Short-term Success Research Articles

Technology and material-oriented strategies can reduce lead industry carbon emissions in China

Achieving carbon neutrality in the lead industry requires both technological decarbonization and comprehensive reduction of surplus lead to mitigate environmental risks from stacking. A successful decarbonization pathway requires integrating material-oriented and technology-oriented factors synergistically. In this study, a comprehensive dynamic model was developed to encompass emissions of greenhouse gases throughout various processes and levels of lead redundancy across different scenarios. The results show that China’s cumulative lead consumption amounts to 190.24 million tonnes, with greenhouse gases emissions reach 250.96 million tonnes CO2-equivalent between 2021 and 2060. Strategies focused on material-oriented approaches to achieve an earlier carbon peak can yield short-term success, while a technology-oriented strategy demonstrates superior long-term optimization. In order to achieve synergistic outcomes in reducing pollution and greenhouse gas emissions, it is imperative to prioritize short-term improvements in recycling rates and long-term technological advancements. Additionally, exploring new applications for surplus lead should also be pursued.

Safety and Efficacy of Lumen-Apposing Metal Stents for Management of Late Refractory Gastro-jejunal Structures in Patients with Roux-en-Y Gastric Bypass (with Video).

Roux-en-Y gastric bypass (RYGB) related late gastro-jejunal (GJ) strictures are often resistant to endoscopic balloon dilations. Lumen-apposing metal stents (LAMSs) have been used to treat benign strictures with favorable results. However, the data remains limited to justify LAMS use for management of post-RYGB late GJ strictures. We aim to evaluate the safety and efficacy of LAMS placement for the management of late GJ strictures that are refractory to balloon dilations in post-RYGB patients. This was a single center retrospective study that included all post-RYGB patients who underwent LAMS placement for management of late GJ strictures that had previously failed balloon dilations. Primary outcomes were technical and clinical success, and secondary outcomes were LAMS-related adverse events. A total of 28 patients underwent LAMS placement for management of GJ strictures. Median age was 60.5 (IQR 50.5, 67.0) years and majority were females (27, 96.4%). Median interval between surgery and first diagnosis of GJ stricture was 13 years (IQR 7, 17.5). 20 × 10 mm LAMS was the most used stent (n = 24, 85.7%). The median procedure time was 23.5 (IQR 14.5, 32.0) minutes. Technical and short-term clinical success of LAMS placement was 100% (95% CI 87.9-100.0). Long-term success was achieved in 19 out of 25 patients (76.0%, 95% CI 56.6-88.5) that had over 3 months follow-up after LAMS removal. Stent migration was noted in 2 (7.1%) patients, and 1 (3.6%) patient each experienced pain and minor bleeding without the need for additional interventions. No patient in our cohort required surgical revision of GJ anastomosis. Placement of LAMS is safe, technically feasible, and associated with a high clinical success rate in patients with late GJ strictures after RYGB who have failed prior balloon dilations. Placement of LAMS can be considered early in patients requiring multiple balloon dilations.

Safety and efficacy of ultra-long intermediate-power ablation for outflow tract ventricular arrhythmia arising from the left ventricular summit

Abstract Background Radiofrequency ablation (RFA) has been effective in managing premature ventricular contractions (PVCs). Despite improvement in ablation techniques, recurrence remains high for LV summit PVCs. Epicardial ablation here is often precluded due to fat and proximity to coronaries, thus, aggressive but safe endocardial options are needed. Purpose To evaluate the safety and effectiveness of ultra-long ablation (>240 seconds) duration for refractory LV summit PVCs. Methods Patients with deep intramural LV summit PVCs were identified by lack of PVC elimination or late (>60 s suppression) and recurrence post-lesion under the left aortic sinus of Valsalva. We included patients who received the longest RFA of at least 240 seconds (maximum 15 minutes). RFA power was titrated slowly from 20 to 35W, carefully ensuring that the impedance drop did not exceed 12 ohms. Acute procedure success was defined as clinical PVC suppression for ≥60 minutes after the last lesion. Short-term success was defined as symptom improvement, ejection fraction (EF) recovery, and drop in PVC burden at 3 months. Results Twenty patients (59.5 ± 16.4 years, 55% male) were included. Baseline features are shown in Table 1. All RFA were delivered endocardially. No steam pops were noted. PVC burden was significantly lower at 3-month follow-up (P< 0.01), Figure 1A. Most patients had a normal ejection fraction (EF) at baseline; thus, no significant difference change in EF was observed (Figure 1B). One complication was recorded, which was tamponade likely caused by coronary sinus dissection requiring pericardiocentesis. Acute success was achieved in 95.0% of the cases, and all cases followed at 3 months (18/18) achieved short-term success. Conclusion Ultra-long duration RFA with lesions ≥ 240 seconds at 35W per lesion for LV summit PVCs appeared to be safe and effective in achieving acute and short-term success. The lack of acute suppression should not discourage operators, as there seems to be delayed suppression in some cases. Careful monitoring of biophysics is paramount when attempting this technique.

