Characteristics of Right-Sided Accessory Pathways Associated With Right Cardiac Veins.

BACKGROUND: The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported. METHODS: Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation. RESULTS: Patients enrolled had a median age of 30 (11-51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V1, negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V1 and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60-20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence was observed during 36 (10-60) months follow-up. CONCLUSIONS: The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs.

A case of endocardial dissection caused by Micra implantation.

BACKGROUND: Leadless pacemakers are a recent technological advancement. It has many advantages, but there are still a few serious complications. CASE PRESENTATION: This article reports the case of a patient with an endocardial tear and dissection caused by contact with the tip of the Micra cup during surgery and summarises the relevant data. CONCLUSIONS: This case report details the occurrence and management of the incident and provides some guidance for future clinical management.

Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over.

BACKGROUND: Healthy aging is a process of not only achieving good health but also increasing the life satisfaction of older adults aged 60 years and over, in which health behaviors play an important role. There is a lack of research on the time-varying dependencies between health, life satisfaction, and health behaviors, impeding a deeper understanding of healthy aging. PURPOSE: To develop an integrated framework for modeling the interrelationships among the components of healthy aging between multiple time slices. METHODS: Based on the Chinese Longitudinal Healthy Living Survey (CLHLS) data in the three waves of 2011/2012, 2014, and 2017/2018, Bayesian network and dynamic Bayesian network are jointly employed to study the relationships among the components of healthy aging within one time slice, as well as to explore the time-varying dependencies among the components between time slices. RESULTS: The results of structure learning reveal the direction of effects between different dimensions of health, with mental health and social health affecting physical health and self-rated health affecting both physical and mental health. In addition, health behaviors are found to affect mental health and social health, while self-rated health can influence life satisfaction. The parameters learned from the data show the magnitude and direction of concurrent effects, one-period lagged effects and two-period lagged effects between the factors, which find that the time-varying dependencies vary but are generally positive, long-term, and accumulative over time. In addition, the results of autoregressive effects show the positive predictive effects of health and life satisfaction. CONCLUSIONS: It confirms the influence pathway from health behaviors to multidimensional health to life satisfaction, and the time-varying dependencies among the components of healthy aging, which facilitates a deeper understanding of healthy aging. Combining the results of autoregressive effects and descriptive statistics, it further indicates that healthy aging is a comprehensive result arising from interactions of multiple factors. Policymakers should guide older adults aged 60 years and over to adopt healthier behaviors and ensure the long-term sustainability and continuity of policies.

Associations of chronic exposure to a mixture of pesticides and type 2 diabetes mellitus in a Chinese elderly population.

Epidemiological studies have related exposure to pesticides to increased risk of diabetes. However, few studies have evaluated the health effects of mixed pesticides exposure, especially in an elderly population. Here, we utilized gas chromatography-tandem mass spectrometry to quantify the levels of 39 pesticides in 4 categories in a Chinese elderly population. Then we used general linear models to explore the association between individual pesticide exposure and type 2 diabetes mellitus (T2DM). Restricted cubic spline (RCS) models were fitted to identify potential non-linearities between those associations. Furthermore, stratified analysis by gender was conducted to explore the gender-specific associations. Finally, we used weighted quantile sum (WQS) regression, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR) to evaluate the effects of mixed exposure to 39 pesticides. The results showed that exposure to pesticides was associated with high risk of T2DM, with ß-Hexachlorocyclohexane (ß-BHC) and oxadiazon being the most significant independent contributors, which was pronounced among elderly women. Moreover, the association of ß-BHC and oxadiazon with T2DM was linear. These indicated that it is an urgent need to take practical measures to control these harmful pesticides.

Feasibility study of cryoballoon ablation for atrial fibrillation with KODEX-EPD: a single center experience.

