Prevalence, Predictors and Mechanisms of Steam Pops in Ablation Index-Guided High-Power Pulmonary Vein Isolation

Despite the good cooling effect of the contact-force porous catheter, the risk of steam pops (SP) remains one of the major concerns in high-power circumferential pulmonary vein isolation (CPVI). This study aimed to investigate the prevalence, predictors and possible mechanisms of SPs in CPVI. Patients experiencing SPs in de novo high-power CPVI were 1:3 matched by non-SP patients with gender, age (±5 years) and left atrial diameter (LAD) (±5 mm) to compare the ablation parameters of SP and non-SP lesions. Catheter tip displacement (Tipdisp) was compared between “edge-of-ridge” and “PV-side-of-ridge” placement at anterior and roof segments of the left pulmonary vein (PV). SPs occurred in 11 (1.57%) of 701 patients, including 6 at the antero-superior left PV, 2 at the roof, 1 at the postero-superior left PV, 1 at the bottom left PV and 1 at the antero-superior aspect of the right PV. There was significantly shorter RF delivery duration (13.9 ± 6.3 vs. 23.3 ± 6.0 s), greater Δimpedance (17.6 ± 6.7 vs. 6.7 ± 4.1 Ω) and lower ablation index (357.7 ± 68.8 vs. 430.2 ± 30.7) in SP patients than those in non-SP patients. Δimpedance >12 Ω during ablation could predict SP occurrence. Tipdisp was greater in “PV-side-of-ridge” than that in “edge-of -ridge” placement (3.2 ± 1.6 mm vs. 2.0 ± 0.8 mm) at antero-superior and roof segments of the left PV. The prevalence of SP was 1.57% in high-power CPVI procedures, with the most common site at the antero-superior segment of the left PV. Δimpedance was a significant predictor of SP occurrence. “PV-side-of-ridge” ablation at antero-superior and roof segments of left PV might predispose to SP occurrence due to excessive tissue coverage

In Situ Diffuse Reflectance Fourier Transform Infrared Spectroscopy (DRIFTS) Study of Formaldehyde Adsorption and Reactions on Pd-Doped Nano-gamma-Fe2O3 Films

Palladium-doped nano-gamma-Fe2O3 films were printed on Al2O3 substrates by screen printing injecting hybrid technology. X-ray diffraction and scanning electron microscopy techniques were used to characterize the phase structures and morphologies of the films, respectively. The sensitivity of the films to 100 ppm formaldehyde in air was investigated. The surface adsorption and reaction process between Pd-doped nano-gamma-Fe2O3 films and formaldehyde was studied by in situ diffuse reflectance Fourier transform infrared spectroscopy (DRIFTS) at different temperatures. Dioxymethylene, formate ions, polyoxymethylene, and adsorbed formaldehyde were detected when the Pd-doped nano-gamma-Fe2O3 films were exposed to 100 ppm formaldehyde at different temperatures. A possible mechanism of the reaction process is discussed

In situ diffuse reflectance infrared Fourier transform spectroscopy study of formaldehyde adsorption and reactions on nano gamma-Fe2O3 films

The nano gamma-Fe2O3 films gas sensor was fabricated by the screen printing technology. The phase structures and morphologies of nano gamma-Fe2O3 films were characterized by X-ray diffraction (XRD) and field-emission scanning electron microscopy (FESEM), respectively. The gas sensitivity of the films to 100 ppm formaldehyde was investigated. The surface adsorption and reaction process between nano gamma-Fe2O3 films and formaldehyde was studied by in situ diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) method at different temperatures. DRIFTS results showed that dioxymethylene, formate ions, polyoxymethylene and molecularly formaldehyde surface species were detected when the nano gamma-Fe2O3 films exposed to 100 ppm formaldehyde at different temperatures. A possible mechanism of the reaction process was discussed. (c) 2013 Elsevier B.V. All rights reserved

An Antibacterial Peptide with High Resistance to Trypsin Obtained by Substituting d-Amino Acids for Trypsin Cleavage Sites

