Anterior Region Research Articles

Unconsciously triggered cognitive conflict influences perceptual choice in active and sedentary individuals.

People who regularly exercise and receive training perform better when actioning unconscious cognitive tasks. The information flow triggered by a single unconscious visual stimulus has been extensively investigated, but it remains unclear whether multiple unconscious visual stimuli interact. This study aimed to explore the relationship between three simultaneous subliminal arrow stimuli (pointing in same or different directions), focusing on how they interact with each other and the subsequent priming effect on the target arrow in active and sedentary groups. We used a priming paradigm combining flanker task to test the hypothesis. A total of 42 participants were recruited. Of these, 22 constituted the active group and 20 constituted the sedentary group. Behavioral data results revealed that the main effects of group and prime-target compatibility were significant. In the neurophysiological data, prime-target compatibility significantly influenced the latency of PP1. The amplitude of TP1 and TN2 mainly influenced the prime-flanker congruency. The prime-flanker congruency and groups interacted when the prime-target showed sufficient compatibility. The prime-flanker congruency, and the prime-target compatibility considerably influenced the TP3 amplitude in the anterior central frontal region (CZ electrode point). Event-related potentials revealed the interactions between conscious processing and subliminal conflict in the early stages of perceptual and attention processing (target-related P1 potential component). These results suggest that exercise is helpful for coping with unconscious cognitive conflict.

Delivery Room Lung Ultrasound-Feasibility, Normal Patterns, and Predictive Value for Respiratory Support in Term and Near-Term Neonates: A Monocentric Study.

our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001-delivery room; r = 4.0443, p < 0.001-one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support.

The hippocampus dissociates present from past and future goals

Our brain adeptly navigates goals across time frames, distinguishing between urgent needs and those of the past or future. The hippocampus is a region known for supporting mental time travel and organizing information along its longitudinal axis, transitioning from detailed posterior representations to generalized anterior ones. This study investigates the role of the hippocampus in distinguishing goals over time: whether the hippocampus encodes time regardless of detail or abstraction, and whether the hippocampus preferentially activates its anterior region for temporally distant goals (past and future) and its posterior region for immediate goals. We use a space-themed experiment with 7T functional MRI on 31 participants to examine how the hippocampus encodes the temporal distance of goals. During a simulated Mars mission, we find that the hippocampus tracks goals solely by temporal proximity. We show that past and future goals activate the left anterior hippocampus, while current goals engage the left posterior hippocampus. This suggests that the hippocampus maps goals using timestamps, extending its long axis system to include temporal goal organization.

Unveiling two novel Ditylenchus (Nematoda: Anguinidae) species inhabiting the growing medium of Rhododendron simsii imported from Japan

Summary The present study describes two new Ditylenchus species, isolated from the growing medium of Rhododendron simsii imported from Japan, at the Ningbo plant quarantine laboratory, Ningbo, P.R. China. Ditylenchus parvicauda n. sp. is an amphimictic species. Females have six incisures in the lateral fields, a medium length slim body, a short delicate stylet with asymmetrical stylet knobs, the secretory-excretory (S-E) pore located posterior to the isthmus and in the anterior region of the basal pharyngeal bulb, a posteriorly located vulva (V = 80.9-83.0), post-uterine sac (PUS) tube-like, and the tail cylindrical, tapering gradually towards finely rounded terminus. Males are similar to females in general morphology and have 10.1-14.9 μm long spicules. The second new species, D. gracicauda n. sp. is characterised by having a long and slender body, the presence of a vulval flap, four lines in the lateral field, a narrow and low lip region not offset, the S-E pore located posterior to the isthmus but not in the anterior region of the basal pharyngeal bulb, a posteriorly located vulva (V = 71.1-76.2), a short post-vulval uterine sac short (4.5-9.2 μm), and the tail slender, tapering gradually towards finely rounded to wedge-shaped terminus. The two new species were also characterised molecularly using 18S, ITS and the D2-D3 expansion segments of 28S rRNA genes. Our phylogenetic analyses showed their independent place among available Ditylenchus species. Several Ditylenchus species are regulated pests, and the introduction of these species into a new environment may result in diseases among native plants or vegetation in the area. Therefore, careful attention must be directed towards newly discovered species, particularly those under quarantine observation.

Respiratory internal kinematics of the tongue base and soft palate in obese minipigs with obstructive sleep apnea.