To evaluate the feasibility of cryoballoon (CB) ablation of atrial fibrillation (AF) under the guidance of a new three-dimensional (3D) mapping system KODEX-EPD. 40 patients scheduled for CB ablation of AF in the first affiliated Hospital of Xinjiang Medical University from August 2021 to July 2022 were randomly divided into two groups: KODEX-EPD 3D mapping system guidance group (KODEX group, n = 20) and conventional two-dimensional perspective group (standard group, n = 20). The ablation time, operation time, fluoroscopy time, fluoroscopy dose, contrast agent dosage and follow-up data were compared between the two groups. Besides, the feasibility and accuracy of the dielectric sensing system in evaluating pulmonary vein (PV) occlusion in patients with AF during CB ablation were verified. All pulmonary veins were being isolated. The ablation time (36.40 ± 6.72 min vs 35.15 ± 6.29 min, P > 0.05) and the operation time (64.20 ± 11.82 min vs 66.00 ± 13.18 min, P > 0.05) were not statistically different in the two groups. The standard group has longer fluoroscopy time, dose and contrast medium dosage. There were significant differences in fluoroscopy time (532.30 ± 72.83 s vs 676.25 ± 269.33 s, P < 0.05), fluoroscopy dose (110.00 ± 28.64 mGy vs 144.68 ± 66.66 mGy, P < 0.05), and contrast medium dosage (71.90 ± 5.97 ml vs 76.05 ± 5.93 ml, P < 0.05) between the two groups. The learning curves of the first 5 patients and the last 15 patients in the KODEX group were compared. There was no statistical difference in the ablation time (36.80 ± 8.56 min vs 36.27 ± 6.34 min, P > 0.05) or the operation time (69.00 ± 5.00 min vs 62.60 ± 13.10 min, P > 0.05); however, compared to the first 5 patients, fluoroscopy time (587.40 ± 38.34 s vs 513.93 ± 73.02 s, P < 0.05), fluoroscopy dose (147.85 ± 35.19 mGy vs 97.39 ± 8.80 mGy, P < 0.05) and contrast medium dosage (79.60 ± 1.14 ml vs 69.33 ± 4.45 ml, P < 0.05) were significantly decreased. Using pulmonary venography as the gold standard, the sensitivity, specificity of the completely occlusion in KODEX group was 93.6% (95% CI 85-97.6%) and 69.6% (95% CI 54-81.8%); and the sensitivity, specificity of the small leak in KODEX group was 93.1% (95% CI 82.4-97.8%) and 82.0% (95% CI 65.9-91.9%). During an average follow-up of (9.90 ± 1.06) months, there was no statistical difference in arrhythmia recurrence and antiarrhythmic drugs taking after CB ablation between the two groups (P > 0.05). Using the KODEX-EPD system, the CB ablation procedure can correctly evaluate the PV occlusion, and significantly reduce fluoroscopy exposure and contrast medium without significantly increasing the operation time.

The heterogeneous impacts of government on health system efficiency in China's new health reform, 2010-2019.

BACKGROUND: Contextualizing in China's recent health reform, we empirically explore the heterogeneous effects of two distinct government roles, accommodating private hospitals vs investing in public hospitals, on health system efficiency. METHODS: We use panel data covering 31 provinces during 2010-2019 to assess health system efficiency. We incorporate health service volumes and population health outcomes to ascertain health system outputs, employing the non-radial directional distance function to estimate efficiency. We employ Bayesian Tobit quantile regression to explore the heterogeneous effects of the share of private hospitals and government subsidy to public providers on efficiency. RESULTS: China's health system inefficiency scores range from 0 to 0.45. The association between the share of private hospitals and inefficiency score are only significant in higher-inefficiency quantiles (coefficients -0.0258, -0.0315 and -0.0327 for quantiles 0.7, 0.8 and 0.9), meaning a heterogeneously positive impact for low-efficiency provinces. The association between government subsidy and inefficiency score are positive for all quantiles (from 0.0339 to 0.0567), meaning persistent negative impacts on efficiency. CONCLUSIONS: The heterogeneous impacts of the share of private hospitals suggest that the government should accommodate more private hospitals in provinces with low efficiency. The persistent negative impacts of government subsidy suggest that the government investment seems not be subjected to economic objectives.

Construction and evaluation of hourly average indoor PM2.5 concentration prediction models based on multiple types of places.

