Video 1 Research Articles

Examining the impact of an online educational video on the contraceptive knowledge, awareness and choices of young women living in rural and remote Australia

ObjectiveTo assess whether an online educational video, tailored to young women living in rural and remote areas, increases their contraceptive knowledge, preference for and uptake of long-acting reversible contraception (LARC). Study DesignA single group pre-post survey design, in which participants completed the pre-video survey (S1), watched the 13-min video, then completed a survey immediately after (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression. ResultsA total of 153 participants watched the video and completed S1 and S2; 56 % of these completed S3. Prevideo (S1) 33 % of participants were unaware of LARC methods. Only 3 % rated their knowledge about every method as high. Knowledge improved immediately post video (S2) for all methods (aOR 12.5, 95 % CI 5.2 to 29.8) and LARC methods (aOR 7.9, 95 % CI 4.3 to 11.8). Overall method preference for LARC increased from 23.5 % (n = 36) at S1 to 48 % (n = 74) at S2. Likelihood of using a LARC increased at S2 (aOR 2.1, 95 % CI 1.5 to 2.9). The overall proportion of participants using a LARC increased from 18 % at S1 to 21 % at S3, however, this increase was not significant (p = 0.3). ConclusionOur findings underscore the effectiveness of tailored online educational videos in enhancing contraceptive knowledge and preference for LARCs amongst young women living in rural and remote areas. However preference did not translate into uptake, suggesting that structural and other barriers may be prominent. ImplicationsThis study emphasises the need for a multifaceted approach to facilitating young womens’ access to effective methods of contraception, including LARC. Efforts to promote knowledge should be coordinated with place-based initiatives and policies that directly address the structural barriers to accessing critical sexual and reproductive health services unique to women in rural and remote areas.

Long-term evolution of the Sulzberger Ice Shelf, West Antarctica: Insights from 74-year observations and 2022 Hunga-Tonga volcanic tsunami-induced calving

On January 15, 2022, the eruption of the Hunga-Tonga volcano unleashed a tsunami that rapidly traversed the Pacific Ocean, soon reaching the Sulzberger Ice Shelf (SIS), West Antarctica. In the aftermath, the West Sulzberger Ice Shelf (WSIS) experienced a significant calving event, shedding 106 km2 of ice and reducing its size to the smallest recorded since 1948. To investigate the potential association between this calving event and the tsunami, and to elucidate the long-term evolution of the WSIS, this study employed tide gage records and remote sensing data for an extensive cross-cycle observation spanning 74 years. The results indicate that post-2014, the WSIS exhibited heightened instability, manifesting as an increased frequency of calving events, a shift from an expanding to a contracting shelf area, and accelerated ice flow velocities (Video S1). The critical rift, instrumental in the 2022 calving, also displayed an accelerated widening rate post-2014, culminating in rapid expansion upon the tsunami's arrival, completing the final 2% of the iceberg's detachment boundary. Modeling results quantify the tsunami induced flexural strains on the ice shelf, with peak values occurring near the region of the subsequent calving event. Notably, multiple calving events during the study period coincided with local minima in landfast sea ice extent, underscoring its protective role for the ice shelf. Furthermore, a significant decline in landfast sea ice near the SIS had been observed over the past two decades, suggesting a weakening of this protective effect. A combination of modeling results and comparative analysis with other similar calving events suggests that tsunamis tend to expedite ice shelf calving predominantly when the shelf is already teetering on instability, which casts a shadow on the SIS's future resilience against natural hazards.

