Left bundle branch area pacing using a lumenless lead: A systematic literature review and meta-analysis.

BACKGROUND: Although left bundle branch area pacing (LBBAP) has been shown to be a feasible option for delivering physiological pacing, data are largely limited to single-center reports. The aim of this analysis was to systematically assess the safety and efficacy of LBBAP with the Model 3830 lead among primarily bradycardia patients. METHODS AND RESULTS: PubMed, Embase, Cochrane Library, and Google Scholar were searched for full-text articles on LBBAP using the SelectSecure Model 3830 lumenless lead. Rates and means were estimated using random- and mixed-effects models. Of 3395 articles, 53 met inclusion criteria, representing 6061 patients undergoing an implant attempt. Average patient age was 68.1 years (95% CI: 66.6, 69.6) and 53.1% were male (95% CI: 50.5%, 55.7%). The average implant success rate among bradycardia-indicated patients was 92.7% (95% CI: 89.5%, 94.9%). The overall estimated procedural adverse event rate was 2.5% (95% CI: 1.1%, 5.4%). The estimated septal perforation rate at implant was 1.6% (95% CI: 1.0%, 2.6%) with no adverse clinical sequelae reported. Pacing thresholds were low at implant (0.67 V [95% CI: 0.64, 0.70]) and remained stable through 12 months (0.76 V [95% CI: 0.72, 0.80]). Among bradycardia-indicated patients, LVEF remained stable from baseline to post-implant (59.5% [95% CI: 57.9%, 61.1%] vs. 60.1% [95% CI: 58.5%, 61.7%]). CONCLUSION: This meta-analysis including 6061 patients implanted with a Model 3830 lead for LBBAP found an average implant success rate of 92.7% and a procedural adverse event rate of 2.5% with stable electrical parameters and LVEF post-implant.

An inguinal hernia 'hard to stomach'.

Inguinal hernias containing the stomach are extremely rare, and have never been described in females. We are reporting the case of a 79 year old female who presented in septic shock with a left inguinal hernia containing the stomach, resulting in gastric perforation and loss of abdominal domain. She underwent emergency exploratory laparotomy with manual reduction of the hernia, wedge resection of the perforated gastric segment, abdominal washout, and closure of the abdominal fascia using biological mesh. She had a complicated but successful postoperative course, and was discharged to a rehabilitation center three weeks after hospital admission.

Reading Food Experiences from the Face: Effects of Familiarity and Branding of Soy Sauce on Facial Expressions and Video-Based RPPG Heart Rate.

Food experiences are not only driven by the food's intrinsic properties, such as its taste, texture, and aroma, but also by extrinsic properties such as visual brand information and the consumers' previous experiences with the foods. Recent developments in automated facial expression analysis and heart rate detection based on skin color changes (remote photoplethysmography or RPPG) allow for the monitoring of food experiences based on video images of the face. RPPG offers the possibility of large-scale non-laboratory and web-based testing of food products. In this study, results from the video-based analysis were compared to the more conventional tests (scores of valence and arousal using Emojis and photoplethysmography heart rate (PPG)). Forty participants with varying degrees of familiarity with soy sauce were presented with samples of rice and three commercial soy sauces with and without brand information. The results showed that (1) liking and arousal were affected primarily by the specific tastes, but not by branding and familiarity. In contrast, facial expressions were affected by branding and familiarity, and to a lesser degree by specific tastes. (2) RPPG heart rate and PPG both showed effects of branding and familiarity. However, RPPG heart rate needs further development because it underestimated the heart rate compared to PPG and was less sensitive to changes over time and with activity (viewing of brand information and tasting). In conclusion, this study suggests that recording of facial expressions and heart rates may no longer be limited to laboratories but can be done remotely using video images, which offers opportunities for large-scale testing in consumer science.

Predictors of Sudden Cardiac Arrest Among Patients With Post-Myocardial Infarction Ejection Fraction Greater Than 35.