Long-Term Outcomes of Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Due to Sigmoid Sinus Wall Anomalies.

To assess the long-term outcomes of sigmoid sinus wall reconstruction (SSWR) in patients with pulsatile tinnitus (PT) with sigmoid sinus wall anomalies (SSWAs). Single-center retrospective review. Tertiary referral center. Patients who underwent SSWR for PT with SSWAs more than 5 years prior to study initiation. Therapeutic-all patients underwent sinus wall reconstruction for pulsatile tinnitus with sigmoid sinus anomalies. The primary outcomes were complete or partial resolution of PT lasting at least 5 years postoperatively and short-term relief from PT after surgery with long-term recurrence as determined by a self-assessment questionnaire and corroborated by the medical record. Thirty-five patients (37 ears) out of 58 eligible patients 5 years postoperatively from SSWR completed the survey. Short-term and long-term success rates of SSWR are 97.3% (36/37 ears) and 83.8% (31/37 ears), respectively. Of the patients, 13.5% (5/37 ears) experienced recurrence of PT on the same side following initial resolution. Of our patients, 8.6% had a confirmed diagnosis of idiopathic intracranial hypertension (IIH) after a follow-up period of more than 5 years. Sinus wall reconstruction is an effective procedure for long-term control of PT in patients with SSWAs, with an acceptable safety profile and very low additional risk of exacerbating or provoking complications associated with IIH.

The Derivers, Behaviors, and Consequences of the Fear of Missing Out in Iranian Youth

Objectives The present study was aims to investigating the derivers, behaviors, and consequences of the fear of missing out (FOMO) in Iranian youth. Methods This is qualitative study using the grounded theory. Participants were 21 young adults with FOMO aged 18-25 in Mashhad, Iran. Sampling was done using a purposeful sampling method until reaching data saturation. Przybylski’s FOMO scale was used to diagnose FOMO in samples. Unstructured in-depth interviews were conducted to collect data. In addition, semi-structured interviews with experts were conducted for data richness. Results We extracted one central theme “trying to achieve self-adequacy” and eight main themes including inadequacy of the family, personal factors, biosocial challenges, perpetuating factors, resulting failures, short-term successes, drowning in FOMO, and rescue from FOMO. Conclusion The FOMO in Iranian youth originates from their lack of self-adequacy. It is necessary to pay attention to and strengthen the sense of self-adequacy in young adults to prevent the development of FOMO.

Lower extremity osteotomies for limb preservation: Indications, outcomes, and risk factors

ObjectivesTo delineate the key factors associated with treatment success or failure for patients undergoing lower extremity osteotomies to address a spectrum of lower extremity joint and limb deformities at an Integrated Limb Preservation Center (ILPC). MethodsDesign: Retrospective cohort study.Setting: Level I Academic Trauma Center.Patient selection criteria: Patients of the ILPC with at least 1-year of follow-up data regarding previous surgery to correct trauma-or developmental-related deformities between January 1, 2005, and October 1, 2022.Outcome measures and comparisons: Patients were categorized first based on etiology (developmental vs. traumatic) and then based on the nature of deformity (joint, limb, nonunion). Treatment data, demographics including age, sex, body mass index (BMI), tobacco use history, insurance status, marital status, mental health history, and history of comorbidities, concurrent procedures, and post-operative infection, revision, reoperation, and bone healing status were extracted from the medical record and compared. Treatment failure was defined as conversion of the limb preservation surgery (ies) to amputation of any type. Results139 patients were included for analysis; 47 patients in the developmental-related cohort, and 92 patients in the trauma-related cohort. The treatment success rate in terms of preserving the affected limb for patients undergoing lower extremity osteotomies was 94.7 % for the developmental-related cohort and 92.4 % for the traumatic-related cohort. 57.4 % of patients in the developmental-related cohort and 59.8 % of patients in the trauma-related underwent unplanned secondary procedures Concurrent osteomyelitis debridement (p = 0.01) and postoperative infection (p = 0.049) were the only factors measured significantly associated with conversion to amputation. ConclusionsPatients undergoing osteotomies at an ILPC to address developmental-related or trauma-related joint and/or limb deformities experienced high short-term success (>90 %) with respect to preserving the affected limb. However, 56 % of patients required subsequent unplanned surgeries and improvements in PROMs were only statistically significant in patients with trauma-related deformities. Level of evidenceIII.

