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In patients with preserved ejection fraction or right bundle branch block (RBBB) pattern requiring a high percentage of ventricular pacing, His‐bundle pacing (HBP) might be an alternative to biventricular pacing, although the high threshold occasionally occurs. We provided a case of the intrinsic RBBB correction by capturing intra‐Hisian left bundle branch (LBB) or distal His‐bundle with different output settings. LBB pacing had the advantage of a much lower threshold while remained most synchrony as HBP. LBB pacing might be a promisingly safe and effective procedure for patients with high‐grade atrioventricular (AV) block and RBBB pattern.

Objective To compare the paced QRS duration on different sites in age‐, gender‐, and indication‐matched patients implanted with Micra leadless pacemakers and conventional transvenous pacemakers (TV‐PM). Method A total of 82 patients from Xinhua Hospital, Shanghai Jiaotong University, were enrolled, including two groups of 41 patients matched according to gender, age, and pacemaker indications, who underwent Micra and TV‐PM implantations, respectively. The baseline data of the patients, the pacing site described using three‐ and nine‐partition methods, and the paced QRS duration on 12‐lead electrocardiogram were then analyzed. Results Overall, patients in our population were on average 79.2 years of age and mostly male (75.6%). Atrioventricular node dysfunction was the most common indication (56.1%) for pacemaker therapy. Mid‐septum, especially Site 5, is the implantation site for most patients in both groups. Micra (145 ms) and TV‐PM (133 ms) both had the narrowest‐paced QRS at high septum, but Micra may exhibit significantly more reduced QRS duration than TV‐PM at low septum (Micra vs. TV‐PM: 143.0 [142.8–156.5] ms vs. 163.5 ± 17.5 ms, p = 0.044). Conclusion The narrowest‐paced QRS complex for Micra leadless pacemakers is achieved at high septum, and pacing at low septum by Micra may acquire shorter QRS duration than conventional TV‐PM. The narrowest‐paced QRS complex for the Micra leadless pacemaker is observed at the high septum. Moreover, pacing at the low septum using the Micra may result in a shorter QRS duration compared to the conventional transvenous pacemaker.

Background Although previous studies reported frequent premature atrial contractions(fPACs) increased the risk of adverse cardiovascular outcomes, especially atrial fibrillation(AF), there is a substantial inconsistency between reports concerning the definition of fPAC. In this study, we aimed to investigate the relationship between fPAC and cardiovascular outcomes, especially AF. We further searched for a cutoff value of fPAC for prediction of AF. Methods We retrospectively analyzed the ambulatory 24‐hr Holter monitoring records and 392 patients included. Frequent PAC was defined as more than 720 PAC/24 hr as used for frequent ventricular premature beats. Patients’ baseline characteristics, echocardiographic variables and medical history were recorded. Results There were 189 patients with fPAC and 203 patients without fPAC. Patients with fPAC had more comorbidities in terms of hypertension, diabetes mellitus, coronary artery disease and congestive heart failure. CHA2DS2‐VaSc was higher in patients with fPAC. Mean follow‐up duration was 31 months, and the number of patients with new‐onset AF during follow‐up was significantly higher in fPAC group (22% vs. 5%, p < .001). fPAC was significantly and independently associated with new‐onset AF and predicted AF with a cutoff value of 3,459 PAC/24 hr, and the risk of AF was 11‐fold higher than those with <3,000 PAC/24 hr. In addition, an increased CHA2DS2‐VaSc score was also associated with new‐onset atrial fibrillation. Conclusion In our study, we have demonstrated that fPAC is significantly associated with new‐onset AF, and this association is the strongest among those patients who have more than 3,000 PAC in 24 hr.

Prenatal diagnosis of hereditary diseases has substantially altered the way medical geneticists are helping families affected by genetic disorders. However, the risk of miscarriage and fear of invasive diagnostic procedures may discourage many couples from seeking prenatal diagnosis. With the discovery of maternal plasma cell-free fetal DNA, prenatal diagnosis has entered a new era of progress. Cell-free DNA is released during normal physiological functions as well as through the cell death programs of apoptosis and necrosis. It can be found in the plasma and other body fluids. Although this method has the advantage of being noninvasive, it is still rather expensive and requires advanced hardware and comprehensive data analysis. Promising implications of noninvasive prenatal diagnosis methods for the diagnosis of common trisomy disorders have paved the way for the development of more complicated assays of single-gene disorders. Relative mutation dosage and relative haplotype dosage are the most widely implemented assays for noninvasive prenatal diagnosis of single-gene disorders. However, each assay has its own advantages and disadvantages. Relative mutation dosage is based on the droplet digital polymerase chain reaction (PCR) technique which includes quantification features of real-time PCR assays. Relative haplotype dosage is based on next-generation sequencing that includes analysis of the maternal and paternal genome followed by sequencing of maternal plasma cell-free DNA. Co-amplification at a lower denaturation temperature PCR is another approach that is based on forming heteroduplexes between alleles to selectively amplify paternal mutations. In this review, we have described the most common noninvasive prenatal diagnosis approaches and compared their applications in genetic disorder diagnosis with different inheritance patterns. Key words: Cell-free nucleic acids, Prenatal diagnosis, Noninvasive prenatal testing, Single-gene diseases, Non-invasive techniques.

