Development and Application of Four Foodborne Pathogens by TaqMan Multiplex Real-Time PCR.

A TaqMan multiplex real-time PCR (mRT-PCR) was developed to detect simultaneously Salmonella spp., Escherichia coli O157, Staphylococcus aureus, and Listeria monocytogenes in food samples. The method involves four sets of primers and probes tailored to the unique DNA sequences found in the invA, nuc, rfbE, and hly genes of each pathogen. The generated standard curves, correlating gene copy numbers with Ct values, demonstrated high accuracy (R2 > 0.99) and efficiency (92%-104%). Meanwhile, the limit of detection was 100 CFU/mL for the four target bacteria in artificially contaminated food samples after 6-8 h of enrichment. The assay's effectiveness was further verified by testing 80 naturally contaminated food samples, showing results largely in agreement with traditional culture methods. Overall, this newly developed TaqMan mRT-PCR, inclusive of a pre-enrichment step, proves to be a dependable and effective tool for detecting single or multiple pathogens in diverse food items, offering significant potential for in vitro diagnostics.

Polysaccharides from fructus corni: Extraction, purification, structural features, and biological activities.

Fructus Corni, derived from the dried fruit of Cornus officinalis Sieb. Et Zucc., is widely used as a food source and Chinese herb. Fructus Corni, as an indispensable ingredient in Liuwei Dihuang decoction, tonifies the liver and kidneys. As the main component of water decoctions, Fructus Corni polysaccharides demonstrate multifaceted effects, including hypoglycemic, hypolipidemic, antioxidant, anti-aging, sexual function regulation, and anti-epileptic, The ultrasound-assisted extraction method obtained the highest yields of Fructus Corni polysaccharides. However, it has notable shortcomings and lacks further innovation. The homogeneous polysaccharides obtained from Fructus Corni are mostly neutral polysaccharides with relatively limited structure, and the mechanism of their biological activity needs to be further elucidated. In addition, different extraction, isolation and purification methods may change the molecular weight, monosaccharide composition, and biological activity of polysaccharides. Therefore, this study systematically summarized the extraction, purification, structural features, and biological activities of Fructus Corni polysaccharides. This study aimed to provide support for the ongoing development and application of Fructus Corni polysaccharides.

Clearance of intracellular bacterial infections by hyaluronic acid-based ROS responsive drug delivery micelles.

Pathogenic bacteria residing inside cells could cause disruption of cellular metabolic balance. Therefore, basing on high oxidative stress response of the intracellular bacteria infected micro-environment, a novel amphipathic micelle (HATAD-TCS) was developed consisting of hyaluronic acid-derivative and reactive oxygen species (ROS) - responsive group and antibacterial agent triclosan (TCS). ROS-generating cinnamaldehyde (CA) was incorporated into ROS-cleavable linkages which are future linked to the 1-decylamine to form hydrophobicity. The cinnamaldehyde released did not just killed bacteria however, also maintained intracellular ROS levels. In this study, the HATAD-TCS micelles have been characterized by scanning electron microscopy (SEM) and dynamic light scattering (DLS). The HATAD-TCS micelles could release drug gradually upon exposure to endogenous ROS being caused by infected intracellular bacteria. Furthermore, the more promising therapeutic effect of the HATAD-TCS micelles was observed in a mouse pneumonia model. These results might highlight a ROS-responsive hyaluronic acid-based nanoparticle, which could effectively treat intracellular bacterial infections.

Clinical use conditions of lead deployment and simulated lead fracture rate in left bundle branch area pacing.

