Hg Mean Research Articles

Incident Left Ventricular Hypertrophy in Masked Hypertension.

In the PAMELA study (Pressioni Arteriose Monitorate e Loro Associazioni), clinical variables, an echocardiogram, as well as office and ambulatory blood pressure (ABP) were simultaneously measured at baseline and after a 10-year follow-up. The study design allowed us to assess the value of masked hypertension (MH) as a predictor of new-onset left ventricular hypertrophy (LVH). The present analysis included 803 participants without LVH at baseline (left ventricular mass index <115 g/m2 in men and <100 g/m2 in women). Based on office and 24-hour mean ABP values, subjects were divided into 3 groups: normal subjects (normotensive, office blood pressure [BP] <140/90 mm Hg and 24-hour mean ABP <130/80 mm Hg), MH (office BP, normal, and 24-hour mean ABP, elevated), and sustained hypertension (office and 24-hour BP, both elevated). At entry, 57 of 803 subjects fulfilled diagnostic criteria for MH (7.1%); 182 participants developed LVH (22.6%). Compared with subjects with normal in-office and out-of-office BP, the risk of new-onset LVH was greater in MH (odds ratio, 2.22; CI, 1.11-4.46, P=0.0250) after adjustment for potential confounders. This was also the case for the absolute increase of left ventricular mass index. Our study provides a new piece of evidence that MH, identified by office and ABP values, is associated with an increased risk of new-onset LVH. Moreover, our findings convey the notion that office BP may inaccurately estimate the risk of incident LVH in the general population.

An insider view on the World Symposium on Pulmonary Hypertension

An insider view on the World Symposium on Pulmonary Hypertension

Non-invasive Estimation of Right Atrial Pressure Using Inferior Vena Cava Echography

The pulsatility of the inferior vena cava (IVC) reflects the volume status and central venous pressure of patients. The standard clinical indicator of IVC pulsatility is the caval index (CI), measured from ultrasound recordings. However, its estimation is not standardized and is vulnerable to artifacts, mostly because of IVC movements during respiration. Thus, we used a (recently patented) semi-automated method that tracks IVC movements and averages the CI across an entire section of the vein, which provides a more stable indication of pulsatility. This algorithm was used to estimate the CI, pulsatility indicators reflecting either respiratory or cardiac stimulation and the mean diameter of the IVC. These IVC indices, together with anthropometric information, were used as potential features to build an innovative model for the estimation of the right atrial pressure (RAP) recorded from 49 catheterized patients. An exhaustive search was carried out for the best among all possible models that could be obtained by using combinations of these features. The model with minimum estimation error (tested with a leave-one-out approach) was selected. This model estimated RAP with an error of about 3.6 ± 2.6 mm Hg (mean ± standard deviation); the error when using only operator measured variables, without software, was about 4.0 ± 2.5 mm Hg. These promising results underline the need for further study of our RAP estimation method on a larger data set.

Noninvasive Blood Pressure Monitor Designed for Patients With Heart Failure Supported with Continuous-Flow Left Ventricular Assist Devices.

The gold standard for noninvasive blood pressure (BP) measurement, the Doppler technique, does not provide systolic blood pressure (SBP) and diastolic blood pressure (DBP) and may limit therapy outcomes. To improve patient care, we tested specifically designed experimental BP (ExpBP) monitor and the Doppler technique by comparing noninvasive measures to the intraarterial (I-A) BP in 31 patients with end-stage heart failure (4 females) 2.6 ± 3.4 days post-LVAD implantation (20 HeartMate II and 11 HeartWare). Bland-Altman plots revealed that the ExpBP monitor overestimated mean arterial pressure (MAP) by 1.2 (4.8) mm Hg (mean difference [standard deviation]), whereas the Doppler by 6.7 (5.8) mm Hg. The ExpBP SBP was overestimated by 0.8 (6.1) mm Hg and DBP by 1.9 (5.3) mm Hg compared with the respective I-A pressures. Both techniques achieved similar measurement reliability. In the measurement "success rate" expressed as a frequency (percent) of readable BP values per measurement attempts, Doppler accomplished 100% vs. 97%, 97%, and 94% of successful detections of MAP, SBP, and DBP provided by the ExpBP monitor. The ExpBP monitor demonstrated higher accuracy in the MAP assessment than the Doppler in addition to providing SBP and DBP in majority of subjects. Improved BP control may help to mitigate related neurologic adverse event rates.

