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Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MI). However, CABG benefits are unclear in octogenarians, where surgical risk is often perceived as higher and PCI is chosen more liberally. We performed a meta-analysis of studies comparing outcomes in octogenarians with left main or multivessel disease who underwent CABG or PCI. Primary outcome was late mortality (> 5 years). Secondary outcomes were perioperative mortality, MI, re-revascularization (R-R), acute renal failure (ARF), and stroke. Fourteen studies with 17,942 patients were included. CABG was associated with lower late mortality (hazard ratio, HR: 1.23, 95% confidence interval: CI 1.05–1.44, p < 0.01). In the pooled Kaplan–Meier analysis CABG showed significantly lower risk of death in the follow-up compared to PCI (HR: 1.08, 95%CI 1.02–1.41, p = 0.005). Landmark analyses confirmed the survival advantage of CABG over PCI after 21.5 months of follow-up (HR: 1.31, 1.19–1.44, p < 0.0001), but suggested advantage of PCI over CABG in the first 30-days (HR: 0.72, 0.64–0.82, p < 0.0001) and comparable survival from 1 to 21.5 months (HR: 0.98, 0.92–1.05, p = 0.652). We found lower risk for MI and R-R after CABG but higher perioperative mortality and no differences in ARF and stroke. CABG appears superior to PCI over time in octogenarians with complex CAD. This survival advantage is associated with fewer events of MI and R-R; however, it comes with an increased risk in perioperative mortality.

ObjectivesBarlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease.MethodsBetween 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%).ResultsAnnuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms.ConclusionsMinimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

More than 50% of patients with infective endocarditis (IE) develop an indication for surgery. Despite its benefit, surgery is associated with a high incidence of multiple organ dysfunction syndrome (MODS) and mortality, which may be linked to increased release of inflammatory mediators during cardiopulmonary bypass (CPB). We therefore assessed plasma cytokine profiles in patients undergoing valve surgery with or without IE. We performed a prospective case-control pilot study comparing patients undergoing cardiac valve surgery with or without IE. Plasma profiles of inflammatory mediators were measured at 7 defined time points and reported as median (interquartile). The degree of MODS was measured using sequential organ failure assessment (SOFA) score. Between May and December 2016 we included 40 patients (20 in each group). Both groups showed similar distribution of age and gender. Patients with IE had higher preoperative SOFA (6.9± 2.6 vs 3.8 ± 1.1, p<0.001) and operative risk scores (EuroSCORE II 18.6±17.4 vs. 1.8±1.3, p<0.001). In-hospital mortality was higher in IE patients (35% vs. 5%; p<0.001). Multiple organ failure was the cause of death in all non-survivors. At the end of CPB, median levels of following inflammatory mediators were higher in IE compared to control group: IL-6 (119.73 (226.49) vs. 24.48 (40.09) pg/ml, p = 0.001); IL-18 (104.82 (105.99) vs. 57.30 (49.53) pg/ml, p<0.001); Mid-regional pro-adrenomedullin (MR-proADM) (2.06 (1.58) vs. 1.11 (0.53) nmol/L, p = 0.003); MR- pro-atrial natriuretic peptide (MR-proANP) (479.49 (224.74) vs. 266.55 (308.26) pmol/l, p = 0.028). IL-1β and TNF- α were only detectable in IE patients and first after starting CPB. Plasma levels of IL-6, IL-18, MRproADM, and MRproANP during CPB were significantly lower in survivors than in those who died. The presence of infective endocarditis during cardiac valve surgery is associated with increased inflammatory response as evident by higher plasma cytokine levels and other inflammatory mediators. Actively reducing inflammatory response appears to be a plausible therapeutic concept. ClinicalTrials.gov, ID: NCT02727413.

