Myocarditis is associated with increased morbidity and mortaity in patients with Covid-19 infection. Little is known about the true nature and exact pathogenesis of myocardial involvement in these patients. 44 year old patient admitted with exertional dyspnea. He had previous coronary artery bypass surgey and received hemodialysis for lupus nephritis. He was diagnosed with Covid-19 infection 1 month ago. Echocardiography revealed decreased left ventricular ejection fraction and left ventricular global longitudinal strain (GLS). Coronary computerized tomographic angiography revealed patent bypass grafts. His medical treatment was adjusted. Follow up echocardiography after 3 months showed markedly improved LVEF and left ventricular GLS.

To demonstrate prognostic utility of left atrial strain (LAS) in adult patients with repaired Tetralogy of Fallot (rTOF). Adults patients with rTOF were prospectively enrolled in this study between years 2011 and 2015. Left atrium (LA) phasic functions were assessed using 2D speckle tracking echocardiography. Association of LA strain (LAS) with primary (any cardiovascular event) and secondary (death, heart failure or arrhythmia) composite endpoints was assessed using Cox regression analysis. Hundred-and-twelve rTOF patients, in whom LAS was feasible and were in sinus rhythm, were included in the final analysis (age 33 ± 10years, 68[61%] male). Median duration of follow-up was 8.6 [4.2-9.7] years in the study group. Primary composite endpoint was reached in 48 patients (mean event-free survival time: 7.2 [6.6-7.9] years), and secondary composite endpoint was reached in 22 patients (mean event-free survival time: 8.7 [8.1-9.2] years). LA reservoir strain (LAS-r) was defined as tertile groups (1st tertile < 33%, 2nd tertile = 33-44%, 3rd tertile > 44%). Decreasing tertiles of LAS-r was associated with primary and secondary composite endpoints in Kaplan-Meier analysis (p = 0.02 and 0.002, respectively). In univariable Cox-regression, both decreasing LAS-r and LAS-r tertiles were associated with primary and secondary composite endpoints. Adjusted by initial repair age and NT-proBNP quartiles, increased LAS-r was associated with significantly decreased occurrence of experiencing any events (HR = 0.97, CI 0.93-0.99, p < 0.001). Decreasing LAS-r was still associated with primary endpoint when adjusted by left atrium volume index (LAVImax) (HR = 0.96, CI 0.92-0.99, p = 0.01), left ventricle global longitudinal strain (HR = 0.96, CI 0.93-0.99, p < 0.001) or right ventricle free wall longitudinal strain (HR = 0.96, CI 0.93-0.99, p = 0.03). Assessment of LA mechanics with the use of STE has incremental utility in determination of mortality and morbidity in rTOF, and may be implemented in clinical practice.

Abstract Background Ablation Index (AI) is a novel multiparametric radiofrequency (RF) ablation lesion quality metric, which incorporates contact force, time, and power in a weighted formula. AI guided strategies have been shown to be clinically effective for catheter ablation of atrial arrhythmias. The utility of AI to guide ablation of ventricular tachycardia (VT) in patients with structural heart disease is not known. Objectives To assess RF ablation and procedural characteristics, safety, and long-term clinical outcomes in patients undergoing VT ablation using either an AI guided strategy (maximum AI target value 550) or conventional approach using traditional parameters at a large tertiary medical center. Methods Consecutive patients (n=91) undergoing initial VT ablation for both ischemic (ICM) and non-ischemic (NICM) VT at single tertiary medical center between 2017 and 2022 were examined. Patients were 1:1 propensity matched for baseline characteristics, co-morbid conditions, and antiarrhythmic use depending on whether the ablation was guided by AI or traditional lesion quality parameters. Baseline categorical variables were compared using chi square test or Fisher exact test, and continuous measures were evaluated using Wilcoxon rank sum test. Linear regression was used to assess the impact of the use of AI on ablation characteristics and Cox proportional hazard model was used evaluate clinical outcomes. Results After propensity matching, baseline characteristics were well balanced between AI (n=37) and non-AI (n=37) groups (Table 1). Patients undergoing an AI guided strategy had shorter average procedure duration (-30.9 minutes, 95% CI [-60.4, -1.4], p=0.04) and average time per lesion (-13.7 seconds, 95% CI [-17.9, -9.5], p &amp;lt;0.001), as well as a trend toward significantly lower total RF ablation duration (357 seconds, 95% CI [-776, 61.9] p=0.09) and fewer steam pops (-0.19, 95% CI [-0.40, 0.02] p = 0.08). Lesion sets were similar between AI and non-AI groups (Scar homogenization: 41% vs 27%; p=0.22, Linear: 23% vs 73%; p=0.31, elimination LPs/LAVAs: 50% vs 43%; p=0.25, Scar dechanneling: 19% vs 8%; p=0.19, Core isolation: 5% vs 11%; p=0.4) as was use of epicardial mapping and ablation (11% vs 14%; p=0.73) Inducibility of VT (70% vs 67%; p=0.8) and termination of clinical VT during ablation (11% vs 16%; p=0.17) were also similar between AI and non-AI groups. When compared to a traditional strategy, patients undergoing an AI strategy had similar hazard for VT recurrence (0.97, 95% CI [0.42 – 2.2], p=0.93) and appropriate device therapy (0.79, 95% CI [0.32 – 1.95] p=0.61). Conclusions Compared to a strategy guided by traditional lesion parameters, use of AI of 550 for VT ablation in patients with structural heart disease resulted in shorter procedure time and average time of RF delivery per lesion with similar intermediate term clinical outcomes.Table 1Figure 1

