Chamber Size Research Articles

A NEGLECTED RARE DISORDER: IGG4 RELATED DISEASE

Abstract IgG4–related disease (IgG4–RD) is an autoimmune disorder characterized by infiltration of plasma cells with IgG4. Almost any organ could be affected. Common presentations include lung manifestation, autoimmune pancreatitis, retroperitoneal fibrosis and tubulointerstitial nephritis. Cardiovascular involvement is less frequent. Corticosteroids are first line therapy, with or without anti–rheumatic drugs. Long–term prognosis of IgG4–RLD remains unknown. We present the case of a 65–years old woman, with a previuos diagnosis of IgG4–RD with mediastinal involvement. In the meantime she was recovered for pyelonephritis with high fever and positive blood coltures (S. hominis). We were called to perform a transthoracic echocardiogram to rule out infective endocarditis. The exam showed normal size of cardiac chambers, normal biventricular systolic function, absence of relevant valvular disease. In apical view we noticed a hyperechogenic ovalar imagine in the right atrium, not visible in all the projections. A first differential diagnosis included a mass with site of implantation at the top of the right atrium or something external but contiguous to heart structures. To clear this doubt the patient performed a thoracic CT with stunning results. The CT highlighted parietal encasement of chardiac structures and, particularly, of the superior vena cava at the confluence in right atrium, explaining the image we saw with transthoracic echo. The exam also showed encasement of ascending aorta, aortic arch and descending aorta with maximum thickness of 18 mm. CT also reported encasement of right pulmonary arthery. The CT highlighted a progression of the disease with indication to more aggressive therapy. In fact IgG4–RD of the cardiovascular system results in serious complications that need to be recognized and treated. Aortic involvement in IgG4–RD is extremely rare and tipically affects the infrarenal abdominal aorta. Cardiovascular IgG4–RD could also lead to aortitis, medium–vessel arteritis, pulmonary vascular disease, phlebitis, valvulopathy, pericarditis and myocardial disease. These forms of Igg4–RD are often underdiagnosed as clinical presentations is similar to cardiovascular disease due to more common aetiologies. Regarding our case the patient began methotrexate based on the results of the CT. This was a really interesting case for our working group to deepen this little–known disease. “The eyes see only what the mind is prepared to comprehend”.

Cardiac screening in pediatric patients with neurofibromatosis type 1: similarities with Noonan syndrome?

Both Neurofibromatosis type 1 (NF1) and Noonan syndrome (NS) are RASopathies. Characteristic cardiac phenotypes of NS, including specific electrocardiographic changes, pulmonary valve stenosis and hypertrophic cardiomyopathy have not been completely studied in NF1. Purpose: The aims of this study were to assess: (1) similarities in the prevalence and types of ECG and conventional echocardiographic findings described in NS in asymptomatic patients with NF1, and (2) the presence of discrete myocardial dysfunction in NF1 patients using myocardial strain imaging. Methods: Fifty-eight patients with NF1 (ages 0–18 years), and thirty-one age-matched healthy controls underwent cardiac assessment including blood pressure measurements, a 12-lead ECG, and detailed echocardiography. Quantification of cardiac chamber size, mass and function were measured using conventional echocardiography. Myocardial strain parameters were assessed using 2-Dimensional (2D) Speckle tracking echocardiography. Results: Asymptomatic patients with NF1 had normal electrocardiograms, none with the typical ECG patterns described in NS. However, patients with NF1 showed significantly decreased calculated Z scores of the left ventricular internal diameter in diastole and systole, reduced left ventricular mass index and a higher incidence of cardiac abnormal findings, mainly of the mitral valve, in contrast to the frequently described types of cardiac abnormalities in NS. Peak and end systolic global circumferential strain were the only significantly reduced speckle tracking derived myocardial strain parameter. Conclusions: Children with NF1 demonstrated more dissimilarities than similarities in the prevalence and types of ECG and conventional echocardiographic findings described in NS. The role of the abnormal myocardial strain parameter needs to be explored.

