Cardiac Monitoring Research Articles

Comprehensive Cardiac Monitoring and Early Intervention in a Patient with Hypertension Using Smartphone-based Portable Electrocardiogram

Abstract Cardiovascular diseases pose significant global health challenges, necessitating effective early detection and management strategies. Smartphone-based portable electrocardiogram (ECG) devices offer a promising solution by enabling convenient, real-time cardiac monitoring outside traditional health-care settings. This case report examines the clinical course of a 70-year-old male with a history of hypertension who presented with symptoms of breathlessness. Utilizing the Spandan ECG device, the patient underwent multiple at-home ECG tests, identifying premature ventricular complexes, sinus bradycardia, and left ventricular hypertrophy. Subsequent diagnostic evaluations, including echocardiography, stress testing, and coronary angiography, confirmed coronary artery disease with significant stenosis in the left anterior descending and left circumflex arteries. Portable ECG monitoring facilitated early intervention and personalized treatment, underscoring its role in improving patient outcomes through proactive cardiovascular care. This case highlights the transformative potential of smartphone-based ECG devices in enhancing diagnostic accuracy, facilitating timely interventions, and empowering patients in their health-care journey.

Safety and Efficacy of Echo- vs. Fluoroscopy-Guided Pericardiocentesis in Cardiac Tamponade

Background and Objectives: Cardiac tamponade is managed through echo- or fluoroscopy-guided percutaneous pericardiocentesis. The European Society of Cardiology’s Working Group on Myocardial and Pericardial Diseases proposed a triage strategy for these patients. This study evaluated the triage score and compared the safety and efficacy of fluoroscopy- versus echo-guided procedures without additional visualization control. Materials and Methods: This prospective observational study included 71 patients with cardiac tamponade from February 2021 to June 2022. Pericardiocentesis was performed using fluoroscopy or echo guidance based on clinical assessment and catheterization laboratory availability, without the additional control of needle/guidewire position or ECG monitoring. Patients were followed for three months. Results: The study included 71 patients (52.1% female, mean age 59.7 ± 15.7 years). Malignancy was the most common comorbidity (59.2%). Echo criteria led to urgent procedures in 47.9%, with subcostal access used most often (60.6%), particularly in fluoroscopy-guided procedures (93.8%, p = 0.003). The success rate was 97.1%, with minor complications in 14% of patients. Diabetes and malignancy predicted complications regardless of access site or guiding method. The triage score did not affect complication rates or short-term mortality. Conclusions: Fluoroscopy- and echo-guided pericardiocentesis without additional visualization control showed no difference in safety or efficacy. Delaying the procedure for patients with a triage score ≥6, or performing it early for those with a low score, did not impact complication rates or mortality, which were more influenced by the progression of the underlying disease.

Adherence to delayed-release cysteamine in nephropathic cystinosis over time: data from the prospective CrYSTobs cohort study.

Adherence to cysteamine in nephropathic cystinosis (NC) remains challenging. A better adherence with delayed-release (DR) compared to immediate-release (IR) cysteamine at 1year was previously shown. This study aimed to evaluate adherence to DR cysteamine at 2years. Treatment adherence was assessed using a medication event monitoring system; adherence ranged from 0 (poor) to 2 (good). Leukocyte cystine level was measured at each 3-month visit. Long-term follow-up data (7years after the end of the study) on self-reported adherence and quality of life was also obtained in a sub-group of patients. Seventeen patients with NC under DR cysteamine from three French centers were included at a median age of 13.9 (5.4-33.0) years. The median adherence score was 1.62 (0.03-1.98) over the 2-year follow-up, with 65% of patients having good adherence and 75% having partial or good adherence. No significant difference in leukocyte cystine level between baseline and 2years was found (0.8nmol vs. 0.4nmol, respectively; difference in median of - 1.0nmol; 95% CI - 0.7, 0.4; P = 0.64). Long-term follow-up data highlighted that no patient wished to switch back to IR cysteamine, as taking the medication twice rather than four times a day was easier. This study found a fairly good adherence to DR cysteamine over time. Decreasing the number of intakes per day may improve adherence and limit the side effects of the drug, representing an additional argument in favor of its use in patients with cystinosis.

Model-informed repurposing of eliglustat for treatment and prophylaxis of Shiga toxin-producing Escherichia coli hemolytic-uremic syndrome (STEC-HUS) in children.

