Left Bundle Branch Area Pacing using a Stylet-Driven, Retractable-Helix Lead: Short Term Results from a Prospective, Multicenter IDE Trial (The BIO-CONDUCT Study).

BACKGROUND: Left bundle branch area pacing (LBBAP) has swiftly emerged as a safe and effective alternative to right ventricular (RV) pacing. Limited data exists on the use of retractable-helix, stylet-driven leads (SDL) for LBBAP. OBJECTIVE: The objective is to prospectively evaluate performance and safety of the Solia S stylet-driven pacing lead in a rigorously controlled multi-center trial to support U.S. market application. METHODS: A multi-center, prospective, non-randomized trial enrolled patients with standard pacing indications. Implant procedural and lead data, including threshold, sensing, impedance, and capture type were collected through 3-months. Primary endpoints were freedom from LBBAP lead-related serious complications through 3-months and LBBAP implant success according to pre-specified criteria. A blinded Clinical Events Committee (CEC) adjudicated all potential endpoint complications. RESULTS: A total of 186 patients were included from 14 US sites. LBBAP implants were successful in 95.7% (178/186; 95% CI: 91.7%, 98.1%; p< 0.0001 for comparison to performance goal of 88%). Through the 3-month follow-up, 3 patients experienced a serious LBBAP complication, all lead dislodgements, resulting in a LBBAP lead-related complication-free rate of 98.3%. A total of 13 patients (7.8%) experienced any system-related or procedure-related complication. Mean threshold was 0.89V at 0.4ms, sensing was 10.8mV, and impedance was 608 ohms. CONCLUSION: The short-term results from this prospective trial demonstrate both high implant success and freedom from LBBAP lead-related complications utilizing this stylet driven retractable helix lead. This trial supports the safety, use, and effectiveness of SDL for performing contemporary physiologic pacing.

Evaluating metal cookware as a source of lead exposure.

BACKGROUND: We previously demonstrated that aluminum cookware brought from Afghanistan by resettled families as well as some aluminum cookware available for purchase in the United States represent a previously unrecognized source of lead exposure. However, the extent to which this cookware represents a source of lead exposure to other United States residents is unclear. OBJECTIVES: To test additional cookware for lead content and its propensity to leach lead and other toxic metals. This will further our understanding of the extent to which this cookware represents a lead poisoning risk in the United States and elsewhere. METHODS: We screened an additional 28 pieces of aluminum cookware and 5 brass items for lead content using an X-ray fluorescence (XRF) analyzer and used our leachate method to estimate the amount of lead that migrates into food. We also tested 17 additional stainless steel items to determine whether they would be safer alternatives. RESULTS: Many aluminum cookware products contained in excess of 100 parts per million (ppm) of lead. Many also leached enough lead under simulated cooking and storage conditions to exceed recommended dietary limits. One hindalium appam pan (an Indian frying pan/wok) leached sufficient lead to exceed the childhood limit by 1400-fold. Brass cookpots from India also yielded high lead levels, with one exceeding the childhood limit by over 1200-fold. In contrast, stainless steel cookware leached much lower levels of lead. IMPACT: Aluminum and brass cookware available for purchase in the United States represents a previously unrecognized source of lead exposure.

Ultrafast Dynamics of Self-Trapped Excitons in Cs2AgInCl6:Al3+ Double Perovskite Nanocrystals.

It is a huge challenge to increase the photoluminescence (PL) of lead-free halide perovskites, and understanding the mechanism behind exciton dynamics can provide a valuable solution. Herein, we achieved enhanced broad-band emission at ambient conditions in Cs2AgInCl6 by tuning self-trapped excitons (STEs) through Al3+ doping. Cryogenic measurements showed an inhomogeneous nature of STE emission due to the presence of defect states and is subject to thermal quenching. An increased Huang-Rhys factor (S-factor) resulted in better electron-phonon coupling and high-density STE states post Al3+ doping. Femtosecond transient absorption (fs-TA) results provided insights into the distribution dynamics of excitons, which occurs through gradient energy levels from free excitons (FE) to STEs, where each STE state potentially possesses higher quantized energy states. Overall, this study aims to comprehend the origins of self-trapping and decay of STEs in Cs2AgInCl6:Al3+ and emphasizes the potential of compositional engineering to mitigate self-trapping in this material.

