Introduction
Left bundle branch pacing (LBBP) has emerged in recent years as a new pacing modality, providing patients with a narrower paced QRS than conventional pacing and stable pacing parameters. ...At the same time, there is a growing concern about the use of fluoroscopy in pacemaker implantations, given its harmful effects on both patients and operators. However, there are no prior experiences of zero‐fluoroscopy in LBBP procedure.
Methods
We conducted an observational prospective study recruiting consecutive patients that underwent zero‐fluoroscopy LBBP pacemaker implantation. A 6‐month follow‐up visit was programmed for every patient. The main goal of our study was to assess the efficacy, feasibility, and safety of the procedure.
Results
From January 2021 to February 2022, we included 10 patients, 8 males. The average age was 63 ± 4 years. The procedure was successful in all patients. We observed a significant reduction in paced QRS width compared with basal QRS width (149 ± 31.9 vs. 116 ± 15.6 ms, p = .02). All device parameters remained stable at 6‐month follow‐up: no significant differences in mean impedance (700.5 ± 136.4 vs. 494 ± 72.7 Ohm, p = .09), capture threshold (0.67 ± 0.2 vs. 0.83 ± 0.2 V @ 0.4 ms, p = .27) or endocardial V‐wave amplitude (10.6 ± 5.2 vs. 13.9 ± 6.3 mV, p = .19). No complications were reported in any case.
Conclusion
Zero‐fluoroscopy LBBP is feasible and safe, and it may be considered in cases where radiation exposure is contraindicated or especially undesirable. Future randomized clinical trials are needed for the widespread use of this new technique.
A, D: Right anterior oblique views of the anatomical map of the right atrium and right ventricle from patients 1 and 2. B,E: Left anterior oblique views. C: paced QRS with the mapping catheter from left bundle area with “W” morphology, marked with green tags in the map. F: paced QRS from the final position of the electrode. His bundle are marked with yellow tags in the map. SVC: superior vena cava. RA: right atrium. RV: right ventricle. CS: coronary sinus. RAA: right atrial appendage
Almost 30 years have passed since the first publication reporting regeneration of transformed peach plants. Nevertheless, the general applicability of genetic transformation of this species has not ...yet been established. Many strategies have been tested in order to obtain an efficient peach transformation system. Despite the amount of time and the efforts invested, the lack of success has significantly limited the utility of peach as a model genetic system for trees, despite its relatively short generation time; small, high-quality genome; and well-studied genetic resources. Additionally, the absence of efficient genetic transformation protocols precludes the application of many biotechnological tools in peach breeding programs. In this review, we provide an overview of research on regeneration and genetic transformation in this species and summarize novel strategies and procedures aimed at producing transgenic peaches. Promising future approaches to develop a robust peach transformation system are discussed, focusing on the main bottlenecks to success including the low efficiency of
-mediated transformation, the low level of correspondence between cells competent for transformation and those that have regenerative competence, and the high rate of chimerism in the few shoots that are produced following transformation.
Purpose We analyzed gender differences in health-related quality of life (HRQoL) and associated factors between informal male and female caregivers in Spain. It is important because of growing rates ...of dependent people and dwindling public resources. Methods We conducted a cross-sectional study of 610 informal caregivers (265 male and 345 female) using an ad hoc structured questionnaire. We performed a descriptive analysis and used multivariate logistic regression to analyze the risk of poor HRQoL, measured with the EQ-5D-5L, according to caregiver sex, sociodemographic characteristics of caregivers and dependents, caregiving circumstances, and support received. Results Male caregivers were older than women were, and cared more often for their partners. More women used family caregiving allowance (FCA), respite care services, and counseling services, while more men used paid help, home help, and other forms of instrumental help. Women had worse HRQoL than men, particularly in the pain/discomfort dimension. In addition to older age and poor previous health, caring for a partner (OR = 2.379), for a person with major dependence (OR = 1.917), low social class (OR = 1.634), and low social support (OR = 2.311) were factors associated with poor HRQoL. Receiving FCA was associated with better HRQoL (OR = 0.319). Controlling for all these variables, women had 131% more odds than men to have poor HRQoL. Conclusions Male and female caregivers in Spain differ in received support and how their HRQoL is affected. These differences are important to design interventions to promote more equitable sharing of care responsibilities and better caregiver health.
Lightweight aggregates are extensively used in construction and other industrial applications due to their technological characteristics. The extraction of natural aggregates results in serious ...environmental effects. Thus, within the circular economy concept, the valorization of waste through the optimization of materials and product design is encouraged. In this work, glass lightweight aggregates were prepared from mixtures of white glass cullet and carbonate wastes from mining (wastes originating from the extraction, manufacture and marketing of magnesite and its derivatives) and the food industry (eggshell and mussel shell). The effects of different processing parameters, such as the particle size of the base glass, percentage of the blowing additive, shaping method, heating rate, temperature and processing time, were evaluated. The results indicate that the mineralogical composition of the blowing agent and the particle size of the base glass are the two processing parameters with the greatest impact on expansion efficiency. Thus, glass artificial aggregates were obtained with characteristics similar to those of commercial products (density values ranged between 0.3 and 0.8 g/cm
and mechanical strength between 0.7 and 1.5 MPa) from thermal shock expansion treatments in the temperature range 800-900 °C and with dwell times no longer than 15 min.
