Lateral Wall Research Articles

Magneto-convection ?ow of Nano-encapsulated phase change material (NEPCM) confined within a trapezoidal porous enclosure

This research attempts to study the thermal activity of suspension consisting of water and NEPCM elements inside a cavity with a trapezoidal cross-section. In addition, the cavity center contains a cold circular object rotating at a constant speed. The cavity is thermally characterized by the following: the upper and lower walls are thermally insulated (adiabatic), while the two lateral walls have a high temperature. The purpose of this study is to find out how the suspension interferes with the transfer of heat from hot walls to the cold body through the intervention of some initial conditions, which are: The effects of rotating cylinder speed (Re = 1 -500), medium permeability (Da = 10-5 – 10-2) and the magnetic field strength (Ha= 0 -100). The study used a digital simulation by solving the differential equations related to fluid mechanics and heat transfer using the Galerkin finite element (GFEM) method.to understand the influences of studied parameters (Re, Da and Ha numbers), the contours of isotherms, heat capacity and pathlines are presented in terms of these parameters. The findings indicated that as the rotation speed of the obstacle increased, the forced convection became dominant, and the thermal transmission rate improved. The improvement of the thermal transfer rate was also observed for higher Da numbers. Increasing the strength of the magnetic field hiders the fluid motion and reduces the thermal activity. At the highest studied Re, increasing Da from 10-5 to 10-2 augmented the Nusselt number by 10 times, while augmenting Ha from 0 to 100 reduced the Nu by 46%.

A Computational Model Reveals How Varying Muscle Activation in the Lateral Pharyngeal Wall and Soft Palate Differentiates Velopharyngeal Closure Patterns.

Finite element (FE) models have emerged as a powerful method to study biomechanical complexities of velopharyngeal (VP) function. However, existing models have overlooked the active contributions of the lateral pharyngeal wall (LPW) in VP closure. This study aimed to develop and validate a more comprehensive FE model of VP closure to include the superior pharyngeal constrictor (SPC) muscle within the LPW as an active component of VP closure. The geometry of the velum and the lateral and posterior pharyngeal walls with biomechanical activation governed by the levator veli palatini (LVP) and SPC muscles were incorporated into an FE model of VP closure. Differing muscle activations were employed to identify the impact of anatomic contributions from the SPC muscle, LVP muscle, and/or velum for achieving VP closure. The model was validated against normative magnetic resonance imaging data at rest and during speech production. A highly accurate and validated biomechanical model of VP function was developed. Differing combinations and activation of muscles within the LPW and velum provided insight into the relationship between muscle activation and closure patterns, with objective quantification of anatomic change necessary to achieve VP closure. This model is the first to include the anatomic properties and active contributions of the LPW and SPC muscle for achieving VP closure. Now validated, this method can be utilized to build robust, comprehensive models to understand VP dysfunction. This represents an important advancement in patient-specific modeling of VP function and provides a foundation to support development of computational tools to meet clinical demand.

Choice of hernioplasty method based on the degree of intra-abdominal hypertension

Aim. To study the variability of intra-abdominal pressure and the choice of hernioplasty method for large and giant abdominal hernias.Material and Methods. This study analyzed the outcomes of various hernial orifice repair methods in 134 patients with large and giant hernias of the anterior and lateral abdominal walls. The majority of cases involved incisional hernias (n=52), while 47 patients presented with recurrent hernias, and 35 cases involved primary hernias. In 84.3% of cases, the hernias were localized in the anterior abdominal wall, and concomitant comorbidities were identified in 82 patients. Preoperative evaluations included clinical examination, imaging studies, and assessment of intra-abdominal pressure. Research results. In 31 (29.2%) observations, hernia repair was performed using the inlay method due to high intra-abdominal pressure. Anterior and posterior component separation with prosthetic reinforcement using the sub lay technique was carried out in 21 patients (7.5%). Additionally, the placement of a mesh prosthesis using the on lay method was performed in 54 patients (20.7%). The overall mortality rate was 2.2% (n=3), while 11 patients experienced recurrence in the late postoperative period, resulting in a recurrence rate of 8.2%.Conclusion. The increasing frequency of abdominal and retroperitoneal surgeries has led to a rise in the incidence of abdominal hernias. Traditional hernia repair techniques continue to evolve, and new, minimally invasive approaches are being developed to enhance patient outcomes. Despite ongoing advancements in surgical techniques for large and giant abdominal hernias, several challenges remain unresolved, necessitating further research and innovation in this field.

