Occurrence Of Disturbances Research Articles

Pain After Lower Limb Amputations: Insights from the Heidelberg Amputation Registry.

Background and Objectives: The experience of unpleasant sensory phenomena after lower limb amputations (LLAs), including phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP), impacts global healthcare and adversely affects outcomes post-amputation. This study aimed to describe the distribution of PLP, PLS, and RLP among patients with LLAs registered in the Heidelberg Amputation Registry. The primary objective was to determine the prevalence of sensory abnormalities across different amputation levels and causes. Materials and Methods: In this single-center, cross-sectional study, data from 459 patients registered in the Heidelberg Amputation Registry were analyzed for the occurrence of PLP, PLS and RLP. Subsequently, logistic regression models were used to identify the independent risk factors associated with sensory disturbances following LLAs. The mean age of the LLA patients (31% female, 69% male) was 58 years (SD ± 18). Results: The patients were, on average, 44 years old (SD ± 22) at the time of amputation, with a mean duration since amputation of 15 years (SD ± 17). Transtibial amputations were the most common (43%), followed by transfemoral (39%) and partial foot amputations (10%). Hip and knee disarticulations were observed in 3.7% and 3.5% of the cohort, respectively, with hemipelvectomies accounting for 1%. Traumatic injuries (32%) and neoplastic disorders (22%) were the leading causes of LLAs, while peripheral artery disease and diabetes were responsible for 12% and 6% of cases, respectively. Importantly, a significant proportion of participants (85%) reported experiencing abnormal sensations. The prevalence rates for phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) were 58%, 66%, and 46%, respectively. The occurrence of sensory disturbances, with the exception of RLP, was significantly affected by the level of amputation. Notably, the age at amputation emerged as an independent risk factor for developing abnormal sensations, including PLS. Conclusions: In conclusion, this study provides a comprehensive overview of sensory abnormalities in a diverse cohort of LLA patients, highlighting the age at amputation as an important factor. The findings emphasize the role of comprehensive registries in enhancing care for individuals with amputations and guiding targeted pain management strategies.

Does the COVID-19 Vaccines Effect on the Menstrual Cycle, Cross-Sectional Study Among Adult Females at King Saud University

COVID-19 vaccinations have been associated with irregularities in the menstrual cycle and symptoms occurring pre and post-menstruation, affecting women’s reproductive health. This study aimed to demonstrate the impact of COVID-19 vaccines on women’s reproductive health by examining the association between COVID-19 vaccines and disturbed menstrual cycles. This cross-sectional survey-based study was conducted among adult females at King Saud University, Saudi Arabia, from April 2022 to August 2022. A total of 380 participants were selected through a stratified random sampling technique. Ethical approval was obtained from the Deanship of Scientific Research at King Saud University. The data were analysed using descriptive statistics and appropriate statistical tests. The results revealed that 53.9% of the participants experienced disturbances in the menstrual cycle after receiving the COVID-19 vaccination. Adult females aged 18-25 showed the highest rate of disorders. Menstrual disruptions were substantially correlated with marital status (p = 0.05), with a significant association between the number of COVID-19 vaccine doses and the occurrence of menstrual disturbances (p = 0.001). The administration of the vaccination during menstruation was linked to a notable occurrence of menstrual disturbances, although the p-value showed no statistical significance. A significant correlation was examined (p < 0.05) between pre-existing menstrual problems and the occurrence of disorders after receiving the COVID-19 vaccine (p < 0.05). The study emphasised the importance of tailored healthcare treatments for women following COVID-19 vaccination and the need for regular evaluation of reproductive health outcomes post-COVID-19 vaccination.

