COUGH AND CHEST PAIN WITH AN UNCOMMON CAUSE

Multiple  Hereditary  Exostoses  is  an  autosomal  dominant  disorder  with  multiple  cartilage  capped  bony  outgrowths  in  tibia  ,fibula, femur,  and  sometimes  the  ribs  and  scapula. They may  present  with  variety  of  symptoms  depending  on  the  structures  it  compresses  such  as  nerves,  arteries  or  may  lead  to  limb  deformities  or  may  cause  bursitis , or  may  undergo  malignant  transformation. A  33 year old  male  presented  to  our  outpatient  department  with  recurrent  cough  and  left  sided  chest  pain. On  evaluation  he  was  found  to  have  multiple  bony  outgrowths  in the scapula ,5th  rib , and  limbs. Similar  bony  outgrowths  were  also  present  in  his  father  and  grandfather. On  clinical  and  radiological  basis  a  diagnosis of  Multiple  Hereditary  Exostoses  was  made. His  symptoms  gradually  subsided  with  removal  of  the  rib  and  scapular  exostoses. Thus  evaluation  of  bony  structures  should  not  be  overlooked  in  cases  of  cough  and  chest  pain.Keywords: Cough, Chestpain, Multiple  Hereditary  Exostoses.Â

Long-term outcomes after ablation of persistent atrial fibrillation: an observational study over 6 years.

ObjectivesTo address the limited long-term outcome data for catheter ablation (CA) of persistent atrial fibrillation (PeAF), we analysed consecutive ablations performed at our centre from 1 January 2008 to 31 December 2010 and followed patients prospectively until January 2014.MethodsBoth arrhythmia recurrence and symptom relief were assessed. Follow-up data were collected from hospital records, supplemented by data from general practitioners and referring hospitals. At the end of the follow-up period, all patients were contacted by phone to determine their up-to-date clinical condition.Results188 consecutive patients with PeAF (157 male, mean age 57.3±9.7 years, 20% with long-standing PeAF) underwent a mean of 1.75 procedures (range 1-4). Telephone follow-up was achieved for 77% of surviving patients. Over a mean follow-up of 46±16 months (range 4-72), 139 (75%) patients experienced arrhythmia recurrence after a single procedure and 90 (48%) after their final procedure. Median time to first recurrence was 210 days (range 91-1850). 71% of recurrences were within the first year following ablation and 91% within 2 years. At final follow-up, 82% of patients reported symptomatic improvement. 7 (2.3%) major complications occurred, and there was no procedure-related death or stroke.ConclusionsCA for PeAF is safe with a low rate of complications. Over a follow-up period of up to 6 years, a large majority of patients experience significant symptomatic improvement but recurrence after the initial procedure is the norm rather than the exception. 2 years' follow-up is sufficient to observe 90% of AF recurrences, but recurrence can occur even after 5 years' remission

Rationale and study design of the MINERVA study: Multicentre Investigation of Novel Electrocardiogram Risk markers in Ventricular Arrhythmia prediction-UK multicentre collaboration

Introduction The purpose of this study is to assess the ability of two new ECG markers (Regional Repolarisation Instability Index (R2I2) and Peak Electrical Restitution Slope) to predict sudden cardiac death (SCD) or ventricular arrhythmia (VA) events in patients with ischaemic cardiomyopathy undergoing implantation of an implantable cardioverter defibrillator for primary prevention indication. Methods and analysis Multicentre Investigation of Novel Electrocardiogram Risk markers in Ventricular Arrhythmia prediction is a prospective, open label, single blinded, multicentre observational study to establish the efficacy of two ECG biomarkers in predicting VA risk. 440 participants with ischaemic cardiomyopathy undergoing routine first time implantable cardioverter-defibrillator (ICD) implantation for primary prevention indication are currently being recruited. An electrophysiological (EP) study is performed using a non-invasive programmed electrical stimulation protocol via the implanted device. All participants will undergo the EP study hence no randomisation is required. Participants will be followed up over a minimum of 18 months and up to 3 years. The first patient was recruited in August 2016 and the study will be completed at the final participant follow-up visit. The primary endpoint is ventricular fibrillation or sustained ventricular tachycardia >200 beats/min as recorded by the ICD. The secondary endpoint is SCD. Analysis of the ECG data obtained during the EP study will be performed by the core lab where blinding of patient health status and endpoints will be maintained. Ethics and dissemination Ethical approval has been granted by Research Ethics Committees Northern Ireland (reference no. 16/NI/0069). The results will inform the design of a definitive Randomised Controlled Trial (RCT). Dissemination will include peer reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries

Contributing factors and clinical relevance of early arrhythmia recurrence and electrical reconnection of the pulmonary veins following pulmonary vein isolation for atrial fibrillation