Influence of Structural Parameters of Gearbox Seal System of Electrical Multiple Units on Seal Performance

The gearbox seal system is a critical component of the electrical multiple units drive system, with a direct impact on the safety and reliability of train operations. This study intends to analyze how structural parameters of the gearbox seal system influence the seal performance from the viewpoint of “oil–air separation and scavenge oil” by using a discrete phase model and volume of fluid. The results show that the oil–air separation performance is mainly affected by the oil droplets’ inertia force and the airflow traction force, and the scavenge oil performance is decided by the oil–air separation performance of each seal chamber. The relationships between seal chamber size, axial seal clearance width, height difference, scavenge oil hole diameter, and seal performance are analyzed, and the study also found that optimizing the stator chamber depth–width ratio of the seal system studied in this paper at 2.5, reducing the rotor chamber depth–width ratio and axial seal clearance width, and increasing the relative height difference can improve the seal performance. And increasing the scavenge oil hole diameter also enhances the seal system’s performance. The simulation results can be used as design references for gearbox seal systems.

Normative Values of Echocardiographic Chamber Size and Function in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis.

Echocardiographic (2-dimensional echocardiography) thresholds indicating disease or impaired functional status compared with normal physiological aging in individuals aged ≥65 years are not clearly defined. In the present study, we sought to establish standard values for 2-dimensional echocardiography parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions. In this cross-sectional study of 3032 individuals who underwent 2-dimensional echocardiography at exam 6 in the MESA (Multi-Ethnic Study of Atherosclerosis), 608 participants fulfilled our inclusion criteria of healthy aging, with normative values defined as the mean ± 1.96 standard deviation and compared across sex and race and ethnicity. Functional status measures included NT-proBNP (N-terminal pro-B-type natriuretic peptide), 6-minute walk distance, and Kansas City Cardiomyopathy Questionnaire. Prognostic performance using MESA cutoffs was compared with established guideline cutoffs using time-to-event analysis. The normative aging cohort (69.5±7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6-minute walk distance, and higher (better) Kansas City Cardiomyopathy Questionnaire summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, whereas Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities. Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function by sex and race/ethnicity, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.

The High Beam to Power Efficiency Investigation of Miniaturized Microwave Ion Source

A miniaturized 2.45 GHz microwave ion source (MIS) with plasma chamber of ϕ30 mm × 40 mm that has the ability to produce more than 20 mA CW hydrogen ion beam with 180 W microwave power has been built at Peking University (PKU) 5 years ago1. A hibrid discharge principle has been proposed on this kind of MIS2. Recently, under the structure of this MIS, factors such as input power, pressure, magnetic field configuration and the size of plasma chamber have been investigated. Based on this research, a more compact 2.45 GHz microwave ion source with inner diameter of 24 mm has been developed. A 32.5 mA hydrogen ion beam was obtained with only 100 W microwave power.

Design and Experiment of a Slotted Antenna Surface Wave Plasma Flood Gun

In a modern ion implanter, plasma flood gun (PFG) is used to neutralize wafer charge during doping process, preventing the breakdown of floating wafers caused by the space charge accumulation. In order to obtain the PFG which can produce ribbon electron beams with the characteristics of high stability, high plasma density, no metal pollution and long life, studies at Peking University (PKU) are focused on surface wave plasma flood gun (SW-PFG) recently. A 2.45 GHz SW-PFG with a quartz plate and a series of metal slotted antenna arrays was designed and tested. Theoretical studies are carried out to optimize the SW-PFG structural parameters. The quartz plate thickness is determined as 15 mm. The size of the plasma chamber is 280 mm×150 mm×40 mm with a 280 mm×2 mm extraction slit. In the experiment, a relatively uniform argon plasma is obtained under the condition of gas flow rate of 2 sccm and input power of 800 W. In this case, the plasma distribution is studied by emission spectrum diagnosis and 73 mA ribbon electron beam is measured.

An Innovative Apical-4-Chamber-long-axis Imaging Approach Precisely Tracks Progressive Deterioration of Mouse Ventricles, Atria, and Atrioventricular Valves

