BACKGROUND: Bioprosthetic surgical mitral valve replacement (SMVR) remains an important treatment option in the era of transcatheter valve interventions. We present 10-year clinical outcomes of Medicare beneficiaries undergoing SMVR with a contemporary low-profile mitral porcine valve.
METHODS: This is a single-arm observational study using Medicare fee-for-service claims data. De-identified patients undergoing SMVR with the Epic™ Mitral valve (Abbott, Minnesota, USA) in the United States between 1/1/2008-12/31/2019 were selected by ICD-9/10 procedure codes and then linked to a manufacturer device tracking database. All-cause mortality, heart failure (HF) re-hospitalization, and mitral valve reintervention (surgical or transcatheter valve-in-valve) were evaluated at 10-years using the Kaplan Meier method.
RESULTS: Among 75,739 Medicare beneficiaries undergoing SMVR during the study period, 14,015 were implanted with the Epic™ Mitral valve, of which 76.5% (10,720) had underlying HF. Mean age was 74±8 years. Survival at 10-years in patients without preoperative HF was 40.4% (95% CI 37.4%-43.4%) compared to 25.4% (95% CI 23.8%-27.0%) for patients with HF (p < 0.001). The 10-year freedom from HF rehospitalization was 51.3% (95% CI 49.4%-53.1%). Freedom from mitral valve reintervention was 91.4% (95% CI 89.7%-92.7%) at 10 years.
CONCLUSIONS: This real-world nationwide study of Medicare beneficiaries receiving the Epic™ Mitral valve demonstrates >90% freedom from all-cause valve reintervention and >50% freedom from HF rehospitalization at 10-years post-implant. Long-term survival and HF rehospitalization in this population with mitral valve disease undergoing SMVR was found to be impacted by underlying HF.

UNASSIGNED: To compare acute physiological responses and perceived training stress between one long and two short time- and intensity-matched sessions of moderate-intensity training in endurance athletes.
UNASSIGNED: Fourteen male endurance athletes (VO2max: 69.2 ± 4.2 mL·min-1·kg-1) performed one 6 × 10-min interval session (SINGLE) and two 3 × 10-min interval sessions interspersed with 6.5 h recovery (DOUBLE) of moderate-intensity training on two separate days, while running in the laboratory, using a counterbalanced cross-over trial. The two training days were separated into a first part/session (interval stage 1-3) and second part/session (interval stage 4-6). Respiratory variables, heart rate (HR), blood lactate concentrations (BLa), and rating of perceived exertion (RPE) were collected during sessions, whereas supine heart rate (HR) was assessed in a 60-min recovery period following sessions. Measures of perceived training stress (1-10) were assessed in the morning of the subsequent day.
UNASSIGNED: HR, Bla, and RPE increased in the second compared to first part of SINGLE (168 ± 7 vs. 173 ± 7 bpm, 2.60 ± 0.75 vs. 3.01 ± 0.81 mmol·L-1, and 13.4 ± 1.0 vs. 14.8 ± 1.1-point, respectively, all p < 0.05). HR and Bla decreased in the second compared to first session of DOUBLE (171 ± 9 vs. 166 ± 9 bpm and 2.72 ± 0.96 vs. 2.14 ± 0.65 mmol·L-1, respectively, both p < 0.05). SINGLE revealed higher supine HR in the recovery period following sessions (65.4 ± 2.5 vs. 60.7 ± 2.5 bpm p < 0.05), session RPE (sRPE, 7.0 ± 1.0 vs. 6.0 ± 1.3-point, p = .001) and sRPE training load (929 ± 112 vs. 743 ± 98, p < 0.001) compared to DOUBLE. In the subsequent morning, increased levels of perceived fatigue and muscle soreness were observed following SINGLE compared to DOUBLE (7.0 ± 2.5 vs. 8.0 ± 1.0-point, p = .049 and 6.0 ± 2.5 vs. 7.0 ± 2.5-point, p = .002, respectively).
UNASSIGNED: One long moderate-intensity training session was associated with a duration-dependent \"drift\" in physiological responses compared to two short time- and intensity-matched sessions, thereby suggesting a higher overall training stimulus. Simultaneously, the lower cost of the two shorter sessions indicates that such organization could allow more accumulated time at this intensity. Overall, these findings serve as a starting point to better understand the pros and cons of organizing moderate-intensity training as one long versus shorter sessions performed more frequently (e.g., as \"double threshold training\") in endurance athletes.