Background Sudden cardiac arrest (SCA) risk increases after myocardial infarction (MI) in patients with a reduced ejection fraction (EF). However, the risk factors for SCA among patients with a post-MI EF >35% remain poorly understood. Methods and Results Using the Optum de-identified electronic health record data set from 2008 to 2017, we identified patients with an incident MI diagnosis and troponin elevation who had a post-MI EF >35% and underwent coronary angiography. Primary outcome was SCA within 1 year post-MI. The database was divided into derivation (70%) and validation (30%) cohorts by random selection. Cox proportional hazard regression was used to generate and validate a risk prediction model. Among 31 286 patients with an MI (median age 64.1; 39% female; 87% White), 499 experienced SCA within 1 year post-MI (estimated probability 1.8%). Lack of revascularization at MI, post-MI EF <50%, Black race, renal failure, chronic obstructive pulmonary disease, antiarrhythmic therapy, and absence of beta blocker therapy were independent predictors of SCA. A multivariable model consisting of these variables predicted SCA risk (C-statistic 0.73). Based on this model, the estimated annual probability of SCA was 4.4% (95% CI, 3.9-4.9) in the highest quartile of risk versus 0.6% (95% CI, 0.4-0.8) in the lowest quartile. Conclusions Patients with a post-MI EF >35% have a substantial annual risk of SCA. A risk model consisting of acute coronary revascularization, EF, race, renal failure, chronic obstructive pulmonary disease, antiarrhythmic therapy, and beta blocker therapy can identify patients with higher risk of SCA, who may benefit from further risk stratification and closer monitoring.

Implantable Cardioverter-Defibrillator Shocks During COVID-19 Outbreak.

Background COVID-19 was temporally associated with an increase in out-of-hospital cardiac arrests, but the underlying mechanisms are unclear. We sought to determine if patients with implantable defibrillators residing in areas with high COVID-19 activity experienced an increase in defibrillator shocks during the COVID-19 outbreak. Methods and Results Using the Medtronic (Mounds View, MN) Carelink database from 2019 and 2020, we retrospectively determined the incidence of implantable defibrillator shock episodes among patients residing in New York City, New Orleans, LA, and Boston, MA. A total of 14 665 patients with a Medtronic implantable defibrillator (age, 66±13 years; and 72% men) were included in the analysis. Comparing analysis time periods coinciding with the COVID-19 outbreak in 2020 with the same periods in 2019, we observed a larger mean rate of defibrillator shock episodes per 1000 patients in New York City (17.8 versus 11.7, respectively), New Orleans (26.4 versus 13.5, respectively), and Boston (30.9 versus 20.6, respectively) during the COVID-19 surge. Age- and sex-adjusted hurdle model showed that the Poisson distribution rate of defibrillator shocks for patients with ≥1 shock was 3.11 times larger (95% CI, 1.08-8.99; P=0.036) in New York City, 3.74 times larger (95% CI, 0.88-15.89; P=0.074) in New Orleans, and 1.97 times larger (95% CI, 0.69-5.61; P=0.202) in Boston in 2020 versus 2019. However, the binomial odds of any given patient having a shock episode was not different in 2020 versus 2019. Conclusions Defibrillator shock episodes increased during the higher COVID-19 activity in New York City, New Orleans, and Boston. These observations may provide insights into COVID-19-related increase in cardiac arrests.

Redefining the Classifications of Response to Cardiac Resynchronization Therapy: Results From the REVERSE Study.

