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Background: Application of electrocautery to a J‐wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. Methods: Two hundred consecutive patients were randomized in a 1:1 fashion to either the ICE‐guided electrified J‐wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20 W, "coag" mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. Results: All patients complete the procedure safely. The electrified J‐wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra‐atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the two groups (3/32 patients in the J‐wire TSP group and 2/26 patients in conventional BRK TSP group, p =.82). And no difference in the incidence of residual intra‐atrial shunt (4.3% vs. 6%, p =.654) during the 3‐month's follow up. Conclusion: Using an electrified J‐wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non‐fluoroscopy AF ablation. [ABSTRACT FROM AUTHOR]

To investigate the mechanical behaviors of failure and rockburst proneness of fractured rock mass during excavation unloading under high in-situ stress. Triaxial loading and unloading tests of fractured rock samples with different dip angles under different stress paths were conducted, and mechanisms inducing catastrophic effects of deeply buried fractured granite were discussed from the perspectives of mechanical characteristics of failure and energy evolution. The results imply that failure modes of fractured granite under triaxial loading and unloading are mainly dominated by shear failure. Coplanar cracks produced by granite under unloading generally often are composite tensile-shear cracks, which show more significant brittle failure. Under loading and unloading, the energy storage limit Uem of rock first decreases, then increases with the increase of the dip angle of fractures. When the dip angle of prefabricated fractures is closer to the fracture angle of the intact rock mass, the energy storage limit is smaller and shows an increasing linear relationship with the unloading ratio. The rate of change of elastic strain energy in fractured rock under triaxial loading suddenly increases more frequently. The elastic energy release rate δ was defined to evaluate the rockburst proneness of deeply buried fractured granite under loading and unloading. Under unloading, the elastic energy release rate δ of rock is slightly affected by changes of the dip angle; the elastic strain energy in the rock is rapidly released, greatly increasing the rockburst proneness. [ABSTRACT FROM AUTHOR]

Background: Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non‐selective AF patients. Objective: To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF. Methods: A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra‐procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre‐procedure TEE examination. The incidence of thrombus, peri‐procedure complications, and hospital efficiency were assessed. Results: The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo‐embolic events was comparable between two groups (0.2% vs. 0.1%, p =.76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post‐procedure fever was less common in the ICE group (12.7% vs. 17.4%, p <.001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87–197 min] vs. 150 min [95–205 min], and 3[2–4] day vs. 4[3–5] day, respectively, both p <.001). Conclusions: ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate the association between the albumin-corrected anion gap (ACAG) and the prognosis of cardiogenic shock (CS)., Design: A multicentre retrospective cohort study., Setting: Data were collected from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) datasets., Participants: 808 and 700 individuals from the MIMIC-IV and eICU-CRD, respectively, who were diagnosed with CS., Primary and Secondary Outcomes: The primary endpoint was short-term all-cause mortality, including intensive care unit (ICU), in-hospital and 28-day mortality. The secondary endpoints were the 28-day free from the ICU duration and the length of ICU stay., Results: CS patients were divided into two groups according to the admission ACAG value: the normal ACAG group (≤20 mmol/L) and the high ACAG group (> 20 mmol/L). CS patients with higher ACAG values exhibited increased short-term all-cause mortality rates, including ICU mortality (MIMIC-IV cohort: adjusted HR: 1.43, 95% CI=1.05-1.93, p=0.022; eICU-CRD cohort: adjusted HR: 1.38, 95% CI=1.02-1.86, p=0.036), in-hospital mortality (MIMIC-IV cohort: adjusted HR: 1.31, 95% CI=1.01-1.71, p=0.03; eICU-CRD cohort: adjusted HR: 1.47, 95% CI=1.12-1.94, p=0.006) and 28-day mortality (adjusted HR: 1.42, 95% CI: 1.11 to 1.83, p=0.007). A positive linear correlation was observed between the ACAG value and short-term mortality rates via restricted cubic splines. Compared with the AG, the ACAG presented a larger area under the curve for short-term mortality prediction. In addition, the duration of intensive care was longer, whereas the 28-day free from the ICU duration was shorter in patients with a higher ACAG value in both cohorts., Conclusion: The ACAG value was independently and strongly associated with the prognosis of patients with CS, indicating that the ACAG value is superior to the conventional AG value., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)