Catheter ablation (CA) is a recognized treatment for people experiencing symptomatic paroxysmal or persistent atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the predominant therapeutic intervention for AF globally. According to PVI, some individuals may require supplementary ablation interventions. Literature has shown that the closeness of the esophagus to the posterior wall of the left atrium might result in injury to the vagal nerve branches during CA, causing conditions such as "gastroparesis" or "pyloric spasms." This report details a case of superior mesenteric artery compression syndrome following AF ablation, which did not improve with conservative management and was ultimately addressed by surgical procedure.

Adenotonsillectomy procedures can provide effective relief to children affected by sleep-disordered breathing (SDB), but the post-adenotonsillectomy pain management remains challenging, and the most effective approach to managing postoperative pain in these cases remains uncertain. The use of electronic media as a form of distraction therapy aimed at mitigating postoperative pain in children, it is unknown whether increases in screen time can effectively reduce persistent postoperative pain intensity or the incidence of negatively biased pain memories. A total of 107 SDB children undergoing adenotonsillectomy were enrolled and divided into two groups. Children in the intervention group were allowed to increase their screen time, while screen time was restricted for children in the control group. Child-reported pain intensity and negatively biased pain memories, pain-related fear were analyzed. The results indicated that no significant differences in initial postoperative pain intensity or fear were observed among groups. However, children in the intervention group did exhibit significantly reduced remembered Day 1 postoperative pain intensity (ηp2 = 0.043, p = 0.035), memory of worst pain intensity (ηp2 = 0.047, p = 0.027), and memory of worst pain-related fear (ηp2 = 0.042, p = 0.036) as compared to controls. Subgroup analyses based on age and gender indicated that males and school-aged children presented with lower scores for negatively biased pain memories. Our study exhibited the association between screen time and post-surgical pain intensity and negatively biased pain memories, These findings suggest that increasing screen time represents an effective approach to the postoperative management of negatively biased pain memories in certain subsets of children with SDB.

Background A sudden increase in heart rate (HR) during ablation of the right superior pulmonary venous vestibule (RSPVV) is often detected in patients undergoing circumferential pulmonary vein isolation (CPVI). In our clinical practices, we observed that some patients had few complaints of pain during the procedures under conscious sedation. Aim We aimed to investigate whether there is a correlation between a sudden increase in HR during AF ablation of the RSPVV and pain relief under conscious sedation. Methods We prospectively enrolled 161 consecutive paroxysmal AF patients who underwent the first ablation from July 1, 2018, to November 30, 2021. Patients were assigned to the R group when they had a sudden increase in HR during the ablation of the RSPVV, and the others were assigned to the NR group. Atrial effective refractory period and HR were measured before and after the procedure. Visual Analogue Scale (VAS) scores, vagal response (VR) during ablation, and the amount of fentanyl used were also documented. Results Eighty-one patients were assigned to the R group, and the remaining 80 were assigned to the NR group. The post-ablation HR (86.3 ± 8.8 vs. 70.0 ± 9.4 b/min; p ≤ 0.001) was higher in the R group than in pre-ablation. Ten patients in the R group had VRs during CPVI, as well as 52 patients in the NR group. The VAS score [2.3 (1.3–3.4) vs . 6.0 (4.4–6.9); p ≤ 0.001)] and the amount of fentanyl used (107 ± 12 vs. 172 ± 26 ug; p ≤ 0.001) were significantly lower in the R group. Conclusion A sudden increase in HR during the ablation of the RSPVV was correlated with pain relief in patients undergoing AF ablation under conscious sedation.

目的 探索采用Runthrough导丝辅助下,结合X线透视技术完成无碘对比剂房间隔穿刺的方法.方法 2021 年 2 月至 10 月在皖南医学院第一附属医院接受导管射频消融治疗的阵发性房颤患者60 例,随机分为常规房间隔穿刺组 30 例和Runthrough导丝辅助房间隔穿刺组 30 例.比较两组患者在房间隔穿刺过程中的总操作时间、透视时间、X线放射剂量,评估安全性.结果 两组患者房间隔穿刺过程中的总操作时间[(1.98±0.29)min比(2.11±0.14)min]、透视时间[(1.83±0.30)min比(1.98±0.14)min]、X线放射剂量[(27.77±3.08)μGy·m2 比(29.13±1.54)μGy·m2]差异均有统计学意义(均P＜0.05).所有患者均无心包填塞、主动脉穿孔等并发症发生.结论 X线透视下Runthrough导丝辅助的房间隔穿刺技术安全、经济、易行、可重复性强,可作为碘对比剂过敏患者房间隔穿刺的一种新方法.

