For heart failure(HF) patients with reduced ejection fraction and atrial fibrillation (AF) with rapid ventricular response, cardiac resynchronization therapy (CRT) combined with atrioventricular junction ablation (AVJA) is an important treatment strategy. This article reports a case of HF with AF with rapid ventricular response in which the left ventricular lead implantation of CRT failed, and was successfully treated with left bundle branch pacing(LBBP) combined with AVJA and related literature is reviewed.

Background. Limited data exist regarding left atrial appendage (LAA) thrombi and spontaneous echocardiographic contrast (SEC) in patients with atrial flutter (AFL). Objectives. We sought to evaluate the LAA thrombi prevalzence in AFL ablation patients compared to atrial fibrillation (AFib) ablation patients. Methods and Results. 321 consecutive patients referred for either AFib (n = 229) or AFL ablation (n = 92) were included with a thrombus detected by transesophageal echocardiography (TEE) in 3.22% (12/321). The percentage of thrombi was similar between AFL and AFib ablation patients (5.4% [n = 5/92] vs. 3.1% [n = 7/229]; p = 0.3). In the overall population, LAA thrombi patients had a higher CHA²DS²-VASc score (3 ± 2 vs. 2 ± 1.5; p = 0.048) and a higher presence of valvular prothesis (25% vs. 4.9%; p=0.003), with relevant left atrial remodeling such as demonstrated by a higher left atrium (LA) volume (57 ± 19 vs. 46 ± 17 ml/m²; p = 0.04) and a lower LAA velocity (0.41 ± 0.3 vs. 0.55 ± 0.2; p=0.04). In patients with right AFL, patients with LAA thrombi had a higher CHA²DS²-VASc score (4.4 ± 1 vs. 2.5 ± 1.5; p = 0.008), had more hypertension (100% vs. 53%; p = 0.04) and more diabetes mellitus (60% vs. 18.4%; p = 0.03), and a more severe LAA echo contrast (80% vs. 5.7%; p <0.0001). Conclusions. The risk of LAA thrombi is better related to the presence of valvular prosthesis, CHA²DS²-VASc score and LA remodelling than the atrial arrhythmia itself.

ABSTRACT Introduction: Compliance with anticoagulation treatment for atrial fibrillation is highly variable. Smartphone electrocardiograms that allow patients to have greater insight into their arrhythmia burden may improve anticoagulant compliance. Methods: Patients were enrolled if they had atrial fibrillation with a CHA2DS2-VASc score of 2 or more, were eligible for anticoagulation and had a smartphone. Participants were randomly assigned to receive a smartphone electrocardiogram (AliveCor, Kardia) to record their electrocardiograms 5 times/week or to the control group. All patients received 6 months of anticoagulant (apixaban) dispensed as 1-month pre-loaded pill boxes. Results: A total of 100 patients were enrolled from July 2017 to August 2019, but 5 patients in the monitor arm and 1 in the control arm withdrew prematurely. The monitor and control groups did not differ in age, gender, CHA2DS2-VASc score, or comorbidities. Median medication compliance was 99.7%, with non-significantly greater compliance in the monitor group (100%) than in the control group (99.7%) (p-value=0.247). There was also no significant difference between missing any dose and use/nonuse of the smartphone monitor (48.9% vs. 55.1%; p-value=0.692). Mean monitor compliance was 86.8% ±14.0% with an average of 4.34 recorded electrocardiograms per week. Monitor group patients with perfect medication compliance had significantly higher monitor compliance than those patients who missed doses (median, 95.3% vs 86.7%; p-value=0.02). Conclusions: In a study population with higher-than-expected medication compliance, the use of smartphone electrocardiogram did not demonstrate an improvement in medication compliance as compared to usual care. Greater monitor compliance was associated with greater medication compliance.

