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Aims Pulmonary vein isolation using radiofrequency ablation is an effective treatment option for patients with symptomatic atrial fibrillation (AF). Application of high power over a short period of time (HPSD) is reported to create more efficient lesions and may prevent collateral thermal oesophageal injury. This study aims to compare efficacy and safety of two different HPSD ablation approaches using different ablation index settings. Methods and results Consecutive patients undergoing AF ablation with HPSD (50 W; ablation index–guided) using the ThermoCool SmartTouch SF catheter were included. Patients were grouped by ablation protocol: ablation with target ablation index (AI) of 400 on the anterior left atrial wall vs. 300 at the posterior left atrial wall (AI 400/300) or AI 450/350 was performed upon the operator’s preference and compared. Peri-procedural parameters and complications were recorded, and incidences of endoscopically detected thermal oesophageal lesions (EDEL) analysed. Recurrence rates after a mean follow-up of 25 ± 7 months and reconnection patterns in patients undergoing redo procedures were investigated. A total of 795 patients (67 ± 10 years; 58% male; 48% paroxysmal AF) underwent a first AF ablation with HPSD (211 in group AI 400/300 and 584 in group 450/350). Median procedure time was 82.9 ± 24.6 min with longer ablation times in patients with target AI 400/300 due to higher intraprocedural reconnection rates, increased box lesions, and additional right atrial isthmus ablations. EDEL rates among target AI 400/300 procedures were significantly lower (3% vs. 7%; P = 0.019). Correspondingly, AI 450/350 was the strongest independent predictor of post-ablation EDEL (OR 4.799, CI 1.427–16.138, P = 0.011). Twelve-month (76% vs. 76%; P = 0.892) and long-term ablation single procedure success (68% vs. 71%; log-rank P = 0.452) after a mean of 25 ± 7 months were comparable among both target AI groups; however, long-term success was significantly higher for paroxysmal AF compared to persistent AF (12 months: 80% vs. 72%; P = 0.010; end of follow-up: 76% vs. 65%; log-rank P = 0.001). One hundred three patients (16%) underwent a redo procedure during follow-up documented comparable pulmonary vein (PV) reconnection among groups. Multivariate predictors of AF recurrence were age, left atrium (LA) size, persistent AF, and extra-PV ablation targets. Conclusion High-power short-duration AF ablation with target AI of 400 for non-posterior wall and 300 for posterior wall lesions resulted in comparable long-term results compared to higher AI (450/350) ablations with significantly lower risk for thermal oesophageal lesions. Older age, larger LA size, persistent AF, and extra-PV ablation targets were identified in a multivariate analysis as independent risk factors for recurrences of atrial arrhythmias.

ZusammenfassungVorhofflimmern (VHF) und eine Herzinsuffizienz begünstigen sich gegenseitig und treten häufig in Kombination auf. Eine effektive Therapie des VHF inklusive der möglicherweise notwendigen Antikoagulation sollte zentraler Baustein bei Patienten mit eingeschränkter systolischer Funktion und VHF sein. Medikamentöse Therapieoptionen sind in der Regel wenig effektiv, sodass zunehmend Katheterablationsverfahren zur Behandlung dieser Patienten in den Vordergrund gestellt werden. Randomisierte Studien bei selektierten Patienten zeigen nicht nur einen symptomatischen Effekt auf die Herzinsuffizienz, sondern neben Verbesserung der LV-Funktion auch einen Letalitätsbenefit der effektiven Ablation von VHF. In der Zukunft gilt es, Patienten sinnvoll für die Katheterablation zu identifizieren. Ob das reine Vorhandensein von VHF oder eher die VHF-Last bei Patienten mit Herzinsuffizienz entscheidend für die Prognose ist, wird aktuell in weiteren Studien untersucht.

