Long-Term Freedom From Ventricular Arrhythmias in ARVC With Endocardial Only Ablation: Predictors of Success.

BACKGROUND: Although the epicardial predominance of substrate abnormalities has been well demonstrated in early stages of arrhythmogenic right ventricular cardiomyopathy (ARVC), endocardial (ENDO) ablation may suffice to eliminate ventricular tachycardia (VT) in some patients. OBJECTIVES: This study aimed to report the long-term outcomes of ENDO-only ablation in ARVC patients and factors that predict VT-free survival. METHODS: We included consecutive patients with Task Force Criteria diagnosis of ARVC undergoing a first ENDO-only VT ablation between 1998 and 2020. Ablation was predominantly guided by activation/entrainment mapping for mappable VTs and pace mapping/targeting abnormal electrograms for unmappable VTs. The primary endpoint was freedom from any recurrent sustained VT after the last ENDO-only ablation. RESULTS: Seventy-four ARVC patients underwent ENDO-only VT ablation. VT noninducibility was achieved in 49 (66%) patients. During median follow-up of 6.6 years (Q1-Q3: 3.4-11.2 years), 40 (54.1%) patients remained free from any VT recurrence with rare VT ≤2 episodes in additional 12.2%. Among patients with noninducibility, VT-free survival was 75.5% during long-term follow-up. In multivariable analysis, >45 y of age at diagnosis (HR: 0.41; 95% CI: 0.17-0.98) and VT noninducibility (HR: 0.36; 95% CI: 0.16-0.80) were predictors of VT-free survival. CONCLUSIONS: Long-term VT-free survival can be achieved in over half of ARVC patients following ENDO-only VT ablation, increasing to over 75% if VT noninducibility is achieved. Our results support consideration of a stepwise ENDO-only approach before proceeding to epicardial ablation if VT noninducibility can be achieved particularly in older patients.

Tuning Wetting-Dewetting Thermomechanical Energy for Hydrophobic Nanopores via Preferential Intrusion.

Heat and the work of compression/decompression are among the basic properties of thermodynamic systems. Being relevant to many industrial and natural processes, this thermomechanical energy is challenging to tune due to fundamental boundaries for simple fluids. Here via direct experimental and atomistic observations, we demonstrate, for fluids consisting of nanoporous material and a liquid, one can overcome these limitations and noticeably affect both thermal and mechanical energies of compression/decompression exploiting preferential intrusion of water from aqueous solutions into subnanometer pores. We hypothesize that this effect is due to the enthalpy of dilution manifesting itself as the aqueous solution concentrates upon the preferential intrusion of pure water into pores. We suggest this genuinely subnanoscale phenomenon can be potentially a strategy for controlling the thermomechanical energy of microporous liquids and tuning the wetting/dewetting heat of nanopores relevant to a variety of natural and technological processes spanning from biomedical applications to oil-extraction and renewable energy.

Accessing Properties of Molecular Compounds Involved in Cellular Metabolic Processes with Electron Paramagnetic Resonance, Raman Spectroscopy, and Differential Scanning Calorimetry.

In this work, we review some physical methods of macroscopic experiments, which have been recently argued to be promising for the acquisition of valuable characteristics of biomolecular structures and interactions. The methods we focused on are electron paramagnetic resonance spectroscopy, Raman spectroscopy, and differential scanning calorimetry. They were chosen since it can be shown that they are able to provide a mutually complementary picture of the composition of cellular envelopes (with special attention paid to mycobacteria), transitions between their molecular patterning, and the response to biologically active substances (reactive oxygen species and their antagonists-antioxidants-as considered in our case study).

Early complications of percutaneous K-wire fixation in pediatric distal radius fractures-a prospective cohort study.

