NR Group Research Articles

Differential Atrial Pacing to Detect Reconnection Gaps After Pulmonary Vein Isolation in Atrial Fibrillation.

High-resolution mapping is useful to identify reconnection gaps in the pulmonary vein after pulmonary vein isolation for atrial fibrillation. However, it is sometimes difficult to differentiate pulmonary vein potentials from far-field potentials because of very low amplitudes. Our purpose was to evaluate the usefulness of a novel differential atrial pacing method to differentiate reconnected pulmonary vein potentials from isolated pulmonary vein potentials. This retrospective observational study included 34 patients with atrial fibrillation (22 men; mean age, 64 ± 14 years; 28 with paroxysmal atrial fibrillation) who underwent radiofrequency or cryoballoon ablation. Following pulmonary vein isolation, we created a high-resolution activation map during pacing from both the coronary sinus and left atrial appendage. We compared the characteristics of the pulmonary vein potentials and the pattern of activation between the reconnected and isolated pulmonary veins. We analyzed 131 pulmonary veins and found reconnections in 41 pulmonary veins (R group); 90 pulmonary veins had no reconnection (NR group). The R group had a significantly shorter distance between the earliest pulmonary vein activation sites in both activation maps, compared with the NR group (5.22 ± 0.53 mm versus 17.08 ± 0.36 mm, respectively; P < 0.0001). The amplitude of the pulmonary vein potentials was higher in the R group versus the NR group (0.61 ± 0.05 mV versus 0.04 ± 0.03 mV, respectively; P < 0.0001). Six gaps (14%) in the R group that were unrecognized using a conventional method were identified using our novel method. In conclusion, differential atrial pacing was useful to identify pulmonary vein reconnection gaps during ablation using a novel high-resolution mapping system.

The effect of subscapularis management technique on outcomes and complication rates following reverse total shoulder arthroplasty

BackgroundRepair of the subscapularis tendon following rTSA has been shown to decrease postoperative dislocations in some studies, but the effect of repair on other outcomes has not been defined. We proposed to assess differences in postoperative pain, function, range of motion, strength, complications, and reoperations after three types of management of the subscapularis tendon—primary repair (tendon-to-tendon), transosseous repair, and no repair—at a minimum of two years of follow-up after rTSA. MethodsReview of an institutional database identified patients with primary rTSA treated by a single surgeon using the same operative technique and implant (medial glenoid with lateral humeral implant) except for subscapularis repair (tendon-to-tendon repair, transosseous repair, no repair). Patients with revision rTSA, anatomic TSA, hemiarthroplasty, or surgery for proximal humeral fracture, nonunion, or malunion were excluded. ResultsOf 210 patients meeting inclusion criteria, 82 (39%) had primary tendon repair of the subscapularis (PTR), 88 (41.9%) had transosseous repair (TOR), and 40 (19%) did not have the subscapularis repaired (NR). Of all demographics and comorbidities measured, the only significant differences among treatments groups were in gender (54.9% female in PTR, 43.2% in TOR, and 72.5% in NR, p = 0.008) and subscapularis status before surgery (89% intact in PTR, 80.7% in TOR, and 38.5% in NR, p < 0.001). There were significantly more patients in the NR group whose operative indication was massive rotator cuff tear compared to the TO and PR groups. Similarly, there were significantly more patients whose operative indication was primary osteoarthritis in the TR group over the PR group, and the PR group over the NR group. There were no significant differences in complication rates (11% PTR, 13.6% TOR, 15% NR, p = 0.79) or reoperation rates (PTR 2.4%, TOR 2.3%, NR 5.0%, p = 0.66) or associations between subscapularis management technique and reoperation or complication rates. ConclusionSubscapularis management technique in rTSA did not affect complication or reoperation rates, and the procedure led to improvements in pain, function, range of motion, and strength in all three treatment groups. Repair of the subscapularis, regardless of technique, led to greater improvements in pain compared to no repair, although this may be partially attributable to better preoperative subscapularis status in the repair groups. Both repair techniques led to equal improvements in all measured outcomes, with the exception of primary tendon repair producing more improvement in ER strength compared to transosseous repair. Level of evidenceLevel III; Case Control Study

Nicotinamide riboside protects noise-induced hearing loss by recovering the hair cell ribbon synapses

ObjectiveNicotinamide riboside (NR) has been proved to protect the hearing. To achieve animal models of temporary threshold shift (TTS) and permanent threshold shift (PTS) respectively, evaluate the dynamic change of ribbon synapse before and after NR administration. MethodsMice were divided into control group, noise exposure (NE) group and NR group. The noise was exposed to NE and NR group, and NR was injected before noise exposure. Auditory brainstem response (ABR), ribbon synapse count and cochlear morphology were tested, as well as the concentration of hydrogen peroxide (H2O2) and ATP. ResultsRibbon synapse count decrease with the intensity of noise exposure, and the cochlear morphology remains stable during TTS and was damaged during PTS. NR promotes the oxidation resistance to protect the synapse and the inner ear morphology. ConclusionOur findings suggest that TTS mice are more vulnerable to noise, and NR can promote the recovery of the synapse count to protect the animals’ hearing.

