Comparison of outcomes and required tools between transvenous extraction of pacemaker and implantable cardioverter defibrillator leads: Insight from single high-volume center experience.

INTRODUCTION: Reports of comparison with procedural outcomes for implantable cardioverter defibrillator (ICD) and pacemaker (PM) transvenous lead extraction (TLE) are old and limited. We sought to compare the safety, efficacy, and procedural properties of ICD and PM TLE and assess the impact of lead age. METHODS: The study cohort included all consecutive patients with ICD and PM TLE in the Cleveland Clinic Prospective TLE Registry between 2013 and 2022. Extraction success, complications, and failure employed the definitions described in the HRS 2017 TLE guidelines. RESULTS: A total of 885 ICD leads, a median implant duration of 8 (5-11) years in 810 patients, and 1352 PM leads of 7 (3-13) years in 807 patients were included. Procedural success rates in ICD patients were superior to those of PM in >20 years leads but similar in ≤20 years leads. In the PM group, the complete success rate of TLE decreased significantly according to the increase of lead age, but not in the ICD group. ICD TLE required more extraction tools compared with PM TLE but cases with older leads required non-laser sheath extraction tools in both groups. The most common injury site in major complication cases differed between ICD and PM TLE, although major complication rates showed no difference in both groups (2.7% vs. 1.6%, p = .12). CONCLUSION: The procedural success rate by TLE is greater for ICD patients than PM patients with leads >20 years old but requires more extraction tools. Common vascular complication sites and the impact of lead age on procedural outcomes and required tools differed between ICD and PM TLE.

Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life.

BACKGROUND: Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. METHODS: All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculate quality of life (QoL) metrics: the AF severity score as well as the AF burden. RESULTS: A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. CONCLUSION: Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.

Fiber-optic frequency comb generation using low-seed power FWM and Brillouin-assisted power equalization.

In this paper, we experimentally demonstrate an all-fiber broadband tunable optical frequency comb (OFC) operating in the C-band. The OFC is generated by broadening a power-equalized stimulated Brillouin scattering (SBS)-based seed comb (SBS-OFC) using four-wave mixing (FWM) in a highly nonlinear fiber (HNLF). The seed SBS-OFC is obtained from a pump and Stokes power recycling cavity, which yields ≈15 comb lines with 10.8 GHz line spacing having 16 dBm average power. The seed SBS-OFC is further power-equalized by a Brillouin-assisted power equalization (BAPE) technique to minimize the high pump contribution at the recycling cavity output. The power-equalized seed SBS-OFC, which has low-power of -4.5d B m at the BAPE cavity output, is propagated down a dual-pass 200 m dispersion flattened HNLF. At the HNLF output, we obtain ≈140 comb lines within a 12 nm bandwidth having 10.8 GHz line spacing. We demonstrate wavelength tunability over a span of 35 nm by using a tunable laser source as the Brillouin pump. We also observe and measure a secondary OFC generated during the power-equalization process by placing a 10% coupler inside the BAPE cavity. Our experimental results closely match the trends obtained in the simulation.

Brain tumor detection and screening using artificial intelligence techniques: Current trends and future perspectives.

A brain tumor is an abnormal mass of tissue located inside the skull. In addition to putting pressure on the healthy parts of the brain, it can lead to significant health problems. Depending on the region of the brain tumor, it can cause a wide range of health issues. As malignant brain tumors grow rapidly, the mortality rate of individuals with this cancer can increase substantially with each passing week. Hence it is vital to detect these tumors early so that preventive measures can be taken at the initial stages. Computer-aided diagnostic (CAD) systems, in coordination with artificial intelligence (AI) techniques, have a vital role in the early detection of this disorder. In this review, we studied 124 research articles published from 2000 to 2022. Here, the challenges faced by CAD systems based on different modalities are highlighted along with the current requirements of this domain and future prospects in this area of research.

Recurrent Pericardial Effusions and Pericarditis Due to Yellow Nail Syndrome.

A 79-year-old woman presents with recurrent pericardial and pleural effusions for several years. She was noted to have exudative pleural effusions and bilateral nailbed discoloration. The constellation of her presenting symptoms and existing physical examination findings revealed a diagnosis of yellow nail syndrome, a rare cause of recurrent pericardial effusions. (Level of Difficulty: Advanced.).

Postoperative Apical Ballooning Syndrome Following Orthotopic Liver Transplantation.

As the mainstay of therapy for end-stage liver disease (ESLD), orthotopic liver transplantation (OLT) has complex effects on multiple organ systems. We present a representative case of acute heart failure with apical ballooning syndrome following OLT and review its mechanisms. Recognition of this and other potential cardiovascular and hemodynamic complications of OLT are essential to periprocedural anesthesia management. Once an acute phase of the condition is stabilized, conservative treatment and resolution of physical or emotional stressors usually allow for rapid resolution of symptoms, typically recovering systolic ventricular function within one to three weeks.

Posterior reversible encephalopathy syndrome following coronary angiography.

Posterior reversible encephalopathy syndrome (PRES) is a relatively rare neurotoxic disorder. A 56-year-old male underwent elective coronary angiography. A Few hours postprocedure, the patient developed bilateral painless vision loss, headache, vomiting and hypertension and was subsequently diagnosed with PRES. Possible trigger factors could be contrast agent used, or hypertension. Contrast agent-induced PRES in hypertensive patients is benign and reversible, and a high-grade suspicion about this possibility is critical for precise management. Our patient was successfully treated with supportive management and was doing well on follow-up.

All-SBS fiber-based setup for optical frequency comb generation utilizing a pump recycling technique and comb line isolation by implementing Brillouin amplification.

