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The presence of potentially harmful metals in commercially available saltwater fish has been extensively documented in scientific literature. This has demonstrated the significance of monitoring the crucial copper (Cu) levels in fish fillets from a perspective focused on human health risks (HHR). This study aimed to evaluate the human health risk (HHR) associated with the presence of Cu in 40 different species of commercial marine fish purchased from Malaysia. The fish samples were gathered from various sources from April to May 2023. The 40 species of commercial marine fish had concentrations of Cu (0.72–82.3 mg/kg dry weight) that fell below acceptable levels defined by seafood safety recommendations. Therefore, these fish are considered good sources of the essential element. The target hazard quotient values for Cu were below 1, suggesting that the hazards of Cu from fish eating are non-carcinogenic. Furthermore, it was discovered that the computed values for the predicted weekly consumption were lower than the defined provisional tolerated weekly intake of Cu. Consuming fish purchased from Malaysia is unlikely to harm consumers’ necessary copper intake. However, it is crucial to consistently monitor the safety of consumers who heavily depend on commercially caught marine fish from Malaysia. This monitoring is an essential aspect of implementing environmental, social, and governance (ESG) practices, which industries are concerned about and report on annually.

The abundance, distribution, and composition of microparticles (MPs) in the sea-surface microlayer (S-SML, less than 100 μm of sea surface in this experiment) and in bulk water (1 m under the sea surface) were investigated to evaluate the pollution level of MPs in Osaka Bay in Japan. Both seawater fractions were collected at eight sites including ship navigation routes, the coastal area, and the center of Osaka Bay for 2021–2023. MPs were filtered for four size ranges (10–53, 53–125, 125–500, and >500 μm) and then digested with H2O2. MPs’ abundance was microscopically assessed; and polymer types of MPs were identified by a Fourier transform infrared spectrometer (FTIR). For the 22 collections performed along eight sites, the average MPs’ abundance was 903 ± 921 items/kg for S-SML, while for the 25 collections performed along the same sites, the average MPs’ abundance was 55.9 ± 40.4 items/kg for bulk water, respectively. MPs in both S-SML and bulk water exhibited their highest abundance along the navigation routes. The smallest MPs (10–53 μm) accounted for 81.2% and for 62.2% of all MPs in S-SML and in bulk water among all sites, respectively. Polymethyl methacrylate (PMMA) was the major type of MPs identified while minor ones were polyethylene, polyesters, polystyrene, polypropylene, polyvinyl chloride, polyamide, etc. PMMA comprised 95.1% of total MPs in S-SML and 45.6% of total MPs in bulk water. In addition, PMMA accounted for 96.6% in S-SML and 49.5% in bulk water for the smallest MP category (10–53 μm). It can be assumed that the MP sources were marine paints—primarily APPs (antifouling paint particles)—as well as land coatings. Sea pollution due to microparticles from ship vessels should be given proper attention.

The green-lipped mussel Perna viridis’ sensitive nature and characteristic as a benthos organism that filters the sediment in its environment make it one of the possible bioindicators for pollution in the aquatic ecosystem. The present study aimed to determine the percentages of total shell deformities in comparison to the past data in the coastal waters of Peninsular Malaysia. It was found that several types of discontinuous, continuous, and unexplained shell abnormalities contributed to the overall range of shell deformities of 15.8–87.5%, which was greater in comparison to that (0.0–36.8%). The present study showed that the highest overall proportion of shell abnormalities occurred in Teluk Jawa, whereas the lowest percentages were found in Kampung (Kg.) Pasir Puteh. The regulative mechanisms at the well-known polluted sites at Kg. Pasir Puteh could be the explanation. Further research should be conducted to determine the degree of heavy metal that may be the source of these malformations in the mussel shells.

