Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta-analysis.

Background: Fluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults. Method: A systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023. All observational or experimental studies comparing ZMF approach to fluoroscopy for adult CIEDs therapy were included. Reviews, case report/series, animal studies, and non-English articles were excluded. The success rate, procedural time, fluoroscopy time, radiation dose, and complications rate were compared for each approach. Results: Seven articles for permanent and three articles for temporary CIEDs were included for analysis. The success rate of ZMF for permanent CIEDs was similar to fluoroscopy method (OR: 0.77, 95% CI: 0.33-4.15). The procedural time of ZMF was similar to fluoroscopy for both permanent and temporary CIEDs (standardized mean difference [SMD]: 0.10, 95% CI: -0.35 to 0.55 and SMD: -0.71, 95% CI: -1.87-0.44, respectively). However, ZMF approach markedly reduced the fluoroscopy time and radiation exposure for permanent CIEDs (SMD: -1.80, 95% CI: -2.49 to -1.12 and SMD: -1.26, 95% CI: -2.24 to -0.29). The complication rate was similar for permanent CIEDs (OR: 1.08, 95% CI: 0.41-2.84), yet lowered for temporary CIEDs (OR: 0.34, 95% CI: 0.20-0.59). Conclusion: ZMF had similar success rate, procedural time, and sum complication rate for permanent CIEDs implantation with a significant reduction of fluoroscopy time and radiation exposure.

Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During the COVID-19 Pandemic.

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted the health-related quality of life (HRQoL) and mental health worldwide. However, its impact on medical students in Indonesia has not been well documented. This study aimed to evaluate HRQoL and mental health in 729 Indonesian medical students during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a cross-sectional study from 31 August to 30 September 2021. The study instrument was an online questionnaire that was distributed via social media platforms. The 12-item short form version 2 (SF12v2) was used to measure HRQoL, and the 21-item Depression, Anxiety, and Stress Scale (DASS-21) was used to measure mental health. RESULTS From 729 Indonesian medical students included in the analyses, 37.3% had impaired physical component and 66.9% had impaired mental component of HRQoL. The determinants were medical students' island of residence, history of hospitalization, and family member's hospitalization and death due to COVID-19. Concerning mental health, the prevalence of reported symptoms of depression, anxiety, and stress were 45.4%, 65.2%, and 60.9%, respectively. Sex, study method, grade, previous COVID-19 disease severity, comorbidities, previous learning experience, and history of family isolation were identified as the determinants of mental health. CONCLUSIONS This study highlights the adverse effects of COVID-19 on HRQoL and mental health in Indonesian medical students. The results identified key associations, including SARS-CoV-2 infection and comorbidities experienced by the students, the health of their families, including grief following bereavement, and the effects of social isolation during the pandemic.

Direct cardiac reprogramming: basics and future challenges.

BACKGROUND: Heart failure is the leading cause of morbidity and mortality worldwide and is characterized by reduced cardiac function. Currently, cardiac transplantation therapy is applied for end-stage heart failure, but it is limited by the number of available donors. METHODS AND RESULTS: Following an assessment of available literature, a narrative review was conducted to summarizes the current status and challenges of cardiac reprogramming for clinical application. Scientists have developed different regenerative treatment strategies for curing heart failure, including progenitor cell delivery and pluripotent cell delivery. Recently, a novel strategy has emerged that directly reprograms cardiac fibroblast into a functional cardiomyocyte. In this treatment, transcription factors are first identified to reprogram fibroblast into a cardiomyocyte. After that, microRNA and small molecules show great potential to optimize the reprogramming process. Some challenges regarding cell reprogramming in humans are conversion efficiency, virus utilization, immature and heterogenous induced cardiomyocytes, technical reproducibility issues, and physiological effects of depleted fibroblasts on myocardial tissue. CONCLUSION: Several strategies have shown positive results in direct cardiac reprogramming. However, direct cardiac reprogramming still needs improvement if it is used as a mainstay therapy in humans, and challenges need to be overcome before cardiac reprogramming can be considered a viable therapeutic strategy. Further advances in cardiac reprogramming studies are needed in cardiac regenerative therapy.

Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome.

Introduction: Rapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome. Material and methods: A systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16. Results: A total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13-25%), and PH was 22% (95% CI: 14-31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50-5.89), p = 0.002), severity (OR = 3.61 (95% CI: 2.05-6.35), p < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12-2.56), p = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14-2.25), p = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66-11.060, p < 0.001), severity (OR = 5.74 (95% CI: 2.28-14.49), p < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55-46.41), p < 0.001). Conclusions: RVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.

Initial and terminal T wave angle as hyperkalemia indicator in chronic kidney disease.

BACKGROUND: Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity. AIM: This study aims to determine the predictive value of initial and terminal T wave angle in detecting hyperkalemia among CKD patients. METHODS: A cross-sectional study was conducted at Dr. Soetomo General Hospital, including all adult hospitalized CKD patients. A caliper was used to measure T wave morphology. The initial deflection angle (Tia) and terminal deflection angle (Tta) were calculated from an arctan of T peak amplitude and the respective initial or terminal length. The receiver operating characteristics (ROC) curve was analyzed to determine the area under the curve (AUC) and optimal cutoff. RESULTS: A total of 220 CKD patients were enrolled in this study, with 98 patients with hyperkalemia (potassium >5.0). The majority of the patients were male, with a mean age of 51.12 ± 12.58 years. Ti-Tp duration, Tp-Tt duration, Tia, Tta, and Tp amplitude were significantly higher in the hyperkalemia group (all p < 0.05). A Spearman correlation analysis demonstrated a significant positive correlation of Tia (r = 0.346 and p < 0.001) and Tta (r = 0.445 and p < 0.001) with potassium levels in the participants. The optimal cutoff angle for Tta was 66.20° (sensitivity = 67.3% and specificity = 73.8%) and Tia was 61.07° (sensitivity = 66.3% and specificity = 69.7%). CONCLUSION: The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.

Coronary stent infection: a systematic review.

Coronary stent infection (CSI) is the rarest complication associated with the percutaneous coronary intervention, occurring in less than 0.1% of cases. So far, all reported instances are limited to case reports. CSI presents itself in various, often confusing, ways in clinical settings. Therefore, the current systematic review summarizes reports of CSI's clinical presentations, causative pathogens, diagnoses and treatments. This systematic review considered three online databases, using reference lists as an additional source. All case reports or case series with stent infection in the coronary artery were included - however, reviews or commentaries, articles not published in English, and articles mentioning a history of hemodialysis or any surgery were excluded. Thirty-two studies on 34 CSI patients were included in the final qualitative analysis. CSI predominantly affected males of a wide range of ages. The most common symptoms were chest pain and fever with various onsets. Interestingly, CSI usually occurred during the first stent implantation. Cultures and coronary angiography were the most common methods used to diagnose CSI. Furthermore, drug-eluting stents had a higher risk of infection than bare-metal stents. Aneurysms were the most frequent abnormalities observed in infected stents. The bacteria that most often caused CSI were Staphylococcus aureus and Pseudomonas aeroginosa. More than 90% of the reports mentioned using various antibiotics, and 74% mentioned carrying out surgery. Finally, a mortality rate of 26.47% among CSI patients was calculated.

Inhaled prostacyclin analogues in COVID-19 associated acute respiratory distress syndrome: scientific rationale.

