Anatomy Of Heart Research Articles

Evaluation of the relationship between vitamin D level during pregnancy and the rate of fetal heart problems: a cross-sectional study.

One of the most important things that change during pregnancy is the serum vitamin D level, which is essential for both the mother's and the fetus's health. Vitamin D deficiency can increase the possibility of fetal abnormalities, including heart abnormalities in the fetus. This descriptive cross-sectional study was carried out on 81 pregnant women who were referred to Bandar Abbas Children's Hospital in 2019 to examine the fetal heart. Individuals were classified into three groups (average reduction - mild/moderate reduction - severe reduction) considering serum vitamin D levels measured by high-performance liquid chromatography methods. Also, in terms of the echocardiographic status of the heart, examined at 18-28 weeks of gestation, they were divided into three groups: regular, heart failure, and anatomical heart abnormality (defect). Finally, the relationship between these two indicators, namely the serum vitamin D level of the pregnant woman and fetal heart status, was investigated. There was a statistically significant relationship between maternal serum vitamin D level and fetal heart status based on the Chi-square test (P=0.007). Heart problems increased in fetuses of mothers with lower serum vitamin D levels. No abnormality was also observed in the fetal heart of mothers with normal vitamin D levels. There is a significant relationship between serum vitamin D levels during pregnancy and the rate of fetal heart problems; therefore, vitamin D replacement therapy can cause reducing the cases of functional and structural abnormalities of the heart in the fetus and improve the final prognosis of pregnancy. Vitamin D deficiency in the mother can also be considered an indication of fetal echocardiography.

Bridging with Veno-Arterial Extracorporeal Membrane Oxygenation in Children: A 10-Year Single-Center Experience

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is frequently used in children with and without congenital heart disease (CHD). This study, of a single-center and retrospective design, evaluated the use and timing of V-A ECMO in a pediatric cohort who underwent V-A ECMO implantation between January 2009 and December 2019. The patients were divided into a pre-/non-surgical group and a post-surgical group. Among the investigated variables were age, gender, weight, duration of ECMO, ECMO indication, and ventricular physiology, with only the latter being statistically relevant between the two groups. A total of 111 children (58 male/53 female), with a median age of 87 days (IQR: 7–623) were supported using V-A ECMO. The pre-/non-surgical group consisted of 59 patients and the post-surgical group of 52 patients. Survival at discharge was 49% for the pre-/non-surgical group and 21% for the surgical group (p = 0.04). Single-ventricle physiology was significant for a worse outcome (p = 0.0193). Heart anatomy still has the biggest role in the outcomes of children on ECMO. Nevertheless, children with CHD can be successfully bridged with ECMO to cardiac operation.

EP07.03-004 Efficacy of Thoracic Radiotherapy for Local Progression in Advanced Thymic Carcinoma

Advanced thymic carcinoma is a rare epithelial tumor of the thymus with a poor prognosis. Local advance is crucial in many patients due to the anatomical adjacent large vessels, bronchus, and heart. Thoracic radiotherapy is the main modality for the treatment of local progression. We analyzed the efficacy of radiotherapy to anti-mediastinal region in patients with advanced and recurrent thymic carcinoma.

Spontaneous Pneumothorax in a Patient with Systemic Lupus Erythematosus and Recent Infection with Coronavirus

A 50-year-old woman with a history of systemic lupus erythematosus and a recent infection with COVID-19 presented to the emergency department with acute shortness of breath twice in 10 days. She was diagnosed with myopericarditis attributed to COVID-19 infection (first admission), and chest X-ray revealed a small left-sided pneumothorax, pericardial effusion (second admission), with no mediastinal shift or other signs of tension. Computed tomography confirmed these results and revealed a few small cysts in the right lung. An echocardiogram demonstrated normal heart anatomy and filling dynamics. The patient was diagnosed with simple pneumothorax and ongoing myopericarditis managed with colchicine, ibuprofen, and low-dose prednisolone. The patient responded to treatment and was discharged. Pneumothorax association with COVID-19 is reported in a small number of publications, but the association is less clear with SLE. Our patient may have been predisposed to developing pneumothorax after COVID-19 infection due to her existing connective tissue disorder.

