Degree Of Dilatation Research Articles

A novel approach for the early prediction and prevention of placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa: leveraging three-dimensional placental topography, cervical length, and dilatation parameters on magnetic resonance imaging

BackgroundTo evaluate the reliability of placental volume and other magnetic resonance imaging (MRI) markers for predicting placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa.MethodsThis single-center retrospective cohort study was conducted at a tertiary care facility and included 216 pregnant women diagnosed with complete placenta previa. Two radiologists, blinded to each other’s assessments, independently evaluated the prenatal placental magnetic resonance imaging (pMRI) findings of 150 singleton pregnancies that met the inclusion criteria and were delivered in the third trimester. The three-dimensional placental volume (from the S1 and S2 sectors), cervical canal length (CCL), and degree of cervical canal dilatation (CCD) were compared with clinical and pathological findings. Univariate and multivariate logistic regression analyses identified risk factors for placenta accreta spectrum (PAS) and severe peripartum hemorrhage (SPPH). Receiver operating characteristic (ROC) curve analysis determined the cutoff values of significant predictors.ResultsUnivariate analysis revealed significant risk factors for PAS, including decreased cervical canal length (odds ratio [OR] = 1.330, p < 0.001), increased cervical canal dilation (OR = 1.869, p < 0.001), decreased S1 volume (OR = 1.008, p < 0.001), and increased S2 volume (OR = 1.008, p < 0.001). Multivariate analysis confirmed that cervical canal length was an independent risk factor (odds ratio [OR] = 1.253, p = 0.03). Significant predictors of severe peripartum hemorrhage included decreased cervical canal length (odds ratio [OR] = 0.406, p = 0.006), increased cervical canal dilatation (OR = 3.22, p < 0.001), decreased S1 volume (OR = 1.079, p = 0.017), and increased S2 volume (OR = 1.032, p < 0.001), all of which were confirmed as independent risk factors. ROC analysis demonstrated high precision for MRI markers, with area under the curve values above 0.8 for critical predictors of PAS and severe peripartum hemorrhage, confirming their reliability (all p < 0.001).ConclusionThis study emphasizes the pivotal role of three-dimensional placental volume measurements in the S1 and S2 sectors, along with cervical canal length and dilation, in predicting PAS and severe peripartum hemorrhage in patients with complete placenta previa. Integrating these advanced MRI markers into prenatal care can enhance early detection, improve clinical decision-making, and ultimately improve maternal and fetal outcomes.

Assessment of Midwives’ Knowledge and Application of the Modified WHO Partograph at Ga South Public Health Facilities, Greater Accra, Ghana

Background The partograph, one of the vital tools available for the midwife, was originally developed from Friedman’s 1954 Cervicograph by Philpott and Castle in 1972. It was later modified and adopted by the WHO as a universal ‘gold standard’ tool for recording and monitoring progress in labour and providing interventions in cases of abnormal labour. The goal of this study was to assess the level of knowledge of midwives and their utilisation of the modified WHO partograph at the Ga South Municipality in the Greater Accra Region of Ghana. Methodology An institution-based quantitative cross-sectional study was conducted within the municipality from February to March 2019. One hundred and ten (110) midwives were recruited using the census approach. Data were collected using a structured self-administered questionnaire. STATA statistical software version 14 was used for descriptive analysis and results were reported in the form of percentages and frequencies using charts and tables. Pearson’s Chi-Square estimation was also performed to test the association between selected variables with a p value &lt;.05 as the threshold for statistical significance. Results Of the 110 participants, 105 (95.5%) of the midwives could properly describe the partograph and 104 (94.5%) understood that it was used as a tool for vital decision-making, while 92 (83.6%) indicated that partograph contributes in reducing maternal and new-born deaths. Almost all participants, 109 (99.09%) knew all the parameters of the partograph and were also aware that plotting the partograph begins at a cervical dilation of 4 cm. Also, while a good number of participants 103 (93.64%) knew that cervical dilation on the partograph is carried out every four hours during the active phase of labour, 110 (100%) indicated that progress of labour is assessed by the degree of cervical dilation and descent of the presenting part. Routine usage of the partograph was recorded among the majority of midwives, 102 (92.7%), to record and monitor the progress of labour in expectant women. Bivariate analysis showed a significant association between the use of the modified WHO partograph and the knowledge of midwives on Ghana Health Service (GHS) policies ( p = .045). There was, however, no positive association determined among age ( p = .66), rank ( p = .77), years of professional experience ( p = 1.00), place of work ( p = .51), work shift and highest qualification ( p = 1.00) as far as knowledge and use of the WHO modified partograph are concerned. Conclusion The findings of the study underscore the desirable level of knowledge and usage of the partograph among study participants. This affirms that the knowledge and usage of the partograph within the facilities in Ga South health facilities hold the prospect of enhancing the safety of expectant mothers.

