Sequential hybrid ablation vs. surgical CryoMaze alone for treatment of atrial fibrillation: results of multicentre randomized controlled trial.

AIMS: Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation alone. METHODS AND RESULTS: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either radiofrequency catheter ablation [Hybrid Group (HG)] or no further treatment (Surgery Group). The primary efficacy endpoint was the first recurrence of AF/AT without class I or III antiarrhythmic drugs as assessed by implantable cardiac monitors. The primary clinical endpoint was a composite of hospitalization for arrhythmia recurrence, worsening of heart failure, cardioembolic event, or major bleeding. We analysed 113 and 116 patients in the Hybrid and Surgery Groups, respectively, with a median follow-up of 715 (IQR: 528-1072) days. The primary efficacy endpoint was significantly reduced in the HG [41.1% vs. 67.4%, hazard ratio (HR) = 0.38, 95% confidence interval (CI): 0.26-0.57, P < 0.001] as well as the primary clinical endpoint (19.9% vs. 40.1%, HR = 0.51, 95% CI: 0.29-0.86, P = 0.012). The trial groups did not differ in all-cause mortality (10.6% vs. 8.6%, HR = 1.17, 95%CI: 0.51-2.71, P = 0.71). The major complications of catheter ablation were infrequent (1.9%). CONCLUSION: Pre-emptively performed catheter ablation after the CryoMaze procedure was safe and associated with higher freedom from AF/AT and improved clinical outcomes.

Carbon dioxide mid-infrared sensing based on Dy3+-doped chalcogenide waveguide photoluminescence.

Climate-active gases, notably carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O), display fundamental absorption bands in the mid-infrared (mid-IR). The detection and monitoring of those gases could be enabled by the development of mid-IR optical sources. Broadband mid-IR on-chip light emission from rare-earth-doped chalcogenide photonic integrated circuits could provide a compact, efficient, and cost-effective gas sensing solution. Mid-IR photoluminescence of dysprosium-doped selenide ridge waveguides obtained under optical pumping at a telecommunication wavelength (∼1.3 µm) is investigated for Dy3+ ion concentrations in the 2500-10,000 ppmw range. CO2 detection at around 4.3 µm is then demonstrated based on absorption of this broadband mid-IR emission.

Sequential hybrid ablation versus surgical CryoMaze alone for treatment of atrial fibrillation (SurHyb Trial): a protocol of the multicentre randomized controlled trial.

BACKGROUND: Atrial fibrillation is common in patients with structural heart disease who are undergoing cardiac surgery. Surgical CryoMaze has been shown to be an effective treatment in several trials, but success rates have varied considerably, between 47-95%. The sequential hybrid approach, combining surgical CryoMaze followed by radiofrequency catheter ablation, can achieve high freedom from atrial arrhythmias. However, in patients with concomitant surgical atrial fibrillation treatment, data comparing the hybrid approach to CryoMaze alone are lacking. METHODS: The SurHyb study was designed as a prospective, open-label, multicentre randomized trial. Patients with non-paroxysmal atrial fibrillation who were scheduled for coronary artery bypass grafting or valve repair/replacement were randomized to either surgical CryoMaze alone or surgical CryoMaze followed by radiofrequency catheter ablation 3 months post-surgery. The primary outcome measure was arrhythmia-free survival without class I or III antiarrhythmic drugs, which has been evaluated using implantable cardiac monitors. CONCLUSIONS: This is the first randomized study that compares concomitant surgical CryoMaze alone with the staged hybrid surgical CryoMaze followed by catheter ablation, in patients with non-paroxysmal atrial fibrillation using rigorous rhythm monitoring. The results may contribute to the optimization of the treatment in patients undergoing concomitant CryoMaze for atrial fibrillation.

Personalized external aortic root support - how to implant it.

Personalized External Aortic Root Support (PEARS) is an evolving method of treatment for patients with a dilated aortic root or ascending aorta. This treatment is being adopted in an increasing number of centres. For the sake of the safety of the procedure a standardized surgical technique is necessary. The authors describe a surgical technique of implantation that is derived from their extensive experience.