Although the ectopic foci responsible for initiating atrial fibrillation (AF) are usually located in the pulmonary veins (PVs), non-PV sources may initiate AF in approximately 11% of unselected patients with paroxysmal or persistent AF. The superior vena cava (SVC) is one of the most frequent non-PV origins for initiating AF. This study aims to investigate the effect of empirical SVC isolation in redo AF ablation procedures.Consecutive patients undergoing redo AF ablation procedures using a high-power short-duration protocol (HPSD) (50 W; ablation index guided; target AI 350 for posterior wall ablation, AI 450 for anterior wall ablation; CARTO 3 mapping system) were included. Patients with SVC isolation were compared to patients without SVC isolation. Periprocedural parameters and complications were recorded and analyzed. Short-term endpoints included intrahospital AF recurrence, midterm endpoint AF freedom after 3 months, and long-term endpoint AF freedom after 12 months.A total of 276 patients underwent repeat ablation for recurrent AF (67 ± 10 years; 57% male; 31.5% paroxysmal AF). The patients were divided into two groups: redo procedures with SVC isolation vs redo procedure without SVC isolation. Additional LA substrate modification was done based on intraprocedural voltage maps. Baseline characteristics did not differ significantly between the two groups. Median procedure time was 85.4 ± 27.1 min with ablation times of 14.0 ± 8.5 min. Intrahospital AF recurrence occurred in 32 patients (12%) with no difference among both groups: 17 patients (13%) SVC vs 15 patients (10%) No-SVC; p = 0.416. At 3-month follow-up, 47 (17%) presented an AF recurrence during the blanking period: 25 patients (19%) SVC vs 22 patients (15%) No-SVC; p = 0.304). After 12 months, 202 (73%) of all patients were in stable sinus rhythm with no significant difference between the two groups: 93 patients (73%) SVC vs 109 patients (74%) No-SVC; p = 0.853). No significant differences were noted when dividing the patients in paroxysmal or persistent AF with and without SVC isolation.In our series of repeat AF ablation procedures, the addition of empirical SVC isolation to Re-PVI and LA substrate modification did not influence AF recurrence rates. This strategy can however be safe and useful in patients in whom SVC is identified as a trigger of AF.

Disposable diapers are considered indispensable hygiene products, which is reflected in their massive levels of consumption globally and waste generation. Most of the diaper waste is neither segregated nor treated and ends up in landfills or incinerators. The reported life cycle assessment highlights that the diaper waste is not solely generated after single-use but begins as early as the raw materials acquisition stage. Although what is done cannot be undone, diaper waste can be recycled. Diaper waste valorization has been explored on laboratory- and commercial-scales for years, with varying degrees of success. Leading diaper manufacturers such as Procter & Gamble, Kimberly–Clark, and Unicharm are making progress in establishing closed-loop recycling of used diapers and converting diaper waste into new diapers. However, the broad potential for possible new products made from diaper waste has yet to be fully exploited. This review focuses on the enormous promise of diaper waste from the perspective of emerging open-loop recycling pathways. We demonstrate that diaper waste can be harnessed and converted into nondiaper products, including energy pellets, anode material for lithium-ion batteries, concrete admixture, catalysts, soil amendment, and mushroom cultivation substrates. We also explore several active, commercial-scale diaper recycling approaches and provide a comprehensive blueprint to encourage open-loop recycling. Open-loop recycling is a practical strategy for managing diaper waste, rectifying environmental damage, and contributing to circular supply chains.

Background: Despite improved risk stratification tools and identification of novel biomarkers, sepsis-related mortality has not significantly improved during the past years. Objective: This study investigates the diagnostic and prognostic role of the serum albumin and cholinesterase (ChE) in patients with sepsis and septic shock. Methods: Consecutive patients with sepsis and septic shock from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (day 1), day 2,3,5 and 7. Firstly, the diagnostic value of the serum albumin for the diagnosis of a septic shock was compared to the ChE. Secondly, the prognostic value of the serum albumin and the ChE for 30-day all-cause mortality was tested. Results: A total of 239 patients were included. With an area under the curve (AUC) of 0.641 to 0.762 on day 3 and 5, the ChE revealed a moderate but better diagnostic discrimination between sepsis and septic shock than the serum albumin. Furthermore, the ChE was able to discriminate between non-survivors and survivors of the 30-day time inter-val (range of AUC 0.612 to 0.686). Patients with a ChE below the median had higher rates of 30-days all-cause mortality in comparison to patients with a ChE above the median (65% vs. 42%, log rank p = 0.001; HR = 1.820; 95% CI 1.273 – 2.601; p = 0.001). Conclusion: The ChE reflects a reliable diagnostic and prognostic tool in patients with sepsis and septic shock.