Verification of intra- and inter-atrial conduction during Bachmann's bundle pacing using longitudinal bi-atrial strain

Abstract Introduction Although atrial septal pacing has been reported to reduce atrial fibrillation (AF) burden, there is less evidence regarding its effect on the prevention of permanent AF and the improvement of long-term clinical outcomes. However, Bachmann's bundle pacing (BBp), which features P-wave morphology similar to sinus rhythm and shortened P-wave duration (PWD), was reported to significantly reduce permanent AF recurrences and occurrences compared with right atrial appendage pacing (RAAp) and non-specific right septal pacing. Purpose Possible mechanisms for AF suppression with BBp are that fast inter-atrial conduction through BB decreases global atrial activation time and the dispersion of the overall atrial refractoriness, and it prevents the decrease in left ventricular filling and increase in left atrial pressure associated with delayed left atrial contraction. Intra-and inter-atrial conduction during BBp was evaluated using longitudinal bi-atrial strain. Methods In patients with successful BBp implantation defined by electrocardiographic criteria using SelectSecure pacing lead and C315 delivery catheter (Medtronic, Inc), both left atrium (LA) and right atrium (RA) global longitudinal strain (GLS) in simultaneous phases were measured using Philips Ultrasound Workspace 2D Strain in apical 4-chamber view during atrial pacing to assess intra- and inter-atrial conduction delay. The atrial GLS were measured semi-automatically, and the strain rate was analyzed in the three segments of septal wall, lateral wall, and roof and their average. The negative peak of strain rate during atrial systole was the starting point of atrial contraction, and time to peak (TTP) was measured. The difference in TTP between septal and lateral walls in each atrium was measured as intra-atrial conduction delay and the difference in average TTP between LA and RA as inter-atrial conduction delay. Results Ten patients who underwent successful BBp were enrolled (Sick sinus syndrome: 3, advanced atrioventricular block: 2, complete atrioventricular block: 5). At implantation, bipolar atrial electrogram amplitude was 2.03±0.93 mV, atrial lead impedance was 632.7±157.6 Ω, and atrial pacing threshold was 0.7±0.2 V at 0.4 ms. The PWD during sinus rhythm on the 12-lead ECG was 132.8±10.6 ms, while during BBp it was 108.0±11.9 ms, which was significantly shorter in the BBp group (p<0.001). The intra-atrial conduction delay in RA and LA was 10.9 ± 12.1 ms and 12.1 ± 17.3 ms, respectively, and the inter-atrial conduction delay was 6.6 ± 8.6 ms. On the other hand, for the 10 RAAp and 10 sinus rhythm patients as control groups, the inter-atrial conduction delay was 29.7±13.8 ms and 8.5±9.5 ms, respectively. BBp had significantly less inter-atrial conduction delay than RAAp (p=0.005) and was comparable to sinus rhythm (p=0.719). Conclusion Longitudinal bi-atrial strain suggested that BBp significantly reduced inter-atrial delay and it might be effective in AF suppression.Longitudinal bi-atrial strain

Plasma knife sphenopalatine artery cauterization via lateral nasal wall incision for posterior epistaxis

Background Endoscopic sphenopalatine artery cauterization (ESPAC) has become an important method to manage posterior epistaxis. Aims/Objectives To investigate the application of plasma knife and lateral nasal wall incision in ESPAC in the treatment of posterior epistaxis. Material and methods A retrospective study of 32 cases who underwent ESPAC for epistaxis was conducted. A vertical incision was made on the lateral nasal well to expose the sphenopalatine artery (SPA). The main branches of SPA were cauterized with a plasma knife or bipolar coagulation forceps. Cases were divided into plasma knife group (group PK) and bipolar group (group BP). The re-bleeding rates, operation time and the incidence of serious complication were compared between the two groups. Results ESPAC was successfully completed via a lateral nasal wall incision without maxillary antrostomy in all cases. All the patients were followed-up for 3 months, no serious complication was reported. There was no significant difference in re-bleeding rates and incidence of serious complication between the two groups. The operation time of group PK was shorter than group BP. Conclusions and significance Lateral nasal well incision without maxillary antrostomy is feasible for ESPAC. The application of a plasma knife may help to shorten the operation time.

The investigation of ultrasound to assess lateral abdominal wall activation with different types of core exercises

BackgroundCore training is the foundation of physical exercise. The activation of the lateral abdominal wall (LAW) muscles in the core muscles, particularly the transversus abdominal (TrA) muscles, has a stabilizing effect on the chest and abdomen. Therefore, we need to focus on the training effect of the TrA. There are many ways to measure the LAW. Ultrasound can assess the effect of training in real time and intuitively. Therefore, we intend to evaluate the activation of the LAW in different types of core training using ultrasound, to determine the best movements that can activate the TrA and train the core muscles.Methods22 healthy subjects (male 10, female 12, age 22.82 ± 0.98, BMI 20.78 ± 2.27) were included. The subjects were given the following instructions to perform breathing exercises at different positions: calm breathing and deep breathing at 0° hip flexion and 0° knee flexion; calm breathing, deep breathing, abdominal crunches and ball crunches at 45° hip flexion and 90° knee flexion; and calm breathing, deep breathing, abdominal crunches and ball crunches at 90° hip flexion and 90° knee flexion. The muscle thicknesses of the bilateral transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and LAW muscles were measured using ultrasonography at the end of expiration during the above movements.Results(1) The action with the greatest contraction ratio of the TrA was deep exhalation, which was significantly greater than crunch and ball crunch; (2) During deep exhalation, the TrA had the greatest contraction ratio, significantly greater than the IO and EO. (3) The TrA was thinnest during deep exhalation at 90°, followed by 45° and 0°.ConclusionIn healthy young people, deep expiration with 90° hip flexion and 90° knee flexion was the optimal action for activating the LAW, especially the TrA.