INTRODUCTION: Distal radius fractures (DRF) are the most common pediatric fractures, but the current evidence for management remains inconclusive. Closed reduction and percutaneous pinning (CRPP) provide excellent stability but are not complications-free. Therefore, a thorough evaluation of their adverse events is necessary to provide reliable information on risks and benefits in different clinical scenarios. The current literature lacks studies conducted with rigorous grading systems and uniform follow-up protocols on this topic. This prospective cohort study used a validated grading scheme to analyze complications associated with CRPP in an unselected pediatric population with displaced, unstable distal third radius fractures. MATERIALS AND METHODS: One hundred and nineteen DRFs (one hundred and sixteen patients) treated with CRPP were enrolled in the study. All patients were followed 4 weeks, 5 weeks, 3 months, and 6 months after the surgery. The same protocol, comprising structured history, physical and radiological assessment, was used throughout the study. All data were prospectively abstracted. The Clavien-Dindo-Sink grading system was used to assess the complications and the Dahl score to evaluate the pin sites. RESULTS: Forty-two wrists (35,3%) had CDS grade I or II complications, and two (1,7%) had a grade III complication. The general complication rate for the study group was 37% (44 complications). Two patients required repeated surgery-deep bone pin-track infection treated with the Masquelet technique and surgical removal of a migrated pin. Among minor complications, pin-site inflammations were the most common-40 wrists (33,6%). CONCLUSIONS: The CRPP is a safe treatment method for DRF in pediatric patients, with a low major complication rate. However, minor adverse events are frequent and can significantly burden the patient's postoperative well-being. The application of rigorous definitions and grading systems should not only lead to the obtainment of high-quality data but also to higher awareness of possible pin tract infections and therefore allow for better therapeutic decisions.

Effect of the Temperature on the Process of Preferential Solvation of 1,4-Dioxane, 12-Crown-4, 15-Crown-5 and 18-Crown-6 Ethers in the Mixture of N-Methylformamide with Water: Composition of the Solvation Shell of the Cyclic Ethers.

The aim of the work was to analyze the preferential solvation process, and determine the composition of the solvation shell of cyclic ethers using the calorimetric method. The heat of solution of 1,4-dioxane, 12-crown-4, 15-crown-5 and 18-crown-6 ethers in the mixture of N-methylformamide with water was measured at four temperatures, 293.15 K, 298.15 K, 303.15 K, and 308.15 K, and the standard partial molar heat capacity of cyclic ethers has been discussed. 18-crown-6 (18C6) molecules can form complexes with NMF molecules through the hydrogen bonds between -CH3 group of NMF and the oxygen atoms of 18C6. Using the model of preferential solvation, the cyclic ethers were observed to be preferentially solvated by NMF molecules. It has been proved that the molar fraction of NMF in the solvation shell of cyclic ethers is higher than that in the mixed solvent. The exothermic, enthalpic effect of preferential solvation of cyclic ethers increases with increasing ring size and temperature. The increase in the negative effect of the structural properties of the mixed solvent with increase in the ring size in the process of preferential solvation of the cyclic ethers indicates an increasing disturbance of the mixed solvent structure, which is reflected in the influence of the energetic properties of the mixed solvent.

Composition of the Solvation Shell of the Selected Cyclic Ethers (1,4-Dioxane, 12-Crown-4, 15-Crown-5 and 18-Crown-6) in a Mixture of Formamide with Water at Four Temperatures.

The solution enthalpy of 15-crown-5 and 18-crown-6 ethers in the mixture of formamide (F) and water (W) was measured at four temperatures: 293.15 K, 298.15 K, 303.15 K, 308.15 K. The standard molar enthalpy of solution, ΔsolHo, depends on the size of cyclic ethers molecules and the temperature. With increasing temperature, the values of ΔsolHo become less negative. The values of the standard partial molar heat capacity Cp,2o of cyclic ethers at 298.15 K have been calculated. The Cp,2o=f(xW) curve shape indicates the hydrophobic hydration process of cyclic ethers in the range of a high-water content in the mixture with formamide. The enthalpic effect of preferential solvation of cyclic ethers was calculated and the effect of temperature on the preferential solvation process was discussed. The process of complex formation between 18C6 molecules and formamide molecules is observed. The cyclic ethers molecules are preferentially solvated by formamide molecules. The mole fraction of formamide in the solvation sphere of cyclic ethers has been calculated.

An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis.

BACKGROUND: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe. METHODS: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non- -ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH. RESULTS: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67-1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31-0.67); p < 0.001. CONCLUSIONS: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction.

An aggressive course of pyoderma gangrenosum mimicking bacterial osteomyelitis after open reduction and internal fixation of a distal radius fracture with a titanium plate.

Pyoderma gangrenosum (PG) is a rare condition characterized by the development of aseptic, non-healing skin ulcers. Any skin trauma, such as a surgical incision, can trigger an outbreak of lesions. Our case and literature review show that a physician should consider PG in every event of a non-healing, aseptic wound after surgery. The treatment of PG requires collaboration within a multidisciplinary team and immunosuppressive therapy is the first line of treatment, while surgical interventions should be avoided in the active stage of PG.