Ultrasound-guided femoral approach for coronary angiography and interventions in the porcine model

Coronary angiography and percutaneous coronary intervention (PCI) procedural details in swine are similar to those performed to humans, since their heart and coronary anatomy closely resembles. However, only a few detailed descriptions of the procedure are available, containing notable differences. We present a feasible and reproducible protocol for percutaneous coronary interventions in porcine experimental models, utilizing ultrasound-guided femoral approach. Nine female pigs were studied to explore the feasibility of superficial femoral arterial (SFA) access for coronary angiography and provisional PCI, as well as the most suitable guiding coronary catheters and angiographic projections for the above interventions. Experiments were performed under general anesthesia, using ultrasound-guided puncture of the SFA to gain arterial access. The Amplatzer AR1® catheter, and the Right Coronary Bypass® catheter were used for the selective engagement of the right and the left coronary artery, respectively. Successful arterial access and subsequent cardiac catheterization were performed in all pigs. Only one animal required a second puncture for femoral artery access. None of the 9 animals presented any significant tachycardia or hypotensive episode. One animal developed an access site-related complication following the first catheterization procedure. During follow-up, 100% success of SFA catheterization was achieved using the same ultrasound-guided technique. The ultrasound-guided superficial femoral artery access for coronary angiography and provisional interventions in porcine models is a quick and safe alternative to the carotid artery approach. The RCB and AR1 catheters may be the best choice for the quick and easy selective coronary engagement of the right and left ostia, respectively.

Maternal urogenital infection and fetal heart functional assessment - what is the missing link?

Maternal urogenital infections during pregnancy are worldwide frequent problem. The aim was to analyze influence of maternal genitourinary infection on fetal cardiac function, pregnancy development and obstetrical outcomes. This was a single-center cohort study on fetuses (average at 28th week) in two groups: with maternal urogenital infections (study group n=49) and control group with no infections (n=59). Parvovirus B19, toxoplasmosis, cytomegalovirus, herpes simplex infections, congenital malformations, fetal growth restriction, chronic maternal diseases, as well as patients with body mass index (BMI) >25kg/m2 were excluded. We analyzed: maternal age, time of delivery, neonatal birth weight, Apgar scores, average time of hospitalization of newborns after birth and several fetal echocardiographic parameters. The only statistical differences was found for shorter isovolumetric relaxation time (IRT) (40±10 vs. 45±9; p=0.03) and longer ejection time (ET) [ms] for right ventricle (RV) (176±24 vs. 164±18; p=0.01). Thick placenta was observed more frequent in study group than in controls (36.7 vs. 16.9%; p= 0.02). The missing link for explanation of these findings was coincidence with thick placenta. This is probably the first observation suggesting that thick placenta (>5cm) may affect fetal RV function in normal heart anatomy: prolongation of right ventricular ET and shortening of fetal right ventricular IVRT.

End-systole and end-diastole detection in short axis cine MRI using a fully convolutional neural network with dilated convolutions.

The correct assessment and characterization of heart anatomy and functionality is usually done through inspection of magnetic resonance image cine sequences. In the clinical setting it is especially important to determine the state of the left ventricle. This requires the measurement of its volume in the end-diastolic and end-systolic frames within the sequence trough segmentation methods. However, the first step required for this analysis before any segmentation is the detection of the end-systolic and end-diastolic frames within the image acquisition. In this work we present a fully convolutional neural network that makes use of dilated convolutions to encode and process the temporal information of the sequences in contrast to the more widespread use of recurrent networks that are usually employed for problems involving temporal information. We trained the network in two different settings employing different loss functions to train the network: the classical weighted cross-entropy, and the weighted Dice loss. We had access to a database comprising a total of 397 cases. Out of this dataset we used 98 cases as test set to validate our network performance. The final classification on the test set yielded a mean frame distance of 0 for the end-diastolic frame (i.e.: the selected frame was the correct one in all images of the test set) and 1.242 (relative frame distance of 0.036) for the end-systolic frame employing the optimum setting, which involved training the neural network with the Dice loss. Our neural network is capable of classifying each frame and enables the detection of the end-systolic and end-diastolic frames in short axis cine MRI sequences with high accuracy.