Integrating canonical correlation analysis with machine learning for power quality disturbance classification

Abstract Recently, the rapid growth of Renewable Energy Resources (RER) in power generation has resulted in the frequent occurrence of Power Quality Disturbances (PQDs) within the power system. The timely and accurate detection of these PQDs is critical for maintaining good power quality while integrating RER into hybrid power systems to make them more robust and stable. In this paper, a multi-view dimensionality reduction approach based on Canonical Correlation Analysis (CCA) is proposed to differentiate different types of PQDs. Here, a dataset of 29 types of PQDs which include nine single types and twenty multiple types of PQDs have been generated using their mathematical model in MATLAB for experimentation. CCA being multi-view dimensionality reduction technique maximizes the correlation between two different views of the data. Here two cases of datasets have been considered for further exploration, Case 1: PQDs without noise and with 20 dB noise, Case 2: PQDs with 20 dB and 30 dB noise. Furthermore, to test the efficacy of CCA in both cases, the extracted features have been tested using four different classifiers i.e. K-Nearest Neighbour (KNN), Support Vector Machine (SVM), Naive Bayes (NB), and Random Forest (RF). The performance of each of the classifiers has been tested on five different performance metrics such as precision, recall, F1 score, hamming loss and accuracy and the results shows that the proposed technique of multi-view dimensionality reduction is capable of classifying the PQDs with two different views at a time.

Solar cycle phase and occurrence of intense geomagnetic storms

Solar cycles have an asymmetrical shape with a fast rise and a slow decline, which varies from cycle to cycle. This makes it difficult to study the solar cycle phase dependence of the occurrence of intense solar-terrestrial events such as intense geomagnetic storms. In the previous works, differences in the rise and fall time lengths of each solar cycle were not fully considered. We normalized the asymmetric shape of each solar cycle using the rise and fall time lengths and showed the solar cycle phase dependence of occurrence of the intense geomagnetic storms selected using the Dst index for solar cycles 19−24 and using the aa index for solar cycles 12−24. The previous works noted that the occurrence of geomagnetic disturbances shows double peaks before and after solar maximum. Our results showed that the occurrence of the intense geomagnetic storms selected using the Dst and aa indices does not always show clear double peaks and increased more in the earlier half of the fall time than in the other time periods. The Dst and aa indices have been used to select geomagnetic storms in the previous studies. We pointed out that the solar cycle phase dependence of occurrence of the geomagnetic storms selected using the aa index is slightly different from those selected using the Dst index. We showed the geomagnetic storm on 4 August 1972 as an extreme case, which showed difference between Dst and aa. We also showed that intense geomagnetic storms associated with eruptive flares from the active sunspot groups occurred around the solar minima of cycles 17, 19, 20, and 21.Graphical

Correlation of prosthesis position on mid-term pacing burden in patients with new permanent pacemaker after TAVI

Abstract Background Prior studies suggest a strong correlation of the final prosthesis position on the occurrence of new conduction disturbances resulting in permanent pacemaker (PPM) implantation after transcatheter aortic valve implantation (TAVI). A high burden right ventricular pacing (PPM stimulation rate of > 20 %) is associated with poor long-term outcomes. So far, data about predictors influencing the PPM stimulation rate after TAVI are scarce. Purpose Thus, the purpose of this study was to evaluate the influence of the three-dimensional transcatheter heart valve (THV) position, as well as device landing zone characteristics or peri-/post-procedural factors on the stimulation rate in patients with new implanted PPM as TAVI complication. Materials: We evaluated the final THV position of 387 patients (106 with self-expanding Evolut R THV, 281 with balloon-expandable Sapien 3 THV) using fusion imaging of pre- and post-TAVI computed tomography angiography (CTA) to obtain a three-dimensional reconstruction of the THV within the native annulus region. The length of the THV above and below the native annulus was measured within the fused images to assess the implantation depth. PPM stimulation rates were examined pre-discharge and after 3 months. Patient’s clinical long-term outcome was evaluated over 5 years via standardized questionnaire as well as contacting general practitioners. Results Out of the 387 patients 112 (29%) received a new PPM pre-discharge after TAVI between 2014 and 2022. They were grouped into patients with stimulations rate below and above 20%. A stimulation rate > 20% in the PPM control before discharge and after three months was detected in 69 % and 67 % of them, respectively. Using uni- and multivariate logistic regression analysis, only new occurred third degree atrioventricular blocks (p=0.007) was identified as predictor for high burden right ventricular pacing after PPM-implantation as well as after 3 months. The implantation depth of the THV showed no influence on the PPM stimulation rate – neither the mean value nor the exact implantation depth adjacent the left, right and non-coronary cusp (P=0.455, P=0.108 and P=0.932, respectively). There were no significant differences regarding MACE between both groups during long-term follow-up; only the degree of dyspnea 5 years after TAVI was significantly higher in patients with a stimulation rate > 20% (p=0.01). Conclusion We detected no correlation of the exact three-dimensional THV position on mid-term pacing burden in 112 patients implanted with a new PPM after TAVI using CTA fusion imaging. Only a new occurred third degree atrioventricular block was a predictor for a high burden right ventricular pacing (stimulation rate >20%). These results provide important insights into which patients actually require PPM implantation after TAVI.