Background: People usually spend most of their time indoors, so indoor fine particulate matter (PM2.5) concentrations are crucial for refining individual PM2.5 exposure evaluation. The development of indoor PM2.5 concentration prediction models is essential for the health risk assessment of PM2.5 in epidemiological studies involving large populations. Methods: In this study, based on the monitoring data of multiple types of places, the classical multiple linear regression (MLR) method and random forest regression (RFR) algorithm of machine learning were used to develop hourly average indoor PM2.5 concentration prediction models. Indoor PM2.5 concentration data, which included 11,712 records from five types of places, were obtained by on-site monitoring. Moreover, the potential predictor variable data were derived from outdoor monitoring stations and meteorological databases. A ten-fold cross-validation was conducted to examine the performance of all proposed models. Results: The final predictor variables incorporated in the MLR model were outdoor PM2.5 concentration, type of place, season, wind direction, surface wind speed, hour, precipitation, air pressure, and relative humidity. The ten-fold cross-validation results indicated that both models constructed had good predictive performance, with the determination coefficients (R2) of RFR and MLR were 72.20 and 60.35%, respectively. Generally, the RFR model had better predictive performance than the MLR model (RFR model developed using the same predictor variables as the MLR model, R2 = 71.86%). In terms of predictors, the importance results of predictor variables for both types of models suggested that outdoor PM2.5 concentration, type of place, season, hour, wind direction, and surface wind speed were the most important predictor variables. Conclusion: In this research, hourly average indoor PM2.5 concentration prediction models based on multiple types of places were developed for the first time. Both the MLR and RFR models based on easily accessible indicators displayed promising predictive performance, in which the machine learning domain RFR model outperformed the classical MLR model, and this result suggests the potential application of RFR algorithms for indoor air pollutant concentration prediction.

Genesis of Low CBM Production in Mid-Deep Reservoirs and Methods to Increase Regional Production: A Case Study in the Zhengzhuang Minefield, Qinshui Basin, China.

With the increase of the burial depth of the no. 3 coal seam in the Zhengzhuang minefield of Qinshui Basin, the production of surface coal bed methane (CBM) vertical wells was low. By means of theoretical analysis and numerical calculation, the causes of low production of CBM vertical wells were studied from the aspects of reservoir physical properties, development technology, stress conditions, and desorption characteristics. It was found that the high in situ stress conditions and stress state changes were the main controlling factors of the low production in the field. On this basis, the mechanism of increasing production and reservoir stimulation was explored. An L-type horizontal well was constructed alternately among the existing vertical wells on the surface to initiate a method to increase the regional production of fish-bone-shaped well groups. This method has the advantages of a large fracture extension range and a wide pressure relief area. It could also effectively connect the pre-existing fracture extension area of surface vertical wells, realizing the overall stimulation of the low-yield area and increasing the regional production. Through the optimization of the favorable stimulation area in the minefield, 8 L-type horizontal wells that adopted this method were constructed in the area with high gas content (greater than 18 m3/t), a thick coal seam (thicker than 5 m), and relatively rich groundwater in the north of the minefield. The average production of a single L-type horizontal well reached 6000 m3/d, which was about 30 times that of the surrounding vertical wells. The length of the horizontal section and the original gas content of the coal seam had a significant influence on the production of the L-type horizontal wells. This method for increasing the regional production of fish-bone-shaped well groups was an effective and feasible low-yield well stimulation technology, which provided a reference for increasing the production and efficiently developing CBM under the high-stress conditions in mid-deep high-rank coal seams.

Feasibility, safety and effectiveness of mapping system assisted conduction system pacing: a single-center prospective study.

