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PURPOSE: The etiology of postmenopausal recurrent urinary tract infection (UTI) is not completely known, but the urinary microbiome is thought to be implicated. We compared the urinary microbiome in menopausal women with recurrent UTIs to age-matched controls, both in the absence of acute infection. MATERIALS AND METHODS: This is a cross-sectional analysis of baseline data from 64 women enrolled in a longitudinal cohort study. All women were using topically applied vaginal estrogen. Women >55 years of age from the following groups were enrolled: 1) recurrent UTIs on daily antibiotic prophylaxis; 2) recurrent UTIs not on antibiotic prophylaxis; and 3) age-matched controls without recurrent UTIs. Catheterized urine samples were collected at least 4 weeks after last treatment for UTI and at least 6 weeks after initiation of vaginal estrogen. Samples were evaluated using expanded quantitative urine culture (EQUC) and 16S rRNA gene sequencing. RESULTS: With EQUC, there were no significant differences in median numbers of microbial species isolated among groups (p=0.96), even when considering Lactobacilli (p=0.72). However, there were trends towards different Lactobacillus species between groups. With 16S rRNA sequencing, the majority of urinary samples contained Lactobacilli, with non-significant trends in relative abundance of Lactobacilli among groups. Using a Bayesian analysis, we identified significant differences in anaerobic taxa associated with phenotypic groups. Most of these differences centered on Bacteroidales and the family Prevotellaceae, though differences were also noted in Actinobacteria and certain genera of Clostridiales. CONCLUSIONS: Associations between anaerobes within the urinary microbiome and postmenopausal recurrent UTI warrants further investigation.

The high prevalence of somatic symptom disorder (SSD) led to cumulative burdens to the medical system. However, the pathogenesis of this disease still remains unclear. Graph theoretical analysis discovered altered network topology across various psychiatric disorders, yet alteration in the topological structure of brain functional network in SSD patients is still unexplored. Catastrophizing is a common cognitive distortion in SSD. We hypothesize that the network topological metrics of SSD should be altered, and should correlate with catastrophizing scales. 32 medication-naïve, first-episode SSD patients and 30 age, gender matched HCs were recruited. The 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA) and Cognitive Emotion Regulation Questionnaire (CERQ) were accessed. Functional MRI were scanned and brain functional networks were constructed based on 166 anatomically cerebrum regions from the automated anatomical labeling 3 (AAL3) template. Network topological metrics were calculated and compared between the two groups. Correlation between these metrics and clinical scales were also calculated. Network global efficiency of SSD was significantly lower than that of HC. Nodal global efficiency of the left subgenual anterior cingulate cortex (sgACC) of SSD was significantly lower than that of HC. FCs between the left sgACC and other 21 seed nodes were significantly declined in SSD in comparison with HC. In SSD group, HAMD total score was significantly negatively correlated with the connection between the left medial superior frontal gyrus and the left sgACC. CERQ catastrophizing score was significantly negatively correlated with nodal global efficiency of left sgACC and with the FCs between the left sgACC and other 13 seed nodes. Catastrophizing could reflect the specific sgACC-centered dysfunction of brain network global efficiency of SSD. The left sgACC may be a future treatment target of dealing with catastrophizing, which is a core cognitive distortion of SSD.

Purpose. To evaluate long-term outcomes and complications of sutured scleral-fixated foldable intraocular lens (IOL) implantation. Design. Retrospective study. Methods. Patients who underwent sutured scleral-fixated foldable IOL implantation using 10-0 polypropylene suture were followed up for at least 5 years at one Chinese tertiary hospital and two primary hospitals. Results. 52 eyes among 48 patients (35 male and 13 female) were evaluated. The mean age (years) was 50.27 ± 20.08 (range: 6 to 81). The mean postoperative follow-up time (months) was 79.70 ± 18.84 (range: 60 to 121). The mean best-corrected visual acuity (BCVA) improved from 0.83 ± 0.69 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.50 ± 0.45 logMAR at the last follow-up visit. There was improved or unchanged BCVA in 44 eyes (84.62%) and reduced BCVA in 8 eyes (15.38%). Mild intraoperative intravitreal hemorrhage was observed in 3 eyes (5.77%). Early postoperative complications included transient elevated intraocular pressure (IOP) in 5 eyes (9.62%) and hypotony in 1 eye (1.92%). Secondary epimacular membrane occurred in 5 eyes (9.62%) and retinal detachment (RD; 3 years postsurgery), subconjunctival suture knot exposure (5 years postsurgery), and persistent elevated IOP (in a GRAVES patient) occurred in 1 eye (1.92%) each. No suture erosion or breakage nor IOL dislocation was observed. No visually threatening IOL tilt or decentration was reported in any patient. Conclusion. Sutured scleral-fixated foldable IOL implantation demonstrated satisfactory long-term outcomes and rare suture-related complications. This technology was safe and did not require complicated equipment and is of considerable interest in the setting of aphakia without adequate capsule support.