he distribution and prognostic impact of coronary artery disease (CAD) in ES are still under debate.Consecutive ES patients with implantable cardioverter-defibrillator (ICD) were included retrospectively from 2002 to 2016. Three analyses were applied to characterize ES patients: (a) ES patients without CAD (non-CAD), (b) ES patients with CAD (CAD), and (c) diagnostic findings assessed by coronary angiography (CA) at the time of ES (immediate CA). CAD was compared with non-CAD ES patients, and progressive CAD was compared with stable CAD ES patients. The primary endpoint was all-cause mortality at 2.5 years. Secondary endpoints were the composite endpoint of first recurrent ventricular tachyarrhythmias and appropriate ICD therapies, and recurrence of ES (ES-R) at 2.5 years.Within a total of 87 consecutive ES patients. CAD was present in more than two-thirds (67%). However, only 52% patients underwent immediate CA at the time of ES. Here, 84% had CAD, of which 39% revealed progressive CAD with the need of target vessel revascularization (TVR) or cardiac transplantation ( n = 1). At long-term follow-up, neither the presence (or absence) of CAD (41% vs. 34%; log rank P = 0.708) nor of progressive CAD (33% vs. 26%; log rank P = 0.372) was associated with all-cause mortality at 2.5 years, and further secondary endpoints including the composite of recurrent ventricular tachyarrhythmias plus appropriate ICD therapies, or ES-R.In ES patients, CAD was more common than non-CAD-related cardiac diseases, accompanied by an underinvestigated rate of CA despite increasing rates of progressive CAD. CAD had no prognostic impact in ES.

Der Beitrag setzt sich mit der Form politischer Ansprache von Bündnis 90/Die Grünen auseinander. Diese ist gegenwärtig gekennzeichnet durch den reflexiven Umgang mit politischen Werten und den gezielten Einsatz von Paradoxien. Das antizipierte Gegenüber der Partei ist jene von Andreas Reckwitz beschriebene „neue Mittelklasse“. Indem die Grünen in ihrer politischen Kommunikation weniger auf gemeinsame Werte abstellen, sondern stattdessen an die Reflexivität der Einzelnen appellieren, erproben sie derzeit so etwas wie eine Vergemeinschaftung der Singularitäten.

We propose a novel formalization of roles in social networks that unifies the most commonly used definitions of role equivalence. As one consequence, we obtain a single, straightforward proof that role equivalences form lattices. Our formalization focuses on the evolution of roles from arbitrary initial conditions and thereby generalizes notions of relative and iterated roles that have been suggested previously. In addition to the unified structure result this provides a potential micro-foundation for the emergence of roles. Considering the genesis of roles may explain, and help overcome, the problem that social networks rarely exhibit interesting role equivalences of the traditional kind. Finally, we discuss extensions of the role concept to multivariate networks with actor and tie attributes by example., Social Networks, 68

Many European sculptures and altarpieces from the Middle Ages were decorated with Zwischgold, a bilayer metal leaf with an ultra-thin gold face backed by silver. Zwischgold corrodes quickly when exposed to air, causing the surface of the artefact to darken and lose gloss. The conservation of such Zwischgold applied artefacts has been an obstinate problem. We have acquired quantitative, 3D nanoscale images of Zwischgold samples from 15th century artefacts and modern materials using ptychographic X-ray computed tomography (PXCT), a recently developed coherent diffractive imaging technique, to investigate the leaf structure and chemical state of Zwischgold. The measurements clearly demonstrate decreasing density (increasing porosity) of the leaf materials and their corrosion products, as well as delamination of the leaves from their substrate. Each of these effects speak to typically observed issues in the conservation of such Zwischgold applied artefacts. Further, a rare variant of Zwischgold that contains extremely thin multiple gold layers and an overlapping phenomenon of Zwischgold with other metal leaves are observed through PXCT. As supportive data, scanning electron microscopy (SEM) and scanning transmission electron microscopy (STEM) coupled with energy dispersive X-ray analysis (EDX) were performed on the medieval samples.

Although most cancer drugs modulate the activities of cellular pathways by changing posttranslational modifications (PTMs), little is known regarding the extent and the time- and dose-response characteristics of drug-regulated PTMs. In this work, we introduce a proteomic assay called decryptM that quantifies drug-PTM modulation for thousands of PTMs in cells to shed light on target engagement and drug mechanism of action. Examples range from detecting DNA damage by chemotherapeutics, to identifying drug-specific PTM signatures of kinase inhibitors, to demonstrating that rituximab kills CD20-positive B cells by overactivating B cell receptor signaling. DecryptM profiling of 31 cancer drugs in 13 cell lines demonstrates the broad applicability of the approach. The resulting 1.8 million dose-response curves are provided as an interactive molecular resource in ProteomicsDB.