Long-term surveys of ungulates' effects on tree and shrub species in mountainous forests -outcomes and potential limits.

Ungulate herbivory might induce different effects on the diversity and growth of trees and shrubs. The density, distribution, and the species of ungulates as well as plant communities' composition and other factors determine whether ungulate herbivory promotes or limits plants' diversity and growth. The impacts of ungulates on woody plants are commonly surveyed with exclosure-control approaches. In practice, such surveys frequently only cover short periods of time, addressing immediate management needs. Long-term surveys, documenting lasting effects of ungulate herbivory, are highly needed, but still rare. However, the general transferability of outcomes of long-term surveys might be limited due to different disturbing factors. This study addresses two basic aspects of long-term monitoring in mountainous forests, based on a unique 30-year data set: (1) Possible long-term effects of herbivores on forest vegetation (e.g., species/structural diversity of woody plants) and (2) potential differences between short-term and long-term surveys in terms of height growth patterns. In our study, diversity of woody plant species showed great variability with no significant impact of ungulate herbivory. The presence of ungulates had a significantly negative effect on the vertical structural diversity and growth of trees. Due to the slower growth on control plots, it took trees longer to reach a 160 cm height-threshold with their terminal shoots than on exclosure plots. Our long-term control-exclosure data set indicated that long-term survey data indeed might differ from growth patterns represented by short-term surveys. This can be induced by several factors, like site-specific growth patterns of trees, occurrences of natural abiotic disturbances that influence the functional life of exclosures, and others.

Construction and verification of the prediction model for risk of sleep disturbance in elderly patients with hypertension: a cross-sectional survey based on NHANES database from 2005 to 2018

ObjectiveTo construct and verify a risk prediction model for sleep disturbance in elderly patients with hypertension, aiming to offer guidance for sleep management in this demographic.MethodsA cohort of 6,708 elderly hypertensive patients from the NHANES database, spanning 2005 to 2018, met the inclusion criteria and were selected for this study. Participants were randomly assigned to a development group (n = 4,696) and a verification group (n = 2,012) in a 7:3 ratio. The occurrence of sleep disturbance was assessed across the subjects. Independent risk factors for sleep disturbance were analyzed using weighted multivariate logistic regression within the development group. A predictive model for sleep disturbance risk in elderly hypertensive patients was developed and verified using Stata 17.0. The model's predictive accuracy and stability were evaluated using the verification group's data.ResultsOf the 6,708 subjects, 2,014 (30.02%) were identified with sleep disturbance, and the weighted prevalence of sleep disturbance among elderly hypertensive patients was 33.283%. Weighted multivariate logistic regression analysis in the development group revealed that six factors were independently associated with sleep disturbance: higher total depression scores, higher education level, asthma, overweight, arthritis, and work restriction (OR > 1 and P < 0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the nomogram prediction model was 0.709 in the development group and 0.707 in the verification group, indicating good discrimination ability. Brier scores for the nomogram model were 0.185 in the development group and 0.189 in the verification group, both below 0.25, suggesting good calibration. Decision Curve Analysis (DCA) determined that the nomogram's clinical net benefit was maximized when the threshold probability for sleep disturbance in elderly hypertensive patients was 0.13–0.67 in the development group and 0.14–0.61 in the verification group, highlighting the model's clinical utility.LimitationsThis study is not without its limitations, including issues with data collection, the absence of external validation, and the non-extrapolation of results.ConclusionThe prevalence of sleep disturbance among elderly hypertensive patients stands at 33.283%. The nomogram model, based on identified risk factors for sleep disturbance in this population, has demonstrated good predictive efficiency and clinical relevance. It serves as a valuable tool to assist healthcare providers in identifying elderly hypertensive patients at high risk for sleep disturbance.