To assess pacing and electrophysiological parameters, as well as mid-term outcomes, among patients undergoing His bundle pacing (HBP) guided by KODEX-EPD (a novel mapping system). Consecutive patients undergoing conduction system pacing (CSP) for bradycardia indications were evaluated. Procedural and fluoroscopic times and pacing characteristics were compared between conventional fluoroscopy (the standard group, N = 20 cases) and KODEX-EPD mapping system guided group (the KODEX group, N = 20cases) at CSP implantation and all patients were followed at 6-month. HBP was achieved in all patients (the standard group 20/20 and the KODEX group 20/20). There was no difference in the mean procedure time between the two groups (63.7 ± 9.3 vs. 78.2 ± 25.1 min, p = 0.33). Compared with the standard group, the KODEX group significantly reduced the intraoperative X-ray exposure time (3.8 ± 0.5 vs. 19.3 ± 5.1 min, p < 0.05) and X-ray dose (23.6 ± 5.4 vs. 120.2 ± 38.3 mGy, p < 0.05). There were no significant differences in atrial impedance (643.0 ± 98.8 vs. 591.5 ± 92.1 Ω, p = 0.09), atrial sensing (2.9 ± 0.8 vs. 2.5 ± 0.8 mV, p = 0.08), ventricular sensing (12.8 ± 2.4 vs. 13.3 ± 3.3 mV, p = 0.63),atrial pacing threshold (1.0 ± 0.2 vs. 1.0 ± 0.1 V/0.4 ms, p = 0.81) and ventricular pacing threshold (1.0 ± 0.2 vs. 0.9 ± 0.1 V/0.4 ms, p = 0.63) between two groups, There were statistical differences in ventricular impedance (640.0 ± 80.3 vs. 702.0 ± 86.1 Ω, p < 0.05). There was no statistical significance in pacing parameters between the two groups at 6 months after procedure (p > 0.05). During the 6-months follow-up period, no adverse events occurred in the two groups. It can be concluded that KODEX-EPD can safely guide His bundle branch pacing lead implantation with reduced fluoroscopic time and dose without lengthening the procedure time.

Epicardial implantation of a lumenless active fixation lead in a neonate.

BACKGROUND: We present a case of epicardial pacemaker implantation in a low birth weight newborn using a lumenless active fixation lead. RESULTS: We found that superior pacing parameters can be obtained by implanting a lumenless active fixation lead into the epicardium, but more evidence is needed to support this hypothesis.

Use of symptom diary in primary students: association of nitrogen dioxide with prevalence of symptoms.

Air pollution is a global public health concern, and numerous studies have attempted to identify the health effects of air pollutants, including nitrogen dioxide (NO2). In China, there are few studies investigating the relationship between NO2 exposure and symptoms among children at an individual level. The aim of the study was to evaluate the acute effects of NO2 on prevalence of symptoms of primary students. An environmental and health questionnaire survey was administered to 4240 primary students in seven districts of Shanghai. Daily symptoms, as well as the daily air pollution and meteorological data from each community, were recorded during the corresponding period. A multivariable logistic regression model was utilized to analyze the relationship between the prevalence of symptoms and NO2 exposure in school-age children. A model with interaction items was adopted to estimate the interactive effects of NO2 and confounding factors on symptoms. The average NO2 level in central urban, industrial and rural areas were 62.07 ± 21.66, 54.86 ± 18.32 and 36.62 ± 21.23 µg m-3, respectively. Our findings demonstrate that the occurrence of symptoms was significantly affected by NO2 exposure in the short-term. The largest associations were observed for a 10 µg m-3 increase in 5-day moving average (lag04) NO2 concentration with prevalence of general symptoms (odds ratio [OR] = 1.15, 95% confidence interval [95% CI]: 1.07-1.22), throat symptoms (OR = 1.23, 95% CI: 1.13-1.35) and nasal symptoms (OR = 1.142, 95% CI: 1.02-1.27). Subgroup analysis showed that non-rural areas, boys, nearby environmental pollution source and history of present illness were all susceptible factors to the effects of NO2 exposure. Furthermore, there were interactive effects between NO2 exposure and area types on reported symptoms. NO2 can increase the risk of symptoms in primary students in the short-term, which could be significantly enhanced in central urban and industrial areas.

A reliable emergency logistics network for COVID-19 considering the uncertain time-varying demands.