A novel topology of a non‐isolated bidirectional multiphase single inductor DC–DC converter

AbstractThis paper introduces a novel topology for a non‐isolated bidirectional multiphase single inductor (BMPSIC) DC–DC converter. The proposed BMPSIC requires only a single inductor, irrespective of the number of arms, and features reduced volume and weight compared to the total magnetics needed for a conventional converter with similar ratings. The proposed BMPSIC advantages include a high DC voltage gain without operating on a large duty cycle, voltage stress on the power switches equal to that at the high‐voltage port, easy implementation, and a lower cost for application at high‐power densities. Furthermore, this topology requires only one current and voltage control loop. This paper thoroughly details the steady‐state operating principles of the inductor current continuous mode. It provides theoretical and mathematical analysis, including a comparative analysis of the proposed BMPSIC against earlier DC–DC converters, highlighting the superior performance and efficiency of the BMPSIC. An 8‐kW laboratory prototype, designed as a proof of concept, has been meticulously developed and tested, showcasing the performance of the converter across a broad range of load variations. The efficiency measured for the rated load exceeded 98.2% at the low‐voltage port of 250 V and the high‐voltage port of 400 V. Additionally, the article features Video S1, which illustrates the functioning of the converter.

Hybrid primary puncture in stapler-assisted total laryngectomy.

In Video S1, a new surgical technique for hybrid primary tracheoesophageal (TE) puncture in stapler-assisted total laryngectomy is shown. The video describes the surgical steps of the procedure and illustrates some tips and tricks. The procedure incorporates an upper mini-pharyngotomy to enable retrograde placement of the voice prosthesis (VP), eliminating the need for rigid esophagoscopy. This has made it possible to exploit, without additional risks, the potential of the stapler combined with primary TE puncture and VP placement. In our experience, this hybrid procedure in stapler-assisted total laryngectomy is not related to adverse events such as pharyngocutaneous fistula (PCF), hypertonicity, and functional complications. Therefore, it can be considered a valid technique that allows for easy insertion of a primary voice prosthesis also in case of mechanical sutures.

Initial Experience of Robot-Assisted Simple Prostatectomy with Hugo Robot-Assisted Surgery System: Step-by-Step Description of Two Different Techniques.

Introduction: There are only a few clinical data on nononcologic procedures performed with the new Hugo™ robot-assisted surgery (RAS) system. Robot-assisted simple prostatectomy (RASP) is a minimally invasive treatment option for benign prostatic hyperplasia, and it demonstrated equal early functional and better perioperative outcomes as compared with open simple prostatectomy. In this article, we reported the first large series of RASP performed with Hugo RAS system. Methods: This Supplementary Video S1 is a step-by-step description of two different techniques for RASP. We analyzed the data of 20 consecutive patients who underwent RASP at OLV Hospital (Belgium) between February 2022 and March 2023. Patients baseline characteristics, perioperative and pathologic, and 1-month postoperative outcomes were reported, using the median (interquartile range [IQR]) and frequencies, as appropriate. Results: Median age (IQR) and preoperative prostate specific antigen (PSA) were 72 (67-76) years, and 7.7 (5.0-13.4) ng/mL, respectively. A total of 11 patients experienced an episode of preoperative acute urinary retention, and 8 men had an indwelling bladder catheter at the time of the surgery. No intraoperative complication occurred, and there was no need for conversion to open surgery. Median operative and console time were 165 (121-180) and 125 (101-148) minutes. On the first postoperative day the urethral catheter was removed in 80% of the patients. Median length of stay was 3 (3-4) days. Three patients had minor postoperative complications. On final pathology report, median prostate volume was 120 (101-154) g. On postoperative uroflowmetry, median Qmax and postvoid residual were 16 (13-26) mL/s and 15 (0-34) mL, respectively. Conclusions: This series represents the first report of surgical outcomes of RASP executed with Hugo RAS system. Awaiting study with longer follow-up, our study suggests that Hugo RAS has multiple applications, and it can ensure optimal outcomes in nononcologic procedures.

ATP8A2-Related Disorder: Beyond Cerebellar Ataxia.

Text S1: Variant classification – According to ACMG 2015 Video S1: Choreo-dystonia and hypotonia. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Posterior Reconstruction in Retzius Sparing Zero Clip RARP, "The Lisbon Stitch".

Appendix S1: Supporting Information Video S1 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

3830 lead extraction from two patients with left bundle branch area pacing.

3830 lead extraction from two patients with left bundle branch area pacing.

Intravenous thrombolysis for bioprosthetic valve thrombosis.

