Fungal Endocarditis: A Rare Cause of Left Ventricular Outflow Obstruction.

A 53-year-old male presented with worsening fever, chest pain, and dyspnea during the past 2 weeks. He was hypoxic, tachycardic, and hypotensive on admission. Labs were notable for high-sensitivity troponin of 657 pg/mL and B-type natriuretic peptide of 1,648 pg/mL. Chest imaging was consistent with acute respiratory distress syndrome. Transthoracic echocardiography revealed an ejection fraction of 30% to 35% and a mobile 1.5 cm x 1.6 cm hyperechoic mass on the ventricular surface of the aortic valve (AV) with left ventricular outflow obstruction and mean pressure gradient of 38.7 mm Hg and maximum velocity of 3.64 m/s. The patient was initiated on empiric antibiotic and antifungal therapy. Cardiothoracic surgery was consulted for urgent AV repair. Blood cultures were positive for Candida metapsilosis, and intravenous fluconazole and micafungin were initiated. Despite aggressive and prompt medical management, the patient sustained cerebral embolic events in the middle cerebral artery territory and passed away.

Update on Overactive Bladder Therapeutic Options.

BACKGROUND: Millions of Americans are burdened by overactive bladder (OAB) syndrome and the psychogenic and economic hardships that accompany it. Several theories attempt to explain OAB as a neurogenic dysfunction, myogenic dysfunction, urothelial dysfunction, or decreased expression of a channel protein secondary to bladder outlet obstruction. Given that the etiology of OAB is a working theory, the management of OAB is also an evolving subject matter in medicine. There are uncertainties surrounding the pathophysiology of OAB, the strength of a clinical diagnosis, and accurate reporting because of the disease's stigma and decreased use of health care. DATA SOURCES: This is a narrative review that used PubMed, Google Scholar, Medline, and ScienceDirect to review literature on current and future OAB therapies. RESULTS: Currently, first-line treatment for OAB is behavioral therapy that uses lifestyle modifications, bladder-control techniques, and psychotherapy. Second-line therapy includes antimuscarinic agents or beta 3 adrenergic agonists, and studies have shown that combination therapy with antimuscarinics and beta 3 adrenergic agonists provides even greater efficacy than monotherapy. Third-line therapies discussed include onabotulinumtoxinA, posterior tibial nerve stimulation, and sacral neuromodulation. OnabotulinumtoxinA has been FDA-approved as a nonpharmaceutical treatment option for refractory OAB with minimal side effects restricted to the urinary tract. Posterior tibial nerve modulation and sacral neuromodulation are successful in treating refractory OAB, but the costs and complication rates make them high-risk procedures. Therefore, surgical intervention should be a last resort. Estrogen therapy is effective in alleviating urinary incontinence in postmenopausal women, consistent with the association between estrogen deficiency and genitourinary syndrome. Potassium channel activators, voltage-gated calcium channel blockers, and phosphodiesterase inhibitors look to be promising options for the future of OAB management. As new therapies are developed, individuals with OAB can better personalize their treatment to maximize their quality of life and cost-effective care.

A theoretical and experimental approach for correlating nanoparticle structure and electrocatalytic activity.