The evolving COVID-19 epidemic pose significant threats and challenges to emergency response operations. This paper focuses on designing an emergency logistic network, including the deployment of emergency facilities and the allocation of supplies to satisfy the time-varying demands. A Demand prediction-Network optimization-Decision adjustment framework is proposed for the emergency logistic network design. We first present an improved short-term epidemic model to predict the evolutionary trajectory of the epidemic. Then, considering the uncertainty of the estimated demands, we construct a capacitated multi-period, multi-echelon facility deployment and resource allocation robust optimization model to improve the reliability of the decisions. To address the conservativeness of robust solutions during the evolution of the epidemic, an uncertainty budget adjustment strategy is proposed and integrated into the rolling horizon optimization approach. The results of the case study show that (i) the short-term prediction method has higher accuracy and the accuracy increases with the amount of observed data; (ii) considering the demand uncertainty, the proposed robust optimization model combined with uncertainty budget adjustment strategy can improve the performance of the emergency logistic network; (iii) the proposed solution method is more efficient than its benchmark, especially for large-scale cases. Moreover, some managerial insights related to the emergency logistics network design problem are presented.

Decoration of alkalization-intercalated Ti3C2 with ZIF-8@ZIF-67-derived N-doped carbon nanocage for detecting 4-nitrophenol.

The highly effective alk-Ti3C2/bimetallic Co, Zn embedded N-doped carbon (Co-Zn-NC) composite was fabricated by a convenient self-assembled method strategy and applied to  the reduction of 4-nitrophenol(4-NP). Co-Zn-NC nanocage was synthesized by using designed core-shell ZIF-8@ZIF-67 as sacrificial template. The Co-Zn-NC was prepared by pyrolysis of ZIF-8@ZIF-67 at 900 °C with high-specific surface area and hollow structure, which facilitates the dispersion of Co species and produces abundant Co-Nx active sites. In addition, the electrochemical property and specific surface area of Ti3C2 were improved by alkaline treatment. As a result, compared with alk-Ti3C2 and Co-Zn-NC, the alk-Ti3C2/Co-Zn-NC sensor showed higher activity and stability in detecting 4-NP. The alk-Ti3C2/Co-Zn-NC sensor has a wide determination range of 2-500 µM and a low detection limit of 0.23 µM for 4-NP. In addition, the newly developed alk-Ti3C2/Co-Zn-NC sensor displayed satisfactory reproducibility and  good stability in detecting 4-NP in aqueous samples.

Right ventriculography improves the accuracy of leadless pacemaker implantation in right ventricular mid-septum.

BACKGROUND: Implanting leadless pacemakers in the right ventricular (RV) apex is prone to causing pericardial tamponade and myocardial perforation. OBJECTIVE: To investigate the feasibility and safety of right ventriculography-guided implantation of Micra™ leadless pacemaker (Micra™, Medtronic, Minneapolis, MN, USA) in the RV mid-septum. METHODS: One hundred eight consecutive patients who underwent Micra™ implantation intended in the mid-septum were enrolled and randomized (3:1) into the radiography group (n = 81) with assistance of right ventriculography to illustrate the RV septum and the non-radiography group (n = 27). All subjects underwent a postoperative computed tomography (CT) scan to determine the Micra™ location. The Micra™ location assessed by CT image was compared between the two groups to confirm the accuracy of the intended pacing site. The duration of the procedure, X-ray radiation dose, and time were also compared between the two groups. RESULTS: Reconstructed CT 3-D cardiac images found the Micra™ location in the intended mid-septum in 13 patients (48.1%, 13/27) in the non-radiography group and 76 patients (93.8%, 76/81) in the radiography group (P < 0.0001 between two groups). There was no significant difference in procedure interval between the two groups while the X-ray radiation dose (564.86 ± 112.44 vs. 825.85 ± 156.12 mGy, P < 0.0001), X-ray exposure time (7.79 ± 1.43 vs. 12.03 ± 2.86 min, P < 0.0001), and the number of fluoroscopy re-positioning (2.79 ± 1.03 vs. 6.41 ± 1.82, P < 0.0001) were significantly less in the radiography group than in the non-radiography group. No implantation-related complications were observed in both groups. CONCLUSION: Right ventriculography increases the accuracy of Micra™ implantation in the mid-septum and reduces X-ray exposure. TRIAL REGISTRATION: The trial registration number (ChiCTR2100051374) and date (09/22/2021).