Pultruded fiber reinforced polymer composites used in civil, power, and offshore/marine applications use fillers as resin extenders and for process efficiency. Although the primary use of fillers is in the form of an extender and processing aid, the appropriate selection of filler can result in enhancing mechanical performance characteristics, durability, and multifunctionality. This is of special interest in structural and high voltage applications where the previous use of specific fillers has been at levels that are too low to provide these enhancements. This study investigates the use of montmorillonite organoclay fillers of three different particle sizes as substitutes for conventional CaCO3 fillers with the intent of enhancing mechanical performance and hygrothermal durability. The study investigates moisture uptake and kinetics and reveals that uptake is well described by a two-stage process that incorporates both a diffusion dominated initial phase and a second slower phase representing relaxation and deterioration. The incorporation of the organoclay particles substantially decreases uptake levels in comparison to the use of CaCO3 fillers while also enhancing stage I, diffusion, dominated stability, with the use of the 1.5 mm organoclay fillers showing as much as a 41.5% reduction in peak uptake as compared to the CaCO3 fillers at the same 20% loading level (by weight of resin). The mechanical performance was characterized using tension, flexure, and short beam shear tests. The organoclay fillers showed a significant improvement in each, albeit with differences due to particle size. Overall, the best performance after exposure to four different temperatures of immersion in deionized water was shown by the 4.8 mm organoclay filler-based E-glass/vinylester composite system, which was the only one to have less than a 50% deterioration over all characteristics after immersion for a year in deionized water at the highest temperature investigated (70 °C). The fillers not only enhance resistance to uptake but also increase tortuosity in the path, thereby decreasing the overall effect of uptake. The observations demonstrate that the use of the exfoliated organoclay particles with intercalation, which have been previously used in very low amounts, and which are known to be beneficial in relation to enhanced thermal stability, flame retardancy, and decreased flammability, provide enhanced mechanical characteristics, decreased moisture uptake, and increased hygrothermal durability when used at particle loading levels comparable to those of conventional fillers, suggesting that these novel systems could be considered for critical structural applications.

Preventing corrosion in the steel reinforcement of concrete structures is crucial for maintaining structural integrity and load-bearing capacity as it directly impacts the safety and lifespan of concrete structures. By preventing rebar corrosion, the durability and seismic performance of the structures can be significantly enhanced. This study investigates the hysteresis behavior of both corroded and non-corroded engineered cementitious composite (ECC)-glass-fiber-reinforced polymer (GFRP) spiral-confined reinforced-concrete (RC) columns. Employing experimental methods and finite element analysis, this research explores key seismic parameters such as crack patterns, failure modes, hysteretic responses, load-bearing capacities, ductility, stiffness degradation, and energy dissipation. The results demonstrate that ECC-GFRP spiral-confined RC columns, compared to traditional RC columns, show reduced corrosion rates, smaller crack widths, and fewer corrosion products, indicating superior crack control and corrosion resistance. Hysteresis tests revealed that ECC-GFRP columns, at a 20% target corrosion rate, exhibit an enhanced load-bearing capacity, ductility, and energy dissipation, suggesting improved durability and seismic resilience. Parametric and sensitivity analyses confirm the finite element model\'s accuracy and highlight the significant influence of concrete compressive strength on load-bearing capacity. The findings suggest that ECC-GFRP spiral-confined RC columns offer promising applications in coastal and seismic-prone regions, enhancing corrosion resistance and mechanical properties, thus potentially reducing formwork costs and improving construction quality and efficiency.

For the application of poly(lactic acid) (PLA) and PLA/starch composites in technical components such as toys, it is essential to know their degradation behavior under relevant application conditions in a hydrothermal environment. For this purpose, composites made from PLA and native potato starch were produced using twin-screw extruders and then processed into test specimens, which were then subjected to various one-week ageing processes with varying temperatures (23, 50, 70, 90 °C) and humidity levels (10, 50, 75, 90%). This was followed by mechanical characterization (tensile test) and identification of degradation using Gel Permeation Chromatography (GPC), Thermogravimetric Analysis (TGA), Fourier Transform Infrared Spectroscopy (FTIR), and Nuclear Magnetic Resonance spectroscopy (NMR). With increasing temperature and humidity, there was a clear degradation of the PLA, which could be reduced or slowed down by adding 50 wt.% starch, due to increased crystallinity. Hydrolysis was identified as the main degradation mechanism for PLA and PLA/starch composites, especially above the glass transition temperature, with thermo-oxidative degradation also playing a subordinate role. Both hydrolytic degradation and thermo-oxidative degradation led to a reduction in mechanical properties such as tensile strength.

