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Objective Methods Results Significance Epilepsy surgery outcomes tend to be judged by the percentage in seizure reduction without considering the effect on specific seizure types, particularly tonic–clonic seizures, which produce the greatest morbidity and mortality. We assess how often focal to bilateral tonic–clonic seizures (BTCS) stop and how often they appear de novo after epilepsy surgery.Analysis of a prospectively maintained epilepsy surgery database between 1986 and 2022 that characterizes the burden of BTCS after resective epilepsy surgery. Patients were stratified according to presence or absence of preoperative BTCS and whether these were active (defined as ≥1 BTCS/year prior to surgery) or remote.A total of 804 patients were followed for a median of 7 years (interquartile range [IQR] = 3–13 years) after epilepsy surgery, most being temporal lobe resections (91%, 95% confidence interval [CI] = 89–93%). At last visit, 72% of patients (95% CI = 69–75%) were seizure‐free for 1 year or more. Of 521 patients with preoperative BTCS, 300 (58%, 95% CI = 53%–61%) no longer had them after surgery. BTCS recurred in 221 patients, but 128 of them (58%, 95% CI = 51%–64%) had no BTCS in the last year of follow‐up. Those patients who continued to experience BTCS after surgery had a median reduction of 92% in yearly BTCS frequency (IQR = 65%–98%, p < .001). Of 283 patients with no preoperative BTCS, 17 developed de novo BTCS (6%, 95% CI = 4%–9%), with a median of 2 BTCS during the entire follow‐up period. Forty‐seven percent (95% CI = 42%–53%) of patients without preoperative BTCS became seizure‐free after surgery, compared with 33% (95% CI = 29–37, p < .001) of patients with preoperative BTCS.Epilepsy surgery markedly reduces or eliminates BTCS, which should have a potential positive impact on morbidity and mortality. This favors offering surgery even if the chance of seizure freedom is not high and calls for a new surgical outcome scale to factor in seizure severity reduction. [ABSTRACT FROM AUTHOR]

This study investigates the quantum features of quantum entanglement (QE) in N-level atomic systems interacting with the thermal state subjected to varying Stark shift (SS) parameters. The N-level atomic system does not move in the presence of the SS interacting with the electromagnetic field. It is observed that a larger value of the SS parameter influences the quantum Fisher information (QFI) of 5-level atomic systems and increases the value of QFI of the 5-level atoms compared to 3- and 4-level atomic systems. The von Neumann entropy (VNE) also increases for the 5-level atoms at different values of the SS parameter. Hence, it is concluded that the SS enhances the VNE of a higher dimensional atomic system such as the 5-level atom. The QE of a higher dimensional atomic system such as the 5-level atom increases with the evolution of time at larger values of the SS parameter, and it also sustains as time progresses. The effect of the SS is more prominent on the 5-level atomic system. When an atom is in motion, in the presence of the SS interacting with the thermal state, the sudden death and birth of QE are observed. The SS environment is favorable for maintaining sudden death and birth of QE, so we can say in the case of a moving N-level atom interacting with the electromagnetic field, the SS supports the QE to maintain and sustain. Hence, non-moving and moving-N-level atomic systems interacting with the electromagnetic field in the presence of the SS are supportive of maintaining and sustaining the QE. [ABSTRACT FROM AUTHOR]

Background: The use of electronic cigarettes (e-cigarettes) as a perceived safer alternative to traditional cigarettes has grown rapidly. However, the cardiovascular risks associated with e-cigarettes compared to regular cigarettes remain unclear. Objective: To systematically review and compare the cardiovascular outcomes of e-cigarette use versus traditional cigarette use, focusing on the risks of myocardial infarction, arrhythmias, and sudden death. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Peer-reviewed studies published in English were included if they reported cardiovascular outcomes related to e-cigarette or traditional cigarette use. A total of 20 studies were included, covering observational and interventional studies focusing on heart rate variability, myocardial infarction, arrhythmias, and sudden cardiac events. The quality of the evidence was assessed using the GRADE criteria, and data were extracted and analyzed based on the PICOS (Population, Interventions, Comparisons, Outcomes, and Study designs) framework. Results: The systematic review found that both e-cigarettes and traditional cigarettes pose significant cardiovascular risks, with traditional cigarettes linked to a higher incidence of myocardial infarction, arrhythmias, and sudden cardiac death. E-cigarette users also face increased risks of arrhythmias and myocardial infarction compared to non-smokers, primarily due to the constituents of aerosolized e-liquid, including nicotine and flavorings, which contribute to adverse cardiac effects. Regular e-cigarette use, particularly in combination with traditional cigarette use, was associated with a heightened risk of myocardial infarction. Studies also reported heart function abnormalities, such as systolic and diastolic dysfunction, and reduced ejection fractions. Additionally, changes in heart rate variability, heart rate, and blood pressure were observed, indicating both acute and chronic effects of e-cigarettes on cardiovascular autonomic regulation. Conclusions: While e-cigarettes may present a lower cardiovascular risk compared to traditional cigarettes, they are not without harm. Both products are linked to increased risks of myocardial infarction and arrhythmias, though traditional cigarettes pose a higher overall threat. Given the limitations in the current evidence base, particularly concerning the long-term effects of e-cigarette use, further research is needed to clarify these cardiovascular risks and inform public health guidelines. [ABSTRACT FROM AUTHOR]

Sudden deaths (SDs) in young people, including competitive athletes, albeit uncommon, are usually attributable to genetic, congenital or acquired cardiovascular conditions. However, it is under-appreciated that mitral valve prolapse (MVP), a relatively common valvular heart disease, is associated with SD in this youthful population. Forty-three MVP-related SDs were identified from 2 large cardiovascular registries with pathologic, clinical, and demographic findings reported. Events occurred in both sexes, but females were unexpectedly common (49%); median age was 22 ± 8 years, and 29 (67%) were engaged in competitive sports, including 17 with preparticipation examination. Of the 43 MVP cases, 21 died suddenly during or just after vigorous exercise, including 6 during organized sports. Sixteen (37%) had been evaluated by a cardiologist, resulting in confirmed MVP diagnosis in 11. Pathologic findings characteristic of MVP included bileaflet myxomatous involvement (in all cases) and areas of interstitial or replacement myocardial fibrosis (in 79%), most evident in posterolateral left ventricular wall. Arrhythmogenic myxomatous degeneration (MVP) is an under-recognized cause of SD in young people, including competitive athletes, disproportionally affecting females and requires a high index of clinical suspicion. Frequency of left ventricular fibrosis in these young people with MVP suggests a mechanism for ventricular tachyarrhythmias and SD, relevant to future risk stratification. [ABSTRACT FROM AUTHOR]