We describe an all-stimulated Brillouin scattering (SBS) fiber-based setup for the generation, amplification, and isolation of frequency components from an optical frequency comb (OFC). The cascaded SBS-OFC is obtained by utilizing pump and Stokes power recycling techniques. A total of >15 comb lines within a 45 dB bandwidth, having an average power of 16 dBm, is observed in the 1550 nm wavelength region of operation. By implementing a polarizer-analyzer setup exploiting the weak birefringence in silica fibers, we amplified and isolated the first Stokes component of the generated comb. The isolated component at 1550.03 nm was amplified by ≈55dB. In order to verify the isolation of a single comb line, the SBS-OFC is intensity modulated using sinusoidal signals of different frequencies, and the modulation is detected after the comb line isolation. We also observe that with the increase in Brillouin pump power during comb line isolation, the spontaneous Brillouin noise acts as a limitation to the selective amplification process.

SGLT2 inhibitors in heart failure with reduced ejection fraction.

Sodium - glucose co-transporter 2 (SGLT2) inhibitors reduce blood glucose by inhibiting reabsorption of glucose from the proximal renal tubules. Initial studies showed that apart from reducing blood glucose they also reduce the combined endpoint of myocardial infarction, stroke, and cardiovascular death, hospitalization from heart failure, and occurrence of renal failure in patients with known cardiovascular disease or at high risk of developing cardiovascular disease. Recent studies have shown that these drugs also could be used in patients to treat heart failure or to slow the progression of renal failure, irrespective of whether the patients have diabetes or not. In this review, we discuss the clinical trial evidence for the use of SGLT2 inhibitors for the treatment of patients with heart failure with reduced ejection fraction and for the prevention of heart failure in patients with diabetes who are at high risk of cardiovascular events. We also discuss the plausible mechanisms of action for the cardiovascular beneficial effects of SGLT2 inhibitors. EMPA-REG OUTCOME TRIAL, DECLARE-TIMI 58, CANVAS, VERTIS-CV studies have shown that SGLT2 inhibitors namely empagliflozin, dapagliflozin, canagliflozin and ertugliflozin reduce the chances of hospitalisation in patients who have cardiovascular disease or at high risk of cardiovascular disease. The DAPA-HF study and the EMPEROR-REDUCED TRIAL have further shown that Dapagliflozin and Empagliflozin could be used to treat patients with heart failure, with or without diabetes. SGLT2 inhibitors provide us with a new armamentarium for treatment of patients with a triad of diabetes, heart or renal disease. Their mechanism of action in prevention or treatment of patients with heart failure however still remains speculative.

Herpes simplex virus-1 oesophagitis presenting with persistent hiccough in an immunocompetent host: A case report.

Herpes simplex virus-1 (HSV-1) oesophagitis as an aetiology of persistent hiccough is a rarity in immunocompetent hosts and entails an exhaustive diagnostic work-up, since it does not present with any of the typical oesophagitis symptoms. Our patient presented with persistent hiccoughs that were resistant to treatment with baclofen. Oesophagogastroduodenoscopy with biopsy confirmed the diagnosis of HSV-1 oesophagitis. The hiccough subsided within 48 h of aciclovir therapy.

Paraneoplastic Dermatomyositis in a Case of Gallbladder Signet Ring Cell Carcinoma.

Dermatomyositis (DM), as a paraneoplastic presentation, is rare, though the incidence of malignancies in patients with DM is very high. While it has been reported with a wide range of cancers, association with gallbladder carcinoma is uncommon. Furthermore, signet ring cell carcinoma detected in the metastasis presumably from our patient's gallbladder mass is itself a rare and highly malignant variant of gallbladder adenocarcinoma. Thus, this association can be considered to be a very novel finding.  We describe the case of a 64-year-old Indian man who presented with cervical lymph node swelling concurrent with facial rashes, periorbital oedema, nasal regurgitation, dysphagia and weakness in his limbs. The presence of characteristic Gottron's papules and shawl-like truncal rash on examination led to the diagnosis of DM. Fine needle aspiration cytology (FNAC) of the cervical lymph nodes revealed metastatic signet ring cells, and contrast-enhanced CT (CECT) scan of the abdomen showed a significant gallbladder mass with liver infiltration, thus confirming the underlying association.

Hybrid pumped gain-switched thulium fiber laser at a high repetition rate.

A gain-switched all-fiber thulium laser at 2 µm with high repetition rate has been demonstrated under a hybrid pumping scheme combined of a pulsed pump at 1.56 µm and CW pump at 793 nm. The in-band pulsed pump at 1.56 µm triggers the gain-switching pulses while the CW pump at 793 nm facilitates the energy storage. Therefore, the seed cavity delivers high energy pulses allowing the elimination of multistage amplification. Such hybrid pump configuration is effective for generating gain-switched pulses of high average power with better slope efficiency and pulse width of a few hundreds of a nanosecond. The optimized cavity under such hybrid pump configuration provides output power of 5.92 W from the gain-switched oscillator with slope efficiency of 60% and pulse width of 300 ns at a repetition rate of 344 kHz. Maximum pulse energy of 17.2 µJ and peak power of 53.9 W has been achieved at this repetition rate. Stable gain-switched pulses at reduced pump pulse energy have been achieved by the use of a CW pump at 793 nm. This novel pump configuration facilitates gain switch at higher repetition rates where enough pump pulse energy may not be available. The gain-switched laser also operates at 520 kHz and 1.3 MHz repetition rate by changing the 1.56 µm pulsed pump and cavity length.