Purpose Prostate-specific membrane antigen (PSMA)-targeted PET is increasingly used for staging prostate cancer (PCa) with high accuracy to detect significant PCa (sigPCa). [68 Ga]PSMA-11 PET/MRI-guided biopsy showed promising results but also persisting limitation of sampling error, due to impaired image fusion. We aimed to assess the possibility of intraoperative quantification of [18F]PSMA-1007 PET/CT uptake in core biopsies as an instant confirmation for accurate lesion sampling. Methods In this IRB-approved, prospective, proof-of-concept study, we included five consecutive patients with suspected PCa. All underwent [18F]PSMA-1007 PET/CT scans followed by immediate PET/CT-guided and saturation template biopsy (3.1 ± 0.3 h after PET). The activity in biopsy cores was measured as counts per minute (cpm) in a gamma spectrometer. Pearson’s test was used to correlate counts with histopathology (WHO/ISUP), tumor length, and membranous PSMA expression on immunohistochemistry (IHC). Results In 43 of 113 needles, PCa was present. The mean cpm was overall significantly higher in needles with PCa (263 ± 396 cpm) compared to needles without PCa (73 ± 44 cpm, p max 8.7), 13 out of 24 needles had increased counts (100–200 cpm) but only signs of inflammation and PSMA expression in benign glands on IHC. Excluding this case, ROC analysis resulted in an AUC of 0.81, with an optimal cut-off to confirm PCa at 75 cpm (sens/spec of 65.1%/87%). In all 4 patients with PCa, the first or second PSMA PET-guided needle was positive for sigPCa with high counts (156–2079 cpm). Conclusions [18F]PSMA-1007 uptake in PCa can be used to confirm accurate lesion sampling of the dominant tumor intraoperatively. This technique could improve confidence in imaging-based biopsy guidance and reduce the need for saturation biopsy. Trial registration number NCT03187990, 15/06/2017.

Eine junge Patientin prasentiert sich mit Palpitationen. Bei der Abklarung fallen im Langzeit-EKG gehaufte ventrikulare Extrasystolen (VES) auf, echokardiographisch eine hochgradige Mitralklappeninsuffizienz mit Mitralklappenprolaps. Es wurde daher eine Mitralklappenoperation geplant, nach weiterem diagnostischen Work-up der Patientin wurde jedoch eine andere Therapie durchgefuhrt, die sich retrospektiv als hocheffizient darstellt.

All solid-state batteries offer the possibility of increased safety at potentially higher energy densities compared to conventional lithium-ion batteries. In an all-ceramic oxide battery, the composite cathode consists of at least one ion-conducting solid electrolyte and an active material, which are typically densified by sintering. In this study, the reaction of the solid electrolyte Li1.3Al0.3Ti1.7(PO4)3 (LATP) and the active material LiNi0.6Co0.2Mn0.2O2 (NCM622) is investigated by cosintering at temperatures between 550 and 650 °C. The characterization of the composites and the reaction layer is performed by optical dilatometry, X-ray diffractometry, field emission scanning electron microscopy with energy dispersive X-ray spectroscopy, time-of-flight secondary ion mass spectrometry, as well as scanning transmission electron microscopy (STEM). Even at low sintering temperatures, elemental diffusion occurs between the two phases, which leads to the formation of secondary phases and decomposition reactions of the active material and the solid electrolyte. As a result, the densification of the composite is prevented and ion-conducting paths between individual particles cannot be formed. Based on the experimental results, a mechanism of the reactions in cosintered LATP and NCM622 oxide composite cathodes is suggested.

Eficacia terapeútica del abordaje con punción seca de la musculatura cervical en pacientes con cervicalgia crónica