It is largely unknown how the tongue base and soft palate deform to alter the configuration of the oropharyngeal airway during respiration. This study is to address this important gap. After live sleep monitoring of five Yucatan and two Panepinto minipigs to verify obstructive sleep apnea (OSA), eight and four ultrasonic crystals were implanted into the tongue base and soft palate to circumscribe a cubic and square region, respectively. The 3D and 2D deformational changes of the circumscribed regions were measured simultaneously with electromyographic activity of the oropharyngeal muscles during spontaneous respiration under sedated sleep. The results indicated that both obese Yucatan and Panepinto minipigs presented spontaneous OSA, but not in threenonobese Yucatan minipigs. During inspiration, the tongue base showed elongation in both dorsal and ventral regions but thinning and thickening in the anterior and posterior regions, respectively. The widths showed opposite directions, widening in the dorsal but narrowing in the ventral regions. The soft palate expanded in both length and width. Compared to normal controls, obese/OSA ones showed similar directions of deformational changes, but the magnitude of change was two times larger in the tongue base and soft palate, and obese/OSA Panepinto minipigs presented 10 times larger changes in all dimensions of both the tongue base and the soft palate. The distance changes between the dorsal surface of tongue base and soft palate during inspiration increased in normal but decreased in obese OSA minipigs.

Distribution of myocardial fibrosis in patients with nonischemic cardiomyopathy and ventricular tachycardia based on genetic variant

BackgroundMany genetic nonischemic dilated cardiomyopathies (NICMs) cause ventricular tachycardias (VTs) originating from scar substrate identified as areas of low electrogram voltage. Substrate locations vary, and the causes of scar are not well defined. ObjectiveThis study evaluated VT substrate locations in genetic NICM patients undergoing VT ablation to evaluate spatial relationships between specific variants and substrate locations. MethodsIn this retrospective case series analysis, 32 patients (aged 55 ± 16 years; 94% male; left ventricular ejection fraction, 34% ± 13%) with genetic NICM referred for VT ablation between October 2018 and November 2022 at a single medical center were evaluated. Scar locations were defined as areas of low unipolar or bipolar voltage. ResultsOf the 32 patients evaluated, mutations in TTN (n = 11), LMNA (n = 6), PKP2 (n = 5), MYBPC3 (n = 3), DSP (n = 2), TTR (n = 1), FLNC (n = 1), AGL (n = 1), DES (n = 1), and DSG2 (n = 1) were observed. Substrates associated with mutations in TTN were observed only in basal subregions, predominantly anterior (100%) and septal (50%) regions. LMNA mutations were associated with fibrosis in mid inferolateral (60%) and apical inferolateral (60%) regions. Substrate location for individuals with PKP2 mutations was solely observed in the right ventricle, predominantly basal inferolateral regions. ConclusionUnderstanding spatial relationships between genetic variants causing NICM and VT substrate locations can help lead to generalizable regions in patients with genetically related NICM presenting in VT, which can be investigated during ablation procedures.

Injury Risk Estimation in Mandible-Related Surgical Procedures: A CBCT Study Based on Vital Interforaminal Anatomical Structures.

The mandibular interforaminal region has been considered safe for surgical procedures; nevertheless, the risk of injury to neurovascular structures, such as the mental foramen (MF) and its related structures (anterior loop [AL] and lingual foramina [LF]) should not be overlooked. The study aimed to evaluate the relative risk of injury to these structures during surgical procedures in the anterior region of the mandible based on cone-beam computed tomography (CBCT) scans. A retrospective cross-sectional and observational study was performed on 250 CBCTs from adults (18-69 years) with dentate jaws. Linear measurements of the MF, AL, and LF were evaluated to estimate the risk of injury to these structures during chin-related surgical procedures. The most frequent distance between the base of the mandible (BM) and MF was 8 mm (30.2%). In addition, 20.4% of the CTs had 6 mm from the vestibular cortical bone to the LF. The commonly found measurement from LF to the apex of the nearest tooth was 7 mm (24.0%); 64.2% of the CTs showed a 2-mm distance between the most distal point of the dental implant site to the most anterior point of the AL. Safety distances for genioplasty techniques (MF to mandible base > 6 mm, 96.6% [CI 95%, 95.0%-98.2%]) were observed. Considering the 5-mm cut-off point between the lower limit of a hypothetical bone graft and the chin, 65.4% (CI 95%, 58.9%-71.9%) of CTs were within this distance. Regarding the safety margin of 8 mm, 85.6% (CI 95%, 80.8%-90.4%) were up to this value. This study found safety margins for genioplasty and chin bone grafting surgical techniques that adopt a 5-mm cut-off point. Further similar studies assessing other surgical methods and employing larger samples from different geographical origins may contribute to this field of investigation.