The possible protective effect of luteolin on cardiovascular and hepatic changes in metabolic syndrome rat model.

The metabolic syndrome, or MetS, is currently a global health concern. The anti-inflammatory, anti-proliferative, and antioxidant properties of luteolin are some of its advantageous pharmacological characteristics. This research was designed to establish a MetS rat model and investigate the possible protective effect of luteolin on cardiovascular, hepatic, and metabolic changes in diet-induced metabolic syndrome in rats. Forty adult male albino rats were split into four groups: a negative control group, a group treated with luteolin, a group induced MetS (fed 20% fructose), and a group treated with luteolin (fed 20% fructose and given luteolin). Following the experiment after 8weeks, biochemical, histological (light and electron), and immunohistochemistry analyses were performed on liver and heart tissues. Serum levels of cTnI, CK-MB, and LDH were significantly elevated in response to the cardiovascular effect of MetS. Furthermore, compared to the negative control group, the MetS group showed a marked increase in lipid peroxidation in the cardiac and hepatic tissues, as evidenced by elevated levels of MDA and a decline in the antioxidant defense system, as demonstrated by lower activities of GSH and SOD. The fatty liver-induced group exhibited histological alterations, including disrupted hepatic architecture, dilated and congested central veins, blood sinusoids, and portal veins. In addition to nuclear structural alterations, most hepatocytes displayed varying degrees of cytoplasmic vacuolation, mitochondrial alterations, and endoplasmic reticulum dilatation. These alterations were linked to inflammatory cellular infiltrations, collagen fiber deposition, active hepatic stellate cells, and scattered hypertrophied Kupffer cells, as demonstrated by electron microscopy and validated by immunohistochemical analysis. It is interesting to note that eosinophils were seen between the liver cells and in dilated blood sinusoids. Moreover, the biochemical (hepatic and cardiac) and histological (liver) changes were significantly less severe in luteolin-treated raton a high-fructose diet.These results suggested that luteolin protects against a type of metabolic syndrome that is produced experimentally.

Prognostic role of exercise stress echocardiography in asymptomatic severe aortic stenosis

Abstract Background Guidelines recognize the role of exercise stress testing in evaluating functional capacity in patients with asymptomatic severe aortic stenosis (AS). The study aimed to identify the prognostic role of exercise stress echocardiography (ESE) in asymptomatic severe AS. Methods We enrolled 153 asymptomatic patients (70±13 years; 88 male, 57%) with severe AS, aortic valve area (AVA) &amp;lt;1.0 cm2, mean aortic gradient ≥ 40 mmHg, ejection fraction (EF) ≥55%. All were referred for ESE in 7 quality-controlled centers from 5 countries. Rest and ESE assessment also included global longitudinal strain (GLS) and left atrial volume index (LAVI). B-lines were assessed by LUS with the 4-site simplified scan of the third intercostal space. A 4-point ESE score was based on 4 parameters (0 for normal, 1 for abnormal), with the following pre-determined cutoffs of abnormality: ∆-maximal aortic gradient (MAG) ≥20 mmHg; GLS at peak ≤ 19%, according to receiver operating characteristics curve analysis, stress B-lines ≥2; stress LAVI ≥ 34 mL/m2. Follow-up was completed in 142/153 patients (92%). Results At rest, AVA was 0.85±0.14 cm2, maximal aortic gradient: 79±14 mmHg, and peak aortic velocity: 4.42 ± 0.41 m/s. Mean EF at rest: 63.4±5.3% During a median follow-up of 1802 days (IQ range 651-2302), 41 events occurred in 39 patients: 15 all-cause deaths, 17 acute HF, 1 stroke, 1 myocardial infarction, and 7 coronary revascularization. Patients experiencing events displayed a greater increase in MAG during peak ESE, more B-lines with exercise, greater degree of LAVI dilation with exercise and slightly lower GLS compared to those without events (Table). Increase in ESE score was associated with a significant rise (p=0.001) in event incidence from score 0 (n=0/13, 0%) to score 1 (n=2/21, 9.5%), score 2 (n=10/42, 23.8%), and ≥3 (n=27/66, 40.9%), see figure. Conclusions In asymptomatic severe AS cases with preserved LV EF, comprehensive ESE provides early marker of potential cardiac decompensation at follow-up. The composite ESE index, including MAG, GLS, LAVI, and B-lines, holds promise as a prognostic predictor.TableFigure

Three-dimensional pseudocontinuous arterial spin labeling with dual postlabeling delay for reflecting cerebral blood flow regulation in patients with hydrocephalus: a retrospective cross-sectional study.