OBJECTIVES: This study sought to assess the impact of a more detailed classification of response on survival. BACKGROUND: Cardiac resynchronization therapy (CRT) improves functional status and outcomes in selected populations with heart failure (HF). However, approximately 30% of patients do not improve with CRT by various metrics, and they are traditionally classified as nonresponders. METHODS: REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) was a randomized trial of CRT among patients with mild HF. Patients were classified as Improved, Stabilized, or Worsened using prespecified criteria based on the clinical composite score (CCS) and change in left ventricular end-systolic volume index (LVESVi). All-cause mortality across CRT ON subgroups at 5 years was compared. RESULTS: Of the 406 subjects surviving 1 year, 5-year survival differed between CCS subgroups (p = 0.03), with increased mortality in the Worsened response group. Of the 353 subjects with adequate echocardiograms, survival differed significantly between response groups (p < 0.001), also due to increased mortality in the Worsened group. When combining CCS and LVESVi results, the lowest survival was observed among subjects who worsened for both measures, whereas the highest survival occurred in subjects who did not worsen by either endpoint. Multivariate analysis showed that LVESVi worsening with CRT at 6 months, baseline LVESVi, and gender were independent predictors of survival. CONCLUSIONS: For both CCS and reverse remodeling, patients who worsen with CRT have a high mortality, although remodeling was the more important endpoint. Patients who stabilize early with CRT have a much better prognosis than previously recognized, suggesting that the current convention of nonresponder classification should be modified. (REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction]; NCT00271154).

Effect of Branding and Familiarity of Soy Sauces on Valence and Arousal as Determined by Facial Expressions, Physiological Measures, Emojis, and Ratings.

Food experiences can be summarized along two main dimensions: valence and arousal, which can be measured explicitly with subjective ratings or implicitly with physiological and behavioral measures. Food experiences are not only driven by the food's intrinsic properties, such as its taste, texture, and aroma, but also by extrinsic properties such as brand information and the consumers' previous experiences with the foods. In this study, valence and arousal to intrinsic and extrinsic properties of soy sauce were measured in consumers that varied in their previous experience with soy sauce, using a combination of explicit (scores and emojis), implicit (heart rate and skin conductance), and behavioral measures (facial expressions). Forty participants, high- and low-frequency users, were presented with samples of rice and three commercial soy sauces without and with brand information that either matched or non-matched the taste of the soy sauce. In general, skin conductance and facial expressions showed relatively low arousal during exposure to the brand name and again lowest arousal during tasting. Heart rate was lowest during exposure to the brand name and increased during tasting probably resulting from the motor activity during chewing. Furthermore, the results showed that explicit liking and arousal scores were primarily affected by the taste of the specific soy sauce and by the participants' previous experience with soy sauces. These scores were not affected by branding information. In contrast, facial expressions, skin conductance, and heart rate were primarily affected by (1) the participants' level of experience with soy sauce, (2) whether or not branding information was provided, and (3) whether or not the branding information matched with the taste. In conclusion, this study suggests that liking scores may be most sensitive to the food's intrinsic taste properties, whereas implicit measures and facial expressions may be most sensitive to extrinsic properties such as brand information. All measures were affected by the consumers' previous food experiences.

The Use of an Automated System (GreenFeed) to Monitor Enteric Methane and Carbon Dioxide Emissions from Ruminant Animals.

Ruminant animals (domesticated or wild) emit methane (CH4) through enteric fermentation in their digestive tract and from decomposition of manure during storage. These processes are the major sources of greenhouse gas (GHG) emissions from animal production systems. Techniques for measuring enteric CH4 vary from direct measurements (respiration chambers, which are highly accurate, but with limited applicability) to various indirect methods (sniffers, laser technology, which are practical, but with variable accuracy). The sulfur hexafluoride (SF6) tracer gas method is commonly used to measure enteric CH4 production by animal scientists and more recently, application of an Automated Head-Chamber System (AHCS) (GreenFeed, C-Lock, Inc., Rapid City, SD), which is the focus of this experiment, has been growing. AHCS is an automated system to monitor CH4 and carbon dioxide (CO2) mass fluxes from the breath of ruminant animals. In a typical AHCS operation, small quantities of baiting feed are dispensed to individual animals to lure them to AHCS multiple times daily. As the animal visits AHCS, a fan system pulls air past the animal's muzzle into an intake manifold, and through an air collection pipe where continuous airflow rates are measured. A sub-sample of air is pumped out of the pipe into non-dispersive infra-red sensors for continuous measurement of CH4 and CO2 concentrations. Field comparisons of AHCS to respiration chambers or SF6 have demonstrated that AHCS produces repeatable and accurate CH4 emission results, provided that animal visits to AHCS are sufficient so emission estimates are representative of the diurnal rhythm of rumen gas production. Here, we demonstrate the use of AHCS to measure CO2 and CH4 fluxes from dairy cows given a control diet or a diet supplemented with technical-grade cashew nut shell liquid.

