Depolarization-repolarization synchrony after right ventricular and left bundle branch area pacing

Introduction: Left bundle branch area pacing (LBBAP) has been recently proposed to overcome the limitations associated with right ventricular pacing (RVP) and has been suggested as a new physiological pacing form with high feasibility and safety. A greater difference between QRS complex and T-wave angle directions has been proposed as a marker of abnormal electrical activity in several patient populations, but a comparison between these two pacing modalities has never been performed. The total cosine R to T (TCRT) is an ECG descriptor that accounts for depolarization-repolarization synchrony by measuring the difference between their directions. The purpose of this study was to compare TCRT in patients referred for RVP and LBBAP pacing as anti-bradycardia therapy. Methods: ECG recordings from 134 patients (82 LBBAP, 52 RVP) were classified into two groups, narrow QRS and wide QRS, depending on the patient’s QRS duration prior to implantation. In the post-implantation state, the TCRT index was calculated from a median beat calculated for each patient. Singular value decomposition was applied to the median beat in the eight independent ECG leads (I, II, V1, V2, V3, V4, V5, V6). The QRS complex and T wave loops in a three-dimensional space were determined from the first three components of the decomposition. TCRT was computed as the average of the cosines of the angles between the QRS complex directions and the maximum T wave direction. More positive values corresponded to more synchronized depolarization and repolarization processes while more negative values indicated larger differences in the orientation of the QRS and T wave loops and, therefore, greater dyssynchronization. Results: showed that TCRT took negative values for both techniques, RVP and LBBAP, and both groups, narrow and wide QRS, indicating that pacing generated dyssynchronization between ventricular depolarization and repolarization. Nevertheless, TCRT values for both groups were significantly more negative (p<0.01) for RVP than for LBBAP. We hypothesize that cardiac memory induced by pacing could account for these negative TCRT values. In any case, LBBAP did not increase the difference in the QRS complex and T wave loop orientations as much as RVP. Conclusion: LBBAP induces less dyssynchrony than RVP in the depolarization-repolarization process

Supplementation of lamb diets with vitamin E and rosemary extracts on meat quality parameters

BACKGROUND Supranutritional supplementation of lamb diets with alpha-tocopherol is an effective method to reduce lipid oxidation and colour deterioration in meat products. However, alternative antioxidant sources have been proposed to replace the supranutritional vitamin E applications. RESULTS Indoor concentrate-fed Rasa Aragonesa male lambs (n = 480) were supplemented with increasing levels of all-rac-alpha-tocopheryl acetate (0.25, 0.5, 1.0 g kg(-1) compound feed), rosemary extract (0.20, 0.40, or 0.80 g kg(-1) compound feed), or rosemary extract embedded in a fat matrix (0.20, 0.40, or 0.80 g kg(-1) compound feed) for 14 days before slaughter. The longissimus thoracis et lumborum muscle from three lambs per pen (18 lambs per treatment) were modified-atmosphere packaged (70% O-2 + 30% CO2) and maintained under retail conditions for 14 days. Supranutritional supplementation with antioxidants had no effect (P > 0.05) on average daily weight gain, feed intake, and feed efficiency. Rosemary extract supplementation (with or without fat embedment) had no effect on lipid oxidation, myoglobin forms, or colour stability parameters, regardless of the dose. All vitamin E supplementation levels significantly affected lipid oxidation, colour stability (L*, C*, and h), myoglobin forms, and meat discoloration parameters compared with non-supplemented lambs. CONCLUSIONS This study demonstrates that, unlike vitamin E, neither dose nor protection of the rosemary extract had an effect on lipid oxidation or meat colour stability of lambs during the 14 days of storage under retail conditions

Estimated United States Residential Energy Use in 2005

A flow chart depicting energy flow in the residential sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 11,000 trillion British Thermal Units (trBTUs) of electricity and fuels were used throughout the United States residential sector in lighting, electronics, air conditioning, space heating, water heating, washing appliances, cooking appliances, refrigerators, and other appliances. The residential sector is powered mainly by electricity and natural gas. Other fuels used include petroleum products (fuel oil, liquefied petroleum gas and kerosene), biomass (wood), and on-premises solar, wind, and geothermal energy. The flow patterns represent a comprehensive systems view of energy used within the residential sector