Shiga toxin-producing Escherichia coli hemolytic-uremic syndrome (STEC-HUS) is a severe illness predominantly affecting young children, with limited treatment options beyond supportive care. Eliglustat, approved for Gaucher disease, shows potential in reducing Shiga toxin binding to target glomerular endothelial cells in vitro, prompting interest as a treatment for STEC-HUS. However, it remains unknown what dose is likely to be effective and safe for treatment of STEC-HUS in the pediatric population. We hypothesize that effective and safe levels of eliglustat can be reached in children. We identified pharmacokinetic targets of efficacy for treatment and prophylaxis of STEC-HUS based on a preclinical model and human cardiac safety data. Then, we developed oral and intravenous dosing regimens using population pharmacokinetic (popPK) simulations based on an existing model enriched to allow extrapolation to a simulated virtual pediatric population. These dosing regimens were then confirmed using a verified physiologically based pharmacokinetic (PBPK) model. We simulated, using popPK data, oral and intravenous dosing regimens resulting in adequate target exposure in > 90% of all patients, with minimal expected risk for cardiotoxicity. Confirmation of these dosing regimens with PBPK modeling resulted in very similar exposure, with lower interindividual variability and minimal toxicity potential. Based on pharmacokinetic modeling, we developed oral and intravenous eliglustat dosing regimens that are likely safe and effective for treatment of STEC-HUS and prophylaxis in case of outbreaks of STEC infections. Clinical evaluation of these dosing regimens in children suspected of or diagnosed with STEC-HUS is required and should include assessment of pharmacokinetics, efficacy, and safety (e.g., ECG monitoring).

Dual Therapy in Inflammatory Bowel Disease

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic and complex autoimmune conditions. Despite the advancements in biologics and small molecules, the therapeutic ceiling persists, posing significant treatment challenges and contributing to the concept of difficult-to-treat IBD. Dual-targeted therapy (DTT), combining two biologic agents or biologics with small molecules, has emerged as a novel approach to address this unmet need by targeting multiple inflammatory pathways simultaneously. Evidence suggests that DTT holds promise in improving clinical and endoscopic outcomes, especially in patients with refractory disease or extraintestinal manifestations. Safety data, while consistent with monotherapy profiles, highlight the importance of vigilant monitoring for infections and other adverse events. Continued research and high-quality trials are crucial to defining optimal DTT regimens and broadening its clinical applicability. This review explores the efficacy and safety of DTT in IBD, reporting data from clinical trials, systematic reviews, and real-world studies.

WF-PPG: A Wrist-finger Dual-Channel Dataset for Studying the Impact of Contact Pressure on PPG Morphology

Photoplethysmography (PPG) is a simple optical technique widely used in wearable devices for continuous cardiac health monitoring. However, the quality of PPG signals, particularly their morphology, is influenced by the contact pressure between the skin and the sensor. This variability in signal quality complicates complex tasks that rely on high-quality signals, such as blood pressure and heart rate variability estimation, making them less reliable or even impossible. To address this issue, we present a novel dataset (termed WF-PPG) comprising PPG signals from the wrist measured under varying contact pressures, along with high-quality PPG signals from the fingertip captured simultaneously. Data collection was conducted using a custom device setup capable of precisely adjusting the contact pressure for wrist PPG signals while also recording additional metrics such as contact pressure, electrocardiogram (ECG), blood pressure, and oxygen saturation. WF-PPG is designed to facilitate the analysis of effects of contact pressure on PPG morphology and to support the development and evaluation of advanced data-driven techniques aimed at enhancing the reliability of PPG-based health monitoring.

Catastrophic Severe Injuries and Medical Conditions in Girls' and Women's Softball: An 8-Year Epidemiologic Study.

