Background: Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE) Aim: To evaluate the impact of ICE vs. TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. Methods: All studies comparing ICE-guided vs. TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. Results: Twelve studies (n=5637) were included. There were no differences in procedural success group (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p=0.27; I2=0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p=0.25; I2=0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-minute reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p=0.64); however, an increased prevalence of residual IASD was observed with ICE-guided vs. TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p=0.04). Conclusion: ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.
Laminitis associated with hyperinsulinemia a significant cause of morbidity and mortality in horses with equine metabolic syndrome. The diagnosis and management of insulin dysregulation are therefore critical to prevent the development of hyperinsulinemia-associated laminitis. This review article aims to help primary care clinicians manage patients with insulin dysregulation by providing an overview of diagnostics, management strategies and new therapies that are available.
Ultrasonographic Manifestations ofMultiple TuberousXanthomas on Bilateral Buttocks with Hypercholesterolemia: One rare case reportDongmei Li a , Lei Wang, MDb ,a University of Electronic Science and Technology, Chengdu 610072, China.b Department of Medical Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China.
The QDOT MICROTM Catheter is a novel open-irrigated contact force-sensing single-tip radiofrequency ablation catheter. It incorporates six thermocouples at its tip and offers temperature-controlled and very high-power short-duration (vHPSD) ablation with 90 Watts for 4 seconds to improve safety and efficacy of catheter ablation procedures. The QDOT MICROTM Catheter was recently evaluated for pulmonary vein isolation and safety, efficacy and long-term follow-up found promising results. Although the QDOT MICROTM Catheter was mainly designed for pulmonary vein isolation its versatility to treat atrial fibrillation as well as other types of arrythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article.
The potentially wide application of Phenolic acids (PAs) in industries was severely limited by their inadequate solubility and stability in polar/non-polar media. To overcome these limits, studies on the enzymatic esterification of PAs with glycerol were carried out to reach a yield of 95% of phenolic acid glycerols (PAGs) under the following reaction conditions: 1:150 molar ratio of caffeic acid (CA) to glycerol; 25% Lipozyme 435 relative to the weight of total substrates; temperature 80 oC, 500 rpm; 86.7 kPa and reaction time 10 h. Three resulting PAGs including caffeoyl glycerol (CG), feruloyl glycerol (FG) and p-hydroxycinnamoyl glycerol ( p-HCG) were confirmed by MS, 1H NMR and 13C NMR. Among them, CG showed a comparative free radical scavenging ability to CA, indicating its potential use as a water-soluble antioxidant alternative to CA for food and cosmetic applications.
Although gaining much attention in recent years, it is unclear whether mycorrhizal fungi distribute meaningful amounts of resources among trees in ways that increase the fitness of the receiving trees. To this end, we used shaded and non-shaded pairs of inter- and intra-species Pinus halepensis and Quercus calliprinos saplings growing outdoors in forest soil. Carbon transfer was measured using pulse labeling with 13CO2 and the mycorrhizal community of each tree was identified by DNA barcoding. The effects of belowground connections were examined by tree performance and Non-Structural Carbohydrates (NSC) pools. Although we did not observe any growth benefits, shaded recipient oaks exhibited higher levels of root NSC compared to their control counterparts, which were not connected belowground. This finding suggests a potential benefit of establishing below-ground connections. We also show that non-shaded pines connected to shaded oaks were depleted of their starch pools, suggesting a possible cost of the tree-fungi-tree interaction. Additionally, we monitored the carbon (C) flow from a 13CO2 labeled donor pine tree to the final recipient oak tree and were able to demonstrate C transfer from pines to shaded oaks. Finally, we were able to identify the main fungal symbionts interacting with pines and oaks. Our results link specific mycorrhizal species to belowground C transfer and suggest C-driven fitness costs and benefits to the trees.
Our knowledge of biodiversity hinges on sufficient data, reliable methods, and realistic models. Without an accurate assessment of species distributions, we cannot effectively target and stem biodiversity loss. Species range maps are the foundation of such efforts, but countless studies have failed to account for the most basic assumptions of reliable species mapping practices, undermining the credibility of their results and potentially misleading and hindering conservation and management efforts. Here, we use examples from the recent literature and broader conservation community to highlight the substantial shortfalls in current practices and their consequences for both analyses and conservation management. We detail how different decisions on data filtering impact the outcomes of analysis and provide practical recommendations and steps for more reliable analysis, whilst understanding the limits of what available data will reliably allow and what methods are most appropriate. Whilst “perfect” analyses are not possible for many taxa given limited data, and biases, ensuring we use data within reasonable limits and understanding inherent assumptions is crucial to ensure appropriate use. By embracing and enacting such best practices, we can ensure both the accuracy and improved comparability of biodiversity analyses going forward, ultimately enhancing our ability to use data to facilitate our protection of the natural world.
Due to recent advances in computational power and sophisticated software, modeling many complex systems has come within reach for the first time, promising understanding these systems better than ever before. A prime example of the impact of these advances is on the use computational models to construct performance landscapes. As interpretive tools, performance landscapes are incredibly powerful for interrogating evolutionary trends, competitive dynamics in an ecosystem, and even niche partitioning. If carefully crafted, these landscapes can lead to important insights in the evolutionary systems that they model. In this synthesis, we cover best practices for constructing performance landscapes, including: selecting parameter inputs and outputs, building morphospaces, constructing physical models, parameter spaces and surrogates, and performance space analysis. We conclude with a call for additional work linking biology and mathematics around the unique challenges presented by performance-space construction and validation.