BACKGROUND: COVID-19 associated acute respiratory distress syndrome (CARDS) is a severe form of SARS CoV-2 infection and affects about 15-30% of hospitalized patients with a high mortality rate. Growing research and data suggest several available drugs with appropriate pharmacological effects to treat COVID-19. MAIN BODY: Prostacyclin analogues are regiments for pulmonary artery hypertension. Prostacyclin analogues are expected to be beneficial in treating CARDS based on at least four rationales: (1) inhaled prostacyclin analogues improve oxygenation, V/Q mismatch, and act as an ARDS therapy alternative; (2) it alleviates direct SARS-CoV-2-related coagulopathy; (3) increases nitric oxide production; and (4) possible anti-inflammatory effect. Prostacyclin analogues are available in oral, intravenous, and inhaled forms. The inhaled form has the advantage over other forms, such as parenteral administration risks. Previously, a meta-analysis demonstrated the beneficial effects of inhaled prostaglandins for ARDS treatment, such as improved PaO2/FiO2 and PaO2 along with reduced pulmonary artery pressure. Currently, two ongoing randomized controlled trials are evaluating inhaled epoprostenol (VPCOVID [NCT04452669]) and iloprost (ILOCOVID [NCT04445246]) for severe COVID-19 patients. CONCLUSIONS: Inhaled prostacyclin could be considered in patients with refractory, life-threatening hypoxia despite standard management.

Association of calcium channel blocker use with clinical outcome of COVID-19: A meta-analysis.

AIMS: This meta-analysis aims to analyze the association of calcium channel blocker (CCB) use with COVID-19 clinical outcomes. METHODS: PubMed, ProQuest, Science Direct, Scopus, and medRxiv databases were searched systematically in a limited period. The primary outcome was mortality. RESULTS: A total of 119,298 patients from 31 eligible studies were included. Pooled analysis of the random-effect model revealed CCB was not associated with reduced mortality (OR = 1.21 [95%CI: 0.98-1.49], p = 0.08). Interestingly, subgroup analysis in hypertensive patients revealed significantly reduced mortality (OR = 0.69 [95%CI: 0.52-0.91], p = 0.009). CONCLUSION: CCB usage was not associated with the outcome of COVID-19. However, CCB was associated with a decreased mortality rate in hypertensive COVID-19 patients.

Methylene blue for vasoplegic syndrome in cardiopulmonary bypass surgery: A systematic review and meta-analysis.

BACKGROUND: To evaluate the benefit of methylene blue as an adjunct treatment by assessing hemodynamic, morbidity rate, intensive care unit length of stay, and mortality rate outcomes in adult patients with vasoplegic syndrome. METHODS: A systematic search through electronic databases including Pubmed, Embase, Scopus, and Medline for studies assessing the use of methylene blue in patients with vasoplegic syndrome compared to control treatments. The Newcastle-Ottawa Scale tool was used for observational studies, and Jadad Scale was used for controlled trials to assess the risk of bias. RESULTS: This systematic review included six studies for qualitative synthesis and five studies for quantitative synthesis. Pooled analysis revealed that mean arterial pressure, systemic vascular resistance, heart rate, and hospital stay were not statistically significant in methylene blue administration compared to control. However, administration of methylene blue in vasoplegic syndrome patients significantly reduces renal failure (OR = 0.25; 95% CI = 0.08-0.75), development of multiple organ failure (OR = 0.09; 95% CI = 0.02-0.51), and mortality rate (OR = 0.12; 95% CI = 0.03-0.46). CONCLUSION: Adjunct administration of methylene blue for vasoplegic syndrome patients significantly reduces renal failure, multiple organ failure, and mortality.

Wafer-scale low-loss lithium niobate photonic integrated circuits.

Thin-film lithium niobate (LN) photonic integrated circuits (PICs) could enable ultrahigh performance in electro-optic and nonlinear optical devices. To date, realizations have been limited to chip-scale proof-of-concepts. Here we demonstrate monolithic LN PICs fabricated on 4- and 6-inch wafers with deep ultraviolet lithography and show smooth and uniform etching, achieving 0.27 dB/cm optical propagation loss on wafer-scale. Our results show that LN PICs are fundamentally scalable and can be highly cost-effective.

