Factors to improve odds of success following medial opening-wedge high tibial osteotomy: a machine learning analysis.

BACKGROUND: Although high tibial osteotomy (HTO) is an established treatment option for medial compartment osteoarthritis, predictive factors for HTO treatment success remain unclear. This study aimed to identify informative variables associated with HTO treatment success and to develop and internally validate machine learning algorithms to predict which patients will achieve HTO treatment success for medial compartmental osteoarthritis. METHODS: This study retrospectively reviewed patients who underwent medial opening-wedge HTO (MOWHTO) at our center between March 2010 and December 2015. The primary outcomes were a lack of conversion to total knee arthroplasty (TKA) and achievement of a minimal clinically important difference of improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) at a minimum of five years postoperatively. Recursive feature selection was used to identify the combination of variables from an initial pool of 25 features that optimized model performance. Five machine learning algorithms (XGBoost, multilayer perception, support vector machine, elastic-net penalized logistic regression, and random forest) were trained using five-fold cross-validation three times and applied to an independent test set of patients. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 231 patients were included, and 200 patients (86.6%) achieved treatment success at the mean of 9 years of follow-up. A combination of seven variables optimized algorithm performance, and the following specific cutoffs increased the likelihood of MOWHTO treatment success: body mass index (BMI) ≤ 26.8 kg/m2, preoperative KOOS for pain ≤ 46.0, preoperative KOOS for quality of life ≤ 33.0, preoperative International Knee Documentation Committee score ≤ 42.0, preoperative Short-Form 36 questionnaire (SF-36) score > 42.25, three-month postoperative hip-knee-ankle angle > 1.0°, and three-month postoperative medial proximal tibial angle (MPTA) > 91.5° and ≤ 94.7°. The random forest model demonstrated the best performance (F1 score: 0.93; AUC: 0.81) and was transformed into an online application as an educational tool to demonstrate the capabilities of machine learning. CONCLUSIONS: The random forest machine learning algorithm best predicted MOWHTO treatment success. Patients with a lower BMI, poor clinical status, slight valgus overcorrection, and postoperative MPTA < 94.7 more frequently achieved a greater likelihood of treatment success. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Photoilluminated Redox-Processed Rh2P Nanoparticles on Photocathodes for Stable Hydrogen Production in Acidic Environments.

While photoelectrochemical (PEC) cells show promise for solar-driven green hydrogen production, exploration of various light-absorbing multilayer coatings has yet to significantly enhance their hydrogen generation efficiency. Acidic conditions can enhance the hydrogen evolution reaction (HER) kinetics and reduce overpotential losses. However, prolonged acidic exposure deactivates noble metal electrocatalysts, hindering their long-term stability. Progress requires addressing catalyst degradation to enable stable, efficient, and acidic PEC cells. Here, we proposed a process design based on the photoilluminated redox deposition (PRoD) approach. We use this to grow crystalline Rh2P nanoparticles (NPs) with a size of 5-10 on 30 nm-thick TiO2, without annealing. Atomically precise reaction control was performed by using several cyclic voltammetry cycles coincident with light irradiation to create a system with optimal catalytic activity. The optimized photocathode, composed of Rh2P/TiO2/Al-ZnO/Cu2O/Sb-Cu2O/ITO, achieved an excellent photocurrent density of 8.2 mA cm-2 at 0 VRHE and a durable water-splitting reaction in a strong acidic solution. Specifically, the Rh2P-loaded photocathode exhibited a 5.3-fold enhancement in mass activity compared to that utilizing just a Rh catalyst. Furthermore, in situ scanning transmission electron microscopy (STEM) was performed to observe the real-time growth process of Rh2P NPs in a liquid cell.

Timing of critical isthmus from end of P wave and usefulness of activation mapping with window of interest from end to end of P wave in reentrant atrial tachycardia.