Iron Deficiency in Patients with Advanced Heart Failure.

Background and Objectives: Iron deficiency (ID) is a common comorbidity in patients with heart failure. It is associated with reduced physical performance, frequent hospitalisations for heart failure decompensation, and high cardiovascular and overall mortality. The aim was to determine the prevalence of ID in patients with advanced heart failure on the waiting list for heart transplantation. Methods and Materials: We included 52 patients placed on the waiting list for heart transplantation in 2021 at our centre. The cohort included seven patients with LVAD (left ventricle assist device) as a bridge to transplantation implanted before the time of results collection. In addition to standard tests, the parameters of iron metabolism were monitored. ID was defined as a ferritin value <100 µg/L, or 100−299 µg/L if transferrin saturation (T-sat) is <20%. Results: ID was present in 79% of all subjects, but only in 35% of these patients anaemia was expressed. In the group without LVAD, ID was present in 82%, a median (lower−upper quartile) of ferritin level was 95.4 (62.2−152.1) µg/mL and mean T-sat was 0.18 ± 0.09. In LVAD group, ID was present in 57%, ferritin level was 268 (106−368) µg/mL and mean T-sat was 0.14 ± 0.04. Haemoglobin concentration was the same in patients with or without ID (133 ± 16) vs. (133 ± 23). ID was not associated with anaemia defined with regard to patient's gender. In 40.5% of cases, iron deficiency was accompanied by chronic renal insufficiency, compared to 12.5% of the patients without ID. In the patients with LVAD, ID was present in four out of seven patients, but the group was too small for reliable statistical testing due to low statistical power. Conclusions: ID was present in the majority of patients with advanced heart failure and was not always accompanied by anaemia and renal insufficiency. Research on optimal markers for the diagnosis of iron deficiency, especially for specific groups of patients with heart failure, is still ongoing.

Changes in surgical revascularization strategy after fractional flow reserve.

AIMS: In the randomized GRAFFITI trial, surgeons drew their strategy based on coronary angiography. When patients were randomized to fractional flow reserve (FFR)-guidance, surgeons were informed of the FFR values and asked to redraw their strategy. The aim of this study was to investigate the changes induced by FFR knowledge. METHODS AND RESULTS: The intended and performed strategy (before and after FFR) were compared. Among 172 patients, 84 with 300 lesions were randomized to the FFR-guided group. The intended strategy was to bypass 236 stenoses:108 with a venous and 128 with an arterial graft. After disclosing FFR, a change in strategy occurred in 64 lesions (21.3%) of 48 (55%) patients. Among 64 lesions for which the intended strategy was medical therapy, 16 (25%) were bypassed after disclosing FFR. The number of procedures with >1 venous graft planned was significantly reduced from 37 to 27 patients (p = .031). The proportion of on-pump surgery was significantly reduced from 71 to 61 patients (p = .006). The rates of clinical events at 1 year were similar between patients with or without at least one change in strategy. DISCUSSION: FFR-guided CABG is associated with a simplified surgical procedure in 55% of the patients, with similar clinical outcomes.

Recurrence of primary sclerosing cholangitis after liver transplantation - analysing the European Liver Transplant Registry and beyond.

Liver transplantation for primary sclerosing cholangitis (PSC) can be complicated by recurrence of PSC (rPSC). This may compromise graft survival but the effect on patient survival is less clear. We investigated the effect of post-transplant rPSC on graft and patient survival in a large European cohort. Registry data from the European Liver Transplant Registry regarding all first transplants for PSC between 1980 and 2015 were supplemented with detailed data on rPSC from 48 out of 138 contributing transplant centres, involving 1,549 patients. Bayesian proportional hazards models were used to investigate the impact of rPSC and other covariates on patient and graft survival. Recurrence of PSC was diagnosed in 259 patients (16.7%) after a median follow-up of 5.0 years (quantile 2.5%-97.5%: 0.4-18.5), with a significant negative impact on both graft (HR 6.7; 95% CI 4.9-9.1) and patient survival (HR 2.3; 95% CI 1.5-3.3). Patients with rPSC underwent significantly more re-transplants than those without rPSC (OR 3.6, 95% CI 2.7-4.8). PSC recurrence has a negative impact on both graft and patient survival, independent of transplant-related covariates. Recurrence of PSC leads to higher number of re-transplantations and a 33% decrease in 10-year graft survival.

