His bundle pacing versus left bundle branch pacing on ventricular function in atrial fibrillation patients referred for pacing: a prospective crossover comparison.

BACKGROUND: His bundle pacing (HBP) and left bundle branch pacing (LBBP) both provide physiologic pacing which maintain left ventricular synchrony. They both improve heart failure (HF) symptoms in atrial fibrillation (AF) patients. We aimed to assess the intra-patient comparison of ventricular function and remodeling as well as leads parameters corresponding to two pacing modalities in AF patients referred for pacing in intermediate term. METHODS: Uncontrolled tachycardia AF patients with both leads implantation successfully were randomized to either modality. Echocardiographic measurements, New York Heart Association (NYHA) classification, quality-of-life assessments and leads parameters were obtained at baseline and at each 6-month follow up. Left ventricular function including the left ventricular endo-systolic volume (LVESV), left ventricular ejection fraction (LVEF) and right ventricular (RV) function quantified by tricuspid annular plane systolic excursion (TAPSE) were all assessed. RESULTS: Consecutively twenty-eight patients implanted with both HBP and LBBP leads successfully were enrolled (69.1 ± 8.1 years, 53.6% male, LVEF 59.2% ± 13.7%). The LVESV was improved by both pacing modalities in all patients (n = 23) and the LVEF was improved in patients with baseline LVEF at less than 50% (n = 6). The TAPSE was improved by HBP but not LBBP (n = 23). CONCLUSION: In this crossover comparison between HBP and LBBP, LBBP was found to have an equivalent effect on LV function and remodeling but better and more stable parameters in AF patients with uncontrolled ventricular rates referred for atrioventricular node (AVN) ablation. HBP could be preferred in patients with reduced TAPSE at baseline rather than LBBP.

Effect of soil spatial configuration on Trifolium repens varies with resource amount.

Soil spatial heterogeneity involves nutrients being patchily distributed at a range of scales and is prevalent in natural habitats. However, little is known about the effect of soil spatial configurations at the small scale on plant foraging behavior and plant growth under different resource amounts. Here, we experimentally investigated how a stoloniferous species, Trifolium repens, responded to varied resource amounts and spatial configuration combinations. Plant foraging behavior (i.e., the orientation of the primary stolon, mean length of the primary stolon, foraging precision, and foraging scale) and plant growth (i.e., total biomass, root biomass, shoot biomass, and root/shoot) were compared among differently designed configurations of soil resources in different amounts. The relationships of foraging behavior and plant biomass were analyzed. The results showed that the effect of the spatial configuration of soil resources on Trifolium repens depended on the resource amount. Specifically, when the total resource amount was low, fragmented soil patches promoted root foraging and increased Trifolium repens plant biomass; however, when the total resource amount was high, the soil spatial configuration did not affect foraging behavior or plant growth. Our results also showed that plant growth was facilitated by root foraging scale to adapt to low resource amounts. We conclude that the spatial configuration of soil resources at small scales affects whole plant growth, which is mediated by a distinct foraging strategy. These findings contribute to a better understanding of how the growth strategy of clonal plants responds to heterogeneous environments caused by different resource amounts and its spatial configurations.

Comparison of synchronization between left bundle branch and his bundle pacing in atrial fibrillation patients: An intra-patient-controlled study.

BACKGROUND: His bundle pacing (HBP) is a physiological pacing strategy to preserve the electrical synchrony of ventricular conduction and left ventricular (LV) function. Left bundle branch pacing (LBBP) has emerged as an alternative physiological pacing technique. OBJECTIVE: To evaluate cardiac electrical and mechanical synchrony comparing LBBP and HBP in patients with permanent atrial fibrillation (AF). METHODS: Consecutive patients with symptomatic bradycardia and AF were enrolled from January to June of 2019. The cardiac electrical and mechanical synchrony in different pacing mode were evaluated at baseline and after implantation. RESULTS: Both HBP and LBBP were performed in 20 patients. LBBP significantly widened the QRS duration compared with the intrinsic conduction (113.2 ± 14.5  vs. 96.5 ± 16.2 ms; p = .01), while HBP did not (104.5 ± 22.3  vs. 96.5 ± 16.2 ms; p = .12). Both LBBP and HBP patients had similar LV myocardial strain measurements for the mechanical synchrony evaluation without significant change compared with baseline. There was no significant difference in right ventricular synchrony measurement between LBBP and HBP. Compared to HBP, LBBP had less interventricular synchrony (IMVD, 14.7 ± 9.2  vs. 3.1 ± 12.7 ms, p < .01; Ts-LV-RV, 37.9 ± 10.7  vs. 18.5 ± 10.8 ms, p < .001). CONCLUSIONS: Although LBBP's a physiological pacing mode can achieve a similar cardiac electrical and mechanical synchronization when compared to HBP, LBBP results in modest delay in RV activation, and the clinical implication remains to be studied.