The role of sickle cell trait (SCT) in sudden exertional death is well‐recognized in sports and military training. However, it is not yet studied for non‐firearm arrest‐related death (NF‐ARD). With extensive multi‐pronged searches, a large database (n = 1389) of NF‐ARDs was established. For the years 2006–2021 (inclusive) there were 50 NF‐ARDs of Black persons in which postmortem evidence of SCT was found. A control cohort consisted of 414 NF‐ARDs of Black persons with no reported SCT. The mean age for SCT cases was 33.1 ± 10.4 years versus 37.0 ± 10.4 years for the control group (p = 0.01). The body‐mass index for SCT cases was 28.3 ± 6.6 kg/m2 versus 30.7 ± 7.6 kg/m2 for the control group (p = 0.03). The prevalence of cardiomegaly was 21% for SCT cases versus 39% in the control cohort (p = 0.008). The postmortem prevalence of SCT in NF‐ARDs of Black persons (n = 50, 10.7%) was higher than the prevalence of SCT in the US Black population, which is 7.1% (p = 0.003). In this study of NF‐ARDs in Black persons, the prevalence of SCT and the differences between the SCT cases and the control cohort suggest that exertional collapse associated with sickle cell trait may be a contributory factor in NF‐ARDs. [ABSTRACT FROM AUTHOR]

Sudden unexpected death in the young (SUDY) is defined as the rapid, unsuspected demise of an apparently healthy individual between the ages of one and 40 years. There is a gap in research pertaining to this population in a South African context. This retrospective study aimed to explore the burden, scope of post-mortem investigation, and risk factors of SUDY admissions to Salt River Mortuary (SRM) in Cape Town between 1 January 2010 and 31 December 2019. Medico-legal case files pertaining to SUDY cases from SRM were reviewed. SRM received a total of 34 601 admissions in the 10-year period; of which 1 997 (5.77%) were SUDY cases. Nearly two-thirds (62.59%) of the SUDY admissions were male. The leading cause of death was pneumonia (17.11%), and the most prevalent organ system implicated in cause of death was the pulmonary system (45.19%). At least 32.46% of SUDY cases were infectious-related, with varying degrees of confidence. A large proportion of cases had no history of acute or chronic illness (45.43%), and no family history of illness (56.66%). In total, 52 potential candidates were identified for a molecular autopsy, of which 47 have stored biological samples for future investigations. This study advocates for the routine performance of post-mortem ancillary microbiological and toxicological testing in cases of SUD, considering the large burden of infectious disease and substance abuse in South Africa. The retention of biological samples in undetermined or non-specific natural cases is also urged, to allow for cause of death determination on a molecular level. [ABSTRACT FROM AUTHOR]

Sudden unexplained death (SUD) can affect apparently healthy adolescents and young adults with no prior clinical symptoms and no clear diagnostic findings at autopsy. Although primary cardiac arrhythmias have been shown to be the direct cause of death in the majority of SUD cases, the genetic predisposition contributing to SUD remains incompletely understood. Currently, molecular autopsy is considered to be an effective diagnostic tool in the multidisciplinary management of SUD, but the analysis focuses mainly on the coding region and the significance of many identified variants remains unclear. Recent studies have demonstrated the strong association between human disease and genetic variants in untranslated regions (UTRs), highlighting the potential role of UTR variants in the genetic predisposition to SUD. In this study, we searched for UTR variants with likely functional effects in the exome data of 45 SUD cases. Among 244 genes associated with cardiac diseases, three candidate variants with high confidence of pathogenicity were identified in the UTRs of SCO2, CALM2 and TBX3 based on a rigorous filtering strategy. A functional assay further validated the effect of these candidate variants on gene transcriptional activity. In addition, the constraint metrics, intolerance indexes, and dosage sensitivity scores of genes affected by the candidate variants were considered when estimating the consequence of aberrant gene expression. In conclusion, our study presents a practical strategy for UTR variant prioritization and functional annotation, which could improve the interpretation of molecular autopsy findings in SUD cohorts. [ABSTRACT FROM AUTHOR]

