A simple and practical criterion for determining a failed His-bundle pacing.

AIMS: To establish a simple criterion for determining a failed His-bundle pacing (HBP). This criterion states that if stimulus to QRS end interval is longer than His-bundle potential to QRS end interval ('S-QRSend > H-QRSend') then a failed HBP can be determined. METHODS AND RESULTS: We performed retrospective analysis on 737 pacing tests around His-bundle in 241 patients and prospective analysis on 400 tests in 123 patients. A successful HBP is defined as that whole His-bundle is captured with or without capture of adjacent ventricular myocardium, otherwise, a failed HBP was considered. The output criteria and effective refractory period criteria were used as the gold standards for determining a successful HBP. The gold standards are that if decreasing the pacing output or pacing cycle length to a certain level results in duration or morphology changes of QRS, then a successful HBP is ascertained. In retrospective analysis of patients with normal His-Purkinje conduction, a failed HBP was determined in 31% (154/492) of pacing tests according to 'S-QRSend > H-QRSend'; all of them were validated by the gold standards (specificity = 100%). In prospective study, a failed HBP was confirmed according to the simple criterion with 100% accuracy in 33% (79/241) pacing tests. This simple criterion was also suitable for patients with His-Purkinje conduction disease although cases with 'S-QRSend > H-QRSend' rarely occurred. CONCLUSION: A failed HBP can be easily and reliably determined solely by 'S-QRSend > H-QRSend' in more than 30% pacing tests.

Selective adhesion of nitrogen-containing toxic gasses on hexagonal boron phosphide monolayer: a computational study.

CONTEXT: Various toxic gasses are being released into the environment with the increasing industrialization. However, detecting these gasses at low concentrations has become one of the main challenges in environmental monitoring and protection. Thus, developing sensors with high performance to detect toxic gasses is of utmost significance. For this purpose, researchers have introduced 2D materials thanks to their unique electronic qualities and large specific surface area. Within this piece of research, a hexagonal boron phosphide monolayer (h-BPML) is employed as the substrate material. The adhesion behavior of ambient nitrogen-containing toxic gasses, i.e., N2O, NH3, NO2, and NO, onto the h-BPML is investigated through DFT computations. The adhesion energy values for gasses NO and NO2 were calculated to be - 0.509 and - 0.694 eV on the h-BPML, respectively. Meanwhile, the absorbed energy values for gasses NH3 and N2O were found to be - 0.326 and - 0.119 eV, respectively. The recovery time, DOS, workfunction, and Bader charges were computed based on four optimal adhesion structures. After the absorption of NO on the h-BPML, the value of workfunction of a monolayer decreased from 1.54 to 0.47 eV. This amount of decrease was the greatest among the other gasses absorbed. By comparing the investigated parameters, it can be concluded that the h-BPML has a greater tendency to interact with NO gas compared to other gasses, and it can be proposed as a sensor for NO gas. METHOD: Within this piece of research, the sensitivity of the h-BPML to four nitrogenous toxic gasses, namely, N2O, NH3, NO2, and NO, was investigated using the DFT with HSE06 hybrid functional by using GAMESS software. For this purpose, we computed the DOS, workfunction, and the Bader charges for the four adhesion systems with most stability.

A randomized, double-blind, double-dummy, multicenter, controlled trial on brotizolam intervention in outpatients with insomnia.

AIM: To investigate the efficacy and safety of brotizolam in outpatients with insomnia. METHODS: This randomized, double-blind, double-dummy, multicenter, controlled trial recruited 253 outpatients randomized to receive either brotizolam (n = 126) or estazolam (n = 127) for 14 days followed by 1 week of follow-up for rebound detection. Sleep Dysfunction Rating Scale (SDRS) and Clinical General Impression Scale were applied for efficacy evaluation. Safety evaluation was based on data regarding vital signs, physical examination, lab tests, ECG and collection of adverse events. RESULTS: Full Analyses Set (FAS) and Safety Set (SS) included data of 251 subjects, with 126 from brotizolam group and 125 from estazolam group. Per Protocol Set (PPS) analysis included data of 235 subjects, with 121 and 114 from each group. After 14 days of treatment, there was no difference with statistical significance between the two groups regarding SDRS total score change from baseline. FAS and PPS analysis showed that the brotizolam is non-inferior to estazolam in efficacy evaluation. There was also no difference with statistical significance regarding rebound rate between brotizolam and estazolam group in FAS. The rate of adverse event in two groups was with no statistically significant difference in SS. CONCLUSION: Brotizolam is effective and safe in relieving the symptoms of insomnia.