Distributed Bipartite Consensus of Multi-Agent Systems via Disturbance Rejection Control Strategy

This work aims to focus on analyzing the consensus control problem in cooperative–competitive networks in the occurrence of external disturbances. The primary motive of this work is to employ the equivalent input-disturbance estimation technique to compensate for the impact of external disturbances in the considered multi-agent system. In particular, a suitable low-pass filter is implemented to enhance the accuracy of disturbance estimation performance. In addition, a specific signed, connected, and structurally balanced undirected communication graph with positive and negative edge weights is considered to express the cooperation–competition communication among neighboring agents. The cooperative–competitive multi-agent system reaches its final state with same magnitude and in opposite direction under the considered structurally balanced graph. By utilizing the properties of Lyapunov stability theory and graph theory, the adequate conditions assuring the bipartite consensus of the examined multi-agent system are established as linear matrix inequalities. An illustrative example is delivered at the end to check the efficacy of the designed control scheme.

Factors Affecting the Menstrual Cycle in Adolescent Girls at SMA Negeri 1 Kluet Selatan, South Aceh Regency, Aceh Province in 2023

The menstrual cycle is a problem among teenagers. The number of women who experience abnormal menstrual cycle problems caused by many factors, one of which is nutritional status, stress, physical activity and menarche age. Abnormal cycles are generally caused by unstable hormonal levels. Abnormal menstrual cycles cause long-term disruption to the reproductive system if left untreated. This type of research is an analytical survey research with a Cross Sectional research design. The purpose of the study was to find out the factors that affect the menstrual cycle in adolescent girls at SMA N 1 Kluet Selatan. The sample in this study is a student of SMA N 1 Kluet Selatan Class X, XI and XII which was obtained through the probability sampling technique, which is sampling that provides the same opportunity for population members to be selected as sample members. The results of the study showed that there was an effect of nutritional status with a P value of 0.003 (&lt; 0.05), stress with a P value of 0.002 (&lt; 0.05), physical activity with a P value of 0.026 (&lt; 0.05. Menarche age, with a P value of 0.000 (&lt; 0.05) on the menstrual cycle in adolescent girls at SMA N 1 Kluet Selatan From the results of the research, it was found that there was an effect of nutritional status, stress, physical activity, and menarche age on the menstrual cycle in adolescent girls at SMA N1 Kluet Selatan. The suggestion in this study is that it is hoped that adolescent girls can find information about factors that can affect the menstrual cycle so that they can find out early and can overcome the occurrence of disturbances during menstruation.

A case study on the exposure-response relationship of sleep disturbance due to road traffic noise - As a case in Japan in the 2020s

A socio-acoustic survey was conducted among residents living along major arterial roads in Kanagawa Prefecture, Japan, to examine the occurrence of sleep disturbances due to road traffic noise. Lnight noise maps was introduced for estimating ranges from 30 dB to 80 dB. We asked the frequency of "difficulty falling asleep," "nocturnal awakenings," "early morning awakenings", "feeling unrefreshed in the morning",and "daytime sleepiness" due to road traffic noise. Cases experiencing any of these items more than three times a week were defined as "highly sleep disturbed (HSD)", and that one or twice a week were defined as "sleep disturbed (SD)", respectively. The exposure response relationships between those and Lnight were examined with the independent variables of noise sensitivity, gender, and age. The results of multiple logistic regression analysis revealed that Lnight, and noise sensitivity had a significant effect on SD, while noise sensitivity significantly affected HSD. We show the results of this study in comparison with previous surveys on sleep disturbances conducted in Japan and other regions.

Microbial growth on temporary pacemaker leads post-TAVR: pathogen spectrum and clinical implications.