Editor's Choice - Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years

Background: Case mix and outcomes of complex surgical procedures vary over time and between regions. This study analyses peri-operative mortality after intact abdominal aortic aneurysm (AAA) repair in 11 countries over 9 years. Methods: Data on primary AAA repair from vascular surgery registries in 11 countries for the years 2005-2009 and 2010-2013 were analysed. Multivariate adjusted logistic regression analyses were carried out to adjust for variations in case mix. Results: A total of 83,253 patients were included. Over the two periods, the proportion of patients >= 80 years old increased (18.5% vs. 23.1%; p <.0001) as did the proportion of endovascular repair (EVAR) (44.3% vs. 60.6; p <.0001). In the latter period, 25.8% of AAAs were less than 5.5 cm. The mean annual volume of open repairs per centre decreased from 12.9 to 10.6 between the two periods (p <.0001), and it increased for EVAR from 10.0 to 17.1 (p <.0001). Overall, peri-operative mortality fell from 3.0% to 2.4% (p <.0001). Mortality for EVAR decreased from 1.5% to 1.1% (p <.0001), but the outcome worsened for open repair from 3.9% to 4.4% (p = .008). The peri-operative risk was greater for octogenarians (overall, 3.6% vs. 2.1%, p <.0001; open, 9.5% vs. 3.6%, p <.0001; EVAR, 1.8% vs. 0.7%, p <.0001), and women (overall, 3.8% vs. 2.2%, p <.0001; open, 6.0% vs. 4.0%, p <.0001; EVAR, 1.9% vs. 0.9%, p <.0001). Peri-operative mortality after repair of AAAs Conclusions: In this large international cohort, total peri-operative mortality continues to fall for the treatment of intact AAAs. The number of EVAR procedures now exceeds open procedures. Mortality after EVAR has decreased, but mortality for open operations has increased. The peri-operative mortality for small AM treatment, particularly open surgical repair, is still considerable and should be weighed against the risk of rupture. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Penicillin susceptibility among invasive MSSA infections: a multicentre study in 16 Spanish hospitals

Objectives: To determine the prevalence of penicillin susceptibility among MSSA causing bloodstream infections (BSIs) in 16 Spanish hospitals and to characterize the penicillin-susceptible MSSA (MSSA-PENS) isolates. Methods: A total of 1011 Staphylococcus aureus isolates were collected from blood cultures in 16 Spanish hospitals during 2018–19 (6–12 months) and their susceptibility to 18 antimicrobials was determined. The MSSA-PENS isolates were selected and examined by PCR to determine the presence of the blaZ gene, other resistance genes and the genes lukF/lukS-PV, eta, etb and tst. The immune evasion cluster (IEC) type was also analysed. All the MSSA-PENS isolates were submitted to S. aureus protein A (spa) typing and the clonal complexes (CCs) were assigned according to their spa type. Results: The prevalence of MSSA was 74.6% (754/1011) and 14.9% (151/1011) were MSSA-PENS-blaZnegative. MSSA-PENS-blaZnegative isolates (n = 151) were ascribed to 88 spa types and 11 CCs. The most frequent CCs were CC5 (35/151) and CC398 (25/151), with t002-CC5 and t571-CC398 being the most common lineages. Pan-susceptibility was identified in 117 of the 151 MSSA-PENS-blaZnegative isolates (77.5%). In the remaining isolates, erythromycin and clindamycin resistance was the most frequent resistance found, although tobramycin, ciprofloxacin, fusidic acid, mupirocin and/or tetracycline resistance was also detected. Thirty-eight MSSA-PENS-blaZnegative isolates were IEC negative and four isolates were Panton–Valentine leucocidin (‘PVL’) positive. Conclusions: A high penicillin susceptibility rate was detected among MSSA, opening therapeutic opportunities for BSIs. The emergence of new successful MSSA-PENS clones could be responsible for these data. The detection among MSSA-PENS-blaZnegative isolates of the clonal lineage CC398 or the absence of an IEC raises questions about their possible animal origin, requiring further analysis