1. Stress has pervasive consequences for the well-being of animals. Currently, understanding how individuals cope with stressors is typically accomplished via short-term quantification of blood glucocorticoids released after activation of the hypothalamic-pituitary-adrenal (HPA) axis. 2. We investigated whether the amount of corticosterone (CORT) deposited in growing feathers provides a long-term, integrated measure of HPA activity in birds using captive red-legged partridges Alectoris rufa as a model species. 3. We examined CORT levels in primary feathers induced to grow at the same time as stress series were performed with a capture and restraint protocol. Plasma CORT titres after stress-induced stimulation, but not baseline values, correlated with feather CORT. Feather levels showed the same pattern as plasma of decline across the breeding season, but more severely. 4. For females, CORT in naturally moulted flank feathers was highly and positively correlated with the number of eggs laid in the previous few months, but not clutch size of the following year. For males, the amount of black on a feather, known to be a social signal, was positively correlated with its CORT level. 5. The analysis of feather CORT is a novel methodology that allows for meaningful interpretations of how individuals respond to environmental perturbations and adjust to life-history stages. 6. The analysis of feather hormones has the unique advantages of allowing for experimentation and sampling at any time of the year with minimal investigator-induced impacts and artefacts, and shows the HPA activity of an individual with a flexible time frame from days to months depending on the length of time taken to grow the feather. As this technique can be applied to living or dead birds, or feathers picked up after moult, it provides the ultimate non-invasive physiological measure of considerable benefit in terms of animal welfare and sampling effort.

Coronary artery spasms (CAS) can manifest in various forms, from silent ischemia to severe cardiac events like myocardial infarction and sudden death. This case involves a 56‐year‐old male with recurrent ischemic chest pain and varying ECG signs. Cardiac catheterization revealed multiple coronary spasms that resolved spontaneously or with intracoronary nitroglycerin. The report emphasizes the severe presentations of multiple CAS and the importance of thorough diagnostic evaluation to avoid unnecessary interventions, highlighting the diagnostic challenges in managing such cases. This case report highlights the severe presentations and diagnostic challenges associated with simultaneous spasms in multiple coronary arteries, emphasizing the need for comprehensive evaluation and appropriate management to prevent unnecessary interventions and improve patient outcomes.

Background Identification of coronary ischemia in patients presenting with chronic chest pain is difficult as resting ECG can be normal. Diagnosis of coronary ischemia requires evaluation during exercise or pharmacological stress. A noninvasive test to identify coronary ischemia at rest without the need for exercise is desirable. We studied the diagnostic accuracy of magnetocardiography (MCG) at rest to detect coronary ischemia in these patients. Methods Patients with chronic chest pain and suspected coronary ischemia with a normal ECG were included. Patients underwent treadmill test (TMT) and were divided into TMT positive and TMT negative groups. MCG was recorded in a magnetically shielded room. Iso‐field contour maps generated at the T‐wave peak were compared between the groups. From the magnetic field map (MFM), the magnetic field angle at T‐wave peak was calculated and was also compared across the two groups. Results There were a total of 29 patients, 12 with positive TMT and 17 with negative TMT. An abnormal magnetic field angle was more common in the TMT positive group (72% vs. 6%). Abnormal contour maps in the form of nondipole patterns or abnormal orientation were seen in 81.8% (9/11) patients in TMT positive group and 6.8% (1/17) patients in the TMT negative group (p < .001). Conclusion Abnormal magnetic field angle and abnormal magnetic field maps in MCG recorded at rest are able to identify the presence of coronary ischemia in patients with chronic chest pain and a normal resting ECG.

The middle‐aged male was diagnosed with “acute anterior wall myocardial infarction” based on clinical symptoms, laboratory examination, and coronary angiography (CAG), but his ECG showed no significant change in QRS wave or ST‐T within 6 h of admission. Thus, a perfect explanation with the existing theory is difficult, and only the case is presented here. The middle‐aged male was diagnosed with \"acute anterior wall myocardial infarction\" based on clinical symptoms, laboratory examination, and coronary angiography (CAG), but his ECG showed no significant change in QRS wave or ST‐T within 6 h of admission. Thus, a perfect explanation with the existing theory is difficult, and only the case is presented here.