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Background: Cardioneuroablation is an emerging therapy for refractory vasovagal syncope (VVS), but the standard enrollment criterion is undetermined. Mainstream studies empirically enroll patients with cardioinhibitory and mixed types of VVS on the basis of the head-up tilt (HUT). However, a variety of studies have shown that the results of HUT exhibit unpleasant reproducibility.Objective: We aimed to investigate the prognostic value of baseline deceleration capacity in patients with refractory VVS after cardioneuroablation.Methods: This study enrolled 123 patients (mean age 42.2±17.7 years; 54 males [43.9%]) with the diagnosis of VVS, of whom 16 patients had a negative result of HUT (13.0%), 8 (6.5%) had vasodepressive VVS, 32 (26.0%) cardioinhibitory VVS, and 67 (54.5%) mixed VVS. All patients underwent cardioneuroablation that was performed in the left atrium.Results: After a mean follow-up of 4.0±1.1 years, 33 patients experienced syncope/presyncope events (26.8%). Patients with recurrent syncope/presyncope have a lower baseline deceleration capacity level than do those without (8.9±3.2 ms vs 11.3±3.7 ms; P < .001). Each 1-ms increase in deceleration capacity had a 34% (95% confidence interval [CI] 12%-50%) reduced risk of syncope/presyncope recurrence after cardioneuroablation. Nighttime deceleration capacity had the highest discrimination value (area under the curve 0.757; 95% confidence interval 0.657-0.858). At a high-risk threshold of 51% (nighttime deceleration capacity at a cutoff of 9.9 ms), the nighttime deceleration capacity enrollment strategy additionally benefited 18 per 100 patients after cardioneuroablation without syncope/presyncope recurrence as compared with the HUT strategy in decision curve analyses.Conclusion: Baseline nighttime deceleration capacity ≥ 10 ms may act as an indication for cardioneuroablation in patients with refractory VVS. [ABSTRACT FROM AUTHOR]

The authors develop a theory to deal with excess consumption sensitivity and excess equity premium in Samuelson's basic model of optimum consumption and portfolio decisions.

Autoimmune myocarditis, with increasing incidence and limited therapeutic strategies, is in urgent need to explore its underlying mechanisms and effective drugs. Pyroptosis is a programmed cell death that may contribute to the pathogenesis of myocarditis. Nonetheless, no direct evidence validated the role of pyroptosis in autoimmune myocarditis. Lupeol (Lup), a pentacyclic triterpene, possesses various biological activities such as antidiabetic properties. However, the effects of Lup on autoimmune myocarditis and pyroptosis remain unelucidated. This study aimed to reveal the role of pyroptosis in autoimmune myocarditis and explore the protective effects of Lup, and its engaged mechanisms. The experimental autoimmune myocarditis (EAM) mouse model was established by immunization with a fragment of cardiac myosin in Balb/c mice. Lup and MCC950 were administered after EAM induction. The protective effects were assessed by inflammation score, cardiac injury, chronic fibrosis, and cardiac function. Mechanistically, the effects of Lup on the M1 polarization and pyroptosis of macrophages were evaluated. Transcriptome sequencing and molecular docking were subsequently employed, and the underlying mechanisms of Lup were further explored in vitro with small interfering RNA and adenovirus. Administration of Lup and MCC950 alleviated EAM progression. Western blotting and immunofluorescence staining identified macrophages as the primary cells undergoing pyroptosis. Lup inhibited the expression of pyroptosis-associated proteins in macrophages during EAM in a dose-dependent manner. Furthermore, Lup suppressed pyroptosis in both bone marrow-derived macrophages (BMDMs) and THP-1-derived macrophages in vitro. In addition, Lup inhibited the M1 polarization of macrophages both in vivo and in vitro. Mechanistically, the protective effects of Lup were demonstrated via the suppression of the nuclear factor-κΒ (NF-κB) signaling pathway. Transcriptome sequencing and molecular docking revealed the potential involvement of peroxisome proliferator-associated receptor α (PPARα). Subsequently, we demonstrated that Lup activated PPARα to reduce the expression level of LACC1, thereby inhibiting the NF-κB pathway and pyroptosis. Our findings indicated the crucial role of macrophage pyroptosis in the pathogenesis of EAM. Lup ameliorated EAM by inhibiting the M1 polarization and pyroptosis of macrophages through the PPARα/LACC1/NF-κB signaling pathway. Thus, our results provided a novel therapeutic target and agent for myocarditis. [Display omitted] [ABSTRACT FROM AUTHOR]