A 77-year-old woman experienced new-onset dyspnoea on exertion 1 year after alcohol septal ablation and transcatheter aortic valve implantation (TAVI) with a balloon-expandable valve for symptomatic severe aortic stenosis and basal septal hypertrophy. Transthoracic echocardiographic assessment (TTE) revealed an incremental transvalvular peak velocity from 2.9 m/s 3 days after TAVI to 4.3 m/s. Multislice computed tomography (MSCT) demonstrated hypoattenuated leaflet thickening (HALT) of all leaflets and reduced leaflet motion (RLM) of one leaflet (Panel A). Her antithrombotic regimen was changed from apixaban 5 mg bi-daily to acenocoumarol with a target international normalized ratio (INR) of 2.5–3.5. Six weeks later, symptoms persisted and the transvalvular peak velocity was 3.9 m/s (Panel B). A decision was made to attempt to resolve the thrombus with repeated intravenous infusions of alteplase.1,2 Four sequential infusions of 25 mg alteplase/25 h resulted in an uneventful but stepwise decrease of the transvalvular peak velocity to 2.8 m/s (Panel C–F). Multislice computed tomography confirmed normalization of leaflet motion with some residual remaining leaflet thickening (Panel F). MSCT cine images before and after alteplase infusion are available in the Supplementary data online (Videos S1 and S2).

Immediate right chambers remodelling after orthotopic transcatheter valve tricuspid replacement.

An 84-year-old man with atrial fibrillation, ischemic heart disease with surgical and percutaneous revascularization, complained about effort abdominal pain and dyspnoea (NYHA III), with asthenia and peripheral oedema. Transoesophageal echocardiography showed torrential atrial tricuspid regurgitation and dilated right ventricle with preserved ejection fraction (Panels A–C). Invasive systolic pulmonary pressure was 30 mmHg. The TRI-SCORE was 30%. Considering the symptoms and signs of right heart failure despite optimal medical treatment and the prohibitive surgical risk, the patient was selected for tricuspid transcatheter valve replacement with Cardiovalve (VenusMedtech, Hangzhou, China) according to Heart Team evaluation. Repair percutaneous techniques were rejected, transcatheter annuloplasty due to right coronary artery proximity and thin tissue, and edge-to-edge approach because of the gap of 1 cm. The 32-F Large Cardiovalve system was inserted via surgically exposed femoral vein and was advanced into the right atrium. Under transesophageal echocardiographic and fluoroscopic guidance, the device legs were opened in the atrium and advanced into ventricle and grasp the 3 native leaflets by pulling the system (Panel D). Finally, the atrial followed the ventricular flanges that were released (Panel E). There was a posterior mild paravalvular regurgitation (Panels F and G, Supplementary data online, Videos S1 and S2). After 1 month, the patient is NYHA class I, neither having effort abdominal pain nor peripheral oedema. CT scan showed a significant reduction of the right ventricular diastolic volume from 256 to 216 mL, and the right atrium from 89 to 71 mL, even persisting atrial fibrillation (Panel H, Supplementary data online, Video S3).

Oasis or trap? Mass mortality of overwintering fishes at an Arctic perennial spring and subsequent scavenging activity.

Appendix S1 Video S1 Video S2 Video S3 Video S4 Video S5 Video S6 Video S7 Video S1 Metadata Video S2 Metadata Video S3 Metadata Video S4 Metadata Video S5 Metadata Video S6 Metadata Video S7 Metadata Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Eosinophilic myocarditis as presentation of hypereosinophilic syndrome.

