4291Six-month outcomes from the multicenter, prospective study with the novel PASCAL transcatheter valve repair system for patients with mitral regurgitation in the CLASP study

Background

Severe mitral regurgitation may lead to an impaired prognosis if left untreated. Transcatheter treatment options have emerged as an alternative to surgery and an adjunct to medical therapy. We report the six-month results of the PASCAL transcatheter valve repair system in treating patients with mitral regurgitation enrolled in the multicenter, prospective, single arm CLASP study.

Methods

The PASCAL Transcatheter Valve Repair System is a leaflet repair therapy that uses clasps and paddles to place a woven Nitinol spacer between the native valve leaflets to fill the regurgitant orifice via a transseptal approach. Eligible patients had clinically significant MR despite optimal medical therapy and were deemed candidates for transcatheter mitral repair by the local Heart Team. Safety, performance, and clinical outcomes were prospectively assessed at baseline, discharge, 30 days, and 6 months post-procedure. All major adverse events (MAE) were adjudicated by an independent clinical events committee and echocardiographic images were assessed by a core lab. The MAE rate was the primary safety endpoint, defined as the composite of cardiovascular mortality, stroke, MI, new need for renal replacement therapy, severe bleeding, and re-intervention for study device-related complications.

Results

Between June 2017 and September 2018, 62 patients were enrolled at 14 sites worldwide for transcatheter mitral valve reconstruction using the PASCAL system. The mean age was 76.5 years (62.9% male). All patients had MR grade ≥3+, with 59% functional, 34% degenerative, and 7% mixed etiology, and 51.6% of patients were in NYHA Class III/IV. Successful implantation of the PASCAL device was achieved in 95% of patients. At discharge, 95% of patients had MR grade ≤2+ with 81% grade ≤1+. There was one cardiovascular mortality and the MAE rate was 4.8%. At 30-day follow-up, paired analyses shows that 98% of patients had MR grade ≤2+ with 81% grade ≤1+ and 88% were in NYHA Class I/II (p<0.0001). The 6MWD improved by 38.9 m (p=0.0015) and was accompanied by average improvements in KCCQ and EQ5D scores by 14.1 points (p<0.0001) and 8.3 points (p=0.0028), respectively. The six-month data will be available for presentation.

Conclusions

In this early device experience, the PASCAL transcatheter valve repair system showed an acceptable safety profile and performed as intended in treating patients with mitral regurgitation. The PASCAL device resulted in significant MR grade reduction, which was associated with clinically and statistically significant improvements in functional status, exercise capacity, and quality of life. Continued follow-up is warranted to validate these initial promising results.

Acknowledgement/Funding

Edwards Lifesciences

Modulating Activity through Defect Engineering of Tin Oxides for Electrochemical CO2 Reduction

The large-scale application of electrochemical reduction of CO2, as a viable strategy to mitigate the effects of anthropogenic climate change, is hindered by the lack of active and cost-effective electrocatalysts that can be generated in bulk. To this end, SnO2 nanoparticles that are prepared using the industrially adopted flame spray pyrolysis (FSP) technique as active catalysts are reported for the conversion of CO2 to formate (HCOO-), exhibiting a FEHCOO - of 85% with a current density of -23.7 mA cm-2 at an applied potential of -1.1 V versus reversible hydrogen electrode. Through tuning of the flame synthesis conditions, the amount of oxygen hole center (OHC; Sn≡O●) is synthetically manipulated, which plays a vital role in CO2 activation and thereby governing the high activity displayed by the FSP-SnO2 catalysts for formate production. The controlled generation of defects through a simple, scalable fabrication technique presents an ideal approach for rationally designing active CO2 reduction reactions catalysts.

Proton-assisted creation of controllable volumetric oxygen vacancies in ultrathin CeO2-x for pseudocapacitive energy storage applications

Two-dimensional metal oxide pseudocapacitors are promising candidates for size-sensitive applications. However, they exhibit limited energy densities and inferior power densities. Here, we present an electrodeposition technique by which ultrathin CeO_2−x films with controllable volumetric oxygen vacancy concentrations can be produced. This technique offers a layer-by-layer fabrication route for ultrathin CeO_2−x films that render Ce³⁺ concentrations as high as ~60 at% and a volumetric capacitance of 1873 F cm⁻³, which is among the highest reported to the best of our knowledge. This exceptional behaviour originates from both volumetric oxygen vacancies, which enhance electron conduction, and intercrystallite water, which promotes proton conduction. Consequently, simultaneous charging on the surface and in the bulk occur, leading to the observation of redox pseudocapacitive behaviour in CeO_2−x. Thermodynamic investigations reveal that the energy required for oxygen vacancy formation can be reduced significantly by proton-assisted reactions. This cyclic deposition technique represents an efficient method to fabricate metal oxides of precisely controlled defect concentrations and thicknesses.

Two-dimensional pseudocapacitors may benefit portable electronic devices but require improved energy and power densities. Here, the authors achieve high volumetric capacitance in ultrathin films with oxygen vacancies that enhance electron conduction and intercrystallite water that promotes proton conduction.