Introducción: La cervicalgia crónica (CC) representa un 14,6% de todos los problemas musculo esqueléticos actuales. Se ha relacionado el dolor crónico cervical con el síndrome de dolor miofascial (SDM), siendo los puntos gatillo miofasciales (PGM), que caracterizan el SDM, una fuente de dolor en sujetos con CC. La punción seca es una técnica utilizada para tratar los PGM. A día de hoy los estudios presentan mucha heterogeneidad en cuanto a diversidad metodológica y no se ha definido una aplicación estándar de la PS para pacientes con CC. A diferencia de buena parte de los estudios nuestra investigación propone evaluar la eficacia terapéutica del abordaje con PS en todos los PGM activos presentes de la musculatura cervical en pacientes con CC. Material y Métodos: Ensayo clínico aleatorizado controlado de simple ciego. Se reclutarán un mínimo de 30 pacientes con diagnóstico médico de CC. Un examinador realizará 3 evaluaciones por paciente: antes de la primera sesión de tratamiento, a las 4 semanas y a los 3 meses. Se medirán las siguientes variables: Algometria de presión de los PGM, Intensidad del dolor (EVA), movilidad cervical (CROM) e índice de discapacidad cervical (Neck Disability Index). Un segundo investigador realizará 3 sesiones, con una periodicidad semanal de PS y estiramientos sobre todos los PGM activos en el grupo de intervención. El grupo control recibirá únicamente estiramientos.Análisis estadístico: estudio descriptivo de la movilidad y de la discapacidad. Estudio de la prevalencia y expresión clínica de los puntos gatillo activos para cada músculo. Estudio de los efectos de la punción seca en el diagnóstico de punto gatillo activo (Chi-cuadrado), el umbral del dolor a la presión (ANOVA) y área del dolor referido (ANOVA) para cada músculo tratado. ANOVAS de los cambios en el dolor, en la movilidad y en la discapacidad de la muestra. Palabras clave: Punción Seca, Cervicalgia Crónica, Puntos Gatillo Miofasciales, Estiramientos, Eficacia terapéutica

Isothermal and thermomechanical fatigue behavior of duplex stainless steel (DSS) X2CrNiMoN22-5-3 was investigated. The aim of this work was to understand the fatigue behavior by correlation of the isothermal and thermomechanical fatigue behavior with microstructural observations. Fatigue tests at plastic-strain-amplitude of 0.2% were carried out at 20, 300 and 600 °C, while in-phase (IP) and out-of-phase (OP) thermomechanical fatigue (TMF) experiments were performed between 300 and 600 °C. During the 20 °C fatigue test, a continuous softening was observed. Transmission electron microscopy examinations reveal pronounced planar slip behavior in austenite. At 300 °C, deformation concentrates in the ferrite, where strong interactions between CrxN and dislocations were observed that explain the pronounced cyclic hardening. DSS studied exhibits softening throughout the whole isothermal fatigue test at 600 °C. In ferrite, during the 600 °C fatigue test, the G phase, γ′ austenite precipitated, and an unordered dislocation arrangement was observed. The stress responses of the TMF tests can be correlated to those of the isothermal fatigue tests. In IP mode, a positive mean stress resulted in premature failure. No γ′ austenite but the formation of subgrains in the ferrite phase was observed after TMF tests. The plastic deformation of the austenite at high temperatures results in an unordered dislocation arrangement.

It has been shown that endocardial occlusion of the left atrial appendage (LAA) is equally effective in preventing embolic events compared to oral anticoagulation in patients with nonvalvular atrial fibrillation. An 82-year-old female patient was admitted for LAA occlusion for repetitive GI bleeding. She had high CHADSVASC Score and HASBLED with long persistent atrial fibrillation with many comorbities. The preprocedural transesophageal echo revealed a great mass in the left atrium (Picture 1). Cardiac surgery was denied, we performed an epicardial only ligation for closing the LAA. For this approach we performed an epicardial puncture and contrast injection within the pericardial space to delineate the LAA. An epicardial wire with a suction mechanism at its distal end was attached to the anterior lobe of the LAA. Using this epicardial wire the snare could be advanced over the appendage and closed down. Complete exclusion of the LAA was achieved. There were no procedural complications and the patient is doing well after 3 months.

The systematics of Annelida has repeatedly been changed based on morphological data, but more recently established transcriptomic approaches yielded a stable and widely accepted phylogenetic tree, placing Magelonidae and Oweniidae as sister group to all remaining annelids. This led to an increased interest in these groups in terms of morphological traits and their phylogenetic significance. As one of the most characteristic morphological characters of annelids, the chaetae of Magelonidae are well investigated regarding their shape, but phylogenetically relevant aspects like their general arrangement are still poorly studied. Furthermore, some species possess abdominal internal support chaetae that no study has addressed in detail thus far. The chaetal arrangement and position of formative sites were studied in the differently expressed parapodia of the thorax, the ninth chaetiger and the abdomen of Magelona mirabilis and Magelona johnstoni. Our results show that all chaetigers primarily bore one row of chaetae per parapodial ramus, each with a single formative site. We also present the first histological as well as ultrastructural data on the magelonid support chaetae, showing that they represent internal hooded hooks, with which they share a common chaetal sac. Their distribution within Magelonidae, however, still requires a broader examination to evaluate their presence as a convergent or homologous trait.