Transthoracic echocardiography stands as the primary non-invasive method for cardiac function evaluation in clinical settings. It’s widely used to assess chamber sizes, heart wall integrity, as well as the hemodynamic performance of the left ventricle (LV), right ventricle (RV), atria, and valves. However, applying comprehensive echocardiography assessments to mice has been challenging, primarily due to diffculties in obtaining on-axis apical 4-chamber views; most mouse studies have thus been restricted to evaluating the LV using short-axis M-mode assays. To overcome this limitation, we’ve recently developed a novel methodology to consistently obtain high-quality apical 4-chamber-long-axis (A4CLAX) view images of mouse heart. This advancement permits a range of clinically relevant functional assessments, including Long Axis Biplane (LAX-BP) assay, which has been shown to surpasses M-mode in estimating LV function. In this study, we delve into the breadth of comprehensive echocardiography assessments made possible for mice through the A4CLAX imaging approach. We performed a severe transverse aortic constriction (TAC) surgery on mice and monitored the pathological development in their hearts post-surgery. Alongside the expected hypertrophy, the LAX-BP assay revealed LV volumetric dilation as early as 1-week after TAC surgery Indicative of decompensated heart failure; however, m-mode was not able to pick up on this early dilation due to its lack of longitudinal assessment and inconsistent measurements of EDV and ESV. The apical 4 chamber view significantly improved the consistency and reliability of trans mitral and pulmonary vein doppler recordings and enabled us to reliably estimate the pressure relationships of the LV and Left Atrial (LA) pressure, which is consistent with the LAX-BP detected LV decompensation. Additionally, the high clarity of the 4 chamber images achieved improved visualization of both mitral and tricuspid valve leaflets. This allowed more precise characterization of valvular issues, including mitral regurgitation caused by LV dilatation, as well as identification of less common pathological occurrences like desynchronization of the tricuspid and mitral valve opening. A speckle tracking assay of the Right ventricle (RV) showed that a delayed contraction of the lateral apical RV wall caused the tricuspid valve to not open during the early filling phase, but rather at the atrial kick, leading to this valve desynchrony. This delayed contraction indicates a possible elevation of pulmonary pressure, as evidenced by pulmonary vein doppler indices and the analysis of pulmonary congestion. In conclusion, the innovative A4CLAX imaging technique revolutionizes murine heart analysis, bringing it in line with clinical echocardiography standards allowing for a whole heart analysis approach. It sensitively identifies subtle anomalies, providing a precise characterization of cardiac remodeling and disease progression in mouse hearts. This study has been supported by grants NIH-R01HL139006 and R21OD031965. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Left Ventricular Dilation Resulting from the Absence of Either Rgs2 or Rgs5 Is Associated with Increased Immune Cell Infiltration in the Myocardium

Sustained sympathoexcitation is a hallmark of heart failure, with equally sustained activation of downstream signaling pathways involving Gs- and Gi/o-coupled β-adrenergic receptors (βAR) stimulating cAMP production and PKA activation. A critical mechanism controlling G protein-mediated βAR signaling is the activity of regulator of G protein signaling (RGS) proteins, including members of the B/R4 subfamily, which accelerate the termination of Gq/11 and Gi/o protein signaling. Previous studies by us and others reported that moderation of Gi/o activity separately by RGS2 and RGS5 of the R4 subfamily is key to maintaining normal ventricular rhythm. The loss of one or both R4 RGS proteins also results in left ventricular (LV) dilation and reduced ejection fraction. Here, we tested the hypothesis that the LV structural remodeling is due to the disruption of the coordinated activity of RGS2 and 5 resulting in sensitization of βAR signaling. To test this hypothesis, we challenged wild type (WT), Rgs2 KO ,Rgs5 KO, and Rgs2/5 double knockout (dbKO) adult male mice with sub-chronic infusion of isoproterenol (ISO, 30 mg/kg/day, 3 days) via a peritoneal osmotic minipump implantation. Rgs2 KO and Rgs5 KO mice showed increased LV chamber size at baseline, which was unchanged by ISO administration. In saline-treated animals, the loss of Rgs2 increased Rgs5 mRNA expression, while Rgs5 absence increased Rgs4 mRNA expression. ISO infusion induced concentric cardiac hypertrophy in WT mice, as evidenced by increased heart weight/tibia length (HW/TL) ratio and cardiomyocyte cross sectional area. While ISO infusion increased interstitial fibrosis in midventricular tissue and HW/TL ratio in dbKO mice, it did not affect cardiomyocyte cross sectional area or exacerbate LV dilation, despite increased expression of the cardiac fetal gene Nppa as well as the sarcomeric protein α-actinin and Ca2+/calmodulin-dependent kinase II (CaMKII). Cardiact tissue from saline-treated Rgs2 KO and Rgs5 KO mice had markedly increased CD45+ cells vs WT, while tissue from Rgs5 KO mice showed increased CD68+ cells, as revealed by immunohistochemistry. Taken together, these results indicate that ventricular remodeling seen in Rgs2 KO, Rgs5 KO, and Rgs2/5 dbKO mice is insensitive to sustained βAR stimulation but may be due to increased cardiac resident immune cell population. This work was supported by NIH R56 DK132859-01A1 and R01 HL139754, and Craig H. Neilsen Foundation Grant 382566 to Patrick Osei-Owusu. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Do athletic ECG changes predict athletic performance in Gurkha recruits?