Pulmonary vein isolation (PVI) is the cornerstone of ablation for paroxysmal atrial fibrillation (AF). However, success rates from AF ablation are not as high as would be hoped and this body of work focussed on improving outcomes from this procedure. Late PV reconnection following PVI is very common and is strongly associated with atrial tachyarrhythmia (AT) recurrence. The primary study of this work involved a randomised controlled trial comparing standard care with a strategy of early repeat electrophysiology study, irrespective of symptoms, to assess for and treat PV reconnection. Patients were followed-up for 12 months with daily ECG monitoring using a portable monitor. This study demonstrated a reduction in AT recurrence and burden and an improvement in quality-of-life in the repeat study group. At present, a 3-month blanking period following PVI is recommended, during which AT recurrences are not deemed indicative of procedure failure. In a secondary study, the relationship between episodes of AT recorded within this 3-month blanking period and PV reconnection was studied. Early recurrence beyond 4 weeks after PVI was associated with PV reconnection, whereas recurrence within the first 4 weeks was not. Force-Time Integral is a commonly-used ablation lesion quality marker but has limitations. Ablation Index is a novel marker incorporating power along with contact force and time in a weighted formula. In a further study, the relationship between Ablation Index and late PV reconnection was examined. Reconnected segments had significantly lower minimum Ablation Index values than non-reconnected segments, and higher values were required to avoid reconnection in anterior/roof segments compared to posterior/inferior segments. In the final part of the work, the relationship between sites of acute PV reconnection that underwent re-ablation and sites of late reconnection was studied, as the effectiveness of such re-ablation is unclear. No difference was found in the rates of late reconnection between areas with and without acute reconnection. Taken together, the findings from these studies provide insights into the potential success rates that can be achieved from durable PVI in patients with paroxysmal AF, and techniques that may help to achieve this. Furthermore, assessment for early recurrence may allow better identification of those patients at higher risk of later recurrence.Open Acces

Picosecond Solvation Dynamics of Coumarin153 in Bis(1-methyl-1H-imidazol-3-ium-3-yl)dihydroborate Cation Containing Room Temperature Ionic Liquid and Ionic Liquid-DMF Mixtures

Abstract: Steady state and time-resolved fluorescence behavior of coumarin153(C153) in bis(1-methyl-1H-imidazol-3-ium-3-yl)dihydroborate cation containing room temperature ionic liquid and its mixture with dimethylformamide (DMF) has been investigated. Density functional calculations on the present ionic liquid have been carried out to have ground state structural information of this system. C-H···N and C-H···O hydrogen bonding interactions between cationic and anionic moiety of the present ionic liquid has been observed. Steady state absorption and emission spectral profiles of C153 are found not to be influenced by the polar cosolvent. Time-resolved fluorescence anisotropy experiments show that the rotational motion of the probe becomes faster in presence of DMF. During time dependent dynamic Stokes shift measurements in ionic liquid-DMF mixtures, the average solvation time is found to decrease with the addition of DMF to the ionic liquid. The decrease in both average solvation and rotational time of probe molecule upon gradual addition of polar organic co-solvent is attributed to the lowering of bulk viscosity of the medium

Wally and the Major [picture] : from bad to worse /

Part of the Stan Cross Archive of cartoons and drawings, 1912-1974.; Inscription: "Stan Cross 8/30"--Lower right. "5467 Tue Feb 4 From Bad To Worse"--In ink, right margin; "5390"--In ink, upper right corner; "6"--In pencil, upper left corner.; Also available in an electronic version via the internet at: http://nla.gov.au/nla.pic-vn4302353

Successful cryoablation of an incessant atrial tachycardia arising from the right atrial appendage

The right atrial appendage can be the origin of focal atrial tachycardias. Their ablation can be challenging owing to the complexity of the appendage anatomy. To our knowledge, we describe the first successful solid tip cryoablation of a focal tachycardia within the right atrial appendage in a patient presenting with tachycardia-induced cardiomyopathy

Diffusion–Viscosity Decoupling in Solute Rotation and Solvent Relaxation of Coumarin153 in Ionic Liquids Containing Fluoroalkylphosphate (FAP) Anion: A Thermophysical and Photophysical Study