This article provides a brief description of microcapsule self-healing technique and its potential use in concrete structures. Because concrete is readily available and reasonably priced, it is widely utilised in the building industry globally, despite its susceptibility to the formation of cracks. The longevity and security of concrete buildings are greatly impacted by the existence of cracks and other deterioration occurring during the course of their use. Through the encapsulation of healing material inside microcapsules, which shows rupture upon cracking in cement-based materials, the microcapsule exhibits promise in accomplishing self-healing and increasing durability and strength in the structures. The article first explains the basic ideas behind the science of microcapsule self-healing and then looks at different ways to prepare microcapsules. It also looks into how adding microcapsules affects the basic characteristics of the concrete building. A summary of the efficiency and self-healing mechanisms of microcapsules is also provided.
The article explains the advantages of the microcapsule self-healing method in concrete.Preparation method and intrinsic properties of different microcapsules are discussed.Different self-healing measurement techniques in cement-based materials are discussed.The study examines the qualitative aspects of various self-healing methods.Looks into how adding microcapsules affects the properties of cementitious materials.

In the process of research and development of self-healing concrete, it is observed that there are three main factors controlling the self-healing effect of concrete: first, the bacteria with repair ability and strong vitality; Second, the carrying capacity of the carrier and the matching degree with concrete; The third is the concentration of bacteria. This paper focuses on the mechanical properties of Bacillus subtilis self-healing concrete with sisal fiber, PVA, and expanded perlite as the carrier. To better study the mechanical properties of self-healing concrete caused by the carrier, the experiment adopts the design parameters of C30 concrete and conducts experiments on compressive resistance, flexural resistance, freeze-thaw cycle, and sulfate corrosion resistance to analyze the influence of different carriers on the mechanical properties of self-healing concrete, and obtains the best carrier. The concentration gradients of three groups of bacterial solution were set as 2od, 2.5od, and 3od, respectively, for comparison to avoid the influence of bacterial concentration. It compared the impact of bacterial solution concentrations on the specimen\'s mechanical properties, and the effect of carriers was also analyzed. The experimental results show that the mechanical properties of the specimen using 2.5od bacterial liquid concentration with PVA as the carrier have peaked. With the increase in bacterial solution concentration, the specimens\' comprehensive mechanical properties increased first and then decreased. The compression resistance of the specimen with PVA is higher than that of the specimen with sisal fiber and expanded perlite. At the same time, the frost resistance and corrosion resistance of the PVA carrier specimen is also higher than that of the specimen with sisal fiber and expanded perlite carrier.

UNASSIGNED: Longitudinal changes in vaccination-induced immune response remain inadequately characterized in adolescents. We present long-term safety, immunogenicity, and COVID-19 incidence following a 2-dose mRNA-1273 100-μg primary series, and immunogenicity following a single dose of mRNA-1273 50 μg in vaccine-naïve adolescents.
UNASSIGNED: TeenCOVE (NCT04649151) Part 1 randomized adolescents (12-17 years) to 2-dose mRNA-1273 100 μg (n = 2490) or placebo (n = 1243) 28 days apart. Subsequently, placebo recipients (n = 91) could receive open-label mRNA-1273. Primary objectives included prespecified adverse events through 12 months; secondary objectives were COVID-19 incidence and neutralizing and spike-binding antibodies (nAbs/bAbs) against SARS-CoV-2 (ancestral/variants) through 12 months (study period: December 2020-January 2022). In Part 2, vaccine-naïve adolescents (n = 52) received up to 2 doses of mRNA-1273 50 μg; interim analysis included Day 28 (D28) nAbs post-injection 1 in SARS-CoV-2-baseline-positive participants (serologic/virologic evidence of prior infection).
UNASSIGNED: In SARS-CoV-2-baseline-negative adolescents (N = 369), mRNA-1273 induced robust nAb responses versus baseline (geometric mean concentration [GMC] = 11; 95% CI, 11-12) at D28 (1868 [1759-1985]), 6 months (625 [583-670]) and 12 months (550 [490-618]) post-injection 2. Similar bAb responses were observed to alpha/beta/delta/gamma variants; nAb/bAb responses were similar in SARS-CoV-2-baseline-positive adolescents. The 2-dose mRNA-1273 100-μg primary series was generally well-tolerated; one case of nonserious, moderate, probable acute myocarditis resolved by 8 days from symptom onset. A single dose of mRNA-1273 50 μg in SARS-CoV-2-baseline-positive adolescents induced higher D28 nAb GMCs against ancestral SARS-CoV-2 than 2-dose mRNA-1273 100 μg in young adults (geometric mean ratio = 4.322 [3.274-5.707]).
UNASSIGNED: The overall risk-benefit profile of mRNA-1273 remains favorable in adolescents, with durable 12-month immune responses against SARS-CoV-2 (ancestral/variants). A single mRNA-1273 50-μg injection in vaccine-naïve adolescents elicited robust immune responses against SARS-CoV-2.
UNASSIGNED: This project has been funded in whole or in part with federal funds by the Department of Health and Human Services, United States; Administration for Strategic Preparedness and Response, United States; Biomedical Advanced Research and Development Authority, United States, under Contract No. 75A50120C00034. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Department of Health and Human Services or its components.