In activation mapping of reentrant atrial tachycardia (AT), there was no reference for window of interest (WOI). We examined the timing of a successful termination site from end of the P wave and attempted to determine whether the critical isthmus can be identified using activation mapping when WOI was set as end to end of the P wave. Forty patients with 54 reentrant AT who underwent 3D electroanatomic mapping and radiofrequency catheter ablation were evaluated retrospectively. The critical isthmus was defined as a successful termination site. We evaluate critical isthmus timing from end of the P wave and percentage of critical isthmus timing from end of the P wave to tachycardia cycle length. In 54 reentrant AT, Macro-reentry was identified in 46 (85.2%) and micro-reentry was identified in eight (14.8%). The timing of the critical isthmus site from end of the P wave was - 4.0 ± 31.1 ms (Macro-reentry vs. Micro-reentry; - 8.9 ± 29.4 ms vs. 24.0 ± 26.7 ms; P = 0.005). The percentage of critical isthmus timing from end of the P wave/tachycardia cycle length was - 1.4 ± 10.5% (Macro-reentry vs. Micro-reentry; - 3.1 ± 9.8% vs. 8.3 ± 9.3%, P = 0.004) The critical isthmus of reentrant AT is located within 10% backward and forward from end of the P wave to tachycardia cycle length. Setting the WOI from end to end of the P wave is useful for identification of the critical isthmus through activation mapping.

The impact of early cryoballoon ablation on clinical outcome in patients with atrial fibrillation: From the Korean cryoballoon ablation registry.

INTRODUCTION: Influence of early atrial fibrillation (AF) ablation, particularly cryoballoon ablation (CBA), on clinical outcome during long-term follow-up has not been clarified. The objective was to determine whether an early CBA (diagnosis-to-ablation of ≤6 months) strategy could affect freedom from AF recurrence after index CBA. METHODS: The study included 2605 patients from Korean CBA registry data with follow-up >12 months after de novo CBA. The primary outcome was recurrence of atrial tachyarrhythmias (ATs) of ≥30-s after a 3-month blanking period. RESULTS: Compared to patients in early CBA group, patients in late CBA group had higher prevalence of diabetes, congestive heart failure, and chronic kidney disease, and higher mean CHA2 DS2 -VAS score. During mean follow-up of >21 months, ATs recurrence was detected in 839 (32.2%) patients. The early CBA group showed a significantly lower 2-year recurrence rate of ATs than the late CBA group (26.1% vs. 31.7%, p = 0.043). In subgroup analysis, the early CBA group showed significantly higher 1-year and 2-year freedom from ATs recurrence than the late CBA group only in paroxysmal atrial fibrillation (PAF) patients in overall and propensity score matched cohorts. Multivariate analysis showed that early CBA was an independent factor for preventing ATs recurrence in PAF (hazard ratio: 0.637; 95% confidence intervals: 0.412-0.984). CONCLUSION: Early CBA strategy, resulting in significantly lower ATs recurrence during 2-year follow-up after index CBA, might be considered as an initial rhythm control therapy in patients with paroxysmal AF.

Retraction: Progressive p-channel vertical transistors fabricated using electrodeposited copper oxide designed with grain boundary tunability.

Retraction of 'Progressive p-channel vertical transistors fabricated using electrodeposited copper oxide designed with grain boundary tunability' by Sung Hyeon Jung et al., Mater. Horiz., 2022, 9, 1010-1022, https://doi.org/10.1039/D1MH01568K.

Association of right bundle branch block or intraventricular conduction delay with recurrence of atrial fibrillation after catheter ablation.

