Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review.

Atrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation. Comparing general anesthesia with conscious sedation, we find that general anesthesia provides superior catheter stability due to reduced respiratory variability, resulting in more effective lesion formation, and reduced pulmonary vein reconnection. The use of high-frequency jet ventilation under general anesthesia, delivering low tidal volumes, effectively minimizes left atrial movement, decreasing catheter displacement and procedure time, and reducing recurrence in paroxysmal atrial fibrillation. An alternative, high-frequency low tidal volume ventilation using conventional ventilators, also shows improved catheter stability and lesion durability compared to traditional ventilation methods. However, a detailed comparative study of high-frequency jet ventilation, high-frequency low tidal volume ventilation, and conventional mechanical ventilation in catheter ablation for atrial fibrillation is lacking. This review emphasizes the need for such studies to identify optimal anesthetic techniques, potentially enhancing patient outcomes in atrial fibrillation treatment. Our findings suggest that careful selection of anesthetic methods, including ventilation strategies, plays a crucial role in the success of catheter ablation for atrial fibrillation, warranting further research for evidence-based practice.

Monitoring Variability of Laboratory Results in a Clinical Data Warehouse Using Automatic Dashboard.

Hospital laboratory results are a significant data source in Clinical Data Ware-houses (CDW). To ensure comparability across healthcare organizations and for use in research studies, the results need to be interoperable. The LOINC (Logical Observation Identifiers, Names, and Codes) terminology provides a unique identifier for local codes for lab tests, enabling interoperability. However, in real-world, events occur over time and can disrupt the distribution of lab result values. For example, new equipment may be added to the analysis pipeline, a machine may be replaced, formulas may evolve due to new scientific knowledge, and legacy terminologies may be adopted. This article proposes a pipeline for creating an automated dashboard to monitor these events and data quality. We used automatic change point detection methods such as PELT for event detection in lab results. For a given LOINC code, we create a dashboard that summarizes the number of local codes mapped, and the number of patients (by sex, age, and hospital service) associated with the code. Finally, the dashboard enables the visualization of time events that disrupt the signal distribution. The biologists were able to explain to us the changes for several biological assays.

BioTrojans: viscoelastic microvalve-based attacks in flow-based microfluidic biochips and their countermeasures.

Flow-based microfluidic biochips (FMBs) are widely used in biomedical research and diagnostics. However, their security against potential material-level cyber-physical attacks remains inadequately explored, posing a significant future challenge. One of the main components, polydimethylsiloxane (PDMS) microvalves, is pivotal to FMBs' functionality. However, their fabrication, which involves thermal curing, makes them susceptible to chemical tampering-induced material degradation attacks. Here, we demonstrate one such material-based attack termed "BioTrojans," which are chemically tampered and optically stealthy microvalves that can be ruptured through low-frequency actuations. To chemically tamper with the microvalves, we altered the associated PDMS curing ratio. Attack demonstrations showed that BioTrojan valves with 30:1 and 50:1 curing ratios ruptured quickly under 2 Hz frequency actuations, while authentic microvalves with a 10:1 ratio remained intact even after being actuated at the same frequency for 2 days (345,600 cycles). Dynamic mechanical analyzer (DMA) results and associated finite element analysis revealed that a BioTrojan valve stores three orders of magnitude more mechanical energy than the authentic one, making it highly susceptible to low-frequency-induced ruptures. To counter BioTrojan attacks, we propose a security-by-design approach using smooth peripheral fillets to reduce stress concentration by over 50% and a spectral authentication method using fluorescent microvalves capable of effectively detecting BioTrojans.

Measurement of Aerosol Particles from Vibrated Lab Coats.

A study was conducted to measure aerosol particles emitted from laboratory coats (lab coats) under vibration, comparing them with a suit and a shirt. This study focused on particles ranging from 0.3 µm to >10 µm. Experimental results showed that lab coat vibration increased particles >5 µm while reducing submicron particles. The lab coat (old and used) exhibited greater particle concentration variations under vibration compared to those using the new lab coat or the shirt. Contrastingly, the suit under vibration did not significantly affect particle concentrations. These findings highlight the impact of lab coat vibration on aerosol particle concentrations in the surrounding air, which is important for work environments.

Genomic Sequence of Streptococcus salivarius MDI13 and Latilactobacillus sakei MEI5: Two Promising Probiotic Strains Isolated from European Hakes (Merluccius merluccius, L.).

