ABSTRACT Introduction: The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI. Methods: We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison. Results: No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006). Conclusion: MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.

Abstract Introduction: Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be associated with unfavorable hemodynamic outcomes. This study aimed to estimate the prevalence, identify the risk factors, and evaluate the outcomes and survival of patients with high residual gradients after TAVI-ViV. Methods: A total of 85 patients were included in the study. The cohort was divided into group A, with postprocedural mean pressure gradient (PG) ≥ 20 mmHg, and group B, with mean PG < 20 mmHg. Results: Postprocedural PG ≥ 20 mmHg was observed in 24.7% of the patients. In a univariate analysis, preoperative gradient, pre-existing patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated valves, and an older generation of transcatheter aortic valves were found to be risk factors for high residual gradient. Multivariate analysis showed that preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and degenerated valve size ≤ 23 mm were independent predictors of high residual gradient. There were no differences in early morbidity (myocardial infarction, pacemaker implantation, stroke, acute renal insufficiency) between groups. Kaplan-Meier estimated that the survival rate was comparable at one and five years regardless of postoperative gradient. Survivors with high residual mean gradient were significantly affected by a high New York Heart Association (NYHA) class. Conclusion: High residual transvalvular gradient after TAVI-ViV is not rare, but it does not significantly affect mortality. High residual mean gradient has a negative impact on NYHA functional class improvement after the procedure. High preoperative gradient, implantation level, and small failed bioprosthesis may predispose to increased residual gradient.

Abstract Vitamin D can be harmful if taken for a long time, or taken in large acute dose, cause many problems including hypercalcemia. Here, we examined the protective effects of Eugenia Caryophyllata against vitamin D toxicity induced renal inflammation in rats. This study employed four experimental groups (n = 10) that underwent two months of treatment as follows: control group animal received saline (0.9% NaCl), vitamin D group that was received (100 mg/kg) of vitamin D, Eugenol group that was received Eugenol (100 mg/kg), vitamin D + eugenol group that was received vitamin D (100 mg/kg) then will be orally given Eugenol (100 mg/kg). The current study showed that a significant upregulation in the IL-2, TNF- α and iNOS gene expression levels caused by vitamin D compared to the control group. Eugenol treatment caused a significant decreased IL-2, TNF-α and iNOS activity and also upregulated gene expression levels. Histological features investigated showed that administered with vitamin D intoxication showed distinct alterations from that of the untreated control groups, such Shrinkage of glomeruli, hypercellularity of the glomeruli and necrosis. However, retreatment with Eugenol showed improvement in the histological features in by slight infiltration, fibrosis, minimal pleomorphism and less disarrangement and compared with that of Vitamin D treated rats. In conclusion, the Eugenol exhibited renoprotective effects against vitamin D-induced nephrotoxicity. These renoprotective effects could be achieved by the antioxidant and anti-inflammatory activities of the Eugenol. Thus, for vitamin D-induced nephrotoxicity, the use of Eugenol could be beneficial.

Introduction: Ingredients of oily fish include a large amount of polyunsaturated fatty acids, which are important elements in various metabolic processes of humans, and have also been used to prevent diseases. However, in an attempt to reduce cost, recent developments are starting a replace the ingredients of fish oil with products of microalgae, that also produce polyunsaturated fatty acids. To do so, it is important to closely monitor morphological changes in algae cells and monitor their age in order to achieve the best results. This paper aims to describe an advanced vision-based system to automatically detect, classify, and track the organic cells using a recently developed SOPAT-System (Smart On-line Particle Analysis Technology), a photo-optical image acquisition device combined with innovative image analysis software. Methods The proposed method includes image de-noising, binarization and Enhancement, as well as object recognition, localization and classification based on the analysis of particles’ size and texture. Results The methods allowed for correctly computing cell’s size for each particle separately. By computing an area histogram for the input images (1h, 18h, and 42h), the variation could be observed showing a clear increase in cell. Conclusion The proposed method allows for algae particles to be correctly identified with accuracies up to 99% and classified correctly with accuracies up to 100%.