Solid-phase synthesis of diverse spiroisoxazolinodiketopiperazines.

A convenient, efficient protocol to prepare diverse spiroisoxazolino-diketopiperazines via a parallel solid-supported synthesis was developed. The key steps are (1) a coupling reaction of an amino acid; (2) tosylation with concomitant ß-elimination to form an α, ß-unsaturated ester; (3) a 1,3-dipolar cycloaddition with an oxime to form isoxazoline rings; and (4) cyclic cleavage to release the product from the resin. All reaction steps and workup procedures were modified to allow the use of automated or semiautomated equipment. A 100-member demonstration library with two diversity sites was prepared in good purity and acceptable overall yields.

Parallel synthesis of natural product-like polyhydroxylated pyrrolidine and piperidine alkaloids.

The preparation of natural product-like polyhydroxylated pyrrolidine and piperidine alkaloids using a combination of solid- and solution-phase organic synthesis is described. The key intermediates, enantiopure five- or six-membered tri-O-benzyl cyclic nitrones, were efficiently prepared on solid support from accessible chiral furanosides and pyranosides, respectively. The substituent diversity was achieved by a diastereoselective addition of a variety of Grignard reagents to the cyclic nitrones in solution-phase synthesis. All reaction steps and work-up procedures were modified to allow the use of automated equipment. A 36-membered demonstration library with three diversity elements (core, configuration, and substituent) was prepared in good yield and purity.

Chromium-manganese selenide carbonyl complexes: paramagnetic clusters and relevance to C=O activation of acetone.

The paramagnetic even-electron cluster, [Et(4)N](2)[Se(2)Cr(3)(CO)(10)], was found to react readily with Mn(CO)(5)Br in acetone to produce two unprecedented mixed chromium-manganese selenide carbonyl complexes, [Et(4)N][Me(2)CSe(2){Mn(CO)(4)}{Cr(CO)(5)}(2)] ([Et(4)N][1]) and [Et(4)N](2)[Se(2)Mn(3)(CO)(10){Cr(CO)(5)}(2)] ([Et(4)N](2)[2]). X-ray crystallographic analysis showed that anion 1 consisted of two Se-Cr(CO)(5) moieties, which were further bridged by one isopropylene group and one Mn(CO)(4) moiety. The dianionic cluster 2 was shown to display a Se(2)Mn(3) square-pyramidal core with each Se atom externally coordinated by one Cr(CO)(5) group. The formation of complex 1, presumably via C=O activation of acetone, was further facilitated by acidification of the reaction of [Et(4)N](2)[Se(2)Cr(3)(CO)(10)] with Mn(CO)(5)Br in acetone. Complex 1 readily transformed into 2 upon treatment with Mn(2)(CO)(10) in a KOH/MeOH/MeCN solution. Cluster 2 was a 51-electron species, which readily converted to the known 49-electron cluster [Se(2)Mn(3)(CO)(9)](2-) upon heating and bubbling with CO. Magnetic studies of the even-electron cluster, [Et(4)N](2)[Se(2)Cr(3)(CO)(10)], and the odd-electron species, [Et(4)N](2)[2] and [PPN](2)[Se(2)Mn(3)(CO)(9)], were determined by the SQUID measurement to have 2, 3, and 1 unpaired electrons, respectively. In addition, the nature and formation of complexes 1 and 2 are discussed, and the magnetic properties and electrochemistry of [Se(2)Cr(3)(CO)(10)](2-), 2, and [Se(2)Mn(3)(CO)(9)](2-) were further studied and elucidated by molecular orbital calculations at the PW91 level of density functional theory.