Recurrent urinary tract infections (UTI) are highly prevalent in postmenopausal women, where vaginal estrogen and prophylactic antibiotics are used for treatment. The etiology of recurrent UTIs is not completely known, but the urinary microbiome is thought to be implicated. Thus, we aimed to compare the “steady state” urinary microbiome in three groups of menopausal women who were all using topically-applied vaginal estrogen: 1) women with recurrent UTIs on daily antibiotic prophylaxis; 2) women with recurrent UTIs not on antibiotic prophylaxis; and 3) age-matched controls without recurrent UTIs. Here we present a cross-sectional analysis of baseline data from 64 women enrolled in a longitudinal cohort study. Catheterized urine samples were collected > 4 weeks after last treatment for UTI. Samples were evaluated using expanded quantitative urine culture (EQUC) and 16S rRNA gene sequencing. With EQUC techniques, there were no significant differences in the median numbers of microbial species isolated among groups (p=0.96), even when considering Lactobacilli (p=0.72). However, there were trends towards different Lactobacillus species between groups. With sequencing the overwhelming majority of urinary samples contained Lactobacilli, with non-significant trends in relative abundance of Lactobacilli among groups. Using a Bayesian regression analysis for compositional data, we identified significant differences in anaerobic taxa that were associated with phenotypic groups. Most of these differences centered on Bacteroidales and the family Prevotellaceae, though differences were also noted in Actinobacteria and certain genera of Clostridiales. Associations between anaerobes within the urinary microbiome and recurrent UTI warrants further investigation.IMPORTANCEIn menopausal women with recurrent urinary tract infections (UTIs) compared to those without, the abundance of Lactobacillus within the urinary microbiome is not significantly different when vaginal estrogen is regularly used. In this population, Lactobacillaceae were identified in 97% of urine samples using culture-independent techniques. However, with expanded urine cultures, women with recurrent UTIs taking daily antibiotics had a disproportionately low amount of L. gasseri/L. acidophilus compared to the other phenotypic groups. These findings support the theory that certain Lactobacillus species may be more important than others in the pathophysiology of postmenopausal recurrent UTIs. Furthermore, when using culture-independent techniques to explore urinary microbiota across phenotypic groups, we identified differences in multiple anaerobic taxa. Taken together, these results suggest that altered ratios of anaerobes and certain Lactobacillus species within the urinary microbiome may be implicated in postmenopausal recurrent UTI.

IntroductionThe detection rate of somatic symptom disorder (SSD) in general hospitals is unsatisfactory. Self-report questionnaires that assess both somatic symptoms and psychological characteristics will improve the process of screening for SSD. The Somatic Symptom Scale-China (SSS-CN) questionnaire has been developed to meet this urgent clinical demand. The aim of this research is to validate the self-reported SSS-CN as a timely and practical instrument that can be used to identify SSD and to assess the severity of this disorder.Methods and analysisAt least 852 patients without organic disease but presenting physical discomfort will be recruited at a general hospital. Each patient will undergo aDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5)-guided physician diagnosis, including disease identification and severity assessment, as the reference standard. This research will compare the diagnostic performance of the SSS-CN for SSD, the Patient Health Questionnaire-15 (PHQ-15) and other SSD-related questionnaires. Statistical tests to measure the area under the curve (AUC) and volume under the surface of the receiver operating curve will be used to assess the accuracy of the SSD identification and the severity assessment, respectively. In addition to this standard diagnostic study, we will conduct follow-up investigations to explore the effectiveness of the SSS-CN in monitoring treatment effects.Ethics and disseminationEthical approval was obtained from the Renji Hospital Human Research Ethics Committee, approval number 2 015 016. The findings of this study will be disseminated via peer-reviewed journals and presented at international conferences.Trial registration numberNCT03513185.