The ecological and children’s Health Risk Assessments (HRA) of Copper (Cu) in aquatic bodies ranging from rivers, mangrove, estuaries, and offshore areas were studied using the Cited Cu Data in The Sediments (CCDITS) from 125 randomly selected papers published from 1980 to 2022. The ecological and children’s HRA were assessed in all CCDITS. Generally, local point Cu sources (8%) and lithogenic sources were the main controlling factors of Cu concentrations. The present review revealed three interesting points. First, there were 11 papers (8%) documenting Cu levels of more than 500 mg/kg dw while China was the country with the highest number (26%) of papers published between 1980 and 2022, out of 37 countries. Second, with the Cu data cited from the literature not normally distributed, the maximum Cu level was higher than all the established guidelines. However, the median Cu concentration was lower than most of the established guidelines. The median values of the geoaccumulation index (Igeo) indicated a status of ‘unpolluted‘ and ‘moderate contamination’ for the contamination factor (CF), and ‘low potential ecological risk’ for the ecological risk (ER) of Cu. However, the Cu ER could be based at present on the above mentioned 8% of the literature in the present study. Third, the calculated hazard index (HI) values were found to be below 1, indicating no potential chance of Cu non–carcinogenic effects in both adults and children, except for children’s HI values from Lake Pamvotis of Greece, and Victoria Harbor in Hong Kong. Thus, regular monitoring (every 2 years), depending upon the available resources, is recommended to assess the ecological–health risk of Cu pollution in aquatic bodies to abate the risk of Cu exposure to children’s health and avoid injurious impacts on the biota. It can be concluded that there is always a need for the mitigation and management of a Cu exposure risk assessment that can be used successfully for screening purposes to detect important human health exposure routes. Consequently, any sediments contaminated with Cu require rapid sediment remediation techniques.

The present study investigated the antioxidant enzyme activities (AEA) of ascorbate peroxidase (APX), catalase (CAT), guaiacol peroxidase (GPX), and superoxide dismutase (SOD) as biomarkers of Cu and Pb stress by using Centella asiatica grown in an experimental hydroponic condition. The results showed (i) higher accumulations of Cu and Pb in the roots of C. asiatica than those in the leaves, (ii) synergistic effects of Cu and Pb stress at higher metal-level exposures, and (iii) Cu and Pb stress triggered the increment of APX, CAT, GPX, and SOD levels in both the leaves and roots of C. asiatica. The increment of four AEA indicated that C. asiatica underwent oxidative stress caused by the production of reactive oxygen species when the plant was exposed to Cu and Pb. In order to prevent damages caused by Cu and Pb stress, the AEA system was heightened in C. asiatica, in which APX, CAT, GPX, and SOD can be used as biomarkers of Pb and Cu stress in the plant.

The current study assessed the ecological–health risks of potentially toxic arsenic (As) and antimony (Sb) in the vegetable Centella asiatica, topsoils, and mangrove sediments sampled from Peninsular Malaysia. The As concentrations ranged from 0.21 to 4.33, 0.18 to 1.83, and 1.32 to 20.8 mg/kg dry weight, for the leaves, stems, and roots of the vegetable, respectively. The ranges of Sb concentrations were 0.31–0.62, 0.12–0.35, and 0.64–1.61 mg/kg dry weight, for leaves, stems, and roots of the vegetable, respectively. The children’s target hazard quotient (THQ) values indicated no non-carcinogenic risks of As and Sb in both leaves and stems, although children’s THQ values were higher than those in adults. The calculated values of estimated weekly intake were lower than established provisional tolerable weekly intake of As and Sb for both children and adult consumers. The carcinogenic risk (CR) values of As for children’s intake of leaves and stems of vegetables showed more public concern than those of adults. The levels of Sb and As in the topsoils were generally higher (although not significantly) than those in the mangrove sediments, resulting in a higher geoaccumulation index, contamination factor and ecological risk, hazard index, THQ, and CR values. This indicated that the anthropogenic sources of Sb and As originated from the land-based activities before reaching the mangrove near the coast. The CR of As signifies a dire need for comprehensive ecological–health risks exposure studies, as dietary intake involves more than just vegetable consumption. Therefore, risk management for As and Sb in Malaysia is highly recommended. The present findings of the ecological–health risks of As and Sb based on 2010–2012 samples can be used as an important baseline for future reference and comparison.