Postmortem analysis of C-reactive protein (CRP) in autopsies has been extensively researched for its potential utility. This analysis could aid forensic pathologists in screening for and investigating the potential infectious or inflammatory causes of death, thereby guiding appropriate autopsy procedures. To assess the diagnostic accuracy of postmortem CRP analysis in autopsy settings, a thorough electronic literature search was conducted across databases such as PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers screened eligible studies, followed by a methodological quality assessment using the QUADAS-2 checklist. Utilising a random-effects model, hierarchical summary receiver operating characteristic (HSROC) curve analysis and bivariate model meta-analysis were performed to evaluate heterogeneity across studies. Of the 1286 studies initially identified, nine met the eligibility criteria for the final analysis. The pooled sensitivity of postmortem CRP analysis was 0.93 (95% CI, 0.76, 0.98), with a pooled specificity of 0.80 (95% CI, 0.71, 0.87). The prevalence across studies ranged from 0.23 to 0.68, with a median of 0.5. Moderate variability was observed in the heterogeneity assessment across the primary studies. In summary, the study findings indicate that postmortem serum CRP analysis demonstrates high diagnostic accuracy with moderate heterogeneity. Additionally, postmortem CRP testing may be useful as a screening tool in autopsy practice to rule out the likelihood of sepsis. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the prevalence of subclinical cardiomyopathy and cardiac mortality in a research colony of non-purebred cats, established as a model of the wider cat population in New Zealand. Methods: All apparently healthy, compliant, non-pregnant, non-neonatal cats in the colony at the Centre for Feline Nutrition (Massey University, Palmerston North, NZ) underwent physical examination and echocardiography using a 4.4–6.2-MHz probe by a board-certified veterinary cardiologist. Cardiac phenotype was classified following current guidelines. Hypertrophic cardiomyopathy (HCM) phenotype was defined as an end-diastolic left ventricular wall thickness ≥ 6 mm. Colony mortality data from February 2012 to February 2022 was reviewed to determine cardiac mortality. Results: Cats (n = 132; 65 females and 67 males) included in the study had a median age of 4.1 (IQR 3.0–8.0) years. Thirty-two (24%) cats had a heart murmur, and three (2%) cats had an arrhythmia. Echocardiography revealed heart disease in 24 (18.2%) cats, including 23 with an HCM phenotype and one with a restrictive cardiomyopathy phenotype. Of the cats with the HCM phenotype, 3/23 had systemic hypertension or hyperthyroidism or both, and these cats were excluded from the final diagnosis of HCM (20/132; 15.2 (95% CI = 9.5–22.4)%). Between 2012 and 2022, 168 colony cats died, with 132 undergoing post-mortem examination. Heart disease was considered the cause of death in 7/132 (5.3%; 95% CI = 2.2–10.6%) cats; five had HCM, one a congenital heart defect, and one myocarditis. The overall prevalence of death related to HCM in the colony during this period was 3.8% (95% CI = 1.2–8.6%). Three cats with HCM and the cat with a congenital heart defect died unexpectedly without prior clinical signs, while congestive heart failure was observed prior to death in two cats with HCM and the cat with myocarditis. Additionally, 30/132 (22.7%) cats had cardiac abnormalities but died for non-cardiac reasons. Conclusions: Subclinical cardiomyopathy, specifically HCM, was common in cats in the colony. Given that the colony originated as a convenience selection of non-purebred cats in New Zealand, the true prevalence of HCM in the wider New Zealand population is likely to fall within the 95% CI (9.5–22%). The proportion of deaths of colony cats due to HCM was lower (3.8%) supporting the conclusion that subclinical cardiomyopathy may not progress to clinical disease causing death. Clinical relevance: Veterinarians should be aware of the high prevalence of subclinical HCM when treating cats. Abbreviations: CAM: Systolic anterior motion of the chordae tendineae; CFN: Centre for Feline Nutrition; HCM: Hypertrophic cardiomyopathy; LA/Ao: Left atrial to aortic ratio; LV FS: Left ventricular fractional shortening; LVIDd: Left ventricular internal diameters in end-diastole; LVIDs: Left ventricular internal diameter in end-systole; LVWT: Max Maximum left ventricular wall thickness; SAM: Systolic anterior motion of the mitral valve; 2D: Two-dimensional [ABSTRACT FROM AUTHOR]

Case history: Over a period of 2 months in the spring and early summer of 2021, 13 cases of sudden death in cull ewes due to aortic rupture were diagnosed at a small number of New Zealand abattoirs. Clinical findings: In 12/13 (92%) cases, a large blood clot was present in the thorax, and in one case the blood clot was seen in the tissues dorsal to the heart. There were no obvious signs of external trauma. The pluck (heart and lungs) or fixed aorta was submitted for histological examination in seven cases and in all of these, a tear in the aorta was found. Comparing the microscopic appearance of the proximal aorta in these seven cases to three clinically normal ewes from unaffected farms, the aortic wall thickness appeared thinner in the case ewes than the unaffected ewes. Subjectively, there was increased collagen in the tunica media in 3/7 and decreased elastin fibres in 5/7 case ewes compared to the control ewes. Further investigations on the index farm (where the first cases originated), found that the mean liver and serum Cu concentrations in 10 similarly aged, clinically normal ewes were within the normal reference range for New Zealand sheep. Similarly, the liver Cu concentrations of the seven case ewes were within the normal reference range. Diagnosis: Aortic rupture due to an unknown aetiology. Clinical relevance: Clinicians should be aware of this condition as a differential diagnosis for sudden death in older sheep and to assist the Ministry for Primary Industries in establishing the extent of this problem in New Zealand. [ABSTRACT FROM AUTHOR]

Splenic rupture in cattle is scarcely described in the literature. The aim of this work was to report the occurrence of splenic rupture in cattle in southern Brazil as well as to describe the causes of the condition. Between 2013 and 2022, 24 of the 1769 bovine necropsies performed in southern Brazil were due to splenic rupture, accounting for 1.36% of the diagnoses. Animals died due to hemoperitoneum caused by a rupture in the splenic capsule, typically associated with marked splenomegaly and a large hematoma between the capsule and the parenchyma. Clinical signs were described in a subset of cases (11 of 24 cases, 46%) and included apathy, abdominal pain, mucosal pallor, tachycardia, and respiratory distress. However, the majority (13 of 24 cases, 54%) presented as sudden death. The underlying cause of splenic rupture was established as follows: 16 cases (67%) secondary to babesiosis, 4 cases (17%) due to lymphoma, 1 case (4%) due to a thrombus, 1 case (4%) due to external trauma, 1 case due to a ruptured nodular lymphoid hyperplasia (4%), and 1 case of undetermined cause (4%). Hypovolemic shock caused by splenic rupture is an important cause of death of dairy cattle, and babesiosis and bovine leukemia virus–associated lymphoma are among the most common etiologic diagnoses (84% of cases). The description of the causes of this condition is important to clarify the pathogenesis and occurrence of splenic rupture in dairy cattle. [ABSTRACT FROM AUTHOR]