Aims Frequent premature atrial contractions (PACs) are associated with increased risk of atrial fibrillation (AF), stroke, and death. This study aimed to explore the electrophysiological features of PACs with and without inducing AF and to evaluate the effectiveness of catheter ablation for PACs. Methods and results Thirty-five consecutive patients with symptomatic, frequent, and drug-refractory PACs in the absence of AF (group A) and 35 patients with PACs-induced AF (group B) were enrolled. Coupling intervals (CoIs) of PACs were compared. Premature atrial contractions were mapped by the point-by-point and/or circular mapping technique. Focal ablation or pulmonary vein/superior vena cava isolation was applied as appropriate. A total of 35 ectopic foci were identified in group A. The majority of them were at pulmonary vein (PV) ( n = 7), crista terminalis ( n = 6), and para-Hisian area ( n = 6). In group B, ectopic foci were in left-sided PVs in 21 patients, in right-sided PVs in 13 patients, and in SVC in 1 patient. There was significant difference in CoIs of PACs triggering AF and those from PVs and non-PV areas but without causing AF (362.8 ± 23.0 ms vs. 470.6 ± 60.1 ms vs. 515.6 ± 77.2 ms, P < 0.001). Premature atrial contractions were abolished in 32 of 35 patients from group A and in all patients from group B. At the end of follow-up, 29 patients in group A and 28 patients in group B were free of recurrence (off antiarrhythmic drugs) after the initial ablation ( P = 0.97). Conclusions Frequent PACs in the absence of AF were characterized as having their predilection sites and longer CoIs than those inducing AF. Catheter ablation was effective to eliminate symptomatic, frequent, and drug-refractory PACs.

Circulating primary bile acid was involved in the regulation of cardiac ionic channel currents and ventricular myocyte apoptosis, but it was unknown whether or not it played a role in structural remodeling of AF. This study was aimed to testify the hypothesis that elevated chenodeoxycholic acid (CDCA) concentration correlated with left atrial low voltage area (LVA) and could induce apoptosis of atrial myocytes in AF. Serum concentrations of 12 types of bile acids were determined in patients with paroxysmal (n = 21), persistent AF (n = 20), and type A pre-excitation and paroxysmal supraventricular tachycardia (PSVT) (n = 19) and were correlated with LVA in AF, which was obtained by electroanatomical mapping during ablation. Additionally, the impact of CDCA incubation on apoptosis of mouse atrial myocytes was evaluated. Serum levels of CDCA and cholic acid were significantly higher in AF than in PSVT. CDCA serum concentration was significantly higher in persistent AF than in paroxysmal AF. CDCA serum level was positively correlated with the size (r = 0.78, P

The prevalence, risk factors of left atrial low voltage areas (LVA) in paroxysmal atrial fibrillation (PAF) and the impact of LVA on the effectiveness of circumferential pulmonary vein isolation (CPVI) were not fully clarified.One hundred fifty patients (mean age 64.7 years, 89 males) with PAF were consecutively enrolled to undergo CPVI. Prior to ablation a contact force sensing ablation catheter was utilized for LVA mapping in sinus rhythm. The patients were graded based on the proportion of LVA (LVA%): non LVA, mild (LVA% ≤ 10%), moderate (LVA% 10%-20%) and severe (LVA% ≥ 20%), and were followed up for 12 months after initial CPVI.There were 56 in non LVA, 54 in mild LVA, 22 in moderate LVA and 18 in severe LVA. The prevalence of LVA was 62.7% in this PAF cohort, with the most frequent localization at anterior free wall (35.3%), PV antrum (22%) and septum (14.7%). Female gender (OR 3.634, 95% CI 1.704-7.751, P = 0.001) and left atrial surface area (LASA) (OR 1.024, 95% CI 1.000-1.048, P = 0.048) were risk factors of LVA. LVA% exceeding10% was associated with poor effectiveness of CPVI. LVA grade (HR 1.633, 95% CI 1.122-2.378, P = 0.011) was an independent predictor for AF recurrence after initial ablation.LVA affected60% of patients with PAF. Female gender and LASA were two risk factors of LVA. LVA grade was an independent predictor for AF recurrence following CPVI.