Background: Atrial flutter (AFL) is a large re-entrant circuit located in the right atrium. Anti-arrhythmic drugs (AADs) can provoke AFL with 1:1 atrioventricular conduction (AVC) to cause hemodynamic collapse. We elucidated the characteristics of patients with AFL exhibiting spontaneous 1:1 AVC. Methods: Fifteen patients (1:1 AFL group; 11 males, 52.4±13.7 years old) who documented AFL with 1:1 AVC were enrolled and compared to 77 patients without 1:1 AVC (Control group; 71 males, 68.1±10.9 years old). Results: The use of AADs was greater in the 1:1 AFL group than in the control group (60.0 vs. 14.3%, p < 0.001). AFL cycle length during maximum AVC was significantly longer in the 1:1 AFL group than in the control group (274.7 ± 37.0 vs. 220.4 ± 26.2 msec, p < 0.001). Among 1:1 AVC group, 9 patients had AADs and AFL cycle length was significantly longer during 1:1 AVC as compared with 2:1 AVC documented the other day (284.4 ± 41.3 vs. 233.3 ± 26.0 msec, p <0.001), suggesting enhancement effect of the AADs during 1:1 AVC. Remaining 6 patients who did not take AADs, 2 patients showed enlargement of the tricuspid annulus and 3 patients developed 1:1 AVC during exercise. Conclusions: In addition to the enhancement of AAD effect, prolonged AFL cycle length associated with enlargement of the tricuspid annulus and shortened refractory period of the AV node might increase the risk of 1:1 AVC during AFL. Keywords: atrial flutter, atrial flutter cycle length, tricuspid annulus. Atrioventricular node, atrioventricular conduction, anti-arrhythmic drug

Introduction. Acute myeloid leukemia (AML) is a heterogeneous disease and about one third do not have evident genetic abnormalities. The mutation of specific molecular markers such as fms-like tyrosine kinase 3 (FTL3) internal tandem duplication (ITD) and nucleophosmin (NPM1) are associated with an adverse and favorable prognosis, respectively. Objective. To determine the prevalence of FLT3/ITD and NPM1 in Chilean children under 18 years and its association with clinical data and prognosis. Results. Two hundred and thirty-two children with AML were studied between 2011-2017, median 8.6 years (range 1 month-18). Acute promyelocytic leukemia (APL) was diagnosed in 29%. FLT3/ITD mutated in non-promyelocytic AML was 10% (14/133), and FLT3/TKD 3.7% (2/54). In APL was 25.4% (16/63). In non-promyelocytic AML, FLT3/ITD mutated was associated with high leucocyte count, median 28.5 xmm3 (n=14) versus 19.4 xmm3 (n=119), (p=0.25) in unmutated cases. In APL was, median 33.6 xmm3 (n=15) versus 2.8 xmm3 (n=47), (p<0.001). Five-year overall survival (OS) in non-promyelocytic AML with unmutated and mutated FLT3/ITD, 62.7% and 21.4%, (p<0.001); 5-year event free survival (EFS) 79.5% and 50%, (p <0.01). Five-year OS in APL with unmutated and mutated FLT3/ITD was 84.7% and 62.5%, (p =0.05); while 5-year EFS was 84.7% and 68.8% (p =0.122). NPM1 mutation was observed in 3.2% (5/155), all non-promyelocytic AML with normal karyotype. Conclusion. FLT3/ITD mutation was observed more frequently in APL and associated with higher white cell count at diagnosis. However, the most important finding was that FLT3/ITD mutation was associated with lower survival in non-promyelocytic AML.

In this paper, a higher-order uniformly convergent finite difference method is presented to solve one dimensional unsteady singularly perturbed Burger-Huxley equation. The quadratically convergent quasilinearization technique is used to linearize the nonlinear term of the equation under consideration. An upwind finite difference approximation is applied in the temporal direction, and a nonuniform Shishkin mesh type is used in the spatial direction. To accelerate the rate of convergence from first to second-order, the Richardson extrapolation technique is applied. The convergence analysis of the proposed method has been established. Finally, numerical experiments were conducted to support the theoretical results. Further, the result shows that the proposed method gives more accurate solution than some existing methods in the literature.