Hemodynamic effects of right and biventricular pacing during exercise in hypertrophic obstructive cardiomyopathy

Abstract Background One third of patients with hypertrophic cardiomyopathy present with dynamic left ventricular outflow tract obstruction (LVOTO), referred to as hypertrophic obstructive cardiomyopathy (HOCM). Symptomatic treatment aims at reducing LVOTO with either medications, invasive septal reduction, or pacing. The importance of pacing site is unclear, and effects of pacing during physical activity have not been investigated. Purpose To determine the effect of right ventricular (RV) and biventricular (BiV) pacing, respectively, on LVOTO and cardiac output (CO) during exercise in patients with HOCM. Methods Patients with symptomatic HOCM, sinus rhythm, and no bundle branch block, scheduled for alcohol septal ablation (ASA), were eligible for inclusion. The day before ASA, we placed temporary pacing leads in the right atrium, the RV apex, and on the left ventricle’s lateral wall via the coronary sinus. LVOTO was assessed by echocardiography, and CO was measured by thermodilution with a pulmonary artery catheter. Patients performed supine cycling for 2 minutes until heart rate (HR) increased ≥20 bpm. We measured LVOTO and CO in sinus rhythm, and during cycling with atrial sensed RV pacing, and atrial sensed BiV pacing. The order of pacing sites was randomized, and the personnel performing echocardiography and CO measurements were blinded to the order of pacing. Results We included six patients (54±15 years) with a mean maximal left ventricular wall thickness of 16.7±1.8 mm. Resting LVOTO was 55.7±30.9 mmHg. The figures show LVOTO and CO in sinus rhythm (HR 85±10 bpm), RV pacing (HR 90±10 bpm), and BiV pacing (HR 91±9 bpm) during supine cycling. The LVOTO declined from 56±34 mmHg in sinus rhythm to 27±12 mmHg and 25±5 mmHg respectively for atrial sensed RV and BiV pacing. CO remained unchanged during sinus rhythm (9.0±1.2 L/min), atrial sensed RV pacing (9.0±1.7 L/min), and BiV pacing (8.9±1.5 L/min). Conclusion In this ongoing study evaluating cardiac pacing in HOCM, preliminary data indicate that both RV and BiV pacing are effective in reducing LVOTO during exercise, without compromising CO.

Differences in left ventricular contraction in left bundle branch block with preserved and reduced ejection fraction: an evaluation using 2-dimensional speckle tracking echocardiography

Abstract Background Left ventricular (LV) contraction in left bundle branch block (LBBB) is characterized by early septal contraction and delayed contraction of the lateral wall, but the process may differ depending on myocardial contractility in addition to the degree of conduction block. Purpose This study aimed to evaluate LV contraction in patients with LBBB by analysis of longitudinal strain (LS) and to compare it between patients with preserved LV ejection fraction (pEF: EF>50%) and reduced LV EF (rEF: EF<40%). Methods We studied 87 patients with LBBB. Fifty had pEF (EF 59±7%) with a mean QRS duration of 144±12ms, and 38 had rEF (EF: 29±4%) with a mean QRS duration of 147±12ms (p=0.32 vs. pEF). We also studied 43 patients without conduction block (Narrow-QRS; pEF, n=23; rEF, n=20). Patients with a heart rate less than 60 or greater than 80 beats/min during echocardiography or with a history of myocardial infarction were excluded. Three standard apical images were recorded, and the LS of one heartbeat starting at the beginning of the QRS was evaluated in 18 LV segments. When the strain waveform showed a negative peak during the pre-ejection period, it was identified as early systolic contraction (ESC), and the first negative peak that appeared after aortic valve opening (AVO) was identified as late systolic contraction (LSC). The time from the beginning of QRS to the peak of the LSC (Q-Peak) and the strain value at the end of the QRS were measured in each segment. Results In patients with LBBB, the septum contracted early, and ESC was seen mainly in the early contracted area. The lateral wall contraction was delayed, and the difference between the maximum and minimum Q-Peak was greater than the Narrow-QRS in the same EF category. Patients with rEF and LBBB had a larger number of segments with ESC and a smaller minimum Q-Peak than those with pEF. The difference between the maximum and minimum Q-Peak was greater for patients with rEF than for patients with pEF. Conclusions Although patients with LBBB had significant dyssynchrony due to conduction block even those with pEF, LV contractile properties were altered in patients with rEF and associated with further increased dyssynchrony.