Mullite (3Al2O3·2SiO2) is an aluminosilicate characterized by excellent physical properties, which makes it an important ceramic material. In this way, ceramics based on mullite find applications in ...different technological fields as refractory material (metallurgy, glass, ceramics, etc.), matrix in composite materials for high temperature applications, substrate in multilayer packaging, protective coatings, components of turbine engines, windows transparent to infrared radiation, etc. However, mullite is scarce in nature so it has to be manufactured through different synthesis methods, such as sintering, melting-crystallization or through a sol-gel route. Commonly, mullite is fabricated from pure technical grade raw materials, making the manufacturing process expensive. An alternative to lowering the cost is the use of mining waste as silica (SiO2) and alumina (Al2O3) feedstock, which are the necessary chemical compounds required to manufacture mullite ceramics. In addition to the economic benefits, the use of mining waste brings out environmental benefits as it prevents the over-exploitation of natural resources and reduces the volume of mining waste that needs to be managed. This article reviews the scientific studies carried out in order to use waste (steriles and tailings) generated in mining activities for the manufacture of clay-based ceramic materials containing mullite as a main crystalline phase.
In this study, different lightweight expanded glass aggregates (LEGAs) were produced from glass cullet and various carbonated wastes, through a thermal impact process. The effects of LEGA ...microstructure and morphology on both the adherence to the cement paste and the mechanical properties of mortars after 28 days of curing were studied. The properties of lightweight mortars made of either LEGAs or expanded clay aggregates were compared. The results demonstrated the feasibility of using LEGAs to produce glass lightweight aggregate mortar, with flexural and compressive strength values ranging from 5.5 to 8.2 MPa and from 28.1 to 47.6 MPa, respectively. The differences in mechanical properties were explained according to the microstructures of the fracture surfaces. Thus, arlite-type ceramic aggregates presented surface porosities that allowed mortar intrusion and the formation of an interconnected interface; although the surfaces of the vitreous aggregates were free from porosity due to their vitreous nature, the mortars obtained from different wastes presented compressive and flexural strengths in the range of lightweight mortars.
As a first step to the establishment of an in vitro conservation protocol for apricot and neem, the effect of several growth retardants on the sprouting and development from nodal buds of both ...species and meristem development at the histological level was evaluated. Nodal section bud sprouting was affected by growth retardants, ranged from 4 to 100 % in apricot and from 10 to 100 % in neem, depending on the retardant and its concentration. Retardants paclobutrazol (PBZ), flurprimidol (FMD), diniconazole (DIN), and acetyl-salicylic acid (ASA) produced a drastic reduction of shoot length in apricot. PBZ, DIN and ASA decreased the number of leaves, whereas 1-Aminocyclopropane-1-carboxylic acid (ACC) at 10⁻⁵ µM improved the number of leaves. Length of neem sprouted buds as well as the number of leaves was affected by all of the growth retardants, with the exception of ACC that only affected the number of leaves. Triiodobenzoic acid (TIBA) at 10⁻⁵ µM improved neem shoot length. PBZ, FMD, and DIN produced several effects as very thin, long, and dark green colored leaves in shoots from both species. Once growth retardants were removed from the proliferation medium the recovery of apricot bud growth was good from PBZ and FMD at low and medium concentrations and from ACC and ASA at all concentrations tested. In neem, the recovery was good only from TIBA and ASA at low concentrations; TIBA at 10⁻⁵ µM produced an increment of shoot length higher than the control. Histological changes observed in the meristems of apricot and neem buds during growth retardation induced by FMD and ASA could be related to some extent with those observed in the dormant shoot apex.
A new adsorbent based on an immobilized waste-derived LTA zeolite in agarose (AG) has proven to be an innovative and efficient alternative for removing metallic contaminants from water impacted by ...acid mine drainage (AMD) because the immobilization prevents the solubilization of the zeolite in acidic media and eases its separation from the adsorbed solution. A pilot device was developed containing slices of the sorbent material AG (1.5%)-LTA (8%) to be used in a treatment system under an upward continuous flow. High removals of Fe
(93.45%), Mn
(91.62%), and Al
(96.56%) were achieved, thus transforming river water heavily contaminated by metallic ions into water suitable for non-potable use for these parameters, according to Brazilian and/or FAO standards. Breakthrough curves were constructed and the corresponding maximum adsorption capacities (mg/g) (Fe
, 17.42; Mn
, 1.38; Al
, 15.20) calculated from them. Thomas mathematical model was well fitted to the experimental data, indicating the participation of an ion-exchange mechanism in the removal of the metallic ions. The pilot-scale process studied, in addition to being highly efficient in removing metal ions at toxic levels in AMD-impacted water, is linked to the sustainability and circular economy concepts, due to the use as an adsorbent of a synthetic zeolite derived from a hazardous aluminum waste.
The mean age of patients presenting with acute coronary syndrome (ACS) has been increasing steadily in the last decades, so managing very old patients has become common practice. The oldest patients ...are under-represented in clinical trials, so specific evidence is scarce. Still, antithrombotic therapy and invasive strategy are the pillars of appropriate treatment even in the oldest patients. However, the elderly population is a heterogeneous group showing important divergences between chronological and biological age, which needs specific evaluation. Physical, and social function, geriatric syndromes, such as frailty or cognitive decline, and comorbidities must be taken into consideration for clinical decision-making but this requires evaluation beyond the traditional cardiologic approach. In general, elderly patients with ACS who are functional and independent should be treated with the same methods as younger patients although more cautiously. However, specific measures should be put in place to prevent functional decline and delirium, two of the most frequent and devastating specific complications in older patients. Multidisciplinary approaches are needed for that. In general, a new paradigm for the management of very old patients with ACS is warranted, in which evaluation of outcomes traditionally ignored by cardiologists should be considered.
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