Background and objectives: Injury patterns in bicycle accidents may vary depending on patient age and mechanism of accident. We aimed to investigate characteristics of patients involved in bicycle accidents, along with mechanisms of accidents and clinical outcomes in children. Methods: Children admitted to the pediatric emergency department of a tertiary referral hospital during a four-year period due to bicycle accidents were included. The mechanism of accident was classified into two groups; high-energy trauma and low-energy trauma. Statistical analyses were performed to recognize injury patterns and clinical outcomes associated with mechanism of accident. Results: 360 children were included. 2 patients were using helmet. 29 patients required surgery. 14 patients had clinically important traumatic brain injury. 8 and 2 patients had permanent neurologic sequela and finger amputation, respectively. In high-energy trauma, significantly more commonly affected anatomical areas compared to low-energy trauma were extremities, head and neck, and multiple injuries. Abrasions/soft tissue injuries, scalp fractures, maxillofacial fractures and traumatic brain injury were also significantly more common types of injury in high-energy trauma. Conclusions: In a retrospective cohort with low rate and no obligatory regulation of helmet use, high-energy bicycle accidents can cause significant clinical outcomes, including maxillofacial and scalp fractures, traumatic brain injury, and permanent disability.

Objective Various direct and indirect mechanisms by which glucocorticoid excess and elevated adrenocorticotropic hormone (ACTH) levels impair bone metabolism have been described. In the literature, there are different factors described which affect the early outcome of pituitary surgery in patients with Cushing’s Disease (CD) including preoperative ACTH levels and the clinical severity of the disease. We aimed to investigate the association of BMD Z-scores as a direct indicator of severity of GC excess with the early postoperative remission rate and clinical parameters of the patients with CD. Method Patients diagnosed with CD were retrospectively evaluated. After the exclusion of 230 patients, a final cohort of 87 CD patients were included. Results No significant association was found between DXA results and early postoperative remission. A significant negative correlation between preoperative morning cortisol level and BMD, T-score and Z-score of FT was shown, while there was a positive correlation between preoperative ACTH/Cortisol ratio and DXA results of L1-4. Conclusions This is the first study which investigates if the severity of bone loss is a predictive risk factor for the failure of transsphenoidal surgery for Cushing’s disease and there was no statistically significant relationship between these two entities.

During first wave of the COVID pandemic, infection prevention measures were enforced at our Pediatric Neuro-Oncology unit. A retrospective study analysing patients booked in this unit during lockdown was performed to describe its performance. There were 438 consultations for 123 patients (320 on-site/118 telephone). Eight new diagnoses, with one significant delay. Only one patient tested positive for SARS-COV2. Delay in imaging testing occurred in 15 patients. Chemotherapy was delayed in one case and not in radiotherapy. Measures implemented were effective in minimizing the risk of COVID-19 infection, achieving continuity in diagnoses and treatment and avoiding delays that could impact survival.

This case report describes a pediatric patient requiring enteral tube treatment with isavuconazole for an invasive fungal infection post-hematopoietic stem cell transplantation. Previously reported literature in adult patients support this administration technique, however, no literature specific to pediatric patients exists. This brief report will examine subsequent trough concentrations of enteral tube administration of isavuconazole capsules for a pediatric patient being treated with a concomitant interacting medication.