Transcatheter aortic valve replacement (TAVR) is an established treatment option for patients with symptomatic severe aortic stenosis across all stages of surgical risk. Rapid pacing during the procedure and the risk for the occurrence of conduction disturbances after TAVR requires the pre-interventional insertion of a temporary pacemaker (TP). However, this approach poses risks, including the risk of infection. For this reason, the following study aimed to investigate microbial growth on temporary pacemaker leads and its association with outcome post-TAVR and to identify associated pathogens and related risk factors. A prospective study was conducted including 344 patients undergoing TAVR at the Heart Centre Bonn. Of these, 97 patients did not require TP leads as they already had permanent pacemakers; this group was considered as comparison group. The TP leads of the remaining 247 patients were removed, sonicated, and cultured to investigate bacterial growth over a period of 14days. Finally, we compared patients without microbial growth (n = 184) and patients with microbial growth (n = 63). The primary endpoint of the study was 30-day all-cause mortality, secondary endpoints were periprocedural infections, the length of the postprocedural hospital stay, 30-day major vascular complications and the 30-day stroke rate. The majority of cases (74.5%) showed no bacterial growth. In the remaining cases (25.5%), diverse microorganisms were identified, mostly non-pathogenic bacteria. The statistical analysis revealed no significant differences between groups according to microbial growth in terms of 30-day mortality (p = 0.446), postprocedural hospital stay (p = 0.401), periprocedural infections (p = 0.434), 30-day major vascular complications (p = 1.0), and 30-day stroke rate (p = 1.0). Notably, the timing of sheath insertion was significantly associated with microbial growth; sheath placement more than 2days prior to the procedure was associated with a significantly higher risk of microbial growth (OR: 2.1; 95% CI 1.1-4.3) (p = 0.030). The presence of temporary leads does not significantly impact clinical outcomes, irrespective of bacterial growth on the lead. However, the timing and duration of sheath placement plays a crucial role in contamination incidence. Thus, temporary leads/sheaths should be placed shortly before the procedure and removed promptly to reduce the risk of contamination/infection.

Real-time analysis of conduction disturbances during TAVR with the CARA monitor

BackgroundThe occurrence of conduction disturbances (CDs) remains the most frequent complication of transcatheter aortic valve replacement (TAVR). However, little is known about the timing of electrocardiogram (ECG) changes and CDs during the TAVR procedure. ObjectiveThe objective of this study was to describe ECG changes throughout the TAVR procedure using the CARA monitor. MethodsThis was a multicenter study including 196 prospectively enrolled patients without preexisting CDs undergoing TAVR. All patients were monitored with the CARA system, which uses a 12-lead ECG to measure PQ and QRS intervals, QRS axis, and variations with each heartbeat at every step: baseline, wire insertion, pre-dilatation, valve deployment, post-dilatation, and end of procedure. ResultsPQ and QRS intervals progressively increased throughout the procedure, with a cumulative increase from 169.2 ± 20.0 ms to 186.0 ± 31.6 ms (P < .001) for the PQ interval and from 101.3 ± 10.5 ms to 126.0 ± 25.4 ms (P < .001) for the QRS interval, from baseline to the end of the procedure. A significant increase in the number of patients with left axis deviation was observed (7.7% at baseline vs 31.8% at end of procedure; P < .001). A total of 161 (82.1%) patients exhibited at least 1 CD episode (PQ >200 ms, QRS ≥120 ms, advanced heart block) during the procedure, with most episodes occurring during pre-dilatation and valve implantation maneuvers. ConclusionThe CARA system facilitated real-time ECG monitoring, detecting subtle and progressive changes during TAVR. ECG changes occurred at each step, with most patients experiencing CDs, especially during pre-dilatation and valve implantation. The potential clinical impact of monitoring ECG dynamics and timing for early detection of severe CDs should be explored in future studies.

Interrelations between iron content and immune dysfunctions in frequently ill children of the Aral Sea Region