Three-dimensional pseudo-continuous arterial spin-labeling (3D pCASL) with dual postlabeling delay (PLD) captures both early and delayed cerebral blood flow (CBF), yet its potential in reflecting blood flow regulation in hydrocephalus patients remains uncertain. This study investigated the hemodynamic characteristics in patients with hydrocephalus and whether the difference in cerebral blood flow using short and long PLDs (ΔCBF = CBFPLD =2.5 s - CBFPLD =1.5 s) could reflect cerebral regulation and further aimed to demonstrate the associations between regional ΔCBF and the degree of ventricular dilatation. This retrospective study included consecutive patients with hydrocephalus and control participants attending The Second Affiliated Hospital of Nanchang University from December 2017 to December 2022. The CBF in 18 brain regions was manually delineated by two radiologists. Regional CBF and ΔCBF were compared via covariance analyses. The associations between ΔCBF and the degree of ventricular dilatation were investigated using linear regression analyses and interaction analysis. In total, 58 patients with communicating hydrocephalus, 57 patients with obstructive hydrocephalus, and 52 controls were analyzed. CBF of the hydrocephalus groups was lower than that of the control group at the shorter PLD. CBF was higher at a longer PLD, with no difference between the hydrocephalus groups and the control group in some regions. The hydrocephalus groups showed a higher ΔCBF compared to the control group. Furthermore, in the left medial watershed (10.6±5.66 vs. 7.01±5.88 mL/100 g/min; P=0.038), communicating hydrocephalus exhibited greater ΔCBF than did obstructive hydrocephalus. ΔCBF of the right posterior external watershed [adjusted β: 0.276; 95% confidence interval (CI): 0.047-0.505; P=0.019] and right parietal cortex (adjusted β: 0.277; 95% CI: 0.056-0.498; P=0.015) in the obstructive hydrocephalus group and ΔCBF of the left internal watershed (adjusted β: 0.274; 95% CI: 0.013-0.536; P=0.040) in the communicating hydrocephalus group were associated with the degree of ventricular dilatation, respectively. Patients with hydrocephalus showed cerebral regulation in maintaining adequate CBF, resulting in longer arterial transit times. The ability to regulate CBF in brain regions represented by the watershed was associated with the degree of ventricular dilation.

Impaired Left Atrial Reserve Function in Heart Failure With Preserved Ejection Fraction.

Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes. Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography. Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, P=0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; P=0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (P<0.001 and P=0.022) and booster pump strain (P=0.011 and 0.028) at rest and during exercise, respectively. Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.

Thermo-mechanical response of near-pearlitic steel heated under restriction of thermal expansion

Railway wheels experience high temperatures during operation, especially during severe block braking. The thermal expansion of wheel rim material due to frictional heating is limited by the wheel's geometry and size. This study investigated the impact of this combined mechanical and thermal loading on the mechanical properties and microstructure in the tread surface of an ER7T steel railway wheel.The material response below the austenitisation temperature is comprehensively evaluated through thermal cycling at peak temperatures of 300, 400, 600, and 650 °C, simulating severe block braking cycles with varying degrees of thermal dilatation (25 %, 50 %, 75 %, and 100 %). An initial plastic deformation was observed during the first heating cycle for the two lower temperatures at lower restrictions, followed by a predominantly elastic response. However, at higher restrictions, the material showed time-dependent relaxation during heating, and some plastic deformation was observed during cooling. Notably, even at the lowest level of restriction, similar observations were made at higher peak temperatures. Increasing the restriction resulted in large strains and a wider hysteresis loop. The test bars exposed to the two higher temperatures retained large tensile stresses after cooling. This indicates a risk of a significantly altered residual stress state in the rim of an overheated railway wheel, which could adversely affect its fatigue properties. The study's outcomes will aid in designing and calibrating constitutive material models for severe block braking. Furthermore, it will significantly contribute to research into the thermo-mechanical behaviour of pearlitic/near-pearlitic materials during railway operations and maintenance.

Myocardial perfusion impairment in children with Kawasaki disease: assessment with cardiac magnetic resonance first-pass perfusion.