INTRODUCTION: Left bundle branch area pacing (LBBAP) is achieved by advancing the lead tip deep in the septum. Most LBBAP implants are performed using the Medtronic SelectSecure™ MRI SecureScan™ Model 3830 featuring a unique 4 Fr fixed helix lumenless design. Details of lead use conditions and long-term reliability have not been reported. This study was designed to quantify the mechanical use conditions for the 3830 lead during and after LBBAP implant, and to evaluate reliability using bench testing and simulation. METHODS: Fifty bradycardia patients with implantation of the 3830 lead for LBBAP were enrolled. Use conditions of lead deployment at implantation were collected and computed tomography (CT) scans were performed at 3-month follow-up. Curvature amplitude along the pacing lead was determined with CT images. Fatigue bending was performed using accelerated testing in a more severe environment than routine clinical use conditions. Conductor fracture rate in a simulated patient population was estimated based on clinical use conditions and fatigue test results. RESULTS: The number of attempts to place the 3830 lead for LBBAP was 2.1 ± 1.3 (range: 1-7) with 13 ± 6 lead rotations at the final attempt. Extreme implant conditions were simulated in bench testing with 5 applications of 20 turns followed by up to 400 million bending cycles. Reliability modeling predicted a 10-year fracture rate of 0.02%. CONCLUSIONS: LBBAP implants require more lead rotations than standard pacing implants and result in unique lead bending. Application of simulated LBBAP use conditions to the 3830 lead in an accelerated in-vitro model does not produce excess conductor fractures. IMAGE-LBBP Study ID of ClinicalTrial.GOV: NCT04119323.

New criterion to determine left bundle branch capture on the basis of individualized His bundle or right ventricular septal pacing.

BACKGROUND: Left bundle branch pacing (LBBP) is an emerging physiological pacing modality. How to differentiate LBBP from left ventricular septal pacing (LVSP) remains challenging. OBJECTIVE: We aimed to develop a new personalized intraoperative criterion to confirm left bundle branch (LBB) capture in patients with or without heart failure (HF). METHODS: Patients were enrolled if 12-lead surface electrocardiograms of LBBP, LVSP, temporary His bundle pacing (HBP), and right ventricular septal pacing (RVSP) were recorded during the procedure, with the leads placed in the basal midseptal region. Left ventricular activation time (LVAT) was measured during different pacing modalities. ΔLVAT1 was defined as the difference in LVAT between HBP and LBBP/LVSP. ΔLVAT2 was estimated by the difference in LVAT between RVSP and LBBP/LVSP. ΔLVAT1% and ΔLVAT2% were calculated as the percent reduction of ΔLVAT1 and ΔLVAT2, respectively. RESULTS: A total of 105 consecutive patients were included, of whom 80 (76.2%) had normal cardiac function (65 LBBP and 15 LVSP) and 25 had HF. Patients with LBBP showed significantly shorter LVAT than did those with LVSP. In patients with normal cardiac function, a cutoff value of ΔLVAT1 > 12.5 ms showed 73.9% sensitivity and 93.3% specificity to confirm LBB capture. In patients with HF, a cutoff value of ΔLVAT1% > 9.8% exhibited great accuracy for LBB capture (sensitivity 92.0%; specificity 92.3%). The optimal value of ΔLVAT2% for differentiating LBBP from LVSP was 21.2%. CONCLUSION: Temporary HBP and RVSP can serve as references to confirm LBB capture in an individualized fashion in patients with or without HF.

Anti-inflammatory Effect of a Novel Pectin Polysaccharide From Rubus chingii Hu on Colitis Mice.

Rubus chingii Hu has been used as a functional food for a long time. A novel pectin polysaccharide named RCHP-S from R. chingii Hu was structurally identified and explored its anti-inflammatory effect on colitis mice. RCHP-S was composed of mannose, rhamnose, glucuronic acid, galacturonic acid, glucose, galactose, and arabinose. NMR spectroscopy and methylation analysis showed that RCHP-S was mainly composed of HG-type pectin domains but also contains a small amount of RG-I. The anti-inflammatory tests indicated that the mouse macrophage RAW 264.7 cells pretreated with RCHP-S could show a significant inhibitory effect on the mRNA level of iNOS, IL-1ß, IL-6, and TNF-α in vitro. Polysaccharide RCHP-S reduced the enteritis symptoms in dextran sulfate sodium (DSS)-induced colitis mice by inhibiting released inflammatory factors. These results indicated that the R. chingii Hu polysaccharide can be used as food additives for the treatment of intestinal inflammation.

Computed tomography imaging-identified location and electrocardiographic characteristics of left bundle branch area pacing in bradycardia patients.