Left Ventricular Ejection Fraction Recovery in Patients with Heart Failure and Reduced Ejection Fraction Treated with Sacubitril/Valsartan

Background: A significant number of heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) experience ventricular function recovery during follow-up. We studied the variables associated with LVEF recovery in patients treated with sacubitril/valsartan (SV) in clinical practice. Methods: We analyzed data from a prospective and multicenter registry including 249 HF outpatients with reduced LVEF who started SV between October 2016 and March 2017. The patients were classified into 2 groups according to LVEF at the end of follow-up (>35%: group R, or ≤35%: group NR). Results: After a mean follow-up of 7 ± 0.1 months, 62 patients (24.8%) had LVEF >35%. They were older (71.3 ± 10.8 vs. 67.5 ± 12.1 years, p = 0.025), and suffered more often from hypertension (83.9 vs. 73.8%, p = 0.096) and higher blood pressure before and after SV (both, p < 0.01). They took more often high doses of beta-blockers (30.6 vs. 27.8%, p = 0.002), with a smaller proportion undergoing cardiac resynchronization therapy (14.8 vs. 29.0%, p = 0.028) and fewer implanted cardioverter defibrillators (ICD; 32.8 vs. 67.9%, p < 0.001), this being the only predictive variable of NR in the multivariate analysis (OR 0.26, 95% CI 0.13–0.47, p < 0.0001). At the end of follow-up, the mean LVEF in group R was 41.9 ± 8.1% (vs. 26.3 ± 4.7% in group NR, p < 0.001), with an improvement compared with the initial LVEF of 14.6 ± 10.8% (vs. 0.8 ± 4.5% in group NR, p < 0.0001). Functional class improved in both groups, mainly in group R (p = 0.035), with fewer visits to the emergency department (11.5 vs. 21.6%, p = 0.07). Conclusions: In patients with LVEF ≤35% treated with SV, not carrying an ICD was independently associated with LVEF recovery, which was related to greater improvement in functional class.

P37 Long-term outcomes of patients at risks for Fontan operation: role of temporary fenestration

Abstract Purpose Whereas fenestration at Fontan operation was reported to be effective for smooth initiation to Fontan circulation, subsequently developed aortopulmonary collateral arteries under the presence of remaining hypoxia were a matter of concern.So as our institutional policy, it is closed as much and early as possible (temporary fenestration). This study aimed to reveal long-term outcomes for patients at riskswho underwent Fontan operation with temporary fenestration. Methods Of 107 patients undergoing Fontan operation from 1995 to 2004, 79 patients (73.8%) were free from any risks (NR group) and 28 patients (26.2%) had risks for Fontan operation (R group). Hypoplastic left heart syndrome, heterotaxy syndrome with obstructive total anomalous of pulmonary venous connection, and individual cases with high preoperative pulmonary artery pressure (PAP), systemic ventricular end diastolic pressure (SVEDP) or low ejection fraction (SVEF) were defined as a risk for Fontan completion.Age at Fontan operation was older in R group (6.6 vs 2.3years-old, p = 0.0004). Preoperative PAP (12.8 vs 11.3mmHg, p = 0.03) and SVEDP (8.8 vs 7.1mmHg, p = 0.02) were higher and SVEF (53.7 vs 60.0%, p = 0.002) was lower in R group. Pulmonary vascular resistance (PVR) was not different. Fenestration was created in all patients in R group, then it was closed at the mean duration of 2.9 years after Fontan operation. Results Freedom from death or protein-losing enteropathy rate at 5, 10, and 15 years after Fontan operation were 97, 96, and 93% in NR group and 96, 93, and 86% in R group (log-rank: p = 0.20). Fifty-one patients (64.6%) in NR group and 17 patients (60.7%) in R group underwent serial catheter examinations at 5, 10, and 15 years after Fontan operation and exercise capacity testing at 15 years after Fontan operation (Figure). In R group, arterial oxygen saturation was lower and PVR was higher even after close of fenestration (Figure). In addition, 12 patients (71%) in R group developed significant veno-venous collaterals, which were defined by more than 3mm in diameter of collateral veins or a condition where pulmonary veins were contrasted in venography. On the contrary, cardiac index (CI), SVEDP, and PAP were not different and no significant difference on peak oxygen uptake and anaerobic threshold were observed between in 2 groups. Conclusions Although the mild cyanosis remained due to the development of veno-venous collaterals after the closure of temporary fenestration, CI, SVEDP and PAP well maintained in patients at risk for Fontan operation. These results might to lead acceptable life prognosis and freedom fromprotein-losing enteropathy rate for patients at risk for Fontan operation. Abstract P37 Figure