Connecting single-cell properties to collective behavior in multiple wild isolates of the Enterobacter cloacae complex

Some strains of motile bacteria self-organize to form spatial patterns of high and low cell density over length scales that can be observed by eye. One such collective behavior is the formation in semisolid agar media of a high cell density swarm band. We isolated 7 wild strains of the Enterobacter cloacae complex capable of forming this band and found its propagation speed can vary 2.5 fold across strains. To connect such variability in collective motility to strain properties, each strain’s single-cell motility and exponential growth rates were measured. The band speed did not significantly correlate with any individual strain property; however, a multilinear analysis revealed that the band speed was set by a combination of the run speed and tumbling frequency. Comparison of variability in closely-related wild isolates has the potential to reveal how changes in single-cell properties influence the collective behavior of populations.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Mechanistic insights into the phenomena of increasing capacity with cycle number: using pulsed-laser deposited MoO2thin film electrodes

Thin film electrodes often feature fluctuations in capacity with cycle number. This work shows how electrode reactions and peeling off the current collector is a plausible mechanism for these fluctuations.

Correction to: Extranodal lymphoma arising within the maxillary alveolus: a systematic review

Owing to an unfortunate mistake at Springer's end, the original article was published with errors which are corrected with this erratum as suggested by the author. The authors are not responsible for this procedural lapse.

Evaluation of a hepatitis C clinical care coordination programme's effect on treatment initiation and cure: A surveillance-based propensity score matching approach

Hepatitis C (HCV) is a viral infection that if left untreated can severely damage the liver. Project INSPIRE was a 3 year HCV care coordination programme in New York City (NYC) that aimed to address barriers to treatment initiation and cure by providing patients with supportive services and health promotion. We examined whether enrolment in Project INSPIRE was associated with differences in HCV treatment and cure compared with a demographically similar group not enrolled in the programme. INSPIRE participants in 2015 were matched with a cohort of HCV-infected persons identified in the NYC surveillance registry, using full optimal matching on propensity scores and stratified by INSPIRE enrolment status. Conditional logistic regression was used to assess group differences in the two treatment outcomes. Two follow-up sensitivity analyses using individual pair-matched sets and the full unadjusted cohort were also conducted. Treatment was initiated by 72% (790/1130) of INSPIRE participants and 36% (11 960/32 819) of study-eligible controls. Among initiators, 65% (514/790) of INSPIRE participants compared with 47% (5641/11 960) of controls achieved cure. In the matched analysis, enrolment in INSPIRE increased the odds of treatment initiation (OR: 5.25, 95% CI: 4.47-6.17) and cure (OR: 2.52, 95% CI: 2.00-3.16). Results from the sensitivity analyses showed agreement with the results from the full optimal match. Participation in the HCV care coordination programme significantly increased the probability of treatment initiation and cure, demonstrating that care coordination for HCV-infected individuals improves treatment outcomes.

An Ecological Study on the Risk of Gastric Cancer With Helicobacter Pylori Prevalence and Other Potential Cofactors in Korea

Background: Korea has a high incidence of gastric cancer and a high prevalence of Helicobacter pylori infection. Observation of prevalence trends and determination of risk factors for gastric cancer are important to establish health policies to prevent and reduce the burden of disease. Currently, there is no evidence of complete correlation between prevalence of H. pylori infection and the occurrence of gastric cancer. Several explanations have been proposed for the paradox of high prevalence of infection and low gastric cancer incidence in certain places, including diet and salt consumption, genetic susceptibility, other infections, aflatoxin-contaminated food, and the interaction of all these factors, but none of them has been clearly established. Aim: To explore the potential effects of prevalence of H. pylori infection and other risk factors on gastric cancer incidence in Korea. Methods: Information on gastric cancer incidence, prevalence of H. pylori infection, and the risk factors for gastric cancer were evaluated from nationally representative data - the Korean National Cancer Registry, nationwide routine health check-up surveillance system, and National Health and Nutrition Survey, respectively. Secular trends of H. pylori infection prevalence and age-standardized incidence rates for gastric cancer by region were examined. Furthermore, trends of income level, education level, marital status, number of family members, smoking status, drinking status, obesity, diabetes, hypertension, dyslipidemia, and age-standardized incidence rates for gastric cancer by region were examined. Results: Gastric cancer incidence showed a decreasing trend from 2011 to 2015; 50.6%–44.4% for men and 22.1%–17.0% for women. The prevalence of H. pylori infection also showed a decreasing trend; from 66.9% in 1998%–54.4% in 2011. In Korea, areas with high prevalence of H. pylori infection also showed high gastric cancer incidence. However, the Chungcheong area showed relatively low prevalence of H. pylori infection, but had the highest gastric cancer incidence in Korea. Other factors which showed similar effects on gastric cancer incidence, like H. pylori infection were large family size (4 or more family members), low income, low education, and obesity. The effect of introduction of 'National Cancer Screening Program' will be evaluated in the final outcome. Conclusion: The results of this study indicated that significant regional differences exist between trends in H. pylori infection prevalence and gastric cancer incidence in Korea. Also, the possibility of lack of association between H. pylori prevalence and the incidence of gastric cancer are suggested. Overall, this study suggests the need for further research to explore potential factors accounting for regional differences in gastric cancer incidence in Korea.