This study was conducted to evaluate outcomes in patients presenting with fungus ball of the maxillary sinus (MSFB) and frontal sinusitis who were treated via middle meatal antrostomy alone. This was a randomized, controlled study with a parallel group design. Patients with MSFB and frontal sinusitis were randomly assigned to the maxillary middle meatal antrostomy (MMMA) or control (MMMA + frontal sinusotomy) groups. Patient demographics, complaints, imaging findings were analyzed, and surgical outcomes were evaluated using the Lund–Kennedy endoscopic score (LKES) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaire. In total, 40 patients were separated into two groups, with similar symptoms including nasal obstruction, mucopurulent rhinorrhea, maxillary or frontal pain, blood stained nasal discharge, nasal cacosmia and orbital pain being observed in both groups. Total LKES and SNOT-22 scores were significantly improved in both groups at 6 months post-treatment, with no significant differences in these scores between groups within a mean 6.8-month follow-up. These results suggest that frontal sinusotomy is not required to resolve frontal sinusitis associated with MSFB. As such frontal sinusitis appears to be a reactive process caused by fungal ball obstruction, it regresses spontaneously following fungus ball removal, drainage of the maxillary sinus, and middle meatal antrostomy.

目的:评估在消融指数指导下,环肺静脉电隔离术是否安全有效及不同术者之间环肺静脉电隔离率是否存在可重复性.方法:接受导管消融治疗的房颤患者90例,根据不同术者分为A,B,C 3组,每组入选30例患者.记录术中肺静脉隔离时间、X线透视时间、肺静脉单圈隔离率.结果:C组患者X线透视时间、肺静脉隔离时间均长于A,B组患者(P＜0.05 ),而A,B组患者差异无统计学意义(P＞0.05).3组患者肺静脉单圈隔离率差异均无统计学意义(P＞0.05).3组患者术中及术后均无手术相关并发症出现.结论:消融指数指导下环肺静脉电隔离术是安全有效的,具有可行性.利用消融指导下不同术者之间的环肺静脉电隔离术质量趋于同质性.

Background Intermediate-risk acute pulmonary embolism (APE) patients are usually defined as hemodynamically stable, comprehending a great therapeutic dilemma. Although anticoagulation therapy is sufficient for most intermediate-risk APE patients, some patients can deteriorate and eventually require a systemic fibrinolytic agent or thrombectomy. Hence, this study aimed to evaluate the predictive value of differences in clinical data for the short-term prognosis of intermediate-risk APE patients. Methods A retrospective cohort of 74 intermediate-risk APE patients confirmed by computed tomography pulmonary angiography was analyzed in the present study. Adverse clinical event outcomes included PE-related in-hospital deaths, critical systolic blood pressure consistently under 90 mmHg, refractory to volume loading and vasopressor infusion requirements, mechanical ventilation, and cardiopulmonary resuscitation. The APE patients were stratified into two groups: adverse outcome (n = 25) and control (n = 49) groups. Then, the clinical data of the two groups were compared. Receiver operating characteristic (ROC) curves were used to explore the predictive value of white blood cell (WBC) counts and the right to left ventricular short-axis (RV/LV) ratio. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit statistic. Results The brain natriuretic peptide, WBC count, and the RV/LV ratio were higher in patients with adverse outcomes compared to controls. The APE patients with adverse outcomes presented significantly higher rates of syncope, Negative T waves (NTW) in V1-V3, intermediate-high risk, thrombolytic therapy, and low arterial oxygen saturation (SaO(2)) compared to controls. In the multivariate logistic regression analysis, the SaO(2) < 90%, [odds ratio (OR) 5.343, 95% confidence interval (CI) 1.241-23.008; p = 0.024], RV/LV ratio (OR 7.429, 95% CI 1.145-48.209; p = 0.036), Syncope (OR 12.309, 95% CI 1.702-89.032; p = 0.013), NTW in V1-V3 (OR 5.617, 95% CI 1.228-25.683; p = 0.026), and WBC count (OR 1.212, 95% CI 1.035-1.419; p = 0.017) were independent predictors of in-hospital adverse outcomes among APE patients. The ROC curve analysis indicated that the RV/LV ratio can be used to predict adverse outcomes (AUC = 0.748, p < 0.01) and calibration (Hosmer-Lemeshow goodness of fit test, p = 0.070). Moreover, an RV/LV ratio > 1.165 was predictive of adverse outcomes with sensitivity and specificity of 88.00 and 59.20%, respectively. The WBC counts were also able to predict adverse outcomes (AUC = 0.752, p < 0.01) and calibration (Hosmer-Lemeshow goodness of fit test, p = 0.251). A WBC count > 9.05 was predictive of adverse outcomes with sensitivity and specificity of 68.00 and 73.50%, respectively. Conclusion Overall, a SaO(2) < 90%, RV/LV ratio, Syncope, NTW in V1-V3, and WBC counts could independently predict adverse outcomes in hospitalized intermediate-risk APE patients.