BACKGROUND: The association between bundle branch block (BBB) and recurrence of atrial fibrillation (AF) after catheter ablation is unclear. The aim of this study was to determine whether AF combined with BBB is associated with AF recurrence after catheter ablation. METHODS: A total of 477 consecutive AF patients who underwent catheter ablation were included. The AF patients were divided into three groups according to BBB: AF without BBB (n = 427), AF with right bundle branch block (AF with RBBB) (n = 16), and AF with intraventricular conduction delay (AF with IVCD) (n = 34). RESULTS: Of the 477 AF patients (mean age 57 years, 81% men, median CHA2 DS2 -VASc score of 1), 16 (3.4%) patients had RBBB, and 34 (7.1%) patients had IVCD. During a mean follow-up of 15.2 ± 6.7 months, 119 patients (24.9%) had recurrence of AF. Of these, 111 (26%) patients were in the AF without BBB group, with 2 (12.5%) and 6 (17.6%) patients in the RBBB and IVCD groups, respectively. The Kaplan-Meier estimate of the rate of recurrent AF was not significantly different among the three groups (p = .39). Multivariable analysis showed that persistent AF (HR 1.7, 95% CI 1.15-2.50, p = .007), chronic kidney disease (HR 2.94, 95% CI 1.20-7.17, p = .01), and left atrial diameter (HR 1.04, 95% CI 1.009-1.082, p = .01) were significantly associated with AF recurrence. CONCLUSION: AF with BBB was not significantly associated with the recurrence of AF after catheter ablation in middle-aged patients with low-risk cardiovascular profile.

Intensive harmonized synapses with amorphous Cu2O-based memristors using ultrafine Cu nanoparticle sublayers formed via atomically controlled electrochemical pulse deposition.

Resistive random-access memory (RRAM) devices have significant advantages for neuromorphic computing but have fatal problems of uncontrollability and abrupt resistive switching behaviors degrading their synaptic performance. In this paper, we propose the electrochemical design of an active Cu2O layer containing a strategic sublayer of ultrafine Cu nanoparticles (U-Cu NPs) to form uniformly dispersed conducting filaments, which can effectively improve the reliability for analog switching of RRAM-based neuromorphic computing. The electrochemical pulse deposited (EPD) U-Cu NPs are linked to the bottom electrode through a semi-conductive path within the bottom Cu2O layer, since the EPD is preferentially carried out on the conductive sites. All Cu2O films with U-Cu NPs are developed in situ in the single electrolyte bath without any pause. The proposed U-Cu NPs can concentrate the external electric field and can generate conductive filament paths for analog resistive switching. The applied electric field was uniformly spread to U-Cu NPs at the center of the active layer and displays resistive switching behavior via multiple conductive filaments. This shows a strong harmony between the resistance-switching characteristics and the analog operation of the active layer. This RRAM device shows outstanding gradual analog switching, great linearity, dynamic range, endurance, precision, speed, and retention characteristics simultaneously and adequately for neuromorphic computing by realizing multiple weak filament-type operation.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Decreases Passive Anterior Tibial Subluxation Compared With Isolated Anterior Cruciate Ligament Reconstruction Despite Similar Rotational Stability and Clinical Outcomes.

PURPOSE: To analyze the effect of augmenting a hamstring autograft anterior cruciate ligament reconstruction (ACLR) with an anterolateral ligament reconstruction (ALLR) on a primary outcome of passive anterior tibial subluxation (PATS) and a secondary outcome of the clinical outcomes. METHODS: ACL-injured patients who underwent primary ACLR between March 2014 and February 2020 at our center were enrolled. Patients who underwent combined procedures (ACLR + ALLR) were matched in a 1:1 propensity ratio to patients who underwent ACLR only. We evaluated PATS, knee stability (side-to-side laxity difference, pivot-shift test), and patient-reported outcome measures (PROMs) after the procedure and documented complications. RESULTS: From an initial cohort of 252 patients with a minimum follow-up period of 2 years (48.4 ± 16.6 months), 35 matched pairs were included, and 17 patients (48.6%) in each group underwent second-look arthroscopy. The combined ACLR + ALLR group showed significantly better improvement of PATS in the lateral compartments than the isolated ACLR group (P = .034). There were no significant differences between the groups regarding knee stability (side-to-side laxity difference, pivot-shift test), PROMs, complications, and second-look arthroscopic findings (all P > .05). Moreover, the proportions of patients who achieved the minimal clinically important difference in PROMs were not different between groups. CONCLUSIONS: The combined ACLR + ALLR procedure was associated with a mean improvement in anterior tibial subluxation for the lateral compartment that was 1.2 mm better than an isolated ACLR procedure, despite its lack of clinical significance. LEVEL OF EVIDENCE: Level III, cohort study.