The poor stability of antibacterial peptide to protease limits its clinical application. Among these limitations, trypsin mainly exists in digestive tract, which is an insurmountable obstacle to orally delivered peptides. OM19R is a random curly polyproline cationic antimicrobial peptide, which has high antibacterial activity against some gram-negative bacteria, but its stability against pancreatin is poor. According to the structure-activity relationship of OM19R, all cationic amino acid residues (l-arginine and l-lysine) at the trypsin cleavage sites were replaced with corresponding d-amino acid residues to obtain the designed peptide OM19D, which not only maintained its antibacterial activity but also enhanced the stability of trypsin. Proceeding high concentrations of trypsin and long-time (such as 10 mg/mL, 8 h) treatment, it still had high antibacterial activity (MIC = 16–32 µg/mL). In addition, OM19D also showed high stability to serum, plasma and other environmental factors. It is similar to its parent peptide in secondary structure and mechanism of action. Therefore, this strategy is beneficial to improve the protease stability of antibacterial peptides

Antibiotic resistance of probiotics isolated from Chinese corn stover silage

ABSTRACTOne of the most important drivers of the emergence of antimicrobial resistance is the irrational usage of antibiotics. But alongside some indirect sources such as feeding Chinese corn stover silage could also transmit resistant genes to animals. This study was aimed at assessing the antibiotic resistance phenotypes, drug resistance genes and mediated drug resistance mechanisms. A total of 37 isolates were obtained by selective medium and identified by 16S rDNA sequencing including Lactobacillus acidophilus (n = 3), Lactobacillus amylovorus (n = 4), Weissella confusa (n = 3), Acetobacter pasteurianus (n = 9), Lactobacillus buchneri (n = 6), Enterococcus faecium (n = 8) and Lactobacillus reuteri (n = 4). Antimicrobial resistance of all isolates to 12 antibiotics was determined using the agar dilution method. Widespread resistance to ampicillin, erythromycin, clindamycin, kanamycin, streptomycin, levofloxacin and ciprofloxacin was observed. The presence of relevant resistance genes was examined by PCR, and the genes pbp5, blaZ, bla TEM, mecA, mexI, tetW, ermB, msrA, msrC, ermC, vatE, aacA-aphD, aphA1, aadA1, aadA2 and vanX were detected. All the isolated strains had multiple drug resistance, and harboured related drug-resistant genes; therefore, the use of probiotics in animal feed should be standardized to reduce the risks of horizontal transmission of drug resistance genes to animal products and human population

Image_1_Impact of technical aspects of vein of Marshall ethanol infusion on mitral isthmus block for persistent atrial fibrillation ablation.tif

AimsEthanol infusion into the VOM (EIVOM) adjunctive to radiofrequency catheter ablation (RFCA) was a novel approach facilitating mitral isthmus (MIth) block for persistent atrial fibrillation (PeAF); However, there were remarkable disparities in its technical aspects. This study aimed to evaluate the impact of EIVOM technical aspects on acute MIth block.MethodsEighty consecutive patients (63 males, average age 66.4 ± 8.6 years) undergoing de novo PeAF ablation were assigned to different groups. The procedural parameters in “EIVOM first” (n = 13) or “RFCA first” (n = 13) as well as small dose ([SD], ≤4 ml, n = 26) or big dose ([BD], >4 ml, n = 54) approaches were analyzed to identify the predictors for acute MIth block.ResultsCompared with the “EIVOM first” approach, the “RFCA first” approach was associated with longer procedural and MIth ablation time (134 ± 27 min vs. 112 ± 17 min; 14.9 ± 5.5 min vs. 9.3 ± 5.1 min, both P 5.75 ml independently predicted successful MIth block (OR: 0.428, 95% CI: 0.219–0.839, P = 0.01).ConclusionsDespite the comparable effectiveness on MIth block, the “EIVOM first” approach was associated with shorter procedural and MIth ablation time than the “RFCA first” approach. The ethanol dose in EIVOM was an independent predictor for MIth block.</p

High Cell Selectivity and Bactericidal Mechanism of Symmetric Peptides Centered on d-Pro–Gly Pairs