Background and purpose: The recent unprecedented pandemic caused by Sars-Cov-2, is threatening public health over the world. Although several studies have been performed there is no identified treatment for Covid-19 patients. Here we assessed the efficacy of oseltamivir in combination therapy, by comparing two different therapeutic regimens in hospitalized patients. Experimental approach: This is a retrospective, according to the date of admission, the patients were divided into two groups; group 1 (oselta group) from Feb 20, 2020 to March 15, 2020 received Oseltamivir with routine regimen and group 2 (control group) from March 20, 2020 to April 20, 2020 received routine regimen alone including Azithromycin 500 mg/daily and Hydroxychloroquine 200 mg/12h. The endpoints including, the duration of hospitalization, requirement to intensive care unit (ICU) admission and mechanical ventilation, the outcome and rate of mortality. Key Results: A total of 285 patients were enrolled over the two months, 120 patients for group 1 and 165 for group 2. The median time from admission to discharge was significantly shorter in oselta group in comparison with control Group. Additionally, the mortality rate was found to be lower in oselta group than control group which was statistically significant by multivariate analysis. The incidence of ICU admission and mechanical ventilation were also decreased in oselta group but were not found to be statistically significant. Conclusion and implications: This study showed that administration of oseltamivir was associated with shorter length of hospital stay and earlier recovery and discharge of hospital, and a lower mortality rate.

Background: Little case was reported about coronary artery spasm after a mitral valve replacement and concomitant Cox-Maze IV procedure. We reported a case of an adult male who develop right coronary artery (RCA) spasm after a mitral valve replacement with tricuspid valve repair and Cox-Maze IV procedure. Case Report: A 66-year-old male, complaining progressive exertional shortness of breath, was diagnosed as severe mitral stenosis, moderate tricuspid regurgitation, complete right bundle branch block and persistent atrial fibrillation (AF) in our clinic. The patient underwent elective mitral valve replacement, tricuspid valve repair and Cox-Maze IV procedure. 4 h after surgery, a 12-lead electrocardiogram (ECG) showed progressive elevation of ST-segment in the avF and III leads and Troponin-T was over 7000 pg/mL. After 1 h, Troponin-T increased to over 10000 pg/mL and ECG still showed persisted ST-segment elevation in inferior leads. Emergent angiography was performed and intra-coronary administration of nitroglycerin completely relieved the spasm. KEYWORDS mitral valve replacement, Cox-Maze IV, coronary artery spasm

Significant atrioventricular valve insufficiency is associated with increased mortality and morbidity in patients with a single-ventricle because of the congestion associated with single-ventricle circulation. Treatment of atrioventricular valve insufficiency is mandatory for completing Fontan circulation. Although valve repair is a favorable procedure for the lesion because it preserves the valve leaflet and ventricular motion, replacement of the atrioventricular valve is the last option of treatment. The choice of a mechanical valve is often made for atrioventricular valve replacement in children. However, because children's small body size, mechanical valve implantation can cause early and late complications, including thromboembolic or hemorrhagic events, the artificial valve leaflet becoming stuck, and ventricular dysfunction. Because of these complications, valve replacement can be performed several times, and repeat surgical intervention can induce technical difficulties of artificial valve implantation as well. We present a patient who received multiple mechanical valve replacements due to repeat valve leaflet stuck after first palliation of pulmonary artery banding followed by Glenn anastomosis and Fontan completion. To overcome surgical difficulty, some technical modification was required during the repeat valve replacement.