A Systematic Review of Early General Parenting Interventions: Long-term Effects in Underrepresented Populations and Implications for Obesity Prevention.

While some parenting interventions designed for early-life obesity prevention have demonstrated short-term success, there is limited evidence of longer-term impacts and feasibility with underrepresented populations. The goal of this review was to examine existing general parenting programs for parents of children 0-5years that were not designed to target obesity but investigated long-term effects on parenting and/or were conducted with underrepresented populations to offer recommendations for the modification or development of parenting-focused obesity prevention programs. Most studies with sustained impacts on parenting in underrepresented populations were brief, group-based programs for parents of children 2-5years. Many effective interventions included guided practice of skills and cultural adaptations. Unique intervention approaches included remote or school-based delivery models and motivational interviewing. Brief, group-based programs for parents of young children may be a promising approach to achieving longer-term impacts of parenting interventions on obesity risk among underrepresented populations.

Clinical outcomes of endoscopic balloon dilation for refractory esophageal strictures after esophageal atresia repair

BackgroundManaging refractory esophageal strictures (RES) presents formidable challenges. Although endoscopic balloon dilation (EBD) is the first step for esophageal stricture, the clinical outcomes of EBD for RES after esophageal atresia (EA) repair are not established. MethodsAll EA patients with esophageal balloon strictures (EBS) from October 2016 to October 2022 treated by EBD in our institution were retrospectively reviewed. The primary endpoint was to evaluate the clinical outcomes and the risk factors for poor outcomes of EBD for RES. The secondary endpoint was to evaluate the risk factors for pathological weight in RES patients. Results87 patients with RES were included in our study. After the first session of EBDs, 40.2 % experienced a recurrence of esophageal strictures. The median number (IQR) of the first session of EBD was 13.0 (8.0, 16.0), and the median number (IQR) of total dilations of achieving long-term clinical success was 14.0 (10.0, 19.0) with 81.6 % achieving long-term clinical success with less than 20 EBDs. In follow-up, all patients achieved a total oral diet. On multivariable analysis, the presence of GERD (OR 4.17, 95%Cl 1.29–13.51, p = 0.017), LGEA (long-gap esophageal atresia) (OR 5.19, 95 % Cl 1.15–23.52, p = 0.033), eccentric stricture shape (OR 3.34, 95%Cl 1.06–10.53, p = 0.040), and longer stricture length (OR 10.22, 95%Cl 1.14–92.01, p = 0.038) were statistically significant associated with increased endoscopic dilations. The presence of LGEA (OR 3.25, 95%Cl 1.03–10.20, p = 0.044) was significantly associated with recurrence after short-term clinical success. Additionally, Older age at first dilation after LEAP, stricture level at 1/3 upper (ref = 1/3 middle), and LGEA were identified as risk factors for developing pathological weight. ConclusionEndoscopic balloon dilation is an effective method for treating RES after EA repair. GERD, LGEA, eccentric stricture shape, and longer stricture length are the risk factors for increased dilation times. Older age at first dilation after LEAP, stricture level at 1/3 upper, and LGEA were identified as risk factors for developing pathological weight.