Nutritional Recovery and its Effect on Tryptophan-5-Hydroxylases Expression, Cell Number and on Changes Caused by Intrauterine Growth Restriction in the Developing Brain

Objective: The aim of this work was to determine whether the changes in tryptophan-5-hydroxylase (TPH) 1 or 2 brain expression caused by intrauterine growth restriction (IUGR) are maintained or return to normal in the nutritionally-recovered undernourished offspring (UNDO) of rats. Methods: The experimental procedure was: Wistar female rats were subjected to a protein-caloric-restricted diet during gestation. At birth, part of the newborn UNDO pups were fed by their own mothers (UNDO Group), and others were fed by normal control mothers to allow their nutritional recovery (NR Group); pups from normal control dams were fed by them (C Group). On days 1, 15 and 21, brainstem tissue, at the level of dorsal raphe nucleus (DRN), was obtained, in order to determine L-tryptophan (L-Trp), serotonin (5-HT) and TPH activity. In addition, TPH 1 or 2 expressions were determined using specific monoclonal antibodies by Western blot and by immunohistochemistry in neurons. Results: In the UNDO group, an increase in L-Trp, 5-HT and TPH activity was confirmed. Both TPH isoforms were expressed since birth, with TPH1 expression being higher in the UNDO group. TPH2 activity was also elevated but was lower activity in comparison with controls. The NR group was able to physically recover to normality, but their neurochemical changes and elevated number of TPH1 neurons remained unchanged and did not return to control values. TPH2 neuronal number did return to normal control values. Discussion: These results strongly suggest that the changes in the UNDO group may explain, together with a possible important Pet-1 molecular system participation, the chronic activation of the brain serotonin system in subjects that suffered IUGR due to undernourishment.

PSII-7 Uterine artery hemodynamics and placentome quantification during maternal nutrient restriction in beef cattle

Abstract Proper fetal nutrition via adequate uteroplacental blood flow is critical for maximizing fetal development and reducing mortality. However, our understanding of adaptations during maternal nutrient restriction is incomplete. The purpose of this study was to determine the effect of nutrient restriction during mid to late gestation on utero-placental hemodynamics and placentome morphometrics in gestating beef cattle. Animals (n = 10) were randomly assigned one of 2 treatments: Control (CON; 100% NRC Requirements) vs Restricted Feed (NR; 60% of NRC Requirements) from 140 to 240 days of gestation. Hemodynamic parameters were collected by Doppler ultrasonography 1 week prior to slaughter from the ipsilateral and contralateral uterine arteries, after which, total uterine artery blood flow was calculated. Six animals (n = 3 per treatment) were slaughtered on day 240 of gestation (Group 1) and the remaining 4 animals were slaughtered on 265 ± 15 days (Group 2). Placentome tissues were harvested for weight and number determination. Placentome number decreased (P = 0.01) in nutrient restricted (49 ± 6) versus control (83 ± 6) fed dams. There was an interaction between treatment and group in which ipsilateral diameter increased (P &amp;lt; 0.05) in group 2 NR animals versus group 2 CON animals while there was no difference between NR and CON in group 1. There was no difference (P = 0.30) in total uterine artery blood flow in fetal weight, which averaged 212 ± 37 mL/min*kg in nutrient restricted versus 153 ± 34 mL/min*kg in control fed dams. In summary, these data indicate limited alterations in uterine artery blood flow and fetal weight in nutrient restricted dams during the last half of gestation. The decrease in placentome number with no difference in placentome weight could indicate larger placentomes in nutrient restricted dams were able to compensate for the reduction in total number.

AST-120, an Oral Carbon Absorbent, Protects against the Progression of Atherosclerosis in a Mouse Chronic Renal Failure Model by Preserving sFlt-1 Expression Levels

Soluble Flt-1 (sFlt-1), an endogenous antagonist of the proatherogenic cytokine placental growth factor, is decreased in chronic kidney disease (CKD), leading to atherosclerotic progression. In this study, we investigated the effect of AST-120, an oral carbon adsorbent which can remove uremic toxins, on sFlt-1 expression levels and atherosclerosis progression. Atherosclerotic apolipoprotein E-deficient mice underwent a 5/6 nephrectomy (5/6 NR) or a sham operation (sham) at 8 weeks of age and were then treated or not with oral AST-120 for 12 weeks. sFlt-1 expression levels and the degree of atherosclerosis were assessed at 22 weeks of age in each of the four groups (sham; n = 7, 5/6 NR; n = 10, sham + AST-120: n = 8, 5/6 NR + AST-120; n = 8). The expression levels of sFlt-1 mRNA in the kidney were significantly lower in the 5/6 NR group than in the sham group, but AST-120 treatment prevented this decrease in sFlt-1 levels. Similarly, the atherosclerotic plaque area of the thoracoabdominal aorta was significantly larger in the 5/6 NR group than in the sham group, and AST-120 treatment prevented this increase in atherosclerosis. AST-120 could, therefore, be used as a therapeutic to treat atherosclerosis in patients with CKD.