Comparison Between Autologous Albumin Gel and Liquid Platelet-Rich Fibrin Mixture Versus Connective Tissue Graft to Modify the Gingival Phenotype: A Randomized Controlled Trial.

Objectives To assess changes in gingival thickness (GTH) and the width of keratinized gingival tissue (KTW) following treatment with either connective tissue graft (CTG) or an albumin gel-platelet-rich fibrin mixture (Alb-PRF). Materials and methods Twenty treatment sites were included in a split-mouth design involving 10 patients with a thin gingival phenotype in the mandibular anterior region. The sample was randomly divided into two groups, with the Alb-PRF applied to the experimental group and CTG used for the control group. GTH and KTW were measured at baseline and after one, three, and six months. Results GTH increased in both groups during all follow-up periods. However, no statistically significant differences (p > 0.05) between the groups were observed at baseline and six months. At three months, the experimental group exhibited significantly higher GTH (p < 0.001). Additionally, at three and six months, the CTG group showed a superior increase in KTW (p < 0.05). Conclusion Within the constraints of this study, Alb-PRF application for modifying thin gingival phenotypes proved to be an effective therapeutic option, potentially serving as an alternative to CTGs. Although Alb-PRF resulted in thicker gingiva, CTG demonstrated a greater enhancement in KTW.

Bone turnover prediction in patients with chronic kidney disease (CKD) undergoing hemodialysis using shortened dynamic 18F-NaF PET/CT Ki–Patlak

This study investigated whether Ki–Patlak derived from a shortened scan time for dynamic 18F-NaF PET/CT in chronic kidney disease (CKD) patients undergoing hemodialysis can provide predictive accuracy comparable to that obtained from a longer scan. Twenty-seven patients on chronic hemodialysis, involving a total of 42 scans between December 2021 and August 2023 were recruited. Dynamic 18F-NaF PET/CT scans, lasting 60–90 min, were immediately acquired post-injection, covering the mid-twelfth thoracic vertebra to the pelvis region. Ki–Patlak analysis was performed on bone time–activity curves at 15, 30, 45, 60, and 90 min in the lumbar spine (L1–L4) and both anterior iliac crests. Spearman’s rank correlation (rs) and interclass correlation coefficient were used to assess the correlation and agreement of Ki–Patlak between shortened and standard scan times. Bone-specific alkaline phosphatase (BsAP) and tartrate-resistant acid phosphatase isoform 5b (TRAP5b) were tested for their correlation with individual Ki–Patlak. Strong correlations and good agreement were observed between Ki–Patlak values from shortened 30-min scans and longer 60–90-min scans in both lumbar spine (rs = 0.858, p < 0.001) and anterior iliac crest regions (rs = 0.850, p < 0.001). The correlation between BsAP and Ki–Patlak in the anterior iliac crests was weak and statistically insignificant. This finding suggests that a proposed shortened dynamic 18F-NaF PET/CT scan is effective in assessing bone metabolic flux in CKD patients undergoing hemodialysis, offering a non-invasive alternative approach for bone turnover prediction.

Fluid-Solid Interfacial Properties and Drag-Reducing Characterization of the Flexible Conical Microstructured Film Inspired by the Streamlined Body Surface of the Pufferfish.

Given the challenges in accurately replicating the surface of the pufferfish, this study employed three-dimensional (3D) printing to create a model based on inverse modeling. The morphology of the pufferfish exhibits a streamlined configuration, characterized by a gradual widening from the anterior oral region to the central ocular area, followed by a progressive narrowing from the midabdominal region toward the caudal extremity. The RNG k-ε turbulence simulation results demonstrate that the streamlined body surface of the pufferfish diminishes differential pressure resistance. This enhancement promotes laminar flow formation, delays fluid separation, minimizes turbulence-induced vortices, and reduces frictional resistance. Moreover, the pufferfish's supple and uneven outer epidermis was simplified into a flexible, nonsmooth planar film to conduct fluid-solid coupling simulations. These revealed that the pufferfish's unique skin can absorb turbulent energy and minimize momentum transfer between the fluid and the solid film, lowering the fluid resistance during swimming. In summary, The high-efficiency swimming capacity of pufferfish stems not only from their streamlined body surface but also significantly from the unique structural characteristics and mechanical properties of their flexible skin. This research provides critical theoretical underpinnings for the design of functional bionic surfaces aimed at drag reduction.