A New Hope - Patient Specific Bone-Anchored Subperiosteal Implants: Perspective of 3 US Institutions on this Resurrected Treatment Modality

BackgroundSince subperiosteal implants were first developed in the 1940s, they have fallen out of favour due to their high complication rate and low long-term survival rate. Many of these complications were due to micromotion. More recently, patient-specific bone-anchored subperiosteal implants (BASIs) have been developed, which utilize screw fixation to mitigate micromotion. This article discusses the early experience of three US institutions, Duke University, University of Michigan, and Mayo Clinic, describes the recommendations of the BASI’s European designer, and provides our treatment recommendations. ConclusionPatient-specific bone-anchored subperiosteal implants have demonstrated acceptable short-term success. At this point in time, we feel this is a viable treatment option but recommend utilizing traditional treatment modalities, such as standard endosseous implants, prior to utilization of a BASI until additional long-term research has been completed.

Safety and efficacy of conventional compared to segmented esophageal fully covered self-expanding metal stents: a retrospective multicenter case-control study.

Segmented self-expanding metal stents (SEMS) are an alternative to conventional unsegmented SEMS in the treatment of esophageal strictures. Due to their segmented design, they may adapt better to the surrounding structures making them less likely to migrate or cause trauma. We examined if there are clinically relevant differences between segmented and conventional esophageal SEMS in benign and malignant stenosis in terms of their functionality and safety. We performed a multicenter, retrospective case-control study of segmented and conventional SEMS implantations in esophageal stenosis. Outcome parameters were adverse events such as migration, occlusion, and severe complications (i.e., bleeding and perforation). 79 segmented SEMS were identified and compared to 79 conventional SEMS implantations. Groups were similar in terms of age, gender, and etiology. We observed 13.9% severe complications (SEMS-associated clinically significant bleeding or perforation) in the conventional SEMS group compared to 3.8% in the segmented SEMS group. This difference was statistically significant (p = 0.025). Rates of migration and occlusion were similar between both groups. Likewise, there was no significant difference in terms of short-term (30days) clinical success. In this first controlled analysis, segmented SEMS were associated with fewer severe clinical complications compared to conventional SEMS.

"Necessary evil": the difficulties of establishing programmatic culture in the transfer portal era.

The implementation of the transfer portal and eased transfer restrictions has drastically impacted the migration of college football players. While such athlete autonomy aligns with sweeping organizational policy adopted, and mandated, by the National Collegiate Athletic Association (NCAA), the absence of barriers preventing the mobility of players may have a resultant effect on the development of sustained organizational culture. Through interviews with direct stakeholders currently coaching football at the Football Bowl Subdivision (FBS) level, the findings of this study reveal that while the transfer portal is commonly utilized to achieve short-term success, building a roster composed predominantly of transfer players was perceived as unsustainable in the desired cultivation of meaningful organizational culture. As coaches grapple with the intensified demands to win football games, the findings of this study indicate that sustained long-term programmatic success may be more suitably achieved through the cultivation of distinct organizational culture rather than a reliance on transfer players.

Long-term outcomes of mechanochemical ablation using the Clarivein device for the treatment of great saphenous vein incompetence

ObjectiveThe short-term anatomical success rates of mechanochemical ablation using the Clarivein device (Merit Medical) in the treatment of great saphenous vein (GSV) incompetence are high. However, the anatomical success rates seem to drop over time. The aim of this study was to determine the long-term outcomes of GSV treatment using the Clarivein and to assess whether specific anatomical features better correlate with clinical or quality of life (QoL)-related outcomes. MethodsThis is a single-center, prospective cohort study in follow-up of a multicenter, randomized controlled trial using Clarivein with liquid polidocanol for the treatment of GSV incompetence. The primary outcome was anatomical success (AS), defined as complete occlusion or a recanalized segment, irrespective of reflux, of <10 cm in length. In addition, reflux-free anatomical success (RF-AS) was determined, and defined as complete occlusion or a recanalized segment with <10 cm of reflux. Clinical success was assessed using the Venous Clinical Severity Score (VCSS), and QoL was assessed using the Dutch version of the Aberdeen Varicose Vein Questionnaire (DAVVQ) and the 36-Item Short Form Health Survey (SF-36). Subgroup analyses were performed based on whether AS or RF-AS was achieved or not. ResultsA total of 109 patients (115 limbs) were included. The mean follow-up time was 8.4 ± 0.9 years (range, 5.5-10.3 years). AS was seen in 60.5% of limbs, and RF-AS was seen in 72.8% of limbs. Compared with baseline, the overall mean VCSS improved from 5.3 ± 2.4 to 4.1 ± 2.4, and the overall median DAVVQ score from 13.5 (interquartile range [IQR], 8.7-20.0) to 10.5 (IQR, 5.3-16.2) (P < .001). Improvement in VCSS was only significant in patients with successful treatment: from 5.5 ± 2.7 to 3.7 ± 2.5 (P < .001) if AS was achieved and from 5.0 ± 1.7 to 4.5 ± 1.9 (P = .20) if AS was not achieved. The same results were found for DAVVQ scores: improvement from13.5 (IQR, 8.7-20.6) to 10.3 (IQR, 3.0-14.5) (P < .01) if AS was achieved and from 12.9 (IQR, 8.3-19.3) to 10.8 (IQR, 6.7-18.2) (P = .35) if AS was not achieved. Regarding the overall SF-36 scores, the domains of vitality, mental health, and general health worsened significantly. ConclusionsIn over 8 years of follow-up, the anatomical success rate after the treatment of GSV incompetence using the Clarivein device decreased to 60.5%. However, clinical scores and disease-specific QoL still improved significantly compared with baseline. We found no convincing evidence that the absence of reflux correlates better with clinical and QoL-related outcomes compared with recanalization irrespective of reflux.