Stress hyperglycemia has been associated with poor prognosis in patients admitted to the cardiac intensive care unit (ICU). Recently, the stress hyperglycemia ratio (SHR) has been proposed to reflect true acute hyperglycemic. This study aimed to investigate the relationship between SHR and prognosis of patients in the cardiac ICU. A retrospective analysis was conducted on a cohort of 5,564 patients admitted to the cardiac ICU. The participants were divided into seven groups based on their SHR levels. SHR was calculated as admission blood glucose/[(28.7 × HbA1c %) - 46.7]. The primary outcomes of this study were 28-day all-cause mortality. During the follow-up period, 349 (6.3%) patients succumbed within 28 days. A U-shaped correlation between SHR and mortality persisted, even after adjusting for other confounding variables, with a discernible inflection point at 0.95. When SHR surpassed 0.95, each standard deviation (SD) increase corresponded to a 1.41-fold elevation in the risk of mortality (odds ratio [OR]: 1.41, 95% CI: 1.25 to 1.59). In contrast, when SHR fell below 0.95, each SD increment correlated with a significantly reduced risk of mortality (OR: 0.56, 95% CI: 0.34 to 0.91). There was a U-shaped association between SHR and short -term mortality in patients in the cardiac ICU. The inflection point of SHR for poor prognosis was identified at an SHR value of 0.95. • Stress hyperglycemia ratio predicts prognosis in cardiac ICU patients with a U-shaped association for 28-day mortality. • Mild-to-moderate stress hyperglycemia ratio has a protective effect, while deviations increase mortality risk. • A stress hyperglycemia ratio of 0.95 identifies the poor prognosis threshold in this patient population. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation of ganglionated plexus (GP) as cardioneuroablation in the left atrium (LA) has been used to treat vasovagal syncope (VVS).Objective: The purpose of this study was to assess the effects of ablation of GPs on heart rate and to observe the acute, short-term, and long-term effects after cardioneuroablation.Methods: A total of 115 consecutive patients with VVS who underwent cardioneuroablation were enrolled. GPs of the LA were identified by high-frequency stimulation and/or anatomic landmarks being targeted by radiofrequency catheter ablation.Results: During ablation of right anterior ganglionated plexus (RAGP), heart rate increased from 61.3 ± 12.2 bpm to 82.4 ± 14.7 bpm (P <.001), whereas during ablation of other GPs only vagal responses were observed. During follow-up of 21.4 ± 13.1 months (median 18 months), 106 participants (92.2%) had no recurrence of syncope or presyncope. Holter data showed that minimal heart rate significantly increased at all follow-up time points (all P<.05), and mean heart rate remained higher than baseline 12 months after ablation (P = .001).Conclusion: Cardioneuroablation via GP ablation in the LA effectively inhibited the recurrence of VVS. Ablation of RAGP could increase heart rate immediately and for the long term. This unique phenomenon may provide a new potential approach for treatment of neural reflex syncope or bradyarrhythmias. [ABSTRACT FROM AUTHOR]

Background: Ventricular arrhythmias (VAs) originating from the left ventricular anterobasal wall (LV-ABW) may represent a therapeutic challenge.Objective: The purpose of this study was to investigate the delayed efficacy of radiofrequency catheter (RFCA) ablation without an epicardial approach on VAs originating from the LV-ABW.Methods: Eighty patients (mean age 46.9 ± 14.9 years; 47 male) with VAs originating from the LV-ABW were enrolled. After systematic mapping of the right ventricular outflow tract, aortic root, adjacent LV endocardium, and coronary venous system, 3-4 ablation attempts were made at the earliest activation sites and/or best pace-mapping sites. Delayed efficacy was evaluated in patients with acute failure.Results: During mean follow-up of 23.8 ± 21.9 months (range 3-72 months), complete elimination of all VAs was achieved in 47 patients (59%) and partial success in 19 (24%), for an overall success rate of 83%. In 25 of 37 patients (68%) with acute failure, VAs were eliminated or significantly reduced (>80% VA burden) by the delayed effect of RFCA during follow-up. Logistic regression analysis revealed that response time to ablation was a predictor of occurrence of delayed efficacy. No complications occurred during follow-up.Conclusion: Instead of extensive ablation, waiting for delayed efficacy of RFCA may be a reasonable choice for patients with VAs arising from the LV-ABW. [ABSTRACT FROM AUTHOR]