Frequently, diseases in aquaculture have been fought indiscriminately with the use of antibiotics, which has led to the development and dissemination of (multiple) antibiotic resistances in bacteria. Consequently, it is necessary to look for alternative and complementary approaches to chemotheraphy that are safe for humans, animals, and the environment, such as the use of probiotics in fish farming. The objective of this work was the Whole-Genome Sequencing (WGS) and bioinformatic and functional analyses of S. salivarius MDI13 and L. sakei MEI5, two LAB strains isolated from the gut of commercial European hakes (M. merluccius, L.) caught in the Northeast Atlantic Ocean. The WGS and bioinformatic and functional analyses confirmed the lack of transferable antibiotic resistance genes, the lack of virulence and pathogenicity issues, and their potentially probiotic characteristics. Specifically, genes involved in adhesion and aggregation, vitamin biosynthesis, and amino acid metabolism were detected in both strains. In addition, genes related to lactic acid production, active metabolism, and/or adaptation to stress and adverse conditions in the host gastrointestinal tract were detected in L. sakei MEI5. Moreover, a gene cluster encoding three bacteriocins (SlvV, BlpK, and BlpE) was identified in the genome of S. salivarius MDI13. The in vitro-synthesized bacteriocin BlpK showed antimicrobial activity against the ichthyopathogens Lc. garvieae and S. parauberis. Altogether, our results suggest that S. salivarius MDI13 and L. sakei MEI5 have a strong potential as probiotics to prevent fish diseases in aquaculture as an appropriate alternative/complementary strategy to the use of antibiotics.

Sudden infantile death due to left ventricular myocardial ischemia associated with undiagnosed single coronary artery of Lipton's type LII-B.

Single coronary artery (SCA) is a rare malformation, particularly in isolation without other congenital heart defects. Here, we describe a case of sudden infantile death due to myocardial ischemia associated with undiagnosed SCA. A 1-year-and-7-month-old female infant died suddenly after vomiting at home. A medicolegal autopsy revealed that the orifice of the right coronary artery (RCA) was absent. As expected, the left coronary artery was detached from the left coronary sinus; however, the ostium was covered with a flap-like fibrous ridge. The thin RCA originated from the left main trunk (LMT) and passed between the aorta and pulmonary artery trunk. The left circumflex artery branched from the LMT at a right angle. Judging from the origin and course of the anomalous RCA, the deceased was diagnosed with SCA of Lipton's type LII-B. Microscopic examination revealed ischemic changes around the endocardium of the lateral wall of the left ventricle (LV) rather than on the side of the abnormal RCA. This evoked attention, as there appeared to be some discrepancy. To the best of our knowledge, this is the first case report describing sudden infantile death related to LV myocardial ischemia associated with undiagnosed SCA of Lipton's type LⅡ-B.

Enhancing Cadaver Labs for Endoscopic Spine Surgery: the glove as the "lesion".

OBJECTIVE: We describe a novel yet simple training exercise for residents who are being introduced to endoscopic spine surgery. METHODS: Prior to residents training on the endoscopic interlaminar approach, the course faculty performed an endoscopic transforaminal approach and inserted a small piece of a surgical glove into the ventral epidural space of a cadaveric torso. The transforaminal approach did not alter the anatomy of the interlaminar approach so the residents were able to practice as if it were a de novo situation. Placing the small "lesion" provided an exercise to confirm the residents were able to safely access the area and provided practice for them to carefully grasp the "lesion" and remove it. Prior to resident training on the endoscopic transforaminal approach, the course faculty utilized an interlaminar approach to place the "lesion". A questionnaire with a five-point Likert scale of agreement was completed by the residents to assess their experience with the training exercise. RESULTS: Five residents attended the cadaver lab, and 100% strongly agreed that the cadaver lab provided a realistic representation of the procedure demonstrated, the "lesion" removal added to their educational experience, and they were overall satisfied with the educational session. CONCLUSION: One of the lessons learned with this exercise that we will consider in future courses would be to place a radiodense "lesion" that could be visualized on fluoroscopy, and serve as a radiologic target to find. This can help guide the trainee in knowing where to search if the "lesion" is more difficult to find.

Interprofessional Modules for Teaching Skills in Skill Labs.

Clinical skills laboratories are educational facilities that have the potential benefit for undergraduate and postgraduate medical students and medical staff. They provide a safe and protected environment in which the learner can practice clinical skills before using them in real clinical settings. These skills laboratories help to ensure that all students acquire the necessary techniques and are properly assessed before practicing on real patients. In addition, they support the acquisition, maintenance and enhancement of the clinical skills of students in the healthcare profession. Teaching skills in skill lab require a standardized module for each skill that can be applied to all the students universally. The study was started with the aim to solve a problem that has arisen as National Medical Council (NMC) has announced implementation of Competency based medical education (CBME) a new syllabus for medical education from 2019 MBBS batch that includes skill teaching. Faculty in various Medical colleges is not trained in developing modules and teaching skills to students in skill lab. There are no standardized teaching modules for skills training in skill laboratories. As part of the project we decided to develop modules for the two competencies to be taught in the skill lab for the subject Otorhinolaryngology i.e. Otoscopy and Anterior Nasal packing; NMC guidelines being the benchmark in developing these modules. Later modules were also to be implemented on sample students to get a feedback on the structure of the module for further improvement. These modules developed as part of the project will help as a baseline tool for developing other modules in different subjects by various Institutes. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04568-0.