Comparison Between Static and Dynamic Spica Cast for Closed Reduction Cases of DDH: A Short-Term Follow-Up

Background: developmental dysplasia of the hip (DDH) is a typical childhood disease that, if left untreated, can lead to early-onset osteoarthritis. Closed reduction and spica casting are the first line of treatment for infants aged 6-18 months. Static and dynamic spica casts are the two primary treatment method used in practice, but the evidence is mixed as to which method provides the best outcomes. Methods: This prospective, randomized, controlled trial compared static and dynamic spica casting in 98 DDH patients from Kurdistan, Iraq. Patients were divided into dynamic and static groups. The hip was follow-up ed by using radiographic parameters such as the acetabular index and Tonnis grade. Treatment success was defined as a favorable hip outcome after one year. Results: There was no significant difference in treatment success between the groups, with 68% of patients in both groups achieving normal hip modification. However, the dynamic cast group had significantly better acetabular indices at 3, 6, and 12 months, and all of them were done under general anesthesia (GA), better hygiene, better caring and more comfortable parents with less cost. Conclusions: Static and dynamic spica casting have similar short-term clinical success rates for DDH, but dynamic casting produces better radiographic outcomes, especially in infants younger than 1. Longer-term studies are needed to determine possible radiographic improvement and whether dynamic type translate into better clinical outcomes since its more comfortable for parent, with less cost.

Pengaruh Disiplin Kerja Terhadap Kinerja Karyawan Melalui Motivasi Sebagai Variabel Intervening Pada Perumda Tirta Kanjuruhan Kabupaten Malang

Companies can invest time and resources in developing, motivating, and nurturing the well-being of their employees. This not only has an impact on short-term success, but also on the company's long-term growth and sustainability. The purpose of this study is to analyze the Influence of Work Discipline on Employee Performance with Work Motivation as an Intervening Variable in Perumda Tirta Kanjuruhan, Malang Regency. The method used is quantitative in the form of explanatory research. The data was collected with a questionnaire that was distributed to all staff at Perumda Tirta Kanjuruhan, Malang Regency, totaling 80 people. Meanwhile, the data analysis used is SEM with PLS as the analysis technique. The results of the study showed that work discipline had an effect on employee performance at Perumda Tirta Kanjuruhan, Malang Regency. Work discipline affects work motivation at Perumda Tirta Kanjuruhan Malang Regency. Work motivation affects employee performance at Perumda Tirta Kanjuruhan, Malang Regency. Work discipline affects employee performance through work motivation at Perumda Tirta Kanjuruhan, Malang Regency. The conclusion in this study is that work discipline includes punctuality, precision, and consistency in carrying out tasks. Meanwhile, work motivation is a key factor that encourages employees to achieve their goals and give their best performance.