Effect of Different Levels and Sources of Dietary Copper, Zinc and Manganese on the Performance and Immune and Redox Status of Turkeys.

Simple SummaryCompanies producing turkey genetic (breeding) material recommend a much higher addition of Cu, Zn, and Mn to compound feed than recommended by the NRC. In practice, the poultry breeding companies in their feeding programs use an addition of these elements similar to the recommendations of breeding companies, without taking into account their content in the raw materials used for the production of feed. The aim of the study was to determine the effectiveness of the combined use of Cu, Zn, and Mn nanoparticles in the diet of slaughter turkeys with regard to potential reduction of the levels of these elements added to feed. Turkeys received the addition of Cu, Zn, and Mn in inorganic form or nanoparticles in amounts recommended by breeding companies, reduced to 10% of these recommendations or without the addition of these elements. The results of our research, showed that reducing the addition of these elements does not cause deterioration of performance and immunity of turkeys. It was also found that the addition of standard forms of these elements (inorganic forms) can be reduced without having to be replaced by nanoparticles.The aim of the study was to determine the effectiveness of the combined use of Cu, Zn, and Mn nanoparticles in the diet of turkeys with regard to potential reduction of the levels of these elements added to feed. The experiment was carried out on turkeys’ hens assigned to four groups. Turkeys from the PC group received feed with the addition of inorganic forms of Cu, Zn, and Mn in the B.U.T. (British United Turkeys) recommended levels, from group IR received the addition in amounts reduced to 10% of the recommended levels, and from group NR received the addition of elements in the form of nanoparticles in the same amounts as in group IR. The turkeys from group NC received feed without the addition of these elements. The research showed that the addition of Cu, Zn, and Mn to turkey diets, in both inorganic forms and as nanoparticles, in quantities covering only 10% of B.U.T. recommendations had no adverse effect on growth performance or on the antioxidant and immune defense of turkeys. The changes in the redox status of the turkeys whose diet was not supplemented with Cu, Zn, and Mn indicate reduced oxidation processes in the tissues.

ATUAÇÃO DAS UNIVERSIDADES PROMOTORAS DE SAÚDE NA PREVENÇÃO DE NEOPLASIAS DO COLO DO ÚTERO

Estudo descritivo de corte transversal realizado com mulheres (n= 61) que atuam no setor de limpeza de uma instituição de ensino superior privada no município de Maringá-PR. O objetivo foi avaliar a percepção delas sobre a prevenção da neoplasia do colo do útero. Foram aplicados questionários semiestruturados, elaborados com base nas informações do Instituto Nacional do Câncer. Verificou-se que 8,20% das funcionárias nunca realizaram o preventivo (grupo NR); 26,23% realizaram há mais de dois anos (grupo R+2); 65,57% há menos de dois anos (grupo R-2). Para NR, 20% reconhecem o HPV como fator necessário para o câncer, 43,75% para NR, e 40% para R+2. Para NR, 60% reconhecem que o preventivo auxilia no diagnóstico, 70% para R+2, e 80% para R-2. Para R+2, 25% reconhecem que toda mulher entre 25 e 64 anos de idade deve fazer o exame, e 7,5% para R-2. Para R+2, 12,5% têm hábito de realizar exames rotineiramente, e 30% para R-2. Conclui-se que a adesão ao exame preventivo é intuitiva e o conhecimento sobre a doença é limitado, ressaltando a necessidade de educação em saúde.