Hydrodynamics of fossil fishes

Fromtheir earliest origins, fishes have developed a suite of adaptations for locomotion in water, which determine performance and ultimately fitness. Even without data from behaviour, soft tissue and extant relatives, it is possible to infer a wealth of palaeobiological and palaeoecological information. As in extant species, aspects of gross morphology such as streamlining, fin position and tail type are optimized even in the earliest fishes, indicating similar life strategies have been present throughout their evolutionary history. As hydrodynamical studies become more sophisticated, increasingly complex fluid movement can be modelled, including vortex formation and boundary layer control. Drag-reducing riblets ornamenting the scales of fast-moving sharks have been subjected to particularly intense research, but this has not been extended to extinct forms. Riblets are a convergent adaptation seen in many Palaeozoic fishes, and probably served a similar hydrodynamic purpose. Conversely, structures which appear to increase skin friction may act as turbulisors, reducing overall dragwhile serving a protective function. Here,we examine the diverse adaptions that contribute to drag reduction in modern fishes and review the few attempts to elucidate the hydrodynamics of extinct forms

The Red Radio Ring: a gravitationally lensed hyperluminous infrared radio galaxy at z=2.553 discovered through the citizen science project SpaceWarps

We report the discovery of a gravitationally lensed hyperluminous infrared galaxy (intrinsic LIR≈1013 L⊙) with strong radio emission (intrinsic L1.4 GHz≈1025WHz−1) at z=2.553. The source was identified in the citizen science project SpaceWarpsthrough the visual inspection of tens of thousands of iJKs colour composite images of luminous red galaxies (LRGs), groups and clusters of galaxies and quasars. Appearing as a partial Einstein ring (re≈3 arcsec) around an LRG at z=0.2, the galaxy is extremely bright in the sub-millimetre for a cosmological source, with the thermal dust emission approaching 1 Jy at peak. The redshift of the lensed galaxy is determined through the detection of the CO(3→2) molecular emission line with the Large Millimetre Telescope's Redshift Search Receiver and through [O iii] and Hα line detections in the near-infrared from Subaru/Infrared Camera and Spectrograph. We have resolved the radio emission with high-resolution (300-400 mas) eMERLIN L-band and Very Large Array C-band imaging. These observations are used in combination with the near-infrared imaging to construct a lens model, which indicates a lensing magnification of μ≈10. The source reconstruction appears to support a radio morphology comprised of a compact (<250 pc) core and more extended component, perhaps indicative of an active nucleus and jet or lob

The Red Radio Ring: a gravitationally lensed hyperluminous infrared radio galaxy at z = 2.553 discovered through the citizen science project SPACE WARPS

This article has been accepted for publication in Monthly Notices of the Royal Astronomical Society. © 2015 The Authors. Published by Oxford University Press on behalf of the Royal Astronomical Society.We report the discovery of a gravitationally lensed hyperluminous infrared galaxy (intrinsic LIR ≈ 1013 L⊙) with strong radio emission (intrinsic L1.4 GHz ≈ 1025 W Hz−1) at z = 2.553. The source was identified in the citizen science project SPACE WARPS through the visual inspection of tens of thousands of iJKs colour composite images of luminous red galaxies (LRGs), groups and clusters of galaxies and quasars. Appearing as a partial Einstein ring (re ≈ 3 arcsec) around an LRG at z = 0.2, the galaxy is extremely bright in the sub-millimetre for a cosmological source, with the thermal dust emission approaching 1 Jy at peak. The redshift of the lensed galaxy is determined through the detection of the CO(3→2) molecular emission line with the Large Millimetre Telescope's Redshift Search Receiver and through [O III] and Hα line detections in the near-infrared from Subaru/Infrared Camera and Spectrograph. We have resolved the radio emission with high-resolution (300–400 mas) eMERLIN L-band and Very Large Array C-band imaging. These observations are used in combination with the near-infrared imaging to construct a lens model, which indicates a lensing magnification of μ ≈ 10. The source reconstruction appears to support a radio morphology comprised of a compact (<250 pc) core and more extended component, perhaps indicative of an active nucleus and jet or lobe.Peer reviewedFinal Published versio