Research on catastrophic injuries and medical conditions among majority girls' and women's sports are underrepresented. In this study, we describe the incidence, characteristics, and mechanisms of severe softball injuries/medical conditions between 2014 and 2021. Catastrophic injury and illness patterns will be observed with a higher incidence rate at the collegiate level. Descriptive epidemiologic study. Level 3. Events from the National Center for Catastrophic Sport Injury Research (NCCSIR) and National Electronic Injury Surveillance System (NEISS) were included. NCCSIR included catastrophic injuries during participation in high school (HS) or college sponsored girls'/women's softball resulting in death, temporary or permanent disability, or life-threatening injury. NEISS included severe girls'/women's softball injuries (product code 5034) among 13- to 17- and 18- to 24-year-olds among severe dispositions. National estimates were derived using a weighted sample for NEISS. Counts (%) and incidence rates (IR) per 100,000 participants overall and by age level, injury/medical event, and outcome were reported. NCCSIR captured 0.3 events per 100,000 participants (95% confidence interval, 0.1-0.5), and incidence was higher in college (IR, 2.5; 0.9-6.6) compared with HS (IR, 0.1; 0.1-0.4). Sudden cardiac arrest was the most common event (5, 63%), and 2 (25%) fatalities were reported. NEISS captured 10.2 events per 100,000 participants (9.7-10.8). Incidence was higher in 18- to 24-year-olds (IR, 8.9; 8.3-9.6) compared with 13- to 17-year-olds (IR, 4.2; 3.8-4.6), and no fatalities were captured. Collegiate and 18- to 24-year-old athletes demonstrated a higher incidence of severe injuries than HS and 13- to 17-year-old athletes across both surveillance systems. NEISS captured a higher incidence of catastrophic events than NCCSIR. NCCSIR observed more cardiac events, whereas NEISS observed more head/face injuries. Continued monitoring of severe injuries and medical events in softball is necessary to support response and prevention measures.

Abstract TP157: Sex Disparities in Stroke Care at Comprehensive Stroke Centers: DiVERT Stroke Study Phase I

Introduction: Prior studies have shown various sex disparities in stroke care; whether sex disparities exist for cardiac consultation or monitoring post-stroke is unknown. Methods: DiVERT (SeconDary Stroke PreVEntion ThRough Pathway ManagemenT) is an ongoing, retrospective, multicenter study evaluating in-hospital care pathways for patients with cryptogenic, large-vessel atherosclerotic disease and small vessel disease stroke subtypes. Phase I included in-person clinician interviews across cardiology and vascular neurology subspecialities, data collection from electronic health records and the American Heart Association Get With the Guidelines (AHA GWTG) registry from 2017 to 2019. Baseline demographics and 6 months post-index stroke discharge data were collected at 5 comprehensive stroke centers (CSC) in the United States and compared between females and males. Results: Among 2,699 patients, the majority presented with cryptogenic stroke (70.9%) and females (48.8%) were older than males (68.3, SD=14.6 vs. 65.7, SD=13.3; p<0.001) (Table). Females were less likely to receive cardiology referrals during index hospitalization (12.8% vs. 15.5%, p=0.043), had shorter length of stay (6.8 vs. 7.7 days; p=0.025) and were less likely to receive post-stroke cardiac monitoring (19.9% vs. 23.0%, p=0.048). There were no sex differences for type of cardiac monitoring (external vs. insertable). The rate of atrial fibrillation detected post-stroke was higher for any type of cardiac monitoring vs. non-monitoring, irrespective of sex (7.4% vs. 3.9%, p=0.015 for females and 8.0% vs. 3.5%, p<0.001 for males). Conclusion: Among stroke patients admitted to CSC, women had shorter length of stay at index stroke hospitalization, fewer referrals to cardiology and less frequent post-stroke cardiac monitoring than men. These differences could represent sex disparities that impact preventive actions for secondary stroke and long-term outcomes.

Practical management of adverse events in patients receiving tarlatamab, a delta-like ligand 3-targeted bispecific T-cell engager immunotherapy, for previously treated small cell lung cancer.

Tarlatamab is a bispecific T-cell engager immunotherapy targeting delta-like ligand 3 (DLL3) and the cluster of differentiation 3 (CD3) molecule. In the phase 2 DeLLphi-301 trial of tarlatamab for patients with previously treated small cell lung cancer, tarlatamab 10 mg every 2 weeks achieved durable responses and encouraging survival outcomes. Analyses of updated safety data from the DeLLphi-301 trial demonstrated that the most common treatment-emergent adverse events were cytokine release syndrome (53%), pyrexia (38%), decreased appetite (36%), dysgeusia (32%), and an emia (30%). Cytokine release syndrome was mostly grade 1 or 2 in severity, occurred primarily after the first or second tarlatamab dose, and was managed with supportive care, which included the administration of antipyretics (e.g., acetaminophen), intravenous hydration, and/or glucocorticoids. Other treatment-emergent adverse effects of interest included neutropenia (16%) and immune effector cell-associated neurotoxicity syndrome and associated neurologic events (10%). Given that tarlatamab is the first T-cell engager approved for the treatment of small cell lung cancer, raising awareness with regard to the monitoring and management of tarlatamab-associated adverse events is essential. Here, the authors describe the timing, occurrence, and duration of these adverse events and review the management and risk-mitigation strategies used by clinical investigators during the DeLLphi-301 trial.