Optical frequency comb assisted reconfigurable broadband spread spectrum signal generation.

A photonic-assisted scheme for spread spectrum communication signals generation is proposed and demonstrated in this article. The spreading sequence and the baseband data codes are modulated on the photonic link by electro-optic modulators, and the spread spectrum process is completed through stream processing on the analog microwave photonic link. By combining optical frequency comb and injection locking technologies, the carrier frequency of the communication signals can be tuned over an ultra-broadband range of 3-39 GHz. In the proof-of-concept experiments, spread spectrum signals at 3 GHz and 6 GHz are obtained with a spread factor of 31. The analysis results indicate that the generated signals possess excellent reconfiguration, anti-interference, and anti-interception properties. Overall, our proposed scheme offers a flexible photonic architecture with significant potential in the application of ultra-broadband covert communication systems.

Classification of three types of ginseng samples based on ginsenoside profiles: appropriate data normalization improves the efficiency of multivariate analysis.

Background: It is well known that ginsenosides are the main active ingredients in ginseng, and they have also been important indexes for assessing the quality of ginseng. However, the absolute contents of ginsenosides in ginseng were shown to be varied with the origin, cultivated type, cultivated year and climate. It is a great challenge to distinguish the commercial types of ginsengs according to the content of one or several ginsenosides. Methods: The common commercial types of ginsengs are white ginseng (WG), red ginseng (RG), American ginseng (AG). To clearly illustrate the differences among WG, RG and AG at the ginsenosides level, we established a strategy for the detection and identification of ginsenosides based on an optimized LC-Q-Orbitrap MS/MS method coupled with an in-house database of ginsenosides. Before and after the normalization, the ginsenosides datasheet was analyzed and compared using several state-of-the-art multivariate statistical analysis methods. Results: Here, 81 ginsenosides were identified in different ginseng samples. The majority of the ginsenosides (59 in 81) were all shared by WG, RG and AG. When the shared ginsenosides datasheet was normalized by the level of ginsenoside Ro, our analysis strategy clearly divided the ginseng samples into three groups (i.e., WG, RG and AG groups). We found that the ginsenoside profiles in RG and WG were significantly different from those in AG. The potential markers and multivariate diagnostic models differentiating the three types of ginsengs were also indicated. Conclusion: Our novel methodology based on ginsenoside profiles is more robust than existing methods, and data normalization is required to improve the efficiency of multivariate statistical analysis.

Study of the optimum fluoroscopic angle for the implant fixation test of a leadless cardiac pacemaker.

The Micra TPS™ (Medtronic) is the first leadless pacemaker listed in China. The best fluoroscopic angle for the intraoperative fixation test is selected according to different implantation sites to reduce the fluoroscopy duration and radiation dose, and the test is based on the early safety and effectiveness of the device after implantation. A total of 110 patients who underwent Micra TPS™ implantation were selected. Eighty patients were in group A, and 30 patients were in group B. Under the guidance of the conclusions from group A, the fluoroscopy duration, radiation dose and number of fluoroscopic positions of the best fluoroscopic angle of the fixation test according to different positions of the implanted interventricular septum were compared. In 85.0% of the group A implants, these angles were based on the right interior oblique (RAO) angle, with 48.5% cranial (CRA) and 29.4% caudal (CAU) angles. The angle of the tilting head side of the RAO angle was prioritized in group B, and referring to the average angle data, the average fluoroscopy duration for finding the best angle of fixation test was 1.7 ± 0.6 vs. 3.2 ± 1.8 min (P < 0.001), the average radiation dose was 270.4 ± 56.3 vs. 338.1 ± 112.9 mGy (P = 0.002), and the average number of fluoroscopic positions was 2.2 ± 0.6 vs. 4.2 ± 2.1 (P < 0.001), which was significantly less than that in group A. This study found that there was regularity in the fluoroscopic angle for the fixation test during Micra TPS™ operation.Level of Evidence Level 3, local nonrandom sample.

In Vitro Drug Screening Using iPSC-Derived Cardiomyocytes of a Long QT-Syndrome Patient Carrying KCNQ1 & TRPM4 Dual Mutation: An Experimental Personalized Treatment.