Causal Cortical and Thalamic Connections in the Human Brain.

The brain's functional architecture is intricately shaped by causal connections between its cortical and subcortical structures. Here, we studied 27 participants with 4864 electrodes implanted across the anterior, mediodorsal, and pulvinar thalamic regions, and the cortex. Using data from electrical stimulation procedures and a data-driven approach informed by neurophysiological standards, we dissociated three unique spectral patterns generated by the perturbation of a given brain area. Among these, a novel waveform emerged, marked by delayed-onset slow oscillations in both ipsilateral and contralateral cortices following thalamic stimulations, suggesting a mechanism by which a thalamic site can influence bilateral cortical activity. Moreover, cortical stimulations evoked earlier signals in the thalamus than in other connected cortical areas suggesting that the thalamus receives a copy of signals before they are exchanged across the cortex. Our causal connectivity data can be used to inform biologically-inspired computational models of the functional architecture of the brain.

Sinonasal seromucinous hamartoma: a single institution case series combined with a narrative review of the literature.

This study aimed to investigate the clinical and histopathological characteristics of sinonasal seromucinous hamartomas (SHs). Eight patients with sinonasal SH and treated at a tertiary hospital between November 2005 and September 2023 were included. Additionally, a systematic review of published articles was conducted, analyzing 48 cases of SH described in the literature. Among the eight patients treated at our institution, tumors originated from the posterior nasal cavity in four patients and middle turbinate and middle meatus were the primary origin in two patients each. Coexistence of inflammatory nasal polyps (NPs) was observed in four cases. Histopathologically, four patients exhibited focal respiratory epithelial adenomatoid hamartoma (REAH) features, and low-grade dysplasia was found in one patient. A combined analysis with previous literature revealed that 46.3% of all cases originated in the anterior nasal cavity. The proportions of cases accompanied by NPs and those with focal REAH features were 20.5% and 39.1%, respectively. Additionally, the frequencies of cases exhibiting dysplastic features (5.4%) and recurrence (2.1%) were low. Remarkably, tumors originating from the anterior region tended to have a higher frequency of dysplasia than those originating from the posterior region, although this difference was not statistically significant (p = 0.0996). Patients with sinonasal SH showed favorable treatment outcomes following surgical resection. Focal REAH features and accompanying NPs were frequently observed. A substantial proportion of cases originate in the anterior nasal cavity, and these tumors may exhibit a high tendency for dysplasia.

Morphological evaluation of the nasopalatine canal using cone beam computed tomography and its clinical implications for orthodontic miniscrew insertion.

The morphology of the nasopalatine canal is crucial in the planning of prosthetic restorations in the anterior region of the maxilla, as well as in the placement of orthodontic mini-implants. The aim of this study was to assess the morphology of the nasopalatine canal using cone beam computed tomography (CBCT) scans of patients from the University Dental Clinic in Krakow, Poland, to define the position of the canal in relation to common sites of palatal median microimplant placement, and to investigate potential correlations between the anatomy of the canal and age and gender of the patients. A total of 120 CBCT images were used to assess the anatomy of the nasopalatine canal in 3 planes of space. The bone thickness anterior to the nasopalatine canal and the distance between the distal margin of Stenson's foramen and the predicted midpalatal microimplant position were also measured. The most frequently observed canal type in the coronal plane was the Y-shaped canal, which was present in 60.8% of patients. The nasopalatine canal was classified as cone-shaped in 31.7% of the scans, cylindrical in 28.3%, hourglass-shaped in 27.5%, and banana-shaped in 12.5%. The mean length of the nasopalatine canal was 11.58 mm. The mean width of the canal was 2.89 mm at the nasal fossa level, 1.94 mm in the middle, and 5.09 mm at the palatal level. The mean bone thickness anterior to the nasopalatine canal was 9.07 mm at the level of the nasal opening, 6.84 mm at the level of the oral opening, and 7.32 mm in the middle. The mean distance between the distal margin of Stenson's foramen and the predicted midpalatal microimplant position varied from 0 to 11.94 mm, with a mean of 2.49 mm. Given the variety of nasopalatine canal forms and dimensions, detailed analysis of CBCT scans is essential prior to the placement of implants and microimplants.