Heavy metals in spices commonly consumed in Republic of Korea

ABSTRACTLevels of lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg) were evaluated in 359 samples of commonly consumed spices (cinnamon, parsley, basil, oregano, coriander seed, nutmeg, cumin, bay leaf, fenugreek, rosemary, thyme, fennel, sage, clove, marjoram, tarragon, caraway, dill seed, pepper, and turmeric) from the market in the Republic of Korea. The content of Pb, Cd, and As was assessed by acid wet digestion using a microwave oven and inductively coupled plasma mass spectrometry (ICP-MS). The content of Hg was analysed using a direct mercury analyzer (DMA). Pb, Cd, As, and Hg mean content in spices ranged from 0.039–0.972 mg kg−1, 0.013–0.315 mg kg−1, 0.121–0.861 mg kg−1, and 0.001–0.025 mg kg−1, respectively.

From point source to diffuse source of contaminants: The example of mercury dispersion in the Paglia River (Central Italy)

Fluvial sediments of the Paglia River, a tributary of Tiber River (Central Italy), are contaminated by mercury (Hg) as a consequence of past mining activity (1846–1981, with main production 1900–1970) in the Monte Amiata district (the 3rd largest Hg producer worldwide). In this study, we combine a geomorphological analysis with geochemical data to try and understand the influence of fluvial dynamics on the spatial distribution of Hg in fluvial sediments over a 43 km segment of the river.By considering the evolution of the river course between 1883 and 2013, eight different geomorphic units (GUs) were recognised, including the active channel bed (baseflow channel and bar), the floodplain, and five orders of terraces. The distribution of Hg in sediments of these GUs reflects the timing of their formation with respect to evolution of the mining activity. In GUs formed before the main peak of mining activity, or after mine closure, sediments show mean Hg contents comparable to, or slightly higher than, the local background, estimated at 2–6 mg/kg; in GUs formed during the peak production, Hg mean contents are definitely higher (up to 26 mg/kg). The current floodplain also shows high contents (mean 19 mg/kg), because of continuous reworking and transport of older contaminated sediments during major flood events. Therefore, the point contaminant sources represented by mining centres evolved into a diffuse source spread over several tens of kilometres.By combining geochemical data with calculated sediment volumes, we estimate that not less than 63 tonnes of Hg are currently contained in the sediments of the investigated river stretch. Such amount of Hg will probably limit for the near future a full land use along the Paglia–Tiber course.

Feasibility of a Smartphone-enabled Cardiac Rehabilitation Program in Male Veterans With Previous Clinical Evidence of Coronary Heart Disease

Cardiac rehabilitation (CR) is recommended for patients with coronary heart disease, however, participation among veterans remains poor. Smartphones may facilitate data transfer and communication between patients and providers, among other benefits. We evaluated the feasibility of a smartphone-enabled CR program in a population of veterans. Qualifying veterans were prospectively enrolled in a single-arm, nonrandomized feasibility study of a smartphone-enabled, home-based CR program, featuring an app with daily reminders to exercise, log vitals, and review educational materials. A coach remotely monitored patients through an online dashboard and scheduled telephone visits. Clinical end points were assessed as an exploratory aim. After 21 veterans provided informed consent, 18 were enrolled and successfully completed at least 30days of the program; 13 completed the entire 12-week intervention. Mean (standard deviation) age was 62 (7) years and 96% were male. Program completers logged a mean (standard deviation) of 3.5 (1.4) exercise sessions and 150 (86) exercise minutes per week. The majority (84%) of program completers reported being satisfied overall with the program. Mean functional capacity improved by 1.0 metabolic equivalents (5.3 to 6.3, 95% confidence interval 0.3 to 1.7; p = 0.008) and mean systolic blood pressure at rest improved by 9.6mm Hg (mean difference 9.6, 95% confidence interval -19.0 to -0.7; p = 0.049) among completers. Smartphone-enabled, home-based CR is feasible in veterans with heart disease and is associated with moderate to high levels of engagement and patient satisfaction.

Modeling Arterial Pulse Pressure From Heart Rate During Sympathetic Activation by Progressive Central Hypovolemia.