Kawasaki disease (KD) potentially increases the risk of myocardial ischemia. This study aimed to semi-quantitatively evaluate myocardial perfusion impairment using cardiac magnetic resonance (CMR) first-pass perfusion in children with KD and explore the association between coronary artery (CA) dilation and myocardial perfusion. From December 2018 to July 2021, 77 patients with KD (48 male, 5.71±2.80 years) and 37 age- and sex-matched normal controls (20 male, 6.19±3.32 years) who underwent CMR in West China Second University Hospital were enrolled in this cross-sectional study with prospective data collection. A total of 30 of these patients completed the follow-up CMR, with a median interval of 13 months. Myocardial perfusion parameters including perfusion index (PI) and maximum signal intensity (Max SI) were obtained through rest first-pass perfusion. The internal diameter of the CA was assessed via coronary magnetic resonance angiography (CMRA) to calculate the coronary Z score. The global and regional myocardial parameters among the subgroups were compared. Statistical analysis included one-way analysis of variance (ANOVA), Pearson's correlation, and multivariate linear regression. The global Max SI and regional Max SI of all segments in patients with and without CA dilation decreased compared with those in controls (P=0.19 and P<0.001, respectively). The global PI of patients with CA dilation and regional PI in segments subtended by dilated CA were lower than that of controls (P=0.002 and P<0.001, respectively) and were negatively correlated with the Z score (global: r=-0.576; regional: r=-0.351, both P<0.001). Multivariate analysis revealed that the Z score was negatively associated with global PI in KD (β=-0.409, P=0.02, model R2=0.170). The global Max SI of patients with and without CA dilation during the follow-up CMR decreased compared with that of the first CMR (42.18±9.84 vs. 34.48±8.24, P=0.02; 44.82±7.13 vs. 36.61±7.67, P=0.03, respectively). CMR myocardial first-pass perfusion imaging can semi-quantitatively evaluate impaired myocardial perfusion in KD patients. Not only patients with CA dilation and segments subtended by dilated CA but also those without CA dilation and segments subtended by non-dilated CA developed myocardial perfusion impairment, the severity of myocardial perfusion impairment is associated with the degree of CA dilation.

Right ventricular phenotyping in incident patients with idiopathic pulmonary arterial hypertension

BackgroundRight ventricular (RV) imaging has not a definite role in risk stratification of pulmonary arterial hypertension (PAH) patients. We tested the hypothesis that echocardiography-derived phenotypes, depicting different degrees of RV remodeling and dysfunction, may provide additional prognostic information to current risk stratification tools. MethodsConsecutive incident PAH patients aged ≥ 18 years, diagnosed between January 2005 and December 2021, underwent clinical assessment, right heart catheterization, standard echocardiography. Simple echocardiographic variables were combined in order to define a priori four phenotypes representing different degrees of RV dilatation and RV-pulmonary arterial (PA) coupling: Phenotype 1 with mildy dilated right ventricle and preserved RV-PA coupling (n=152 patients); phenotype 2 with mildly dilated right ventricle and poor RV-PA coupling (n=143 patients); phenotype 3 with severely dilated right ventricle and preserved RV-PA coupling (n=201 patients); phenotype 4 with severely dilated right ventricle and poor RV-PA coupling, with or without severe tricuspid regurgitation (n=519 patients). Risk stratification was based on on the ESC/ERS 3-strata model and REVEAL 2.0 score. ResultsThese phenotypes were present in all risk groups. Notably, regardless of the ESC/ERS risk stratum assigned to the patient, phenotype 4 was associated with a 2-fold increase of the odds of death (HR 2.1, 95% C.I. 1.6-2.8, p<0.001), while phenotype 1 was associated with a 71% reduction in the odds of dying (HR 0.29, 95% C.I. 0.18-0.47, p<0.001). ConclusionsEchocardiography-derived phenotypes describing RV remodeling and dysfunction may provide prognostic information which is independent of and additional to the clinically defined risk in incident PAH patients.

Automatic three-dimensional reconstruction of the oesophagus in achalasia patients undergoing POEM: an innovative approach for evaluating treatment outcomes

Background and aimsPeroral endoscopic myotomy (POEM) is a standard treatment option for achalasia patients. Treatment response varies due to factors such as achalasia type, degree of dilatation, pressure and distensibility...

Study of Correlation between Fetal Bowel Dilation and Congenital Gastrointestinal Malformation.

Ultrasound serves as a valuable tool for the early detection of fetal bowel dilatation, yet the correlation between fetal bowel dilatation and gastrointestinal malformations remains to be further investigated. This study aims to explore the relationship by conducting a follow-up and analysis of fetuses with bowel dilation. A retrospective analysis was conducted on 113 fetuses with bowel dilatation at our center from July 2014 to December 2019. The location and degree of bowel dilatation were analyzed. ROC curves were constructed based on the diameter of the bowel and its ratio to fetal gestational age. In total, 40 of 41 cases (97.6%) with upper gastrointestinal dilatation (double-bubble sign) and 46 of 72 cases (63.9%) with lower gastrointestinal dilatation were diagnosed with gastrointestinal malformations postnatally. The AUC of the dilatation diameter was 0.854 with a cutoff value of 18.05 mm in patients with lower gastrointestinal dilatation. The ratio of the diameter to gestational age (D/GA) showed a higher AUC of 0.906 with a cutoff value of 0.4931. The presence of the double-bubble sign in fetuses indicates a close association with duodenal obstruction. The risk of gastrointestinal malformations increases when the bowel diameter exceeds 18.05 mm, particularly when the D/GA surpasses 0.4931.