White luminescence of Dy3+ ions doped 12CaO 7Al2O3 nanopowders under UV light excitation.

12CaO 7Al2O3:Dy3+ nanopowders were successfully synthesized by the chemical co-precipitation method. X-ray diffraction result shows that the single 12CaO 7Al2O3 phase is formed with Dy3+ ions to replace the Ca2+ ions in the host of 12CaO 7Al2O3. The yellow and blue emissions, attributed to the forced electric dipole transition of 4F(9/2) --> 6H(13/2) centered at 571 nm and the magnetic dipole transition of 4F(9/2) --> 6H(15/2) centered at 480 nm, respectively, were observed. The integrated intensity ratios of yellow to blue increase from 1.63 to 1.70 with Dy3+ concentration increasing from 0.8 to 2.0% for the as-prepared 12CaO 7Al2O3:xDy3+ phosphor. The significantly enhanced emission intensities of 12CaO 7Al2O3:1.0% Dy3+ phosphor annealed at 900 degrees C for 2 hours in vacuum ambient could be ascribed to the decrease of OH(-) groups and the change of the surface topography. The thermal stability and the Commission International de l'Eclairage coordinates were also investigated. All the photoluminescence characteristics indicate that Dy3+ ions doped 12CaO 7Al2O3 may be a good candidate for the solid state lighting phosphor as well as white light-emitting diodes.

[Evaluation of MODS score system and its modified system for the postoperative patients with cardiac surgery].

OBJECTIVE: To establish a feasible postoperative score system for cardiac surgery patients. METHODS: A prospective study was assigned of the 1 935 consecutive patients entering a single cardiac postoperative intensive care unit of Anzhen Hospital between Octorber, 2007 and January, 2008. Mutiple organ dysfunction score (MODS score) and modified mutiple organ dysfunction score (modified MODS score) were calculated daily at least three days, or until intensive care discharge or death. MODS score and modified MODS score of the first day, maximum MODS and modified MODS scores during the first 3 days, and maximal MODS and modified MODS scores, MODS score and modified MODS score changes between the first and the third postoperative day were calculated, then the sensitivity and specificity of the two score systems were compared by the receiver operating characteristic curve (ROC). RESULTS: ROC of the operative day score: MODS was 0.742, and modified MODS was 0.810; ROC of the maximum score: MODS was 0.896, and modified MODS was 0.901; ROC of the maximum scores during the first three: MODS was 0.886, and modified MODS was 0.896; ROC of the change between the third day and the first day score: MODS was 0.777, and modified MODS was 0.808. CONCLUSION: Both MODS score system and modified MODS score system are feasible to evaluate the patient's prognosis after cardiac surgery, and the sensitivity and specificity of modified MODS score system are better than those of MODS score system.

[Postoperative acute renal failure in adult patients with cardiac surgery: evaluation of the RIFLE classification].

OBJECTIVE: To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. METHODS: From October 1st 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE II score and SOFA score were also evaluated, as well as the maximum scores were recorded. RESULTS: Mean duration of ventilation support was 18 (14-19) hours, the time of ICU stay was 1.4 +/- 1.0 days, and the time of postoperative hospital stay was 12.0 (10.0-15.0) days. 167 patients (32.8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4.3% (22/502). A significant increase (P < 0.01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0.933, (95% CI 0.872-0.995), P < 0.001]. CONCLUSIONS: ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.

[Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery].

OBJECTIVE: To investigate the treatment experience of extracorporeal membrane oxygenation (ECMO) support after cardiac surgery. METHODS: Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of (48.7 +/- 16.5) years old. The cardiac operations included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle (n = 9), coronary artery bypass grafting and valvular operation (n = 5), repair of ventricular septal perforation following acute myocardial infarction (n = 2), valvular operation (n = 46), heart transplantation (n = 20), lung heart transplantation and repair of ventricular septal defect (n = 1), correction of congenital heart defects (n = 10), aortic operations (n = 4). Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time (ACT) of 160 to 200 s in centrifugal pump (14 cases), and 200 to 250 s in roller pump (3 cases) to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases. RESULTS: Mean ECMO duration was 61 h (ranged 3 to 225 h) and the mean duration of ICU stay was 5 d. 87 patients (74.4%) were successfully weaned from ECMO. 69 patients (59.0%) survived to discharge. The most common complications were re-exploration for bleeding (n = 24) and alimentary tract hemorrhage (n = 14), renal failure required renal replacement therapy (n = 29), infection(n = 32), limb ischemia (n = 5), plasma leak of oxygenators (n = 29), hemolysis (n = 7), neurological complication (n = 4). CONCLUSIONS: ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.

[Application and exploration of micro-class combined with flipped classroom in cardiopulmonary resuscitation teaching for dental students].

PURPOSE: To explore the application of micro-class combined with flipped classroom in cardiopulmonary resuscitation teaching for dental students. METHODS: The experimental group included 46 students from grade 2014 in college of stomatology, Shanghai Jiao Tong University. The control group included 45 students from grade 2013. Students in the control group were taught in traditional method, while those in the experimental group were taught in micro-class combined with flipped classroom teaching. After the course, we compared the outcome of didactic test and skill evaluation about CPR. A questionnaire survey was conducted in the experimental group. SPSS16.0 software was employed for statistical analysis. RESULTS: The results of didactic test and skill evaluation in the experimental group was significantly better than that in the control group(P<0.05). The results of questionnaire showed that application of micro-class combined with flipped classroom was appreciated by over 80% students. CONCLUSIONS: The implementation of micro-class combined with flipped classroom can achieve a better teaching effect in cardiopulmonary resuscitation teaching for dental students.

[The application of extracorporeal membrane oxygenation for surgical treatment of coronary artery disease].

OBJECTIVE: To summarize the results and experiences on extracorporeal membrane oxygenation (ECMO) for post-cardiac surgery of coronary artery disease. METHODS: From June 2004 to November 2006, sixteen patients with the mean age of (58 +/- 11) years old undergoing cardiac surgical procedures were placed on ECMO using a heparin-bonded circuit. Fourteen patients were male and two patients were female. Thirteen patients underwent on pump coronary artery bypass surgery (CABG) and three patients underwent off-pump coronary artery bypass grafting. The duration of ECMO support, stay of intensive care unit (ICU stay), complications and turnovers were recorded. RESULTS: The mean duration of ECMO support was 51 hours, and the mean duration of ICU stay was 5 days. Thirteen patients (81.3%) were successfully weaned form ECMO, ten patients (62.5%) were discharged from hospital. The main complications were bleeding, infection, renal failure and ischemia of the lower limbs with the incidence of 18.8%, 37.5%, 25% and 18.8% respectively. CONCLUSION: ECMO is an acceptable technique for shortterm treatment of refractory low cardiac output after cardiac surgery of coronary artery disease.

Comparison of quetiapine and risperidone in Chinese Han patients with schizophrenia: results of a single-blind, randomized study.