Toward Chalcogenide Platform Infrared Sensor Dedicated to the In Situ Detection of Aromatic Hydrocarbons in Natural Waters via an Attenuated Total Reflection Spectroscopy Study.

The objective of this study is to demonstrate the successful functionalization of the surface of a chalcogenide infrared waveguide with the ultimate goal of developing an infrared micro-sensor device. First, a polyisobutylene coating was selected by testing its physico-chemical compatibility with a Ge-Sb-Se selenide surface. To simulate the chalcogenide platform infrared sensor, the detection of benzene, toluene, and ortho-, meta- and para-xylenes was efficaciously performed using a polyisobutylene layer spin-coated on 1 and 2.5 µm co-sputtered selenide films of Ge28Sb12Se60 composition deposited on a zinc selenide prism used for attenuated total reflection spectroscopy. The thickness of the polymer coating was optimized by attenuated total reflection spectroscopy to achieve the highest possible attenuation of water absorption while maintaining the diffusion rate of the pollutant through the polymer film compatible with the targeted in situ analysis. Then, natural water, i.e., groundwater, wastewater, and seawater, was sampled for detection measurement by means of attenuated total reflection spectroscopy. This study is a valuable contribution concerning the functionalization by a hydrophobic polymer compatible with a chalcogenide optical sensor designed to operate in the mid-infrared spectral range to detect in situ organic molecules in natural water.

Inorganic Salts of N-phenylbiguanidium(1+)-Novel Family with Promising Representatives for Nonlinear Optics.

Seven inorganic salts containing N-phenylbiguanide as a prospective organic molecular carrier of nonlinear optical properties were prepared and studied within our research of novel hydrogen-bonded materials for nonlinear optics (NLO). All seven salts, namely N-phenylbiguanidium(1+) nitrate (C2/c), N-phenylbiguanidium(1+) perchlorate (P-1), N-phenylbiguanidium(1+) hydrogen carbonate (P21/c), bis(N-phenylbiguanidium(1+)) sulfate (C2), bis(N-phenylbiguanidium(1+)) hydrogen phosphate sesquihydrate (P-1), bis(N-phenylbiguanidium(1+)) phosphite (P21), and bis(N-phenylbiguanidium(1+)) phosphite dihydrate (P21/n), were characterised by X-ray diffraction (powder and single-crystal X-ray diffraction) and by vibrational spectroscopy (FTIR and Raman). Two salts with non-centrosymmetric crystal structures-bis(N-phenylbiguanidium(1+)) sulfate and bis(N-phenylbiguanidium(1+)) phosphite-were further studied to examine their linear and nonlinear optical properties using experimental and computational methods. As a highly SHG-efficient and phase-matchable material transparent down to 320 nm and thermally stable to 483 K, bis(N-phenylbiguanidium(1+)) sulfate is a promising novel candidate for NLO.

Co-sputtered Pr3+-doped Ga-Ge-Sb-Se active waveguides for mid-infrared operation.

This work reports on the properties of luminescent waveguides based on quaternary Ga-Ge-Sb-Se amorphous thin films doped with praseodymium. The waveguides were fabricated via magnetron co-sputtering, followed by inductively coupled plasma reactive ion etching. The initial thin film thickness and optical properties were assessed and the spectroscopic properties of the waveguides were measured. The measurements show promising results-it is possible to obtain mid-infrared fluorescence at 2.5 and 4.5 µm by injecting near-infrared light at 1.5 µm as the pump beam. By comparing waveguides with various praseodymium concentrations, the optimal doping content for maximum fluorescence intensity was identified to be close to 4100 ppmw. Finally, correlation between the intensity of mid-infrared emission and the width/length of the waveguide is shown.

GaTe-Sb2Te3 thin-films phase change characteristics.