Background and Purpose: Sevoflurane (Sev) is a commonly used anesthetic in clinic which can cause neurotoxicity. Postoperative cognitive dysfunction is a common clinical problem induced by some anesthetics such as Sev. However, the exact mechanism of neurotoxicity induced by Sev is unclear. Here we aimed to clarify a new mechanism of POCD induced by Sev. Experimental Approach: 15-month-old mice were treated with 2% Sev for 6 hours. Morris water maze (MWM) was used to evaluate the capacity of the mouse for spatial learning and memory. Major signalling profiles and the underlying mechanism of neurotoxicity or POCD was further explored by using the isobaric tags for relative and absolute quantitation, synchrotron radiation micro-X-ray fluorescence, the Seahorse XFe8 Extracellular Flux Analyzer, Western blot, RT-qPCR, and immunofluorescence assay. Key results: Sev caused POCD symptom through inducing iron accumulation and dysfunction of iron metabolism. Excessive iron increased ROS levels which further impaired mitochondrial function and led to glucose metabolism disorder and ATP decrease through regulating the expression of key enzyme genes or proteins including G6Pase, Pck1 and Cs. Meanwhile, Sev also inhibited the oxygen consumption rate and glucose absorption by down-regulating expression of glucose transporter 1 in cerebral vascular endothelial cells. The cross-dysfunction of iron and glucose metabolism caused the apoptosis in cortex and hippocampus through Bcl2/Bax pathway. Conclusions and implications: Sev caused apoptosis by cross-dysregulation of iron and glucose metabolism and induced energy stress in mice. Maintaining iron and glucose metabolism homeostasis maybe played an important role in cognitive impairment induced by Sev.

Objectives: To determine the incidence of cervical cancer in women referred through the two-week-wait pathway for postcoital bleeding and abnormal appearance of the cervix and calculate the associated costs. Design: A retrospective cohort study. Setting: United Kingdom. Population: 604 women with postcoital bleeding and abnormal appearance of the cervix seen in two-week-wait colposcopy clinics over five years. Methods: Women were identified from a departmental database. Clinical and demographic data was collected. Categorical data was analysed with Chi-squared or Fisher’s exact tests and predictive values were calculated. Cost analysis was performed using Care Commissioning Group tariffs and national statistics on the cervical screening programme. Main outcome measure: Histopathological diagnosis of cervical cancer. Results: Of the 604 women referred, 1·16% were diagnosed with cervical cancer. None of the women who were up-to-date with cervical screening were diagnosed with cervical cancer, whilst 6·67% of women out-of-date with cervical screening were diagnosed with cervical cancer (p<0·001). The positive predictive value for diagnosing cervical cancer was 1·70% for postcoital bleeding [95% CI 0·64–3·7] and 0·31% for abnormal appearance of the cervix [95% CI 0·0008–1·7]. At Cambridge University Hospitals, the cost of two-week-wait colposcopy for these referral indications was £23,829·20 annually. In England, the cost of colposcopy for urgent clinical indications of cervical abnormalities was £2,657,176·00 annually. Conclusions: The incidence of cervical cancer in women referred through the two-week-wait pathway for postcoital bleeding and abnormal appearance of the cervix is low. These referrals carry substantial cost despite low predictive values and national guidelines should be refined.

Genetic difference hypothesis Birds migrated to Britain were captured and brought into the lab. These birds bred in the lab and produced F1 offspring (in Ger) which never experienced migration. In the Fall both parents and F1 offspring experience migratory restlessness (birds constantly moving around the cage). Birds in funnel cages “mark” their intended flight direction. In the Fall both parents and F1 offspring experience migratory restlessness (birds constantly moving around the cage) going towards GB, genetically determined direction controlled. Also can determine migration distance based on duration of migratory restlessness. Hybrids go in between the two direction and duration of migratory restlessness, more evidence for genetic basis for this type of behavior. Hypothesis: Migratory Avialae use teleportptilochronology Prediction: genetic difference hypothesis using special funnel cage on typewriter correction paper shows marking causation for migratory route and duration being genetic Prediction 2: they can get to a place teleporting using genetic difference hypothesis rather than commuting. Prediction 4: They can control the use or nonuse of the teleport Prediction 3: after writing Avialae Washoe Co. Locomotion, I would document the ones that come to my deck (teleport users)