Introduction: Sudden cardiac arrest (SCA) is a critical and lethal emergency, particularly in out-of-hospital settings, with shockable rhythms like ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) presenting significant challenges. Antiarrhythmic drugs, including amiodarone and lidocaine, are commonly used alongside defibrillation to stabilize cardiac rhythms. While amiodarone is the guideline-recommended choice, lidocaine serves as an alternative. Evidence from studies shows both drugs improve hospital admission rates, especially in bystander-witnessed cases, but their impact on survival to discharge and neurological outcomes remains uncertain. This review evaluates the comparative efficacy of these drugs to guide clinical practice and improve resuscitation outcomes. Materials and methods: A thorough literature review was performed using electronic databases such as PubMed, Web of Science, Embase, and Google Scholar. The search strategy employed a combination of keywords, including "lidocaine," "amiodarone," "VF," "ventricular fibrillation," "pulseless ventricular tachycardia," "pVT" and "cardiac arrest." The search was restricted to Englishlanguage articles published from 1970 to 2024. Aim of the study: The aim of this study is to systematically review and compare the efficacy of lidocaine and amiodarone in the treatment of cardiac arrest due to ventricular fibrillation and ventricular tachycardia in adults. This review seeks to evaluate the existing literature to determine the effectiveness and clinical outcomes associated with each medication. Conclusions: The comparative analysis of amiodarone and lidocaine highlights their respective strengths and limitations in managing cardiac arrest, offering valuable insights for clinical practice. Amiodarone stands out as the preferred antiarrhythmic agent due to its significant efficacy in improving short-term outcomes, such as return of spontaneous circulation (ROSC) and survival to hospital admission. Its potential to enhance functional survival further reinforces its role, particularly when administered promptly during resuscitation efforts. In contrast, lidocaine remains a viable alternative, particularly in resource-limited settings or when contraindications to amiodarone exist. However, its limited impact on long-term survival and neurological recovery restricts its broader applicability. Overall, amiodarone's efficacy and broader applicability position it as the first-line agent for shock-refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT). Lidocaine serves as an important alternative in specific scenarios. Future research should aim to optimize antiarrhythmic protocols, improve long-term survival and neurological outcomes, and explore innovative approaches to resuscitation. [ABSTRACT FROM AUTHOR]

Sudden deaths in infants and children represent a profound and tragic event that continues to challenge researchers despite extensive investigation over several decades. The predominant phenotype, sudden infant death syndrome (SIDS), has evolved into the broader category of sudden unexpected infant death (SUID). In older children, a less understood phenomenon known as sudden unexplained death in childhood (SUDC) has garnered attention. Additionally, sudden unexpected death in epilepsy (SUDEP) constitutes a rare but recognized complication of epilepsy. Recent investigations indicate overlapping clinical, neuropathological, and genetic characteristics among SUID, SUDC, and SUDEP. Common features include death occurring during sleep, discovery in the prone position, hippocampal abnormalities, and genetic variations associated with epilepsy or cardiac arrhythmias. Notably, video recordings in certain examples of SUDC have captured ‘convulsive’ episodes preceding death in children without prior seizure history, suggesting that seizures may contribute more significantly to sudden paediatric deaths than previously presumed. This review explores these shared elements, underscoring their importance in formulating possible preventative measures against these devastating conditions. [ABSTRACT FROM AUTHOR]

Lifetime exposures to potentially psychologically traumatic events (PPTEs) among Royal Canadian Mounted Police (RCMP) cadets starting the Cadet Training Program (CTP) appear lower than exposures reported by serving RCMP, but the prevalence of PPTE exposures during the CTP remains unknown. The current study assessed PPTE exposures during the CTP and examined associations with mental disorders among RCMP cadets. Participants were cadets (n = 449, 24.7% women) from the larger RCMP Longitudinal Study who self‐reported critical incidents, PPTE exposures, and mental health disorder symptoms at pretraining and predeployment. Most participants reported no exposures to a PPTE (n = 374, 83.3%) during the CTP. Participants who reported any PPTE exposure (n = 75, 16.7%; i.e., direct or indirect) most commonly reported serious transport accidents, physical assault, and sudden accidental death. The most common direct PPTEs (i.e., “happened to me”) during the CTP were physical assault (n = 13), other unwanted or uncomfortable sexual experience (n = 11), and serious transportation accident (n = 8). The total number of PPTE types reported at predeployment was associated with increased odds of screening positive for any mental health disorder, aOR = 1.22, 95% CI [1.01, 1.49], p = .049, and positively associated with mental health disorder symptoms, ps < .001. These results provide the first assessment of PPTE exposure among RCMP cadets during the CTP, indicating that 16.7% of cadets experience PPTEs directly or indirectly. The PPTEs reported by cadets may help inform additional opportunities to further increase safety during training. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular (LV) pseudoaneurysm is a rare but life-threatening complication following myocardial infarction (MI). Unlike true aneurysms, pseudoaneurysms lack myocardial elements in their structure, which increases the risk of rupture and sudden death. The diagnosis is challenging due to its often subtle and nonspecific symptoms. The high mortality rate associated with untreated pseudoaneurysms highlights the importance of awareness and prompt diagnosis. All patients after MI should receive specialized care and follow-up examinations to prevent unattended states of emergency. Purpose of research: This systematic review aims to discuss a rare complication of MI in a form of LV pseudoaneurysm. Due to its potential asymptomatic course, it is important to highlight the importance of a meticulous clinical and echocardiographic follow-up in all patients with a history of MI. Materials and methods: The study was conducted through search across PubMed and Google Scholar databases, using keywords such as "left ventricular pseudoaneurysm", "myocardial infarction", "post-infarction imagining", "surgical treatment of pseudoaneurysms". The analysis focused on scientific literature with validated insights into the pathophysiology, clinical presentation, diagnostic methods and treatment strategies of the MI complication in a form of left ventricular pseudoaneurysm. Results and conclusions: The potentially fatal consequences of pseudoaneurysm dictate proactive approach in the treatment of patients with a history of MI. Routine follow-up examinations, comprehensive cardiac imaging and a high clinical alertness are essential for early diagnosis. By providing meticulous post-MI care, healthcare professionals can improve patients outcomes and reduce mortality. [ABSTRACT FROM AUTHOR]

Among patients with congenital heart disease, those with single ventricles have the highest risk of early mortality. Sudden cardiac death is an important cause of death in this population. Understanding the risk factors for sudden cardiac events (SCE) in Fontan patients could improve prediction and prevention. The goal of this study was to determine the prevalence of SCE and risk factors for SCE in the Fontan population. The Fontan Outcomes Registry Using CMR Examinations (FORCE) is an international registry collecting clinical and imaging data on Fontan patients. SCE was defined as: 1) cardiac arrest from a shockable rhythm; 2) need for emergent cardioversion/defibrillation; or 3) documented sustained ventricular tachycardia. Univariate and multivariate Cox proportional hazards regression models estimated hazard ratios for predictors of SCE. Our sample included 3,132 patients (41% female). The median age at first cardiac magnetic resonance was 14.6 years. SCE was experienced by 3.5% (n = 109) over a median follow-up time of 4.00 years. Of the 109 patients with SCE, 39 (36%) died. On multivariable analysis, NYHA functional class >II (HR: 4.91; P < 0.0001), history of protein-losing enteropathy/plastic bronchitis (HR: 2.37; P = 0.0082), single-ventricle end-diastolic volume index >104 mL/m2 (HR: 3.15; P < 0.0001), and ejection fraction <50% (HR: 1.73; P = 0.0437) were associated with SCE. Kaplan-Meier analysis demonstrated that in patients with none of the above risk factors, the 4-year freedom from SCE was 99.5%. SCE occurred in 3.5% of the study population, and one-third of patients who experienced SCE died. Mild ventricular dysfunction and dilatation by cardiac magnetic resonance, NYHA functional class, and history of protein-losing enteropathy/plastic bronchitis were associated with SCE. [Display omitted] [ABSTRACT FROM AUTHOR]