IntroductionECG changes are associated with regular long-term intensive exercise due to electrical manifestations of increased vagal tone, increased ventricular wall thickness and enlarged chamber size. The aim of this study...

Micro-macro modeling of tensile behavior of a friction stir welded hybrid joint of AlSi10Mg parts produced by powder bed fusion and casting

Additive manufacturing (AM) has gained considerable interest due to its ability to produce lightweight parts with hierarchical microstructures. However, the current constraints on the build chamber size in powder-bed fusion type AM processes limit its industrial application. A hybrid welded joint, consisting of an AM-processed and a conventionally manufactured part, can be employed to produce larger components. Due to the varying processing conditions, these hybrid welded joints contain a wide range of microstructural heterogeneities, which influences the mechanical properties of the joint. Using a numerical model to predict the mechanical behavior of welded joints by considering the microstructural variations is essential for the safe and reliable implementation of hybrid welded joints. This study aims to predict the local tensile behavior of each region of a hybrid friction-stir welded joint of AlSi10Mg produced by laser-based powder bed fusion and casting using a microstructure-sensitive model as well as the global tensile behavior by considering the properties of each region using a joint macroscopic model. The results from this modeling approach agree well with the experimental results. Therefore, this method can predict the mechanical behavior of hybrid welded joints and can establish the structure–property relationship in each weld region.

Effects of high-gravity acceleration forces and anti-gravity maneuver on the cardiac function of fighter pilots.

The fighter pilots exposed to high gravitational (G) acceleration must perform anti-G maneuvers similar to the Valsalva maneuver. However, the effects of high-G acceleration and anti-G maneuvers on cardiac function have rarely been studied. This study aimed to investigate the effects of high-G forces on cardiac function of fighter pilots. Fighter pilots who underwent regular health check-ups and echocardiography were included (n = 29; 100% men, 41 ± 10years old; mean flight time, 1821 ± 1186h). Trainees who had not experienced any flights were included in the control group (n = 16; 100% men, 36 ± 17years old). Echocardiographic data included left ventricular chamber size, systolic and diastolic functions, right ventricular systolic pressure (RVSP), inferior vena cava (IVC) collapsibility, and tricuspid annular plane systolic excursion (TAPSE). No significant differences in left ventricular ejection fraction, RVSP, or IVC collapsibility were observed between two groups. In the multivariate linear regression analysis with total flight time as an independent continuous variable for fighter pilots, TAPSE was positively correlated with total flight time. The experience of fighter pilots who were exposed to high-G acceleration forces and anti-G maneuvers did not cause cardiac structural changes, but the exposure might be associated with right heart function changes.

Contribution of epicardial adipose tissue to atrial fibrillation development in patients with arterial hypertension: a pilot study

Aim. To evaluate the value of body mass index (BMI), visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) depots in the development of atrial fibrillation (AF).Material and methods. The study included 24 people with isolated hypertension (HTN) and 28 people with HTN in combination with AF. The median age of patients was 61,5 [53,8;69,0] years. The observational study assessed height, weight, BMI, proportion of VAT, EAT thickness, and cardiac chamber sizes. Height was measured using a metal height meter Rm-1 "Diakoms"; the results were expressed in centimeters. Weight, BMI, and VAT proportion were measured using an Omron BF-508 body composition monitor (Omron, Japan). EAT thickness and cardiac chamber sizes were assessed using two-dimensional echocardiography. Univariate logistic regression models were used to assess the independent contribution of the identified factors associated with the disease presence.Results. Hypertensive patients with and without AF were comparable in terms of BMI and VAT content. At the same time, the EAT content was significantly higher in the group of patients with HTN and AF and amounted to 7,0 [5,0;8,2] mm and 6,0 [4,5;7,0] mm (p=0,027) in the group HTN with and without AF, respectively.Left atrial (LA) volume was 70 [55,2;83,0] ml and 52 [45,5;59,0] ml (p=0,003) in the hypertensive group with and without AF, respectively. Univariate analysis revealed the greatest significance of EAT and LA volume in terms of AF prediction. Logistic regression models did not reveal significant effect of VAT.Conclusion. In hypertensive patients with and without AF at comparable levels of BMI and VAT, differences in EAT thickness and LA volume were identified. Univariate analysis showed that these factors have an advantage in the development of AF. However, even despite the limited sample, the EAT depot was found to be more significant than the VAT depot and BMI in predicting the AF risk.The data that EAT depot and LA volume have the same effect on the arrhythmia risk indicates that patients with AF should be treated not only for hypertension, but also hidden obesity, which we can judge by EAT thickness.

