Molecular basis for passive immunotherapy of Alzheimer's disease

Amyloid aggregates of the amyloid-{beta} (A{beta}) peptide are implicated in the pathology of Alzheimer's disease. Anti-A{beta} monoclonal antibodies (mAbs) have been shown to reduce amyloid plaques in vitro and in animal studies. Consequently, passive immunization is being considered for treating Alzheimer's, and anti-A{beta} mAbs are now in phase II trials. We report the isolation of two mAbs (PFA1 and PFA2) that recognize A{beta} monomers, protofibrils, and fibrils and the structures of their antigen binding fragments (Fabs) in complex with the A{beta}(1–8) peptide DAEFRHDS. The immunodominant EFRHD sequence forms salt bridges, hydrogen bonds, and hydrophobic contacts, including interactions with a striking WWDDD motif of the antigen binding fragments. We also show that a similar sequence (AKFRHD) derived from the human protein GRIP1 is able to cross-react with both PFA1 and PFA2 and, when cocrystallized with PFA1, binds in an identical conformation to A{beta}(1–8). Because such cross-reactivity has implications for potential side effects of immunotherapy, our structures provide a template for designing derivative mAbs that target A{beta} with improved specificity and higher affinity

Erratum to Evaluation of stucco binder for agglomeration in the heap leaching of copper ore

ManuscriptFigure 8 top legend is mentioned incorrectly. The legend "With ferric sulfate: column leaching of agglomerates (stucco) should be red in color and column leaching of agglomerates (no stucco) should be blue in color. The correct Fig. 8 is shown below. The authors would like to apologize for the inconvenience this error may have caused

Evaluation of stucco binder for agglomeration in the heap leaching of copper ore

ManuscriptIt is known that the presence of excess fines in heap leaching operations may cause low recovery due to reduced heap permeability and/or channeling of lixiviant flow. These problems are mitigated to some extent by agglomeration pretreatment prior to heap leaching. Sulfuric acid leach solution is the conventional liquid bridge used for copper ore agglomeration, but these agglomerates exhibit poor stability when compared to the agglomerates formed using stucco binder, calcium sulfate hemihydrates, CaSO4.1/2 H2O. Results obtained from agglomeration experiments on the Zaldivar ore reveal that the stucco hydration reaction provides the agglomerates with more stability, increased size with less release of fines, and better permeability of the packed agglomerate bed. A phase diagram has been constructed to identify preferred agglomeration conditions. Finally a proposed description for the action of stucco binder during the agglomeration process is presented and discussed

Particle damage and exposure analysis in HPGR crushing of selected copper ores for column leaching

ManuscriptIn mining operations, jaw and gyratory crushers are generally used for primary crushing, and cone crushers are used for secondary crushing. During the past decade, however, High-Pressure Grinding Rolls (HPGR) are being considered due to potential processing benefits such as energy savings, improved exposure/liberation and particle weakening. At this time there is no detailed quantification of particle damage and downstream benefits from HPGR crushing are uncertain. In the present research, copper ores (copper oxide ore and copper sulfide ore) were crushed by a jaw crusher and by HPGR and the products were evaluated for particle damage and copper grain exposure by X-ray computed tomography. Column leaching was done to determine the rate and extent of copper recovery. X-ray computed tomography analysis and laboratory column leaching experiments for copper oxide ore revealed that products from HPGR crushing have more particle damage and higher copper recoveries when compared with products of the same size class from jaw crusher crushing. Generally the copper recovery from column leaching of the oxide ore was found to be dependent on the extent of grain exposure, which increases with a decrease in particle size. In the case of the copper sulfide ore, copper recovery was found to be independent of the crushing technique despite the fact that more particle damage was observed in products from HPGR crushing. This unexpected behavior for the copper sulfide ore might be due to the high head grade and strong leach solution. Column leaching results also show that about 80 to 90% of the copper was recovered from the copper sulfide ore in a relatively short leaching time irrespective of crushing technique. As expected, copper recoveries improved with a decrease in the particle size of the copper sulfide ore as exposure of copper mineral grains increased

Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.

IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES: Survival, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis

Two-year outcomes after transcatheter or surgical aortic-valve replacement.

BACKGROUND: The Placement of Aortic Transcatheter Valves (PARTNER) trial showed that among high-risk patients with aortic stenosis, the 1-year survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical replacement. However, longer-term follow-up is necessary to determine whether TAVR has prolonged benefits. METHODS: At 25 centers, we randomly assigned 699 high-risk patients with severe aortic stenosis to undergo either surgical aortic-valve replacement or TAVR. All patients were followed for at least 2 years, with assessment of clinical outcomes and echocardiographic evaluation. RESULTS: The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90; 95% confidence interval [CI], 0.71 to 1.15; P=0.41) and at 2 years (Kaplan-Meier analysis) were 33.9% in the TAVR group and 35.0% in the surgery group (P=0.78). The frequency of all strokes during follow-up did not differ significantly between the two groups (hazard ratio, 1.22; 95% CI, 0.67 to 2.23; P=0.52). At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%, P=0.12); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR (P<0.001), and even mild paravalvular regurgitation was associated with increased late mortality (P<0.001). CONCLUSIONS: A 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality. (Funded by Edwards Lifesciences; ClinicalTrials.gov number, NCT00530894.)