A multicenter prospective study to evaluate the efficacy of resection for initially unresectable hepatocellular carcinoma after atezolizumab combined with bevacizumab (the RACB study): Short-term outcomes.

521 Background: The IMbrave150 study showed that atezolizumab plus bevacizumab (atezo+bev) is superior to sorafenib in progression-free survival and overall survival, making it the recommended first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). The RACB study was scheduled to evaluate the efficacy of atezo+bev in achieving conversion surgery for initially unresectable HCC. This time, we report the short-term outcomes of the RACB study. Methods: This prospective, single-arm, multicenter Phase II trial evaluates atezo+bev to achieve conversion surgery in patients with technically or oncologically unresectable HCC. Eligible patients had unresectable HCC without prior systemic chemotherapy and at least one target lesion based on RECIST ver1.1. Patients received atezolizumab (1200 mg) plus bevacizumab (15 mg/kg) every three weeks. If resectable on radiological assessment at 12 weeks, atezolizumab monotherapy was given followed by surgery. The primary endpoint was the progression-free survival. The secondary endpoints included the overall response rate, overall survival, resection rate, curative resection rate, on-protocol resection rate, and ICG retention rate at 15 min after atezo+bev therapy. The study is registered with the Japan Registry of Clinical Trials (jRCTs051210148). Results: Between March 2022 and March 2024, 55 patients from 17 centers were enrolled. Four patients were excluded due to ineligible lesions or other reasons. A total of 50 patients were included in the efficacy evaluation set. Macrovascular invasion and extrahepatic metastases were observed in 38 (76.0%) and 6 patients (12.0%), respectively. Two patients (4.0%) had metachronous extrahepatic metastases without intrahepatic tumors. The complete and partial response rates were 0% and 13% based on RECIST, and 2.2% and 26.1% based on mRECIST. The overall resection rate was 48%, corresponding to 24 cases. R0, R1, and R2 resections were performed in 21 (87.5%), 1 (4.2%), and 2 (8.3%) patients, respectively. Complications ≥Grade III according to the Clavien-Dindo classification included 3 bile leakages, 2 infections, 1 anastomotic leakage, and 1 hemoptysis. There were no surgery-related deaths. Of the 51 patients included in the safety analysis set, adverse events occurred in 34 cases (66.7%), with 16 Grade 3 or higher instances with one Grade 4 upper gastrointestinal bleeding, 1 Grade 4 encephalopathy, and 1 unexpected death after 1 cycle of atezo+bev. Conclusions: The RACB study's short-term outcomes demonstrated the feasibility of conversion surgery after atezo+bev in patients with initially unresectable HCC. The response rate of atezo+bev, as measured by mRECIST, was similar to IMbrave150, with a 48% resection rate, though careful monitoring of severe adverse events is essential. Clinical trial information: 051210148.

Patient characteristics and use for bevacizumab in ophthalmology and oncology in a distributed research network.

