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Chronic low-grade inflammation associated with obesity may be a target for improvement of metabolic health. Some exopolysaccharide (EPS)-producing bacteria have been shown to have anti-inflammatory effects in gastrointestinal inflammatory conditions. However, evidence for the role of EPS-producing probiotics in the management of obesity and associated conditions is scarce and the role of the microbiota is unclear. In this study, two probiotic candidates were screened for their effects on metabolic health using the diet-induced obesity (DIO) mouse model. Mice fed a high-fat diet supplemented with the anti-inflammatory, EPS-producing strain L. caseiLC-XCAL™ showed significantly reduced hepatic triglycerides, hepatic total cholesterol, and fat pad weight compared to those fed a high-fat diet alone, likely as a result of reduced energy absorption from food. 16-S rRNA amplicon analysis of the fecal microbiota of these mice indicated that the altered metabolic phenotype as a result of the L. casei LC-XCAL strain administration was not associated with an overall change in the composition or inferred functional capacity of the fecal microbiota despite some abundance changes in individual taxa and functions. These findings provide evidence that specific microbial strategies can improve metabolic health independent of the microbiome and reinforce the importance of carefully selecting the most appropriate strain for specific indications by thorough screening programmes.

Could COVID-​19, this unexpected crisis, act as a comma 6 in a co-​research-​creation project to become a breathing space and not a full stop? Maybe this pause is a colon: the two different periods of the project (and life in general) on either side of the pandemic, equally important and dependent on each other for full meaning. In this chapter, we tell the story of how a co-​research-​creation event (the Sci Curious Project) unfolded before and during the COVID-​19 pandemic 7 ; the lead-​up to its irruption (St. Pierre, 1997) and then what came after. ‘Scicurious as method’ emerged out of the unexpected pause and recalibration of the project; a method that emphasizes the creation of research spaces that activate scicuriosity in situated practice. We understand scicuriosity as emerging from collaborative research-​creation events that ignite curiosity and creativity. Scicurious as method is presented through an encounter with speculative fiction and scicurious zine travels. Scicurious as method has significant ethical implications, these reify the potential of co-​designed speculative inquiries with creativity and curiosity at their heart. This is, in part, due to its contingency on cultivating digital co-​research-​creation spaces that enfold rather than eschew the analogue and highlight the joyous potential of a deeply situated, co-​designed speculative inquiry; an inquiry with galleries, libraries, archives and museums (GLAM) young people living in a pandemic.

Pacemakers can be directly involved in initiating or sustaining different forms of arrhythmia. These can cause symptoms such as dyspnea, palpitations, and decom-pensated heart failure. Early detection of these arrhythmias and optimal pacemaker programming is pivotal. The aim of this review article is to summarize the different types of pacemaker-mediated arrhythmias, their predisposing factors, and mechanisms of prevention or termination.Copyright © 2018 The Authors.

Background: Failure of the Biotronik Linox/Sorin Vigila implantable cardioverter-defibrillator leads has been reported at rates above other ICD leads. The aim of this study was to assess failure rate in these leads implanted in our centre. Method(s): We performed a retrospective analysis of all implantations of Linox/Vigila leads over the last 12 years at our centre. All patients with a Linox family ICD Lead or Vigilla lead implanted at our center were identified and all clinical data and device interrogations including a new device check were considered. Result(s): A total of 205 patients [169 (82.4%) men] had one of these leads (166 Linox family leads and 39 Vigila leads) implanted at our center between 2007 till 2015. 164 (80%) of implantations had been because of a secondary prevention indication and 140 (68.3%) leads had been implanted in right ventricular apex. Cephalic access had been used in 116 (56.9%) patients. Of these, 12 patients (5.9%) had lead failure. In four patients, lead fracture was the reason for lead failure, while noise and inappropriate shock was the issue in 4 patients and sensing/pacing problems in two patients. Conclusion(s): In our patients with a Linox family or Sorin Vigila lead, the failure rate was 5.9%.Copyright © 2019

Background: Andersen-Tawil syndrome (ATS), also known as Long QT syndrome type 7, is an autosomal dominant disorder with cardiac and musculoskeletal manifestations. Most cases are due to mutations in KCNJ2. Case Report: We report on a 26-year-old lady with ATS confirmed on genetic testing. She initially presented with recurrent palpitations and documented bidirectional ventricular tachycardia (VT). Prolongation of the QT interval was noted on resting ECG. Transthoracic echocardiography and cardiac magnetic resonance imaging (MRI) revealed a structurally normal heart, and an exercise stress test showed ectopy and self-limiting bidirectional VT at rest that abated during exercise. Initially, other more common causes of bidirectional VT, including catecholaminergic polymorphic ventricular tachycardia (CPVT), were considered; however, our patient's exercise stress test result coupled with her phenotypic features led to the clinical diagnosis of ATS. Facial features are subtle in ATS; hypertelorism, low-set ears and micrognathia were present in our patient. Having initially suffered ongoing palpitations despite beta-blocker therapy, she has now been stabilized with a combination of atenolol and flecainide. Given her clinical presentation and investigation results lack high-risk features for sudden cardiac death (syncope, malignant arrhythmia with circulatory failure, family history of sudden cardiac death), an implantable cardiac defibrillator (ICD) has not been implanted. Conclusion(s): This case illustrates the importance of considering the diagnosis of ATS in patients with syncope, prolonged QT interval, ventricular arrhythmias and typical physical features. Risk stratification is paramount in guiding therapy to prevent sudden cardiac death due to arrhythmia.