Heart rate (HR) has an impact on the central blood pressure (BP) wave shape and is related to pulse wave velocity and therefore to timing and duration of systole and diastole. This study tested the hypothesis that in healthy subjects both in rest and during sympathetic stimulation the relation between HR and pulse pressure (PP) is described by a linear effect model. Forty-four healthy volunteers were subjected to sympathetic stimulation by continuous lower body negative pressure (LBNP) until the onset of pre-syncopal symptoms. Changes in PP and HR were tracked non-invasively and modeled by linear mixed effect (LME) models. The dataset was split into two groups: the first was used for creating a model and the second for its evaluation. Models were created on the data obtained during LBNP. Model performance was expressed as absolute median error (1st; 3rd quantiles) and bias with limits of agreement (LOA) between modeled and measured PP. From rest to sympathetic stimulation, mean BP was maintained while HR increased (~30%) and PP decreased gradually (~20%). During baseline, PP could be modeled with an absolute error of 6 (4; 10) mm Hg and geometric mean ratio of the bias was 0.97 (LOA: 0.8–1.1). During LBNP, absolute median model error was 5 (4; 8) mmHg with geometric mean ratio 1.02 (LOA: 0.8–1.3). In conclusion, both during rest and during sustained sympathetic outflow induced by progressive central hypovolemia, a LME model of HR provides for an estimate of PP in healthy young adults.

Left Ventricular Unloading During Veno-Arterial ECMO: A Simulation Study.

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is widely used in cardiogenic shock. It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated, and effects of various adjunct LV unloading interventions were quantified. After VA ECMO initiation (4 L/min) in cardiogenic shock (baseline), hemodynamics improved (increased to 85 mm Hg), while LV overload occurred (10% increase in end-diastolic volume [EDV], and 5 mm Hg increase in pulmonary capillary wedge pressure [PCWP]). Decreasing afterload (65 mm Hg mean arterial pressure) and circulating volume (-800 mL) reduced LV overload (12% decrease in EDV and 37% decrease in PCWP) compared with baseline. Additional intra-aortic balloon pumping only marginally decreased cardiac loading. Instead, adjunct Impella™ enhanced LV unloading (23% decrease in EDV and 41% decrease in PCWP). Alternative interventions, for example, left atrial/ventricular venting, yielded substantial unloading. We conclude that real-time simulations may provide quantitative clinical measures of LV overload, depending on the degree of VA ECMO support and adjunct management. Simulations offer insights into individualized LV unloading interventions in cardiogenic shock supported by VA ECMO as a proof of concept for potential future applications in clinical decision support, which may help to improve individualized patient management in complex cardiovascular disease.

TAKE OFF THE BLINDERS: DON'T FORGET CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION IN THE DIFFERENTIAL DIAGNOSIS OF UNEXPLAINED DYSPNEA

Chronic Thromboembolic Pulmonary Hypertension(CTEPH) is the only pulmonary hypertension group with a cure. 50-year-old male presented with disabling dyspnea. Right heart catheterization(RHC) showed pulmonary artery pressure(PAP) 90/30 mm Hg (mean 51 mm Hg), pulmonary capillary wedge pressure(PCWP)

3:00 PM Abstract No. 399 Percutaneous revascularization for chronic mesenteric ischemia: does a residual pressure gradient affect clinical outcomes?

Percutaneous revascularization has become a reliable option in the management of chronic mesenteric ischemia with much lower associated morbidity and mortality than surgical methods. Unlike peripheral arterial interventions, there are no quantitiative endpoints for to determine the success of mesenteric angioplasty. Complete angiographic patency or alleviation of an arterial pressure gradient across the stenosis are often not feasible. Furthermore, aggressive angioplasty is typicall avoided as the consequences of a dissection or acute occlusion can be catastrophic. Our purpose is to examine whether a residual arterial pressure gradient after percutaneous revascularization affects clinical outcomes and patient symptomatology. We present a single-institution retrospective observational study involving patients who underwent mesenteric revascularization between January 2009 and June 2017 for chronic mesenteric ischemia. Simultaneous intra-arterial pressures were obtained in the aorta and SMA or celiac trunk using an end-hole catheter with a pressure transducer. Patients who did not have post-angioplasty intra-arterial pressures recorded were excluded. Postprocedural vascular surgery clinic notes were reviewed to determine whether or not symptoms had improved. There were 20 revascularization procedures for which post-angioplasty arterial pressures are available: 14 SMA and 6 celiac trunk. Mean patient age was 69.3 years. All patients experienced post-prandial abdominal pain and most reported weight loss. All patients had at least one risk factor: hypertension, type 2 diabetes, coronary artery disease or stroke and smoking. Mean follow-up was 90.2 days (range, 33-218 days) Post-angioplasty gradients (systolic/mean) ranged from 4/0 - 65/28 mm Hg (mean 34.2/12.6 mm Hg). Minor complication rate was 8.6%. There were no deaths. Clinical improvement was reported in 100% of patients in follow-up. Three procedures were done prophylactically as the patients were asymptomatic but young with rising PSV on routine ultrasound. Percutaneous mesenteric revascularization can improve symptoms of chronic mesenteric ischemia despite a residual arterial pressure gradient.