The association of cardiac troponin and cardiovascular events in patients with concomitant heart failure preserved ejection fraction and atrial fibrillation.

BACKGROUND: Limited data are available for risk stratification in patients with atrial fibrillation (AF) and combined heart failure with preserved ejection fraction (HFpEF). We aimed to explore the prognostic utility of high-sensitivity cardiac troponin I (hs-cTnI) in patients with newly detected AF and concomitant HFpEF. METHODS: From August 2014 to December 2016, 2,361 patients with newly detected AF were polled in a retrospective single-center registry. Of which, 634 patients were eligible for HFpEF diagnosis (HFA-PEFF score ≥ 5) and 165 patients were excluded with exclusion criteria. Finally, 469 patients are classified into elevated or non-elevated hs-cTnI groups based on the 99th percentile upper reference limit (URL). The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) during follow-up. RESULTS: In 469 patients, 295 were stratified into the non-elevated hs-cTnI group (< 99th percentile URL of hs-cTnI) and 174 were placed in the elevated hs-cTnI group (≥ 99th percentile URL of hs-cTnI). The median follow-up period was 24.2 (interquartile range, 7.5-38.6) months. During the follow-up period, 106 patients (22.6%) in the study population experienced MACCE. In a multivariable Cox regression model, the elevated hs-cTnI group had a higher incidence of MACCE (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.08-2.55; p = 0.03) and coronary revascularization-caused readmission (adjusted HR, 3.86; 95% CI, 1.39-15.09; p = 0.02) compared with the non-elevated hs-cTnI group. The incidence of heart failure-caused readmission tended to occur more frequently in the elevated hs-cTnI group (8.5% versus 15.5%; adjusted HR, 1.52; 95% CI, 0.86-2.67; p = 0.08). CONCLUSIONS: One-fifth of patients with AF and concomitant HFpEF experienced MACCE during follow-up, and elevated hs-cTnI was independently associated with higher risk of MACCE, as driven by heart failure and revascularization-caused readmission. This finding suggested that hs-cTnI may be a useful tool in individualized risk stratification of future cardiovascular events in patients with AF and concomitant HFpEF.

Surface-Confined Ultra-Low Scale Pd Engineered Layered Co(OH)2 toward High-Performance Hydrazine Electrooxidation in Alkaline Saline Water.

Applications of abundant seawater in electrochemical energy conversion are constrained due to the sluggish oxygen evolution reaction and the corrosive chlorine oxidation reaction. Hence, it is imperative to develop an efficient anodic reaction alternative suitable for coupling with the cathodic counterpart. Due to a low thermodynamic oxidation potential, hydrazine oxidation reaction (HzOR) offers a unique pathway to overcome these challenges. Herein, spontaneously in situ reduced atomic scale Pd surface-confined to electrochemically prepared layered Co(OH)2 on carbon cloth is synthesized. This study reveals the hydrazine and Pd-dependent morphological evolution of Co(OH)2 and its Pd hybrids into nanoparticulate form. Unlike various layered double hydroxides, Pd integrated Co(OH)2 benefits from the contribution of Co(OH)2 as an active HzOR catalyst and the reductive support to host Pd, resulting in synergistically improved performances. Mass activities of Pd in alkaline and alkaline saline electrolyte are 11.24 and 9.83 A mgPd -1 at 200 mV, respectively, corresponding to the highest HzOR activities among noble metals. The optimized Pd hybrid demonstrates ≈6.5 times the current density relative to PtC (14.91 mA cm-2 at 200 mV) in alkaline saline water with hydrazine. These findings would be beneficial to realize high overpotential anodic alternatives and reduce over-dependence on freshwater for electrocatalysis.

The natural course of hemoglobin levels after allogenic blood transfusion in total knee arthroplasty.

