Revascularization in ischaemic heart failure with preserved ejection fraction: a nationwide cohort study.

AIMS: Despite the common occurrence of coronary artery disease (CAD) and heart failure (HF) with preserved ejection fraction (HFpEF), there is limited evidence to guide revascularization. METHODS AND RESULTS: We investigated the long-term outcomes of coronary artery bypass grafting (CABG) in patients with HF and significant CAD across the spectrum of ejection fraction, using a large national cohort of patients from the Veteran Affairs (VA) Medical Centers in the US. Patients with HF were stratified into groups, HFpEF, HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF) and compared to patients with no preoperative HF. We analysed 10 396 patients. Despite an increased hazard in the first year following revascularization, the long-term survival (median follow-up 6.6 years; interquartile range 3.7-10.1) of HFpEF post-CABG was similar to controls (hazard ratio 0.85, 95% confidence interval 0.68-1.06), but survival progressively declined with HFmrEF and HFrEF. Similar trends were seen with recurrent HF hospitalization with lower risk with baseline HFpEF (43.9 ± 6.9/100 patient-years) compared to HFmrEF (65.9 ± 3.8/100 patient-years) and HFrEF (93.4 ± 4.8/100 patient-years). Although HFpEF patients had lower mortality and HF hospitalization post-CABG compared to patients with a lower ejection fraction, they experienced the highest rates of future myocardial infarction. CONCLUSION: Although HFpEF patients with CAD have greater short-term risk post-CABG, their long-term survival is comparable to controls. However, they are at increased risk for HF hospitalizations and myocardial infarction. These data support the safety of CABG in HFpEF patients and suggest continuum of mortality risk for ischaemic HF when stratified by baseline ejection fraction before revascularization.

Rapid sequence evolution is associated with genetic incompatibilities in the plastid Clp complex.

KEY MESSAGE: Replacing the native clpP1 gene in the Nicotiana plastid genome with homologs from different donor species showed that the extent of genetic incompatibilities depended on the rate of sequence evolution. The plastid caseinolytic protease (Clp) complex plays essential roles in maintaining protein homeostasis and comprises both plastid-encoded and nuclear-encoded subunits. Despite the Clp complex being retained across green plants with highly conserved protein sequences in most species, examples of extremely accelerated amino acid substitution rates have been identified in numerous angiosperms. The causes of these accelerations have been the subject of extensive speculation but still remain unclear. To distinguish among prevailing hypotheses and begin to understand the functional consequences of rapid sequence divergence in Clp subunits, we used plastome transformation to replace the native clpP1 gene in tobacco (Nicotiana tabacum) with counterparts from another angiosperm genus (Silene) that exhibits a wide range in rates of Clp protein sequence evolution. We found that antibiotic-mediated selection could drive a transgenic clpP1 replacement from a slowly evolving donor species (S. latifolia) to homoplasmy but that clpP1 copies from Silene species with accelerated evolutionary rates remained heteroplasmic, meaning that they could not functionally replace the essential tobacco clpP1 gene. These results suggest that observed cases of rapid Clp sequence evolution are a source of epistatic incompatibilities that must be ameliorated by coevolutionary responses between plastid and nuclear subunits.