Non-invasive high-frequency oscillatory ventilation in preterm infants: a randomised controlled cross-over trial

ObjectiveNon-invasive high-frequency oscillatory ventilation (nHFOV) has recently been described as a novel mode of respiratory support for premature infants. This study was designed to determine whether nHFOV decreases CO2 partial...

Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months

To evaluate the intraocular pressure (IOP)-lowering performance and safety of an ab interno gelatin stent (XEN 45 Gel Stent, Allergan plc, Irvine, California, USA), a minimally invasive glaucoma surgery device, in refractory glaucoma. Single-arm, open-label, multicenter clinical study. Following mitomycin C pretreatment, the stent was placed ab interno in patients who failed prior filtering/cilioablative procedure or had uncontrolled IOP on maximum-tolerated medical therapy, with medicated IOP ≥20 and ≤35mm Hg and visual field mean deviation ≤-3 dB. Primary performance outcomes: patients (%) achieving ≥20% IOP reduction from baseline on the same or fewer medications and mean IOP change from baseline at month 12. Procedure-related complications and ocular adverse events (AEs) were assessed. Sixty-five patients were implanted (intent-to-treat/safety population). At 12months, 75.4% (46/61; observed data) reported ≥20% IOP lowering from baseline on the same or fewer medications. Mean IOP change from baseline was-9.1mm Hg (95% confidence interval [CI]:-10.7,-7.5) (n= 52; observed data) at 12months, excluding patients with missing data (n= 4) and those requiring a glaucoma-related secondary surgical intervention (n= 9). Mean medication count decreased from 3.5 (baseline) to 1.7 (12months). No intraoperative complications or unexpected postoperative AEs were reported. Most AEs were mild/moderate; common AEs included needling (without sight-threatening complications), nonpersistent loss of best-corrected visual acuity, and transient hypotony (requiring no surgical intervention). The gelatin stent reduced IOP and medication use without raising unexpected safety concerns, offering a minimally invasive surgical option for refractory glaucoma patients.

Mercury, n-alkane and unresolved complex mixture hydrocarbon pollution in surface sediment across the rural–urban–estuarine continuum of the River Clyde, Scotland, UK

ABSTRACTSurface sediments (n=85) from a 160-km river-estuarine transect of the Clyde, UK, were analysed for total mercury (Hg), saturated hydrocarbons and unresolved complex mixtures (UCMs) of hydrocarbons. Results show that sediment-Hg concentration ranges from 0.01 to 1.38mgkg–1 (mean 0.20mgkg–1) and a spatial trend in Hg-content low–high–low–high, from freshwater source, to Glasgow, to estuary, is evident. In summary, sediment-Hg content is low in the upper Clyde (mean of 0.05Hg mgkg–1), whereas sediments from the Clyde in urbanised Glasgow have higher Hg concentrations (0.04 to 1.26mgkg–1; mean 0.45mgkg–1), and the inner estuary sediments contain less Hg (mean 0.06mgkg–1). The highest mean sediment Hg (0.65mgkg–1) found in the outer estuary is attributed to historical anthropogenic activities. A significant positive Spearman correlation between Hg and total organic carbon is observed throughout the river estuary (0.86; P&lt;0.001). Comparison with Marine Scotland guidelines suggests that no sites exceed the 1.5mgkg–1 criterion (Action Level 2); 22 fall between 0.25 and 1.5mgkg–1 dry wt. (Action Level 1) and 63 are of no immediate concern (&lt;0.25mgkg–1 dry wt.). Saturated (n-alkane) hydrocarbons in the upper Clyde are of natural terrestrial origin. By contrast, the urbanised Glasgow reaches and outer estuary are characterised by pronounced and potentially toxic UCM concentrations in sediments (380–914mg/kg and 103–247mgkg–1, respectively), suggesting anthropogenic inputs such as biodegraded crude oil, sewage discharge and/or urban run-off.