Lead Isotope Signatures and Source Identification of Heavy Metals in Vegetable Soils Irrigated with Swine Wastewater of Jiangxi Province, China.

The rapid development of livestock and poultry industry in China has caused serious environment pollution problems. To understand the heavy metals accumulation and identify their sources, 7 heavy metals contents and lead isotope ratios were determined in 24 soil samples from vegetable fields irrigated with swine wastewater in Dongxiang County, Jiangxi Province, China. The results showed that the concentration of Cr, Ni, Cu, Zn, As, Cd and Pb in the swine wastewater irrigated vegetable soils varied from 38.5 to 86.4, 7.57 to 30.6, 20.0 to 57.1, 37.5 to 174, 9.18 to 53.1, 0.043 to 0.274 and 12.8 to 37.1 mg/kg, respectively. The soils were moderately to heavily polluted by As, moderately polluted by Cr, Ni, Cu, Zn and Cd, and unpolluted to moderately polluted by Pb. Sampling soils were classified as moderately polluted according to the Nemerow comprehensive pollution index. Lead isotope and Principal Component Analysis (PCA) analysis indicated that swine wastewater irrigation and atmospheric deposition were the primary sources of the heavy metals.

Radiation exposure of urologists during endourological procedures: a systematic review.

INTRODUCTION: Ionizing radiation is used daily during endourological procedures. Despite the dangers of both deterministic and stochastic effects of radiation, there is a lack of knowledge and awareness among urologists. This study reviewed the literature to identify the radiation exposure (RE) of urologists during endourological procedures. METHODS: A literature search of the Medline, Web of Science, and Google Scholar databases was conducted to collect articles related to the radiation dose to urologists during endourological procedures. A total of 1966 articles were screened. 21 publications met the inclusion criteria using the PRIMA standards. RESULTS: Twenty-one studies were included, of which 14 were prospective. There was a large variation in the mean RE to the urologist between studies. PCNL had the highest RE to the urologist, especially in the prone position. RE to the eyes and hands was highest in prone PCNL, compared to supine PCNL. Wearing a thyroid shield and lead apron resulted in a reduction of RE ranging between 94.1 and 100%. Educational courses about the possible dangers of radiation decreased RE and increased awareness among endourologists. CONCLUSIONS: This is the first systematic review in the literature analyzing RE to urologists over a time period of more than four decades. Wearing protective garments such as lead glasses, a thyroid shield, and a lead apron are essential to protect the urologist from radiation. Educational courses on radiation should be encouraged to further reduce RE and increase awareness on the harmful effects of radiation, as the awareness of endourologists is currently very low.

Probabilistic risk assessment of dietary exposure to lead in residents of Guangzhou, China.

Lead and its compounds can have cumulative harmful effects on the nervous, cardiovascular, and other systems, and especially affect the brain development of children. We collected 4918 samples from 15 food categories in 11 districts of Guangzhou, China, from 2017 to 2022, to investigate the extent of lead contamination in commercial foods and assess the health risk from dietary lead intake of the residents. Lead was measured in the samples using inductively coupled plasma mass spectrometry. Dietary exposure to lead was calculated based on the food consumption survey of Guangzhou residents in 2011, and the health risk of the population was evaluated using the margin of exposure (MOE) method. Lead was detected in 76.5% of the overall samples, with an average lead content of 29.4 µg kg-1. The highest lead level was found in bivalves. The mean daily dietary lead intakes were as follows: 0.44, 0.34, 0.25, and 0.28 µg kg-1 body weight (bw) day-1 for groups aged 3-6, 7-17, 18-59, and ≥ 60 years, respectively. Rice and rice products, leafy vegetables, and wheat flour and wheat products were identified as the primary sources of dietary lead exposure, accounting for 73.1%. The MOE values demonstrated the following tendency: younger age groups had lower MOEs, and 95% confidence ranges for the groups aged 3-6 and 7-17 began at 0.6 and 0.7, respectively, indicating the potential health risk of children, while those for other age groups were all above 1.0. Continued efforts are needed to reduce dietary lead exposure in Guangzhou.