3D printing of all-regenerated cellulose material with truly 3D configuration: The critical role of cellulose microfiber

Direct ink writing, as a prospective three-dimensional (3D) printing technique, opens opportunities for offering high freedom to process cellulose into complex shapes. Current challenges are the accomplishment of dimensional accuracy of printed object and its truly 3D configuration, which put stringent requirements to the ink rheology that should be easily flowable under a suitable shear force while can rapidly recover to solid state after the force is removed. In this study, benefiting from the exquisite regulation of residual cellulose microfiber in a dissolved cellulose solution, a remarkable ink with excellent thixotropic property is prepared, which elaborately balance the traditional rheology tradeoff (extrudability and self-supporting) upon the formation of interconnected microfiber network. As a result, the optimized cellulose ink allows the printed object to successfully display arbitrary and truly 3D configurations, such as anatomical heart, ear, rabbit, lamp, and cup, and exhibit fine microstructure with a resolution of 250 μm.

5-Methoxytryptophan pretreatment alleviates lipopolysaccharide-induced cardiac injury and dysfunction

Reducing inflammation is a promising therapeutic approach for sepsis-induced cardiomyopathy (SIC). The 5-Methoxytryptophan (5-MTP) is a tryptophan metabolite that demonstrates anti-inflammatory, anti-fibrosis, anti-tumorigenesis, and anti-senescence features. Current investigations aimed to assess the 5-MTP pretreatment impacts on lipopolysaccharide (LPS)-induced cardiac injury and dysfunction. For in vivo studies, the mice were categorized randomly into four groups: control, LPS, LPS+5-MTP (25 mg/kg) and LPS+5-MTP (50 mg/kg). The mice in the LPS+5-MTP groups were given 5-MTP intraperitoneally once a day for 7 days. LPS (10 mg/kg) was then administered intraperitoneally for 24 h. Echocardiography, cardiac injury biomarkers, and H & E staining evaluated heart anatomy and function. The findings indicate that 5-MTP pretreatment significantly reduced LPS-induced heart dysfunction and morphological alterations. Western blot assay was used for investigating molecular mechanisms. After LPS stimulation, the pro-inflammatory cytokines (IL-1β, IL-6, TNF-α and NLRP3) protein levels increased while anti-inflammatory cytokine (IL-10) decreased; however, 5-MTP pretreatment mitigated this response by suppressing the stimulation of the NF-κB signaling pathway. Furthermore, 5-MTP administration reduced LPS-induced cardiac apoptosis, as demonstrated by increased protein levels of cleaved-Casepase-1, cleaved-Casepase-3 and Bax, and decreased protein level of Bcl-2 after LPS stimulation, whereas LPS-induced cardiac apoptosis was reversed by 5-MTP pretreatment. In vitro, 5-MTP pretreatment had a similar cardioprotective effect on cultured cardiac fibroblasts challenged with LPS. In conclusion, 5-MTP pretreatment can reduce LPS-induced cardiac inflammation and apoptosis, implying that 5-MTP is a possible therapeutic option for SIC.

Inversion of Left Atrial Appendage Will Cause Compressive Stresses in the Tissue: Simulation Study of Potential Therapy

In atrial fibrillation (AF), thromboembolic events can result from the particular conformation of the left atrial appendage (LAA) bearing increased clot formation and accumulation. Current therapies to reduce the risk of adverse events rely on surgical exclusion or percutaneous occlusion, each of which has drawbacks limiting application and efficacy. We sought to quantify the hemodynamic and structural loads of a novel potential procedure to partially invert the “dead” LAA space to eliminate the auricle apex where clots develop. A realistic left atrial geometry was first achieved from the heart anatomy of the Living Heart Human Model (LHHM) and then the left atrial appendage inversion (LAAI) was simulated by finite-element analysis. The LAAI procedure was simulated by pulling the elements at the LAA tip and prescribing a displacement motion along a predefined path. The deformed configuration was then used to develop a computational flow analysis of LAAI. Results demonstrated that the inverted LAA wall undergoes a change in the stress distribution from tensile to compressive in the inverted appendage, and this can lead to resorption of the LAA tissue as per a reduced stress/resorption relationship. Computational flow analyses highlighted a slightly nested low-flow velocity pattern for the inverted LAA with minimal differences from that of a model without inversion of the LAA apex. Our study revealed important insights into the biomechanics of LAAI and demonstrated the inversion of the stress field (from tensile to compressive), which &can ultimately lead the long-term resorption of the LAA.