BACKGROUND: SARS-CoV-2 serological testing has seen extensive academic and clinical use from investigating correlates of immunity to seroprevalence, convalescent plasma and vaccine trials. Interpretation of these studies will depend on robust validation of the longitudinal sensitivities of serological assays. OBJECTIVE: To conduct longitudinal sensitivity analysis on four different SAR-CoV-2 antibody assays in a convalescent cohort with predominantly mild Coronavirus Disease 2019 (COVID-19). STUDY DESIGN: Hospital staff (n=94) returning to work following polymerase chain reaction (PCR) confirmed COVID-19 were offered antibody testing to assist with laboratory verification. Initial specimens were collected at median 29 days post-symptom onset and run on the Roche, Abbott, Siemens and DiaSorin platforms. Re-sampling occurred at median 142 days from a subset of the initial cohort (n=62) that had volunteered to provide further sera to assist in longitudinal sensitivity analysis. Samples that were not run across all four platforms were excluded from analysis. RESULTS: Comparative sensitivity analysis was conducted on 89/94 of the initial specimens and 55/62 of the repeat specimens. Sensitivity at initial sampling ranged from 78-87% across platforms. At re-sampling, sensitivities were: 100% (Roche), 45% (Abbott), 100% (Siemens), and 80% (DiaSorin). Paired analysis using the longitudinal cohort (n=55) demonstrated stable or increasing median assay values on three platforms, with a clear reduction seen only on the Abbott platform (4.78 to 1.34) with corresponding sensitivity drop-off. CONCLUSION: The Abbott assay demonstrated sensitivity drop-off and decrease in median assay signal below detection threshold at 4-5 months. This has implications on the interpretation and design of future studies

A 17yo male marriage with uneventful previous history developed generalised myalgias, exercise intolerance, and general fatigue after two dosages of azithromycin (500mg/d) during 3d for febrile infection. Neurologic exam revealed generally reduced tendon reflexes. Serum creatine-kinase was elevated to 25000U/L. Needle-EMG showed short and small, polyphasic motor-units and abnormal spontaneous activity, being interpreted as myositis. Azithromycin was discontinued and he was advised to avoid the fitness studio and to drink plenty of liquids. Myalgias disappeared within two days and CK continuously declined. Azithromycin may trigger rhabdomyolysis in the context of exercise and infection. Azithromycin may be myotoxic why it should be prescribed with caution in exercising and infected patients.

The identification of vertebrate species is important in numerous fields such as ecology, archaeology, and food and forensic sciences. Real-time quantitative PCR (qPCR) assays specific for one vertebrate species are promising approaches for species identification, although there are several drawbacks such as difficulty determining whether the detected DNA is authentic or a contaminant. Here, we describe a qPCR assay specific for vertebrate mitochondrial DNA (mtDNA) which can overcome these drawbacks. Since we found that mitochondrial 16S rRNA contains regions that are perfectly (not highly) conserved across virtually all vertebrates, but are variable in invertebrates, we were able to design a vertebrate-specific qPCR assay by placing primers/probe within these regions. The specificity and accuracy of this assay were validated with representative vertebrate and invertebrate samples. This assay detected DNA from all vertebrate samples, but not from any invertebrate samples. In addition, this assay was able to quantify vertebrate mtDNAs as accurately as previously reported species-specific qPCR assays. The results demonstrated it is feasible to quantify vertebrate mtDNA specifically and accurately in a sample. In conjunction with this assay as an endogenous internal control, species-specific qPCR assays will allow for the robust identification of vertebrate species.