#485 Studying the features of heart remodeling processes depending on the degree of renal dysfunction

Abstract Background and Aims Chronic kidney disease (CKD) and heart failure (HF) affect many people worldwide and both diseases remain associated with considerable morbidity and mortality. Aim of the study was to features of changes in cardiac remodelling parameters depending on the degree of kidney dysfunction. Method A comprehensive examination of 105 patients with coronary heart disease (CHD) with functional class I-III and chronic heart failure (CHF) was carried out, assessing the clinical condition, exercise tolerance, left ventricular remodelling processes, and the functional state of the kidneys. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n=51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n=54) The average age of patients in group I was 58.77 ± 0.94 years, in group II 61.3±0.68 years and 62.14 ± 0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n = 51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n = 54) The average age of patients in group I was 58.77±0.94 years, in group II 61.3 ± 0.68 years and 62.14±0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. Results The progression of the severity of CHF with eGFR ≤60 ml/min/1.73 m2 was accompanied by an increase in LV volume parameters, pronounced structural changes, as well as a pronounced degree of LV dilatation. At the same time, in the group of patients with FC III CHF, there was an increase in ESR by 26.8% (p &amp;lt; 0.001) and EDV by 10.64% (p &amp;lt; 0.01) in relation to the data of group I with FC I CHF. Analysis of the parameters of LV systolic function (SV and EF), as well as fractional shortening of the LV in systole, showed that in group II there was a significant decrease in LVEF, SV and Fs% in patients with class II CHF by 10.7%, 14.4% and by 9.0% (p &amp;gt; 0.05) in relation to the data of CHF I FC. In patients with FC III CHF, there was also a pronounced decrease in EF by 28.8% (p &amp;lt; 0.01) and Fs% by 31.75% (p &amp;lt; 0.001) in relation to the FC I CHF data. Analysis of diastolic function indicators in patients with CHF with GFR ≤60 ml/min. Severe disturbances in LV diastolic function are observed in the group of patients with FC II CHF, where there is an increase in the maximum rate of late atrial filling (RA) by 25.1% (p &amp;lt; 0.001) and a significant decrease in the maximum rate of early filling of the left ventricle (PE) compared to study group I by 12.6% (p &amp;gt; 0.05). Conclusion The results of the analysis of indicators of the sizes of the LV and LA cavities, as well as the LV walls, established the peculiarity of structural and geometric changes in the left parts of the heart in patients with FC I-III CHF (increase in LVMM by 10.25%; p &amp;lt; 0.001) in relation to data with eGFR&amp;gt;60 ml/min/1.73 m2. A decrease in the level of LVEF in patients with eGFR ≤60 ml/min/1.73 m2 is evidence of the role of the severity of DP in reducing systolic function in patients with CHF (EF by 25.4% and Fs% by 11.2% (p &amp;lt; 0.001)). 2. Analysis of diastolic function indicators in patients of group II with eGFR ≤60 ml/min/1.73 m2 showed an increase in the maximum rate of early left ventricular filling (PE) by 13.25% (p &amp;lt; 0.001), which led to an increase in E/ and by 20.5% in patients with CHF eGFR ≤60 ml/min/1.73 m2 compared to CHF with eGFR&amp;gt;60 ml/min/1.73 m2 (p &amp;lt; 0.001).

Mediation of White Matter Alterations in the Association Between Ventricular Dilation and Cognitive Decline in Hydrocephalus Patients: An MRI Study.