We retrospectively investigated the natural course of hemoglobin levels after allogenic blood transfusion in total knee arthroplasty. All patients were treated according to the same clinical pathway, and blood tests were performed on the same day. All blood tests were done on pre-op, immediate post-op, midnight of op day, 1st, 2nd, 3rd, 5th, 7th, and 11th day after surgery. Of the total 593 cases, a total of 197 cases (33.2%) were performed within 3 days of surgery. Hemoglobin level was significantly lowest on the 3rd day after surgery and tended to increase afterwards in the non-transfusion group. In the case of blood transfusion on the day of surgery, the hemoglobin level showed an increase on the next day and then showed a minimum value on the fifth day of surgery and then increased. The same pattern was identified when blood transfusion was done on the 1st and 2nd day of surgery. However, when blood transfusion was done on the 3rd day, the hemoglobin level showed a steady increase afterwards. The hemoglobin level of total knee arthroplasty patients with no blood transfusion was the lowest on the 3rd day after surgery and increased afterwards. If blood transfusion was done within 2 days after surgery, the hemoglobin level was the lowest on the 5th day after surgery and increased afterwards. If blood transfusion was done on the 3rd day after surgery, the hemoglobin level increased afterwards.

Efficacy and safety of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation: A comparison with radiofrequency ablation.

BACKGROUND: Cryoballoon ablation was established as an effective and safe modality to achieve pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). However, its role in persistent atrial fibrillation (PersAF) remains unclear. OBJECTIVE: This study aimed to evaluate the efficacy and safety of cryoballoon PVI in PAF and PersAF comparing conventional radiofrequency catheter ablation (RFCA). METHODS: Two hundred patients undergoing cryoballoon ablation for symptomatic AF were consecutively enrolled in this retrospective study. For comparison, 210 patients undergoing RFCA in the same period were included. The primary outcome was a recurrence of any atrial tachyarrhythmias (ATas) after the index ablation. 12-lead ECG and 24-hour Holter monitoring were obtained at 1,3,6 and 9-12 months. RESULTS: PVI by cryoablation alone was achieved in 197 patients (98.5%). ATas-free survival at 12 months post-ablation was 72.7% in the cryoablation and 80.6% in the RFCA group (P = 0.123), respectively. The cryoablation showed comparable efficacy maintaining sinus rhythm compared with RFCA in PAF (P = 0.539), whereas in PersAF, ATas-free survival was significantly lower in cryoablation (P = 0.039). PV reconnection was observed in the majority of patients (14/16, 87.5%) who receive redo RFCA. Complications were encountered in 10 patients, including femoral arteriovenous fistula (n = 1), transient phrenic nerve palsy (n = 8), and minimal amount pericardial effusion (n = 1). CONCLUSION: The efficacy of cryoballoon PVI is comparable with conventional RFCA in PAF, whereas PVI alone using cryoballoon may not be insufficient to maintaining sinus rhythm in PersAF. The safety of cryoballlon PVI is tolerable.

Initial Experience with Left Bundle Branch Area Pacing with Conventional Stylet-Driven Extendable Screw-In Leads and New Pre-Shaped Delivery Sheaths.

Until recently, left bundle branch area pacing (LBBAp) has mostly been performed using lumen-less fixed screw leads. There are limited data on LBBAp with conventional style-driven extendable screw-in (SDES) leads, particularly data performed by operators with no previous experience with LBBAp procedures. In total, 42 consecutive patients undergoing LBBAp using SDES leads and newly designed delivery sheaths (LBBAp group) were compared with those treated with conventional right ventricular pacing (RVp) for atrioventricular block (RVp group, n = 84) using propensity score matching (1:2 ratio). The LBBAp was successful in 83% (35/42) of patients, with satisfactory pacing thresholds (0.8 ± 0.2 V at 0.4 ms). In the LBBAp group, the mean paced-QRS duration obtained during RV apical pacing (173 ± 18 ms) was significantly reduced by LBBAp (116 ± 14 ms, p < 0.001). Compared with the RVp group, the LBBAp group showed more physiological pacing, suggested by a much narrower paced-QRS duration (116 ± 14 vs. 151 ± 21 ms, p < 0.001). The pacing threshold was comparable in both groups. The LBBAp group revealed stable pacing thresholds for 6.8 ± 4.8 months post-implant and no serious complications including lead dislodgement or septal perforation. The novel approach of LBBAp using SDES leads and the new dedicated pre-shaped delivery sheaths was effectively and safely performed, even by inexperienced operators with LBBAp procedures.