Aims : Conventional transseptal puncture(TSP) relies on fluoroscopy and iodinated contrast agent to distinctly position the transseptal needle at the left atrium, however, there exists great challenges in clinic in patients with contrast hypersensitivity or allergy-like reactionsin the procedure. This study aimed to evaluate a novel approach to TSP assisted by Runthrough guidewire and fluoroscopy without use of iodinated contrast agent. Methods: Sixty patients with paroxysmal atrial fibrillation undergone radiofrequency catheter ablation were enrolled from February 2021 to October 2021, and randomised to routine TSP group and Runthrough guidewire assisted group. The two groups were compared regarding the total operative time, length of fluoroscopy exposure, difference of radiation dose in X-ray, and the safety was evaluated in the patients undergone TSP without iodinated contrast agent. Results: There were no differences in baseline demographics or clinical characteristics between the two groups . Although the total procedure time[(1.98±0.29) min vs. (2.11±0.14) min, P <0.04],length of fluoroscopic exposure [(1.83±0.30) vs. (1.98±0.14), P< 0.19] and radiation dose in X-ray[(27.83±3.21) uGym 2 vs. (29.13±1.57) uGym 2 , P <0.30] were somewhat statistically different between groups, yet the difference was insignificant. No complications, including pericardial tamponade and aortic perforation, occurred in all patients. Conclusion: Iodine-free TSP under the guidance of Runthrough guidewire and fluoroscopy can be a simple, safe, economical and effective approach to TSP, and may be reproduced as a novel option for TSP in patients with contrast hypersensitivity or allergy-like reactions.

Background The musculature of the coronary sinus (CS), especially its distal connection with the post wall of the left atrial (LA), has been associated with the genesis and maintenance of atrial flutter (AFL) and atrial fibrillation (AF). However, the relative contributions of the distal coronary sinus (CSD)-LA connection to PersAF with various degrees of atrial fibrosis remain unknown. Objective This study aimed to explore the different roles of blocking the CSD-LA connection in the induction of acute AF and middle-term follow-up of recurrence among PersAF patients with various degrees of LA fibrosis. Methods and results A retrospective cohort of 71 patients with drug-refractory and symptomatic PersAF underwent ablation for the first time were studied. The population was divided into two groups according to disconnection of the CSD-LA or not. All patients enrolled accepted the unified ablation procedure (circumferential pulmonary vein isolation, non-pulmonary vein trigger ablation and ablation of the CSD-LA connection). Group A (n = 47) successfully blocked the CSD-LA electrical connection and Group B (n = 24) failed. Twenty-five patients could be induced into sustained AF in the Group A compared to 20 in the Group B (53.2 vs. 83.3%, p = 0.013). After a mean follow-up of 185 ± 8 days, 24 (33.8%) patients experienced atrial arrhythmia recurrences. The Group A had significantly fewer recurrences (25.5%) compared to Group B (50%). Meanwhile, in Group A, the ROC curve analysis suggested that in the case of blocking CSD-LA, low voltage area (LVA) of LA can act as a predictive factor for acute AF induction (AUC = 0.943, Cut-off = 0.190, P < 0.001) with sensitivity and specificity of 92.3 and 90.5%, and middle-term recurrence (AUC = 0.889, Cut-off = 0.196, P < 0.001) with sensitivity and specificity of 100 and 65.7%. Conclusion Disconnection of CSD-LA could reduce the inducible rate of acute AF and the recurrences of atrial arrhythmia during middle-term follow-up. The PersAF patients with CSD-LA muscular connection blocked, experienced a higher acute AF inducible rate with larger proportion of LVA of LA (≥19%) and a higher recurrent rate of atrial arrhythmias with a larger proportion of LA fibrosis (≥19.6%).