Although bevacizumab and its biosimilars are commonly used, there are limited real-world data on bevacizumab use in the United States, especially biosimilar bevacizumab used in ophthalmologic conditions. To evaluate use patterns and patient characteristics for the originator bevacizumab relative to its biosimilars for labeled and off-label oncology and ophthalmology conditions and characterize adverse events in patients using bevacizumab for oncologic indications. We conducted a retrospective cohort study with the Biologics and Biosimilars Collective Intelligence Consortium-distributed database to identify patients aged 21years and older who received bevacizumab between January 1, 2010, and June 30, 2021. Oncology indications included colon, lung, and gynecologic (cervical, uterine, and ovarian) cancers. Ophthalmologic indications included neovascular age-related macular degeneration (AMD), retinal vein occlusion (RVO), choroidal neovascularization (CNV), and proliferative diabetic retinopathy (PDR). We also captured patients' demographic and clinical characteristics. Total bevacizumab product (originator and biosimilars) use increased over time for RVO, CNV, and PDR starting in 2015 but decreased for AMD after 2016. For ophthalmology, bevacizumab product users were primarily male (56.8%), had a mean age of 62.9years (SD = 0.08), and had a mean Charlson/Elixhauser combined comorbidity score ranging from 0.7 (CNV) to 2.7 (PDR). Bevacizumab users for oncology indications were mostly female (61.8%), had a mean age of 62.9years (SD = 12.2), and had a mean Charlson/Elixhauser combined comorbidity score of 7.4 (SD = 3.0). Oncologic biosimilar product use increased over time between 2019 and 2020 as follows: colon cancer, 6.2% to 49.4%; lung cancer, 1.9% to 36.2%; and gynecologic cancer, 2.4% to 38.1%. Bevacizumab product use increased across most indications during the study period. Use for biosimilars increased in later years relative to the originator once available on the market. Limited data are available on real-world biosimilar use in the United States; future research should include monitoring for use and adverse events of these products.

Which Brugada patient deserves continuous ECG monitoring through implantable loop recorder? An evidence update.

Brugada syndrome (BrS) is a genetic condition that increases the risk of life-threatening arrhythmias, which can result in sudden cardiac death (SCD). Implantable loop recorders (ILRs) have become a key tool in managing patients with unexplained syncope, and guidelines advise their use in individuals with recurrent, unexplained syncope or palpitations. However, the role of ILRs in inherited arrhythmic conditions like BrS remains a topic of debate. Most patients newly diagnosed with BrS show no symptoms, but around 30% may experience symptoms such as syncope or palpitations, which can arise from arrhythmic issues or other causes like neurally mediated reflexes. Accurately assessing the cause of these symptoms is crucial to evaluate the risk of SCD. This document aims to examine current evidence on the role of ILR implantation in patients with BrS. The most frequent arrhythmias recorded by ILR are supraventricular arrhythmias and conduction disorders; ventricular arrhythmias, usually nonsustained, are rarely recorded. Symptoms-to-rhythm correlation by ILR can have therapeutic implications in case of recorded arrhythmias (initiation of drug therapy, ablation procedures or defibrillator/pace-maker implantation), provide reassurance in patients without rhythm disorders documented and improve their quality of life. However, given the low rate of detected arrhythmias, the clinical value of ILR in asymptomatic patients needs further evaluation.

STANDARDIZED ADAPTED CARDIAC REHABILITATION AT AN INPATIENT REHABILITATION FACILITY

https://youtu.be/hXlMMThneUU INTRODUCTION Inpatient rehabilitation facilities (IRFs) serve as an interim level of care for many patients with cardiac dysfunction but are not included among the three phases of cardiac rehabilitation (CR). The education on modifiable risk factors, cardiovascular exercise, and flexibility training given to patients with cardiac diseases are delivered in the acute hospital (phase I) and the outpatient setting (phase II). Our hypothesis was that adapting phase II components to this interim setting would improve outcomes and bridge the gap between phases. In this study, the feasibility of a standardized adapted CR protocol for IRFs and effect on functional outcomes was assessed. METHODS This prospective cohort study screened 60 patients over a 6-month period. Patients with primary cardiac diagnoses were screened for inclusion. Both surgical and non-surgical candidates were included. Exclusion criteria were based on the phase II CR criteria of the American College of Sports Medicine (ACSM). Patients received continuous ECG monitoring and physician clearance prior to participation. The standardized adapted CR protocol included individual prescription for cardiopulmonary endurance exercise consistent with ACSM Phase II CR guidelines, flexibility training, and education on modifiable risk factors. Standardized outcome measures included the 6-minute walk test, Borg rating of perceived exertion scale (6-20), EQ-5D-5L quality of life measure, and Section GG (mobility) scores of the Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument. A one-month follow-up evaluated attendance to phase II CR, and quality of life (including maintenance of functional gains). Physical therapy staff were surveyed to identify limitations. RESULTS Forty-one patients were deemed eligible to participate. Thirty-two patients participated in at least one endurance session with an average of 3 (+ 1) 20-minute sessions completed. Borg scores (14 + 1) reached the recommended range (somewhat hard to hard) during sessions. Participants demonstrated a statistically significant improvement in their GG mobility scores. Sixty-nine percent reached the 6-minute walk minimal clinically important difference (MCID), and 59% met the quality-of-life MCID, despite their short length of stay in the IRF setting (11 + 4 days). Survey results indicated short length of stay, the need to address functional goals over exercise, inability to tolerate 20 minutes of cumulative aerobic exercise, and compliance of protocol amongst therapists were limiting factors to endurance protocol adherence. CONCLUSIONS A standardized adapted CR protocol was feasible within an IRF setting, providing targeted education, increased awareness of phase II CR options, and clear and specific guidelines for creation of individualized exercise programs. Patients demonstrated improvements in functional mobility, cardiovascular endurance, and quality of life.