Acute thrombus formation on the delivery sheath is rare condition during percutaneous left atrial appendage occlusion. We presented two cases that TEE showed a floating thrombus attached to the tip of delivery sheath during the procedure. Cerebral embolic protection devices were used to prevent neurological events after thrombus was detected. The
Accurate flow prediction is a primary goal of hydrological modeling studies, which can be affected by the use of varying rainfall datasets, autocalibration methods, and performance indices. The combined effect of three rainfall datasets — Fifth generation of European ReAnalysis (ERA-5), Gridded meteorological data (gridMET), Global Precipitation Measurement Integrated Multi-satellitE Retrievals (GPM IMERG) — and three autocalibration techniques — Dynamically Dimensioned Search (DDS), Generalized Likelihood Uncertainty Estimation (GLUE), Latin Hypercube Sampling (LHS) — on SWAT+ river flow prediction was measured using three evaluation metrics — Nash Sutcliffe Efficiency (NSE), Kling Gupta Efficiency (KGE) and coefficient of determination (R 2) — for two watersheds in North Carolina (Cape Fear, Tar Pamlico) using the Soil Water Assessment Tool Plus (SWAT+) model. Five parameters in the SWAT+ model, cn2, revap_co, flo_min, revap_min, and awc, were found to be significantly sensitive under all combinations for both watersheds. Simulated flow varied more with the change in rainfall than the calibration technique used. We discovered that GPM IMERG gave the best results of the rainfall datasets, followed by ERA-5 and gridMET. We observed that the NSE score is more sensitive to different combinations of rainfall datasets and calibration techniques than the KGE scores. SWAT+ underperformed in the prediction of base flow for the groundwater-driven watershed. Overall, we recommend using the GPM IMERG rainfall dataset with the GLUE optimization technique and KGE performance index for optimal flow simulations. The results from this study will help hydrological modelers choose an optimal combination of rainfall dataset, autocalibration technique, and performance index depending on watershed characteristics.
Reservoir is a vital tool for human utilization of water resources, and the deterioration of its water quality can seriously threaten the water cycle and sustainable urban development. However, there are relatively few studies in academia that analyze and evaluate the water quality of multiple reservoirs at the same time. To address this knowledge deficit, we collected 108 water samples from three different reservoirs in Chuzhou City for 36 months (from 2019 to 2021), explored the drivers of changes in water quality parameters over time and the extent of eutrophication. Our results indicated that the water quality of the reservoirs was deteriorating during the study period, among which Huanglishu Reservoir and Shahe Reservoir reached mild eutrophic status, and both had higher eutrophication levels than Chengxi Reservoir. Secchi Depth (SD), Total Nitrogen (TN), and Total Phosphorus (TP) were the principal factors inducing eutrophication. The biased utilization of reservoir functions was the major contributor to the discrepancy in the degree of eutrophication. Furthermore, Pearson Correlation Analysis revealed that there are significant correlations between many water quality parameters. Cluster Analysis (CA) grouped the 12 months of each year into three clusters (stable water level period, rainy season high flow period, and winter low flow period). Based on this, Analysis of Variance (ANOVA) showed that most water quality parameters varied considerably between the clusters. Collectively, this study identified the actual water quality conditions of three reservoirs in Chuzhou City and provided guidance for local water quality management and environmental protection.
The National Confectionery Association (NCA) and the Chocolate Manufacturers Association (CMA) jointly developed a method for measuring the yield value and plastic viscosity of chocolates. The NCA/CMA method covers details including sample preparation, viscometer calibration, viscosity measurement, yield value and plastic viscosity calculation. The author recently had an opportunity to closely evaluate this method and has encountered a few issues in its application. After extensive research, the author concludes that the method has mistakenly introduced three parameters including a value, K value, and Xcorr factor. Those values are not only unnecessary but also may introduce artificial errors particularly in calculating the yield value of chocolate. This article shares those findings and intends to inspire more discussion to further improve the NCA/CMA method for viscosity.
Subdural Empyema -A Rare Complication of Chronic Otitis Media: A Case ReportEmnet Tekeste1*+, Genet Tekeste2+, Nahom Daniel3, Samuel Tekle Mengistu41. General practitioner, Barentu Military Hospital, Barentu, Eritrea, Email: firstname.lastname@example.org, ORCID: https://orcid.org/0000-0002-8820-85642. Surgical resident, Orotta National Referral Hospital, Asmara, Eritrea, Email: ORCID:, 3. General practitioner, Mendefera Zonal Referral Hospital, Medefera, Eritrea, Email: email@example.com. Nakfa Hospital, Ministry of Health Northern Red Sea branch, Nakfa, Eritrea. Email: firstname.lastname@example.org ORCID: https://orcid.org/0000-0002-2817-1421*Correspondence: Emnet Tekeste MD, General practitioner, Barentu Military Hospital, Barentu, Eritrea. Tel +291-1-7205051, Email email@example.comIf any equal contribution of authors that you want to acknowledge+: These authors contributed equally to this work
IntroductionHowever, nasal reconstruction has always been challenging to the otolaryngologists, various nasal reconstruction methods have been introduced.These reconstruction techniques depend on various factors including defect etiology, size, location, and depth.1Recently, the forehead flap and the radial forearm free flap are recommended in nasal complex defects.2Our patient had a complex defect involving nasal tip, columella, septum, and a portion of upper lip after MOHS surgery for squamous cell carcinoma. Restoration of a nasal and lip function and contour are the main goals of reconstruction in this case.This report details a two stage approach to repairing such a defect using bilateral inferiorly based malar transposition flaps with auricular cartilage graft for more support and contour.