Background: Patients with atrial fibrillation (AF) receiving timely, multidisciplinary care (MDC) have reduced morbidity and mortality. AF guideline-indicated MDC incorporates early assessment and patient education with medical therapy to improve health outcomes. Aim(s): We established a Nurse Led MDC clinic within our tertiary hospital cardiology service to provide early assessment of AF patients, guideline based management and patient education. Goals included seeing patients within six weeks of referral, triaging their on-going care and providing them with a single point of contact within our complex hospital system. Method(s): From December 2016 referred patients with a diagnosis of AF have attended a Nurse Led, electrophysiologist-supported clinic for assessment, education and therapy optimisation. Data was collected on the referral source, access times and AF subtype. Patients attend a follow-up visit within three months to assess their management strategy and can contact the AF nurse during business hours. Result(s): 65 referrals were made to our dedicated service. Referral sources were predominantly the Emergency Department (60%) and General Practitioners (28%). First presentation AF made up 60% of cases. These patients were previously referred as low priority to general cardiology outpatients, waiting 4-6 months for appointments. Through this new model of care, average access times for AF patients was reduced to 4 weeks. Conclusion(s): A Nurse Led, MDC Clinic for AF patients significantly reduces patient access times preventing delays in assessment, optimisation of therapy and patient education. Further research is needed to evaluate the clinic's impact on patient symptoms, patient satisfaction and hospital readmis-sions.

What does it mean to be at home in a hot city? One response is to shut our doors and close ourselves in a cocoon of air-conditioned thermal comfort. As the climate warms, indoor environments facilitated by technical infrastructures of cooling are fast becoming the condition around which urban life is shaped. The price we pay for this response is high: our bodies have become sedentary, patterns of consumption individualized, and spaces of comfortable mobility and sociality in the city, termed in this paper as “infrastructures of care,” have declined. Drawing on the findings of a transdisciplinary pilot study titled Cooling the Commons, this paper proposes that the production of the home as an enclosed and private space needs to be rethought as an infrastructure that potentially undermines more social, convivial, and environmentally sensitive responses to a warming world. The paper asks, what role might design now play in developing alternative infrastructures of care that start with the idea of “home” as a distributed proposition?.

We discuss a 46-year-old man with history of hypertension and inferior wall myocardial infarction and mild left ventricular dysfunction who presented with aborted sudden cardiac death due to episodes of ventricular tachyarrhythmia detected by a Reveal-LINQ which had been implanted one year prior to presentation.Copyright © 2017 Indian Heart Rhythm Society

Background: Electrophysiology studies/ablations (EPS) and pacemaker/defibrillator implants (PPM) can be prolonged procedures associated with increased pain and discomfort for patients. The safety and efficacy of patient controlled sedation (PCS) with propofol in this setting is unknown. Method(s): Between November 2014 and February 2015, 33 consecutive patients undergoing elective cardiac rhythm management procedures (CRM), were sedated using PCS (28 EPS, 5 PPM). Patient characteristics, procedure details, adverse events (hypotension, desaturation<92%, over sedation, disinhibition, crossover to alternative form of sedation, airway obstruction) and patient satisfaction (assessed using a 9 point visual scale) were recorded. In the 4 months preceding the introduction of PCS 100 patients undergoing elective CRM with nurse-controlled sedation (NCS) had the same data collected (51 PPM, 49 EPS). Summary statistics were compared between the two cohorts using means (t-test) and proportions as appropriate. Result(s): There was a trend towards higher patient satisfaction scores with both sedation (8.1 vs 7.6, p=0.09) and analgesia (8.1 vs 7.6, p=0.07) in the PCS group. Looking at the EPS group separately corrected for differences in patient age and procedure duration with similar differences in satisfaction scores. Rates of adverse events were similar in both groups (p=0.26) with three events recorded in the PCS group (2 disinhibition, 1 crossover) and four in the NCS group (3 desaturations, 1 hypotension). (Figure presented) Conclusion(s): Our initial experience with PCS suggests that it is a safe form of sedation for CRM procedures and may lead to greater patient comfort and satisfaction.

Introduction: Cardiac resynchronisation therapy (CRT) is an established therapy for symptomatic patients with advanced heart failure. However, traditional left ventricular lead placement may not always be technically feasible via the coronary sinus approach. Left ventricular (LV) endocardial lead implantation via a transseptal atrial approach may be a potential alternative. Purpose(s): We sought to review the feasibility and clinical outcomes in patients undergoing LV lead implantations in a single-centre, tertiary, Australian institution. Endpoints included: technical success, peri-procedural complication rates, percent LV pacing load, change in New York Heart Association (NYHA) class and change in LV ejection fraction (LVEF). Method(s): and Results: Between August 2015 and December 2016, four patients underwent endocardial LV lead implantation (3 males, mean age 71 +/-5 years). All patients had previously failed LV lead placement via the coronary sinus. Mean pre-procedural LVEF was 24 +/-8%, mean QRS duration 161+/- 19ms and baseline NYHA was III (n=3) and IV (n=1). All patients had existing indications for therapeutic anticoagulation and were anticoagulated with warfarin (3 for atrial fibrillation, 1 for mechanical aortic valve). Warfarin was withheld for 3 days prior to the procedure. Mean international normalized ratio (INR) at the time of the procedure was 1.6+/-0.3. LV access was via an inferior approach, using femoral transseptal access, with a snare from superior subclavian venous access providing access to the left atrium. The lead was then inserted via the deflectable guiding sheath into the lateral LV endocardial wall. Successful implantation was achieved in all patients. One patient had a thromboembolic complication (non disabling stroke) post procedure, despite an INR of 2.1 at the time. That patient subsequently died from progressive heart failure within a month of the procedure. The 3 remaining patients have a mean follow up of 10 +/-7 months. The me