Accuracy of aortic valve velocity time integral in assessing fluid responsiveness during general anesthesia in elderly patients

Objective To evaluate the accuracy of aortic valve velocity time integral (VTI) in assessing fluid responsiveness during general anesthesia in elderly patients. Methods Forty-four elderly patients of both sexes, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, with New York Heart Association classⅠ or Ⅱ, undergoing elective surgery with general anesthesia in our hospital from February 2018 to August 2018, were enrolled in this study.All the patients underwent tracheal intubation after general anesthesia induction, and then volume expansion was carried out (6% hydroxyethyl starch 250 ml was intravenously infused for 30 min). The heart rate (HR), mean arterial pressure (MAP), VTI and stroke volume (SV) were recorded before and after volume expansion, and ΔHR, ΔMAP, ΔVTI and ΔSV were calculated.Patients were divided into 2 groups according to ΔSV: response group (R group, ΔSV≥15%) and non-response group (NR group, ΔSV<15%). The receiver operating characteristic curve (with the area under the standard ΔSV curve was 1) was used to analyze the ΔHR, ΔMAP and ΔVTI, and the Youden index at its best was calculated.The Person test was used to analyze the correlation between ΔVTI and ΔSV. Results There were 25 cases in R group and 19 cases in NR group.Compared with group NR, ΔHR was significantly decreased, and ΔVTI and ΔSV were increased in group R (P<0.05). The area under the ROC curve of ΔHR, ΔMAP and ΔVTI in assessing fluid responsiveness was 0.509 (95% confidence interval 0.314-0.689, P=0.415), 0.558 (95% confidence interval 0.379-0.737, P=0.515) and 0.905 (95% confidence interval 0.812-0.999, P<0.01), respectively. When Youden index was at its best, ΔVTI was 15.28%, with the sensitivity 88.0% and specificity 94.7%.There was a positive correlation between ΔSV and ΔVTI (r=0.936, P<0.05). Conclusion ΔVTI can accurately assess the fluid responsiveness during general anesthesia in elderly patients. Key words: Aortic valve; Aged; Fluid therapy

1172The increased serum level of troponin T after immunosuppression therapy reflects sustained myocardial FDG accumulation in cardiac sarcoidosis

Abstract Background and purpose Fluorine-18-flurodeoxyglucose positron emission computed tomography (18FDG-PET CT) is the sole but time-consuming and expensive examination assessing active inflammatory myocardium noninvasively in patients with cardiac sarcoidosis (CS). Though immunosuppression is used to treat CS, little is known about the cardiac biomarkers for determining therapeutic effect to immunosuppression therapy other than 18FDG-PET. Methods From Aug 2016, we prospectively enrolled 50 sarcoidosis patients with positively accumulated of FDG in the heart. The initial dose of prednisolone was 30mg/day, wherefrom the dose was tapered down 5mg/month until 6 months. After 6 months, follow-up 18FDG-PET was performed. Using 18FDG-PET images, we calculated total lesion glycolysis (TLG; SUVmeam x metabolic volume) and compared it to various cardiac markers. Non-responder was defined as TLG reduction rate &lt;70% after immunosuppression therapy. Results In 50 CS patients, 41 patients had serial 18FDG-PET before and 6 months after immunosuppression therapy. 18FDG-PET images were acquired following 7 day's carbohydrate limitation and after at least 18-h fasting (mean free fatty acid level right before 18FDG-PET acquisition was 1.03 mEq/L). The mean age and plasma brain natriuretic peptide (BNP) level were 61.9 years old, 184 pg/mL at baseline, respectively. Because of immunosuppression therapy, TLG was significantly reduced from 195.3 (38.6–339.6) to 1.1 (0.01–7.37), p&lt;0.001). Six (14.6%) patients were classified as NR group and the level of TnT at post therapy was significantly higher in NR group than responder-group (R-group) (0.021 (0.012–0.027) ng/ml vs 0.0095 (0.006–0.013) ng/ml, p=0.039) (Figure), while there were no significant differences between NR-group and R-group in the levels of ACE, sIL-2R, BNP, Dd, EF. Figure 1 Conclusions 1) By immunosuppression therapy using prednisolone for CS, about 85% patients showed significant reduction of increased myocardial FDG accumulation. 2) The sustained high level of serum TnT at post 6 months therapy indicates persistent inflammation of sarcoidosis in the heart, which could be an expedient marker for determining therapeutic effect.

