Clinical utility of oesophageal temperature monitoring in AF ablation: An updated meta-analysis and review of literature.

BACKGROUND: Atrial fibrillation (AF) ablation can lead to oesophageal thermal injuries (ETI). These are thought to be the precursor of the much rarer but frequently fatal atrio-oesophageal fistulas. Many centers performing AF ablation routinely use oesophageal temperature monitoring (ETM). This meta-analysis aims to determine the utility of ETM in preventing ETI in the context of radiofrequency catheter ablation of AF. METHODS: A systematic search of PubMed, Embase databases and Cochrane registry was performed comparing ETI between ETM and non-ETM strategies in AF ablation. Data on endoscopically determined ETI, AF recurrence, procedure time and ablation time were extracted. Statistical analyses including subgroup and covariate analyses were performed using random effect model in R platform. RESULTS: ETI were similar in both ETM (n = 864) and non- ETM groups (n = 639) (RR 1.04, 95 % CI 0.34-3.23) across 12 studies. AF recurrence was statistically similar in both groups (IRR 0.92, 95 % CI 0.73-1.17) but showed a lower trend in non-ETM group. Ablation time was numerically lower in the ETM group and procedure time was numerically higher trend in the ETM group; but they were not statistically significant. Covariate analysis found that posterior wall ablation power setting, additional linear ablation, BMI, use of GA or prophylactic PPI after ablation had no significant correlation in the incidence of ETI. CONCLUSION: ETM was not associated with a reduced incidence of ETI during AF ablation. Evidence supporting the routine use of ETM to reduce the risk of ETI or atrio-oesophageal fistulas is lacking.

Giant Aneurysms: Not So Giant in Behavior.

BACKGROUND: Giant intracranial aneurysms (GIAs) are very complex in their behavior and treatment procedure. There are various modalities of treatment. The annual rupture rate of GIA (6%) is higher than that of small aneurysms (1-3%). Neurosurgeons handle these aneurysms during operations. OBJECTIVE: We tried to analyze the intraoperative rupture rate (IRR) of GIA in relation to small aneurysms. IRR is concerned with the rupture of the aneurysms during operative handling. MATERIALS AND METHODS: For conducting the study, we compared the IRR of 7 GIAs and 45 small aneurysms during a span of 10 years. All the operations were performed by the same team and the same principal surgeon. IRR was compared by statistical analysis. RESULT: Z-test was done to compare the two rates: Z = 0.68 and P = 0.49. According to our study, the IRR of GIA is not statistically different from small aneurysms. The IRR of GIA is not higher because of three factors which we have analyzed: 1) layers of intraaneurysmal thrombus, 2) fibrin deposition on the aneurysm wall, and 3) blocked neck of the aneurysm by thrombus. CONCLUSION: The IRR of GIA is not different from small aneurysms.

What Are "Bioplastics"? Defining Renewability, Biosynthesis, Biodegradability, and Biocompatibility.

Today, plastic materials are mostly made from fossil resources, and they are characterized by their long lifetime and pronounced persistence in the open environment. These attributes of plastics are one cause of the ubiquitous pollution we see in our environment. When plastics end up in the environment, most of this pollution can be attributed to a lack of infrastructure for appropriately collecting and recycling plastic waste, mainly due to mismanagement. Because of the huge production volumes of plastics, their merits of being cheap to produce and process and their recalcitrance have turned into a huge disadvantage, since plastic waste has become the end point of our linear economic usage model, and massive amounts have started to accumulate in the environment, leading to microplastics pollution and other detrimental effects. A possible solution to this is offered by "bioplastics", which are materials that are either (partly) biobased and/or degradable under defined conditions. With the rise of bioplastics in the marketplace, several standards and test protocols have been developed to assess, certify, and advertise their properties in this respect. This article summarizes and critically discusses different views on bioplastics, mainly related to the properties of biodegradability and biobased carbon content; this shall allow us to find a common ground for clearly addressing and categorizing bioplastic materials, which could become an essential building block in a circular economy. Today, bioplastics account for only 1-2% of all plastics, while technically, they could replace up to 90% of all fossil-based plastics, particularly in short-lived goods and packaging, the single most important area of use for conventional plastics. Their replacement potential not only applies to thermoplastics but also to thermosets and elastomers. Bioplastics can be recycled through different means, and they can be made from renewable sources, with (bio)degradability being an option for the mismanaged fraction and special applications with an intended end of life in nature (such as in seed coatings and bite protection for trees). Bioplastics can be used in composites and differ in their properties, similarly to conventional plastics. Clear definitions for "biobased" and "biodegradable" are needed to allow stakeholders of (bio)plastics to make fact-based decisions regarding material selection, application, and end-of-life options; the same level of clarity is needed for terms like "renewable carbon" and "bio-attributed" carbon, definitions of which are summarized and discussed in this paper.