Neuromodulatory techniques in eating disorders: From electroconvulsive therapy to transcranial magnetic stimulation and beyond: A mixed method systematic meta-review.

Psychosocial and pharmacological interventions can effectively treat eating disorders (EDs), but improvements are often short-term and modest. Neuromodulation, altering nerve activity through targeted neurological stimulation, is an emerging intervention in neuropsychiatric disorders. This meta-review synthesizes evidence on neuromodulatory techniques in ED patients, identifying research gaps and future directions. PubMed/Medline, EMBASE, and PsycINFO were searched using relevant terms. Only systematic reviews or meta-analyses reporting on neuromodulatory techniques in ED patients were included. Three evaluators extracted data, resolving discrepancies with two experienced researchers. Study quality was assessed using AMSTAR-2. Defined outcomes and effect sizes were reported for systematic reviews, and pooled effect sizes and heterogeneity information for meta-analyses. Eighteen systematic reviews (five meta-analyses) were included, with minimal primary study overlap (<5%). Most focused on anorexia nervosa (AN), some on treatment-resistant cases, and others on bulimia nervosa (BN) and binge eating disorder (BED). The quality of most systematic reviews was critically low, and they often combined observational studies with randomized-controlled trials (RCTs). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) showed promising results in RCTs, managing binge eating and craving levels more effectively than body mass index in AN. Side effects included headaches, nausea, and drowsiness for rTMS and tDCS, and rare instances of seizures and infection with deep brain stimulation. Neuromodulation holds promise for treating EDs. Future studies should prioritize RCTs, objective outcome measures, longer follow-up for stability assessment, and comprehensive adverse event monitoring.

Reversible atrioventricular block during transcatheter ventricular septal defect closure – a serial case report

Background: The transcatheter ventricular septal defect procedure is a sophisticated intervention that carries potential complications, such as complete heart block. We report two cases of patients who experienced total AV block during transcatheter VSD closure and were successfully treated with steroids and atropine. Case Presentation: Perimembranous VSD was found in a 19-year-old military recruit. A baseline 12-lead EKG showed sinus rhythm and no conduction delays. Echocardiography revealed a 6-9 mm perimembranous VSD. Then the VSD was closed with a VSD Occluder No 10-8. ECG monitor and echocardiography showed a complete atrioventricular block during the procedure. Fortunately, 1mg atropine and 125mg methylprednisolone overcame this. Recurrent atrioventricular block and VSD were not found after the procedure. A 33-year-old male patient was diagnosed with a perimembranous VSD during routine screening. Initial 12-lead electrocardiography was unremarkable, while echocardiographic evaluation revealed a 3-5 mm perimembranous VSD. Transcatheter closure was performed using a VSD Occluder device (No. 10-8). Hemodynamic monitoring and echocardiography demonstrated a complete atrioventricular (AV) block intraoperatively. Pharmacological intervention with 1 mg atropine and 125 mg methylprednisolone resolved the conduction disturbance. Despite this transient complication, the procedure continued with successful device deployment. Post-procedural assessment confirmed complete VSD closure with no residual shunt or persistent AV conduction abnormalities. Conclusions: In the context of transcatheter closure of ventricular septal defects, there exists a risk of atrioventricular block, which can be precipitated by mechanical trauma or compression from the delivery system or device. Ensuring the appropriate sizing of the device is pivotal in minimizing this risk. Continuous heart rhythm monitoring is indispensable during both short-term and long-term follow-up periods. Keywords: Ventricular septal defect, Atrioventricular block, transcatheter device closure, case report