The objective of the research described in this Account is the development of high-throughput computational-based screening methods for discovery of catalyst candidates and subsequent experimental validation using appropriate catalytic nanoparticles. Dendrimer-encapsulated nanoparticles (DENs), which are well-defined 1-2 nm diameter metal nanoparticles, fulfill the role of model electrocatalysts. Effective comparison of theory and experiment requires that the theoretical and experimental models map onto one another perfectly. We use novel synthetic methods, advanced characterization techniques, and density functional theory (DFT) calculations to approach this ideal. For example, well-defined core@shell DENs can be synthesized by electrochemical underpotential deposition (UPD), and the observed deposition potentials can be compared to those calculated by DFT. Theory is also used to learn more about structure than can be determined by analytical characterization alone. For example, density functional theory molecular dynamics (DFT-MD) was used to show that the core@shell configuration of Au@Pt DENs undergoes a surface reconstruction that dramatically affects its electrocatalytic properties. A separate Pd@Pt DENs study also revealed reorganization, in this case a core-shell inversion to a Pt@Pd structure. Understanding these types of structural changes is critical to building correlations between structure and catalytic function. Indeed, the second principal focus of the work described here is correlating structure and catalytic function through the combined use of theory and experiment. For example, the Au@Pt DENs system described earlier is used for the oxygen reduction reaction (ORR) as well as for the electro-oxidation of formic acid. The surface reorganization predicted by theory enhances our understanding of the catalytic measurements. In the case of formic acid oxidation, the deformed nanoparticle structure leads to reduced CO binding energy and therefore improved oxidation activity. The final catalytic study we present is an instance of theory correctly predicting (in advance of the experiments) the structure of an effective DEN electrocatalyst. Specifically, DFT was used to determine the optimal composition of the alloy-core in AuPd@Pt DENs for the ORR. This prediction was subsequently confirmed experimentally. This study highlights the major theme of our research: the progression of using theory to rationalize experimental results to the more advanced goal of using theory to predict catalyst function a priori. We still have a long way to go before theory will be the principal means of catalyst discovery, but this Account begins to shed some light on the path that may lead in that direction.

Probing the Limits of Conventional Extended X-ray Absorption Fine Structure Analysis Using Thiolated Gold Nanoparticles.

We present a method for quantifying the accuracy of extended X-ray absorption fine structure (EXAFS) fitting models. As a test system, we consider the structure of bare Au147 nanoparticles as well as particles bound with thiol ligands, which are used to systematically vary disorder in the atomic structure of the nanoparticles. The accuracy of the fitting model is determined by comparing two distributions of bond lengths: (1) a direct average over a molecular dynamics (MD) trajectory using forces and energies from density functional theory (DFT) and (2) a fit to the theoretical EXAFS spectra generated from that same trajectory. Both harmonic and quasi-harmonic EXAFS fitting models are used to characterize the first-shell Au-Au bond length distribution. The harmonic model is found to significantly underestimate the coordination number, disorder, and bond length. The quasi-harmonic model, which includes the third cumulant of the first-shell bond length distribution, yields accurate bond lengths, but incorrectly predicts a decrease in particle size and little change in the disorder with increasing thiol ligands. A direct analysis of the MD data shows that the particle surfaces become much more disordered with ligand binding, and the high disorder is incorrectly interpreted by the EXAFS fitting models. Our DFT calculations compare well with experimental EXAFS measurements of Au nanoparticles, synthesized using a dendrimer encapsulation technique, showing that systematic errors in EXAFS fitting models apply to nanoparticles 1-2 nm in size. Finally we show that a combination of experimental EXAFS analysis with candidate models from DFT is a promising strategy for a more accurate determination of nanoparticle structures.

Multistep galvanic exchange synthesis yielding fully reduced Pt dendrimer-encapsulated nanoparticles.

Here we outline a new method for synthesizing fully reduced Pt dendrimer-encapsulated nanoparticles (DENs). This is achieved by first synthesizing Cu DENs of the appropriate size through sequential dendrimer loading and reduction steps, and then galvanically exchanging the zerovalent Cu DENs for Pt. The properties of Pt DENs having an average of 55, 140, and 225 atoms prepared by direct chemical reduction and by galvanic exchange are compared. Data obtained by UV-vis spectroscopy, X-ray absorption spectroscopy, X-ray photoelectron spectroscopy, and high-resolution electron microscopy confirm only the presence of fully reduced Pt DENs when synthesized by galvanic exchange, while chemical reduction leads to a mixture of reduced DENs and unreduced precursor. These results are significant because Pt DENs are good models for developing a better understanding of the effects of finite size on catalytic reactions. Until now, however, the results of such studies have been complicated by a heterogeneous mixture of Pt catalysts.

Design of Pt-shell nanoparticles with alloy cores for the oxygen reduction reaction.