Enteral tranexamic acid attenuates vasopressor resistance and changes in α1-adrenergic receptor expression in hemorrhagic shock

Irreversible hemorrhagic shock is characterized by hyporesponsiveness to vasopressor and fluid therapy. Little is known, however, about the mechanisms that contribute to this phenomenon. Previous studies have shown that decreased intestinal perfusion in hemorrhagic shock leads to proteolytically mediated increases in gut permeability, with subsequent egress of vasoactive substances systemically. Maintenance of blood pressure is achieved in part by α1 receptor modulation, which may be affected by vasoactive factors; we thus hypothesized that decreases in hemodynamic stability and vasopressor response in shock can be prevented by enteral protease inhibition. Rats were exposed to experimental hemorrhagic shock (35 mm Hg mean arterial blood pressure for 2 hours, followed by reperfusion for 2 hours) and challenged with phenylephrine (2 μg/kg) at discrete intervals to measure vasopressor responsiveness. A second group of animals received enteral injections with the protease inhibitor tranexamic acid (TXA) (127 mM) along the small intestine and cecum 1 hour after induction of hemorrhagic shock. Blood pressure response (duration and amplitude) to phenylephrine after reperfusion was significantly attenuated in animals subjected to hemorrhagic shock compared with baseline and control nonshocked animals and was restored to near baseline by enteral TXA. Arteries from shocked animals also displayed decreased α1 receptor density with restoration to baseline after enteral TXA treatment. In vitro, rat shock plasma decreased α1 receptor density in smooth muscle cells, which was also abrogated by enteral TXA treatment. Results from this study demonstrate that experimental hemorrhagic shock leads to decreased response to the α1-selective agonist phenylephrine and decreased α1 receptor density via circulating shock factors. These changes are mitigated by enteral TXA with correspondingly improved hemodynamics. Proteolytic inhibition in the lumen of the small intestine improves hemodynamics in hemorrhagic shock, possibly by restoring α1 adrenergic functionality necessary to maintain systemic blood pressure and perfusion.

Endoscopic Ultrasound-Guided Direct Portal Pressure Measurement Using a Digital Pressure Wire with Real-Time Remote Display: A Survival Study.

Portal hypertension is necessary for the development of most clinical complications of cirrhosis. We recently reported a novel, endoscopic ultrasound (EUS)-guided technique for direct portal pressure measurements using a digital pressure wire. The aims of this study were to (1) evaluate safety in an animal survival model and (2) compare direct portal vein (PV) versus transhepatic access of a first-order venule. Yorkshire pigs, weighing 40-55 kg. Procedures were performed under general anesthesia. PV was identified using a linear array echoendoscope and accessed with a 22-G fine needle aspiration needle preloaded with a digital pressure wire. Access was confirmed by portal venography. Mean digital pressure measurements were recorded over 30 seconds, and again after accessing a first-order portal venule in a transhepatic manner. Procedure times and video logs were maintained throughout. Animals were survived for 2 weeks. Repeat portal pressure measurements were performed before euthanasia and necropsy. EUS-guided portal pressure measurements ranged from 3 to 11 mm Hg (mean 6.1) and were performed in a mean time of 214 seconds. There was no difference in measurement between the PV and first-order venule, or between baseline and 2-week follow-up. Five of 5 animals survived without incident. On necropsy, there was no evidence of thrombus or hemorrhage. This study represents the first survival study after EUS-guided direct portal pressure measurements using a digital pressure wire. This method appears safe, straightforward, and precise. Measurements of the PV and a first-order portal venule appear equivalent, and serial measurement seems feasible.