The present investigation focused on the toxicity test of cadmium (Cd), copper (Cu), nickel (Ni), lead (Pb) and zinc (Zn), utilizing two groups of juvenile and adult apple snail Pomacea insularum (Gastropod, Thiaridae) with mortality as the endpoint. For the adult snails, the median lethal concentrations (LC50) values based on 48 and 72 h decreased in the following order: Cu < Ni < Pb < Cd < Zn. For the juvenile snails, the LC50 values based on 48 and 72 h decreased in the following order: Cu < Cd < Ni < Pb < Zn. The mussel was more susceptible to Cu than the other four metal exposures, although the juveniles were more sensitive than the adults because the former had lower LC50 values than the latter. This study provided essential baseline information for the five metal toxicities using P. insularum as a test organism, allowing comparisons of the acute sensitivity in this species to the five metals. In conclusion, the present study demonstrated that P. insularum was a sensitive biomonitor and model organism to assess heavy metal risk factors for severe heavy metal toxicities. A comparison of the LC50 values of these metals for this species with those for other freshwater gastropods revealed that P. insularum was equally sensitive to metals. Therefore, P. insularum can be recommended as a good biomonitor for the five metals in freshwater ecosystems.

Abstract. Background:. The comparative outcomes of subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous ICD (T-ICD) have not been well studied. The aim of this study was to evaluate the safety and efficacy of currently available S-ICD and T-ICD. Methods:. The study included 86 patients who received an S-ICD and 1:1 matched to those who received single-chamber T-ICD by gender, age, diagnosis, left ventricular ejection fraction (LVEF), and implant year. The clinical outcomes and implant complications were compared between the two groups. Results:. The mean age of the 172 patients was 45 years, and 129 (75%) were male. The most common cardiac condition was hypertrophic cardiomyopathy (HCM, 37.8%). The mean LVEF was 50%. At a mean follow-up of 23 months, the appropriate and inappropriate ICD therapy rate were 1.2% vs. 4.7% (χ 2 = 1.854, P = 0.368) and 9.3% vs. 3.5% (χ 2 = 2.428, P = 0.211) in S-ICD and T-ICD groups respectively. There were no significant differences in device-related major and minor complications between the two groups (7.0% vs. 3.5%, χ 2 = 1.055, P = 0.496). The S-ICD group had higher T-wave oversensing than T-ICD group (9.3% vs. 0%, χ 2 = 8.390, P = 0.007). Sixty-five patients had HCM (32 in S-ICD and 33 in T-ICD). The incidence of major complications was not significantly different between the two groups. Conclusions:. The efficacy of an S-ICD is comparable to that of T-ICD, especially in a dominantly HCM patient population. The S-ICD is associated with fewer major complications demanding reoperation.

Abstract Background Whether nonsustained ventricular tachycardia (NSVT) is a marker of increased risk of sustained ventricular tachyarrhythmias (VTAs) remains to be established in patients receiving cardiac resynchronization therapy with a defibrillator (CRT‐D) for primary prevention. Methods Among the follow‐up data of the Japan cardiac device treatment registry (JCDTR) with an implantation date between January 2011 and August 2015, information regarding a history of NSVT before the CRT‐D implantation for primary prevention had been registered in 269 patients. Outcomes were compared between two groups with and without NSVT: NSVT group (n = 179) and No NSVT group (n = 90). Results There was no significant difference with regard to age, gender, and NYHA class between the two groups. Left ventricular ejection fraction (LVEF) was 25.6% in the NSVT group and 28.0% in the No NSVT group (P = .046). The rate of appropriate therapy at 24 months was 26.0% and 18.4% in the NSVT and No NSVT groups (P = .22), respectively. Survival free from heart failure death was reduced in the NSVT group, as compared with the No NSVT group, with the rate of 90.2% vs 97.2% at 24 months (P = .030). A multivariate analysis identified a history of NSVT, anemia, and no use of angiotensin‐converting enzyme inhibitor (ACEI) or angiotensin‐receptor blocker (ARB) as predictors of heart failure death. Conclusions NSVT appears to be a surrogate marker of severe heart failure rather than a substrate for subsequent sustained VTAs in patients with CRT‐D for primary prevention.