Abstract Background:Type 1 diabetes mellitus (T1DM) is one of the most common endocrine and metabolic diseases in children. Cardiovascular autonomic neuropathy (CAN) is an important and overlooked complication of diabetes, which almost doubles the mortality. Therefore early recognition and treatment will prevent the development of cardiovascular events. Aim of our study is to determine the necessary parameters to recognize cardiovascular dysfunctions that may develop due to CAN in the early period. Methods:In our study, 30 healthy children and 30 T1DM patients with poor glycemic control were evaluated. Echocardiographic data, heart rate variability (HRV) with 24-hour Holter electrocardiography, exercise capacities, and tilt table test for baroreceptor susceptibility were evaluated. Results: In our study, 30 patients with poor glycemic control were evaluated, their mean diabetes duration was 8±3.66(1-16) years. CAN that may develop in early childhood were evaluated in the patient group. It is observed that there was a decrease in HRV, this situation is accompanied by ventricular dysfunction and postural hypotension. Conclusion:CAN is one of the most common complications of T1DM and is associated with patient's age and poor glycemic control. Decreased baroreceptor susceptibility with autonomic dysfunction is associated with decreased ventricular diastolic functions, respiratory functions, and exercise capacity. In our study, we showed that cardiac autonomic dysfunction may develop in early childhood in T1DM patients with poor glycemic control. It may be valuable to evaluate HRV and tilt table tests in the early detection of CAN in pediatric groups.

Estradiol (E2), a follicle-stimulating hormone (FSH), AMH, and inhibin B levels, along with AFC and MOV, are used to determine ovarian reserve in pre-menopausal women. Studies have shown that AMH levels are more sensitive than those of E2, FSH, and inhibin B and that AFC and MOV can be used to evaluate ovarian reserve. AMH, AFC, and MOV measurements were performed before and after adjuvant SC in 3-month periods for one year. Patients were classified as experiencing chemotherapy-induced amenorrhea (CIA) if they did not have menstrual cycles for a period of six months or longer following the conclusion of their chemotherapy treatment. We aimed to evaluate the factors affecting chemotherapy-induced amenorrhea in breast cancer patients treated with adjuvant chemotherapy and the performance of baseline measurements of AMH, AFC, and MOV to predict chemotherapy-induced amenorrhea. The effects of different chemotherapy regimens on the AMH level, AFC, and MOV in CIA patients were investigated. Seventy-one patients were eligible for this study, and the median age was 38 years (range: 23-45). The median follow-up was 37 months (range: 20-51), and CIA developed in 62% of the patients. The AMH level and AFC were significantly decreased one year after SC (p < 0.0001), whereas MOV was not (p = 0.507). AMH levels before chemotherapy (median: 1.520 vs. 0.755, p = 0.001) and at the end of the first year (median: 0.073 vs. 0.010, p = 0.030) and pre-treatment AFC (median: 12 vs. 4.50, p = 0.026) were lower in patients with CIA compared to those without CIA. The AMH levels before SC were the most valuable and earliest factor for predicting CIA development. In addition, there was no difference between the chemotherapy regimens (including or not including taxane) in terms of CIA development.

ABSTRACT Neurosteroids (NSs) are endogenous steroid hormones, which are synthesised and metabolised within the central nervous system (CNS). NSs aid myelination and glial differentiation and modulate cognitive functions. Herein, we aim to investigate the relationship between NS levels, 5-alpha-dihydroxyprogesterone (5-α-DHP) and allopregnanolone (ALPG), and their relationship with cognitive changes in relapsing remitting MS patients. A total of 43 cases with well controlled, relapsing remitting MS composed the study group. The control group included 21 age and gender matched healthy controls (HC). MS patients were assessed by calculating Expanded Disability Status Scale (EDSS) scores, and the Brief Repeatable Battery of Neuropsychological Tests (BRBNT) was performed in both MS group and HC. Levels of 5-α-DHP and ALPG levels were also evaluated for each participant. The median level of 5-α-DHP was 48 [IQR: 39.2–144.2] pg/mcgL in the MS group and 68.4 [IQR: 57.1–365.9] pg/mcgL in HC (p = 0.02). The median ALPG level was found to be 56.5 [IQR: 37.7–75.4] pg/mcgL in the MS group and 43.9 [IQR: 29.4–70.2] pg/mcgL in HC (p = 0.1). In both groups 5-α-DHP levels were positively correlated with Symbol Digit Modalities Test (SDMT) scores (HC: p = 0.01, r = 0.3 and MS: p = 0.03, r = 0.3). In the MS group, higher EDSS scores were associated with lower scores on Spatial Recall Test (SPART)-Delayed (p = 0.009, r= −0.4) and SDMT (p = 0.01, r= −0.4). The disease duration was negatively correlated with the scores on SPART-Immediate, SPART-Delayed and SDMT (p = 0.02, r= −0.4; p = 0.005, r= −0.4 and p = 0.05, r= −0.3). 5-α-DHP may be lower even in well-controlled cases. 5-α-DHP may contribute to better perceptual processing and attention in cases with MS.

OSCC is a genomically complicated disease and advancements in the modern era of molecular oncology have enabled researchers to portray near-to-complete resolution of signaling landscape. Over the last two decades, overwhelming proof-of-concept has established mechanistic regulatory role of non-coding RNAs in carcinogenesis, including OSCC. Circular RNAs demonstrate a burgeoning facet of oncology research and molecular biologists are only beginning to appreciate and recognize the significance of circRNAs in the pathogenesis of OSCC. Regulatory roles of non-coding RNAs in the re-shaping of signaling pathways offer plausible strategies for prevention/inhibition of OSCC. Circular RNAs have mechanistic roles in OSCC and "sponge effects" mediated by a wider variety of circRNAs need to be rationally targeted for effective cancer prevention. Phenomenal and cutting-edge research works in different types of animal models will further refine our knowledge for selection of most promising circRNAs as pharmacologically valuable targets.