The efficacy of single-lead implantable cardioverter-defibrillator with atrial sensing dipole to detect atrial fibrillation and to reduce inappropriate therapy according to atrial sensing ON or OFF: Rationale and design of the SMART-CONTROL study, a prospective multicenter randomized trial.

BACKGROUND: Few studies have compared the efficacy of single-lead implantable cardioverter-defibrillator (ICD) with atrial sensing dipole (VDD-ICD) and conventional single-chamber ICD from the aspect of atrial fibrillation (AF) detection or inappropriate ICD therapy reduction. In the SMART-CONTROL trial (NCT03932604), we primarily aim to investigate whether the atrial sensing capability of VDD-ICD is useful in AF detection and inappropriate therapy reduction by randomly activating or deactivating the atrial sensing function. METHODS AND DESIGN: This study was designed as a prospective, multicenter, open-label, randomized trial to enroll 640 patients with no history of clinical AF or rhythm control for AF within 1 year who were undergoing the implantation of VDD-ICD system. Patients are assigned randomly to atrial sensing "ON" or "OFF" group, with crossover allowed during follow-up. The coprimary outcomes are the incidence of AF detection and inappropriate ICD therapy over a 2-year follow-up period. The secondary outcomes include non-AF atrial tachyarrhythmia, ventricular tachyarrhythmia with or without ICD therapy, thromboembolic events, bleeding, heart failure hospitalization, mortality, a composite of adverse cardiovascular events, and long-term atrial sensing stability or variability. CONCLUSION: We expect that this trial can evaluate the efficacy of a single-lead ICD system on various clinical outcomes including AF detection and inappropriate therapy reduction, and ultimately provide guidance to selection of ICD system.

Clinical Significance of Ventricular Premature Contraction Provoked by the Treadmill Test.

Background and Objectives: The treadmill test (TMT) is a predictive tool for myocardial ischemia. Recently, exercise-provoked ventricular premature contracture (VPC) during TMT was shown to have a relation with coronary artery disease and cardiovascular mortality. Therefore, we evaluate clinical correlates of exercise-provoked VPC and compare the predictive power for myocardial ischemia and cardiovascular events. Method: Data of 408 patients (≥18 years of age) who underwent TMT for work up of angina, palpitation, dyspnea, syncope, or arrhythmia between February 2015, and January 2016, were collected with consent at Samsung Medical Center, Seoul, Republic of Korea. Among total of 408 patients, 208 were excluded according to the previous history of PCI or CABG, previous MI, decreased left ventricular ejection fraction lower than 50%, arrhythmia that could affect ST-segment change on ECG. Results: Among 200 patients, 32 (16.0%) developed exercise-provoked VPC (21 patients in the exercise phase, 20 patients in the recovery phase). Of them, 20 patients (10.0%) showed positive TMT, and 4 patients (2.0%) underwent revascularization after TMT. Among 21 patients showing exercise phase VPC, 5 (23.8%) showed positive TMT results. In patients younger than 65 years, exercise phase VPC was associated with positive TMT (odds ratio 6.879, 1.458-32.453) considering demographics and previous medical history in multivariable analysis. Among the 20 patients showing recovery phase VPC, 2 (10.0%) underwent revascularization after TMT. In multivariable analysis, recovery phase VPC was associated with revascularization (odds ratio 9.381, 1.144-76.948) considering age, sex, BMI, and TMT result. Conclusion: VPC during the treadmill test was a useful predictor of myocardial ischemia in this study.

Design of Functionally Stacked Channels of Oxide Thin-Film Transistors to Mimic Precise Ultralow-Light-Irradiated Synaptic Weight Modulation.