Abstract A 31‐year‐old female with 10 years indwelled Hickman catheter for idiopathic pulmonary hypertension presented infectious findings. We decided to remove it but simple traction did not work. Although it was an off labeled use, we could remove it using a laser sheath and snare technique without any complication.

Human activities due to different land uses are being studied widely in many countries. This study aimed to determine the ecological risks and human health risk assessments (HHRA) of Cd, Pb, Ni, Cu, and Zn in the topsoils of six land uses in Peninsular Malaysia. The ranges of the potentially toxic metals (PTMs) in the soils (mg/kg, dry weight) of this study were 0.24–12.43 for Cd (mean: 1.94), 4.66–2363 for Cu (mean: 228), 2576–116,344 for Fe (mean: 32,618), 2.38–75.67 for Ni (mean: 16.04), 7.22–969 for Pb (mean: 115) and 11.03–3820 for Zn (mean: 512). For the ecological risk assessments, the potential ecological risk index (PERI) for single metals indicated that the severity of pollution of the five metals decreased in the following sequence: Cd > Cu > Pb > Zn > Ni. It was found that industry, landfill, rubbish heap, and mining areas were categorized as “very high ecological risk”. For HHRA, the land uses of industry, landfill and rubbish heap were found to have higher hazard quotient (HQ) values for the three pathways (with the order: ingestion > dermal contact > inhalation ingestion) of the five metals for children and adults, when compared to the mining, plantation, and residential areas. The values for both the non-carcinogenic (Cd, Cu, Ni, and Zn), and carcinogenic risks (CR) for inhalation (Cd and Ni) obtained for children and adults in this study showed no serious adverse health impacts on their health. However, of public concern, the hazard index (HI), for Pb of children at the landfill (L-3) and the rubbish heap (RH-3) sites exceeded 1.0, indicating non-carcinogenic risk (NCR) for children. Therefore, these PERI and HHRA results provided fundamental data for PTMs pollution mitigation and environmental management in areas of different land uses in Peninsular Malaysia.

A 76-year-old man who had been diagnosed with long-QT syndrome type 2 had frequent syncopal attacks. The electrocardiogram was monitored, and frequent torsades de pointes (TdP) was detected despite administration of conventional medications: oral propranolol, verapamil, intravenous magnesium sulfate, verapamil, and lidocaine. In contrast, 2 μg/kg/min landiolol could completely suppress TdP. Subsequently, an implantable cardioverter defibrillator was placed, and he was diagnosed with silent myocardial ischemia using myocardial perfusion scintigraphy and coronary angiography. This is the first case report wherein landiolol effectively suppressed TdP due to long-QT syndrome with silent myocardial ischemia.

Transvenous lead extraction is becoming popular in Japan since the approval of laser extraction system in 2010. The laser system seems to be the standard method used by most physicians, owing to its efficacy and ease of handling. The efficacy and safety of this technology has been well proven in many studies and the data suggest that it can be used for Japanese patients safely. However, lead extraction can cause serious complications. Thus, it is important to learn the limitations as well as the basic techniques and efficacy of this procedure.