The widespread occurrence of immune-dependent diseases and disturbances in iron metabolism, as well as their co-occurrence and the impact of iron deficiency on the immune system, underscore the relevance of this study. Modern data also indicate the involvement of iron in regulating cytokine production and protein synthesis by lymphocytes. In addition to the age-related characteristics of the child’s immune system, a significant factor in the development of inadequate course of the infectious process is the disruption of immune system adaptation, which can be caused by frequent infections, other somatic diseases such as anemia, and environmental factors. The aim of this study is to assess the relationship between iron levels and immune dysfunction in children with frequent acute respiratory diseases living in the Aral Sea region. A total of 127 children, who are native residents living at the epicenter of the ecological crisis, were examined. The children’s ages ranged from 1 to 5 years old. Among them, there were 105 frequently ill children (with 6 or more episodes of acute respiratory infections per year) with iron-deficiency anemia (IDA), and 22 healthy children of the same age. All children underwent clinical examination and standard laboratory tests, including complete blood count, relative content and ratio of T and B lymphocytes, as well as the levels of pro- and anti-inflammatory cytokines (IL-2 and 4) and ferritin in the serum. According to the results of the conducted research, it was found that among frequently ill children with iron-deficiency anemia (IDA), there is a moderate positive correlation between the relative quantity of T lymphocytes and the hemoglobin level (r = +0.62), as well as a strong positive correlation with the serum iron level (r = +0.78). This indicates a significant influence of iron deficiency on the level of cellular immunity. Clinical data also indicate a higher risk of respiratory infections development in children with IDA compared to the control group. Ferritin, hemoglobin, lymphocytes, and cytokines act as positive regulators of hematopoiesis in IDA conditions and contribute to the compensation of anemia during iron deficiency replenishment.

COVID-19 and menstrual-related disturbances: a Spanish retrospective observational study in formerly menstruating women.

Four years after the start of the pandemic, there is limited evidence on the impact of COVID-19 on the women's health regardless of their reproductive status. The aim was to analyze the prevalence and associated factors of menstrual-related disturbances in formerly menstruating women following SARS-CoV-2 infection. A retrospective observational study of adult women in Spain was conducted during the month of December 2021 using an online survey (N = 17,512). The present analysis includes a subpopulation of SARS-CoV-2-infected and formerly menstruating women (n = 72). The collected data included general characteristics, medical history, and specific information on COVID-19. Chi-square and Mann-Whitney U-tests were performed. Bivariate logistic regression analysis was then performed to investigate possible associations between the occurrence of menstrual-related disturbances after SARS-CoV-2 infection. 38.8% of participants experienced menstrual-related disturbances following COVID-19. Among these, unexpected vaginal bleeding (20.8%) was the most common event, followed by spotting (11.1%) ( Table1). Other reported changes were in the length (shorter = 12.5%) and flow (heavier = 30.3%) of menstrual bleeding in comparison to their previous experience. Regression analysis revealed that being a perimenopausal woman [adjusted odds ratio (AOR) 4.721, CI 95%, 1.022-21.796, p = 0.047] and having a previous diagnosis of menorrhagia (AOR 5.824 CI 95%, 1.521-22.310, p = 0.010) were factors associated with the event. These findings could help health professionals provide their patients with up-to-date scientific information to empower them to actively manage their reproductive health, especially in societies where menstrual health is still taboo.

PMUs data based detection of oscillatory events and identification of their associated variable: Estimation of information measures approach

Information theory can be a useful tool for quantifying the perturbations in the associated state variables at the time of disturbance occurrence. The study introduces a framework for the spectral decomposition of multivariate information measures to detect initiation of low frequency oscillations (LFOs), caused due to physical events in the power grid. A frequency-specific quantification of the information is shared between a target variable and two source variables from their time series data. Initially, the approach is applied on different synthetic test signals having different oscillatory frequency modes and decay time constant. Then, approach is extended on PMUs signals. The combination of cross-spectral and information-theoretic approaches is applied for the multi-variable analysis of PMUs signals from the same bus. The interdependence among the frequency, voltage angle and voltage magnitude, corresponding to specific oscillations, manifested due to cause-effect relationships obtained in terms of statistics is estimated. The dynamics in terms of unique (interaction), redundant and synergetic information is determined with the contribution from two of these three signals as source variables to target variable (frequency/voltage angle). This provides a direct coupling to identify driver-response relationships between source variables and target variable to indicate the onset of LFOs, following physical events in power network. The extension of approach among the variables from different buses aids to identify the responsible area of event occurrence.

Occurrence of neurosensory disturbance after the use of articaine and lidocaine in the inferior alveolar nerve block: a double-blind randomised clinical trial

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study’s predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18–44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.