Pharmacoeconomic comparison of losartan and amlodipine in patients of hypertension in a tertiary care teaching hospital

Background: To conduct a pharmacoeconomic comparison (cost-effectiveness analysis) and to evaluate the overall safety and efficacy of Losartan and Amlodipine in reducing the Mean blood pressure per mm Hg in hypertensive patients.Methods: This was a prospective, randomized, open label, observational analysis of cost-effectiveness; into compare the cost of Losartan 50mg and Amlodipine 5mg in hypertensive patients using either of the two drugs. A total of 80 newly diagnosed drug naïve hypertensive patients were considered for the comparison, of which 40 patients were prescribed Losartan and the other 40 were prescribed Amlodipine as per the recommended dosage. Based on the data, statistical analysis was carried out using SPSS Software Version 21.Results: The two drugs were found to be equi-effective in reducing the blood pressure to the target goal, at their respective equivalent doses Moreover, the cost of reducing 1 mm of Hg mean blood pressure with Losartan was 103.42 INR, whereas that of Amlodipine was 57.11 INR. Hence the cost incurred in treating elevated BP was markedly lower with the Amlodipine group as compared to the Losartan group.Conclusions: This pharmacoeconomic analysis shows that Amlodipine is more cost-effective as compared to Losartan when the cost per mm Hg reduction in mean blood pressure is considered. Hence in India, where the cost of drug is a significant deterrant to patient compliance, cost-effective therapy of chronic disease like hypertension is of prime importance.

An exploratory propensity score matched comparison of second-generation and first-generation baroreflex activation therapy systems

Baroreflex activation therapy (BAT) is a device-based therapy for patients with treatment-resistant hypertension. In a randomized, controlled trial, the first-generation system significantly reduced blood pressure (BP) versus sham. Although an open-label validation study of the second-generation system demonstrated similar BP reductions, controlled data are not presently available. Therefore, this investigation compares results of first- and second-generation BAT systems. Two cohorts of first-generation BAT system patients were generated with propensity matching to compare against the validation group of 30 second-generation subjects. The first cohort was drawn from the first-generation randomized trial sham group and the second cohort from the active therapy group. Safety and efficacy were compared for the second-generation group relative to the first generation. At 6 months, second-generation BAT outperformed first-generation sham systolic BP reduction by 20 ± 28 mm Hg (mean ± standard deviation, P = .008), while BP reduction in first- and second-generation active groups was similar. At 12 months, efficacy was comparable between all three groups after the sham group had received 6 months of therapy; 47% of second-generation patients achieved goal systolic BP of 140 mm Hg or less after 12 months, comparable to 50% of patients at goal in the first-generation group (P > .999). Implant procedure time, system/procedural safety, and pulse generator longevity improved with the second-generation system. Propensity-matched cohort analysis of the first- and second-generation BAT systems suggests similar therapeutic benefit and superior BP reduction of the second-generation system relative to sham control. Implantation procedure duration and perioperative safety were improved with the second-generation device. These findings should be validated in a prospective randomized trial.

Early hemodynamics and clinical outcomes of isolated aortic valve replacement with stentless or transcatheter valve in intermediate-risk patients

ObjectiveStentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement. MethodsFrom 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with intermediate operative risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated. ResultsMean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR (P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 mm Hg); TAVR peak gradients were 20.2 ± 9.5 mm Hg (mean 10.7 ± 6.9 mm Hg) P = .57 (P = .88). Postoperative effective orifice area was 1.93 ± 0.52 cm2 for FS and 1.83 ± 0.3 cm2 for TAVR (P = .65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group (P < .001). ConclusionsIn patients with small aortic annulus and intermediate risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients.

Mercury and selenium concentrations in marine shrimps of NW Mexico: health risk assessment.

We determined total Hg and Se contents of hepatopancreas, exoskeleton, and muscle, and the Se:Hg molar ratios in the muscle of shrimps Farfantepenaeus californiensis and Litopenaeus stylirostris caught in NE Pacific Mexican waters. Total Hg mean values in muscle, hepatopancreas, and exoskeleton were 0.31±0.26, 0.28±0.29, and 0.24±0.06μgg-1, and 0.46±0.46, 0.41±.034, and 0.24±0.06μgg-1 for F. californiensis and L. stylirostris, respectively. In all tissues, the mean concentrations of Se tended to be close to one order of magnitude higher than the respective Hg values. In F. californiensis, the hepatopancreas of the larger commercial size had significantly (p<0.05) higher Hg content than smaller sizes, but correlations size-Hg concentration calculated for each tissue of either species were not significant. The Hg content of the muscle of all commercial sizes of both species was lower than the permissible limit and their Se:Hg ratios in all sizes were higher than 1, indicating low risk for human consumption.