Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report.

Potential use of recycled plastic and rubber aggregate in cementitious materials for sustainable construction: A review

OBJECTIVE Examine FlowTriever thrombectomy feasibility in high-risk PE patients. BACKGROUND The FlowTriever thrombectomy system (Inari Medical, Irvine, CA) can reduce right ventricle (RV) strain in acute submassive pulmonary embolism (PE) patients. This technology has not been studied in higher risk PE patients. METHODS This multicenter retrospective analysis included patients treated with FlowTriever between 2017 and 2019 if they met at least one of the following: vasopressor dependence, PE induced respiratory failure, or decreased cardiac index (CI) measured by right heart catheterization. RESULTS Analysis included 34 patients: 18 massive, four intubated, 12 normotensive but with CI < 1.8. Average age was 56 and their median simplified PE severity index was 2. Patients had high bleeding risk, with 13 having recent surgery, six posttrauma, and four recent strokes. Six patients received cardiopulmonary resuscitation, and two received additional mechanical circulatory support. All patients had RV dilatation and elevated biomarkers. Clot removal was successful in 32/34 patients. CI improved from 2.0 ± 0.1 L/min/m2 before thrombectomy to 2.4 ± 0.1 L/min/m2 after (p = .01). The mean pulmonary artery pressure decreased from 33.2 ± 1.6 mmHg to 25.0 ± 1.5 mmHg (p = .01). The two patients-both with no or minimal thrombus removed-deteriorated during the procedure: one died and the other was successfully stabilized on ECMO. There were no other major complications. All other patients were alive at the time of data collection (mean follow-up of 205 days). CONCLUSION Aspiration thrombectomy appears feasible in higher risk acute PE patients with immediate hemodynamic improvement and low in-hospital mortality.

Percutaneous thrombectomy in patients with massive and very high-risk submassive acute pulmonary embolism.

A comprehensive overview of geopolymer composites: A bibliometric analysis and literature review

The increasing trend of the use of synthetic products may result in an increased level of pollution affecting both the environment and living organisms. Therefore, from the sustainability point of view, natural, renewable and biodegradable materials are urgently needed to replace environmentally harmful synthetic materials. Jute, one of the natural fibers, plays a vital role in developing composite materials that showed potential in a variety of applications such as household, automotive and medical appliances. This paper first reviews the characterization and performance of jute fibers. Subsequently, the main focus is shifted towards research advancements in enhancing physical, mechanical, thermal and tribological properties of the polymeric materials (i.e., synthetic or biobased and thermoplastic or thermoset plastic) reinforced with jute fibers in a variety of forms such as particle, short fiber or woven fabric. It is understood that the physio-mechanical properties of jute-polymer composites largely vary based on the fiber processing and treatment, fiber shape and/or size, fabrication processes, fiber volume fraction, layering sequence within the matrix, interaction of the fiber with the matrix and the matrix materials used. Furthermore, the emerging research on jute fiber, such as nanomaterials from jute, bioplastic packaging, heavy metal absorption, electronics, energy device or medical applications and development of jute fiber composites with 3D printing, is explored. Finally, the key challenges for jute and its derivative products in gaining commercial successes have been highlighted and potential future directions are discussed.

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Current Development and Future Perspective on Natural Jute Fibers and Their Biocomposites

Ultrasound-assisted catheter directed thrombolysis (USAT) has been shown to improve hemodynamic function and reduce bleeding complications in patients with acute massive or submassive pulmonary embolism. We performed a meta-analysis to better evaluate the efficacy and safety of USAT. We conducted an extensive literature search in PUBMED, MEDLINE, and EMBASE databases from January 1, 2008 to December 31, 2018. Efficacy outcomes of interest were pulmonary artery systolic pressure, mean pulmonary pressure, ratio of right ventricular to left ventricular diameter, cardiac index, tricuspid annular plane systolic excursion, Miller Index Score, and Qanadli Score. Safety outcomes were in-hospital mortality, long-term mortality, major and minor bleeding complications, and recurrent pulmonary embolism. Meta-analysis was performed using Cochrane Collaboration Review Manager (version 5.1). Effect size was estimated using random effects model, with 95% confidence intervals (CIs). Twenty-eight studies (n = 2,135) met inclusion criteria. Compared with pretreatment parameters, post-USAT was associated with a reduction in the mean Miller Index Score and Qanadli Score by 10.55 (95% CI −12.98 to −8.12) and 15.64 (95% CI −19.08 to −12.20), respectively. Cardiac index and tricuspid annular plane systolic excursion improved by 0.68 L/m2 (95% CI 0.49 to 0.87) and 3.68 mm (95% CI 2.43 to 4.93), respectively. Pulmonary artery systolic pressure and mean pulmonary pressure after therapy were reduced by a mean difference of 16.69 mm Hg (95% CI −19.73 to −13.65) and 12.13 mm Hg (95% CI −14.67 to −9.59) respectively. The right ventricular to left ventricular diameter dimension ratio decreased by 0.35 (95% CI −0.40 to −0.30) after therapy. In-hospital mortality in patients who underwent USAT was 2.9%, and total long-term mortality was 4.1%. Major and minor bleeding complications were seen in in 5.4% and 6.0% of patients, respectively. Recurrent events occurred in 0.2% of patients after USAT. In conclusion, USAT is a safe and effective procedure associated with significant hemodynamic and clinical improvement in patients with massive and submassive pulmonary embolism.

Jing Liu

Papers

Meta-Analysis of Catheter Directed Ultrasound-Assisted Thrombolysis in Pulmonary Embolism.

A comprehensive overview of jute fiber reinforced cementitious composites