Steady state and time-resolved fluorescence behavior of coumarin153 (C153) has been investigated in two ionic liquids (ILs), namely 1-(2-methoxyethyl)-1-methylpyrrolidinium tris­(pentafluoroethyl)­trifluorophosphate ([MOEMPL]­[FAP]) and 1-(2-methoxyethyl)-1-methylmorpholinium tris­(pentafluoroethyl)­trifluorophosphate ([MOEMMO]­[FAP]) in order to find out the viscosity–diffusion decoupling during solvation and rotational relaxation of C153. Thermophysical studies have also been carried out to understand the physicochemical properties of the media. At 293 K, the measured viscosity of [MOEMMO]­[FAP] is 8 times higher than that of [MOEMPL]­[FAP]. The data obtained from steady state and time-resolved fluorescence measurements show the deviation of average solvation and rotation times from conventional hydrodynamics. The decoupling of solute and solvent dynamics from medium viscosity is manifested through fractional viscosity dependence (η) of the measured average solvation (⟨τ_s⟩) and rotation (⟨τ_r⟩) times: ⟨τ_<i>x</i>⟩ ∝ (η/<i>T</i>)^<i>p</i> (<i>x</i> denotes solvation or rotation and <i>T</i> is the temperature) covering the <i>p</i> value 0.69 < <i>p</i> < 0.85 for solvent relaxation and 0.48 < <i>p</i> < 1.10 for solute rotation. The excitation wavelength dependent fluorescence studies have been performed to correlate the experimental findings with the heterogeneity of the medium. While the excitation wavelength dependent time-resolved fluorescence studies of coumarin153 reveal a very similar variation of average solvation time with a change in excitation wavelengths for both the ionic liquids, the steady state excitation wavelength dependent measurements of 2-amino-7-nitrofluorene (ANF) show a higher (630 cm^–1) shift of the fluorescence maximum for highly viscous ionic liquid as compared to that (430 cm^–1) of another much less viscous ionic liquid. The recent theoretical (<i>Chem. Phys. Lett.</i> <b>2011</b>, <i>517</i>, 180) and experimental (<i>J. Chem. Phys.</i> <b>2012</b>, <i>136</i>, 174503) findings and the outcome of the excitation wavelength dependent fluorescence measurements in the present case seem to suggest that both static and dynamic heterogeneity may play an important role in the observed viscosity–diffusion (<i>d</i>–η) decoupling for highly viscous ionic liquid

Synthesis, Photophysics, Live Cell Imaging, and Aggregation Behavior of Some Structurally Similar Alkyl Chain Containing Bromonaphthalimide Systems: Influence of Alkyl Chain Length on the Aggregation Behavior

A series of 4-bromonaphthalimide systems (BNI-C_<i>n</i> ; <i>n</i> = 4, 6, 10, 12, and 16) comprising different alkyl side chains have been synthesized and used as the building blocks to fabricate organic fluorescent micro materials. The systems have been developed basically to investigate the effect of alkyl side chains on the aggregation behavior of the systems. The aggregation behavior of these systems has been studied by spectroscopic and microscopic techniques. Microscopic investigation reveals that there is a decrease in the size of the aggregates with an increase in the linear alkyl side chain length. A change in the shape from rod-like to spherical with an increase in the length of alkyl group has also been observed during microscopic investigation. The photophysical properties of these well-characterized aggregates have been studied and compared with those in molecular form. A bathochromic shift both in absorption and in emission spectrum of the aggregates has indicated the formation of J aggregates. A confocal fluorescence microscopic investigation also reveals that the long chain systems (12 and 16 member) are cell permeable and can be used as the imaging probe in live cells

Long-term outcomes after ablation of persistent atrial fibrillation: an observational study over 6 years

To address the limited long-term outcome data for catheter ablation (CA) of persistent atrial fibrillation (PeAF), we analysed consecutive ablations performed at our centre from 1 January 2008 to 31 December 2010 and followed patients prospectively until January 2014.Both arrhythmia recurrence and symptom relief were assessed. Follow-up data were collected from hospital records, supplemented by data from general practitioners and referring hospitals. At the end of the follow-up period, all patients were contacted by phone to determine their up-to-date clinical condition.188 consecutive patients with PeAF (157 male, mean age 57.3±9.7 years, 20% with long-standing PeAF) underwent a mean of 1.75 procedures (range 1-4). Telephone follow-up was achieved for 77% of surviving patients. Over a mean follow-up of 46±16 months (range 4-72), 139 (75%) patients experienced arrhythmia recurrence after a single procedure and 90 (48%) after their final procedure. Median time to first recurrence was 210 days (range 91-1850). 71% of recurrences were within the first year following ablation and 91% within 2 years. At final follow-up, 82% of patients reported symptomatic improvement. 7 (2.3%) major complications occurred, and there was no procedure-related death or stroke.CA for PeAF is safe with a low rate of complications. Over a follow-up period of up to 6 years, a large majority of patients experience significant symptomatic improvement but recurrence after the initial procedure is the norm rather than the exception. 2 years' follow-up is sufficient to observe 90% of AF recurrences, but recurrence can occur even after 5 years' remission