Background: Landiolol effectively controls rapid heart rate in atrial fibrillation or flutter (AF/AFL) patients with left ventricular (LV) dysfunction. However, predicting landiolol Responders and Non-Responders and patients who will experience adverse effects remains a challenge. The aim of this study was to clarify the potential applicability of landiolol for rapid AF/AFL and refractory ventricular tachyarrhythmias (VTs) in patients with heart failure. Methods: A total of 39 patients with AF/AFL with ventricular response ≥120 bpm and 12 VTs were retrospectively enrolled. Landiolol Responders for rapid AF/AFL were defined as patients whose ventricular response was suppressed to less than 110 bpm or decreased by ≥20% from the initial heart rate after administration of landiolol. Responders for VTs were defined as patients with no recurrent VTs during the 24 h after the initiation of landiolol. Results: For AF/AFL, 29 patients (74%) were Responders. In nine patients (31%), AF was spontaneously terminated after starting landiolol. Eight Non-Responders (80%) needed to have AF terminated by cardioversion. Left ventricular ejection fraction (LVEF) at baseline was significantly associated with landiolol efficacy. For VTs, seven patients (58%) were Responders, and smaller LV diastolic and systolic diameters were associated with landiolol efficacy. Hypotension after landiolol treatment occurred in 5 of 51 patients, and lower LV systolic function was associated with the development of adverse events. Conclusions: Landiolol is effective in patients with heart failure not only due to rapid AF/AFL but also due to VTs. However, preserved LVEF is important for efficacy and safety in landiolol treatment.

We report the case of a 51-year-old patient with Brugada syndrome (BrS) who experienced inappropriate shock due to T-wave oversensing (TWOS) during exercise when the optimal sensing vector was selected based on the automatic analysis by a subcutaneous implantable cardioverter-defibrillator (S-ICD). After selecting another vector during exercise testing, TWOS did not re-occur. Selection of appropriate sensing vector based on analyses under various conditions, including during exercise after S-ICD implantation, should be considered for patients with BrS.

BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave). Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF. ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

A 65-year-old woman with a history of syncope was diagnosed with hypertrophic cardiomyopathy. She had previously undergone mastectomy of the left breast owing to breast cancer. Holter electrocardiogram (ECG) and monitor ECG revealed sick sinus syndrome (Type II) and non-sustained ventricular tachycardia. Sustained ventricular tachycardia and ventricular fibrillation were induced in an electrophysiological study. Although the patient was eligible for treatment with a dual chamber implantable cardioverter defibrillator (ICD), venography revealed lack of the right superior vena cava (R-SVC). Lead placement from the left subclavian vein would have increased the risk of lymphedema owing to the patient׳s mastectomy history. Consequently, the defibrillation lead was placed in the right ventricle by direct puncture of the right auricle through the tricuspid valve. The atrial lead was sutured to the atrial wall, and the postoperative course was unremarkable. Defibrillation lead placement using a transthoracic transatrial approach can be an alternative method in cases where a transvenous approach for lead placement is not feasible.

The number of patients with chronically implanted cardiovascular implantable electronic devices (CIEDs) keeps growing, and device clinics of major hospitals may soon be unable to fully accommodate the increasing amount of follow-up activities. Consequently, the remote monitoring (RM) technology introduced in Japan in 2010 has been rapidly gaining widespread application in the management of CIEDs. A modern remote monitor not only acts as an alternative to a device clinic, but also as a security monitor for the device and the patient. A number of papers have confirmed the safety, feasibility, and cost-effectiveness of RM systems. Importantly, remote monitors allow physicians to quickly detect and respond to lead problems, atrial arrhythmias, heart failure, and other adverse events, which may also improve the patients׳ survival rate. Several reports from Japan have demonstrated that RM systems are well accepted by both the patients and physicians. However, there remain limitations and problems of the RM technology to be solved, and rules and guidelines for monitor management should be established to fully utilize the advantages of RM systems.

Background: There is little evidence of the efficacy and safety of dabigatran in Japanese patients with non-valvular atrial fibrillation (NVAF). Methods and Results: We evaluated 300 consecutive patients with NVAF (68±11 years old, 209 men, 180 paroxysmal) who received 220 mg/day (203 patients) or 300 mg/day dabigatran (97 patients) at our hospital. Most patients (84%) had lower CHADS2 (congestive heart failure, hypertension, age>75 years, diabetes, stroke/transient ischemic attack) scores of 0 (n=60), 1 (n=114), or 2 (n=78) and lower HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition) scores of 0 (n=39), 1 (n=114), or 2 (n=103). The estimated creatinine clearance was 77±24 mL/min, which was inversely correlated to age (r2=0.48, p

