Bi-atrial or left atrial ablation of atrial fibrillation during concomitant cardiac surgery: A Bayesian network meta-analysis of randomized controlled trials.

OBJECTIVE: Surgical ablation of atrial fibrillation (AF) has become a routine procedure during concomitant cardiac surgery, however, the extension of lesion sets remain controversial. We sought to compare the relative benefit and risk of different lesion sets through a Bayesian network meta-analysis (NMA). METHODS: Pubmed, Embase, and Cochrane Trials databases were searched for randomized controlled trials (RCTs) comparing the rhythm outcome of AF patients undergoing pulmonary vein isolation (PVI), left atrial Maze (LAM), bi-atrial Maze (BAM), or no ablation during concomitant cardiac surgery. An NMA was conducted to explore the difference of over 1 year AF freedom as well as risks for early mortality and permanent pacemaker implantation (PPMI). RESULTS: A total of 2031 patients of 19 RCTs were included. PVI, LAM, and BAM (OR [95% Cr.I]: 5.02 [2.72, 10.02], 7.97 [4.93, 14.29], 8.29 [4.90, 14.86], p < .05) demonstrated higher freedom of AF compared with no ablation, however, no significant difference of rhythm outcome was found among the three ablation strategies based on the random-effects model. BAM was associated with an increase in early mortality when compared with no ablation (OR [95% Cr.I]: 4.08 [1.23, 17.30], p < .05), while none of the remaining comparisons reached statistical difference in terms of early mortality and PPMI. CONCLUSION: Bi-atrial ablation is not superior to left atrial ablation strategies in reducing AF recurrence for un-selected surgical patients. BAM has a higher risk of early mortality than no ablation, but no difference was found between bi-atrial and left atrial ablation in regard to early mortality and PPMI based on the current evidence.

Different effects of additional ganglion plexus ablation on catheter and surgical ablation for atrial fibrillation: a systemic review and meta-analysis.

The effect of ganglion plexus (GP) ablation in addition to pulmonary veins isolation (PVI) for atrial fibrillation (AF) remained controversial between the catheter and surgical-based studies. Eleven studies (five randomized controlled trials and six nonrandomized studies) of 1750 patients were included in a meta-analysis to elucidate the incremental benefit of additional GP ablation in patients undergoing catheter or surgical ablation. Risk ratios were calculated for freedom from AF or AT recurrence after a single procedure. Additional GP ablation was associated with a better rhythm outcome for patients undergone catheter ablation but did not seem to increase freedom from AF/AT for surgical patients. Both paroxysmal and non-paroxysmal AF showed a positive outcome comparing additional GP ablation with PVI alone.

Syndioselective Polymerization of Vinylnaphthalene.

Coordination polymerizations of 1-vinylnaphthalene (1VN), 2-vinylnaphthalene (2VN) and 6-methoxy-2-vinylnaphthalene (MVN) are carried out at room temperature by using the half-sandwich scandium precursor FluSiMe3 Sc(CH2 SiMe3 )2 (THF) (1) and the constrained geometry configuration rare-earth metal precursors FluCH2 PyLn(CH2 SiMe3 )2 (THF)n [Flu = C13 H8 , Py = C5 H4 N; Ln = Sc (2a), n = 0; Ln = Lu (2b), Y(2c), n = 1]. Atactic poly(1VN) and perfect syndiotactic poly(2VN) and poly(MVN) are produced by precursors 2a-2c in a controlled way. Treatment of poly(MVN) with boron tribromide at -20 °C provides a syndiotactic poly(6-hydroxy-2-vinylnaphthalene).

Identifying Medical Diagnoses and Treatable Diseases by Image-Based Deep Learning.

The implementation of clinical-decision support algorithms for medical imaging faces challenges with reliability and interpretability. Here, we establish a diagnostic tool based on a deep-learning framework for the screening of patients with common treatable blinding retinal diseases. Our framework utilizes transfer learning, which trains a neural network with a fraction of the data of conventional approaches. Applying this approach to a dataset of optical coherence tomography images, we demonstrate performance comparable to that of human experts in classifying age-related macular degeneration and diabetic macular edema. We also provide a more transparent and interpretable diagnosis by highlighting the regions recognized by the neural network. We further demonstrate the general applicability of our AI system for diagnosis of pediatric pneumonia using chest X-ray images. This tool may ultimately aid in expediting the diagnosis and referral of these treatable conditions, thereby facilitating earlier treatment, resulting in improved clinical outcomes. VIDEO ABSTRACT.

Blue-light-blocking intraocular lens implantation improves the sleep quality of cataract patients.

STUDY OBJECTIVES: To evaluate whether blue-light-blocking intraocular lens implantation affects the sleep quality of cataract patients. DESIGN: Pre-test/post-test experiment. SETTING: N/A. PARTICIPANTS: 40 patients having bilateral cataracts with level higher than N3 (LOCS II) nucleus hardness, including 26 females (65%) and 14 males (35%). INTERVENTIONS: Cataract phacoemulsification followed by blue-light-blocking intraocular lens (IOLs, SN60WF, Alcon Laboratories, USA) implantation. MEASUREMENTS AND RESULTS: Patients were contacted in site before cataract surgery and followed by telephone at least 2 months later after second-eye surgery. Pittsburgh Sleep Quality Index (PSQI) questionnaires were administered to evaluate sleep quality. Median age of patients was 74 years (IQR 70 to 78). The median PSQI globe scores were 7 before surgery and 4 after surgery (Z = -2.121, p = 0.037). More specifically, there were significant differences on subjective sleep quality (Z = -2.064, p = 0.045), sleep duration (Z = -2.037, p = 0.047) and daytime dysfunction (Z = -2.142, p = 0.034) when compared between before and after surgeries. The ratio of poor sleepers (PSQI > 5) was reduced significantly after surgery (χ² = 14.532, p < 0.001). CONCLUSIONS: Blue-light-blocking IOL had a significantly beneficial effect on the sleep quality of cataract patients.