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.

Release of lead, copper, zinc from the initial corrosion of brass water meter in drinking water: Influences of solution composition and electrochemical characterization.

Corrosion of brass plumbing materials may lead to metal release and deteriorate the drinking water quality. In this study, the initial corrosion of brass coupon cut from commercially available water meter was investigated. High rates of Pb, Cu and Zn release from the brass coupon were found during the early stage of corrosion (0-5 d) due to general corrosion and galvanic corrosion. The corrosion current density (Icorr) increased and resistance (RF) decreased during this period indicating that severe corrosion had occurred. In a later stage (5-30 d), a decreased Icorr and an increased RF were observed due to the development of a denser layer of Pb and Cu corrosion products which regulated the release of soluble Pb and Cu. The release of Zn continued and no significant Zn precipitation was found. Overall, particulate Pb, particulate Cu and soluble Zn dominated in the metal release during the initial corrosion of brass. The release of Pb, Cu and Zn was enhanced by a lower pH. Free chlorine was found to slightly reduce the release of Pb but promote the release of Cu and Zn. The presence of Pb on the brass surfaces was found to alleviate the dezincification process. A conceptual model based on metal release profile and electrochemical characterization was proposed to describe the initial corrosion of brass in typical drinking water.

Do lead (Pb) content of lipsticks expose a health risk to children? A risk assessment study.

BACKGROUND: Lead (Pb) content in lipsticks and potential life-long exposure of which might cause severe effects in consumers are an important concern for public. Thus, studies emphasize that lead exposure has no safe levels. METHODS: From 10 different brands, in total, 25 solid, gloss and creamy lipsticks are deployed from Turkish markets that are also categorized in two different price ranges. In order to evaluate the blood Pb levels in children, the United States Environmental Protection Agency's 'Exposure Uptake Biokinetic Model' is utilized. To assess the health risk of chronic usage both for children and adults, oral daily systemic exposure levels are calculated with the worst-case scenario and are compared with Maximum Allowable Dose Level for lipsticks. For lifetime risk assessment, exposure is assumed to start by age 7, and four different exposure scenarios have been deployed. RESULTS: The mean lead content of lipsticks shows significant statistical differences between the high- and low-priced lipstick groups. Daily level and total risk for lifetime Pb exposure from deployed lipsticks are below the acceptable risk levels but long-worn usage of products with routine monitoring of metal content is crucial for sensitive and unintended exposure groups.

Protective Effects of the Aqueous Extract of Malva sylvestris Plant against the Lethality and Histopathological Damage in Experimental Envenoming of Hemiscorpius lepturus Venom in Balb/c Mice.

INTRODUCTION: Hemiscorpius lepturus envenomation is a serious health problem in the southern provinces of Iran. The antiserum produced in Iran to counteract this scorpion venom is not entirely effective due to the risk of anaphylactic shock and other adverse effects. METHODS: Therefore, more efficient alternatives to treat patients deserve attention, and plants are extensively good candidates to be studied. This study aimed to assess the potential of the aqueous fraction of Malva sylvestris in inhibiting the toxic effects of H. lepturus venom. Injection of sub-lethal dose of H. lepturus venom leads to severe tissue damage in vital organs including the kidney, liver, heart and intestine, after 24 hours. RESULTS: By injecting 80 mg of the aqueous extract of M. sylvestris into the peritoneum helped treat the damaged tissues caused by H. lepturus venom in mice. CONCLUSION: Thus, Malva sylvestris could serve as an alternative treatment for scorpion sting envenomation and may be used as a drug to neutralize relevant toxic effects in patients stung by H. lepturus.