Gene Variants Related to Cardiovascular and Pulmonary Diseases May Correlate with Severe Outcome of COVID-19.

Background: Severe outcomes of COVID-19 account for up to 15% of all cases. The study aims to check if any gene variants related to cardiovascular (CVD) and pulmonary diseases (PD) are correlated with a severe outcome of COVID-19 in a Polish cohort of COVID-19 patients. Methods: In this study, a subset of 747 samples from unrelated individuals collected across Poland in 2020 and 2021 was used and whole-genome sequencing was performed. Results: The GWAS analysis of SNPs and short indels located in genes related to CVD identified one variant significant in COVID-19 severe outcome in the HADHA gene, while for the PD gene panel, we found two significant variants in the DRC1 gene. In this study, both potentially protective and risk variants were identified, of which variants in the HADHA gene deserve the most attention. Conclusions: This is the first study reporting the association between the HADHA and DRC1 genetic variants and COVID-19 severe outcome based on the cohort WGS analysis. Although all the identified variants are localised in introns, they may be correlated and therefore inherited along with other risk variants, potentially causative to severe outcome of COVID-19 but not discovered yet.

Effective method for approximating graded-refractive-index layers in optical simulations.

In this paper, we present an approximation intended to find applications in numerical simulations of optical phenomena in layered structures. The method can be used to avoid approximating graded layers by using numerous homogeneous layers in the simulation. In our approach, a single layer with a graded refractive index profile or any number layers can be replaced with only two layers that for a selected wavelength and normal incidence imitate exactly the optical properties of the replaced layer or layers. The proposed approximation is valid for a wide range of wavelengths and incidence angles. It is especially useful in time-consuming simulations (especially in 3D), where it is of paramount importance to keep the number of layers in the simulated structure low.

Chromatic aberration in planar focusing mirrors based on a monolithic high contrast grating.

We present an experimental and theoretical analysis of chromatic aberration in a monolithic metasurface focusing mirror. The planar focusing mirror is based on a monolithic high contrast grating made from GaAs, designed for a wavelength of 980 nm. Light is focused on the high refractive index side of the mirror. Our measurements, performed between 890 and 1050 nm, indicate a shift of the focal point position that is inversely proportional to the wavelength. The experimental results are in very good agreement with our simulations, in terms of both the position of the focal point and the spectral dependence. Based on our numerical simulations, we show that simply modifying the grating height does not lead to significant alteration of the focal length or to any noticeable reduction in chromatic aberration. Using numerical simulations, we analyze how the height of the stripes, the refractive index of the grating material, and its dispersion combine to influence the chromatic aberration of the mirror.

Experimental Demonstration of Light Focusing Enabled by Monolithic High-Contrast Grating Mirrors.

We present the first experimental demonstration of a planar focusing monolithic subwavelength grating mirror. The grating is formed on the surface of GaAs and focuses 980 nm light in one dimension on the high-refractive-index side of the mirror. According to our measurements, the focal length is 475 µm (300 µm of which is GaAs) and the numerical aperture is 0.52. The intensity of the light at the focal point is 23 times larger than that of the incident light. To the best of our knowledge, this is the highest value reported for a grating mirror. Moreover, the full width at half-maximum (FWHM) at the focal point is only 3.9 µm, which is the smallest reported value for a grating mirror. All of the measured parameters are close to or very close to the theoretically predicted values. Our realization of a sophisticated design of a focusing monolithic subwavelength grating opens a new avenue to technologically simple fabrication of the gratings for use in diverse optoelectronic materials and applications.

Planar focusing reflectors based on monolithic high contrast gratings: design procedure and comparison with parabolic mirrors.

Here, we describe in detail a procedure for the numerical design of planar focusing mirrors based on monolithic high contrast gratings. We put a special emphasis on the reconstruction of the hyperbolic phase of these mirrors and we conclude that the phase does not have to be perfectly mimicked to obtain a focusing reflector. We consider here the grating mirrors that focus light not in the air but in the GaAs substrate and we compare them with conventional parabolic reflectors of corresponding dimensions. The light intensity at the focal point of the focusing grating mirrors was found to be comparable to that of the parabolic reflector. Moreover, the reflectivity of the focusing grating mirrors is almost as high as that of parabolic mirrors covered with an additional reflecting structure, if the ratio of the reflector width to the focal length is less than 0.6. Planar focusing grating mirrors offer a good alternative to parabolic mirrors, especially considering the complexity of fabricating three-dimensional structures compared to planar structures.