Antimicrobial peptides (AMPs) have a unique action mechanism that can help to solve global problems in antibiotic resistance. However, their low therapeutic index and poor stability seriously hamper their development as therapeutic agents. In order to overcome these problems, we designed peptides based on the sequence template XXRXXRRzzRRXXRXX-NH2, where X represents a hydrophobic amino acid like Phe (F), Ile (I), and Leu (L), while zz represents Gly&ndash;Gly (GG) or d-Pro&ndash;Gly (pG). Showing effective antimicrobial activity against Gram-negative bacteria and low toxicity, designed peptides had a tendency to form an &alpha;-helical structure in membrane-mimetic environments. Among them, peptide LRpG (X: L, zz: pG) showed the highest geometric mean average treatment index (GMTI = 73.1), better salt, temperature and pH stability, and an additive effect with conventional antibiotics. Peptide LRpG played the role of anti-Gram-negative bacteria through destroying the cell membrane. In addition, peptide LRpG also exhibited an anti-inflammatory activity by effectively neutralizing endotoxin. Briefly, peptide LRpG has the potential to serve as a therapeutic agent to reduce antibiotic resistance owing to its high therapeutic index and great stability

Identification of Distinct Clinical Phenotypes of Heterogeneous Mechanically Ventilated ICU Patients Using Cluster Analysis

This retrospective study aimed to derive the clinical phenotypes of ventilated ICU patients to predict the outcomes on the first day of ventilation. Clinical phenotypes were derived from the eICU Collaborative Research Database (eICU) cohort via cluster analysis and were validated in the Medical Information Mart for Intensive Care (MIMIC-IV) cohort. Four clinical phenotypes were identified and compared in the eICU cohort (n = 15,256). Phenotype A (n = 3112) was associated with respiratory disease, had the lowest 28-day mortality (16%), and had a high extubation success rate (~80%). Phenotype B (n = 3335) was correlated with cardiovascular disease, had the second-highest 28-day mortality (28%), and had the lowest extubation success rate (69%). Phenotype C (n = 3868) was correlated with renal dysfunction, had the highest 28-day mortality (28%), and had the second-lowest extubation success rate (74%). Phenotype D (n = 4941) was associated with neurological and traumatic diseases, had the second-lowest 28-day mortality (22%), and had the highest extubation success rate (>80%). These findings were validated in the validation cohort (n = 10,813). Additionally, these phenotypes responded differently to ventilation strategies in terms of duration of treatment, but had no difference in mortality. The four clinical phenotypes unveiled the heterogeneity of ICU patients and helped to predict the 28-day mortality and the extubation success rate

Association between Tissue Characteristics of Coronary Plaque and Distal Embolization after Coronary Intervention in Acute Coronary Syndrome Patients: Insights from a Meta-Analysis of Virtual Histology-Intravascular Ultrasound Studies

<div><p>Background and Objectives</p><p>The predictive value of plaque characteristics assessed by virtual histology-intravascular ultrasound (VH-IVUS) including fibrous tissue (FT), fibrofatty (FF), necrotic core (NC) and dense calcium (DC) in identifying distal embolization after percutaneous coronary intervention (PCI) is still controversial. We performed a systematic review and meta-analysis to summarize the association of pre-PCI plaque composition and post-PCI distal embolization in acute coronary syndrome patients.</p><p>Methods</p><p>Studies were identified in PubMed, OVID, EMBASE, the Cochrane Library, the Current Controlled Trials Register, reviews, and reference lists of relevant articles. A meta-analysis using both fixed and random effects models with assessment of study heterogeneity and publication bias was performed.</p><p>Results</p><p>Of the 388 articles screened, 10 studies with a total of 872 subjects (199 with distal embolization and 673 with normal flow) met the eligibility of our study. Compared with normal flow groups, significant higher absolute volume of NC [weighted mean differences (WMD): 5.79 mm³, 95% CI: 3.02 to 8.55 mm³; p<0.001] and DC (WMD: 2.55 mm³, 95% CI: 0.22 to 4.88 mm³; p = 0.03) were found in acute coronary syndrome patients with distal embolization. Further subgroup analysis demonstrated that the predictive value of tissue characteristics in determining distal embolization was correlated to clinical scenario of the patients, definition of distal embolization, and whether the percutaneous aspiration thrombectomy was applied.</p><p>Conclusion</p><p>Our study that pooled current evidence showed that plaque components were closely related to the distal embolization after PCI, especially the absolute volume of NC and DC, supporting further studies with larger sample size and high-methodological quality.</p></div