Fungicidal Activity of New Pyrrolo[2,3-d]thiazoles and Their Potential Action on the Tryptophan Metabolic Pathway and Wax Biosynthesis.

The main challenge in the development of agrochemicals is the lack of new leads and/or targets. It is critical to discover new molecular targets and their corresponding ligands. YZK-C22, which contains a 1,2,3-thiadiazol-[1,2,4]triazolo[3,4-b][1,3,4]thiadiazole skeleton, is a fungicide lead compound with broad-spectrum fungicidal activity. Previous studies suggested that the [1,2,4]triazolo[3,4-b][1,3,4]thiadiazole scaffold exhibited good antifungal activity. Inspired by this, a series of pyrrolo[2,3-d]thiazole derivatives were designed and synthesized through a bioisosteric strategy. Compounds C1, C9, and C20 were found to be more active against Rhizoctonia solani than the positive control YZK-C22. More than half of the target compounds provided favorable activity against Botrytis cinerea, where the EC50 values of compounds C4, C6, C8, C10, and C20 varied from 1.17 to 1.77 µg/mL. Surface plasmon resonance and molecular docking suggested that in vitro potent compounds C9 and C20 have a new mode of action instead of acting as pyruvate kinase inhibitors. Transcriptome analysis revealed that compound C20 can impact the tryptophan metabolic pathway, cutin, suberin, and wax biosynthesis of B. cinerea. Overall, pyrrolo[2,3-d]thiazole is discovered as a new fungicidal lead structure with a potential new mode of action for further exploration.

Result of the left bundle branch area pacing data collection registry, an international multicenter study of conduction system pacing with a Tendril STS 2088 stylet-driven lead.

INTRODUCTION: Left bundle branch area (LBBA) pacing (LBBAP) has been proposed as an alternative therapy option in patients indicated for cardiac pacing to treat bradycardia or heart failure. The aim of the study was to evaluate the safety and effectiveness of LBBAP in patients implanted with a Tendril 2088 stylet-driven lead. METHODS: The international retrospective data collection registry included 11 sites from 5 countries globally. Patients with attempted implants of the Tendril lead in the LBBA were followed for at least 6 months post the implant attempt. The primary safety and efficacy endpoints were freedom from LBBAP lead-related serious adverse events and the composite of LBBA capture threshold of ≤2.0 V and R-wave amplitudes ≥5 mV (or ≥value at implant), respectively. RESULTS: Of 221 patients with attempted implants of the Tendril 2088 lead in the LBBA, 91.4% (202/221) had successful implants for LBBAP. Regardless of the LBBAP implant success, all patients were followed for at least 6 months (8.7 ± 7.3 months). Baseline characteristics: 44% female, 84% ≥65 years old, 34% coronary artery disease, and 86% of primary indications for pacemaker implant. Both primary safety and effectiveness endpoints were met (freedom from LBBAP lead-related serious adverse device effects of 99.5% and electrical performance composite success rate of 93%). The capture thresholds in LBBAP at implant and 6 months were 0.8 ± 0.3 V@0.4 ± 0.1 ms and 0.8 ± 0.3 V@0.4 ± 0.1 ms. The rate of patients with capture threshold rise ≥1 V was 1.5% through 6 months. The R-wave amplitudes in LBBAP at implant and 6 months were 9.3 ± 3.2 mV and 10.6 ± 3.0 mV. CONCLUSIONS: This large multicenter study demonstrates that the stylet-driven Tendril™ STS 2088 lead is safe and effective for LBBAP with high success and low complication rates.