Development of High-Voltage Electrodes for Neutron Scattering Sample Environment Devices

The sample environment is essential to neutron scattering experiments as it induces the sample under study into a phase or state of particular interest. Various sample environments have been developed, yet the high-voltage electric field has rarely been documented. In this study, Bruce electrodes with various sectional geometries and chamber sizes were examined by using simulation modeling based on ANSYS Maxwell. A large uniform field region where samples would sit could be achieved in the planar region for all specifications, but the size of the region and the field strength varied with the gap distance between electrodes. The edging effect was inherently observed even for bare electrodes, about 1.7% higher in the sinusoidal region than the planar region, and was significantly deteriorated when a chamber was applied. This effect, however, presented an exponential decrease as the minimum distance between the electrode edge and the chamber shell increased. A compromise between the spatial confinement and the achievable field (strength and uniform region) could be reached according to the unique applicability of neutron instruments. This research provides a theoretical basis for the subsequent design and manufacturing of high-voltage sample environment devices.

Obesity-Related Hemodynamic Alterations in Patients with Cushing's Disease.

Background: Cushing's disease (CD) is associated with a specific form of metabolic syndrome that includes visceral obesity, which may affect cardiovascular hemodynamics by stimulating hypercortisolism-related metabolic activity. The purpose of this study was to evaluate the relationship between obesity and the hemodynamic profile of patients with CD. Methods: This prospective clinical study involved a hemodynamic status assessment of 54 patients newly diagnosed with CD with no significant comorbidities (mean age of 41 years). The assessments included impedance cardiography (ICG) to assess such parameters as stroke index (SI), cardiac index (CI), velocity index (VI), acceleration index (ACI), Heather index (HI), systemic vascular resistance index (SVRI), and total arterial compliance index (TACI) as well as applanation tonometry to assess such parameters as central pulse pressure (CPP) and augmentation index (AI). These assessments were complemented by echocardiography to assess cardiac structure and function. Results: Compared with CD patients without obesity, individuals with CD and obesity (defined as a body mass index ≥ 30 kg/m2) exhibited significantly lower values of ICG parameters characterizing the pumping function of the heart (VI: 37.0 ± 9.5 vs. 47.2 ± 14.3 × 1*1000-1*s-1, p = 0.006; ACI: 58.7 ± 23.5 vs. 76.0 ± 23.5 × 1/100/s2, p = 0.005; HI: 11.1 ± 3.5 vs. 14.6 ± 5.5 × Ohm/s2, p = 0.01), whereas echocardiography in obese patients showed larger heart chamber sizes and a higher left ventricular mass index. No significant intergroup differences in blood pressure, heart rate, LVEF, GLS, TACI, CPP, or AI were noted. Conclusions: Hemodynamic changes associated with obesity already occur at an early stage of CD and manifest via significantly lower values of the ICG parameters illustrating the heart's function as a pump, despite the normal function of the left ventricle in echocardiography.

Study on the test accuracy of the high-air-volume purifier under different test chamber volumes

Due to the increasing local purification demand of public spaces during production processes, high-air-volume purifiers (HAVPs) with flow rates >800 m3/h have been increasingly applied in commercial and industrial spaces. Compared with clean air standards in the United States, Europe and other countries, relevant HAVP detection guidelines have not been standardized in most countries, and only Chinese and South Korean standards consider scaling HAVP test chambers. There remains a lack of theoretical and experimental HAVP detection studies. In this study, the airtight test chamber decay method was used, and the chamber size was increased by a ratio of 1:2:3 based on the original volume (30 m3). The effect of the test chamber volume on the HAVP accuracy was evaluated considering the amount of valid data, pollutant uniformity, and air cleaner position. Based on the results, the clean air delivery rate (CADR) deviation varied between 1.4% and 35.7% under the effect of the test chamber volume. The test accuracy was higher for the 60 m3 test chamber, which is more suitable for HAVP testing. A new index based on the CADR–test chamber volume relationship was proposed, revealing that the air cleaner performance can be accurately measured when the equivalent clean air volume ventilation rate varies between 9 and 22 L/h. The upper HAVP detection limit should be considered in standard supplementation. The HAVP flow rate classification in Chinese standards should be refined. The results provide a reference for rapid selection of the appropriate test chamber volume for air cleaners with different flow rates, which facilitates HAVP application in industrial and commercial spaces.