Predictive value of total atrial conduction time for developing cerebrovascular stroke in patients with sinus rhythm and normal left ventricular systolic function, a case-control study

Abstract Background Stroke is the second leading cause of death worldwide. Recently, atrial cardiopathy has become recognized as a substantial risk factor for cerebrovascular stroke. Greater LA size is linked to stroke in AF patients, but few data linking LA size to stroke in population with sinus rhythm. Purpose To investigate the value of total atrial conduction time (TACT) measured non-invasively by assessing PA-TDI duration as a predictor of stroke in patients who initially presented with sinus rhythm and have normal LV systolic function. Methods In our case-control study, we included 156 patients with acute ischemic stroke and 50 control subjects all presented in sinus rhythm and normal LV systolic function. All participants underwent echocardiography. The bi-plane modified Simpson's approach was used to determine the LV-EF. The left atrial (LA) diameter was measured also left atrial volume index (LAVI) was assessed. The PA-TDI interval was used to estimate the TACT. In the apical four-chamber view, the pulsed-wave tissue Doppler sample was positioned on the lateral and septal walls of the LA above the mitral annulus. The time between the onset of the P wave (lead II) and the peak of the A' wave was called the PA-TDI interval. Also, speckle tracking indices of LA strain were measured. Results LA volume index was larger in the stroke group (39.24±4 versus 33.6±2.8, p: 0.01), PA-TDI duration showed statistical highly significant difference between both groups (165.94±21.695 versus 99.4±22.960, p: <0.001). There were significantly impaired LAS parameters in the stroke group (LA reservoir, contraction & conduit strain, 22.7%, -6.6% & -16.1% versus 40%, -12%, and − 27% in the control group with P < 0.000). ROC curve showed the best cutoff point for LA volume index is >42.2 ml/m2 for prediction of stroke with area under the curve (AUC): 0.7, p value is 0.005. ROC curve showed the best cutoff point for PA-TDI is >155.5 ms. with AUC: 0.9, 90% sensitivity, 91% specificity, p value: <0.001. ROC curve showed that LA reservoir strain and LA stiffness can independently predict stroke at cut-off values of 30% & 24.5% respectively, P < 0.001. Multivariate logistic regression analysis showed that hypertension, LA volume index, LA stiffness and PA-TDI duration are independent predictors of stroke (p: < 0.05, < 0.05, < 0.01 and < 0.001 respectively). Conclusions The assessment of electromechanical asynchrony by measuring the PA-TDI duration may help to predict patients at risk for stroke. It is easy to measure without the need for special software like speckle tracking indices. We also advise patients who exceed the cutoff points of LA volume index and PA-TDI duration to receive antithrombotic therapy for better stroke prevention. Also we recommend adding PA-TDI to CHA2DS2-VASC-HSF score to assess stroke risk in patients with sinus rhythm and paroxysmal AF during their sinus rhythm intervals.

Heparin does not improve myocardial glucose metabolism suppression in patients with low betahydroxybutyrate level

Abstract Background/introduction Inadequate myocardial glucose metabolism suppression (GMS) can hamper diagnostic PET/CT imaging with [18F]FDG. β-hydroxybutyrate level (BHB) measurement prior to [18F]FDG injection is a newly proposed method of pre-evaluation of adequate GMS. However, more knowledge is needed, if BHB can be used to guide the preparation protocol (diet, fasting or premedication). Purpose The aim of our study was to evaluate if point-of-care measured BHB can be used to guide use of heparin premedication for cardiac [18F]FDG-PET/CT. Methods 139 patients [78 male, median age 58 (19-78) years] with clinical indication for cardiac [18F]FDG PET/CT were recruited. All patients had followed a high fat, low carbohydrate diet for one day and fasted for at least twelve hours. For the first 64 patients, BHB was measured, but it was not used to guide premedication. For the next 75 patients, iv. heparin 50 IU/kg was injected 15-20 minutes before FDG injection, if BHB was low (less than 0.35 mmol/l), whereas those with high BHB (more than 0.35 mmol/l) continued without heparin. [18F]FDG uptake pattern was evaluated visually using grades "no uptake", "focal uptake", "isolated lateral wall uptake", "basal ring", "diffuse uptake" and "focal on diffuse". "No uptake" and "focal uptake" were considered as adequate GMS. Statistical significance of the difference in uptake patterns was evaluated using the Pearson’s chi-square test. Results Median BHB was 0.4 (0.1-5.8) mmol/l. Half of the patients (76, 55 %) reached BHB higher than 0.35 mmol/l. Still, 102 patients (74 %) had adequate GMS. In high BHB group, 65 patients (86 %) had adequate GMS, whereas of those with low BHB, only 37 patients (59 %) had adequate GMS (p<0.001). In low BHB group prevalence of inadequate GMS was comparable in patients with and without heparin (42 % vs. 41 %, p=0.941) Results for the whole scale of visual distribution patterns can be seen in figure 1. Conclusion(s) Patients with high BHB have a high percentage of adequate GMS, whereas in patients with low BHB the probability of adequate GMS is significantly lower. Unfractionated heparin does not seem to improve myocardial GMS in patients with low BHB. Thus, high BHB should be pursued, and a longer diet might be needed for those with low initial BHB.