African Popular Protest and Political Change

Abstract: In the twenty-first century, African countries have hosted more mass movements than any other region in the world. In the last decade, one in every three nonviolent revolutionary campaigns has taken place in Africa. The region also has the highest short-term success rate for people power. But is this success predicated on the mobilizational force of "protest democracy" to hold elites accountable? Or are African social movements' remarkable successes an environmental artefact, the result of ordinary protests in contexts of extraordinary instability? The evidence suggests that African social movements are uniquely effective and that political and military elites are increasingly trying to harness their power. Ordinary people—marshalled in massive demonstrations and persistent civil society organizing—have played a necessary, often decisive role in agitating for democracy. However, eliciting successful breakthroughs requires the alignment of protester demands with the abandonment of the status quo by elite blocs. Recent cascades of irregular power transfers in African politics illustrate these distinctive dynamics, where diverse domestic political contexts share an important common ingredient: the combination of mass movements pushing for change and military power players who are willing to help them.

Tooth autotransplantation with adjunctive application of enamel matrix derivatives using a digital workflow: A prospective case series

ObjectivesDigital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). MethodsTwelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period. ResultsSurvival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. ConclusionThe use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site. Clinical significanceThis is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.

Responsabilidad Social Corporativa como Estrategia para Mejorar el Rendimiento Empresarial

How Corporate Social Responsibility (CSR) can improve business performance will be analyzed through a qualitative literature review. Relevant academic studies and sources were reviewed to explore the relationship between CSR and business performance. The findings indicate that CSR improves consumer perception and behavior, strengthening loyalty and sales. In addition, it contributes to customer loyalty and retention, increases job satisfaction and commitment, and attracts and retains talent. CSR also improves organizational climate and culture, facilitates market differentiation and fosters innovation. In financial terms, CSR translates into improved direct financial performance, better access to capital and more effective risk management. These benefits not only drive short-term financial success, but also ensure long-term sustainability and growth. Integrating CSR practices into a company's business model is not just a matter of regulatory compliance, but a strategic decision that can profoundly transform its performance and sustainability. CSR is a powerful tool for improving business performance across multiple dimensions, and stands out as a strategic priority for modern companies.

Applying the German S2k-Guideline for Diagnosis and Treatment of Spondylodiscitis-A 5-Year Retrospective Evaluation of Patients without Neurological Symptoms.

Spondylodiscitis is a rather rare condition with an annual incidence of 1-7 per 100,000. Thus, empirical data on the treatment of this disease are limited. In 2020, the first German guideline for the diagnosis and treatment of spondylodiscitis was published. In a 5-year retrospective analysis, we examined the patient collective, the current diagnosis and treatment strategy, and the effect of Magnetic Resonance Imaging (MRI) diagnostics on therapeutic decisions of a consecutive monocentric cohort of 66 patients without neurological symptoms. The majority of the patients were male (55%) with a mean age of 74 years. Non-operative therapy was found to be associated with short-term treatment success in 54 (82%) of the patients. In 12 patients, who underwent surgical therapy, MRI diagnostics and clinical findings were equally important for the decision to perform a surgery. Patients treated operatively stayed for an average of 33.6 (±12.9) days in the hospital and thus significantly longer than non-operatively treated patients with 22.2 (±8.0) days. The in-house standard of care did not essentially deviate from the guideline's recommendations. Future research should address early detection of the need for surgical therapy, and immediate anti-infective treatment appropriate to the detected pathogen.

Procedural safety and outcome of additional left atrial posterior wall ablation using pulse field ablation for atrial fibrillation