Over 200 point mutations in the ryanodine receptor (RyR2) of the cardiac sarcoplasmic reticulum (SR) are known to be associated with cardiac arrhythmia. We have already reported on the calcium signaling phenotype of a point mutation in RyR2 Ca2+ binding site Q3925E expressed in human stem-cell-derived cardiomyocytes (hiPSC-CMs) that was found to be lethal in a 9-year-old girl. CRISPR/Cas9-gene-edited mutant cardiomyocytes carrying the RyR2-Q3925E mutation exhibited a loss of calcium-induced calcium release (CICR) and caffeine-triggered calcium release but continued to beat arrhythmically without generating significant SR Ca2+ release, consistent with a remodeling of the calcium signaling pathway. An RNAseq heat map confirmed significant changes in calcium-associated genes, supporting the possibility of remodeling. To determine the in situ cardiac phenotype in an animal model of this mutation, we generated a knock-in mouse model of RyR2-Q3924E+/− using the CRISPR/Cas9 technique. We obtained three homozygous and one chimera mice, but they all died before reaching 3 weeks of age, preventing the establishment of germline mutation transmission in their offspring. A histo-pathological analysis of the heart showed significant cardiac hypertrophy, suggesting the Q3924E-RyR2 mutation was lethal to the mice. [ABSTRACT FROM AUTHOR]

Jean-Marin Charcot died unexpectedly on August 16, 1893, at the age of 67, while on a journey to the Morvan for a short holiday with colleagues and friends. This article reports in detail circumstances of Charcot’s journey, and his untimely death in a small and modest room in a secluded hotel in the French countryside. In Part 1, I describe the reasons for Charcot’s choice to go on the journey, with an emphasis on his role in the recent and controversial “Panama Affair.” Subsequently, I describe the first days of the vacation journey by train, horse-drawn carriage, and walking as he visited castles, churches, and an archeological museum. During this holiday, Charcot’s companions got to know his great versatility: He was interested in history, antiques, excavations from the prehistory, languages, literature, painting, architecture, nature, and horticulture. In Part 2, I narrate Charcot’s sudden death. Additionally, I pay attention to the different reports in the press, the difficult and long journey of the corpse back to Paris, and the religious funeral, followed by the walk to Charcot’s final resting place in the Montmartre Cemetery. [ABSTRACT FROM AUTHOR]

Dichloromethane is widely used as an organic solvent in aerospace, electronics, and medicine. Cases of poisoning caused by this substance are rare. Recently, we successfully treated a patient with an acute dichloromethane poisoning. During the production process, owing to pipeline leakage and lack of personal protection, the patient was poisoned by dichloromethane inhalation, fell from a height, and experienced a sudden cardiac arrest. After successful cardiopulmonary resuscitation, the patient was transferred to a local hospital for diagnosis and treatment and then to our hospital. After two visits to our hospital for systematic diagnosis and active treatment with fluid infusion, anti-infection therapy, glucocorticoids, ventilator-assisted respiration, chest strap fixation, and nutritional support, the patient achieved clinical recovery. [ABSTRACT FROM AUTHOR]

In recent decades, the prevalence of obesity has increased significantly, leading to an epidemic at the global level. Obesity is associated with various metabolic alterations and increases the risk of cardiovascular disease. The most devastating manifestation of cardiovascular disease is sudden cardiac death (SCD), leading to substantial years of potential life lost worldwide. Obesity-related SCD is an increasingly important public health problem and warrants a specific investigative focus on improved risk stratification and prevention. In this review, we summarize the current evidence regarding management of SCD in obesity and discuss knowledge gaps as well as future directions in this field. [Display omitted] [ABSTRACT FROM AUTHOR]

The unique voice of long-term bereaved siblings has been almost completely ignored in the literature. Using 14 semi-structured in-depth interviews, we examine the perspectives of Israeli siblings on their relationship with their bereaved parents. All informants experienced the sudden death of a brother during his army service and, as a result of the loss, became only children. The findings emphasise the complexity of these relationships, which were characterised by the participants’ experience of lack of recognition and subjective presence on the one hand and the heavy responsibility they feel for their parents on the other. These relational components are evident throughout the bereavement years – regardless of the gender or age of the sibling at the time of death – and were echoed in the social messages bereaved siblings received following the loss. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy is an essential procedure in cases of respiratory failure in patients requiring long-term ventilation or showing airway obstruction. Tracheostomy has both immediate and long-term complications. Among these, tracheo-innominate fistula is an emergency that is a rare long-term complication. When it occurs, this event is catastrophic for the patient's life, as it causes death in a very short time due to hemorrhagic shock. Therefore, it is essential to identify risk factors to prevent these cases. Methods: We describe the autopsy findings in a case of death from tracheo-innominate fistula of a patient admitted to the Intensive Care Unit. Results: The autopsy demonstrated, in addition to the large fistula, the coexistence of a malformation of the cervical spine with a significant increase in the diameter of the neck. Therefore, we emphasize in this case the importance of evaluating risk factors in subjects with tracheostomy by highlighting the role of anatomy and the size of the neck as potential predictable risks. Conclusions: The work retraces through a review the pathogenesis of this rare complication and emphasizes the need for early diagnosis and prevention of the risk of death with specific risk scales. [ABSTRACT FROM AUTHOR]