Automatic measurement of stimulation to maximum negative dv/dt in V5 and V6 leads to confirm left bundle capture for conduction system pacing

Abstract Introduction Left bundle area conduction system pacing is obtained when the ventricular pacing lead is implanted into the right ventricular septum and captures the left bundle branch, demonstrated by right bundle branch morphology in the lead V1 and short stimulation to R-wave peak time (SRWPT) in leads V5 or V6. Manual measurements are challenging and result in significant variability. Maximum negative dv/dt in leads V5 and V6, occurring immediate after maximal lateral wall depolarization, represents the ideal measurement of synchronicity of left ventricular depolarization, as suggested by the guidelines. Objective To test feasibility of automatic algorithm to measure the maximum negative dV/dt in comparison to manual SRWPT measurement in V5 and V6. Method Data was collected from 7 patients with confirmed left bundle branch capture. Three trained operators manually measured SRWPT in leads V5 and V6 (Figure A). An algorithm capable of automatically measuring stimulation to maximum dv/dt was retrospectively applied to the same measured beats. Variability and correlation of measurements was compared between manual and automatic using the Bartlett Test for equal variance. Results In total, 137 individual beats were measured in the 2 leads by three operators resulting in 822 manual measurements. The mean variability of SRWPT in V5 and V6 was 2.9 ± 0.7 msec and 3.1 ± 1.1 msec, respectively (inter-operator correlation of 0.83). In contrast the stimulation to max negative dv/ dt mean variability in V5 and V6 was 1.3 ± 0.4 msec and 1.2 ± 0.5 msec, respectively (P < 0.001). The comparison of variation in measurement between manual and automatic measures are shown in a box and whisker plot in figure 2. Conclusion Manual measurement of SRWPT can be challenging resulting in higher variability compared to an automatic algorithm measuring max negative dv/dt. This study demonstrates the feasibility of automatic interval measurement in conduction system pacing; however, further studies are required to validate the reliability of such tool.Fig 1.Example ECG interval measurement

Left atrial function and long-term survival after cardiac resynchronization therapy

Abstract Background Left atrial (LA) reservoir strain after CRT has been linked to long-term outcome, but the role of LA function in response to cardiac resynchronization therapy (CRT) is incompletely understood. LA dyssynchrony during left bundle branch block has negative effects on LA function beyond LA reservoir strain. We hypothesized that correction of LA dyssynchrony after CRT has added value to LA reservoir strain as a marker of long-term outcome. Purpose To explore the role of LA function in long-term survival after CRT. Methods In a recent prospective multicenter study of 168 patients, LA segmental and global strains were measured by speckle-tracking echocardiography before and 7 ± 1 months after CRT. LA reservoir strain was measured as the difference between peak and minimum global strain during the atrial cycle and LA dyssynchrony as the time delay between onset systolic stretch of the interatrial septum and LA lateral wall. Since LA reservoir strain < 18% is associated with elevated LV filling pressure, we used 18% as cutoff and for LA dyssynchrony 43 ms (mean after CRT in the present study). All-cause mortality was used as clinical endpoint during follow-up. Results After 6 years ± 21 months (mean ± SD) follow-up, 35 (21%) patients died. LA reservoir strain was significantly lower (15 ± 9% vs 20 ± 10%, p = 0.003) and LA dyssynchrony numerically higher (61 ± 68 ms vs 39 ± 69 ms, p = 0.099) in patients who died compared to survivors. LA reservoir strain ≥ 18% after CRT was associated with favorable long-term survival (HR: 0.51, 95% CI: 0.26 - 0.98) (upper panel in the Figure). LA dyssynchrony was not independently associated with mortality. However, when used in concert with LA reservoir strain ≥ 18% after CRT, it identified patients with perticularly excellent long-term survival (HR: 0.17, 95% CI: 0.05 - 0.58 vs patients with reservoir strain ≥ 18% and persistent LA dyssynchrony) (lower panel in the Figure). Patients with preserved LA reservoir strain but persistent LA dyssynchrony had similar outcome as patients with reduced LA reservoir strain (HR: 0.98, 95% CI: 0.45 - 2.12). Conclusion LA reservoir strain ≥ 18% and absence of LA dyssynchrony is associated with excellent long-term survival after CRT.LA strain after CRT and survival

Long-term prognostic value of multiple circulating biomarkers for ventricular arrhythmias in patients with left ventricular hypertrabeculation