Evaluation of echocardiography indicators of cows and calves with myocardial dystrophy

Echocardiography is the most informative non‐invasive method of heart disease diagnosis, which makes it possible to determine the structural and functional state of the heart through visualization using reflected ultrasound wave. The purpose of this study is to analyze echocardiograms of the cows and calves with myocardial dystrophy. The studies were carried out in of the Agricultural production cooperative “Gridino” (Russia, Kostroma region) on highly productive cows of the Kostroma breed 20 days after calving (3‐4 lactation) and 2‐month‐old calves obtained from these cows. Four experimental groups of animals were formed: group 1 ‐ clinically healthy cows (n=15), group 2 ‐ cows with symptoms of myocardial dystrophy (n=15), group 3 ‐ calves obtained from clinically healthy cows (n=15), group 4 ‐ calves obtained from cows with symptoms of myocardial dystrophy (n=15). An ultrasonic veterinary machine AcuVista VT98C with a convex scanning transducer with a frequency of 3.5 MHz was used to get the echocardiograms. Access points for the study were prepared according to the heart anatomy; echocardiography was performed in B‐ and M‐modes. The following indices were determined: left ventricular end‐diastolic size (LVd), right ventricular end‐diastolic size (RVd), left ventricular end‐systolic size (LVs), right ventricular end‐systolic size (RVs), thickness of the interventricular septum in diastole (VSd), thickness of left ventricular posterior wall in diastole (LVWd), left ventricular posterior wall thickness in systole (LVWs), left atrial diameter (LA), and aortic root diameter (AO).According to the results of echocardiography, cows with symptoms of myocardial dystrophy had RVs 16.0±1.15 mm, which was 16.79% higher than in clinically healthy cows. At the same time, calves obtained from sick mothers, had a higher value of RVs (11.3±0.65 mm) by 4.63% in comparison with calves from clinically healthy mothers. A lower LA was determined among sick cows and their calves by 13.29% (P<0.001) and 5.29%, respectively, compared with the indices of clinically healthy animals. Cows of both groups did not have significant differences in LVs: for clinically healthy animals, this indicator was 38.1±1.51 mm, for unhealthy ‐ 39.88±0.96 mm. Calves obtained from cows with signs of myocardial dystrophy showed LVs within 23.6±0.72 mm, which was 10.94% less (P<0.05) compared with calves from clinically healthy cows. The VSd index did not have significant differences in comparison for the corresponding groups. The indices of LVWd and LVWs did not differ significantly in the groups of cows. Calves obtained from unhealthy mothers had a tendency to lower values of LVWd and LVWs respectively, by 7.5% and 2.13% in comparison with young calves from clinically healthy cows. Among the cows with symptoms of myocardial dystrophy, the AO index was lower by 14.77% (P<0.001) compared with healthy animals and amounted to 50.2±1.23 mm. Among the calves of both groups, there was no significant difference in AO data.The revealed changes characterized the development of dystrophic processes in the myocardium and the initial stage of heart remodeling in high‐yielding cows in presence of high physiological stress. A similar tendency of the structural and functional myocardium disturbance was observed in calves obtained from cows with symptoms of myocardial dystrophy.

CE-542-04 EASY-WPW: A NOVEL ECG-ALGORITHM FOR EASY AND RELIABLE LOCALIZATION OF MANIFEST ACCESSORY PATHWAYS IN CHILDREN AND ADULTS

Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). 12-lead electrocardiogram (ECG) based delta wave analysis is essential for predicting ablation sites. Previous algorithms have shown to be complex, time-consuming and often unprecise because of variable anatomical heart axis especially in children. Our study aimed to retrospectively develop and prospectively validate a new, simple ECG-based algorithm considering the patients’ heart axis allowing an exact localization of APs in patients undergoing ablation for WPW. Our study included 109 patients undergoing ablation of a single manifest AP due to WPW between 2013 and 2021. For the exact determination of delta wave axis profound analyses of 12-lead ECGs were performed. The new algorithm (EASY WPW) includes a 2-step (left side) and 3-step-identification (right side) of the AP region, respectively. First we validated our algorithm comparing its efficacy to two established ones (Pambrun and Arruda). Then the new algorithm was tested also prospectively focusing on the accuracy of pathway region prediction. In all patients (29±18 years old, 45% female) pathway ablation was performed successfully. 12-lead ECG-based prediction of accurate AP localization using EASY-WPW was correct in 102 patients (94%) (sensitivity 93%, specificity 99%, PPV 97%, NPV 99%). Our algorithm was particularly useful in correctly localizing antero-septal/-lateral (sensitivity and specificity 100%) and posteroseptal (sensitivity 100%, specificity 91%) AP in proximity to the tricuspid valve. The accuracy (percentage of patients with an exact prediction of AP localization) of EASY-WPW was superior compared to the Pambrun (94% vs. 84%, p=0.049*) and the Arruda algorithm (94% vs. 75%, p<0.001*). A subgroup analysis of children (n=40, 11±4 years old, 45% female) revealed significant superiority to the Arruda algorithm (p=0.004*). Our novel 12-lead ECG-based algorithm enables reliable and accurate pre-interventional ablation site determination in WPW patients. Only two steps are necessary to locate left-sided AP and three steps to determine right-sided AP. This can be done with the help of a simple flow chart or, in the future, with the help of an app.

Syntopy of Pulmonary Vein Orifices in the Left Atrium of the Human Heart

INTRODUCTION: The syntopy of the left atrial (LA) structures is the least studied aspect of the normal heart anatomy. The morphometric data on the position of orifices of the pulmonary veins in the LA walls relative to the adjacent heart structures and heart vessels are important as reference parameters of heart morphology and are needed in the endovascular treatment of atrial fibrillations.&#x0D; AIM: To establish the general patterns and topospecific peculiarities of the location of the pulmonary vein orifices relative to the oval fossa and orifices of the venae cavae using morphometric methods of anatomical preparations of conventionally normal adult human heart.&#x0D; MATERIALS AND METHODS: Fiftyfour wet anatomical preparations of the heart without macroscopic signs of hemodynamically significant cardiac pathology were studied. The preparations were obtained from patients aged 3589 years who died from diseases not related to heart pathology. LA diastole was modeled by filling its cavity with silicone; after it hardened, the distances from the oval fossa and orifices of the venae cavae to the orifices of the pulmonary veins were measured using sliding calipers.&#x0D; RESULTS: The article presents variation, medians, and extreme values of distances from the oval fossa and orifices of the venae cavae to the orifices of the pulmonary veins at the site of their opening to LA. The significance of differences of morphometric parameters of the topography was evaluated, and their correlation and oneway regression analyses were implemented. The strongest regression dependence was found for LA width and distance from the orifice of the superior vena cava to the orifice of the left inferior pulmonary vein (Y) r2 = 0.45; Х = 19.94 + 0.545Y). The heart dimensions and LA length were not significant predictors for the studied parameters.&#x0D; CONCLUSION: The right pulmonary veins were located expectedly closer to the orifices of the venae cavae and the oval fossa than the left pulmonary veins. The narrowest was the space between the orifices of the superior vena cava and the right superior pulmonary vein. The farthest from the orifices of both venae cavae was the orifice of the left inferior pulmonary artery. The strongest correlation relationships were characteristic of the distances from the orifices of both venae cavae to the orifices of the homolateral pulmonary veins, which we propose to consider as one of the criteria of the harmoniousness of the structure of the atrial complex.

Stereogram of the Living Heart, Lung, and Adjacent Structures.

Innovations in invasive cardiovascular diagnostics and therapeutics, not only limited to transcatheter approaches but also involving surgical approaches, are based on a precise appreciation of the three-dimensional living heart anatomy. Rapid advancements in three-dimensional cardiovascular imaging technologies in the 21st century have supported such innovations through the periprocedural assessment of the clinical anatomy of the living heart. However, even if high-resolution volume-rendered images are reconstructed, they cannot provide appropriate depth perception when displayed and shared on a two-dimensional display, which is widely used in clinical settings. Currently, images reconstructed from clinical datasets can visualize fine details of the cardiovascular anatomy. Therefore, this is an optimal time for cardiologists and cardiac surgeons to revisit the classic technology, stereopsis, and obtain bonus information from carefully reconstructed clinical images. Using anaglyphs or cross/uncross-fusion of paired images, striking depth perception can be readily obtained without the need for expensive equipment. This conventional technique, when applied to high-resolution volume-rendered images, may help in obtaining appropriate diagnostics, choosing optimal therapeutics, securing procedural success, and preventing complications. Furthermore, it can be used for anatomical education. In this review, we demonstrate multiple stereoscopic images reconstructed from cardiac computed tomographic datasets and discuss their clinical and educational implications.