Fracture resistance of cement-retained lithium disilicate implant-supported crowns: Effect of material used for two-piece abutments.

This study compared the fracture strength of single lithium disilicate implant-supported crowns fabricated on two-piece abutments with various materials: ceramic-reinforced PEEK, zirconia, and lithium disilicate. Thirty-six implants were embedded in acrylic cylinders. A two-piece abutment and a crown were designed following a pre-operation scan for a maxillary left central incisor. The designed crown was used to fabricate 36 lithium disilicate crowns. The designed abutment was used to manufacture 36 abutments from 3 materials, 12 each: (A) zirconia; (B) lithium disilicate; and (C) ceramic-reinforced PEEK. Abutments were surface treated and bonded on the titanium base abutments with resin cement. Then, lithium disilicate crowns were bonded on the assigned abutments. Specimens were then subjected to dynamic loading for 1,200,000 cycles. The fracture strength (N) of the assembly was assessed using a universal testing machine. One-way ANOVA followed by multiple comparison tests was used to evaluate the effect of abutment material on the fracture strength of single implant-supported restorations at a significance of .05. The average fracture strength for the groups with zirconia, PEEK, and lithium disilicate two-piece abutments were 1362N ± 218N, 1235N ± 115N, and 1472N ± 171N, respectively. There was a significant (p < 0.05) difference in fracture strength among the groups. The lithium disilicate group had significantly higher fracture strength (p = 0.0058) than the group with PEEK; however, there was no significant (p > 0.05) difference between the other groups. Two-piece abutments restored with lithium disilicate crowns investigated in the study have the potential to withstand the average physiological occlusal forces in the anterior region.

Dental implant and abutment in PEEK: stress assessment in single crown retainers on anterior region.

Stress distribution assessment by finite elements analysis in poly(etheretherketone) (PEEK) implant and abutment as retainers of single crowns in the anterior region. Five 3D models were created, varying implant/abutment manufacturing materials: titanium (Ti), zirconia (Zr), pure PEEK (PEEKp), carbon fiber-reinforced PEEK (PEEKc), glass fiber-reinforced PEEK (PEEKg). A 50N load was applied 30o off-axis at the incisal edge of the upper central incisor. The Von Mises stress (σvM) was evaluated on abutment, implant/screw, and minimum principal stress (σmin) and maximum shear stress (τmax) for cortical and cancellous bone. The abutment σvM lowest stress was observed in PEEKp group, being 70% lower than Ti and 74% than Zr. On the implant, PEEKp reduced 68% compared to Ti and a 71% to Zr. In the abutment screws, an increase of at least 33% was found in PEEKc compared to Ti, and of at least 81% to Zr. For cortical bone, the highest τmax values were in the PEEKp group, and a slight increase in stress was observed compared to all PEEK groups with Ti and Zr. For σmin, the highest stress was found in the PEEKc. Stress increased at least 7% in cancellous bone for all PEEK groups. Abutments and implants made by PEEKc concentrate less σvM stress, transmitting greater stress to the cortical and medullary bone. The best stress distribution in PEEKc components may contribute to decreased stress shielding; in vitro and in vivo research is recommended to investigate this.

Decreased gray matter volume in the anterior cerebellar of attention deficit/hyperactivity disorder comorbid oppositional defiant disorder children with associated cerebellar-cerebral hyperconnectivity: insights from a combined structural MRI and resting-state fMRI study.

Attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid. Many prior investigations have found that ADHD relates to anatomical abnormalities in gray matter. The abnormal gray matter of ADHD comorbid ODD is still poorly understood. This study aimed to explore the effect of comorbid ODD on gray matter volume (GMV) and functional alterations in ADHD. All data were provided by the ADHD-200 Preprocessed Repository, including 27 ADHD-only children, 27 ADHD + ODD children, and 27 healthy controls aged 9-14 years. Voxel-based morphometry (VBM) and functional connectivity (FC) of resting-state functional magnetic resonance imaging (fMRI) were used to compare the difference in GMV and FC between ADHD + ODD, ADHD-only, and healthy children. The results showed that ADHD children with comorbid ODD had a more significant reduction in cerebellar volume, mainly in the anterior regions of the cerebellum (Cerebellum_4_5). The Cerebellum_4_5 showed increased functional connectivity with multiple cortical regions. These brain regions include numerous executive functioning (EF) and brain default mode network (DMN) nodes. The GMV abnormalities and excessive connectivity between brain regions may further exacerbate the emotional and cognitive deficits associated with ADHD.

A Simple Modified Open Tray Implant Impression Technique in a Patient with Fixed Orthodontic Appliance Therapy

Background: Implant based restorations are an integral part of orthodontic treatment currently and this combination provides increased treatment options. Making impressions for implant based restorations in subjects undergoing orthodontic treatment is a challenging task. Aim: This article presents a simple technique to achieve precise impressions utilizing commonly available materials in dental operatory. Case Description: Patient undergoing orthodontic therapy requiring replacement of missing lateral incisor was planned for implant placement and crown fabrication simultaneously during fixed appliance therapy. A modified open tray implant impression with polyvinyl siloxane was made during the prosthetic phase for successful rehabilitation of the edentulous space in the anterior region. Clinical Significance: Multidisciplinary approach to treatment is time saving, which includes simultaneous Orthodontic and Prosthodontic procedures. A simple modification of the open tray impression procedure can result in an accurate final cast in the region of interest to overcome the difficulties of impression making in a patient with fixed orthodontic appliance.

Posterior wall isolation in patients with persistent atrial fibrillation: a single center comparative study between ablation index and very high power short duration radiofrequency ablation protocol

Abstract Background Circumferential pulmonary veins ablation (CPVA) with posterior wall isolation (PWI) using radiofrequency catheter ablation (RFCA) is gaining increasing interest in terms of safety and efficacy. Purpose To compare procedural data and efficacy between two radiofrequency ablation protocols for the treatment of persistent atrial fibrillation (PersAF): very high power-short duration (vHPSD) ablation using a novel temperature-controlled ablation catheter and Ablation Index (AI) guided RFCA using traditional contact-force catheter. Methods This single center prospective study enrolled 75 consecutive patients (Group 1) with symptomatic PersAF undergoing RFCA using a novel contact-force catheter optimized for temperature-controlled ablation with microelectrodes and 6 thermocouples for real-time temperature monitoring during ablation. The vHPSD algorithm modulates power to maintain target temperature during these lesions (90 Watts, 4 s) in the posterior wall. RF delivery in anterior regions was performed in a temperature guided setting (1-45W, 45°C) to achieve a 500-550 AI. These patients were compared to 75 propensity matched patients (Group 2) undergoing PersAF ablation with traditional AI-guided ablation. Procedural data were compared between the two groups (Table 1). Procedural outcome was considered as loop recorder documented atrial arrhythmias recurrences and compared between the two groups. Results Seventy-five patients (69% male, 63.1±11.2 years old) underwent ablation with vHPSD protocol (Group 1). CPVA and PWI was achieved in all patients with total procedure and fluoroscopy times of 67.5±28.8 min and 4.5±2.8 min, respectively. After 12-month median follow-up, 57/75 patients (76%) were free from AF. Seventy-five propensity matched patients (69% male, 60.7±9.9 years old) have undergone ablation with standard contact-force catheter. CPVA and PWI was achieved in all patients with total procedure and fluoroscopy times of 81.99±20.5 min and 5.7±2.1 min, respectively. After 12-month median follow-up, 55/75 patients (73%) were free from AF. Procedural and fluoroscopy times were significantly lower in in Group 1 than in Group 2 (Table 1). AF recurrencies were comparable between the two groups as assessed with survival analysis (Figure 1, log-rank 0.509). There were no deaths or other severe periprocedural complications. Conclusions PWI on top of CPVA is effective in limiting arrhythmic recurrences following RFCA of PersAF. Compared to standard AI guided ablation, vHPSD protocol significantly reduces procedural time and fluoroscopy exposure. Clinical outcomes between the two protocols are similar.Figure 1

Increased anterior insula connectivity associated with cognitive maintenance in amnestic mild cognitive impairment: a longitudinal study.

