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Aims To characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during left bundle branch area pacing (LBBAP). Methods and results All consecutive patients undergoing LBBAP over an 8-month period were prospectively studied. During lead placement, obligatory septal contrast injection was performed twice, at initiation (implant entry zone) and at completion (fixation zone). An intuitive fluoroscopic schema using orthogonal views (left anterior oblique/right anterior oblique) and familiar landmarks is described. Using this, we resolved zonal distribution (I–VI) of lead position on the ventricular septum and its angulation (post-fixation angle θ). Subjects with and without septal venous channel perforation were compared. Sixty-one patients {male 57.3%, median age [interquartile range (IQR)] 69.5 [62.5–74.5] years} were enrolled. Septal venous channel perforation was observed in eight (13.1%) patients [male 28.5%, median age (IQR) 64 (50–75) years]. They had higher frequency of (i) right-sided implant (25% vs. 1.9%, P = 0.04), (ii) fixation in zone III at the mid-superior septum (75% vs. 28.3%, P = 0.04), (iii) steeper angle of fixation—median θ (IQR) [19 (10–30)° vs. 5 (4–19)°, P = 0.01], and (iv) longer median penetrated-lead length (IQR) [13 (10–14.8) vs. 10 (8.5–12.5) mm, P = 0.03]. Coronary sinus drainage of contrast was noted in five (62.5%) patients. Abnormal impedance drops during implantation (12.5% vs. 5.7%, P = NS) were not significantly different. Conclusion When evaluated systematically, septal venous channel perforation may be encountered commonly after LBBAP. The fiducial reference framework described using fluoroscopic imaging identified salient associated findings. This may be addressed with lead repositioning to a more inferior location and is not associated with adverse consequence acutely or in early follow-up. [ABSTRACT FROM AUTHOR]

Mixing of liquid jet in Mach 1.71 crossflow using a curved pylon configuration has been studied experimentally. The liquid acetone jet was injected at 60 ° against the free stream airflow behind the pylon. High-speed Schlieren and Mie scattering experiments were performed to evaluate the mixing characteristics of liquid jet injected behind the curved pylon. POD and SPOD analyses were employed on the high-speed Schlieren images to observe the coherent structures, their energy levels, and frequencies at which these structures occur. Results showed improvements in penetration height and the lateral spread of liquid jet for the curved pylon configuration. The penetration height of the liquid jet was 7.79% more for the curved pylon case as compared with the standard pylon case for the same momentum flux ratio. Further increase in the momentum flux ratio increased the penetration height to 15.53% more as compared with the standard pylon case. The spread area of the liquid jet was 17.42% more at x / d j = 25 and 25.97% more at x / d j = 40 for the curved pylon case than the standard pylon case for the same momentum flux ratio. The presence of counter-rotating vortices at the top of the liquid plume and in the near-wall region caused a higher spread area in curved pylon cases as compared with standard pylon cases. • Secondary jet injected behind curved pylon resulted in enhanced lateral spread. • Increased penetration for lower injection pressure in the case of curved pylon. • Better mixing is observed due to counter rotating vortices created by curved pylon. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prognostic impact of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) on overall survival (OS) among Indian older patients with cancer. Methods: This observational study was conducted in the geriatric oncology clinic of Tata Memorial Hospital (India). We included all patients who underwent a geriatric assessment (GA) and had a complete blood count available for analysis. The NLR was dichotomized at 3.5, PLR and LMR at the median. Our primary study outcome was OS. Results: Between June 2018 and November 2021, 786 patients were enrolled (median age: 69 years). The most common primary tumour was lung (308, 39.5%), followed by gastrointestinal (261, 33.5%). Metastatic disease was present in 54.3% of patients. Univariate analysis revealed that patients with NLR >3.5 had shorter OS (9.1 months) than NLR <3.5 (15.7 months) (HR: 1.56). Similarly, patients with PLR >183.5 had reduced OS (9.3 months) compared to PLR <183.5 (16.6 months) (HR: 1.56). Conversely, patients with LMR >3.1 showed better OS (14.2) compared to LMR <3.1 (9.8 months) (HR: 0.74). After adjusting for age, performance status, primary tumour, metastatic status and GA-derived factors (function, nutrition and cognition), NLR (HR: 1.25, 95%CI: 1.03-1.52), PLR (HR: 1.34, 95%CI: 1.11-1.63) and LMR (HR: 0.79, 95%CI: 0.65-0.95) were associated with OS. Conclusion: In our study of older cancer patients, we identified three key inflammatory markers (NLR >3.5, PLR >183.5, LMR <3.1) as strong predictors of poor OS. These markers remain predictive even after accounting for traditional prognostic factors and GA-derived scales. [ABSTRACT FROM AUTHOR]

Aims: To characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during left bundle branch area pacing (LBBAP)., Methods and Results: All consecutive patients undergoing LBBAP over an 8-month period were prospectively studied. During lead placement, obligatory septal contrast injection was performed twice, at initiation (implant entry zone) and at completion (fixation zone). An intuitive fluoroscopic schema using orthogonal views (left anterior oblique/right anterior oblique) and familiar landmarks is described. Using this, we resolved zonal distribution (I-VI) of lead position on the ventricular septum and its angulation (post-fixation angle θ). Subjects with and without septal venous channel perforation were compared. Sixty-one patients {male 57.3%, median age [interquartile range (IQR)] 69.5 [62.5-74.5] years} were enrolled. Septal venous channel perforation was observed in eight (13.1%) patients [male 28.5%, median age (IQR) 64 (50-75) years]. They had higher frequency of (i) right-sided implant (25% vs. 1.9%, P = 0.04), (ii) fixation in zone III at the mid-superior septum (75% vs. 28.3%, P = 0.04), (iii) steeper angle of fixation-median θ (IQR) [19 (10-30)° vs. 5 (4-19)°, P = 0.01], and (iv) longer median penetrated-lead length (IQR) [13 (10-14.8) vs. 10 (8.5-12.5) mm, P = 0.03]. Coronary sinus drainage of contrast was noted in five (62.5%) patients. Abnormal impedance drops during implantation (12.5% vs. 5.7%, P = NS) were not significantly different., Conclusion: When evaluated systematically, septal venous channel perforation may be encountered commonly after LBBAP. The fiducial reference framework described using fluoroscopic imaging identified salient associated findings. This may be addressed with lead repositioning to a more inferior location and is not associated with adverse consequence acutely or in early follow-up., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)