A Chronic, Conscious Large Animal Platform to Quantify Therapeutic Effects of Sacral Neuromodulation on Bladder Function.

PURPOSE: Sacral neuromodulation is a Food and Drug Administration approved therapy for urinary urge incontinence, urgency-frequency and fecal incontinence. Most preclinical studies have used anesthetized preparations in small animals. To expand the testing capabilities of sacral neuromodulation stimulation parameters and novel concepts we created a large animal model in fully conscious sheep. MATERIALS AND METHODS: Six adult female sheep were tested weekly using 10 trials of single fill cystometry, similar to clinical urodynamics. Maximal bladder capacity was measured without (trials 1 to 5) and with (trials 6 to 10) sacral neuromodulation. A mixed effects regression model was used to analyze the effect of sacral neuromodulation on bladder capacity. RESULTS: Acute sacral neuromodulation significantly increased bladder capacity in conscious female sheep from 75.2 to 118.7 ml, an almost 60% increase. This was not simply an effect of repeat cystometric trials since testing without sacral neuromodulation was not associated with an increase in bladder capacity. CONCLUSIONS: These data demonstrate the effects of acute sacral neuromodulation on bladder capacity in the conscious sheep. This model represents a useful testing platform for novel sacral neuromodulation concepts such as alternate methods and parameters of therapy delivery.

Proteasome function is required for platelet production.

The proteasome inhibiter bortezomib has been successfully used to treat patients with relapsed multiple myeloma; however, many of these patients become thrombocytopenic, and it is not clear how the proteasome influences platelet production. Here we determined that pharmacologic inhibition of proteasome activity blocks proplatelet formation in human and mouse megakaryocytes. We also found that megakaryocytes isolated from mice deficient for PSMC1, an essential subunit of the 26S proteasome, fail to produce proplatelets. Consistent with decreased proplatelet formation, mice lacking PSMC1 in platelets (Psmc1(fl/fl) Pf4-Cre mice) exhibited severe thrombocytopenia and died shortly after birth. The failure to produce proplatelets in proteasome-inhibited megakaryocytes was due to upregulation and hyperactivation of the small GTPase, RhoA, rather than NF-κB, as has been previously suggested. Inhibition of RhoA or its downstream target, Rho-associated protein kinase (ROCK), restored megakaryocyte proplatelet formation in the setting of proteasome inhibition in vitro. Similarly, fasudil, a ROCK inhibitor used clinically to treat cerebral vasospasm, restored platelet counts in adult mice that were made thrombocytopenic by tamoxifen-induced suppression of proteasome activity in megakaryocytes and platelets (Psmc1(fl/fl) Pdgf-Cre-ER mice). These results indicate that proteasome function is critical for thrombopoiesis, and suggest inhibition of RhoA signaling as a potential strategy to treat thrombocytopenia in bortezomib-treated multiple myeloma patients.

Circulating angiogenic modulatory factors predict survival and functional class in pulmonary arterial hypertension.