OBJECTIVE: To evaluate the efficacy and safety of 750 mg/day quetiapine fumarate (Seroquel) in the treatment of Chinese Han patients with schizophrenia. METHODS: In this 6-week, multicenter, randomized, rater single-blind study, a total of 119 patients with schizophrenia were randomly assigned to quetiapine (n = 60, 750 mg/day) or risperidone (n = 59, 4 mg/day). The efficacy was assessed by the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Change (CGI-C) and the Calgary Depression Scale for Schizophrenia (CDSS). Safety and tolerability assessments included treatment-emergent adverse events, laboratory tests and electrocardiograms. RESULTS: The primary analysis demonstrated no significant difference between treatment in the two groups (quetiapine vs. risperidone: 31.9 ± 17.5 vs. 33.3 ± 17.3; P = 0.668). Improvements with both treatments were comparable for total PANSS, positive and negative subscores, general psychopathology subscales, and excitement and attack symptoms. Improvements in CGI-S were similar between treatment groups (P = 0.046). A more favorable trend was detected for quetiapine than risperidone in the reduction of CDSS scores from baseline, especially at week 1 (1.1 ± 2.2 vs. 0.3 ± 2.1, P < 0.050). The rate of extrapyramidal symptom (EPS) and hyperprolactinemia-related adverse events was significantly lower in the quetiapine group than the risperidone group (13.3% vs. 43.3%, P < 0.001). Dizziness and somnolence were more common in the quetiapine group than the risperidone group. CONCLUSION: Quetiapine fumarate (750 mg/day) has broad clinical efficacy comparable to 4 mg/day risperidone. Dizziness was common in the quetiapine group (P = 0.029), but the rate of somnolence was similar between the two groups (P = 0.114). EPS and hyperprolactinemia rates were significantly higher with risperidone (P < 0.001). Key limitations of this study include small sample size, short treatment periods, and no increase to 6 mg/day for risperidone because of its safety profile.

Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system.

BACKGROUND: Off-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB. METHODS: From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out. RESULTS: Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P < 0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P < 0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P < 0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein. CONCLUSIONS: Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.

Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria.

INTRODUCTION: Acute kidney injury (AKI) is one of the major complications in adult postcardiotomy patients on extracorporeal membrane oxygenation (ECMO) support. The RIFLE (the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-Stage Kidney Disease) classification and the Acute Kidney Injury Network (AKIN) criteria were proposed to identify and classify AKI recently. This study aims to evaluate the occurrence of AKI during the initial 48 h of ECMO support by using both the RIFLE classification and the AKIN criteria, and to determine which scoring tool has better capability for predicting hospital mortality of adult postcardiotomy patients with ECMO support. METHODS: From 2004 to 2008, 67 patients (> or = 18 years) who received extracorporeal membrane oxygenation support after undergoing cardiac surgery were enrolled and retrospectively evaluated. RESULTS: The average age was 50.5+/-13.6 years; 48 patients (72%) were male. According to the RIFLE classification and the AKIN criteria, the incidence of AKI during first 48 h after receiving ECMO support was 81% and 85%, respectively. The overall mortality was 51% and the hospital mortality was much higher among patients who received renal replacement therapy (RRT) than in patients not receiving RRT (73% vs 32%, p=0.001). Either class-Failure for the RIFLE classification (odds ratio (OR)=12.6, 95% confidence interval (CI)=2.2-72.3, p=0.005) or the Stage 3 for the AKIN (OR=30.8, 95% CI=3.3-287.2, p=0.003) was found to be independently associated with the hospital mortality. The area under the receiver operator characteristic (ROC) curve for hospital mortality was 0.738 for the RIFLE classification (p=0.001) and was 0.799 for the AKIN criteria (p<0.001). No significant differences were found in both the incidence of AKI and the hospital mortality of AKI by using the RIFLE/AKIN criteria. CONCLUSIONS: Acute kidney injury is a major complication and associated with high mortality in adult patients who received ECMO support after undergoing cardiac surgery. Both the RIFLE classification and the AKIN criteria have good short-term prognostic capability in these populations and either class-Failure for the RIFLE classification or the Stage 3 for the AKIN were found to be independently associated with the hospital mortality. However, it does not seem that the AKIN criteria have greater sensitivity and specificity, compared with the RIFLE classification in this study population.