Predictive Value of Hematologic Indices in the Diagnosis of Acute Coronary Syndrome.

BACKGROUND: Distinguishing between Acute Coronary Syndrom (ACS) and SCAD (Stable Coronary Artery Disease) requires advanced laboratory instrument and electrocardiogram. However, their availabilities in primary care settings in developing countries are limited. Hematologic changes usually occur in the ACS patient and might be valuable to distinguish ACS from SCAD. AIM: This study compares the hematologic indices between ACS and SCAD patients and analyses its predictive value for ACS. MATERIAL AND METHODS: A total of 191 patients (79 ACS and 112 SCAD) were enrolled in this study based on the inclusion criteria. Patient's characteristic, hematologic indices on admission, and the final diagnosis were obtained from medical records. Statistical analyses were done using SPSS 23.0. RESULTS: In this research MCHC value (33.40 vs. 32.80 g/dL; p < 0.05); WBC (11.16 vs. 7.40 x109/L; p < 0.001); NLR (6.29 vs. 2.18; p < 0.001); and PLR (173.88 vs 122.46; p < 0.001) were significantly higher in ACS compared to SCAD patients. While MPV (6.40 vs. 10.00 fL; p < 0.001) was significantly lower in ACS patients. ROC curve analysis showed MPV had the highest AUC (95%) for ACS diagnosis with an optimum cut-off point at ≤ 8.35 fL (sensitivity 93.6% and specificity 97.3%). CONCLUSION: There was a significant difference between hematologic indices between ACS and SCAD patients. MPV is the best indices to distinguish ACS.

On-chip dual-comb source for spectroscopy.

Dual-comb spectroscopy is a powerful technique for real-time, broadband optical sampling of molecular spectra, which requires no moving components. Recent developments with microresonator-based platforms have enabled frequency combs at the chip scale. However, the need to precisely match the resonance wavelengths of distinct high quality-factor microcavities has hindered the development of on-chip dual combs. We report the simultaneous generation of two microresonator combs on the same chip from a single laser, drastically reducing experimental complexity. We demonstrate broadband optical spectra spanning 51 THz and low-noise operation of both combs by deterministically tuning into soliton mode-locked states using integrated microheaters, resulting in narrow (<10 kHz) microwave beat notes. We further use one comb as a reference to probe the formation dynamics of the other comb, thus introducing a technique to investigate comb evolution without auxiliary lasers or microwave oscillators. We demonstrate high signal-to-noise ratio absorption spectroscopy spanning 170 nm using the dual-comb source over a 20-µs acquisition time. Our device paves the way for compact and robust spectrometers at nanosecond time scales enabled by large beat-note spacings (>1 GHz).

Counter-rotating cavity solitons in a silicon nitride microresonator.

We demonstrate the generation of counter-rotating cavity solitons in a silicon nitride microresonator using a fixed, single-frequency laser. We demonstrate a dual three-soliton state with a difference in the repetition rates of the soliton trains that can be tuned by varying the ratio of pump powers in the two directions. Such a system enables a highly compact, tunable dual comb source that can be used for applications such as spectroscopy and distance ranging.

Breather soliton dynamics in microresonators.

The generation of temporal cavity solitons in microresonators results in coherent low-noise optical frequency combs that are critical for applications in spectroscopy, astronomy, navigation or telecommunications. Breather solitons also form an important part of many different classes of nonlinear wave systems, manifesting themselves as a localized temporal structure that exhibits oscillatory behaviour. To date, the dynamics of breather solitons in microresonators remains largely unexplored, and its experimental characterization is challenging. Here we demonstrate the excitation of breather solitons in two different microresonator platforms based on silicon nitride and on silicon. We investigate the dependence of the breathing frequency on pump detuning and observe the transition from period-1 to period-2 oscillation. Our study constitutes a significant contribution to understanding the soliton dynamics within the larger context of nonlinear science.

Dynamics of mode-coupling-induced microresonator frequency combs in normal dispersion.