A radio frequency magnetron co-sputtering technique exploiting GaTe and ${\rm Sb}_2 {\rm Te}_3$Sb2Te3 targets was used for the fabrication of Ga-Sb-Te thin films. Prepared layers cover broad region of chemical composition (${\sim}{10.0 {-} 26.3}\,\, {\rm at.}$∼10.0-26.3at. % of Ga, ${\sim}{19.9 {-} 34.4}\,\, {\rm at.}$∼19.9-34.4at. % of Sb) while keeping Te content fairly constant (53.8-55.6 at. % of Te). Upon crystallization induced by annealing, large variations in electrical contrast were found, reaching a sheet resistance ratio of ${{R}_{\rm annealed}}/{{R}_{\rm as - deposited}}\;\sim{2.2} \times {{10}^{ - 8}}$Rannealed/Ras-deposited∼2.2×10-8 for the ${{\rm Ga}_{26.3}}{{\rm Sb}_{19.9}}{{\rm Te}_{53.8}}$Ga26.3Sb19.9Te53.8 layer. Phase transition from the amorphous to crystalline state further leads to huge changes of optical functions demonstrated by optical contrast values up to $|\Delta n| + |\Delta k| = {4.20}$|Δn|+|Δk|=4.20 for ${{\rm Ga}_{26.3}}{{\rm Sb}_{19.9}}{{\rm Te}_{53.8}}$Ga26.3Sb19.9Te53.8 composition.

Linear and nonlinear optical properties of co-sputtered Ge-Sb-Se amorphous thin films.

Amorphous Ge-Sb-Se thin films were co-sputtered from ${{\rm GeSe}_4}$GeSe4 and ${{\rm Sb}_2}{{\rm Se}_3}$Sb2Se3 targets. Depending on the film composition, linear optical properties were studied by ellipsometry. The Kerr coefficient and two-photon absorption coefficient were estimated using Sheik-Bahae's formalism for co-sputtered films of ${{\rm GeSe}_4} {\text -} {\rm Sb}_2{{\rm Se}_3}$GeSe4-Sb2Se3 compared to ${{\rm GeSe}_2}{\text -}{\rm Sb}_2{{\rm Se}_3}$GeSe2-Sb2Se3 pseudo-binary system and ${{\rm As}_2}{{\rm Se}_3}$As2Se3 as reference. The Kerr coefficient was found within the range of $4.9 {\unicode {x2013}}- 21 \times {10^{ - 18}}$4.9--21×10-18. Quantitatively by means of a figure of merit at 1.55 µm, thin films with compositions of ${{\rm Ge}_7}{\rm Sb}_{25}{\rm Se}_{68}$Ge7Sb25Se68 and ${{\rm Ge}_9}{\rm Sb}_{20}{\rm Se}_{71}$Ge9Sb20Se71 having an estimated Kerr coefficient of about ${10.1} \times {10^{ - 18}}\;{{\rm m}^2}{{\rm W}^{ - 1}}$10.1×10-18m2W-1 and ${13.4} \times {10^{ - 18}}\;{{\rm m}^2}{{\rm W}^{ - 1}}$13.4×10-18m2W-1 should be considered for the future nonlinear optical integrated platforms. Such compositions being close to ${({{\rm GeSe}_4})_{50}}{({{\rm Sb}_2}{{\rm Se}_3})_{50}}$(GeSe4)50(Sb2Se3)50 pseudo-binary (i.e., ${\rm Ge}_{7.5}{\rm Sb}_{25.0}{\rm Se}_{67.5}$Ge7.5Sb25.0Se67.5) provides just the trade-off between a high Kerr coefficient and low optical losses related to two-photon absorption.

Heart failure etiology and risk of right heart failure in adult left ventricular assist device support: the European Registry for Patients with Mechanical Circulatory Support (EUROMACS).