On the basis of syntheses of three heptamethine indocyanines with methyl, ethyl, or p -carboxybenzyl groups on N atoms in the indole rings, nine novel aminoderivatives were designed and synthesized by butylamine, taurine, or benzylamine reacting with the indocyanines for substitution nitrogen for chlorine. The obtained products were purified by SiO 2 column chromatography, and confirmed by ESI-MS and 1 H NMR. Compared to the parents, the aminoderivatives showed blue shifts, larger Stokes shifts, and stronger fluorescence intensity, which were mainly related to the electron-donating ability of the amino substituents in the aminoderivatives. The stronger electron-donating ability of the amino substituents made the maximum absorption wavelengths show greater blue shifts. [ABSTRACT FROM AUTHOR]

Background: This study attempted to convert atrial fibrillation (AF) to sinus rhythm using a stepwise linear catheter ablation approach.Methods: One hundred and ninety-six patients (43 with persistent AF) were enrolled in the study. A multiple electrode array was used for anatomical navigation and activation mapping. Continuously incremental stimulation was used to induce AF if spontaneous AF was not present. Stepwise linear ablation was applied until AF was converted to sinus rhythm or atypical atrial flutter (AAFL) or atrial tachycardia (AT). The stepwise approach initially utilized a figure-7 lesion line between the right and left superior pulmonary vein on the roof of the left atrium and then extended along the ridge between the left appendage and the left pulmonary veins until the mitral valve annulus, as the primary lesions. If AF still persisted, high-frequency potentials in the inferior left atrium, coronary sinus, or right atrium were targeted. Noninducibility of AF was used as the end point.Results: AF was converted to sinus rhythm in 81.6% of patients (90.8% of paroxysmal and 51.1% of persistent AF, P<.01). The remainders of patients were converted to AAFL or AT. AF was terminated after ablation in right atrium in 7 patients. During an 18.2+/-7.3 month follow-up, 88.3% of patients were free of atrial tachyarrhythmias without medication, 9.7% of patients had refractory AAFL/AT, and only 2.1% of patients had paroxysmal AF.Conclusion: Stepwise linear ablation is effective in converting AF to sinus rhythm and the figure-7 lesion line should be the basic lesion. Right atrium ablation is necessary in some patients. [ABSTRACT FROM AUTHOR]

Cardioneuroablation is an emerging and promising therapy to treat vasovagal syncope (VVS). The aim of this study was to assess the characteristics of vagal response (VR), heart rate (HR), and blood pressure (BP) during cardioneuroablation with different sequences of ganglionated plexus (GPs) catheter ablation and clarify the regulatory mechanism of cardiac GPs of the left atrium. A total of 28 patients with VVS who underwent cardioneuroablation were prospectively enrolled and randomly assigned to 2 groups according to the ablation order of GPs. Group A: Left superior GP (LSGP) - Left inferior GP (LIGP) - Right inferior GP (RIGP) - Right anterior GP (RAGP); Group B: RAGP - LSGP - LIGP - RIGP. In Group A, the VR in LSGP, LIGP, RIGP, and RAGP during ablation was observed in 11 (78.6%), 5 (35.7%), 4 (28.6%) and 2 (14.3%) cases, respectively. In contrast, in Group B, the VR in RAGP, LSGP, LIGP, and RIGP was observed in 2 (14.3%), 1 (7.1%), 0 (0%) and 0 (0%) cases, respectively. BP reduction during procedure was observed eight times in Group A and once in Group B (P = 0.013). In both groups, the HR increased significantly during ablation of the RAGP (all P < 0.001). The sequence of GPs ablation during cardioneuroablation affected the occurrence rate of VR and BP reduction during cardioneuroablation. The RAGP was a critical target to increase HR and inhibit VR and BP reduction during procedure, indicating that it may be a key GP in regulation of the cardiac vagal activity. [ABSTRACT FROM AUTHOR]

• Proposed A new fluid technology for EOR in heterogeneous reservoirs. • The fluid can actively plug high-permeability areas to divert flooding agents. • The surfactant and polymer components in the fluid can enhance overall EOR effects. • The fluid system contains no solid phase, which minimizes formation damage. Conventional water flooding and polymer flooding are common approaches to improve oil recovery. However, flooding agents injected into heterogeneous reservoirs preferentially enter the seepage channels in high-permeability zones. As a result, it is difficult to displace the hydrocarbons in low-permeability areas. Therefore, using the agents with selective plugging capability to block the high-permeability channels and promote the subsequent displacement in the low-permeability area has become a potentially preferable solution for enhanced oil recovery (EOR) in heterogeneous reservoirs. In this study, the techniques and mechanisms of the novel fuzzy-ball fluid for enhancing oil recovery in heterogeneous reservoirs are discussed. Laboratory tests were conducted using 45 mm × 45 mm × 300 mm artificial cores with permeability ranging from 200 to 1200 mD to simulate the formation channels. Two cores with different permeabilities were connected in parallel to simulate the heterogeneous formations. The oil displacement performance of fuzzy-ball fluid was compared with that of polymer and surfactant fluids. Flooding the cores with fuzzy-ball fluid could significantly increase the oil recovery rate of the low-permeability cores. Field tests were conducted in two polymer injection wells located in a heterogeneous conglomerate reservoir in Karamay Oilfield, China. After fuzzy-ball fluid flooding, the average daily liquid production rate decreased, the average daily oil production rate increased and the overall water content decreased. There was a significant improvement in oil displacement effect in low-permeability areas. [ABSTRACT FROM AUTHOR]