Gross anatomic relationship between the human left atrial appendage and the left ventricular summit region: implications for catheter ablation of ventricular arrhythmias originating from the left ventricular summit.

The left ventricular summit (LVS) is a source of difficult-to-treat arrhythmias because of anatomical limitations. The aim of this study was to perform detailed research of the left atrial appendage (LAA) anatomy of cadaveric hearts to analyze their complex anatomy and coverage of the LVS. Eighty human formalin fixed hearts (mean age 44.4 ± 15.5, 27.5% females) were investigated. Each LAA size, type, and its relationship to the LVS were analyzed, as well as possible access sites for mapping/ablating electrode. Four types of LAA were observed over two LVS sites that are either accessible or not. The highest coverage over an inaccessible LVS area was observed in the Broccoli type, followed by the Windsock then the Chicken Wing and finally the Cactus types; over the accessible area of the LVS was observed in the Windsock, then in the Chicken Wing, then in the Cactus, and finally in the Broccoli types. The attainable coverage for electrode access is diminished from 25 to 65% because of the complex pectinate muscles and sharp angles. The highest density of the LAA floor made by pectinate muscles can be found in the Broccoli type (p < 0.005), while the Chicken Wing had the highest number of paper-thin-like pouches. The LAA appears to be a promising entry for ablation-qualified patients with the LV summit originate arrhythmias. The complex internal structure of the LAA may complicate ablation procedures. More prominent appendages are promising in more extensive mapping areas over the LVS.

Computational Methods for Fluid-Structure Interaction Simulation of Heart Valves in Patient-Specific Left Heart Anatomies

Given the complexity of human left heart anatomy and valvular structures, the fluid–structure interaction (FSI) simulation of native and prosthetic valves poses a significant challenge for numerical methods. In this review, recent numerical advancements for both fluid and structural solvers for heart valves in patient-specific left hearts are systematically considered, emphasizing the numerical treatments of blood flow and valve surfaces, which are the most critical aspects for accurate simulations. Numerical methods for hemodynamics are considered under both the continuum and discrete (particle) approaches. The numerical treatments for the structural dynamics of aortic/mitral valves and FSI coupling methods between the solid Ωs and fluid domain Ωf are also reviewed. Future work toward more advanced patient-specific simulations is also discussed, including the fusion of high-fidelity simulation within vivo measurements and physics-based digital twining based on data analytics and machine learning techniques.

The surgical anatomy of hearts with isomeric atrial appendages-implications for surgical management.

The most severe combinations of cardiac malformations exist in individuals having jumbled-up thoracic and abdominal organs. These patients make up 2 distinct syndromes. As yet, the consensus is lacking on how best to describe the subsets. The subsets are frequently grouped together in terms of 'heterotaxy'. The surgical approaches to the subsets, however, are markedly different. We reviewed our experiences with regard to the anatomy as observed in the autopsy room, by the analysis of computed tomographic studies, and in the operating room, to assess whether the lesions might be segregated on the basis of isomerism of the atrial appendages. A review of our findings from the examination of specimens from several archives, along with investigation of a large cohort of patients being prepared for surgical treatment, showed that individuals can uniformly be segregated into subgroups on the basis of isomeric arrangement of the atrial appendages. In all instances, this was made possible by using the criterion of the extent of the pectinate muscles within the appendages as judged relative to the atrial vestibules. Segregation on this basis, which correlated excellently with the bronchial arrangement, sets the scene for an appropriate description of the remainder of the heart, providing the cardiac surgeon with all the inferences required for appropriate surgical intervention. When assessing individuals having the features of so-called 'heterotaxy', it is possible to segregate the groups into subsets of individuals having either isomeric right or left atrial appendages. This approach provides the framework for the assessment of appropriate surgical management.