OBJECTIVE: Transcatheter aortic valve replacement (TAVR) determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis but data on very long-term durability are lacking. We sought to evaluate the clinical and hemodynamic outcomes of the CoreValve porcine pericardial self-expanding bioprosthesis at 12-year follow-up.
METHODS: 882 inoperable or high-risk patients were treated with the CoreValve bioprosthesis in 8 Italian high-volume centers between 2007 and 2011. The endpoints were 12-year all-cause and cardiovascular mortality, and Cumulative Incidence Functions (CIFs) for severe Structural Valve Deterioration (SVD), Bioprosthetic Valve Dysfunction (BVD), Bioprosthetic Valve Failure (BVF), and severe Hemodynamic Valve Deterioration (HVD). VARC-3 definitions were applied.
RESULTS: Baseline characteristics included a mean age of 83 ± 6 years, and NYHA class III or IV in 76.3 % of patients. The actuarial risk of death at 12 years after TAVR was 95.5 % (CI 93.5 %- 97.1 %). The actual risk of cardiovascular death, weighted against the risk of non-cardiac death at 12 years was 23.9 % (21.0 %-26.8 %). The 12-year actual risk of BVD was 7.0 % (5.3 %-8.9 %), of SVD was 3.6 % (2.5 %-5.2 %), of BVF was 3.12 % (2.02 %-4.57 %), and of severe HVD was 1.7 % (0.9 %-2.9 %). Mean transaortic gradient significantly decreased after the procedure (52 ± 15 mmHg vs 9 ± 5 mmHg, p < 0.001), and remained stable up to 12 years (12 ± 4 mmHg, P = 0.08 vs. discharge).
CONCLUSIONS: The first-generation CoreValve bioprosthesis showed reassuring clinical and hemodynamic performance at 12-year follow-up.

Despite great advances in vitrimer, it remains highly challenging to achieve a property portfolio of excellent mechanical properties, desired durability, and high fire safety. Thus, a catalyst-free, closed-loop recyclable transesterification vitrimer (TPN1.50) with superior mechanical properties, durability, and fire retardancy is developed by introducing a rationally designed tertiary amine/phosphorus-containing reactive oligomer (TPN) into epoxy resin (EP). Because of strong covalent interactions between TPN and EP and its linear oligomer structure, as-prepared TPN1.50 achieves a tensile strength of 86.2 MPa and a toughness of 6.8 MJ m-3, superior to previous vitrimer counterparts. TPN1.50 containing 1.50 wt% phosphorus shows desirable fire retardancy, including a limiting oxygen index of 35.2% and a vertical burning (UL-94) V-0 classification. TPN1.50 features great durability and can maintain its structure integrity in 1 M HCl or NaOH solution for 100 days. This is because the tertiary amines are anchored within the cross-linked network and blocked by rigid P-containing groups, thus effectively suppressing the transesterification. Owing to its good chemical recovery, TPN1.50 can be used as a promising resin for creating recyclable carbon fiber-reinforced polymer composites. This work offers a promising integrated method for creating robust durable fire-safe vitrimers which facilitate the sustainable development of high-performance polymer composites.