Pulmonary embolism is the third most common cardiovascular reason for death after myocardial infarction and stroke. The principles of thromboembolic disease prophylaxis are an integral part of care in both surgical and internal medicine. The severity of pulmonary embolism ranges across the spectrum, from completely asymptomatic forms to obstructive shock, where the first and only symptom is sudden death. The mainstay of treatment for low- and intermediate-risk patients is anticoagulation therapy. For high-risk patients, effective thrombolytic therapy is available, but it has a number of contraindications and, even if these are respected, carries a risk of bleeding, including fatal. Until recently, the only alternative, cardiosurgical embolectomy, is now being replaced by widening spectrum of cathetrization techniques. [ABSTRACT FROM AUTHOR]

Many theories attempt to explain the determinants of preferential trade agreements (PTAs) and their design. Existing accounts, however, focus almost exclusively on structural or domestic factors and ignore individual leaders. In this paper, I develop and test novel theoretical claims regarding executive leaders' prior career in business and their trade cooperation policy once in office. I construct a new dataset on the heads of the executive's business managerial experience and test my main claims in a time-series-cross-sectional setting covering 185 countries from 1948 to 2009. To establish causality, I rely on an instrumental variable strategy and leverage exogenous transitions due to sudden deaths or terminal illness in office. The results show that businesspersons-turned-politicians are more likely to enter PTAs and are more likely to sign deeper PTAs. The relationship is further investigated in an illustrative case study of the 1988—Canada trade deal. The substantive effect of business experience is comparable to that of established factors in the literature, such as regime type, and is robust to numerous tests, specifications, subsamples, and measurements of business experience. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection is associated with increased cardiovascular (CV) morbidity and mortality, manifesting as increased adverse outcomes in the first 30 days, extending to 12 months. This study aimed to investigate trends in sudden unexpected deaths between 2018 and 2022, with a focus on CV deaths. A retrospective analysis was performed on autopsy reports (n=9,330) obtained from New South Wales Coroners Court, Australia, specifically targeting cases of unexplained deaths that occurred between 2018 and 2022. Statistical analysis was conducted using chi-square tests and a post hoc analysis with Bonferroni correction, as well as analysis of variance with multiple comparisons. There were 349 (18.3%) CV deaths in 2018, 346 (18.0%) in 2019, 338 (17.5%) in 2020, 395 (21.9%) in 2021, and (23.4%) 413 in 2022 (p=0.0002). Among CV deaths, the number of deaths from sudden arrhythmic death syndrome were 25 (7.2%) in 2018, 26 (7.5%) in 2019, 18 (5.3%) in 2020, 52 (13.2%) in 2021, and 80 (19.4%) in 2022 (p=0.0001). Atherosclerosis was the most common cause of death among all CV categories; there were 196 (56.2%) atherosclerosis deaths in 2018, 207 (59.8%) in 2019, 192 (56.8%) in 2020, 221 (56.0%) in 2021, and 197 (47.7%) in 2022 (p=0.43). The average age of death from sudden arrhythmic death syndrome (42.8±19.1 years) across 2018–2022 was younger than atherosclerosis (56.2±12.4 years) and total groups (53.1±15.1 years) (p<0.001). Males comprised 76% of all CV deaths from 2018 to 2022 (p<0.0001). Compared with pre-pandemic data, a noteworthy increase in CV deaths was observed in occurrence with the escalation in COVID-19 cases in Australia. This may be attributed to direct or indirect factors, such as lifestyle modifications, disrupted access to routine cardiac care, or COVID-19 infection–triggered CV deaths. [ABSTRACT FROM AUTHOR]

Western white pine (Pinus monticola) with genetic tolerance to white pine blister rust disease caused by Cronartium ribicola constitutes an invaluable resource for the mitigation of this disease as well as the restoration of the species and its utilization in managed forests. In the last several years, typical root-rot symptoms and sudden tree death have been observed in some western white pine plantations located in British Columbia (BC) in Canada, and a few Phytophthora species were found to be associated with symptomatic trees. Our objectives were to survey one of the plantations located in south-west BC on Vancouver Island to confirm the presence of these Phytophthora species and other oomycetes and test their pathogenicity on western white pine by completing Koch's postulates. We used direct plating of root samples on PARP(H)-CMA media and by baiting for oomycetes in soil and root samples. Ten oomycetes, including four Phytophthora species (Phytophthora cinnamomi, P. cactorum-like, P. cryptogea and P. pseudocryptogea) were isolated from roots and soil samples of diseased Pi. monticola trees. The Phytophthora species were identified using ITS, β-tubulin and TEF1 gene regions. Koch's postulates were validated with controlled inoculations of 1-year old seedlings; mortality occurred as early as 15 days after inoculation with P. cinnamomi when the seedlings were maintained in warm temperature conditions (25°C). Molecular typing of two P. cinnamomi cultures using Oxford Nanopore MinIONTM sequencing indicated that they belong to one of the two main clonal clusters of mating type A2 that have been recognized as the main drivers of the global P. cinnamomi epidemic. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM. [ABSTRACT FROM AUTHOR]

Introduction: Although sudden death (SD) is a recognized complication of cardiac amyloidosis, there is scarce data about its incidence, mechanisms, and predictors. The aim of this study was to describe incidence of SD and to analyze possible risk factors. Methods: Consecutive patients with ATTR or AL cardiac amyloidosis evaluated at two European centers were identified. SD was defined as unexpected death in clinically stable patients. Cox proportional hazard regression was performed to assess risk factors in univariate analysis. Those statistically significant were then assessed through age-adjusted multivariate analysis. Results: Analysis included 784 patients, 569 with ATTR amyloidosis (mean age 74.1 ± 12.1 years) and 215 with AL amyloidosis (mean age 64.5 ± 10.8 years). After a median follow-up of 1.9 years, SD rate at 2 years was 1.8% in ATTR. Previous pacemaker implantation (PPM) was associated with increased risk after age-adjusted analysis (HR 4.97; 95%CI: 1.39–17.7; p = 0.01). SD rate in AL amyloidosis patients at 2 years was 8.0% after a median follow-up of 1.2 years. Betablockers and NYHA III-IV were independently associated with an increased risk after age-adjusted multivariate analysis (HR 7.06 95%CI (2.31–21.5) p = 0.001) and (HR 4.56 95%CI (1.51–13.8) p = 0.007) respectively. Conclusions: SD is more frequent in AL than in ATTR cardiac amyloidosis. SD is associated with different risk factors in both entities. [ABSTRACT FROM AUTHOR]