We report that the oxygen binding energy of alloy-core@Pt nanoparticles can be linearly tuned by varying the alloy-core composition. Using this tuning mechanism, we are able to predict optimal compositions for different alloy-core@Pt nanoparticles. Subsequent electrochemical measurements of ORR activities of AuPd@Pt dendrimer-encapsulated nanoparticles (DENs) are in a good agreement with the theoretical prediction that the peak of activity is achieved for a 28% Au/72% Pd alloy core supporting a Pt shell. Importantly, these findings represent an unusual case of first-principles theory leading to nearly perfect agreement with experimental results.

Dual-electrode microfluidic cell for characterizing electrocatalysts.

In this paper we introduce a microelectrochemical cell configured for generation-collection experiments and designed primarily for examining the kinetics of electrocatalysts. The heart of the device consists of two, closely spaced, pyrolyzed photoresist microband electrodes enclosed within a microchannel. The cell is suitable for evaluating the efficiency of electrocatalysts under an unprecedented range of conditions. Specifically, compared to the gold-standard rotating ring-disk electrode (RRDE), this device offers four major advantages. First, collection efficiencies of 97% are easily achieved, compared to values of 20-37% that are characteristic of RRDEs. Second, mass transfer coefficients of 0.5 cm s(-1) are accessible for typical redox species, which is significantly higher than RRDEs (up to 0.01 cm s(-1)). Third, we show that the device can operate effectively at temperatures up to 70 °C, which is important for measuring electrochemical kinetics that are relevant to fuel cell catalysts. Finally, much less catalyst and much smaller volumes of electrolyte solution are required to make kinetic measurements using the microelectrochemical device compared to the RRDE. Here, we present the simple procedure used to fabricate the device, fundamental electroanalytical characterization, and electrocatalytic measurements relevant to the oxygen reduction reaction.

Electrochemical synthesis and electrocatalytic properties of Au@Pt dendrimer-encapsulated nanoparticles.

Dendrimer-encapsulated Au nanoparticles comprised of an average of 147 atoms were synthesized and immobilized on a glassy carbon electrode. A one-atom-thick shell of Cu was added to the Au core by electrochemical underpotential deposition, and then this shell was replaced with Pt by galvanic exchange. The results indicate that this synthetic approach leads to well-defined core/shell nanoparticles <2 nm in diameter. The rates of oxygen reduction at the Au@Pt electrocatalysts were compared to Pt-only and Au-only, 147-atom dendrimer-encapsulated nanoparticles.

Social and environmental influences on opioid sensitivity in rats: importance of an opioid's relative efficacy at the mu-receptor.

RATIONALE: Evidence indicates that social and environmental enrichment can influence the functional maturation of the central nervous system and may affect an organism's sensitivity to centrally acting drugs. OBJECTIVE: The purpose of the present study was to examine the effects of social and environmental enrichment on sensitivity to mu-opioids possessing a range of relative efficacies at the mu-receptor. METHODS: Rats were obtained at weaning (21 days) and divided into two groups immediately upon arrival. Isolated rats were housed individually in opaque laboratory cages with no visual or tactile contact with other rats; enriched rats were housed socially in groups of four in large cages and given various novel objects on a daily basis. After 6 weeks under these conditions, the effects of morphine, levorphanol, buprenorphine, butorphanol, and nalbuphine were examined in the warm-water, tail-withdrawal procedure and the place-conditioning procedure. RESULTS: In the tail-withdrawal procedure, isolated and enriched rats did not differ in sensitivity to morphine (1.0-30 mg/kg) and levorphanol (0.3-10 mg/kg), but enriched rats were more sensitive to buprenorphine (0.03-3.0 mg/kg), butorphanol (0.3-30 mg/kg), and nalbuphine (0.3-30 mg/kg). In drug combination tests, butorphanol and nalbuphine antagonized the effects of morphine in isolated rats under conditions in which they produced high levels of antinociception in enriched rats. In the place-conditioning procedure, doses of 10 morphine and 3.0 levorphanol established a place preference in both groups of rats, whereas doses of 0.3 buprenorphine, 3.0 butorphanol, and 10 nalbuphine established a place preference only in enriched rats. CONCLUSIONS: These findings may be taken as evidence that enriched rats are more sensitive than isolated rats to the effects of lower-efficacy mu-opioids and that social and environmental enrichment leads to functional alterations in opioid receptor populations.