Thermal Stability and Non-Linear Optical and Dielectric Properties of Lead-Free K0.5Bi0.5TiO3 Ceramics.

Lead-free K0.5Bi0.5TiO3 (KBT) ceramics with high density (~5.36 g/cm3, 90% of X-ray density) and compositional purity (up to 90%) were synthesized using a solid-state reaction method. Strongly condensed KBT ceramics revealed homogenous local microstructures. TG/DSC (Thermogravimetry-differential scanning calorimetry) techniques characterized the thermal and structural stability of KBT. High mass stability (>0.4%) has proven no KBT thermal decomposition or other phase precipitation up to 1000 °C except for the co-existing K2Ti6O13 impurity. A strong influence of crystallites size and sintering conditions on improved dielectric and non-linear optical properties was reported. A significant increase (more than twice) in dielectric permittivity (εR), substantial for potential applications, was found in the KBT-24h specimen with extensive milling time. Moreover, it was observed that the second harmonic generation (λSHG = 532 nm) was activated at remarkably low fundamental beam intensity. Finally, spectroscopic experiments (Fourier transform Raman and far-infrared spectroscopy (FT-IR)) were supported by DFT (Density functional theory) calculations with a 2 × 2 × 2 supercell (P42mc symmetry and C4v point group). Moreover, the energy band gap was calculated (Eg = 2.46 eV), and a strong hybridization of the O-2p and Ti-3d orbitals at Eg explained the nature of band-gap transition (Γ â†’ Γ).

Interfacial Reactions between Sn-Based Solders and n-Type Bi2(Te,Se)3 Thermoelectric Material.

This study investigated the interfacial reactions between n-type Bi2(Te,Se)3 thermoelectric material, characterized by a highly-oriented (110) plane, and pure Sn and Sn-3.0Ag-0.5Cu (wt.%) solders, respectively. At 250 °C, the liquid-state Sn/Bi2(Te,Se)3 reactions resulted in the formation of both SnTe and BiTe phases, with Bi-rich particles dispersed within the SnTe phase. The growth of the SnTe phase exhibited diffusion-controlled parabolic behavior over time. In contrast, the growth rate was considerably slower compared to that observed with p-type (Bi,Sb)2Te3. Solid-state Sn/Bi2(Te,Se)3 reactions conducted between 160 °C and 200 °C exhibited similar interfacial microstructures. The SnTe phase remained the primary reaction product, embedded with tiny Bi-rich particles, revealing a diffusion-controlled growth. However, the BiTe layer had no significant growth. Further investigation into growth kinetics of intermetallic compounds and microstructural evolution was conducted to elucidate the reaction mechanism. The slower growth rates in Bi2(Te,Se)3, compared to the reactions with (Bi,Sb)2Te3, could be attributed to the strong suppression effect of Se on SnTe growth. Additionally, the interfacial reactions of Bi2(Te,Se)3 with Sn-3.0Ag-0.5Cu were also examined, showing similar growth behavior to those observed with Sn solder. Notably, compared with Ag, Cu tends to diffuse towards the interfacial reaction phases, resulting in a high Cu solubility within the SnTe phase.

Insights on Stability Constants and Structures of Complexes between Coumarin Derivatives and Pb(II) in Aqueous Media.

In the frame of a systematic study on the sequestering ability of natural antioxidants towards metal cations, here the complexation of coumarin-3-carboxilic acid (HCCA) with Pb(II) and the overall stability constants of the resulting complexes, at 37 °C and in 0.16 M NaClO4, are discussed. Reaction of Pb(ClO4)2 with HCCA in an aqueous medium at a pH range from 2 to 6 and various ratios (1:1-1:10) yielded the Pb-CCA complexes, which were characterized spectrometrically by laser desorption ionization mass spectrometry (LD-MS). LD-MS has provided the composition and structure of Pb-CCA species according to the speciation model proposed on the basis of the potentiometric data. The graphic representation of the complex's concentration curves is given by the distribution diagram, which provides a whole depiction of the species present in the solution at the selected pH ranges.