Instrumental neutron activation analysis (INAA) was employed to assay 32 minor and trace elements in bone of Bohemian Duke John of Görlitz (1370–1396) who suddenly died at the age 25 years for unknown reasons. Recently, histological examination of his illium bone was carried out, accompanied by histochemical staining reactions to learn about his health status. The INAA results disproved an elevated Al content indicated by the staining reaction with aluminon, but revealed elevated levels of Mn, As, Sb, and especially of Ag compared with literature values. The results are discussed in terms of toxicity of the above elements, especially whether their elevated levels could be the reason for Duke´s sudden death. [ABSTRACT FROM AUTHOR]

This paper proposes a discourse-oriented approach to genetic literacy. The increased availability of genetic testing requires a certain level of genetic literacy among the public. This is important to understand the benefits and the risks of genetic testing. In this paper, we suggest that genetic literacy is not just a set of knowledge and skills that people have, but something that they do. It is discursively accomplished, and socially and culturally constitutive. We illustrate our approach using a genetic counseling consultation for Sudden Arrhythmic Death Syndrome (SADS). We examine how in this consultation, through careful orientation to the clients' understanding of genetic information, extended explanation-giving and education on genetics, the geneticist supports the clients in their decision about genetic testing. We discuss our findings in relation to clinical and non-clinical genetic contexts and highlight the importance of genetic literacy and professional support in diverse situations where genetic testing is considered. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Chongqing Medical University is the property of Journal of Chongqing Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Chongqing Medical University is the property of Journal of Chongqing Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and aims: Overweight and obesity have been found to exhibit a statistically significant increase in corrected QT interval (QTc), a major contributing factor to sudden death. However, the influence of widely used weight loss strategies including diet, exercise, anti-obesity drugs, and bariatric surgery on QTc remains inconsistent. Therefore, the present systematic review and meta-analysis aim to quantitatively analyse and evaluate the effect of weight loss on QTc in obese patients after diet control with exercise intervention and anti-obesity drugs, as well as bariatric surgery. Methods: Twenty randomised controlled trials (RCT) and observational studies were included in the meta-analysis on the effects of weight loss on QTc. The fixed-effects model was employed in the RCTs, and the random-effects model was employed due to the presence of statistical heterogeneity among observational studies. Subgroup analysis was conducted to understand the differences in distinct weight loss methods and follow-up time. Results: Overall, the QTc of people with obesity after weight loss was shorter than that before (mean difference (MD) = 21.97 ms, 95% confidence interval (CI) = 12.42, 31.52, p <.0001). Subgroup analysis restricted to seven included studies whose intervention was diet control with exercise showed a decrease of QTc with statistical significance (MD = 9.35 ms, 95%CI = 2.56, 37.54, p =.007). In the remaining 11 studies, bariatric surgery was the weight loss method. The results also showed a shortening of QTc after surgery, and the difference was statistically significant (MD = 29.04 ms, 95%CI = −16.46, 41.62, p <.00001). A statistically significant difference in QTc shortening at 6 months compared to pre-operation values was further observed (MD = −31.01 ms, 95%CI = −2.89, −59.12, p =.03). The shortening of QTc at 12 months of follow-up was also significantly different from that before surgery (MD = 36.47 ms, 95%CI = 14.17, 58.78, p <.00001). Moreover, the differences became more pronounced as the follow-up time extended. Conclusions: We demonstrate that weight loss links to a shortened QTc, without considering the means of weight loss. Bariatric surgery has been found to result in a greater reduction in QTc. [ABSTRACT FROM AUTHOR]

Objectives: Comorbidity prediction models have been demonstrated to offer more comprehensive and accurate predictions of death risk compared to single indices. However, their application in China has been limited, particularly among maintenance hemodialysis (MHD) patients. Therefore, the objective of this study was to evaluate the utility of comorbidity index models in predicting mortality risk among Chinese MHD patients. Methodology: The MHD patients in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were taken as the subjects. Claims‐based disease‐specific refinements matching translation to ICD‐10 and flexibility (CDMF‐CCI) model and Liu model were selected as the candidate models for this verification research. Univariate and multivariate Cox regression calculations were used to analyze the independent predictive effect of the models on survival rate. Results: Annually, nearly 500 patients undergo hemodialysis treatment. From January 2019 to June 2022, a total of 199 patients succumbed, with a mean age of 65.2 years. During these 4 years, the mortality rates were 13.04%, 9.68%, 11.69%, and 6.39%, respectively. The leading causes of death were sudden demise (82 patients, 41.2%), cardiovascular disease (48 patients, 24.1%), pulmonary infection (33 patients, 16.5%), and stroke (19 patients, 9.5%). When compared to individual indices, the CDMF‐CCI model displayed more accurate and predictive results, with an HR of 1.190 (P = 0.037). Conversely, the Liu model failed to identify high‐risk individuals. Conclusion: The MHD patients face a significant risk of mortality. When compared to univariate parameters and the Liu model, the CDMF‐CCI model exhibits superior predictive accuracy for mortality in MHD patients. [ABSTRACT FROM AUTHOR]

Aim: The diagnosis of hypertrophic cardiomyopathy (HCM) with moderate hypertrophy is challenging. Hypertensive heart disease (HHD) is the most common differential diagnosis that mimics the LVH of HCM. The aim of this study was to compare the QRS duration in HCM and HHD to create a novel diagnostic tool to identify primary HCM. Methods and results: We conducted an international retrospective multicentre study enrolling patients with true HCM and HHD. A total of 547 individuals with HCM and 139 with HHD were included. The median QRS duration was significantly shorter in HCM than in HHD (88 ms [80–94] vs. 98 ms [88–108]; P < 0.01). Multivariable logistic regression identified for the novel diagnostic HCM (D‐HCM) score: absence of antihypertensive drugs (+2); family history of unexplained sudden death (+2); QRS duration [<95 ms] = +1; maximum wall thickness (mm) [≥17] = +1. A cumulative QRS‐HCM score ≥2 supports the diagnostic certainty of true HCM with a sensitivity of 79%, specificity of 99%, negative predictive value (NPV) of 55%, and positive predictive value (PPV) of 99%. Conclusion: The QRS duration in patient with HCM is significantly shorter compared with patients with HHD‐related LVH. QRS duration can be used as a diagnosis marker to distinguish between HCM and HHD. The D‐HCM score is a novel, simple, and accurate diagnosis tool for HCM patients with mild to moderate phenotypes. [ABSTRACT FROM AUTHOR]