Trimetallic nanoparticles (TMNPs) have emerged as a pivotal area of research due to their unique properties and diverse applications across medicine, agriculture, and environmental sciences. This review provides several novel contributions that distinguish it from existing literature on trimetallic nanoparticles (TMNPs). Firstly, it offers a focused exploration of TMNPs, specifically addressing their unique properties and applications, which have been less examined compared to other multimetallic nanoparticles. This targeted analysis fills a significant gap in current research. Secondly, the review emphasizes innovative biosynthesis methods utilizing microorganisms and plant extracts, positioning these green synthesis approaches as environmentally friendly alternatives to traditional chemical methods. This focus aligns with the increasing demand for sustainable practices in nanotechnology. Furthermore, the review integrates discussions on both medical and agricultural applications of TMNPs, highlighting their multifunctional potential across diverse fields. This comprehensive perspective enhances our understanding of how TMNPs can address various challenges. Additionally, the review explores the synergistic effects among the different metals in TMNPs, providing insights into how these interactions can be harnessed to optimize their properties for specific applications. Such discussions are often overlooked in existing studies. Moreover, this review identifies critical research gaps and challenges within the field, outlining future directions that encourage further investigation and innovation in TMNP development. By doing so, it proactively contributes to advancing the field. Finally, the review advocates for interdisciplinary collaboration among material scientists, biologists, and environmental scientists, emphasizing the importance of diverse expertise in enhancing the research and application of TMNPs.

Mental and physical health are essential for well-being, particularly during adolescence. The study aimed to assess the prevalence, factors, and relationship between physical inactivity and depression, and to determine the predictors of depression among adolescents in the UAE. A cross-sectional study was conducted among students in grades 9–12 from selected schools in the UAE. The study included adolescents of all genders and all nationalities. Two standardized questionnaires were employed: the “Physical Activity Questionnaire for Adolescents (PAQ-A)” to evaluate physical activity levels and the “Centre for Epidemiologic Studies Depression Scale (CES-D)” to assess symptoms of depression among the participants. Correlation test, independent t-test, chi-square test, bivariate and multivariate logistic regression analyses were used, with significance set at p < 0.05. The study included 365 participants, with the majority being over 14 years old (68.7%), female (60%), and in grade 10 (32.2%). The prevalence of depression and physical inactivity was 51.2% and 68.8%, respectively, and a significant negative correlation was found between depression and physical activity scores. Significant positive correlations are found between depression and grade level, and chronic health problems, and a negative correlation with crowding index. Significant negative correlations are found between physical activity, age, grade level, and chronic health problems. Predictors of depression are physical inactivity, female gender, overweight and obesity, and having a chronic disease. The study reveals a high prevalence of depression and physical inactivity among adolescents in the UAE. Consequently, physical activity may serve as a key protector against depression, and it potentially influences mental health through many physiological, neurological, and behavioural pathways. This underlines the critical need for interventions aimed at promoting physical activity.

Non-neoplastic tumor-like conditions of the liver can appear similar to hepatic neoplasms. In many cases, a biopsy is required to confirm the pathology. However, several tumor-like conditions can be correctly diagnosed or suggested prospectively, thus saving patients from unnecessary anxiety and expense. In this image-focused review, we present the ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan features of eight such entities. Clues that indicate the correct pathology are discussed, and the usual clinical setting is described. Many of these lesions are treated differently from true neoplasms, and the current treatment plan is discussed in many of the cases presented. After reviewing this article, the reader will have a better understanding of these lesions and the situations in which they should be included in the differential diagnosis.