Lead-induced liver fibrosis and inflammation in mice by the AMPK/MAPKs/NF-κB and STAT3/TGF-ß1/Smad2/3 pathways: the role of Isochlorogenic acid a.

Lead (Pb) is a nonessential heavy metal, which can cause many health problems. Isochlorogenic acid A (ICAA), a phenolic acid present in tea, fruits, vegetables, coffee, plant-based food products, and various medicinal plants, exerts multiple effects, including anti-oxidant, antiviral, anti-inflammatory and antifibrotic functions. Thus, the purpose of our study was to determine if ICAA could prevent Pb-induced hepatotoxicity in ICR mice. An evaluation was performed on oxidative stress, inflammation and fibrosis, and related signaling. The results indicate that ICAA attenuates Pb-induced abnormal liver function. ICAA reduced liver fibrosis, inflammation and oxidative stress caused by Pb. ICAA abated Pb-induced fibrosis and decreased inflammatory cytokines interleukin-1ß (IL-1ß) and tumor necrosis factor-alpha (TNF-α). ICAA abrogated reductions in activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). Masson staining revealed that ICAA reduced collagen fiber deposition in Pb-induced fibrotic livers. Western blot and immunohistochemistry analyses showed ICAA increased phosphorylated AMP-activated protein kinase (p-AMPK) expression. ICAA also reduced the expression of collagen I, α-smooth muscle actin (α-SMA), phosphorylated extracellular signal-regulated kinase (p-ERK), phosphorylated c-jun N-terminal kinase (p-JNK), p-p38, phosphorylated signal transducer and phosphorylated activator of transcription 3 (p-STAT3), transforming growth factor ß1 (TGF-ß1), and p-Smad2/3 in livers of mice. Overall, ICAA ameliorates Pb-induced hepatitis and fibrosis by inhibiting the AMPK/MAPKs/NF-κB and STAT3/TGF-ß1/Smad2/3 pathways.

Lead with speed: Recasting the forensic laboratory product line and service delivery model.

Forensic laboratories face a multitude of challenges when striving to deliver services to the criminal justice system. While many of these issues change over time, one in particular seems to endure the test of time … the need for faster results. Law enforcement wants and needs quicker response times to access critical information required to investigate their cases. One answer to this persistent problem is evolving technology. Technology not only permits a much quicker response than forensic laboratories are currently delivering, it can open the door to solving previously unsolvable cases. Along with applying new technology, an evaluation of current forensic laboratory product lines, service delivery models, and mindset regarding the role of forensic science-based investigative leads (termed forensic leads) is warranted. Resources and strategic planning are needed to realize the full potential of evolving technologies and what forensic laboratories can do to provide actionable and timely forensic leads to our criminal justice partners as a normal course of action instead of as an exception. This proposal is to establish a permanent, designated Forensic Lead Program (FLP) that resides under the umbrella of an accredited forensic laboratory and is tasked with the development and release of forensic leads. The FLP involves a focused menu of services, defined personnel roles, strict protocols, short turnaround time, standardized expectations, and targeted training, combined with the sense of urgency needed for consistent delivery of timely and actionable forensic leads. A dedicated FLP will save time and money by providing critical information for more focused investigations. 'Speed is the need' … for quick identification of those that threaten public safety and for the equally quick elimination of those wrongfully accused. Programs at two large state forensic laboratories will demonstrate how these concepts could be implemented along with their learning experiences. A business case will also be included to demonstrate the cost benefit of the Forensic Lead Program for DNA (CODIS - Combined DNA Index System) and NIBIN (National Integrated Ballistic Information Network), however other section services are expected to see similar benefits. Improving the response time by one day saves $1677.75 per $1 spent [1]. The return on investment (ROI) for applying DNA to firearms evidence returns $47.88 per $1 spent, or an 4,788 % ROI. Applying NIBIN (National Integrated Ballistic Information Network) to firearms evidence to provide investigative leads is $502.19 per $1 spent, which is a 50,219 % ROI. Recasting the forensic laboratory product line and service delivery model to 'Lead with Speed' makes both economic and investigative sense.