Molecular modification of spiro[fluorene-9,9′-xanthene]-based dopant-free hole transporting materials for perovskite solar cells

The molecular engineering of organic hole-transporting materials (HTMs) plays an important role in enhancing the performance and stability of perovskite solar cells (PSCs) as well as reducing their fabrication cost. Here, two low-cost spiro-OMeTAD analogues, namely SP-Naph and SP-SMe, featuring a spiro[fluorene-9,9-xanthene] (SFX) central core and asymmetric subunits are designed and synthesized. Specifically, the SFX core in the SP-Naph molecule is substituted with dimethoxyphenylnaphthylamine subunits to enhance conductivity and charge transport properties by expansion of the π-conjugated structure. On the other hand, in the molecular structure of SP-SMe, the methoxy groups (–OMe) from diphenylamine units were partially replaced with the methylsulfanyl groups (–SMe) to increase interaction with the perovskite surface through the “Lewis soft” S atoms. By combining various experimental and simulation methods, thestructure–property relationship of the newly synthesized HTMs was thoroughly investigated. The suitable HOMO energy level with the perovskite layer together with superior photoelectric properties and enhanced thermostability and humidity resistivity are obtained for the SP-SMe HTM. As a result, the planar n–i–p PSC with the dopant-free SP-SMe HTM yields a maximum power conversion efficiency (PCE) of 21.95%, which outperforms that with SP-Naph (20.51%) and doped spiro-OMeTAD (19.23%). Importantly, the device with SP-SMe also reveals enhanced operational stability under continuous 1 sun illumination and thermal stability at 65 °C. These findings provide valuable insight for the rational design of dopant-free organic HTMs based on the SFX core, which would promote the development of highly efficient and stable devices

First UK data for CT angiography in persisting upper GI bleeding

Letters to the edito

Evaluation of flow after transcatheter aortic valve replacement in patients with low-flow aortic stenosis : a secondary analysis of the PARTNER randomized clinical trial

Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent predictor of mortality in patients undergoing aortic valve replacement (AVR). Little is known about improvement in flow after AVR and its effects on survival. Objective: To determine whether higher flow (left-ventricular stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate better clinical outcomes in this at-risk population. Design, Setting, and Participants: A substudy analysis of data from the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical trial and continued-access registry was conducted. A total of 984 participants with evaluable echocardiograms and baseline LF AS (LVSVI =35 mL/m2) were included. The trial was conducted at 26 sites in the United States and Canada. Patients were stratified after TAVR into tertiles by discharge LVSVI status (severe low flow [SLF], moderate low flow [MLF], and normal flow [(NF]). The present study was conducted from May 11, 2007, to January 9, 2012, with data analysis performed from April 25, 2014, to January 21, 2016. Main Outcomes and Measures: The primary end point was all-cause mortality at 1 year. Results: Baseline characteristics of 984 patients with LF AS included mean (SD) age, 84 (7) years; 582 (59.1%) men; mean Society of Thoracic Surgeons (STS) score, 11.4% (4.0%); and mean LVSVI, 27.6 (5.0) mL/m2. The discharge LVSVI values by group were SLF, 23.1 (3.5) mL/m2; MLF, 31.7 (2.2) mL/m2; and NF, 43.1 (7.0). All-cause mortality at 1 year was SLF, 26.5%; MLF, 20.1%; and NF, 19.6% (P¿=¿.045). Mean LVSVI normalized by 6 months in the MLF (35.9 [9.3] mL/m2) and NF (38.8 [11.1] mL/m2) groups, but remained low in the SLF group at 6 months and 1 year (31.4 [8.4] and 33.0 [8.3] mL/m2], respectively) (P¿<¿.001 for all groups). Reported as multivariate hazard ratio, mortality at 1 year was higher in the SLF group compared with the other groups (1.61; 95% CI, 1.17-2.23; P¿=¿.004). In addition to SLF, sex (1.59; 95% CI, 1.18-2.13; P¿=¿.002), presence of atrial fibrillation (1.41; 95% CI, 1.06-1.87; P¿=¿.02), STS score (1.03; 95% CI, 1.01-1.06; P¿=¿.02), presence of moderate or severe mitral regurgitation at discharge (1.65; 95% CI, 1.21-2.26; P¿=¿.001), pre-TAVR mean transvalvular gradient (0.98; 95% CI, 0.97-0.99; P¿=¿.004), and effective orifice area index (1.87; 95% CI, 1.09-3.19; P¿=¿.02) were independent predictors of 1-year mortality.CONCLUSIONS AND RELEVANCE: Severe LF at discharge is associated with an increased risk of mortality following TAVR in patients with severe AS and preexisting LF. The identification of remedial causes of persistent LF after TAVR may represent an opportunity to improve the outcome of these patients