Team Approach: Diagnosis, Management, and Prevention of Sudden Cardiac Arrest in the Athlete.

» Sudden cardiac events during sports competition are rare but tragic occurrences that require a timely, comprehensive response by well-prepared athletic trainers and medical providers. This sequence should prioritize prompt emergency medical system activation, immediate initiation of cardiopulmonary resuscitation (CPR), automated early defibrillation (AED), and comprehensive advanced life support efforts.» Exercise-induced cardiac remodeling, referred to as the "athlete's heart," refers to a host of adaptive changes that increase cardiac chamber size and wall thickness to allow for greater pressures and volumes during exercise. This remodeling phenotype may overlap with other inherited cardiomyopathies and cardiac abnormalities, which can complicate clinical care. The long-term implications of this electrical and structural remodeling on cardiac function are unknown.» Although the best screening strategies to optimize primary prevention of sudden cardiac arrest is an evolving topic, the effectiveness of CPR and early defibrillation use in treating out-of-hospital sudden cardiac arrest has been well-established, despite their reported underuse.

Safety, efficacy, and clinical utility of the 5.1-mm debridement catheter for treatment of walled-off pancreatic necrosis (with video)

Background and AimsDirect endoscopic necrosectomy (DEN) is a recommended strategy for treatment of walled-off-necrosis (WON). DEN uses a variety of devices including the EndoRotor (Interscope, Inc.) debridement catheter. Recently, a 5.1 mm EndoRotor with increased chamber size and rate of tissue removal was introduced. The aim of this study was to assess the efficacy and safety of this device. MethodsA multi-center cohort study was conducted at eight institutions including patients who underwent DEN with the 5.1 mm EndoRotor. The primary outcome was the number of DEN sessions needed for WON resolution. Secondary outcomes included the average percent reduction in solid WON debris and decrease in WON area per session, total time spent performing EndoRotor therapy for WON resolution, and adverse events. Results64 procedures in 41 patients were included. For patients in which the 5.1 mm EndoRotor catheter was the sole therapeutic modality, an average of 1.6 DEN sessions resulted in WON resolution with an average cumulative time of 85.5 minutes. Of the 21 procedures with data regarding percent of solid debris, the average reduction was 85% +/- 23% per session. Of the 19 procedures with data regarding WON area, the mean area significantly decreased from 97.6 +/- 72.0 cm2 to 27.1 +/- 35.5 cm2 (p<0.001) per session. Adverse events included two intra-procedural LAMS dislodgements managed endoscopically and three perforations none of which were related to EndoRotor. Bleeding was reported in seven cases, none required embolic or surgical therapy and two required blood transfusions. ConclusionsThis is the first multi-center retrospective study to investigate the efficacy and safety of the 5.1 mm EndoRotor catheter for WON. Results from this study showed an average of 1.6 DEN sessions were needed to achieve WON resolution with an 85% single session reduction in solid debris and a 70% single session decrease in WON area with minimal adverse events.

Outcomes of COMBO therapy for severe mitral regurgitation compared with transcatheter edge-to-edge repair.