The employment of plant extracts for green production of bimetallic nanoparticles (BNPs) has gotten significant consideration because of its cheap, ecological, single–step, and easily scalable procedures. This methodology enables the manufacture of biocompatible nanoparticles (NPs) with improved activity. In this study, an environmentally friendly approach was utilized to biosynthesize manganese oxide–silver BNPs (MnO–Ag BNPs) using Cucumis melo ( C. melo ) peel extract (CPE), which served as the source of the required reducing and stabilizing materials. Several spectroscopic analytical methods, including ultraviolet–visible (UV–vis) spectroscopy, Fourier transform infrared (FTIR) spectroscopy, energy–dispersive X–ray (EDX) spectroscopy, X–ray diffraction (XRD), scanning electron microscopy (SEM), and transmission electron microscopy (TEM), were applied for careful confirmation and characterization of successful MnO–Ag BNPs assembly. This work introduces a novel green route employing CPE for MnO–Ag BNPs synthesis, providing distinct phytochemical efficiency and multifunctional bioactivity compared with previously reported plant–based systems. The biosynthesized MnO–Ag BNPs bacterial inhibitory capability as well as free radical scavenging effect were evaluated. Also, human kidney normal epithelial–derived cells (Vero cell line CCL–81) was employed for assessment of the cytotoxic outcome of MnO–Ag BNPs at various concentrations. Regarding the elemental composition, the manganese (Mn) and Ag contents were detected by the UV–vis, XRD, and EDX studies with consequent validation of MnO–Ag BNPs biosynthesis. The range of the assessed BNPs size was 2 to 10 nm with average diameter of 5.8 ± 1.7 nm and an average area of 22.7 nm 2 . Analysis based on EDX technique revealed the presence of Mn and Ag metals with 23.7–46.6% of the atomic percentages and 32.2–28.0% of the weight percentages, respectively. The biosynthesized NPs showed strong free radical scavenging, achieving 85–90% inhibition at higher concentrations. The cytotoxic activity findings indicated no significant harmful effects, at concentration range of 31.25–250 µg/mL, on Vero cell line. Additionally, the viability of the tested cell line infected with herpes simplex virus type–1 (HSV–1) significantly increased from 43% (untreated) to 78–99% when treated with 125 µg/mL MnO–Ag BNPs and acyclovir, respectively. Moreover, the inhibition rates achieved against the tested virus were 73% for MnO–Ag BNPs and 99% for acyclovir. These outcomes highlight the potential of MnO–Ag BNPs as promising candidates for biomedical and antiviral applications. Graphical abstract

Objectives Current evidence does not support superiority of one cardioplegia type over another, but stems from low-risk populations. Therefore, we compared outcomes of multimorbid, high-risk infective endocarditis (IE) patients receiving Custodiol ® crystalloid or Calafiore blood cardioplegia during cardiac surgery. Methods We retrospectively analyzed 553 patients (mean EuroScore II 22.7 ± 21.1) who underwent surgery for IE between 2009 and 2023 and received either cold crystalloid (Custodiol ® , n  = 335) or warm blood (Calafiore, n  = 218) cardioplegia. The primary endpoint was 1-year mortality. Secondary endpoints included 30-day mortality, postoperative stroke, and new-onset dialysis. Propensity score matching (1:1, 14 covariates) resulted in 175 matched pairs. Statistical analysis included nonparametric and exact tests. Results In the overall cohort, patients receiving Custodiol ® were higher risk and had higher mortality and morbidity. After matching, there was no significant difference in 1-year mortality between patients receiving Custodiol ® and Calafiore (37.1% vs. 28.6%, p = 0.09). 30-day mortality trended to be lower in the Calafiore group without reaching statistical significance (22.9% vs. 14.9%, p = 0.057). However, stroke was less frequent (4.6% vs. 10.9%, p = 0.029), ICU stay was shorter (3[1–8] vs. 6[3–12.5] days, p < 0.001) and postoperative dialysis was numerically less common (13.7 vs. 20.6%, p = 0.091). These differences were most evident in procedures with shorter cross-clamp times, such as isolated mitral or aortic valve surgery, where mortality and recovery parameters consistently favored Calafiore. Conclusions In high-risk endocarditis patients warm blood cardioplegia may be superior to cold crystalloid, although differences did not reach statistical significance. However, propensity matching may not have accounted for all differences, which warrants further discussion and investigation.