Effects of positive allosteric modulators of the GABAB receptor on cocaine self-administration in rats.

RATIONALE: Previous studies have strongly implicated a role for GABA(B) receptors in modulating the reinforcing effects of cocaine. OBJECTIVE: The purpose of the present study was to examine the efficacy of two novel positive allosteric modulators of the GABA(B) receptor, CGP7930 and GS39783, to decrease cocaine self-administration in rats responding under various schedules of reinforcement. METHODS: Rats were trained to self-administer cocaine under progressive ratio (PR), fixed ratio (FR) and discrete trials (DT) schedules of reinforcement, and the ability of CGP7930 and GS39783 to decrease cocaine-maintained responding was examined. RESULTS: On a PR schedule, CGP7930 markedly decreased break points maintained by 1.5 mg/kg per injection cocaine in a dose-dependent manner. GS39783 produced only modest decreases in cocaine-reinforced break points, with only the highest dose decreasing break points relative to baseline. On an FR1 schedule of reinforcement, both drugs decreased responding for a threshold dose of cocaine, but did not alter responding for higher doses of cocaine. In a DT procedure, 1.5 mg/kg per injection cocaine was made available during three 10-min trials each hour during 24-h sessions (DT3), engendering a circadian pattern of responding characterized by high numbers of infusions during the dark phase and low numbers of infusions during the light phase. Doses of 30 mg/kg CGP7930, 3.0 mg/kg GS39783 and 2.5 mg/kg baclofen significantly decreased cocaine-maintained responding when administered at the beginning of the dark phase of the cycle. Across all schedules, CGP7930 was more effective at decreasing cocaine self-administration than GS39783, a finding that may be due to differences in bioavailability between the two drugs. CONCLUSIONS: These findings suggest that positive allosteric modulators of the GABA(B) receptor may hold promise as potential pharmacotherapies for cocaine abuse and dependence.

Sensitivity to the effects of opioids in rats with free access to exercise wheels: mu-opioid tolerance and physical dependence.

RATIONALE: Exercise stimulates the release of endogenous opioid peptides and increases nociceptive (i.e. pain) thresholds in both human and animal subjects. During chronic, long-term exercise, sensitivity to the effects of morphine and other mu opioids decreases, leading some investigators to propose that exercise may lead to the development of cross tolerance to exogenously administered opioid agonists. OBJECTIVE: The purpose of the present investigation was to examine the effects of chronic exercise on sensitivity to mu opioids, and to determine whether these effects can be attributed to the development of opioid tolerance and dependence. METHODS: Rats were obtained at weaning and housed singly in standard polycarbonate cages (sedentary) or modified cages equipped with exercise wheels (exercise). After 6 weeks under these conditions, opioids possessing a range of relative efficacy at the mu receptor (morphine, levorphanol, buprenorphine, butorphanol, nalbuphine) were examined in a warm-water tail-withdrawal procedure. RESULTS: Morphine, levorphanol and buprenorphine produced maximal levels of antinociception in both groups of rats, but all were more potent in sedentary rats than in exercising rats. Butorphanol and nalbuphine produced maximal levels of antinociception in sedentary rats under some conditions in which they failed to produce antinociception in exercising rats. Sensitivity to the effects of buprenorphine was decreased in sedentary rats that were transferred to cages equipped with exercise wheels, and increased in exercising rats that were transferred to sedentary housing conditions. In the latter group, exercise output prior to housing reassignment was positively correlated with increases in sensitivity to buprenorphine following housing reassignment. Naloxone administration precipitated a mild withdrawal syndrome in exercising rats that was not readily apparent in sedentary rats. CONCLUSIONS: These data suggest that chronic exercise leads to the development of mu-opioid tolerance and physical dependence, and that these effects are similar to those produced by chronic opioid administration.