The diagnosis of pulmonary arterial hypertension (PAH) is frequently delayed. We hypothesized that circulating angiogenic modulatory protein levels might correspond with vascular remodeling activity and serve as sensitive biomarkers of PAH. Levels of soluble endoglin (sEng), soluble vascular endothelial growth factor receptor-1 (sVEGFR1), N-terminal brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and other biomarkers were measured in peripheral blood from 97 PAH patients, 16 first-degree relatives of idiopathic or heritable pulmonary arterial hypertension (HPAH) patients, and 56 controls, and correlated with disease, functional class, hemodynamic parameters, exercise capacity, and transplant-free survival. Endoglin expression was analyzed in lung tissues of six individuals with idiopathic or HPAH and four individuals without PAH. Levels of sEng, sVEGFR1, CRP, and NT-proBNP were elevated in Group I PAH of diverse etiologies, with sEng performing better than NT-proBNP in detecting PAH (receiver operator characteristic-area-under-the curve [ROC-AUC] of 0.82 ± 0.03 vs. 0.71 ± 0.05, P = 0.016). While sEng, sVEGFR1, and NT-proBNP correlated with New York Heart Association (NYHA) class, sEng levels were more sensitive than NT-proBNP in detecting NYHA Class I-II disease (ROC-AUC of 0.88 ± 0.05 vs. 0.67 ± 0.08, P = 0.028). sEng, sVEGFR1, CRP, and NT-proBNP predicted transplant-free survival by univariate Cox regression. After adjusting for NT-proBNP levels, each of the other three markers predicted transplant-free survival. In multivariate analysis, sEng and CRP were independent predictors of survival. Endoglin expression was markedly enhanced in the microvascular endothelium and endovascular lesions of PAH versus control lung tissues. Circulating angiogenic proteins sEng and sVEGFR1 are sensitive markers of prognosis and function in Group I PAH, including mildly symptomatic disease, and may provide unique noninvasive data reflecting underlying remodeling activity.

Estimating workload using EEG spectral power and ERPs in the n-back task.

Previous studies indicate that both electroencephalogram (EEG) spectral power (in particular the alpha and theta band) and event-related potentials (ERPs) (in particular the P300) can be used as a measure of mental work or memory load. We compare their ability to estimate workload level in a well-controlled task. In addition, we combine both types of measures in a single classification model to examine whether this results in higher classification accuracy than either one alone. Participants watched a sequence of visually presented letters and indicated whether or not the current letter was the same as the one (n instances) before. Workload was varied by varying n. We developed different classification models using ERP features, frequency power features or a combination (fusion). Training and testing of the models simulated an online workload estimation situation. All our ERP, power and fusion models provide classification accuracies between 80% and 90% when distinguishing between the highest and the lowest workload condition after 2 min. For 32 out of 35 participants, classification was significantly higher than chance level after 2.5 s (or one letter) as estimated by the fusion model. Differences between the models are rather small, though the fusion model performs better than the other models when only short data segments are available for estimating workload.

The Observer XT: a tool for the integration and synchronization of multimodal signals.

The Observer was originally developed as a manual event recorder for the collection, management, analysis, and presentation of observational data in animals. Because of the flexibility of later versions, it became clear that The Observer was suitable for almost any study involving collection of observational data in both animals and humans. Furthermore, the most recent version of The Observer (The Observer XT) allows the integration and synchronization of multimodal signals from various sources, such as observational, video, tracking, and physiological data. This article describes how The Observer XT was used to integrate and synchronize video, observational, tracking, and physiological data from an experiment carried out in 2001 at the Wageningen Institute of Animal Sciences of Wageningen University and Research Centre. The integration and synchronization of these multimodal signals in The Observer XT allows the user to draw a more complete picture of the phenomena under study.

[The emission flux of volatile organic compounds in the Inner Mongolia Grassland].

During the summer season of 2002, emissions of volatile organic compounds were firstly measured by a static enclosure technique at a grassland site in the Inner Mongolia grassland. The parameters including solar radiation, air temperature and relative humidity were also measured in the same time period. The results showed that isoprene was the main component of volatile organic compounds emitted from the grassland. Isoprene exhibited an evident diurnal, daily and seasonal variation. Solar visible radiation, air temperature and water vapor content were the main factors to affect isoprene emission, and solar visible radiation was the most important factor to control the isoprene emission. Base on the correlation analysis, when considering the affecting factors of isoprene emission, it is not only to consider solar visible radiation, temperature, but also the water vapor. It is impossible to avoid the changes of solar radiation, temperature and humidity between inside and outside the chamber by using the enclosure technique. So, it is necessary to take these effects into the considerations and modify isoprene emission. In summer 2002, the maximum emission flux (C) of isoprene was 1649.3 micrograms/(m2.h), and monthly averaged emission flux (C) in June, August and September were 886.6, 707.0 and 427.2 micrograms/(m2.h), respectively.