Journal of the Chinese Medical Association : JCMA
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The recent Atrial Fibrillation Management in Congestive Heart Failure With Ablation trial did not reveal any benefit of catheter ablation in patients with atrial fibrillation (AF), advanced heart failure (HF), and severely reduced left ventricular ejection fraction (LVEF). We hypothesized that radiofrequency catheter ablation (RFCA) could improve outcomes in HF patients with AF and impaired left ventricular systolic function (LVEF <50%) as compared with only medical therapy. ⋯ Compared with medical therapy, RFCA for AF in the setting of HF with impaired systolic function is associated with better clinical (HF hospitalization and all-cause mortality), structural (LVEF improvement), functional (VO 2max ), and quality of life outcomes. However, RFCA for AF failed to reduce all-cause mortality in RCTs that enrolled patients with LVEF ≤35% and thereby indicated the necessary stratification to identify patients who may benefit more from RFCA.
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Patients with hypertrophic cardiomyopathy (HCM) have heterogeneous outcomes. As risk stratification mostly focuses on left-side myocardial function, we sought to investigate the prognostic value of right ventricular (RV) function in patients with HCM. ⋯ RV function assessed by TAPSE or RV free wall strain is predictive of subsequent cardiac events, suggesting that a comprehensive evaluation of RV function is useful for risk stratification in patients with HCM.
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Superior facet joint violation (FJV) is a potential risk factor for adjacent segment disease following lumbar fusion surgery. We sought to conduct a systematic review and meta-analysis to compare screw-related superior FJV rates between the open and different minimally invasive (MI) techniques-fluoroscopy-based, 3D-image navigation, and navigation with robotic assistance-in adult lumbar fusion surgery. ⋯ Among the three common MI techniques, fluoroscopy-based can be associated with a higher risk of superior FJV, while both 3D-image navigation and navigation with robotic assistance may be associated with lower risks as compared with the open method. Considering the limitations of the study, more trials are needed to prove these clinical findings.
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The population of young adults who are hearing impaired increases yearly, and a device that enables convenient hearing screening could help monitor their hearing. However, background noise is a critical issue that limits the capabilities of such a device. Therefore, this study evaluated the effectiveness of commercial active noise cancellation (ANC) headphones for hearing screening applications in the presence of background noise. In particular, six confounders were used for a comprehensive evaluation. ⋯ This study confirmed the effectiveness of ANC headphones for young adult hearing screening applications in the presence of background noise. Furthermore, the statistical results confirmed that as confounding variables, noise type, noise level, hearing screening frequency, ANC headphone model, and sex all affect the effectiveness of the ANC function. These findings suggest that ANC is a potential means of helping users obtain high-accuracy hearing screening results in the presence of background noise. Moreover, we present possible directions of development for ANC headphones in future studies.
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Cochlear implantation (CI) has become the standard treatment for patients with severe-to-profound hearing loss. To date, an estimated 750,000 individuals spanning the entire lifecycle have benefited from this life-changing technology. Traditionally, the device is not "activated" for 3 to 4 weeks after surgery. ⋯ Very early activation is safe and beneficial in patients with cochlear implants. Many CI centers believe that such a process can lead to improvements in both patient-centered and fiscally responsible care. Although not ideal for all patients, cochlear implant programs may consider this option for their patients.