Eliciting critical hope in community-based HIV research with transgender women in Toronto, Canada: methodological insights.

SummaryCritical hope centres optimism and possibilities for change in the midst of struggles for social justice. It was a central tenet of early participatory pedagogy and HIV research. However, critical hope has been overlooked in contemporary HIV research that largely focuses on risk and biomedical interventions in ways that obscure collective agency and community strengths. We conducted a community-based study with transgender (trans) women of colour in Toronto, Canada to adapt an evidence-based HIV prevention intervention. Participants resisted a focus on HIV, instead calling researchers to centre journeys to self-love in contexts of social exclusion. In response, we piloted three arts-based, participatory methods generated with community collaborators: (i) affirmation cards sharing supportive messages with other trans women, (ii) hand-held mirrors for reflecting and sharing messages of self-acceptance and (iii) anatomical heart images to visualize coping strategies. Participants generated solidarity and community through shared stories of self-acceptance within contexts of pain, exclusion and loss. Narratives revealed locating agency and self-acceptance through community connectedness. Critical hope was a by-product of this participatory process, whereby participants shared personal and collective optimism. Participatory and arts-based methods that centre self-acceptance and solidarity can nurture resistance to pathologizing discourses in HIV research. Centring critical hope and participant-generated methodologies is a promising approach to transformative health promotion and intervention research. These methodological insights can be engaged in future participatory work with other marginalized groups facing dominant biomedical risk discourses. Critical hope holds potential as a participatory health promotion strategy for envisioning possibilities for sustainable change.

Lyotropic Liquid Crystals: A Biocompatible and Safe Material for Local Cardiac Application.

The regeneration of cardiac tissue is a multidisciplinary research field aiming to improve the health condition of the post-heart attack patient. Indeed, myocardial tissue has a poor ability to self-regenerate after severe damage. The scientific efforts focused on the research of a biomaterial able to adapt to heart tissue, thus guaranteeing the in situ release of active substances or growth promoters. Many types of hydrogels were proposed for this purpose, showing several limitations. The aim of this study was to suggest a new usage for glyceryl monooleate-based lyotropic liquid crystals (LLCs) as a biocompatible and inert material for a myocardial application. The main advantages of LLCs are mainly related to their easy in situ injection as lamellar phase and their instant in situ transition in the cubic phase. In vivo studies proved the biocompatibility and the inertia of LLCs after their application on the myocardial tissue of mice. In detail, the cardiac activity was monitored through 28 days, and no significant alterations were recorded in the heart anatomy and functionality. Moreover, gross anatomy showed the ability of LLCs to be bio-degraded in a suitable time frame. Overall, these results permitted us to suppose a potential use of LLCs as materials for cardiac drug delivery.

Use of the Apple Watch iECG in adult congenital heart disease patients

IntroductionThis study evaluates the accuracy of iECGs in comparison to the gold standard ECG in adult patients with congenital heart disease and recommends the appropriate iECG derivation based on the patient's characteristics. MethodsIn 106 adults (51 female, 55 male) with congenital heart disease, a gold standard 12-lead ECG was recorded, followed by three iECGs with the Apple Watch series 4, which correspond to Einthoven leads I, II, and III. Two experienced and independent cardiologists analyzed the time intervals, amplitudes, and polarities of the ECG parameters as well as the rhythm type and correlated the patient characteristics with the iECG parameters. ResultsThe iECG parameters of all three iECG leads correlate strongly with those of the gold standard ECG, with exception of the P and T wave durations. We demonstrated that the informative value of the individual iECGs was independent of the patient's characteristics, in particular the heart axis, anatomy, and situs, even if the quality of the Einthoven III-like derivation was partially inadequate. The automatic rhythm analysis of the Apple Watch and the heart rhythm classification of a standard ECG analyzed manually by a cardiologist corresponded in 77%. ConclusioniECG recordings of adults with congenital heart disease provide comparable results with Einthoven recordings I, II, and III of the 12-lead ECG and current data encourage the use of the Apple Watch not only in patients with structurally normal hearts but also in patients with congenital heart disease.