Abstract Background Left ventricular hypertrabeculation (LVHT) is a rare morphologic phenotype of the heart with heterogeneous manifestations and variable prognosis [1,2]. Ventricular arrhythmia (VA) has been recognized as an independent risk factor that significantly impacts the mortality of LVHT patients [1,3]. However, knowledge regarding the prognosis and risk stratification of VAs in LVHT is currently limited. Purpose To explore the long-term predictive value of multiple circulating biomarkers reflecting cardiac function, endothelial function, inflammation, and oxidative stress for the development of VAs in LVHT patients. Methods This longitudinal cohort study consecutively enrolled morphologically diagnosed LVHT patients between January 2012 and December 2020 at a national-level medical center. All participants possessed thorough profiles of multiple biomarkers [N-terminal pro-brain natriuretic peptide, big endothelin-1 (big ET-1), high-sensitivity C-reactive protein, uric acid and free fatty acid] and had no previously documented ventricular arrhythmic events. The cohort were followed annually until October 2022. VA was defined as a composite of non-sustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, and appropriate therapy of implantable cardioverter defibrillator. Potential predictors for VAs in the LVHT cohort were evaluated by multivariable Cox regression. Restricted cubic spline (RCS) analysis was employed to explore the nonlinear association between plasma big ET-1 and clinical outcomes. Differences in the cumulative incidence of VAs according to big ET-1 levels and/or the extent of hypertrabeculation were analyzed by Kaplan-Meier curves. Results A total of 265 morphologically diagnosed LVHT patients (44.2 ± 17.0 years, 65.7% male) were included in this study. Over a median follow-up of 4.34 years, 82 (30.9%) patients experienced ventricular arrhythmic events. Multivariable Cox regression analysis identified that baseline levels of big ET-1 (hazard ratio 1.513, 95% confidence interval 1.136-2.013) and isolated hypertrabeculation in left ventricular lateral wall (LVLW) (hazard ratio 1.810, 95% confidence interval 1.023-3.202) were independently associated with the occurrence of VAs. RCS analysis illustrated that the susceptibility to VAs was remarkably raised with the increase of big ET-1 levels. LVHT patients with higher plasma big ET-1 suffered from more severe cardiac dysfunction and remodeling. Individuals who displayed elevated concentrations of big ET-1 and isolated LVLW hypertrabeculation were at a significantly greater risk of developing VAs. Conclusions Introducing routine assessments for plasma big ET-1 and the extent of hypertrabeculation at baseline can offer valuable support in the risk stratification and clinical management of ventricular arrhythmic events in patients with LVHT.Prognositc value of big ET-1 for VAsbig ET-1/LVLW hypertrabeculation & VAs

Atrial pace mapping with automatic intracardiac pattern matching for non-pulmonary vein trigger ablation: accuracy and feasibility

Abstract Atrial pace mapping (APM) is an alternative method to localize non-pulmonary vein (non-PV) triggers of atrial fibrillation(AF) that are otherwise not eligible for activation mapping due to their instability. The technique applies pattern matching of p-waves and intracardiac signals of atrial trigger and pacing from the site of the suspected origin. A new automated algorithm for intracardiac (IC) pattern matching was recently introduced into the 3D mapping system using the unipolar signal of the reference catheter. The study aims to assess the accuracy and feasibility of APM using IC-pattern matching for localizing non-PV triggers. Methods We assessed the precision of APM using a single chamber and double chamber reference in 20 patients who underwent index pulmonary vein isolation. APM was performed at the anterior and posterior wall of the left atrium (LApost, Laant) and the posterior and lateral wall of the right atrium (Rapost, Ralat). The first pacing point was declared as the origin. The IC-pattern matching algorithm was applied to calculate the similarity of the IC-pattern of the origin to the paced IC-pattern across various distances. The distribution of IC-pattern similarities was analyzed in the Python environment. The feasibility of APM was tested in patients who underwent REDO ablation of AF if all PVs were isolated and no low-voltage substrate was detected. The induction protocol for non-PV triggers included programmed and burst atrial pacing, high-dose isoproterenol, and adenosine infusion. If the IC pattern of the trigger was reproducible, the IC pattern matching was conducted. Ablation was performed at the site of the best IC-pattern matching. Results Atrial PM with IC-pattern matching and a single referent catheter showed lower precision in the RA lateral region (the median[Q1; Q3 ]area of 5% best matching score 1.48 [0.76; 2.01], 0.62[0.15; 1.06], 0.6[0.38; 1.19] and 5.68[2.89; 11.1] cm2 for LApost, LAant, RApost, RAlat accordingly, p = 0.0316). IC-pattern matching with double referent catheter showed high precision at all four anatomical regions (the median [Q1; Q3] area of 5% best matching score 0.126 [0.0879; 0.356], 0.486 [0.205; 0.717], 0.269 [0.198; 0.719], and 0.257 [0.0740; 0.572] cm2 for LApost, LAant, RApost, RAlat accordingly, Fig. 1). Seven out of 37 patients referred to REDO ablation had all PV isolated and absence of low-voltage substrate. In 3 of them, sustained tachycardias (AVNRT, focal atrial tachycardia and typical atrial flutter) were induced, mapped, and ablated. Non-sustained FAT from the RA posterior wall and PAC in the RA septum were induced under the high-dose isoproterenol infusion in two patients. Atrial pace mapping with double chamber referent and successful ablation of these non-PV triggers were performed (Fig.2). Conclusion The atrial pace mapping of non-PV triggers employing the automatic intracardiac pace mapping algorithm is feasible with high accuracy if a double-chamber referent is used.Accuracy of atrial pace mappingNon-PV trigger pace mapping

Impact of CT attenuation correction on viable myocardium detection in combined SPECT and PET/CT: A retrospective cohort study.