INTRODUCTION: Left bundle branch area pacing (LBBAP) is a novel physiological pacing modality. The relationship between the pacing lead tip location and paced electrocardiographic (ECG) characteristics remains unclear. The objectives are to determine the lead tip location within the interventricular septum (IVS) and assess the location-based ECG QRS duration (QRSd) and left ventricular activation time (LVAT). METHODS: This multicenter study enrolled 50 consecutive bradycardia patients who met pacemaker therapy guidelines and received LBBAP implantation via the trans-ventricular septal approach. After at least 3 months postimplant, 12-lead ECGs and pacing parameters were obtained. Cardiac computed tomography (CT) imaging was performed to assess the LBBAP lead tip distance from the LV blood pool. RESULTS: Among the 50 patients, analyzable CT images were obtained in 42. In 23 of the 42 patients, the lead tips were within 2 mm to the LV blood pool (the LV subendocardial (LVSE) group), 13 between 2 and 4 mm (the Near-LVSE group), and the remaining 6 beyond 4 mm (the Mid-LV septal (Mid-LVS) group). No significant differences in paced QRSd were found among the three groups (LVSE, 107 ± 15 ms; Near-LVSE, 106 ± 13 ms; Mid-LVS, 104 ± 15 ms; p = .87). LVAT in the LVSE (64 ± 7 ms) was significantly shorter than in the Mid-LVS (72 ± 8 ms; p < .05), but not significantly different from that in the Near-LVSE (69 ± 8 ms; p > .05). CONCLUSION: In routine LBBAP practice, paced narrow QRSd and fast LVAT, indicative of physiological pacing, were consistently achieved for lead tip location in the LV subendocardial or near LV subendocardial region.

Complete electrical reverse remodeling of native conduction after resynchronization therapies.

BACKGROUND: Electrical reverse remodeling of native conduction is associated with better clinical outcome following cardiac resynchronization therapy (CRT). We aimed to describe characteristics, time course and long-term outcome of patients with complete electrical reverse remodeling (CERR) after resynchronization therapies. METHODS: CRT candidates were treated with bi-ventricular, His bundle or left bundle branch pacing. CERR was defined if native QRS duration post-implantation was narrowed to ≤120 ms. RESULTS: A total of 322 patients met the inclusion criteria. Among them, 66 were super-responders and 12 exhibited CERR. All 12 patients were diagnosed of non-ischemic cardiomyopathy with left bundle branch block (LBBB) meeting the Strauss criteria. The mean native QRS duration when CERR was achieved was 110.8 ± 10.0 ms, significantly shorter than the baseline (175.0 ± 18.8 ms). The occurrence of CERR varied from several days post-implantation to 18-month follow-up. The persistence of CERR also showed great variations. Eleven patients (91.7%, 11/12) showed echocardiographic super-response. Patients with CERR showed similar baseline characteristics compared to those with echocardiographic super-response but without CERR. Two patients with CERR showed different responses after bi-ventricular pacing was turned off. One patient remained stable with narrow QRS complex and great response. The other patient had reappearance of LBBB and decreased cardiac function, but recovered by turning on the device again. CONCLUSIONS: Patients with CERR exhibited great response to different resynchronization therapies. The time course of CERR and echocardiographic super-response varied greatly. The variability of native conduction system and accompanied changes of mechanical remodeling suggest the mechanisms of electrical-disorder related cardiomyopathy.

Differentiating left bundle branch pacing and left ventricular septal pacing: An algorithm based on intracardiac electrophysiology.

BACKGROUND: Left bundle branch pacing (LBBP) is a new near-physiological pacing modality. Distinguishing left ventricular septal only pacing (LVSP) from nonselective LBBP still needs clarification. This prospective study sought to establish a differentiation algorithm to confirm LBBP. METHODS AND RESULTS: LBBP was attempted in consecutive patients. If direct LBB capture (LBBP) could not be confirmed, LVSP was considered to have been achieved. Intracardiac left ventricular (LV) activation sequence and activation time were analyzed using coronary sinus (CS) electrogram mapping. Electrophysiological parameters including S-CSmax, S-CSmin, LV lateral wall activation time, ΔLV, and LBB potential were compared between LBBP and LVSP. Stimulated LV activation time (S-LVAT) and stimulated QRS duration (S-QRSd) were also compared between the two groups. Multivariate logistic regression analysis was used to develop a prediction algorithm for LBBP. Of the 43 prospectively enrolled patients, 27 underwent LBBP and 16 underwent LVSP. All LBBP patients showed identical LV activation sequences to their intrinsic rhythm while no LVSP patients maintained their intrinsic sequence. S-CSmax, ΔLV, LV lateral wall activation time, and S-LVAT during LBBP were significantly shorter than those during LVSP. Combining LBB potential with S-LVAT had the largest area under the curve (AUC) of 0.985 for confirming LBBP with a sensitivity of 95.2% and a specificity of 93.7%. CONCLUSIONS: Compared with LVSP, LBBP preserves a normal LV activation sequence and better electrical synchrony. A combination of LBB potential with S-LVAT can be an effective and practical model to distinguish LBBP from LVSP during implantation in patients with normal LBB activation.