Abstract Introduction Pulsed field ablation (PFA) has recently been shown to be comparable to radiofrequency ablation and cryoablation in terms of acute safety and outcome for pulmonary vein isolation (PVI) for atrial fibrillation (AF). Efficacy and safety of additional left atrial posterior wall ablation (LAPWA) is unknown. We hereby report safety profile and short-term success at 6 months. Methods Consecutive patients with paroxysmal or persistent atrial fibrillation who underwent PFA were included. Procedures were performed under conscious sedation or general anaesthesia, with or without intracardiac echocardiography/ pre- or post-ablation electroanatomic mapping at the operators’ discretion. Safety endpoints included all-cause death within 30 days, cardiac tamponade, stroke/ TIA, MI, diaphragmatic paralysis, AE fistula. Primary efficacy endpoint was arrhythmia recurrence after 90 days blanking period at 6 months. LAPWA was performed using 2.0 kV biphasic waveforms, 2 deliveries for each application site. The lesion set depended on the patient’s AF ablation history, LA size, and anatomy. After LA mapping post PVI (index or re-do), 2 anchor lesions per vein extending to the LAPW were deployed. A lesion set was then performed between the anchor lesions on the LAPW (upper and lower row) with the catheter in a flower configuration and the intention of 50% overlap for the neighbouring application sites at 3D EAM. Results Seventy-two (76% males) patients underwent PFA for AF, 55 (76.4%) were paroxysmal and 4 (5.6%) were redo cases. 19 (72%) underwent additional LAPWA. LAPWA was more likely performed in patients with persistent AF (57.9% vs 11.3%, p&amp;lt;0.001), require GA (p=0.043), with 100% EAM use (p=0.026). While total PFA applications was expectedly higher in the LAPWA group (65.7 ± 12.4 vs 42.9 ± 9.0, p&amp;lt;0.001), there were no significant differences in PFA dwell time in LA (44.2 ± 14.8 vs 42.3 ± 15.5min, p=0.628), procedural time (121.3 ± 43.8 vs 119.2 ± 49.4min, p=0.866) and fluoroscopic dose, AK (130 ± 107 vs 139 ± 102mGy, p=0.748). Average number of applications required for LAPW was 18 applications. LAPW isolation was acutely successful in all 19 patients on EAM. There were 6 inpatient complications of which all happened in the non-LAPWA group and unrelated to PFA. Arrhythmia recurrence was comparable at 6 months (11.1% vs 8.9%, p=1.00). Conclusion Additional LAPWA on top of PVI using PFA is safe with excellent acute isolation of posterior wall and does not increase procedural nor fluoroscopic duration. Short term outcome appears comparable and LAPWA may be useful especially in patients with persistent AF who may not be able to tolerate long procedures but will benefit from durable rhythm control.

Pulsed-field ablation of atrial fibrillation in elderly and frail patients: procedural efficacy and safety from a single-center experience

Abstract Introduction The demographic data shows a growing population, mostly elderly and with multiple comorbidities, therefore becoming increasingly frail. In this context Atrial fibrillation (AF) is the predominant sustained arrhythmia, and over the years trans-catheter isolation of pulmonary veins (PVI) has become a crucial approach in AF treatment. Among the technologies and energy resources employed through the years to perform atrial fibrillation transcatheter ablation, a novel technique has recently begun to gain ground, specifically pulsed-field ablation (PFA). PFA employs sequential brief and high amplitude electrical pulses to induce selective and irreversible electroporation of the myocardium, leading to cell death. The high selectivity of the lesion, ensured by the lower electroporation threshold of myocardial tissue compared to adjacent anatomic structures, allows for a decrease in potential complications associated with conventional thermal ablation. Purpose To assess the efficacy and safety in the use of pulsed field ablation in a selected population of elderly and frail patients undergoing atrial fibrillation ablation. Method We conducted a retrospective study focusing on elderly and frail patients admitted to our centre for paroxysmal or persistent AF ablation. The inclusion criteria were: age greater than 75 years and a Clinical Frailty Scale ≥ 5. The study population consisted of 26 patients [male gender 18, mean age 78 ± 3 years] including 8 who were affected by an oncological or haematological disease at the time of admission. The majority of patients were affected by paroxysmal AF while two of them presented persistent AF (9%). The primary ablation endpoint was the pulmonary vein isolation (PVI) that was achieved by delivering an energy of 2 kV over 8 applications, employing an alternating approach between the two configurations of the basket and flower catheter for each individual vein. Results The short-term success, represented by the complete and verified electrical isolation of the veins was achieved in all 26 patients without any periprocedural complications. First-pass pulmonary vein isolation (FPI) was universally achieved among the patient in study, with a mean skin-to-skin procedural time of 70 ± 30 minutes. From the procedural data perspective, ablation was achieved using an average fluoroscopy time of 22 ± 8.4 minutes and an average dose area product (DAP) of 1320 cGy×cm2. Conclusions In elderly and frail patients, we assessed the efficacy and safety of ablative procedures using the PFA technique. Successful electrical PVI was achieved without additional touch-ups, thanks to a high FPI rate. This results in lower procedural times and shorter intra-operative radiation exposure. These data confer an augmented value within the elderly-frail population, wherein shorter procedural times contribute to a better postoperative course, characterized by reduced bed rest and shorter intra-hospitalization periods.