To utilize continuous ultralow intensity signals from oxide synaptic transistors as artificial synapses that mimic human visual perception, we propose strategic oxide channels that optimally utilize their advantageous functions by stacking two oxide semiconductors with different conductivities. The bottom amorphous indium-gallium-zinc oxide (a-IGZO) layer with a relatively low conductivity was designed for an extremely low initial postsynaptic current (PSCi) by achieving full depletion at a low negative gate voltage, and the stacked top amorphous indium-zinc oxide (a-IZO) layer improved the amplitude of the synaptic current and memory retention owing to the enhancement in the persistent photoconductivity characteristics. We demonstrated an excellent photonic synapse thin-film transistor (TFT) with a precise synaptic weight change even in the range of ultralow light intensity by adapting this stacking IGZO/IZO channel. The proposed device exhibited distinct ∆PSC values of 3.1 and 18.1 nA under ultralow ultraviolet light (350 nm, 50 ms) of 1.6 and 8.0 µW/cm2. In addition, while the lowest light input exhibited short-term plasticity characteristics similar to the "volatile-like" behavior of the human brain with a current recovery close to the initial value, the increase in light intensity caused long-term plasticity characteristics, thus achieving synaptic memory transition in the IGZO/IZO TFTs.

Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy.

The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy.

Site-Selective Antibody-Drug Conjugation by a Proximity-Driven S to N Acyl Transfer Reaction on a Therapeutic Antibody.

Immunoglobulin Gs (IgGs) contain many Lys and Cys residues, which results in an unwanted complex product mixture with conventional drug conjugation methods. We selectively acylated the ε-NH2 of K248 on trastuzumab using an IgG Fc-binding peptide (FcBP) equipped with a 5-norbornene-2-carboxylic acid thioester (AbClick-1). AbClick-1 locates its thioester close to the ε-NH2 of K248 while binding to trastuzumab. Consequently, the thioester underwent proximity-driven selective acylation of ε-NH2 through an S to N acyl transfer reaction. Furthermore, N-tert-butyl maleimide accelerated the cross-linking reaction with an approximately 95% yield of the desired product by scavenging the byproduct (FcBP-SH). Only K248 was modified selectively with the 5-norbornene-2-carbonyl group, which was further modified by click reaction to afford an antibody-drug conjugate (ADC) with two drugs per antibody. The resulting ADCs showed remarkable in vitro and in vivo anticancer activity. Our results demonstrate that a thioester is a promising chemical entity for proximity-driven site-selective conjugation of antibodies.

Predictors of permanent pacemaker implantation after sinus conversion of cavotricuspid isthmus-dependent atrial flutter.

It is unclear which factors are associated with progressive sinus node dysfunction after cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) ablation. We sought to evaluate the incidence and predictors for permanent pacemaker (PPM) implantation after CTI-dependent AFL ablation. Between January 2011 and June 2021, 353 patients underwent CTI-dependent AFL ablation were studied. During a median follow-up of 31.6 months, 30 patients (8.5%) received PPM implantation, 24 for sick sinus syndrome and 6 for atrioventricular block. In multivariable model, prior atrial fibrillation (AF) (HR 3.570; 95% CI 1.034-12.325; P = 0.044), lowest previous sinus heart rate (HR 0.942; 95% CI 0.898-0.988; P = 0.015), and left atrial volume index (LAVI) (HR 1.067; 95% CI 1.024-1.112; P = 0.002) were independently associated with PPM implantation after CTI-dependent AFL ablation. The best cut-off points for predicting PPM implantation were 60.1 ml/m2 for LAVI and 46 beats per minute for lowest previous sinus heart rate. Among the patients discharged without PPM implantation after ablation, sinus pause over three seconds at AFL termination during ablation was an independent predictor of PPM implantation (HR 17.841; 95% CI 4.626-68.807; P < 0.001). Physicians should be aware of the possibility of PPM implantation during follow-up after AFL ablation, especially in patients with the relevant risk factors.