Five major two components systems of Staphylococcus aureus for adaptation in diverse hostile environment.

Staphylococcus aureus is an eminent and opportunistic human pathogen that can colonize in the intestines, skin tissue and perineal regions of the host and cause severe infectious diseases. The presence of complex regulatory network and existence of virulent gene expression along with tuning metabolism enables the S. aureus to adopt the diversity of environments. Two component system (TCS) is a widely distributed mechanism in S. aureus that permit it for changing gene expression profile in response of environment stimuli. TCS usually consist of transmembrane histidine kinase (HK) and cytosolic response regulator. S. aureus contains totally 16 conserved pairs of two component systems, involving in different signaling mechanisms. There is a connection among these regulatory circuits and they can easily have effect on each other's expression. This review has discussed five major types of TCS in S. aureus and covers the recent knowledge of their virulence gene expression. We can get more understanding towards staphylococcal pathogenicity by getting insights about gene regulatory pathways via TCS, which can further provide implications in vaccine formation and new ways for drug design to combat serious infections caused by S. aureus in humans.

Characterization of Anoectochilus roxburghii polysaccharide and its therapeutic effect on type 2 diabetic mice.

Anoectochilus roxburghii is a traditional herb in China that can be potentially used to treat diabetes. A novel polysaccharide ARLP-W was isolated from Anoectochilus roxburghii by chromatography on DEAE-52 cellulose. Chemical analysis indicated that ARLP-W (8.1 × 104 Da) was mainly composed of mannose and glucose. The main linkages of glycosidic bonds of ARLP-W were ß-1, 4-Manp and α-1, 4-Glcp. The terminal Glcp was connected to Manp-via O-3. RT-qPCR and western blotting analysis showed that ARLP-W caused a significant reduction in the levels of the key gluconeogenesis enzymes phosphoenolpyruvate carboxykinase (PEPCK) and glucose 6-phosphatase (G6Pase) in the liver. The results of the insulin resistance tests indicated that ARLP-W increased glucose absorption. These results indicate that ARLP-W has a good therapeutic effect on type 2 diabetes and can assist with further development and application treatment of diabetes.

Investigation of the presence of Ochrobactrum spp. and Brucella spp. in Haemaphysalis longicornis.

Ticks are common vectors of human and animal diseases. Ochrobactrum spp. belong to the Brucellaceae family and have recently been recognized as emerging human pathogens. The ability of Haemaphysalis longicornis ticks to carry Ochrobactrum spp. remains uncertain. During June and July 2018, 686 ticks were collected from 11 sites in Pingdingshan Henan province in central China. We extracted 169 DNA samples for Brucellaceae 16S rRNA nested PCR and sequenced them in order to identify Ochrobactrum spp. The data sequences were aligned with NCBI BLAST program and phylogenetic tree was constructed using Mega 5.0. Twenty samples were sequenced successfully out of a total forty-one positive for Brucellaceae. Thirteen DNA samples were identical to O. intermedium (99.85 %-100.00 %) and 3 were identical to O. cicer (99.85 %-100.00 %) (15 collected from host and one from vegetation). Four DNA samples (3 collected from host and one from vegetation) had 99.83-100 % B. melitensis identity. This study adds to the growing body of evidence that shows Ochrobactrum spp. are present in H. longicornis. Ochrobactrum spp. and Brucella spp. are phenotypically and genetically closely related pathogens. Our finding highlights the importance of gene sequencing and phylogenetic analysis to differentiate between Ochrobactrum spp. and Brucella spp. in the research and potentially clinical setting. Future work is required to investigate the transmission potential of Ochrobactrum spp. by H. longicornis.