Background: Atrial fibrillation (AF) represents an important risk factor for cardioembolic stroke, and most atrial thrombi originate from the left atrial appendage (LAA). Although the CHA2DS2-VASc score is widely used to estimate the risk of cardioembolic stroke in AF patients, yet greatly affected by many factors. This study was undertaken to determine the association between contrast agent retention in LAA after LAA angiography and risks of cardioembolic stroke in patients with AF.Methods: This is a retrospective study. The demographic and clinical data of AF patients undergone left atrial appendage occlusion (LAAO) with or without catheter radiofrequency ablation were retrospectively analyzed. The patients were classified into either stroke or non-stroke group by the history with cardioembolic stroke or transient ischemic attack (TIA).Results: Sixty-two consecutive patients undergone LAAO were finally included, in whom 31 AF patients had a history of cardioembolic stroke or TIA (one TIA), and significantly higher CHA2DS2-VASc score (4.2 ± 1.4 vs. 3.3 ± 1.3; P = 0.006) as well as incidence of contrast agent retention in LAA (n = 20 vs. n = 7; P = 0.001) compared to the patients in non-stroke group. In addition, the relative proportion of distinctive morphological types of LAA was significantly different between groups (P < 0.001). Multivariate logistic regression analysis showed that higher CHA2DS2-VASc scores (OR = 1.7, 95% CI: 1.0–3.0, P = 0.046) and LAA contrast agent retention (OR = 5.1, 95% CI: 1.1–23.9, P = 0.002) were associated with increased risks of cardioembolic stroke. The patients with Windsock type LAA (OR = 7.8, 95% CI: 1.1–57.2, P = 0.044) and Cauliflower LAA (OR = 20.2, 95% CI: 3.2–125.5, P = 0.001) were more prone to cardioembolic stroke compared to those with Chicken Wing type LAA.Conclusion: Left atrial appendage contrast agent retention after LAA angiography is associated with the risks of cardioembolic stroke in patients with AF, and cardioembolic stroke is more seen in AF patients with Windsock or Cauliflower type LAA.

BACKGROUND:Vagal responses (VRs) are often seen in patients undergoing circumferential pulmonary vein isolation (CPVI). The possible mechanism of VR is that CPVI creates a coincidental modification of the cardiac ganglionated plexi (GP).AIM:To investigate whether the presence of VR during CPVI impacts post-ablation recurrence in patients with paroxysmal atrial fibrillation (AF).METHODS:A total of 112 consecutive patients with symptomatic paroxysmal AF who underwent CPVI for the first time from October 1, 2017 to April 30, 2019 were prospectively enrolled, of which two were lost the follow-up. Patients were divided into two groups based on whether VRs were experienced during CPVI. Electrophysiological parameters, including atrial effective refractory period (AERP) and mean heart rate (MHR), were measured before and post-ablation. The patients were then followed up for 12 months.RESULTS:The 71 patients who had experienced VRs during CPVI were assigned to group B, and the remaing 39 patients who did not experience VR during CPVI were assigned to group A. The MHR (79.6 ± 8.3 vs 70.4 ± 7.8 b/min; p ≤ 0.001) was significantly higher; and the AERP (244 ± 22 vs 215 ± 27 ms; p ≤ 0.001) was prolonged in group B compared to respective pre-ablation values. There were no significant changes in the MHR (69.5 ± 7.9 vs 69.7 ± 8.7 b/min; p = 0.541) and AERP (224 ± 28 vs 225 ± 33 ms; p = 0.542) in group A. During the first four months of follow-up after ablation, the MHR gradually slowed down to pre-procedural levels in group B. The recurrence of AF (6/71 vs 7/39; p = 0.023) significantly decreased in group B relative to group A during the first 6 months after ablation, but there was no significant difference (14/71 vs 9/39; p = 0.598) at the end of the 12-month follow-up period.CONCLUSION:Patients with paroxysmal AF who develop VRs during CPVI might have a decreased recurrence of AF and accelerated MHR in the short-term.