Objectives: Development of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation remains a leading cause of perioperative morbidity, end-organ dysfunction and mortality. The objective of this study was to investigate whether the etiology of HF (ischemic HF versus non-ischemic HF) affects the risk of RVF within admission for LVAD implantation and during long-term follow-up. Methods: Between January 2011 and June 27, 2018, 3536 patients were prospectively enrolled into EUROMACS registry. Adult patients (>18 years) who received a first time LVAD were included. When excluding patients with congenital, restrictive, hypertrophic, valvular cardiomyopathies, and myocarditis the total population consisted of 2404 patients. Results: The total cohort consists of 2404 patients. Mean age were 55 years and predominantly male sex [2024 (84.2%)]. At the time of LVAD implantation 1355 (56.4%) patients had ischemic HF and 1049 (43.6%) patients had non-ischemic HF. The incidence of RVF was significantly increased in the non-ischemic HF group in the adjusted model (p = .026). The relative risk difference for RVF in patients with non-ischemic HF was in the adjusted model increased by an absolute value of 5.1% (95% CI: 0.61-9.6). In the ischemic HF group 76 patients (13.4%) developed late RVF and 62 patients (14.8%) in the non-ischemic HF group (p = .56). No differences in occurrence of RVF between HF etiology was observed after 2 and 4 years of follow-up, respectively (crude: p = .25, adjusted (sex and age) p = .2 and crude: p = .59, adjusted (sex and age) p = .44). Conclusions: Patients with non-ischemic HF undergoing LVAD had an increased incidence of early RVF compared to patients with ischemic HF in a large European population. During follow-up after discharge 14% patients developed RVF. We recommend HF etiology to be considered in identifying patients who are at risk for postoperative RVF after LVAD implantation.

Intensity mediated change in the sign of ultrafast third-order nonlinear optical response in As2S2 thin films.

We study experimentally and theoretically the intensity-dependent off-resonant ultrafast third-order nonlinear optical response of As2S2 thin films. At low intensity, we observed saturable absorption with a negative (self-defocusing) nonlinear refractive index (n2) which at higher intensity switched over to reverse saturable absorption with a change in the sign of n2 to positive (self-focusing). Our findings constitute compelling evidence on how to dynamically tune the optical response with the intensity that has its origin in the combined effect of two-photon absorption and Pauli blocking. The results were explained with the help of time-resolved measurements and rigorous theoretical and numerical simulations.

Co-Crystals of 2-Amino-5-Nitropyridine Barbital with Extreme Birefringence and Large Second Harmonic Generation Effect.

Technological innovation enforces a revolutionized approach towards materials chemistry. In this paper a new methodology towards crystal engineering of polar materials for possible applications in linear or non-linear optics (NLO), as well as ferroelectric, pyroelectric or piezoelectric crystals is presented. The necessity to fulfil several criteria concerning symmetry, electron properties of the building blocks, and also mechanical and optical stability was achieved by fusion of a pharmaceutical molecule and an NLO-phore. Co-crystals of 2-amino-5-nitropyridine barbital, presented in this manuscript, show cutting-edge optical performance. Large second harmonic generation (SHG) efficiency (40 times better than potassium dihydrogen phosphate, KDP), extreme birefringence (2.7 times higher than for calcite), simplicity in preparation, and optical and mechanical stability of the product proves that in fact a new generation of smart materials was obtained.

Synthesis, Structure and Application of Intramolecularly-Coordinated Gallium Chalcogenides: Suitable Single-Source precursors for Gax Sey Materials.

Studies have been focused on the synthesis of N→Ga-coordinated organogallium selenides and tellurides [L1 Ga(µ-Se)]2 (1), [L2 Ga(µ-Se)]2 (2) and [L1 Ga(µ-Te)]2 (3), respectively, containing either N,C,N- or C,N-chelating ligands L1, 2 (L1 is {2,6-(Me2 NCH2 )2 C6 H3 }- and L2 is {2-(Et2 NCH2 )-4,6-tBu2 -C6 H2 }- ) having Ga/E (E=Se or Te) atoms in 1/1 ratio. To change the Ga/E ratio, an unusual N→Ga-coordinated organogallium tetraselenide L1 Ga(κ2 -Se4 ) (4) was prepared. An unprecedented complex (L1 Ga)2 (µ-Te2 )(µ-Te) (5), as the result of the non-stability of 3, was also isolated. Compound 2 is a suitable single-source precursor for the preparation of amorphous GaSe thin films by the spin coating. Moreover, simple heating of an octadecylamine solution of 2 provided, after work up, monoclinic Ga2 Se3 crystals with different crystallinity according to conditions used. Therefore, compound 2 may be also used as a source of Ga2 Se3 in the low-temperature doping process of Bi2 Se3 .