A pilot study to determine if left ventricular activation time is a useful parameter for left bundle branch capture: Validated by ventricular mechanical synchrony with SPECT imaging.

BACKGROUND: Left bundle branch (LBB) pacing has emerged as a novel pacing modality. Left ventricular activation time (LVAT) was reported to be associated with the activation via LBB, but the value of LVAT for determining LBB pacing was unknown. We conducted a pilot study to determine if LVAT could define LBB capture by validating left ventricular (LV) mechanical synchrony. METHODS: We analyzed LVAT in 68 bradycardia-indicated patients who received LBB pacing. LVAT was measured from the stimulus to R-wave peak in lead V5 and V6. LV mechanical synchrony assessed by SPECT MPI was compared according to the value of LVAT and the presence of LBB potential. RESULTS: The mean LVAT was 75.4 ± 12.7 ms. LBB potential was recorded in 47 patients (69.1%). Patients with LVAT < 76 ms had better LV mechanical synchrony than those with LVAT ≥ 76 ms. Patients with LVAT < 76 ms or LBB potential had better mechanical synchrony than those with LVAT ≥ 76 ms and no potential. LVAT < 76 ms could predict the normal synchrony with a sensitivity of 88.9% and a specificity of 87.5%. CONCLUSION: A short LVAT indicated favorable mechanical synchrony in SPECT imaging. LVAT < 76 ms might be a practical parameter for defining LBB capture.

Efficacy of upgrading to left bundle branch pacing in patients with heart failure after right ventricular pacing.

BACKGROUND: Chronic right ventricular (RV) pacing is associated with an increased incidence of heart failure and mortality. Left bundle branch (LBB) pacing could produce near-physiological electrical activation and mechanical synchrony. We aimed to report the effects of upgrading to LBB pacing in heart failure patients after chronic RV pacing. METHODS: The indications included pacing-induced cardiomyopathy (PICM) in Group 1 and heart failure after RV pacing with left ventricular ejection fraction (LVEF) ≥ 50% in Group 2. LBB pacing was achieved by penetrating the pacing lead to the subendocardium of left-sided interventricular septum through the venous access. Left ventricular activation time (LVAT) was measured from the pacing stimulus to the ascending peak of lead V5 or V6. All patients underwent clinical and echocardiographic evaluations before and after upgrading. RESULTS: Totally 27 patients (13 in Group 1 and 14 in Group 2) were consecutively enrolled. The mean follow-up time after upgrade was 10.4 ± 6.1 months. Paced QRS duration was significantly shortened from 174.1 ± 15.8 milliseconds to 116.6 ± 11.7 milliseconds (p < .0001). The mean LVAT was 83.2 ± 11.7 milliseconds. LVEF increased from 40.3 ± 5.2% before upgrading to 48.1 ± 9.5% at follow-up in patients with PICM. Serum N-terminal probrain natriuretic peptide levels decreased and New York Heart Association classification improved in both groups. No upgrade-related complications were observed. CONCLUSIONS: Upgrading to LBB pacing was feasible and effective with improved cardiac function in heart failure patients with both reduced and preserved LVEF after RV pacing.

Lead performance and clinical outcomes of patients with permanent His-Purkinje system pacing: a single-centre experience.

AIMS: His-Purkinje system (HPS) pacing, including His bundle (HB) and left bundle branch (LBB) pacing, has emerged as a highlighted topic in recent years. Comparisons in lead performance and clinical outcomes between HB and LBB pacing were seldom reported. We aimed to investigate the mid-long-term lead performance and clinical outcomes of permanent HPS pacing patients in our centre. METHODS AND RESULTS: Permanent HB pacing was implemented by placing the pacing lead helix at the HB area. Left bundle branch pacing was achieved by placing the lead helix in the left-side sub-endocardium of the interventricular septum. Pacing parameters, 12-lead ECG, echocardiography, and clinical outcomes were evaluated during follow-up. A total of 64 patients with HB pacing and 185 with LBB pacing were included. Left bundle branch pacing exhibited a slightly longer paced QRS duration than HB pacing (117.7 ± 11.0 vs. 113.7 ± 19.8 ms, P = 0.04). Immediate post-operation, LBB pacing had a significant higher R-wave amplitude (16.5 ± 7.5 vs. 4.3 ± 3.6 mV, P < 0.001) and lower capture threshold (0.5 ± 0.1 vs. 1.2 ± 0.8 V, P < 0.001) compared with HB pacing. During follow-up, an increase in capture threshold of >1.0 V from baseline was found in eight (12.5%) patients in the HB pacing group and none in LBB pacing. Paced QRS morphology changed from Qr to QS in lead V1 in seven patients (3.8%) with LBB pacing. Both HB and LBB pacing preserved cardiac function in patients with left ventricular ejection fraction (LVEF) over 50%. In patients with LVEF <50%, both HB and LBB pacing improved clinical outcomes during follow-up. CONCLUSION: His-Purkinje system pacing produced favourable electrical synchrony and improved cardiac function in patients with heart failure. Left bundle branch pacing showed superior pacing parameters over HB pacing. Lead micro-displacement with changes in paced QRS morphology posts a concern in LBB pacing.