Long-term zonal isolation is crucial for the development of fossil hydrogen energy, while efficient filter cake removal is the basis for successful zonal isolation. However, enhanced filter cake removal usually relies on adding chemicals into preflush fluid, which are potential pollutants to the environment. In this study, engineering parameter optimization is used to realize enhanced filter cake removal. Firstly, filter cake removal was identified as multiple-phase fluid flow, and a new three-fluid numerical model was established accordingly. The effects of five engineering parameters on the removal efficiency were simulated and the results showed that borehole enlargement and casing eccentricity reduced removal efficiency. The critical borehole deviation angle and casing rotation speed for optimal removal efficiency were 45° and 40 rpm, respectively, while the removal efficiency monotonously increased with flushing velocity. After all engineering parameters were optimized, the maximum removal efficiency was as high as 89.34%, which was comparable to that achieved by using potentially polluting chemicals. The borehole enlargement rate was identified as the most sensitive parameter, followed by casing eccentricity, flushing velocity, borehole deviation angle, and casing rotation speed subsequently. Two empirical models to predict removal efficiency were developed for convenient field application. Briefly, the complex removal behaviors of the filter cake are better understood for reducing the risks of failed zonal isolation and avoiding chemical overuse, which potentially contributes to the cleaner and more environment-friendly production of fossil hydrogen energy. [Display omitted] • Filter cake removal in the annulus is considered as a fluid flow problem. • Empirical models are to predict removal efficiency for practice. • Borehole enlargement rate is the most sensitive engineering parameter. • After engineering parameter optimization, removal efficiency can reach 89.34%. • Removing filter cake by engineering parameter optimization is an eco-friendly way. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • As preconditions, fuzzy ball fluids can overcome the challenge of CBM well drilling. • The drilling fluids can restore the ecosystems and the soil resources. • The nature of fuzzy ball drilling fluids is environmentally friendly. • Solidification landfill is technically & economically efficient for waste disposal. • The friendliness relies on material, structural and functional basis. Abstract To protect the vulnerable ecosystems in coalbed methane(CBM) well plants from the pollution of drilling fluids, the environmental friendliness of fuzzy-ball drilling fluids was evaluated. Further, the combination of solidification and in-situ landfill were proposed to optimize their waste disposal. Firstly, the samples for tests were collected from the well plants. Then, their environment-related properties were evaluated with the indicator vector from wastewater perspective to monitor their environmental friendliness. Lastly, comparative analysis of two wells in Linfen, China was conducted concerning engineering and economic parameters. Results showed that these indicators of the new fuzzy-ball drilling fluids and their raw materials were within the ceiling limits of related national standard, whereas those of waste fuzzy-ball drilling fluids exceeded the limits. The mechanical strengths of the waste drilling fluids solidified directly could meet the practical transport demand, and their leachates met the standardized requirements due to the strong biodegradability of fuzzy-ball fluids. Field studies demonstrated the economic effectiveness of fuzzy-ball drilling fluids, reconciling the conflict between environment-protecting and cost-reducing. In conclusion, fuzzy-ball drilling fluids are feasible for fragile ecosystem protection in CBM well plants. The environmental friendliness relies on their material, structural and functional basis. [ABSTRACT FROM AUTHOR]

• Permeability measurement is for evaluating CBM formation damage by working fluids. • Statistical screening algorithm is developed for screening. • Cuttings pulse decay method is optimal. • Constant flowrate method is also acceptable. • The suitability relies on CBM characteristics and measurement principles. The existing laboratory methods have limitations that make it very difficult to select the most suitable method for obtaining precise permeability measurements for evaluating reservoir formation damage. To date, there has been no research critically addressing this issue. In this study, the permeabilities of core or cuttings samples taken from No.15 Reservoir in the Qinshui Basin before and after damage caused by drilling and fracturing fluids were randomly measured using six general laboratory methods. Their average permeability values, as well as the extent of absolute and relative formation damage, were calculated and analyzed using a simple ranking method, statistical screening algorithm, and theoretical method. The results show that, first, there is a regular distribution of absolute reservoir damage measured by the laboratory methods; and second, the application priority of permeability measurement methods for formation damage evaluation in coal bed methane reservoirs is as follows: cuttings pulse decay method > constant flow rate method > nuclear magnetic resonance method > plunger pulse decay method = pressure oscillation method = constant pressure method. The cuttings pulse decay method is therefore recommended for measuring core matrix damage, while the constant flow rate method is suggested for measuring overall damage to core samples. [ABSTRACT FROM AUTHOR]