We experimentally and theoretically investigate the dynamics of microresonator-based frequency comb generation assisted by mode coupling in the normal group-velocity dispersion (GVD) regime. We show that mode coupling can initiate intracavity modulation instability (MI) by directly perturbing the pump-resonance mode. We also observe the formation of a low-noise comb as the pump frequency is tuned further into resonance from the MI point. We determine the phase-matching conditions that accurately predict all the essential features of the MI and comb spectra, and extend the existing analogy between mode coupling and high-order dispersion to the normal GVD regime. We discuss the applicability of our analysis to the possibility of broadband comb generation in the normal GVD regime.

Quantum random number generator using a microresonator-based Kerr oscillator.

We demonstrate an all-optical quantum random number generator using a dual-pumped degenerate optical parametric oscillator in a silicon nitride microresonator. The frequency-degenerate bi-phase state output is realized using parametric four-wave mixing in the normal group-velocity dispersion regime with two nondegenerate pumps. We achieve a random number generation rate of 2 MHz and verify the randomness of our output using the National Institute of Standards and Technology Statistical Test Suite. The scheme offers potential for a chip-scale random number generator with gigahertz generation rates and no postprocessing.

Gigahertz frequency comb offset stabilization based on supercontinuum generation in silicon nitride waveguides.

Silicon nitride (Si3N4) waveguides represent a novel photonic platform that is ideally suited for energy efficient and ultrabroadband nonlinear interactions from the visible to the mid-infrared. Chip-based supercontinuum generation in Si3N4 offers a path towards a fully-integrated and highly compact comb source for sensing and time-and-frequency metrology applications. We demonstrate the first successful frequency comb offset stabilization that utilizes a Si3N4 waveguide for octave-spanning supercontinuum generation and achieve the lowest integrated residual phase noise of any diode-pumped gigahertz laser comb to date. In addition, we perform a direct comparison to a standard silica photonic crystal fiber (PCF) using the same ultrafast solid-state laser oscillator operating at 1 µm. We identify the minimal role of Raman scattering in Si3N4 as a key benefit that allows to overcome the fundamental limitations of silica fibers set by Raman-induced self-frequency shift.

Thermally controlled comb generation and soliton modelocking in microresonators.

We report, to the best of our knowledge, the first demonstration of thermally controlled soliton mode-locked frequency comb generation in microresonators. By controlling the electric current through heaters integrated with silicon nitride microresonators, we demonstrate a systematic and repeatable pathway to single- and multi-soliton mode-locked states without adjusting the pump laser wavelength. Such an approach could greatly simplify the generation of mode-locked frequency combs and facilitate applications such as chip-based dual-comb spectroscopy.

Tunable squeezing using coupled ring resonators on a silicon nitride chip.

We demonstrate continuous tuning of the squeezing-level generated in a double-ring optical parametric oscillator by externally controlling the coupling condition using electrically controlled integrated microheaters. We accomplish this by utilizing the avoided crossing exhibited by a pair of coupled silicon nitride microring resonators. We directly detect a change in the squeezing level from 0.5 dB in the undercoupled regime to 2 dB in the overcoupled regime, which corresponds to a change in the generated on-chip squeezing factor from 0.9 to 3.9 dB. Such wide tunability in the squeezing level can be harnessed for on-chip quantum-enhanced sensing protocols that require an optimal degree of squeezing.

Dual-pumped degenerate Kerr oscillator in a silicon nitride microresonator.

We demonstrate a degenerate parametric oscillator in a silicon nitride microresonator. We use two frequency-detuned pump waves to perform parametric four-wave mixing and operate in the normal group-velocity dispersion regime to produce signal and idler fields that are frequency degenerate. Our theoretical modeling shows that this regime enables generation of bimodal phase states, analogous to the χ(2)-based degenerate OPO. Our system offers potential for realization of CMOS-chip-based coherent optical computing and an all-optical quantum random number generator.