P1955The CHADS-VASc score is a predictor of No-Reflow in patients with NSTEMI

Abstract Introduction No-reflow (NR) is one of the major complications associated with primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to elucidate the relationship between the CHA2DS2-VASc score and NR phenomena in patients with NSTEMI. Methods A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(−) (n=307), according to their post-PCI, no-reflow status. The thrombus burden was classified according to the TIMI thrombus grade (TTG). CHA2DS2-VASc scores were calculated for all patients. Results The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(−) (3.48±1.19 vs 1.81±0.82, p&lt;0.001). After a multivariate regression analysis, a higher CHA2DS2-VASc score (OR: 6.52, 95% CI: 3.51–12.14, p&lt;0.001), hs-Troponin (OR: 1.077, 95% CI: 1.056–1.099, p&lt;0.001) and TTG (OR: 1.563, 95% CI: 1.134–2.154, p=0.006) were independent predictors of NR. In-hospital mortality rates were significantly higher in the NR(+) group compared to the NR(−) (15% vs. 5%, p&lt;0.001). Table 1. Demographic, clinical, and angiographic characteristic of the patients Variables NR(−) (n=307) NR(+) (n=84) p Age, years, mean ± SD 55.50±8.95 56.67±8.80 0.248 Female gender, n (%) 83 (%27) 25 (%30) 0.536 CHF, n (%) 30 (%10) 17 (%20) 0.019 HT, n (%) 116 (%38) 45 (%54) 0.004 DM, n (%) 67 (%22) 30 (%36) 0.009 Previous stroke/TIA, n (%) 9 (%3) 9 (%11) &lt;0.001 CHA2DS2-VASc score, mean ± SD 1.81±0.82 3.48±1.19 &lt;0.001 LVEF (%), mean ± SD 56.11±9.31 51.15±11.32 &lt;0.001 hs-troponin (pg/ml) (NRI &lt;14pg/ml) 56.59±11.83 114.23±26.42 &lt;0.001 Serum creatinine, mean ± SD, mg/dl 0.89±0.13 0.91±0.22 0.852 Hemoglobin (g/dl) 14.16±1.76 14.10±1.74 0.782 TTG, median 1 (0–3) 3 (1–5) &lt;0.001 TTG(4,5), n (%) 70 (%23) 36 (%42) &lt;0.001 In-hospital mortality, n (%) 16 (%5) 13 (%15) &lt;0.001 Conclusions In conclusion, CHA2DS2-VASc score is associated with higher risk of no-reflow in patients with NSTEMI undergoing PCI. Acknowledgement/Funding None

P959The specific characteristics and independent predictors of no-reflow phenomenon, development of a clinically-adaptable risk estimation system

Abstract Introduction No-reflow (NR) phenomenon occurs, when myocardial perfusion is not re-established despite opening the coronary artery during percutaneous coronary intervention (PCI). Purpose Our aim was to identify no-reflow specific characteristics, its independent predictors, and to develop a clinically-adaptable risk score. Methods We have analysed 4085 patient data from two Hungarian cardiovascular centres. We included all STEMI/NSTEMI patients underwent PCI (n=3187). 158 patients treated with papaverine/adenosine formed NR group, while 3029 patients were in control (C) group. Anamnestic parameters, laboratory and operation data were compared. Statistical analysis was carried out with Mann-Whitney-, Fisher test, binary logistic regression and Kaplan Meier survival curve. Based on our results, we designed a risk estimation system, checking its applicability with ROC analysis. Results As for NR-specific characteristics, malignant ventricular arrhythmias (11% vs. 4%, p=0,0031; NR-C consequently) and complications (21% vs. 11%, p=0,064) showed their vulnerability. The increment of glucose (8,1 vs. 7,1 mmol/l, p=0,004), WBC (12,08 vs. 10,5 G/l, p=0,001), CRP (12,46 vs. 7,67 mg/l, p=0,051) and LDL levels (3,34 vs. 3,13 mmol/l, p=0,059) supported the pathomechanism of NR. Higher biomarker levels (troponinT: 2040 vs. 510,5 ng/ml; CK-MB: 100,4 vs. 63,65 U/l, p&lt;0,0001) indicated severe perfusion disturbance. Tendency was seen in higher BMI (28,65 vs. 28,03 kg/m2, p=0,12). STEMI dominated in NR (83 vs. 59%, p&lt;0,0001). Lower platelet level (213,3 vs. 228 G/l, p=0,107) and single vessel disease (46 vs. 25%, p=0,0042) characterized NR. 30-day survival was significantly different (85,1 vs. 93,54%, p&lt;0,0001). The mortality rate of NR in STEMI was 69,7% (69,7% vs. 7,94%, p&lt;0,0001) and in NSTEMI 3,7% (3,7% vs. 4,32%). From the significant differences, CRP was the independent predictor of NR (OR: 1,011, p=0,004; pro 1 mg/l change). Examining STEMI/NSTEMI separately, in STEMI CRP was the independent predictor (OR: 1,0092, p=0,036). In NSTEMI LDL (OR: 4,23, p=0,021) was the independent factor. In the risk score, the following 8 parameters were included: BMI&gt;28 kg/m2, glucose&gt;8 mmol/l, WBC&gt;12 G/l, CK-MB&gt;100 U/l, hs troponin T&gt;2000 ng/ml, CRP&gt;12 mg/l, LDL&gt;3,3 mmol/l, STEMI (yes/no), thus maximum 8 points could be reached. Low (0–1 points, 5–20%), moderate (2–5 points, 55–70%) and high risk groups (6–8 points, 41–11%) were formed. Supervising the model with ROC analysis: AUC=0,69, p=0,0026, which indicates its ability to discriminate effectively between different risk levels of NR. Conclusions The specific characteristics of NR group were identified, from which CRP was the independent predictor - as well as in STEMI, while in NR-NSTEMI LDL was the independent factor. With the elaborated risk estimation system –using anamnestic and routine laboratory parameters– NR could be predicted and unsuccessful PCI could be reduced, resulting in positive therapeutic consequences.

Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa

GoalTo evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2. MethodRetrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R=21) and without (NR=24) robotic assistance, in the period 2006–2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P< .005. ResultsThree- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P=.34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P=.81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P=.05) without significant impact on 5-year actuarial local control (P=0.78). ConclusionRobotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.

Resting-state brain functional connectivity in patients with chronic pain who responded to subanesthetic-dose ketamine

Ketamine has been used to treat chronic pain; however, it is still unknown as to what types of chronic pain is ketamine effective against. To identify the effect of administration of subanesthetic-dose ketamine in patients with chronic pain and to clarify the mechanism of the effect, we retrospectively investigated brain functional connectivity using resting-state functional magnetic resonance imaging (rs-fMRI). Patients were divided into responders (Group R: ≥50% improvement on Numerical Rating Scale) and non-responders (Group NR). We compared the differences in terms of brain functional connectivity by seed-to-voxel correlation analysis. Two-sample t-test revealed significant lower connectivity between the medial prefrontal cortex (mPFC) and precuneus in Group R. We also found a significant negative correlation between the improvement rate and functional connectivity strength between the mPFC and precuneus. These findings suggest that subanesthetic-dose ketamine is effective in patients with chronic pain whose brain functional connectivity between the mPFC and precuneus is low. We believe that the current study explored for the first time the correlation between brain functional connectivity and the effect of subanesthetic-dose ketamine for chronic pain and indicated the possibility of use of the predictive marker in pharmacological treatment of chronic pain.

Identification of the optimal puncture position in PIEZO-ICSI using image analysis: a pilot study

Oocyte degeneration may take place in Piezo-ICSI as a result of unintentional membrane rupture in the puncturing process. Identifying the appropriate puncturing position may decrease the likelihood of membrane rupture and thus degeneration. Therefore, it was evaluated using image analysis whether it was possible to identify the optimal puncture position. Retrospective image analysis during ICSI procedure. Image feature analysis is generally used to represent the useful features such as color, brightness, and contour. Among capturing image features, Local Binary Patterns (LBP) can efficiently summarize the local structures of images, and it has been applied in texture analysis in various fields including face recognition and moving image analysis in real-time. We employed this methodology to analyze the moving images of 131 oocytes following ICSI. These oocytes were categorized as either unintentional rupture (UR: n = 101) or no rupture (NR: n = 30). An image of the oocyte before puncture and of the puncture position was acquired from the moving images, and LBP values were calculated in the analysis region centered around the puncture position. In order to select an effective pattern for evaluation of rupture from the 256 types of shape patterns acquired by LBP, median values for the UR and NR groups were calculated, and the patterns with little difference to the median were eliminated. Data was classified by hierarchical clustering method using the three effective patterns for evaluation. We employed the Ward’s hierarchical cluster analysis method, and calculated the Euclidean distance between the barycenter of the cluster and each data point in order to define an index indicating the implausibility of membrane rupture. A t-test was used for statistical analysis. Two clusters, Cluster A and B, were classified from hierarchical clustering. Following ICSI, 2 out of 27 oocytes from Cluster A and 28 out of 104 from Cluster B happened to have UR. When Cluster A represented the NR group and Cluster B the UR group, the sensitivity was 0.93. A significant difference between the UR and the NR group was reported from the Euclidean distance calculations between the barycenter of Cluster A and each data point (P = 0.001), where data showed a longer distance from the barycenter amongst the UR group and a shorter distance in the NR group. Through image feature analysis, the presence or absence of membrane rupture was evaluated from the shape feature of the oolemma. The distance from the barycenter of Cluster A was associated with the likeliness of unintentional rupture. From this, visualizing shape features of the oolemma in real-time can contribute to the decrease in ICSI degeneration rate. From now on, it will be necessary to analyze more sample images and establish a visualization technique.

Language regression is associated with faster early motor development in children with autism spectrum disorder.