Cognitive impairment is commonly observed in hydrocephalus patients. Ventricular enlargement compresses brain parenchyma, especially the white matter (WM). To investigate whether the relationship between ventricular dilation and cognitive decline in hydrocephalus patients is mediated by WM alterations. Retrospective. 51 communicating hydrocephalus patients (median age, 54 years), 50 obstructive hydrocephalus patients (median age, 49 years), and 53 control subjects (median age, 50 years). Diffusion tensors imaging, 3D T1 BRAVO, 3D FIESTA, CUBE T2, and FLAIR sequences at 3T. DTI parameters (skeletonized fractional anisotropy (FA), skeletonized mean diffusivity (MD), and peak width of skeletonized mean diffusivity p(PSMD)) were extracted using FSL software. Global, periventricular, and deep white matter hyperintensity (WMH) volumes, degree of ventricular enlargement (Evans index), and other conventional imaging markers (number of lacunes and perivascular spaces, intracranial and brain volume) were extracted using united imaging intelligence. Cognitive tests included Montreal cognitive assessment (MoCA), clock drawing test (CDT), and vocabulary fluency test (VFT). Multivariable linear regression analysis, mediation analyses, and dominance analysis. P-value <0.05 was considered significant. The degree of ventricular dilation, DTI parameters, and cognitive function scores were interrelated. The skeletonized FA values (β = -0.0917, 95% confidence interval (CI): -0.205, -0.024) and normalized global WMH volume (β = -0.0635, 95% CI: -0.13, -0.0005) together mediated 37.2% of the association between Evans index and MoCA. A comparable causal pathway was found for periventricular WMHs but not for deep WMHs. Dominance analysis indicated skeletonized FA values had a greater impact on cognition than WMH volume. The skeletonized FA values also mediated the association between Evans index and CDT (β = -0.0897, 95% CI: -0.165, -0.026) and VFT (β = -0.1589, 95% CI: -0.27, -0.083). WM alterations were causal mediators between ventricular dilation and cognitive decline in hydrocephalus patients. 3. Stage 3.

The association between the degree of cervical dilatation before ultrasound and physical examination indicated cerclage and subsequent neonatal outcomes.

Preterm identification of cervical dilation in pregnant women leads to the application of emergency cervical cerclage with an expectation of achieving term delivery. However, this is not always feasible. Short- and long-term neonatal complications post-preterm birth pose a significant challenge. It is crucial to anticipate potential complications and understand the possibilities of postpartum development as they can be encountered. We aimed to evaluate the effect of the degree of cervical dilatation before ultrasound and physical examination-indicated cerclage in singleton pregnancies presenting with premature cervical dilatation with bulging fetal membranes (rescue cerclage) on subsequent neonatal outcomes. In this retrospective clinical study, over a 10-year period between January 2009 and January 2019, 72 singleton pregnancies undergoing rescue cerclage were included and divided into two groups according to pre-cerclage cervical dilatation: Group 1 (n = 33) and Group 2 (n= 39) with cervical dilatation ≤3 cm and >3 cm, respectively. Latency period for pregnancy prolongation, gestational age at delivery, birth weight, and neonatal morbidity and mortality were compared across the groups. Logistic regression was used to delineate the independent effect of cervical dilatation at cerclage placement on neonatal mortality. Group 2 had a higher delivery rate at ≤28 weeks' gestation (p = 0.007) and lower birth weight (p = 0.002) compared to Group 1, with an increased mean latency period in Group 2 (90 ± 55 days versus 52 ± 54 days, p = 0.005). The newborn intensive care unit (NICU) requirement, respiratory distress syndrome (RDS), neonatal jaundice and sepsis, and retinopathy of prematurity (ROP) were more frequent in Group 2. Neonatal mortality rate was higher (52.6% versus 24.2%, p = 0.015) and intact survival was lower (23.1% versus 48.4%, p = 0.013) in Group 2, whereas rates of cerebral palsy (8% and 9%, respectively) were similar between the groups (p = 0.64). Advanced cervical dilatation (>3 cm) during physical examination-indicated cerclage in singleton pregnancies is associated with earlier delivery, leading to increased neonatal morbidity and mortality when compared with pregnancies having lesser degrees of cervical dilatation at cerclage. However, short-term poor neurological outcomes seem comparable.

Do we still need intra-procedural TTE during Transcatheter aortic valve replacement? A high volume, single center experience

BackgroundTranscatheter aortic valve implantation (TAVI) has undergone significant advances in recent years, with the development of improved pre-planning tools and devices. These advances have led to a reduction in the rate of paravalvular leak (PVL), a complication that is associated with poor outcomes even when mild. As some centers around the world are moving to solely fluoroscopy-focused implantation, we aimed to describe the clinical impact of intra-procedural transthoracic echocardiography (TTE) during TAVI in a high volume hospital. MethodsObservational study during a 3-month period. A limited TTE examination was performed immediately after deployment to assess the existence of PVL and grade its severity. Complete TTE was performed a day after the procedure. In case of ≥mild PVL after valve deployment, a decision was made according to the severity of the PVL, patient anatomy and extent of annular calcification to preform balloon post-dilation. If done, an additional limited TTE was performed to assess possible complication and the degree of PVL post dilatation. Results115 patient were included in the study. Intra-procedural TTE identified 16 patients (14 %) with at least mild PVL, three of them with moderate (3 %). Post balloon dilatation was performed in 10 patients (9 % of the cohort) with significant improvement in the degree of PVL. ConclusionIntra-procedural TTE immediately after TAVI deployment can accurately identify PVL, allowing operators to perform post balloon dilatation with improvement in early echocardiographic results. Our findings support the routine use of TTE during procedures, without relying solely on fluoroscopy.