Effects of Blood Pressure Management Based on Non-Invasive Heart Function Monitoring on Reducing Postoperative Hypotension in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

Postoperative hypotension is a common symptom in elderly patients undergoing total knee arthroplasty (TKA), which is associated with intraoperative blood pressure (BP) management. The study aimed to explore the causes of perioperative hypotension in TKA elderly patients and analyze the effects of BP management strategies based on non-invasive heart function monitoring on reducing postoperative hypotension. A total of 176 elderly TKA patients were divided into four groups: the tourniquet group (Group T), the non-tourniquet group (Group N), the goal-oriented BP management tourniquet group (Group GT), and the goal-oriented BP management non-tourniquet group (Group GN). Patients in Groups T and GT received TKA with a tourniquet. The BP of patients in Groups GT and GN was maintained based on non-invasive heart function monitoring. The mean arterial pressure (MAP), index of cardiac contractility (ICON), stroke volume (SV), and other circulatory indicators were measured using the non-invasive cardiometer monitor at five time points, including before anesthesia (T1), after anesthesia (T2), after completion of the osteotomy (T3), after suturing (T4), and after leaving the post-anesthesia care unit (T5). The frequency of postoperative hypotension within 24 hours was recorded, and the incidence of hypotension was calculated. The ICON, SV, and MAP were lower in Groups N and GN than in Groups T and GT at T3 (P < 0.05). The ICON, SV, and MAP were lower in Group N than in Groups GN at T4 and T5 (P < 0.05), and no significant difference was observed between Groups T and GT (P > 0.05). The incidence of postoperative hypotension within 24 hours was higher in Group N (47.1%) (P = 0.007) than in Group GN (21.6%), Group T (19.4%), and Group GT (14.8%). Postoperative hypotension in elderly patients undergoing TKA with a non-tourniquet was associated with decreased myocardial contractility. Enhancing myocardial contractility based on non-invasive cardiac function monitoring reduced the incidence of postoperative hypotension.

Association of Novel EEG Biomarkers of Sleep Depth and Cortical Arousability with Cardiac Autonomic Modulation in Adolescents.

To examine the developmental association of the odds ratio product (ORP), an electroencephalographic measure of sleep depth, during non-rapid eye movement (NREM) sleep with 24-hour heart rate variability (HRV), an electrocardiographic measure of cardiac autonomic modulation (CAM), in the transition to adolescence. Leveraging data from the Penn State Child Cohort, we performed longitudinal analyses on 313 children (median [Md] age 9 years) followed-up after Md=7.4y and cross-sectional analyses on 344 adolescents (Md=16y). We extracted ORP during NREM sleep and in the 9 seconds following cortical arousals (ORP-9) from 9-hour, in-lab polysomnography, and frequency- and time-domain HRV indices from 24-h Holter ECG monitoring. Longitudinal and cross-sectional, multivariable-adjusted, regression models examined the association between ORP and ORP-9 with adolescent 24-h HRV indices. Longitudinally, a greater increase in ORP-9 since childhood was associated with lower daytime Log-LF, SDNN, RMSSD and higher HR in adolescence (p<0.05). A greater increase in ORP since childhood was associated with lower nighttime Log-LF and SDNN (p<0.05). Cross-sectionally, higher ORP and ORP-9 were associated with lower daytime and nighttime Log-LF, SDNN or RMSSD and higher HR within adolescence (p<0.05). A greater increase in cortical arousability since childhood is a strong developmental predictor of daytime cardiac autonomic imbalance in adolescence. Shallower sleep depth additionally arises as a proximal determinant of both daytime and nighttime cardiac autonomic imbalance within adolescence. These data suggest a coupling between fine-grained spectral measures of the sleeping brain and those of CAM, which may inform sleep-related cardiovascular risk early in life.

The concurrent use of 2.5% polyacrylamide hydrogel and betamethasone esters for intra-articular injection is well tolerated in 10 healthy horses.