Background and Purpose: We have previously shown that the antidiabetic drug metformin protects hepatocytes against toxicity by various stressors. Chronic or excessive consumption of diclofenac (DF), a pain-relieving drug, leads to drug-induced liver injury via a mechanism involving mitochondrial damage and ultimately apoptotic death of hepatocytes. However, whether metformin protects against DF-induced toxicity is unknown. Recently, we have shown that cAMP elevation is protective against DF-induced apoptotic death in hepatocytes, a protective effect primarily involving the downstream cAMP effector EPAC and preservation of mitochondrial function. This study aimed to investigate whether metformin protects against DF-induced toxicity via cAMP-EPACs. Experimental Approach: Primary rat hepatocytes were exposed to 400 µmol/L DF. CE3F4 or ESI-O5 were used as EPAC-1 or 2 inhibitors, respectively. Apoptosis was measured by caspase-3 activity and necrosis by Sytox green staining. Seahorse X96 assay was used to determine mitochondrial function. Mitochondrial reactive oxygen species (ROS) production was measured using MitoSox, mitochondrial MnSOD expression by immunostaining and mitochondrial morphology (fusion and fission ratio) by 3D refractive index imaging. Key Results: Metformin (1 mmol/L) was protective against DF-induced apoptosis in hepatocytes. This protective effect was EPAC-dependent (mainly EPAC-2). Metformin restored mitochondrial morphology in an EPAC-independent manner. DF-induced mitochondrial dysfunction demonstrated by decreased oxygen consumption rate, increased ROS production, and a reduced MnSOD level were all reversed by metformin in an EPAC-dependent manner. Conclusion and Implications: Metformin protects hepatocytes against DF-induced toxicity via cAMP-dependent EPAC-2. Data available on request from the authors.

Background: Thymic lymphoepithelioma-like carcinoma (LELC) is an extremely rare neoplasm in children. The causative role of Epstein-Barr virus (EBV) in the pediatric thymic LELC is unclear with limited treatment guidelines. Materials and methods: At our hospital, a 17-year old boy with thymic LELC was studied based on plasma levels of EBV DNA measured multiple times using real time quantitative polymerase chain reaction (RT-QPCR). For comparison, other patients <18 years old with thymic LELC reported in the English literature were also reviewed. Results: There were only 17 cases of pediatric thymic LELC in the literature. Including the present case, we analyzed a total of 18 such patients. The male to female ratio was 14:4, and the average age was 12.6 years old (range: 4 to 17). Of these 18 patients, the associations with EBV were not determined in 6 due to incomplete data, and the remaining 12 were all EBV-related. The mortality rate of pediatric thymic LELC was 68.8%, with an average survival time of 12.6 months after diagnosis. The plasma level of EBV RT-QPCR of the patient was 77048 copies/ml before chemotherapy. As his expression of PD-L1/PD-1 was 70%, pembrolizumab (2 mg/kg for one day) was also given. After 6 cycles of the above treatments, his CT scan showed a reduction in tumor size of >50% at the mediastinum. Conclusion: Despite limited data and our single case, we are inclined to conclude that children with thymic LELC likely associate with EBV pathogenicity. Immunotherapy may be useful in improving the prognosis.

Characteristics of photo-thermal effect and the functional relationship between the discharge intensity and the released heat are still unclear. In this work, the discharge intensity and the released heat of microwave-induced metal discharge were quantitatively measured using photo-voltage conversion and hydro-thermal exchange method, respectively. The mechanism of microwave-induced metal discharge was also discussed. The average discharge intensity obtained with three wires within 10 min was 44.6% higher than that obtained with one wire. The released heat increased from 67.81 kJ to 113.7 kJ when three wires were inserted instead of one wire. The rate of heat evolution changed by a step way with the decrease of discharge intensity. The electron enrichment on the metal tip causes a skin effect, and then the enhancement of electron enrichment forms Joule heat. After the stage, the electrons escape from the metal surface and cause the breakdown of the medium, forming the discharge.

Ventricular tachycardia storms and fibrillation are potentially lethal arrhythmias with limited treatment options. Failed catheter ablation is associated with a fourfold mortality increase in this population. Stereotactic body radiotherapy has been proposed as last resort in these patients. We report a patient in whom radiotherapy was safely performed leading to the elimination of ventricular arrhythmia during a one- year- follow- up period.

Common trunk of the inferior pulmonary veins (CIPV) is the rarest anatomical variant of the pulmonary vein, posing a challenge to catheter ablation for atrial fibrillation (AF). We show that cryoballoon ablation is safe and effective, and may be a first-line therapy option for AF in patients with CIPV.