Aims: The indication for implantable cardioverter defibrillator (ICD) for sudden cardiac death (SCD) prevention relies mostly on left ventricular ejection fraction (LVEF) ≤ 35%. The use of a wearable cardioverter defibrillator (WCD) in the case of dynamic alterations of LVEF may help avoid an improper early ICD implant when a favourable evolution in the post‐acute phase is observed and may help reduce costs. Methods: This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines. Results: A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P = 0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P = 0.84). The average cost per patient at the end of the waiting period was €23 934 in the early ICD cohort versus €19 167 in the WCD cohort (−19.9%). This cost savings from WCD use appears even higher when projected over a 10 year period (−41.2%). Conclusions: WCD may represent a cost‐effective strategy to more accurately select candidates for the primary prevention ICD implant among high‐risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant. [ABSTRACT FROM AUTHOR]

Objective: Amount of seizure‐free days is a critical determinant of quality of life (QoL) in patients with drug‐resistant epilepsy (DRE). The fractions of patients experiencing prolonged periods of seizure freedom with adjunctive vagus nerve stimulation (VNS) have yet to be assessed on a large scale. Methods: Retrospective analysis of patients in the Japanese VNS prospective observational registry who experienced at least 1 year of seizure freedom from all seizures, focal seizures, or tonic–clonic seizures (TCS), as well as patient‐reported change in QoL in these groups. Results: The study included 362 patients with DRE, 147 were female (40.6%), and the median age at VNS implant was 23.0 years (range: 1.0–73.0). A total of 225 patients reported focal seizures and 184 patients reported TCS. After 36 months of adjunctive VNS, the cumulative proportion of patients experiencing at least 1 year of complete seizure freedom was 11% (38/356) with an average duration of seizure freedom of 19.4 months. In patients with focal seizures, 25% (n = 57/225) experienced at least 1 year of freedom from focal seizures with an average duration of 24.8 months. Higher cumulative rates of freedom from TCS were observed: 55% (n = 101/184) experienced at least 1 year without TCS with an average duration of TCS‐free periods of 28.9 months. 82.1% of patients with 12‐month complete seizure freedom reported markedly improved or improved QoL compared with 51.9% of patients who were not seizure‐free. QoL changes in patients with 12‐month seizure freedom from TCS and focal seizures were similar: 61.8% and 63% of respective patients reported either markedly improved or improved QoL at 36 months. Significance: Complete seizure freedom is rare in patients treated with VNS; however, this analysis found approximately half of patients who experienced TCS prior to VNS experienced prolonged periods of freedom from TCS with adjunctive VNS. Plain Language Summary: We studied patients in Japan with epilepsy that is difficult to treat. To understand if adding vagus nerve stimulation (VNS) helps such patients, we looked at which patients stopped having all seizures or stopped having a specific seizure type (such as tonic–clonic seizures or focal seizures), and how long these periods lasted. With VNS treatment, about 2 out of 4 patients with tonic–clonic seizures and 1 out of 4 patients with focal seizures had more time without these seizure types. Without seizures, patients felt better about their daily lives. Even patients who still had seizures felt better about their daily lives after 3 years of VNS treatment. Trial Registration: The clinical trial registry number is UMIN000014728. [ABSTRACT FROM AUTHOR]

Abstract Aims The indication for implantable cardioverter defibrillator (ICD) for sudden cardiac death (SCD) prevention relies mostly on left ventricular ejection fraction (LVEF) ≤ 35%. The use of a wearable cardioverter defibrillator (WCD) in the case of dynamic alterations of LVEF may help avoid an improper early ICD implant when a favourable evolution in the post‐acute phase is observed and may help reduce costs. Methods This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines. Results A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P = 0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P = 0.84). The average cost per patient at the end of the waiting period was €23 934 in the early ICD cohort versus €19 167 in the WCD cohort (−19.9%). This cost savings from WCD use appears even higher when projected over a 10 year period (−41.2%). Conclusions WCD may represent a cost‐effective strategy to more accurately select candidates for the primary prevention ICD implant among high‐risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant.

Abstract Haemorrhagic bowel syndrome (HBS) is one of the most common causes of death in fattening pigs worldwide. The objective of this descriptive study was to systematically assess predictors or causal components for the appearance of HBS using case farms (mortality rate caused by HBS ≥ 1.5%) in comparison with control farms (mortality rate caused by HBS ≤ 0.25%), focusing on feed ingredients, feed quality and size, and gastrointestinal pathogens. The inclusion of sugar beet as a feed component in liquid feeding systems was found to be associated (p = 0.03) with farms identified as HBS cases. Another predictive or causal factor found for liquid feeding systems, but only for those using meal, was particle size. A higher percentage of small particles (

The review presents current literature data on the prevalence, etiology, and role of sarcomere gene mutations in the pathogenesis of hypertrophic cardiomyopathy, and pathogenetic mechanisms of myocardial hypertrophy. The review discusses the variants of the phenotype, the possible relationship between causative genes and the phenotype. The data on the pathophysiology of left ventricular outflow obstruction, diastolic dysfunction, myocardial ischemia, and rhythm disturbances are presented. The role of non-invasive imaging modalities, the limitations of echocardiography, the advantages of magnetic resonance imaging of the heart, its role in the differential diagnosis of hypertrophic cardiomyopathy and left ventricular hypertrophy in hypertension, in athletes, patients with phenocopies of hypertrophic cardiomyopathy (Anderson-Fabry disease, amyloidosis of the heart) is determined. The criteria for a worse prognosis and a high risk of sudden death are described. Options for drug treatment are discussed, as well as modern therapy with the cardiac myosin-ATP-ase inhibitor mavakamten, which acts by reducing the formation of actin-myosin bridges, reduces contractility and pressure gradient in the left ventricular outflow tract. Invasive interventions (septal myectomy or alcoholic septal ablation) are indicated in patients with ineffective drug therapy. Estimation of risk factors for sudden death is necessary to determine the indications for implantation of a cardioverter defibrillator.