Mitral bioprosthetic valve leaflet fusion treated by balloon valvuloplasty in patients on ECMO.

We present two patients who required extracorporeal membrane oxygenation (ECMO) support after bioprosthetic mitral valve replacement, who developed early structural valve failure due to leaflet fusion. Percutaneous balloon valvuloplasty restored normal leaflet motion and allowed discontinuation of ECMO support.

Relationship of epigenetic variability of miR-124 to extracellular matrix remodelling and age-related MMP-3 expression in rheumatoid arthritis.

The aim of study was to examine relation among miR-124 and serum levels of selected cytokines and chemokines, MMP-3, production of auto-antibodies, and factors describing clinical activity (DAS28) and radiographic progression in rheumatoid arthritis (RA). A total of 80 RA patients according to the ACR classification criteria, and 32 control subjects were recruited into study. The measurements of miR-124 and U-6 expression, CRP, anti-CCP, rheumatoid factors (RFs), radiographs of both hands with calculation of total sharp score (TSS), DAS28 and cytokines, chemokines and MMP levels in serum were obtained from all RA patients. miR-124 was down-regulated in RA patients compared to controls (7-fold decrease). The miR-124 expression correlated to MMP-3 levels (p < 0.001), which were in multivariate analysis associated to age of RA onset. Higher levels were detected in younger subjects. No relation of miR-124 expression to measures of RA activity (DAS28 score; TSS), auto-antibodies (anti-CCP, RF, RF IgG, RF IgA, RF IgM), acute inflammatory markers (CRP, IL-6), and other cytokine and chemokines (IL-13, IL-15, IL-8, TNF-α, MCP-1, RANTES) was observed. In conclusion, we present a down-regulation of miR-124 in RA patients and its correlation to MMP-3 levels, which associated to age of RA onset.

Organization model for allotransplantations of cryopreserved vascular grafts in Czech Republic.

The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No. 296/2008 Coll.). The authors present an organizational model based on cooperation between the majority of Czech Transplant Centers with a tissue establishment licensed by the national competent authority. In various points, we are addressing individual aspects of experimental and clinical studies which affect clinical practice. Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013. The growing number of centers participating in this programme led to a growing number of patients who underwent transplantation of vascular allografts. In 2015 the numbers of transplanted fresh versus cryopreserved allografts in the Czech Republic were almost equal. Cooperation of the participating centers in the Czech Republic with the licensed Tissue Establishment made it possible to achieve a full compliance with the European Union Directives, and harmonized national legal norms and assured a high quality of cryopreserved vascular allografts.

[Polymyalgia rheumatica]. / Polymyalgia rheumatica.

Polymyalgia rheumatica is the most frequent inflammatory disease of people over 50 years of age. It mainly affects the Caucasian race and roughly 2-3 times as many women. From the viewpoint of etiology, polymyalgia rheumatica is a complex disease. Involved in its origin is genetic predisposition, factors of age and outer environment. 16-21 % of patients with polymyalgia rheumatica may at the same time have symptoms of giant cell arteritis. Diagnosis is made primarily on the basis of clinical symptoms and it is supported by the presence of laboratory signs of inflammation. There is no specific diagnostic test available for diagnosing polymyalgia rheumatica. In recent time modern imaging devices, e.g. ultrasonography or positron emission tomography, can be used in diagnosing the disease. In the past a number of diagnostic and classification criteria were established which may be used in diagnosing of polymyalgia rheumatica in general practice. The differential diagnostics of the disease is extensive. Before the treatment commencement it is necessary to rule out the presence of another disease with manifestations simulating polymyalgia rheumatica. The treatment strategy should draw on the current EULAR/ACR Recommendations for the treatment of polymyalgia rheumatica issued in 2015.Key words: polymyalgia rheumatica - positron emission tomography - prognosis - treatment - ultrasonography.