Congenital long QT syndrome is a type of inherited cardiovascular disorder characterized by prolonged QT interval. Patient often suffer from syncopal episodes, electrocardiographic abnormalities and life-threatening arrhythmia. Given the complexity of the root cause of the disease, a combination of clinical diagnosis and drug screening using patient-derived cardiomyocytes represents a more effective way to identify potential cures. We identified a long QT syndrome patient carrying a heterozygous KCNQ1 c.656G>A mutation and a heterozygous TRPM4 c.479C>T mutation. Implantation of implantable cardioverter defibrillator in combination with conventional medication demonstrated limited success in ameliorating long-QT-syndrome-related symptoms. Frequent defibrillator discharge also caused deterioration of patient quality of life. Aiming to identify better therapeutic agents and treatment strategy, we established a patient-specific iPSC line carrying the dual mutations and differentiated these patient-specific iPSCs into cardiomyocytes. We discovered that both verapamil and lidocaine substantially shortened the QT interval of the long QT syndrome patient-specific cardiomyocytes. Verapamil treatment was successful in reducing defibrillator discharge frequency of the KCNQ1/TRPM4 dual mutation patient. These results suggested that verapamil and lidocaine could be alternative therapeutic agents for long QT syndrome patients that do not respond well to conventional treatments. In conclusion, our approach indicated the usefulness of the in vitro disease model based on patient-specific iPSCs in identifying pharmacological mechanisms and drug screening. The long QT patient-specific iPSC line carrying KCNQ1/TRPM4 dual mutations also represents a tool for further understanding long QT syndrome pathogenesis.

Influence of thermal processing on the quality of hawthorn: Quality markers of heat-processed hawthorn.

Hawthorn and its derived products are used worldwide as foods as well as complementary medicine. During the preparation of hawthorn, heating and thermal processing are frequently reported. The thermal processing will change the medicinal purposes and modify the efficacy of hawthorn. However, details including the chemical profile shifting and quality markers of heat-processed hawthorn have not been well understood. In this study, we analyzed the hawthorn samples processed at different temperatures and different times by ultraviolet visible absorption spectrum and liquid-mass spectrometry technologies combined with multivariate statistical analysis. It was revealed for the first time that thermal processing could greatly change the ultraviolet-visible absorption spectra and chemical profiles of hawthorn even with heat treatment at 130°C for 10 min. And the ultraviolet visible absorption spectrum, especially the ratio value (RA500 nm/400 nm ), was a descriptive and qualitative indicator of heating degree for the thermal processing at the macroscopic level. Several components, such as hyperoside, chlorogenic acid, quercetin, and apigenin, decreased or increased in content during the processing, and they could be utilized as the chemical quality markers. The proposed quality markers for heat-processed hawthorn will be helpful for further optimizing the processing conditions of hawthorn.

Evaluation of Unified Healthcare Efficiency in China: A Meta-Frontier Non-radial Directional Distance Function Analysis During 2009-2019.

In this study, we analyze the unified healthcare efficiency in China at the regional level from 2009 to 2019. To accurately evaluate the evolution of unified efficiency from both static and dynamic perspectives, we combine the non-radial directional distance function and the meta-frontier method to evaluate the unified healthcare efficiency and its dynamic changes. This new approach allows for regional heterogeneity and non-radial slack simultaneously. The decomposition of the meta-frontier non-radial Malmquist unified healthcare efficiency index (MNMHEI) can be used to identify the driving factors of dynamic changes. The results show that the unified healthcare efficiency in eastern China is generally higher than that in non-eastern China from the static perspective, implying significant regional differences. Moreover, the unified efficiency in both eastern and non-eastern regions shows similar time trends and reaches the maximum in 2012. From the dynamic perspective, the unified healthcare efficiency increases annually by 2.68% during the study period. This increase in eastern China as a technology leader is mainly driven by technological progress, whereas the increase in non-eastern China is mainly driven by a better catch-up effect. In addition, the impact of the reform on the non-eastern region is more significant for the decreasing technology gap, the stronger growth momentum of technological progress, and global innovative provinces.