The insula, a crucial hub of the human brain network, can be divided into anterior and posterior regions. Previous studies have reported that different insula subregions play various roles in amnestic mild cognitive impairment (aMCI). However, the longitudinal changes in the functional connectivity (FC) of each insula subregion in aMCI patients over time remain unclear. Twenty aMCI patients and 20 healthy controls (HCs) were recruited and underwent resting-state functional magnetic resonance imaging (fMRI) scans and neuropsychological assessments at baseline and at the 15-month follow-up. FMRI data were preprocessed using SPM 12 and the CONN toolbox. Two-way analysis of covariance was used to compare longitudinal changes in the FC of each insula subregion with covariates including sex, age, education, follow-up interval, volume of gray matter, and global correlation (GCOR). Pearson's correlation was used to evaluate the relationship between insula subregional FC and neuropsychological performance in aMCI patients. In aMCI patients, the right anterior insula exhibited significantly increased FC with the left anterior cingulate cortex, whereas the left posterior insula exhibited decreased FC with the right precuneus compared with HCs. Furthermore, FC between the right anterior insula and left anterior cingulate cortex was significantly correlated with global cognition at follow-up. The current findings revealed different functional alterations in the insula subregions and provided new insights into the neurodegenerative process in aMCI patients.

Pulsed field ablation versus very high-power short-duration radiofrequency ablation in persistent atrial fibrillation: a single-centre experience

Abstract Background Pulsed Field ablation (PFA) has recently emerged as a treatment strategy for patients with atrial fibrillation (AF) and early studies showed promising procedural data and durable pulmonary vein isolation (PVI). However, Very High-Power Short-Duration ablation (VHPSD) has previously reported good efficiency and mid-term outcomes, and only a few works compared these two procedures, especially in patients with persistent AF. Objective Our aim is to compare these different modalities of transcatheter ablation in patients with persistent AF, focusing mainly on some procedural aspects, safety and efficacy. Methods We performed a retrospective observational study enrolling all consecutive patients with persistent AF from September 2021 to May 2023 undergoing transcatheter ablation with PFA or VHPSD. In the first group, PVI was achieved by 2kV pulses with eight applications to each vein using both catheter configurations, while isolation of the posterior wall of the left atrium was achieved by applications through the only "flower" configuration; additional lesions were then added at the operator's discretion. In the second group, PVI was achieved by delivering 90W radiofrequency pulses for 4 seconds in the posterior portions of the left atrium and 50W pulses in the anterior region of the pulmonary veins; additional lesions were occasionally applied. All patients received general anaesthesia or deep sedation with fentanyl and dexmedetomidine. Results A total of 79 patients were included, n = 24 (30%) in the PFA group and N = 55 (70%) in the VHPSD one: early persistent AF (n= 2 [8,3%]; N = 7 [12,7%]), persistent AF (n= 17 [70,8%]; N = 36 [65,5%]), long-standing persistent AF (n= 5 [20,8%]; N = 12 [21,8%]). The two populations showed similar clinical features: CHA2DS2-VASc (median value 3 [0-6] in PFA vs 2 [0-6] in VHPSD, p = 0,10), indexed left atrial volume (mean value 42,6 ml/m² in PFA vs 42,4 ml/m² in VHPSD, p = 0,07) and EF (mean value 55,4% in PFA vs 54,8% in VHPSD, p = 0,33). PVI was successfully achieved in all patients. Nevertheless, the PFA group was associated with shorter procedural duration (92,1 ± 36,9 vs 134,2 ± 36,1 minutes, p = 0,00001) but longer fluoroscopy time (25,5 ± 9,3 vs 17,4 ± 11,5 minutes, p = 0,001); it also showed a lower rate of minor complications (n = 1 [4,2%] vs N = 3 [5,5%], p = 0,057), even though serious complications were not observed in either group. After a median follow-up of 14 (9-26) months, n = 19 [79.2%] in the PFA and N = 43 [78.2%] in the VHPSD population were free of any atrial arrhythmia (p = 0,92). Conclusion PFA allows faster procedures, representing a major advantage for the operator and the patient, who is at lower risk of peri-procedural complications. On the other hand, VHPSD correlates with shorter fluoroscopy times, reducing exposure to ionizing radiation. Finally, the two procedures show similar mid-term efficacy in terms of recurrence-free time.