Background: The aim of this study was to establish a score system derived from clinical, echocardiographic and electrocardiographic indexes and evaluate its clinical value for cardiac resynchronization therapy (CRT) patient selection. Methods: Ninety-three patients receiving CRT were enrolled. A patient selection score system was generated by the clinical, echocardiographic and electrocardiographic parameters achieving a significant level by univariate and multivariate Cox regression model. The positive response to CRT was a left ventricular end systolic volume decrease of ≥ 15% and not reaching primary clinical endpoint (death or re-hospitalization for heart failure) at the end of follow-up. Results: Thirty-nine patients were CRT non-responders (41.94%) and 54 were responders (58.06%). A 4-point score system was generated based on tricuspid annular plane systolic ex­cursion (TAPSE), longitudinal strain (LS), and complete left bundle branch block (CLBBB) combined with a wide QRS duration (QRSd). The sensitivity and specificity for prediction of a positive response to CRT at a score > 2 were 0.823 and 0.850, respectively (AUC: 0.92295% CI 0.691–0.916, p< 0.001). Conclusions: A patient selection score system based on the integration of TAPSE, LS and CLBBB combined with a wide QRSd can help to predict positive response to CRT effectively and reliably.

Background Frequent premature ventricular complexes (PVCs) are associated with a reversible form of LV dysfunction. Objective We performed a meta-analysis to evaluate the effects of catheter ablation on improvement of LV function in patients with frequent PVCs. Methods We searched MEDLINE for cohort studies of patients who underwent catheter ablation of frequent PVCs. LVEF both before and postablation was reported. The endpoints were changes from baseline in both LVEF and LV end-diastolic diameter (LVEDd) postablation. Quantitative analysis of continuous variables was performed according to random effect methods by MetaAnalyst Beta 3.13 software. Association between site of origin (SOO) of PVCs and degree of LVEF improvement was evaluated by meta-regression using STATA V.12.0 software. Subgroup analysis of patients with LV dysfunction at baseline was performed. Results Fifteen studies with a total of 712 patients were included. The mean PVC burden before catheter ablation was 24% (95% CI 19% to 29%). The long-term success rate of PVC ablation ranged from 66% to 90%. The overall mean increase from baseline in LVEF postablation was 7.7% (95% CI 6.1% to 9.4%) and the overall mean decrease in LVEDd was −4.6 mm (95% CI −6.0 to −3.1 mm). Meta-regression showed no significant association of SOO of PVCs with the degree of postablation LVEF improvement. Subgroup analysis showed that the overall mean increase from baseline in LVEF postablation was 12.4% (95% CI 8.1% to 16.6%) and the overall mean decrease in LVEDd was −4.8 mm (95% CI −6.2 to −3.4 mm) in patients with LV dysfunction at baseline. Conclusions Ablation of frequent PVCs improves cardiac function, especially for patients with LV dysfunction.

Background Although left ventricular pacing (LVP) leads to a greater acute hemodynamic response than does biventricular pacing (BVP), the long-term effects are diverse. We aimed to assess the efficacy of LVP and BVP in patients undergoing cardiac resynchronization therapy and determine which patients would benefit more from LVP or BVP. Methods Randomized controlled trials that compared left and biventricular pacing were retrieved from MEDLINE and analyzed for changes in cardiac function and dimensions, cardiac resynchronization therapy response, and electromechanical effects. Results A total of 811 patients were included from 9 trials. After a mean follow-up, a shorter QRS duration (−40.92 milliseconds; 95% confidence interval [CI], −64.50 to −17.34; P = 0.0007), and improved left ventricular dimensions were observed in the BVP group compared with the LVP group. Moreover, the BVP group had a longer 6-minute hall walk (6MHW) test (37.19 m; 95% CI, 4.72 to 69.67; P = 0.02). Conclusion Our results indicate that BVP results in a better electromechanical effect and leads to a better 6MHW test. For all other test criteria, LVP showed a benefit equal to that of BVP. Thus, there is currently insufficient evidence to advocate for LV-only pacing.