The ablation therapy for persistent atrial fibrillation (PerAF) is still a challenge due to the high recurrence rate. This study was aimed to investigate the value of extensive linear ablation with contact force sensing techniques for PerAF. A total of 214 patients with PerAF were enrolled in five centers. The patients were randomly assigned to Group I (PVI + LA roof line+ LA anterior wall line) and Group II (PVI + LA roof line), mitral valve isthmus lines were added in both groups if the atrial fibrillation (AF) could not be terminated after all approaches above. Acute success rate of AF termination during the ablation procedure in Group I was significantly higher than Group II (P = 0.028). Two-years follow-up showed no significant difference in the sinus rhythm maintenance rate between the two groups (63.4% in group I vs. 57.2% in group II, P = 0.218). More patients in Group I recurred as organized atrial tachycardia (AT) and can be precisely mapped during repeat ablation procedures (15 vs. 2, P = 0.001). The Kaplan–Meier estimates of AF/AT-free survival after repeat ablation procedures were 76.2% in Group I and 47.1% in Group II (P = 0.039). Extensive linear ablation with contact force monitoring did not improve the long-term outcomes for PerAF patients. Repeat ablation procedure showed a possible higher chance of sinus rhythm restoration during follow-up. • Extensive linear ablation increased the rate of AF termination during procedure. • This strategy did not increase success rate at 24 months after single ablation. • This strategy increased sinus rhythm restoration after repeat ablation procedure. [ABSTRACT FROM AUTHOR]

Conventional industry standards (CIS) or methods that rely on the permeability indicator are incapable of directly and precisely evaluating the working fluid damage in multi-layer reservoirs as a whole via Darcy equation and fail to represent the characteristics of gas flow through the reservoir under an in-situ stress state. In this study, we proposed a flow rate method that was based on theoretical derivation and test parameter optimization to overcome these deficiencies. The rationality of the proposed method was verified through comparative experiments and field case analyses. Results showed that the instantaneous flow rate index was almost equivalent to permeability in characterizing the degree of working fluid damage. Comparing the classification of damage degree with the skin factor, the CIS method was only with a conformity of 25%, while the instantaneous flow rate method was as high as 90%. Although the practicality of the cumulative flow rate index has not been proven, it could be used to comprehensively measure the production loss over a specified period. In conclusion, the proposed flow rate method can effectively reflect the actual reservoir properties and accurately evaluate the overall damage of commingled production reservoirs, then providing better guidance for future development plans. [Display omitted] • Flow rate is feasible for evaluating reservoir damage during commingled production. • Flow rate is a preferred parameter over permeability for multi-layer overall damage. • Optimized test parameters present stress characteristics of different reservoirs. • Flow rate method conforms with skin factor method from well test. [ABSTRACT FROM AUTHOR]

Abstract: A simple and sensitive online field-amplification sample stacking (FASS) pre-enrichment method following by capillary electrophoresis with amperometric detection has been developed for the determination of diuretics, such as indapamide (IDP), hydrochlorothiazide (HCT) and bumetanide (BMTN) in urine. Under the optimum conditions, it was found that the low concentration buffer solution could be used as the diluents for simultaneous field-amplification injection of three diuretics after electrokinetically injecting a short water plug (15kV, 3s). Three analytes could be well separated within 10min in an uncoated fused-silica capillary with H3BO3–Na2B4O7 (BB) buffer solution (pH 8.98). The detection limits (S/N=3) were 9.0ng/mL for IDP, 20ng/mL for HCT and 1.5ng/mL for BMTN, respectively. The detection limits of three diuretics were much lower by FASS than that by conventional sample injection, of which the detection limits were 340, 890 and 330ng/mL for IDP, HCT and BMTN, respectively. Especially, for bumetanide the detection limit was 220-time lower by FASS. The linear ranges of three diuretics were all over three orders of magnitude. The proposed method has been successfully applied to analyze the diuretics in human urine samples without off-column sample pre-concentration. [Copyright &y& Elsevier]