Treatment of pathological fractures due to brown tumours in a patient with hyperparathyroidism and lack of parafibromin expression - A case report.

Brown tumours, known also as osteitis fibrosa cystica, are benign osteolytic lesions found in 5-15% of patients with hyperparathyroidism, and commonly located in mandibles, the shafts of long bones, the pelvis or ribs. As they compromise bone strength, pathological fractures can be a typical effect of their presence; but given the complex nature of the disease process in this case, such fractures require an interdisciplinary approach directed at orthopaedic treatment, plus management of the underlying hyperparathyroidism. In this paper, we present the case of a 36-year-old female patient with bilateral anophthalmia, hyperparathyroidism and nephrolithiasis, in whom a fall led to her sustaining a pathological fracture of the proximal third of the femoral shaft in the place of an osteolytic lesion, as well as second pathological fracture of the left patella also changed by multiple examples of such lesions. Parathyroidectomy on account of adenoma had been performed 2 weeks prior to the trauma. The femoral shaft fracture was treated surgically, the patella fracture conservatively, and a sample brown tumour was found in tissue. As the parathyroid showed no parafibromin expression, a diagnosis of HPT-JT (hyperparathyroidism and jaw tumour) was arrived at, with this condition given as caused by CDC73 mutation. This disease is able to account for brown tumours, hyperparathyroidism, benign or malignant tumours of kidneys, intestinal tract, and lungs. The approach combining treatment of the fractures with intervention over the parathyroid adenoma proved a successful one, with complete bone union ensuing, and no relapse into hyperparathyroidism 2 years on from the surgery. This case indicates the importance of an interdisciplinary approach to the treatment of brown tumours, as well as the necessity for a diagnosis to be extended when incidental brown tumours are found.

Transparent electrode employing deep-subwavelength monolithic high-contrast grating integrated with metal.

This paper demonstrates designs of transparent electrodes for polarized light based on semiconductor deep-subwavelength monolithic high-contrast gratings integrated with metal (metalMHCG). We provide theoretical background explaining the phenomena of high transmittance in the gratings and investigate their optimal parameters, which enable above 95% transmittance for sheet resistance of 2 ΩSq-1 and over 90% transmittance for extremely small sheet resistance of 0.04 ΩSq-1 in a broad spectral range below the semiconductor band-gap. The analysis is based on our fully vectorial optical model, which has been verified previously via comparison with the experimental characteristics of similar structures. The transparent electrodes can be realized in any high refractive index material used in optoelectronics and designed for light in spectral ranges starting from ultra-violet with no upper limit for the wavelength of the electromagnetic waves. They not only enable lateral transport of electrons but can also be used as an electric contact for injecting current into a semiconductor.

Numerical Investigation of the Impact of ITO, AlInN, Plasmonic GaN and Top Gold Metalization on Semipolar Green EELs.

In this paper, we present the results of a computational analysis of continuous-wave (CW) room-temperature (RT) semipolar InGaN/GaN edge-emitting lasers (EELs) operating in the green spectral region. In our calculations, we focused on the most promising materials and design solutions for the cladding layers, in terms of enhancing optical mode confinement. The structural modifications included optimization of top gold metalization, partial replacement of p-type GaN cladding layers with ITO and introducing low refractive index lattice-matched AlInN or plasmonic GaN regions. Based on our numerical findings, we show that by employing new material modifications to green EELs operating at around 540 nm it is possible to decrease their CW RT threshold current densities from over 11 kA/cm2 to less than 7 kA/cm2.

Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

BACKGROUND: European and American guidelines for the placement of implantable cardioverter­defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT­D) in patients with heart failure (HF) remain unchanged despite controversy and ongoing debate on the etiology of HF. However, there are limited data on the long­term follow­up in patients who received primary defibrillator therapy with regard to ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM). The prognostic significance of the etiology of HF is not well established. AIMS: The aim of the study was to assess the predictive value of the cause of HF. METHODS: A total of 1073 patients with the first implantation of ICD/CRT­D between January 2009 and December 2013 from the COMMIT­HF (Contemporary Modalities In Treatment of Heart Failure) registry were selected for the study. Patients were divided into 2 groups depending on the etiology of HF: ischemic (n = 705; 65.7%) and nonischemic (n = 368; 34.3%). The primary endpoint was long­term all­cause mortality. RESULTS: The median follow­up was 60.5 months. The primary endpoint occurred more often in the ICM as compared with the NICM group (35.7% vs 26.6%; P = 0.008). A higher out­of­hospital mortality in patients with ICM tended to be statistically significant (15.5% vs 10.6; P = 0.05). The multivariate analysis revealed that, among others, an ischemic etiology of HF was an independent factor of long­term mortality (hazard ratio, 1.43; 95% CI, 1.30-1.81; P = 0.003). Other independent predictors for mortality are: age older than 65 years, impaired left ventricular ejection fraction, chronic kidney disease, atrial fibrillation, diabetes mellitus. CONCLUSIONS: In the real­world population, significantly worse survival of patients with ICM in comparison with those with NICM is observed, and an ischemic etiology of HF is a strong independent predictor of mortality among individuals following the placement of ICD/ CRT­D.

Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry.

BACKGROUND: Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD. METHODS: Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively. RESULTS: There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi-fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1-3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0-3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01-5.5; p < 0.0001) LVSD. CONCLUSIONS: The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD.

The impact of remote monitoring of implanted cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy device (CRT-D) patients on healthcare costs in the Silesian population: three-year follow-up.

BACKGROUND: The population of patients with implanted cardioverter-defibrillators (ICD) and cardiac resynchronisation therapy devices (CRT-D) is constantly growing. The use of remote-monitoring (RM) techniques in this group can significantly improve clinical outcomes, but there are limited data about the impact of RM on healthcare costs from a payer's perspective. AIM: The aim of the study was to assess the impact on costs for the healthcare system of RM in patients with ICD or CRT-D. METHODS: We examined a cohort of 842 patients with ICD or CRT-D. The group was divided into two groups based on RM (or no RM [NRM]), matched according to important clinical characteristics. The subjects were followed for a maximum of three years after implantation (mean follow-up 2.11 ± 0.83 years). The overall costs for the healthcare provider in the follow-up were defined as the primary endpoint. The secondary endpoint was the use of different types of medical contact events: hospitalisation and number of in-clinic and general practitioner visits (without the number of remote transmissions). RESULTS: In the three-year follow-up, the reduction in the costs of treatment for National Health Care in the RM group was 33.5% (median value, p < 0.001). In patients with implanted CRT-D, the reduction reached 42.7% (p = 0.011), and with ICD it was 31.3% (p = 0.007). We observed no significant reduction in the median hospitalisation costs in the three-year follow-up in the RM group (p = NS), despite a 25% drop in the mean value. The costs of outpatient visits were slightly higher in the RM group (p = NS). In the follow-up period, there was no reduction in the number of medical contact events (p = NS). CONCLUSIONS: Remote monitoring in patients with implanted ICD or CRT-D devices reduces the cost for the national healthcare provider.

Impact of Remote Monitoring on Long-Term Prognosis in Heart Failure Patients in a Real-World Cohort: Results From All-Comers COMMIT-HF Trial.

BACKGROUND: Randomized controlled trials demonstrate that remote monitoring (RM) of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy devices (CRT-Ds) may improve quality of care and prognosis in heart failure (HF) patients. However, the impact of RM on long-term mortality in a real-world cohort is still not well examined. METHODS AND RESULTS: This study was designed as a matched cohort study based on the COMMIT-HF trial--a single-center, ongoing prospective observational registry (NCT02536443). Complete patient demographics, medical history, in-hospital results, hospitalizations, and mortality data were collected based on institutional registries and healthcare providers' records. Patients were divided into 2 groups based on RM presence and matched by means of propensity scores according to clinical characteristics. The primary endpoint of this study was the long-term all-cause mortality. Out of 1,429 consecutive patients, 822 patients with a first implantation of an ICD/CRT-D were included in the analysis. The final matched study population contained 574 patients in RM and in a control group. Although demographic and echocardiographic parameters as well as pharmacological treatments were similar in both groups, a significantly lower 1-year mortality was detected in the RM group (2.1% vs. 11.5%, P < 0.0001). This was also maintained during a 3-year follow-up (4.9% vs. 22.3%, P < 0.0001). Multivariate analysis showed that RM was associated with an improved prognosis (hazard ratio 0.187, 95% confidence interval 0.075-0.467, P = 0.0003). CONCLUSION: RM of HF patients with ICDs/CRT-Ds significantly reduced long-term mortality in a real-world clinical condition.