Background The early- to mid-term impact of bone-marrow-derived stem cells (BMC) on diastolic function and exercise capacity after acute myocardial infarction (AMI) remains controversial. We performed a systematic analysis to assess whether BMC transfer is related to an early improvement in diastolic function and exercise capacity after AMI. Methods Randomized controlled trials (RCTs) of BMC therapy after AMI were extracted from MEDLINE, EMBASE and CENTRAL and analyzed for a change in tissue Doppler annular early (Ea) and late diastolic (Aa) velocities, mitral inflow E velocity to tissue Doppler Ea ( E /Ea) ratio, exercise time and exercise capacity. Results A total of 365 patients were included from 6 trials. A greater improvement was observed in the E /Ea ratio after 1 year in the BMC group compared to the control group. Additionally, the BMC-treated patients had a larger improvement in exercise time, ventilation/CO 2 production (VE/VCO 2 slope) and respiratory exchange ratio (RER) after 1 year. Conclusion The results indicate that intracoronary BMC treatment in AMI patients leads to a mid-term improvement in diastolic function and exercise capacity.

Background The most effective approach for long-standing persistent atrial fibrillation (LPAF) ablation remained undetermined. Our goal was to explore the heterogeneous left atrial substrate in patients with LPAF and to evaluate the effectiveness of a novel individualized substrate modification (ISM) approach in LPAF ablation. Methods One hundred and twenty-four patients with LPAF were randomized to ISM group ( n =64) or stepwise ablation (SA) group ( n =60). After pulmonary vein isolation, ISM was performed in the ISM group and SA was applied in the SA group. The clinical effectiveness after a single and a repeated procedure was compared. Results The total procedural time was significantly shorter in ISM than that in SA. In the ISM group, mild left atrial substrate was observed in 17 (27.4%), moderate in 26 (41.9%) and severe in 19 (30.6%) patients after successful cardioversion of the 62 patients. The intention-to-treat analysis showed that sinus rhythm was maintained in 65.5% of patients in the ISM group and in 45.0% of patients in the SA group after a single procedure, P =0.04. Atrial tachycardia (AT) recurred in 5 of 22 in the ISM group and in 20 of 33 in the SA group, P =0.01. After a repeated procedure, 75% of patients in the ISM group and 63.3% of patients in the SA group were free of further recurrence, P =0.16. Conclusions Left atrial substrate varied noticeably in patients with LPAF. The ISM approach was superior to SA approach in terms of procedural time, recurrence rate of AT and clinical effectiveness after a single procedure. However, they yielded comparable outcomes after a repeated procedure.

Persistent left superior vena cava (PLSVC) with an absent right superior vena cava (RSVC) is a rare anatomic variation (0.07-0.13%) (1) that is typically asymptomatic and discovered incidentally during device implantation. Serious complications, including PLSVC-like shock, cardiac arrest or angina, can occur during catheterisation, which is likely due to the manipulation of the catheter in the coronary sinus or the perforation of the brachiocephalic vein, which can occur in the absence of the RSVC (2). This report presents a patient with PLSVC and an absent RSVC with no other cardiac abnormalities, who was diagnosed incidentally during pacemaker implantation (PMI). A 65-year-old male patient with hypertension was referred to our clinic for pacemaker implantation. The patient had suffered from vertigo with several presyncopal episodes. A 24-hour Holter revealed a 2:1 second-degree atrioventricular block with an intermittent third-degree atrioventricular block. These results prompted pacemaker implantation. The guidewire did not advance to the RSVC after routine puncture of the left axillary vein. Instead, an acute downward angula- tion was performed on the left side, parallel to the right-sided vena cava. A venogram was performed, and the diagnosis of PLSVC with an RSVC that descended into the coronary sinus (CS) was confirmed (Fig. 1A-D). Two 60-cm leads (Setrox S 60-B active fixation, Biotronik GmbH & Co., Berlin, Germany) were advanced separately in the right