There are different types of transcatheter mitral valve repair (TMVr) currently in clinical use, including leaflet approximation, annular cinching, and restoration of the chordal apparatus of the mitral valve (MV). While the concomitant combination (COMBO) therapy of mitral transcatheter edge-to-edge repair (M-TEER) with another TMVr concept has been proven feasible, potentially offering patient-tailored treatment for severe mitral regurgitation (MR), a comparison with M-TEER alone has not been made. To evaluate the procedural and clinical outcome of COMBO therapies compared with M-TEER alone. We included consecutive patients undergoing COMBO and M-TEER between March 2015 and April 2018 at our Heart Valve Center, while excluding patients presenting a case of redo or with previous MV surgery. Procedural outcomes and all-cause mortality were compared between COMBO therapy vs. M-TEER alone. A total of 357 patients (mean age 78.9 ± 7.0 years, 53.2% male, M-TEER n = 322, COMBO n = 35; COMBO: MitraClip and the Carillon mitral contour system n = 26, MitraClip and Cardioband n = 5, and MitraClip and NeoChord n = 4) were analyzed. Patients with COMBO therapy had larger left chamber sizes, a lower left ventricular systolic ejection fraction (LVEF; COMBO: 37.4 ± 13.8%, M-TEER: 47.9 ± 14.3%, p < 0.001), and a more severe MR grade (p < 0.001). There were no significant differences in the prevalence of residual MR ≧2+. However, the need for re-intervention, always employing M-TEER, was more common in the COMBO group. During a mean 3.6-year long-term follow-up, there was no significant difference of all-cause mortality between both groups (Log rank p = 0.921). COMBO therapy may still be a beneficial therapy option for patients with severe MR who already have a more dilated left ventricle (LV), a more severe MR, and a more pronounced LV systolic dysfunction. The higher need for re-intervention in the COMBO group may signal more complex anatomies and possibly underlines the necessity of treating significant MR earlier. Future research is required to establish the COMBO approach as a toolbox-like treatment option, thus offering a patient-tailored approach depending on the individual anatomy and pathology.

Left Ventricular Hypertrophy in Male and Female Judo Athletes.

Changes in cardiac geometry develop after intense and prolonged training. Left ventricular enlargement, increased relative wall thickness, and growing mass of the left ventricle occur after strenuous exercise. Combat sports such as judo can lead to left ventricular hypertrophy. Previous studies have found that there are differences in left ventricular chamber size and thickness between the sexes, with female athletes having smaller wall diameters and less hypertrophy than male athletes. The research aims to examine heart muscle adaptations and remodeling of cardiac geometry among elite judo athletes and to evaluate differences between males and females. A cross-sectional study included a group of 19 (males n=10, females n=9) professional judokas between 20 and 30 years. Demographic and anthropometric data were collected. Cardiac geometry was determined by two-dimensional transthoracic echocardiography. In terms of left ventricular mass and the left ventricular mass index significant differences were found between male and female judokas (233.44±68.75 g vs. 164.11±16.59 g, p=0.009), (105.16±24.89 vs. 84.66±15.06, p=0.044), respectively. A greater enlargement of the heart muscle is observed in male athletes compared to the female group. Left ventricle enlargement is likely to occur among elite-level judokas.

Study of the effect of bio-inspired surface texture on the shear strength of bonded 3D-printed materials: Comparison between stainless steel and polycarbonate joints

Additive Manufacturing (AM) is one of the important technological pillars of Industry 4.0. Thanks to its tool-free manufacturing and extreme flexibility, AM has the potential to respond to individual customer preferences with a customized final product. Nevertheless, the size of 3D printed products is limited by the size of the build chamber of commercially available printers. In addition, deformations, stability, tolerances, and especially cost are highly dependent on the maximum size of the parts. Therefore, a larger final product can only be realized as an assembly group. Therefore, adhesive bonding appears to be an attractive solution for assembling parts made by AM. In this paper, a comparison of the influence of surface texture on the shear strength of 3D-printed metallic and polymeric adhesive joints was performed. A fish scale (FS) bio-inspired surface texture was chosen to examine how surface patterning influences the strength of joints. Fused deposition modeling (FDM) and selective laser melting (SLM) techniques were used to produce polycarbonate (PC) and stainless steel (17-4 PH) specimens, respectively. The effect of bio-surface and material type on the shear strength of adhesive joints was assessed using the ASTM D4501 standardized block shear testing method. The morphological analysis revealed that FDM exhibits reduced resolution and accuracy, making it less suitable for the additive manufacturing of complex surface features in 3D-printed parts when compared to SLM technology. In addition, bio-surface texturing significantly improved the wettability of stainless steel, requiring the synergy of higher surface free energy and increased surface roughness (FS bio-surface) for super-hydrophilicity, while a combination with lower surface free energy (PC material) and the same surface roughness resulted in hydrophobic behavior. On the other hand, the bio-surface texture greatly enhanced the shear strength (+31%) of stainless steel specimens, compared to PC specimens, due to the increase of physical adsorption forces and the enhancement of the mechanical interlocking effect. The analysis of variance (ANOVA) results highlight the predominant influence of material type on surface wettability (84%), while surface texture has a more pronounced impact on the shear strength of bonded joints (71%).