Unveiling a Critical Subacute Complication: Right Apical Septum Pacemaker Lead Dislodgement Leading to Right Ventricular Perforation and Minimal Pericardial Effusion.

The implantation of cardiac pacing devices, such as pacemakers and implanted cardioverter-defibrillators (ICDs), has significantly improved patient outcomes in the treatment of a range of cardiac arrhythmias. Right ventricular (RV) pacing lead perforation is an uncommon but potentially dangerous complication that can occur despite technical breakthroughs. RV lead perforation, which can result in right ventricular perforation as well as possible pulmonary or vascular harm, is caused by the pacing lead breaking through the myocardial wall. Despite being rare, this complication warrants attention because of the risks for morbidity and mortality that are involved. We present a case of right ventricular perforation caused by a pacemaker lead and examine the nuances of RV lead perforation in this instance, including its prevalence, clinical presentation, diagnostic difficulties, and treatment strategies, illuminating the many factors to be taken into account while properly managing this issue.

Jejunal Ectopic Pancreatic Tissue Rest as Lead Point in Patients with Intussusception: A Rare Case Report and Review of Literature.

Background: Ectopic pancreas (EP), characterized by pancreatic tissue outside its usual location, poses diagnostic challenges due to its asymptomatic nature in most cases. Gastric lesions are often symptomatic, causing epigastric pain or gastric outlet obstruction. Rarely, jejunal lesions can lead to intestinal obstruction or intussusception. The elusive preoperative diagnosis lacks specific biochemical markers, relying on intraoperative biopsy and histopathology as gold standards. Case Presentation: We present a unique case of a 37-year-old female with 12-hour crampy abdominal pain, bilious vomiting, blood-mixed diarrhea, abdominal distension, and obstructive symptoms. Imaging revealed jejunojejunal intussusception with a jejunal mass as the lead point. Intraoperatively, also identified jejunal mass as lead point. Resection of mass and end-to-end jejunojejunal anastomosis were performed, resulting in a successful outcome. Histopathological examination identified a type I ectopic pancreas within the muscularis propria. Twelve months postoperatively, the patient exhibited no stricture or recurrence. Conclusion: Ectopic pancreas, with varied symptoms, poses diagnostic hurdles. Despite the diagnostic challenges, surgical excision remains the optimal treatment for symptomatic cases. This report contributes to the limited literature on ectopic pancreas, emphasizing the importance of considering this entity in the differential diagnosis of gastrointestinal pathology.

Costs Saved by Visiting a Nurse-Led Primary Care Facility Comparison of Primary Care Models.

INTRODUCTION: Nurse-led primary care is a relatively rare model for primary care, but given nurses more holistic approach to medicine, can prove effective in both reducing costs and disparities in access and outcomes. The present study compares cost adjusted quality of care between a nurse-led primary care facility and the standard primary care. DESIGN: To compare the cost adjusted quality of care between the standard primary care model and a nurse led primary care model the outcomes from a population of patients that visited each (control and experimental, respectively) are compared with respect to three complications of hypertension (stroke, heart attack, and coronary heart disease). METHOD: The number of three complications (stroke, heart attack, and coronary artery disease) from hypertension for the experimental population is estimated using time-to-event distributions estimated from the control population. Costs are estimated using the control population data. RESULTS: It is found that the population that visited the nurse-led primary care facility had better cost adjusted outcomes than the population that visited the physician led facilities. We can attribute, at least, $3.7 million in costs not realized due to the quality of care provided by the nursing center. CONCLUSION: Nurse-led primary care is one way that the U.S. healthcare system could reduce costs while providing consistent quality of care.