Introduction: Listeria monocytogenes is an important foodbome pathogen of public- and animal-health concern globally. The persistence of L. monocytogenes in the dairy-processing environment has multifactorial causes, including lack of hygiene, inefficient cleaning, and improper disinfection practices. Materials and Methods: A total of 300 dairy-product and environmental samples were collected from dairy-cattle facilities and local dairy shops and vendors in Qena, Egypt. Samples were screened for the incidence of Listeria spp. and to detect virulence determinants and disinfectant-resistance genes. Three marine algal species--Caulerpa racemosa, Jania rubens, and Padina pavonica--were collected from Hurghada on the Red Sea coast. Algal extracts were screened using gas chromatography-mass spectrometry. The antimicrobial activity of some marine algal extracts, nanoparticles derived therefrom, and some disinfectants against L. monocytogenes strains were assessed in vitro using agar-well diffusion and liquid-broth methods. The impact of P. pavonica extract on the growth and survival of virulent L. monocytogenes in cheese and whey were clarified. Results and Discussion: The incidence of L. monocytogenes in dairy products and environmental samples was 15.5% and 19%, respectively. The most common toxigenic gene profile found among the isolates was [hlyA.sup.+]-[inlA.sup.+]-[prfA.sup.+]. The sensitivity pattern of L. monocytogenes strains to disinfectant containing alkyl (C12-16) dimethyl BAC was high compared to other tested quaternary ammonium compounds (QAC) disinfectants tested, which showed lower log reductions against resistant strains. The QAC disinfectant-resistance gene qacH was detected in 40% of the isolates. Potent bactericidal activity of a petroleum ether extract of P. pavonica and silver nanoparticles of P. pavonica were obtained against the virulent L. monocytogenes strain. The population of L. monocytogenes in cheese curd and whey after 14 days was reduced at a rate of 9 log CFU/g and 8 log CFU/mL, respectively due to the effect of P. pavonica extract. After 28 days of storage, L. monocytogenes was completely inactivated in those dairy products. Conclusion: P. pavonica extract showed promising antimicrobial properties, calling for further comprehensive studies prior to it being applied in the food industry to enhance the safety, quality, and shelf life of products and protect public health. Keywords: Listeria monocytogenes, virulence genes, cheese, qacH gene, disinfectants, algae, antimicrobial activity

In patients with aortic stenosis treated by transcatheter aortic valve implantation (TAVI), mitral and tricuspid regurgitation (MR and TR) at baseline and after TAVI are likely to be of prognostic relevance, and questions such as whether and when treatment further improves prognosis in these patients arise. Against that background, the purpose of this study was to analyze a variety of clinical characteristics including MR and TR with respect to their potential value as predictors of 2-year mortality after TAVI. A cohort of 445 typical TAVI patients was available for the study and clinical characteristics were evaluated baseline, 6 to 8 weeks as well as 6 months after TAVI. In 39% of the patients relevant (moderate or severe) MR and in 32% of the patients relevant (moderate or severe) TR could be detected at baseline. The rates were 27% for MR (  = 0.001, compared to baseline) and 35% for TR (  = n.s., compared to baseline) at the 6- to 8-week follow-up. After 6 months, relevant MR was observable in 28% (  = 0.036, compared to baseline) and relevant TR in 34% (  = n.s., compared to baseline) of the patients. As predictors of 2-year mortality, a multivariate analysis identified the following parameters for the different time points: sex, age, AS entity, atrial fibrillation, renal function, relevant TR, systolic pulmonary artery pressure (PAPsys), and 6-min walk distance at baseline; clinical frailty scale and PAPsys 6-8 weeks after TAVI and BNP and relevant MR 6 months after TAVI. There was a significantly worse 2-year survival in patients with relevant TR at baseline (68.4% vs. 82.6%,  < 0.001; whole population,  = 445) and in patients with relevant MR at 6 months (87.9% vs. 95.2%,  = 0.042; landmark analysis:  = 235). This real-life study demonstrated the prognostic relevance of repeated evaluation of MR and TR before and after TAVI. Choosing the right time point for treatment is a remaining clinical challenge, which should be further addressed in randomized trials.