Toupet fundoplication to prevent progression of scleroderma-associated interstitial lung damage: a study protocol

Summary Background Systemic sclerosis (SSc) is a rare autoimmune and multiorgan disorder. Hallmarks of the disease include inflammation, endothelial dysfunction, and dysregulation of fibroblasts leading to fibrosis of the skin and internal organs. The esophagus is often involved, with up to 80% of patients developing gastroesophageal reflux disease (GERD). Reflux can be associated with hiatal hernia and several complications such as erosive esophagitis, peptic stricture, Barrett’s esophagus, aspiration pneumonia, and chronic microaspiration. Silent aspiration can lead to interstitial lung disease (ILD) in up to 50% of patients with scleroderma and accounts for up to 40% of mortality. Treatment of GERD in patients with SSc is challenging. Proton pump inhibitors (PPI) have been shown effective in relieving typical GERD symptoms, but up to 40% of patients are non-responders. Various antireflux surgical procedures have been proposed to treat GERD and to modify the natural course of the disease by preventing lung damage in these patients. However, current algorithms consider only the degree of esophageal dilation as a marker of disease severity/progression, and results of antireflux surgery remain controversial. Methods We propose a feasibility, observational, multicenter, single-arm trial including adult patients diagnosed with SSc. Criteria for inclusion are individuals with GERD symptoms refractory to PPI, absence of peptic stricture at baseline endoscopy, high-resolution computed tomography (HRCT) scan showing no or less than 10% lung fibrosis, forced vital capacity at least 40% of the predicted value, and diffusing capacity of lung for carbon monoxide 30–89% of the predicted value. A laparoscopic partial posterior fundoplication according to the Toupet technique will be performed. Primary study outcome is the efficacy of fundoplication to reduce reflux exposure measured with a pH-impedance study or 4‑day wireless pH recording. Secondary outcomes include endoscopic, HRCT, and respiratory function tests findings as well as quality of life at 12-month follow-up. Conclusions The expected reduction of reflux burden in SSc patients selected for Toupet fundoplication may improve GERD symptoms/complications, pulmonary function, and quality of life, and may be associated with a reduced risk for lung transplant.

Loss of ADAM15 in female mice does not worsen pressure overload cardiomyopathy, independent of ovarian hormones.

Cardiac hypertrophy is a common feature in several cardiomyopathies. We previously reported that loss of ADAM15 (disintegrin and metalloproteinase 15) worsened cardiac hypertrophy and dilated cardiomyopathy following cardiac pressure overload. Here, we investigated the impact of ADAM15 loss in female mice following cardiac pressure overload induced by transverse aortic constriction (TAC). Female Adam15-/- mice developed the same degree of cardiac hypertrophy, dilation, and dysfunction as the parallel female wild-type (WT) mice at 6 wk post-TAC. To determine if this is due to the protective effects of estrogen, which could mask the negative impact of Adam15 loss, WT and Adam15-/- mice underwent ovariectomy (OVx) 2 wk before TAC. Cardiac structure and function analyses were performed at 6 wk post-TAC. OVx similarly impacted females of both genotypes post-TAC. Calcineurin (Cn) activity was increased post-OVx-TAC, and more in Adam15-/- mice; however, this increase was not reflected in the total-to-phospho-NFAT levels. Integrin-α7 expression, which was upstream of Cn activation in male Adam15-/- -TAC mice, remained unchanged in female mice. However, activation of the mitogen-activated protein kinases (ERK, JNK, P38) was greater in Adam15-/--OVx-TAC than in WT-OVx-TAC mice. In addition, ADAM15 protein levels were significantly increased post-TAC in male but not in female WT mice. Myocardial fibrosis was comparable in non-OVx WT-TAC and Adam15-/- -TAC mice. OVx increased the perivascular fibrosis more in Adam15-/- compared with WT mice post-TAC. Our data demonstrate that loss of ovarian hormones did not fully replicate the male phenotype in the female Adam15-/- mice post-TAC. As ADAM15 levels were increased in males but not in females post-TAC, it is plausible that ADAM15 does not play a prominent role in post-TAC events in female mice. Our findings highlight the significance of factors other than sex hormones in mediating cardiomyopathies in females, which require a more thorough understanding.NEW & NOTEWORTHY Loss of ADAM15 in female mice, unlike the male mice, does not worsen the cardiomyopathy following cardiac pressure overload. Ovariectomy does not worsen the post-TAC cardiomyopathy in female Adam15-/- mice compared with female WT mice. Lack of deleterious impact of Adam15 deficiency in female mice is not because of the protective effects of ovarian hormones but could be due to a less prominent role of ADAM15 in cardiac response to post-TAC remodeling in female mice.