The influence of computed tomography attenuation correction (CTAC) on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with F-18-FDG Positron Emission Tomography/Computed Tomography (PET/CT) metabolic imaging, compared with conventional SPECT MPI, remains to be fully elucidated. To evaluate the impact of CTAC on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT, compared to conventional SPECT MPI. 193 patients underwent CZT SPECT and F-18-FDG PET/CT imaging, while 39 patients underwent conventional SPECT and F-18-FDG PET/CT imaging, with both groups utilizing CT for attenuation correction. The injured myocardium (hibernating and scarring) was quantified using the Q.PET software. After CTAC, both groups showed significant improvements in perfusion of the injured myocardial areas, particularly in the inferior wall (INF). The reduction in perfusion was more notable in the CZT SPECT group than that in the conventional group, particularly in the inferior and lateral walls. Among patients with large cardiac chambers, those undergoing MPI with CZT, with normal weights, or males, hibernating myocardium (HM) and scar post-CTAC reductions were particularly significant in the INF. If HM ≥ 10% is considered an indicator for recommended revascularization, among the 87 patients without prior cardiac bypass, 25 (28.7%) might not require revascularization treatment. Dedicated cardiac CZT SPECT and conventional SPECT MPI combined with F-18-FDG PET/CT significantly influenced the assessment of viable myocardium. The impact of CTAC was more profound in dedicated cardiac CZT SPECT, particularly in the INF region. CTAC significantly enhances the accuracy of viable myocardial assessment and may influence clinical decisions regarding revascularization therapy. Therefore, CTAC should be routinely used in dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT for myocardial viability diagnosis.

Functional outcome of treatment of fracture intertrochanteric femur by using proximal femoral nail antirotation II

Background: The elderly are most frequently affected by intertrochanteric fractures, which have a major effect on the medical community and society at large. In 2003, AO introduced the proximal femoral nail anti-rotation device, which was further improved and named proximal femoral nail antirotation II (PFNA II) in 2009. Methods: This study was conducted from December 2020 to August 2022. The 60 cases of proximal femoral nail anti-rotation II-managed intertrochanteric femur fractures were assessed. Results: In the present study, 24 patients (40%) had type IV (Evan’s) fractures. Right hip was involved in 30 patients (50%). Meantime for clinic-radiological union was 20 weeks. There was complication rate of 2.08% as helical blade protrusion and non-union, 2.08% as helical blade protrusion, 2.08% as blade backout, 4.17% as superficial infection and 4.17% as lateral wall fracture. Seven patients expired postoperatively within 3 months while 5 patients lost during follow Up. After a 6-month follow-up, the Harris hip grade was used to evaluate 48 instances. Of these, 8 cases (16.67%) had an excellent score, 29 cases (60.42%) had a good score, 7 cases (14.58%) had a fair score, and 4 cases (8.33%) had a poor score. Thirty-seven of the 48 cases had reached the one-year follow-up mark. Thus, of the 37 patients assessed, 11 cases (29.73%) had excellent Harris hip grades, 19 cases (51.35%) had good scores, 4 cases (10.81%) had fair scores, and 3 cases (8.11%) had poor scores at the end of a one-year follow-up. Conclusions: Even in rural populations, PFN A-II is a better, safer implant with a low rate of complications for treating stable and unstable intertrochanteric femur fractures.

Highly Sensitive Gas Pressure Sensing with Temperature Monitoring Using a Slightly Tapered Fiber with an Inner Micro-Cavity and a Micro-Channel

A highly sensitive optical fiber gas pressure sensor with temperature monitoring is proposed and demonstrated. It is based on a slightly tapered fiber with an inner micro-cavity forming an in-fiber Mach–Zehnder interferometer (MZI), and a micro-channel is drilled into the lateral wall of the in-fiber micro-cavity using a femtosecond laser to allow gas to flow in. Due to the dependence of the refractive index (RI) of air inside the micro-cavity on its gas pressure and the high RI sensitivity of the MZI, the device is extremely sensitive to gas pressure. To prevent fiber breakage, the MZI is housed in a silicate capillary tube with an air inlet. Multiple modes are excited by slightly tapering the inner micro-cavity, and the resonance dips in the sensor’s transmission spectrum feature different linear gas pressure and temperature responses, so a sensitivity matrix algorithm can be used to achieve simultaneous demodulation of two parameters, thus resolving the temperature crosstalk. As expected, the experimental results demonstrated the reliability of the matrix algorithm, with pressure sensitivity reaching up to ~−12.967 nm/MPa and temperature sensitivity of ~89 pm/°C. The features of robust mechanical strength and high air pressure sensitivity with temperature monitoring imply that the proposed sensor has good practical and application prospects.

Amniotic bladder therapy: study of micronized amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) at 6months.