Characterization and immunological activity of polysaccharides from Potentilla chinensis.

Three novel polysaccharides (PCPW, PCPS1 and PCPS2) were isolated from Potentilla chinensis and subjected to structural analysis by using spectral and physicochemical methods. The molecular weights of PCPW, PCPS1 and PCPS2 were calculated to be 4.45 × 103 Da, 1.18 × 104 Da and 4.23 × 104 Da, respectively. Analysis of monosaccharides composition confirmed that PCPW was composed of mannose, rhamnose, glucose, galactose and arabinose, while the two acidic polysaccharides PCPS1 and PCPS2 were consisted of six monosaccharides, including mannose, rhamnose, galacturonic acid, glucose, galactose and arabinose respectively. In addition, the main linkages of glycosidic bonds of PCPS2 were 1, 4-linked-rha, 1, 4-linked-man,1, 4-linked-galA and 1, 6-linked-man. Immunological tests indicated that both PCPW and PCPS2 could increase NO production of RAW264.7 cells, and promote splenocyte proliferation. All three polysaccharides proved to be activators of NF-κB. Overall, three polysaccharides showed a good immunological activity and pose great potential as a novel food or drug additive.

Clinical characteristics and long-term prognosis of ischemic and non-ischemic cardiomyopathy.

OBJECTIVES: The different etiology of HF has different prognostic risk factors. Prognosis assessment of ICM and NICM has important clinical value. This study is aimed to explore the predicting factors for ICM and NICM. METHODS: 1082 HFrEF patients were retrospectively enrolled from Jan. 01, 2016 to Dec. 31, 2017. On Jan. 31, 2019, 873 patients were enrolled for analysis excluding incomplete, unfollowed, and unexplained data. The patients were divided into ischemic and non-ischemic group. The differences in clinical characteristics and long-term prognosis between the two groups were analyzed, and multivariate Cox analysis was used to predict the respective all-cause mortality, SCD and rehospitalization of CHF. RESULTS: 873 patients aged 64(53,73) were divided into two groups: ICM (403, 46.16%) and NICM. At the end, 203 died (111 in ICM, 54.68%), of whom 87 had SCD (53 in ICM, 60.92%) and 269 had rehospitalization for HF(134 in ICM, 49.81%). Independent risk factors affecting all-cause mortality in ICM: DM, previous hospitalization of HF, age, eGFR, LVEF; for SCD: PVB, eGFR, Hb, revascularization; for readmission of HF: low T3 syndrome, PVB, DM, previous hospitalization of HF, eGFR. Otherwise; factors affecting all-cause mortality in NICM: NYHA III-IV, paroxysmal AF/AFL, previous hospitalization of HF, ß-blocker; for SCD: low T3 syndrome, PVB, nitrates, sodium, ß-blocker; for rehospitalization of HF: paroxysmal AF/AFL, previous admission of HF, LVEF. CONCLUSIONS: Both all-cause mortality and SCD in ICM is higher than that in NICM. Different etiologies of CHF have different risk factors affecting the prognosis.

The efficacy of left bundle branch area pacing compared with biventricular pacing in patients with heart failure: A matched case-control study.