Efficacy and Safety of Alprostadil in Microcirculatory Disturbances During Emergency PCI: A Meta-Analysis of Randomized Controlled Trials.

The clinical advantage of alprostadil [prostaglandin E1 (PGE1)] in the treatment of microcirculatory disturbances (defined as no-reflow or slow-flow) in acute percutaneous coronary intervention (PCI) is still disputed. The purpose of our study was to review the efficacy of PGE1 supplements in patients with acute myocardial infarction (AMI) who had urgent PCI. This study was a meta-analysis of randomized controlled trials. PubMed, Embase, the Cochrane Library, Ovid, ProQuest, Scopus, the Chinese BioMedical Literature Database, China National Knowledge Internet, the China Science and Technology Journal Database, and the Wanfang Data Knowledge Service Platform were used as sources. We included randomized controlled trials including PGE1 for the treatment of intraoperative microcirculatory disorders and major cardiovascular adverse events in emergency PCI in people with AMI. Independent data extraction was conducted, and study quality was assessed. The meta-analysis was carried out by using random effects models to calculate the risk ratio (RR) of microcirculatory disorders between groups receiving PGE1 and those receiving placebo, nitroglycerin, or tirofiban. The primary endpoint of the study was the incidence of microcirculatory disturbances. Secondary outcomes included corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC), the percentage of patients with TIMI myocardial perfusion grade 3 (TMPG3), and the percentage of patients with myocardial blush grade 3 (MBG3) as efficacy indicators. Additionally, major adverse cardiovascular events (MACE) at 30 days and 180 days were assessed as safety indicators. There were 18 trials involving a total of 1458 participants. PGE1 significantly reduced the occurrence of microcirculation disorders compared with conventional medications and placebo [risk ratio 0.48, 95% confidence interval (CI) 0.36-0.63, I2 = 46%; cTFC (RR -4.74, 95% -6.85 to -2.63, I2 93%); percentage of patients with TMPG3 (RR 1.34, 95% CI 1.07-1.68, I2 70%) or MBG3 (RR 1.33, 95% CI 1.19-1.49, I2 0%); major adverse cardiovascular events (MACEs) in 30 days (RR 0.48, 95% CI 0.27-0.86, I2 0%); and MACEs in 180 days (RR 0.41, 95% CI 0.28-0.60, I2 0%)]. We found thatPGE1 decreased the occurrence of micro-circulation disturbance in AMI and enhanced the outcome of PCI.Additional studies should be conducted to confirm these findings.

Anatomical Annulus Predictors of New Permanent Pacemaker Implantation Risk After Balloon-Expandable Transcatheter Aortic Valve Implantation

New-generation transcatheter-heart-valves (THV) have significantly improved technical success and procedural safety of transcatheter-aortic-valve-implantation (TAVI) procedures, but incidence of permanent pacemaker implantation (PPI) remains a concern.The study aimed to assess the role of anatomical annulus features in determining peri-procedural conduction disturbances leading to new-PPI following TAVI with the last generation Edwards Sapien balloon-expandable valves (BEV). In the context of a prospective single-center registry, we integrated clinical and procedural predictors of PPI with anatomical data derived from multi-slice-computed-tomography (MSCT). A total of 210 consecutive patients treated with balloon expandable Edwards THV were included in the study from 2015 to 2023. Technical success was achieved in 197 (93.8%) procedures, and 26 patients (12.4%) required new-PPI at 30-day follow-up (median time-to-implantation 3 days). At the univariable logistic-regression analysis, pre-procedural right bundle branch block (RBBB; OR:2.24 [95%CI:1.01-4.97], p=0.047), annulus eccentricity ≥0.25 (OR:5.43 [95%CI:2.21-13.36], p<0.001), calcium volume at annulus of the right coronary cusp (RCC) >48 mm3 (OR:2.60 [95%CI:1.13-5.96], p=0.024) and prosthesis implantation depth greater than membranous septum length (OR:2.17 [95%CI: 1.10-4.28], p=0.026) were associated with new-PPI risk. At multivariable analysis pre-procedural RBBB (OR:2.81 [95%CI:1.01-7.85], p=0.049), annulus eccentricity ≥0.25 (OR:4.14 [95%CI:1.85-9.27], p<0.001), and annulusRCC calcium >48 mm3 (OR:2.89 [95%CI:1.07-7.82], p=0.037) were confirmed as independent predictors of new-PPI. In conclusion, specific anatomical features of the aortic valve annulus might have an additive role in determining the occurrence of conduction disturbances in patients undergoing TAVI with BEV. This suggests the possibility to use the MSCT to improve the prediction of post-TAVI new-PPI risk.