Language regression (LR) is a consistent and reproducible phenomenon that is reported by ~25% of parents who have children with autism spectrum disorder (ASD). However, there is controversy regarding the etiological and clinical significance of this phenomenon. Here, we examined data from a cohort of 218 children with ASD from the Negev Autism Center in Israel. We identified 36 children with ASD who were reported to exhibit clear LR by their parent on three independent occasions and compared them to 104 children whose parents did not report any concern of regression (NR). We compared a variety of key developmental characteristics across these two groups. We found that the age at which children with ASD in the LR group achieve key developmental milestones of crawling, walking, and use of first words is significantly younger than the age of children in the NR group, and comparable to the age of typically developing children. In contrast, no differences were observed in physical growth characteristics such as head circumference, weight, or height between the groups. Furthermore, almost all children with LR were born close to full term (>35 weeks) and none had a history of hypotonia. Notably, despite their apparently typical early development, children with LR were diagnosed with more severe symptoms of ASD than children with NR. These results strengthen the motivation to continue and study LR among children with ASD and suggest that early detection and intervention studies of ASD may benefit from stratifying children into LR and NR groups. Autism Res 2020, 13: 145-156. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The presence of language regression (LR) among children with autism is still a matter of scientific debate. Here, we show that children with autism and reported LR start to crawl, talk, and walk at the same age as other typically developing children and significantly earlier than other children with autism. These findings, along with other medical differences between these groups, suggest that children who experienced LR comprise a distinct subgroup within the autism spectrum.

Postoperative residual pain is associated with a high magnetic resonance imaging (MRI)-based signal intensity of the repaired supraspinatus tendon.

To assess patients with and without postoperative residual pain and to compare clinical function and magnetic resonance imaging (MRI) appearance of the repaired supraspinatus tendon between patients with and without pain. One-hundred and seventeen patients with supraspinatustear were included in this study. Visual Analog Scale (VAS) scores for pain were assessed at a follow-up of at least 1 year. Patients with residual shoulder pain were enrolled in the residual pain group (RP group) and patients without pain enrolled in the no pain group (NP group). The American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, the modified University of California at Los Angeles (UCLA) score and the Fudan University Shoulder Score (FUSS) were also used to evaluate shoulder function. MRIexaminations were performed to evaluate rotator cuff integrity according to the Sugaya method, and muscular hypotrophy, fatty infiltration, and signal/noise quotient (SNQ) of the rotator cuff tendon. Thirty-five patients had residual pain (RP group) and 82 patients had no pain (NR group). At the final follow-up, there was a significant difference in ASES (92 ± 8 points vs 76 ± 10 points; p < 0.001), UCLA (32 ± 3 points vs 28 ± 3 points; p < 0.001), FUSS (90 ± 7 points vs 80 ± 9 points; p < 0.001) and strength (9 ± 3kg vs 6 ± 2kg; p < 0.001) between the NP group and the RP group, respectively. Postoperative MRI revealed that there was no significant difference in the retear rate (9.8% vs 8.6%; ns), the muscular hypotrophy (ns), and the fatty infiltration index (0.9 ± 0.2 vs 0.9 ± 0.2; ns) between the NP and the RP groups, respectively. The postoperative tendon SNQ of the RP group was significantly higher than that of the NP group (4.6 ± 2.5 vs 3 ± 1.7; p < 0.001). There was a significant association between tendon SNQ and VAS for this cohort ([Formula: see text] = 0.29; p = 0.003). Postoperative residual pain is associated with a high MRI signal intensity of the repaired supraspinatus tendon. Since high signal intensity of tendon tissue indicates degenerated tendon tissue quality, it highlighted the necessity of debriding the degenerated rotator cuff tendon tissue. III.

Association between intraoperative nociception and postoperative complications in patients undergoing laparoscopic gastrointestinal surgery.

A higher degree of surgical invasiveness, which increases intraoperative nociception, might induce postoperative complications. Although several nociceptive indices for use during surgery are available in clinical practice, association between intraoperative nociception and postoperative complications has not been reported. An index representing intraoperative nociception, which is the averaged value of Nociceptive Response throughout the surgery (mean NR) was applied to examine the association in the present study. The retrospective study evaluated consecutive adult patients undergoing laparoscopic gastrointestinal surgery, American Society of Anesthesiologists-physical status (ASA-PS) I or II, whose preoperative C-reactive protein level was < 0.3mgdL-1. We first used ordinal logistic analysis to examine the association between preoperative and intraoperative risk factors and complications graded by the Clavien-Dindo classification. Next, we performed propensity score matched analysis to evaluate the effects of mean NR throughout surgery on postoperative complications. Ordinal logistic analysis (n = 158) revealed that duration of surgery (P < 0.001), mean NR during surgery (P = 0.002), and ASA-PS (P = 0.016) were risk factors for postoperative complications. Then all patients were divided into two propensity score matched groups, based on a mean NR of < 0.85 and ≥ 0.85, with matching for age, ASA-PS, body mass index and duration of surgery. The severity of postoperative complications was significantly higher in the high NR group than in the low NR group (P = 0.005). In conclusion, there was likely an association between intraoperative nociception and postoperative complications in patients without serious preoperative conditions and comorbidities.