Introduction Allergic rhinitis is a form of IgE mediated inflammation of the nasal mucosa in response to specific allergens, resulting in typical symptoms. Objectives This study was designed with the primary goal of comparing the clinical efficacy of posterior nasal neurectomy with or without pharyngeal neurectomy for the treatment of moderate-to-severe perennial allergic rhinitis. Secondary study aims included a comparison of the severity of comorbidities, including chronic cough and asthma, between patients in these two surgical treatment groups. Methods A total of 52 patients were enrolled in this randomized controlled trial and were assigned to either the control group (posterior nasal neurectomy) or the experimental group (posterior nasal neurectomy + pharyngeal neurectomy). The visual analog scale and rhinoconjunctivitis quality of life questionnaire were used to compare the differences in patient symptoms between baseline and 6-, 12-, and 24-months post-treatment. In addition, patient cough and asthma symptoms were monitored during follow-up via visual analog scale and asthma control test respectively. Results No significant differences in preoperative scores were evident between groups (p> 0.05). At 6-months post-treatment, there were significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, and asthma control test scores relative to baseline values in experimental group and control group patients (p< 0.05), and this remained true upon 12- and 24-month follow-up. No significant differences in visual analog scale, rhinoconjunctivitis quality of life questionnaire, or asthma control test scores were observed between the two treatment groups at any postoperative follow-up time point (p> 0.05), while coughing severity was found to be significantly reduced in the experimental group relative to the control group (p< 0.05). Conclusion posterior nasal neurectomy can be safely implemented with or without pharyngeal neurectomy in order to effectively treat allergic rhinitis. Combined posterior nasal neurectomy and pharyngeal neurectomy treatment may offer greater value than posterior nasal neurectomy alone for the treatment of allergic rhinitis patients with chronic cough.

目的:评价Visitag软件在心房颤动(房颤)环肺静脉电隔离术中的临床疗效.方法:接受导管消融治疗的房颤患者60例,随机分为Visitag组30例及对照组(关闭Visitag模块)30例.记录术中肺静脉隔离时间、X线透视时间、肺静脉单圈隔离率;Visitag组将环肺静脉消融环分为8个节段,记录每个节段消融导管压力数值,计算各节段总的压力平均值.结果:Visi-tag组较对照组提高了PVI的单圈隔离率(P<0.05),但两组间的肺静脉隔离时间、X线透视时间差异无统计学意义(P>0.05),左肺静脉前下嵴部在整个消融过程中贴靠压力最低.结论:环肺静脉电隔离术中利用Visitag软件,可以获得更好的连续性、透壁性组织损伤,提高肺静脉隔离成功率.

Vitamin D deficiency plays an essential role in allergic rhinitis(AR), but the role of vitamin D deficiency in perennial allergic rhinitis (pAR) remains unclear. Therefore, our study explored 25(OH)D levels in patients with pAR and healthy individuals in a single center in China for three years.

OBJECTIVE:This study describes a surgical approach wherein a lobulated pedicled nasal mucosa flap technique was employed for endoscopic dacryocystorhinostomy (EDCR) as a means of treating nasolacrimal duct obstructions. This study also assessed the long-term outcomes of this EDCR approach when implemented without stenting. METHODS:This was a retrospective study of a total of 63 patients (67 eyes) treated for nasolacrimal duct obstructions between January 2011 and November 2016. All patients had undergone ophthalmic diagnosis followed by EDCR treatment using a lobulated pedicled nasal mucosa flap without stenting. Patients were then monitored for both anatomical patency and sustained symptom relief during the follow-up period in order to assess objective and subjective study outcomes. RESULTS:Patients were followed for a mean of 25.3 ± 1.2 months (range: 24-28 months), with a 100% anatomical patency success rate (67/67) and a 94.03% symptomatic cure rate (63/67). There were no instances of complications. CONCLUSIONS:The use of a lobulated pedicled nasal mucosa flap technique for EDCR without stenting is a straightforward, effective, and safe approach that keeps bone exposure to a minimum while offering a high rate of satisfactory outcomes, making it a procedure worthy of consideration as a means of treating patients suffering from nasolacrimal duct obstructions.

Abstract Rationale: Penetrating neck traumas are dangerous and have a high mortality rate, particularly in patients with common carotid artery injuries. Advances in diagnostic imaging technology have shifted management of penetrating neck injuries from mandatory exploration to selective management. The question is now regarding optimal selection of auxiliary examinations to assess “stability” rapidly and guide clinics in managing such patients. Patient concerns: A 56-year-old man suffered neck trauma with the right common carotid artery caused by a percussive drill. The carotid artery could not be clearly displayed in computed tomography (CT) angiography imaging. Diagnoses: Penetrating neck trauma due to percussive drill bit with common carotid artery injury. Interventions: X-ray and bedside duplex ultrasound with color Doppler flow imaging were used to assess the state of trauma and the foreign body was removed under general anesthesia. Outcomes: The patient was discharged at postoperative day 10 with no complication. The patient had no sequelae from this injury at 6-month follow up. Lessons: X-ray provides a comprehensive assessment of damage, and can efficiently detect foreign bodies in the skull and cervical vertebrae. Duplex ultrasound to be a viable method to exclude macrovascular injury in unstable patients who are not eligible for computed tomography angiography (CTA) or catheter angiography imaging. Widely available duplex ultrasound and x-ray should be considered in emergency situations.