(334) - Degree of Pre-Implant LV Dilation Does Not Preclude Favorable Outcome Post LVAD Weaning: A VAD Wean Registry Analysis

(334) - Degree of Pre-Implant LV Dilation Does Not Preclude Favorable Outcome Post LVAD Weaning: A VAD Wean Registry Analysis

Perinatal and neurodevelopmental outcomes of fetal isolated ventriculomegaly: a systematic review and meta-analysis.

Isolated fetal ventriculomegaly can have a range of consequences, ranging from mild neurodevelopmental delay to perinatal death; the extent of these consequences often depend on the severity of ventriculomegaly. This systematic review and meta-analysis aims to investigate the impact of the degree of ventricular dilatation on the risk of neurodevelopmental delay and adverse perinatal outcomes in fetuses diagnosed with isolated fetal ventriculomegaly from gestational week 15 onwards. PubMed, Embase, Scopus and the Cochrane Library were searched electronically to identify studies investigating the prognosis of mild and/or severe isolated fetal ventriculomegaly. Articles were included if they reported neurodevelopmental or perinatal outcomes in fetuses prenatally diagnosed with isolated fetal ventriculomegaly from week 15 of gestation and onwards. Studies were excluded if they reported on non-isolated ventriculomegaly (IVM), failed to specify the degree of ventriculomegaly, were non-English papers, animal studies or published outside of the 21-year period of interest. Study quality was assessed by two independent reviewers using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Ventriculomegaly was defined as either mild or severe when ventricular diameter measured as 10-15 or >15 mm, respectively. Meta-analyses were conducted for adverse neurodevelopmental outcome, intrauterine fetal demise and infant mortality. Following the removal of duplicates, the search yielded 2,452 citations, of which 23 studies were included and 8 were eligible for meta-analysis. There were 767 and 347 cases of mild and severe isolated fetal ventriculomegaly, respectively. Adverse outcomes were consistently reported at a higher rate in severe cases than mild. The relative risks of adverse neurodevelopmental outcome, intrauterine fetal demise and infant mortality were 4.24 [95% confidence interval (CI): 2.46-7.30], 4.46 (95% CI: 1.64-12.11) and 6.02 (95% CI: 1.73-21.00), respectively, upon comparison of mild versus severe cases of isolated fetal ventriculomegaly. The likelihood of adverse neurodevelopmental and perinatal outcomes, including intrauterine and infant mortality, is increased in severe isolated fetal ventriculomegaly compared to mild isolated fetal ventriculomegaly.

Noninvasive factors predicting the maintenance of pregnancy for more than 4 weeks after rescue cerclage in singleton pregnancies with cervical dilatation and prolapsed membrane.

Studies on noninvasive factors and predicting the maintenance of pregnancy, and those comparing the usefulness of these factors with invasive amniotic fluid markers in predicting the maintenance of pregnancy following rescue cerclage, are lacking. Therefore, this study aimed to determine whether C-reactive protein (CRP) levels, White blood cell (WBC) count, absolute neutrophil count (ANC), and platelet-to-lymphocyte ratio (PLR) in maternal blood, which are noninvasive and readily available clinical markers, can predict the maintenance of pregnancy following rescue cerclage in patients with cervical insufficiency (CI). A total of 142 singleton pregnant women (15-28 wk) who underwent rescue cerclage for CI were retrospectively evaluated. The interleukin (IL)-6 concentration in the amniotic fluid; CRP levels, WBC count, ANC, and PLR in the maternal peripheral blood; and degree of cervical dilatation were evaluated before cerclage. The primary outcome was whether the pregnancy was maintained for >4 weeks after rescue cerclage. Among the 142 patients, prolonged pregnancy for >4 weeks following emergent cerclage was observed in 107 (75.35%), while 35 (24.65%) gave birth within 4 weeks. This study demonstrated that the degree of cervical dilatation at diagnosis; WBC count, ANC, and CRP levels in the maternal peripheral blood; and IL-6 concentration in the amniotic fluid significantly differed between the successful and failure groups (all P < .05). The area under the curve (AUC) of the amniotic fluid IL-6 concentration was .795 for the prediction of spontaneous preterm birth within 4 weeks after rescue cerclage. Additionally, the AUC of the CRP level, cervical dilatation, WBC count, ANC, and PLR were .795, .703, .695, .682, and .625, respectively. These findings suggest that the preoperative CRP levels can be considered a useful noninvasive marker comparable to amniotic fluid IL-6 concentration for identifying pregnant women with CI at high risk of spontaneous preterm birth following rescue cerclage.