Intravesical application of birth tissue has been reported to inhibit inflammation, alleviate collagen fiber accumulation, and enhance bladder tissue generation. We have previously reported that intra-detrusor micronized amnion monolayer (AM) injections provide short-term clinical improvement in refractory IC/BPS patients. Herein, we evaluate the therapeutic responses and adverse events of micronized amnion/chorion bilayer (AC) in patients with refractory IC/BPS with 6months follow-up. Fifteen patients affected by IC/BPS who failed conventional therapy received 100mg of reconstituted micronized AC was injected intra-detrusor via cystoscopy under general anesthesia, using a 23-gauge needle. Twenty 0.5-mL injections were administered into the lateral and posterior bladder walls, avoiding the dome and trigone. Changes in interstitial cystitis symptom index (ICSI), Interstitial cystitis problem index (ICPI), Bladder pain/ interstitial cystitis symptom score (BPIC-SS) and Overactive Bladder Assessment Tool (OAB), from baseline to 6months post-injection were evaluated retrospectively.The safety of injections was analyzed. Fifteen total refractory IC/BPS patients with an average age of 41.1 ± 14.5years were included in the study, receiving intra-detrusor injections of 100mg of micronized AC. One month after injections, significant improvement in IC/BPS symptom scores was noted in all patients. All patients maintained a sustained clinical response at 6months post-injection. No product-related adverse events were observed. Our findings indicate that the AC formulation significantly reduces time to symptom relief in patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS) and maintains a sustained response up to 6months post-injection. These results suggest a promising clinical benefit of using an amnion/chorion bilayer product for treating IC/BPS. Further research is needed to confirm these findings and assess the long-term durability of this treatment approach. This study represents the first evidence supporting the clinical advantages of an amnion/chorion bilayer product in managing IC/BPS.

Adenomyosis and Adolescence: A Challenging Diagnosis and Complex Management

Adenomyosis is a chronic, hormone-related disease characterized by the presence of the endometrial glands and stroma within the myometrium. This condition can manifest in various features, focal or diffuse adenomyosis or as an adenomyoma, and it may involve different uterine walls (posterior, anterior, and/or lateral walls). The disease can also be classified into different degrees, as mild, moderate and severe, which can be associated with more intense symptoms, although this correlation is not always directly proportional. In fact, adenomyosis can be asymptomatic in about a third of cases or it can significantly impact patients’ quality of life through painful symptoms, such as dysmenorrhea and dyspareunia, abnormal uterine bleeding—particularly heavy menstrual bleeding—and potential effects on fertility. Historically, adenomyosis has been considered a disease primarily affecting premenopausal women over the age of 40, often multiparous, because the diagnosis was traditionally based on surgical reports from hysterectomies performed after the completion of reproductive desire. Data on the presence of adenomyosis in adolescent patients remain limited. However, in recent years, advancements in noninvasive diagnostic tools and increased awareness of this pathology have enabled earlier diagnoses. The disease appears to have an early onset during adolescence, with a tendency to progress in terms of extent and severity over time. Adenomyosis often coexists with endometriosis, which also has an early onset. Therefore, it is important, when diagnosing adenomyosis, to also screen for concomitant endometriosis, especially deep endometriosis in the posterior compartment. The aim of this narrative review is to investigate the prevalence of different types and degrees of adenomyosis in younger patients, assess the associated symptoms, and describe the most appropriate diagnostic procedures for effective therapeutic management and follow-up, with the goal of improving the quality of life for these young women.

Clinical and Electrocardiographic Predictors of Cardiac Resynchronization Therapy Response That Correlate with the 6 min Walking Test.

Background: Cardiac resynchronization therapy is an essential treatment for heart failure patients. Candidates typically have cardiomyopathy accompanied by delayed electrical activation in the left ventricular lateral wall, causing uncoordinated contractions and worsening heart failure. Heart failure severity can be assessed with functional tests: the cardiopulmonary test, which is a maximal exercise test, remains the gold standard, but the 6 min walk test has emerged as an easier, faster, and more comfortable alternative to be used by clinicians to adjust treatment protocols for cardiovascular and pulmonary conditions. Methods: This is a prospective observational study that included 69 patients from a single healthcare facility, and the purpose was to determine if the 6 min walk test results could be associated with changes in various electrocardiographic, clinical, functional, and demographic parameters. All the parameters and the 6 min walk distance were recorded at four key time moments: before the procedure and after 6, 9, and 12 months. The electrocardiographic parameters were obtained from the patients' electrocardiograms recorded in the four key moments and included variables such as QRS area, duration, percentage of biventricular pacing, and many others, while the functional variables included the monitored intraprocedural systolic blood pressure and the end-systolic left ventricular volume. We also aimed to check if clinical conditions such as diabetes and chronic kidney disease and demographic variables such as age or sex have any impact. Results and Conclusions: All this research was performed in order to identify which parameters hold a predictive value and can serve as future criteria for better patient selection and for defining a proper resynchronization outcome. The study shows that parameters such as diabetes and QRS duration have an impact over the 6 min walk distance. Also, newer variables such as the QRS area and the R/S ratio may represent a direction worth studying in order to predict the outcomes of cardiac resynchronization therapy.