This study assessed the safety and tolerability of concurrent intra-articular (IA) injection of 2.5% polyacrylamide hydrogel (2.5% iPAAG) and betamethasone sodium phosphate and betamethasone acetate esters (BME) in the metacarpophalangeal joints (MCPJs) of healthy horses. 10 healthy therapeutic riding horses were enrolled in this open-label safety study from August 1 to September 14, 2023. Inclusion criteria required normal physical examinations, insulin level, hematology, biochemistry, soundness at all gaits, and negative forelimb flexion tests. Screening occurred from days -14 to -0. Each horse received a single IA injection of 1 mL of 2.5% iPAAG and 1 mL of BME (6 mg/mL) into the right MCPJ on day 0. Posttreatment veterinary assessments (days 0, 1, 2, 3, 7, 14, and 30) included physical examinations, joint-specific evaluations (skin temperature, fetlock circumference at the level of the MCPJ), soundness assessments, and adverse event monitoring. Caretaker observation diaries (days 0 through 30) were also reviewed. No adverse events occurred, and all horses remained clinically sound. Joint circumference remained stable without evidence of effusion. Transient increases in skin temperature on days 2, 3, 7, and 14 correlated with ambient temperature changes, returning to baseline by day 30. Caretaker observations supported clinical findings. Concurrent IA administration of 2.5% iPAAG and BME was safe and well tolerated in the right MCPJ of healthy horses, with no evidence of local or systemic adverse effects. This therapy combines BME's short-term anti-inflammatory effects with 2.5% iPAAG's long-term synovial integration, warranting further evaluation in diseased joints.

2788 Exercise trainers as key enablers in the remote delivery of dementia prevention interventions in the homes of older adults

Abstract Introduction Social support for physical activity is important for engaging older adults in physically active lifestyles. Few studies examined the impact of individual exercise trainers (IETs) in the context of dementia prevention interventions with physical activity. We aimed to assess the contributions of IETs in the remote delivery of a home-based dementia prevention program combining physical exercise and cognitive training targeting older adults at risk for dementia. Methods Convergent mixed-method analysis was conducted using data from SYNERGIC@Home, a feasibility study of a 16-week intervention that included one-on-one supervised physical exercise (3 sessions/week) fully delivered through Zoom. Quantitative data consisted of descriptive statistics, measures of adherence, participants’ preference and satisfaction. Qualitative interviews centred on participants’ experience and motivation were conducted post-intervention. Results Of the 60 participants randomised to one of four intervention arms (mean age 68.9, 76.7% female), 52 completed the interventions with high overall adherence (87.5%). Pre-intervention, participants expressed a clear preference for cognitive interventions, but post-intervention preference shifted to exercise. IETs (n = 21) were part-time research assistants, each assigned to one participant after completing CSEP Certified Personal Trainer® or Clinical Exercise Physiologist™ certification as part of their training. One full-time Lead IET coordinated and supervised the other trainers. IETs worked the closest with study participants, also working closely with study coordinator and with study physician for adverse event monitoring. Interviewed participants (n = 15) often described the positive relationships that developed with their IET. Trainers were instrumental in participants’ motivation and enjoyment, personalising the sessions and addressing technological issues. Satisfaction rates with IETs (n = 54 exit survey respondents) were high. Conclusions Exercise trainers played crucial roles that extended beyond the supervision of exercise sessions and contributed to participant engagement in the interventions. Access to these allied health professionals should be featured more prominently in strategies/programs promoting active lifestyles among older adults.

Using the Event Monitor extension module for epizootological monitoring at an automated workplace

An information system that allows an epizootologist specialist at an automated workplace (AWP) to technically re-equip the process of collecting, processing and visualizing epizootological monitoring data using standardized symbols of veterinary significant objects is currently missing. The purpose of the research is to develop an algorithm for the Event Monitor extension module for epizootological monitoring to the universal GIS of the automated workplace of a veterinarian. The Module is called via the standard system menu or by pressing a button on the toolbar. Initially, the AWP user can register a new epizootic outbreak of infection / receive information about an already registered outbreak. Then it becomes possible to predict the development of the epizootic process and visualize the data obtained: the zone of the epizootic outbreak, the threatened zone; a list of enterprises; susceptible livestock; municipalities included in the epizootic outbreak; intersections of transport routes with the borders of municipalities located in the epizootic outbreak, on which veterinary and police posts should be established. The entered information and simulation results are added to the database and form a report that is output via the clipboard to an external text editor. Epizootic outbreaks of ASF were modeled to test the AWP module. A practical approbation of the AWP of an epizootologist veterinarian in the Gatchina district of the Leningrad region was carried out.