Permanent pacemaker reduction using temporary-permanent pacemaker as a 1-month bridge after transcatheter aortic valve replacement: a prospective, multicentre, single-arm, observational study

The permanent pacemaker (PPM) implantation and pacemaker dependency rates after transcatheter aortic valve replacement (TAVR) are highly variable as some of the conduction disturbances are reversible. It remains poorly investigated how to optimise temporary pacing in these patients. This study aimed to explore the potential reduction in the PPM implantation rate using temporary-permanent pacemaker (TPPM) as a 1-month bridge. This is a prospective, multicentre, single-arm, observational study. Consecutive patients undergoing TAVR from March 1, 2022 to March 1, 2023 in 13 tertiary hospitals in China were screened. Patients who developed high-degree atrioventricular block, complete heart block, or first-degree atrioventricular block plus new onset left bundle branch block during the TAVR procedure or within 1 month after TAVR were included to receive TPPM. Patients with pre-existing PPM implantation or indications for PPM implantation before the TAVR procedure were excluded. Patients with TPPM were monitored to determine whether the conduction disturbances persisted or recovered. The primary endpoint was the rate of freedom from indications for PPM implantation 1 month after TAVR. This study is registered with ChiCTR, ChiCTR2200057931. Of 688 patients who have undergone TAVR, 71 developed conduction disturbance and met the inclusion criteria, 1 patient withdrew due to noncompliance, 70 patients received TPPM and completed follow-up. There were 41 (58.6%) men and 29 (41.4%) women in the study, with a mean age of 74.3±7.3 years. At 1 month follow-up, 75.7% (53/70) of the patients with TPPM did not require PPM implantation. For 688 patients who have undergone TAVR, the rate of PPM implantation at 1 month was 2.47% (17/688, 95% CI 1.55%-3.92%), representing a significant reduction in self-comparison with the rate at 48 h after TPPM (2.47% vs. 8.28% [95% CI 6.45%-10.58%], P<0.0001). Similar results were obtained in the subgroup analysis of patients with HAVB/CHB. Multivariate analysis revealed the baseline PR interval, difference between the membranous septum length and implantation depth, and timing of postprocedural conduction disturbance occurrence were independent predictors of freedom from indications for PPM implantation at 1 month after TAVR. Using TPPM as a 1-month bridge allows for a buffer period to distinguish whether conduction disturbances are reversible or persistent, resulting in a significant reduction in the PPM implantation rate after TAVR when compared with the current strategy. However, this is an observational study, the results need to be confirmed in a randomized trial. Beijing Science and Technology Plan 2022 from Beijing Municipal Science & Technology Commission.

Atrial Fibrillation in Wolff Parkinson White (WPW) Syndrome: Case Report and Review of the Literature

The occurrence of atrial fibrillation (AF) transmitted to the ventricles by an accessory pathway is a rare, potentially serious arrhythmia. The risk of ventricular fibrillation is a fatal complication that can be increased by certain medications such as digitalis. AF can be the initial presentation of WPW syndrome, in which case it is often poorly tolerated. We report the case of a 42-year-old patient with no particular history, who consulted for palpitations that appeared at rest, a few hours previously; systolic blood pressure was 80 mm Hg without signs of shock. The ECG showed rapid AF with wide QRS. After reduction by external electric shock, the post-ictal ECG was in favor of WPW syndrome. The initial assessment was quickly carried out, and the patient was treated with a combination of two antiarrhythmic drugs. The occurrence of rhythm disturbances requires an etiological assessment on which the specific treatment will depend. In WPW syndrome, stratification of the individual risk of sudden death is essential in the therapeutic management of patients.