BACKGROUND: Left bundle branch area pacing (LBBAP) was reported to improve cardiac function by correcting complete left bundle branch block (CLBBB). Our study aimed to compare the efficacy of LBBAP and biventricular pacing (BIVP) in heart failure patients with CLBBB. METHODS: Ten patients prospectively underwent LBBAP (LBB-CRT group) and 30 patients received BIVP (BIV-CRT group) were matched using propensity score matching. LBBAP was achieved by the trans-interventricular septum method. Echocardiography, electrocardiogram, NYHA classification, and blood B-type natriuretic peptide concentration were evaluated at preimplantation and at 6-month follow up. CRT response was defined as at least 15% decrease in left ventricular end-systolic volume. RESULTS: In the LBB-CRT group, CLBBB were successfully corrected by LBBAP with no complications. QRS duration (QRSd) significantly decreased after implantation in both groups, and the decrease of QRSd in the LBB-CRT group was significantly greater than that in the BIV-CRT group (60.80 ± 20.09 vs. 33.00 ± 21.48 ms, p = .0009). The echocardiographic measurements including left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular ejection fraction significantly improved after 6 months in both groups. The response rate was significantly higher in LBB-CRT group than BIV-CRT group (100.00% vs. 63.33%, p = .038). The percentage of patients in New York Heart Association classification Grades I and II was significantly higher in the LBB-CRT group compared with that in the BIV-CRT group (median 1.5 vs. 2.0, p = .029) at 6-month follow-up. CONCLUSIONS: It is effective and safe to correct CLBBB with LBBAP in heart failure patients. Compared with BIVP, LBBAP can better optimize electrical synchrony and improve cardiac function.

A novel 9-partition method using fluoroscopic images for guiding left bundle branch pacing.

BACKGROUND: Left bundle branch (LBB) pacing is a novel pacing modality, but there is no standard fluoroscopic methodology. OBJECTIVES: This study aimed to analyze the characteristics of His bundle (HB) and LBB pacing lead locations and establish a method to guide LBB pacing using fluoroscopic images. METHODS: Seventy patients who underwent HB or LBB pacing were enrolled. The fluoroscopic image was recorded, and ventricular contraction ring in the right anterior oblique 30° projection was determined. The region between the apex and the ventricular contraction ring was divided into 9 partitions. All patients underwent postoperative computed tomography to confirm components of the ventricular contraction ring and to measure the distance from the lead tip to the junction of the noncoronary aortic cusp and right coronary cusp. RESULTS: HB and LBB pacing leads were successfully implanted in 11 and 35 patients, respectively. All HB pacing leads were distributed in the second partition, and 94.3% (33/35) of LBB pacing leads were in the junctional area of second and fifth partitions. The computed tomography image confirmed that the ventricular contraction ring was composed of cardiac valves. The distance from the lead tip to the junction of the noncoronary cusp and right coronary cusp of LBB and HB pacing leads was 3.8 ± 0.6 and 1.9 ± 0.2 cm, respectively. Under the guidance of the 9-partition method, the success rate of LBB pacing in 30 prospective patients increased from 58.3% (35/60) to 83.3% (25/30) (P = .03). The fluoroscopy time and the number of screwing sites also significantly decreased. CONCLUSION: The distributions of HB and LBB pacing leads exhibited unique imaging characteristics. A new 9-partition method is useful to guide successful LBB pacing.

Gentamicin decorated phosphatidylcholine-chitosan nanoparticles against biofilms and intracellular bacteria.

Biofilms and intracellular bacteria often cause a series of overwhelming public health issues due to their strong drug resistance. Hence, chitosan nanoparticles (CS NPs), phosphatidylcholine and gentamicin were used to synthesize a novel nanodrug delivery system (GPC NPs). Dynamic light scattering (DLS) demonstrated that the surface zeta-potential of GPC NPs was -19.5 mV. The morphology of GPC NPs was observed by scanning electron microscopy (SEM). The gentamicin adsorption and release behaviors of GPC NPs were also investigated. The GPC NPs could effectively damage and remove the biofilm formed by pathogens through permeation of the antibiotic into the biofilm. In addition, the nanoparticles were readily engulfed by macrophages which facilitated the killing of intracellular bacteria and had neglectable cytotoxicity. Our study indicated that GPC NPs could be used as a promising nanoantibacterial agent against biofilms and intracellular bacteria.