Abstract Background Cardiac resynchronization therapy (CRT) has been widely used for the treatment of refractory heart failure (HF). However, the efficacy of CRT is not well established in class IV HF patients on inotropic support. Methods Twenty‐six patients (age 55±18 years, 73% men) with inotrope‐dependent HF were reviewed to evaluate the effectiveness of CRT in class IV HF patients on inotropic support. Results Intravenous inotropic therapy was administered for 72±56 days before CRT and consisted of dobutamine (n=24; 3.0±1.2 μg kg−1 min−1), dopamine (n=2; 4.5±2.1 μg kg−1 min−1), and/or milrinone (n=16; 0.12±0.09 μg kg−1 min−1). CRT did not produce significant reverse remodeling in eligible patients (left ventricular ejection fraction 23±7% to 25±9%; p=0.23, left ventricular end‐diastolic diameter 70±9 mm to 68±9 mm; p=0.14). After CRT device implantation, 13 (50%) patients experienced 1 or more episodes of ventricular tachyarrhythmia or sudden cardiac death. Twenty (77%) patients survived to hospital discharge with weaning from inotropic support (70±70 days after CRT implantation). The 1‐year survival rate was 81%. However, data from long‐term follow‐up showed that 68% of the study patients who attained survival discharge had an HF hospitalization event within the follow‐up period. Conclusion CRT did not result in significant reverse remodeling in patients with inotrope‐dependent class IV end‐stage HF. However, it contributed to dramatically improve the cardiovascular outcomes at least in the short‐term period in some patients.

Loss-of-function mutations in the cardiac sodium channel α-subunit gene SCN5A result in multiple inherited arrhythmic syndromes. This case report describes 2 unrelated probands carrying an identical SCN5A frameshift mutation, V1764fsX1786, who exhibited distinct clinical manifestations: progressive cardiac conduction defect (PCCD)/Brugada syndrome (patient #1) and idiopathic ventricular fibrillation (IVF) (patient #2). Using a whole-cell patch clamp technique, cells expressing V1764fsX1786 showed no observable Na+ current. Therefore, a significant phenotypic overlap was found between IVF and PCCD/Brugada syndrome in the 2 probands with the V1764fsX1786, loss-of-function frameshift mutation of the cardiac sodium channel gene SCN5A.

A 41-year-old woman who had been fitted with a pacemaker 18 years prior presented for lead extraction because of device infection. First, we tried laser sheath. However, it cannot cross the binding in the innominate vein. Then we switched to the rotating mechanical sheath. Although it crunched through binding tissue, the progress halted. We removed the sheath and found pieces of calcified tissue in the sheath lumen. After removing the calcified tissue, both leads were extracted using the laser sheath, without complications. The pathological examination revealed a diagnosis of ossified thrombus. Venous thromboses associated with implanted leads can ossify with time, causing difficulties in the extraction of long-standing intravascular leads.

Introduction: The aim of this study was to clarify the characteristics of lower loop reentry (LLR. in patients who underwent cardiac surgery. Methods: Of 194 patients from 2000 to 2007 with negative flutter waves in the inferior leads (II, III, and aVf), 4 patients had LLR and reentrant circuits identified by a 3D activation sequence mapping system. We studied the characteristics of the surface electrocardiogram (ECG. patterns of those LLRs. Results: All 4 patients had a history of an intracardiac operation. The 3D activation sequence mapping system during the LLR exhibited a clockwise (CW. wavefront around the inferior vena cava (IVC. from the caudal view. During the LLR, the right atrium (RA. free wall was activated in a caudal-cranial sequence and a collision of two activation wavefronts from the lower RA and upper RA occurred at the RA free wall. Conclusions: The 3D activation mapping during the AT revealed an activation wavefront propagating around the IVC and the diagnosis of LLR. Detailed 3D electroanatomical mapping and pacing study are needed to identify the reentrant circuit of LLR in patients with previous intracardiac surgery.