A 67-year-old female with history of eosinophilic gastritis, was admitted with a first episode of heart failure (HF). The X-ray showed a bilateral interstitial infiltrate with a large left pleural effusion (Panel A), with abundant eosinophils in the pleural drainage and eosinophilia in blood stream (22 × 109, normal value 0,5–1 × 109). The transthoracic echocardiogram observed a normal left ventricular function (53%) (see Supplementary Video S1) with restrictive mitral filling pattern (Panel B) and a severely diminished global longitudinal strain of—9.6% (Panel C). The cardiac resonance (see Supplementary Video S2) revealed a septal intramyocardial and anterolateral subepicardial late gadolinium enhancement (Panels D and E) with normal right ventricle function, non-thickened pericardium, and no effusions. Due to high suspicious of a restrictive myocardiopathy (RMC) secondary to a hyperosinophilic syndrome, a right heart catheterization (RHC) and a cardiac biopsy were scheduled. The RHC was compatible with RMC (Panel F), with pulmonary hypertension (mean pulmonary pressure of 28 mmHg), ‘dip & plateau pattern’, and pressure equalization between chambers. Finally, the endomyocardial biopsy (Panel G) revealed an important infiltration of eosinophils in myocardial tissue, confirming the diagnosis of eosinophilic myocarditis (EM), in the context of hypereosinophilic syndrome. High doses of intravenous corticoids plus HF treatment were started, and the patient evolved favourably.

A changing heart in tako-tsubo syndrome.

A 63-year-old female presented with acute chest pain and ECG showing T wave inversion in the anterior and inferior leads. Troponin T (TnT) was significantly elevated (peak 1378 ng/L; normal <14 ng/L), as was NT-proBNP (3091 ng/L; normal <400 ng/L). Invasive angiography showed unobstructed coronary arteries with mid-ventricular ballooning and hypokinesia on ventriculography (see Supplementary data online, Video S1) and echocardiography (see Supplementary data online, Video S2), suggesting a mid-ventricular tako-tsubo syndrome (TTS). Cardiac magnetic resonance (CMR) was booked but the patient was unable to attend. Focussed history using the InterTAK diagnostic score assessment revealed no emotional or physical triggers. The patient re-presented six months later with similar symptoms and elevated TnT. Inpatient echocardiography showed a reverse TTS pattern (see Supplementary data online, Video S3) and CMR at 1.5T showed basal hypokinesia with matching elevated native T1 (1220 ms; normal 950–1100 ms) and T2 (69 ms; normal <48 ms) (Panels A–B). Quantitative perfusion maps following adenosine stress perfusion to investigate microvascular disease showed basal to mid circumferential hypoperfusion with normal apical myocardial blood flow, not suggestive of specific coronary artery territory ischaemia (Panel D) and no late gadolinium enhancement (LGE) (Panel C), confirming a reverse TTS. The patient further presented two months later with chest pain and TnT elevation. Repeat inpatient CMR on this occasion showed a classic TTS pattern with apical hypokinesia and elevated T1 and T2 (1261 ms and 81 ms, respectively) at the mid to apical segments with no LGE (Panels E–G). The case was further explored but no triggers, including neurological or psychiatric abnormalities were found. Recurrent TTS with different phenotypes has previously been described but is rare, especially without a trigger. Our case illustrates the utility of multimodality imaging in the investigation of TTS; in particular, multiparametric tissue mapping by CMR. Furthermore, the novel quantitative perfusion maps characterising myocardial blood flow added diagnostic utility.

Robotic Frykman-Goldberg procedure with natural orifice specimen extraction: A video vignette.

The data that support the findings of this study are available from the corresponding author upon reasonable request. Video S1: Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Pulmonary vein compression by transesophageal echocardiography probe demonstrated using epicardial echocardiography.

The authors declare no competing interests. Research data are not shared. Video S1: Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

'Conventional' haemodynamics even in the quadricuspid aortic valve: clinical recognition using multimodality imaging.

A 76-year-old male with congestive heart failure, accompanied by dyspnoea and irregular rhythm, was transferred to our hospital for treatment of congestive heart failure (NYHAIII/IV). Atrial fibrillation was confirmed by electrocardiography, and transoesophageal echocardiography (TEE) for electrical cardioversion was performed due to poor response to medical therapy. Two- and three-dimensional TEE revealed a quadricuspid aortic valve (QAV) with central leaflet malcoaptation and restriction of valve leaflet opening (Panels A and B; Supplementary data online, Videos S1 and S2). After electrical cardioversion, transthoracic echocardiography showed severe aortic stenosis with a 4.9 m/s peak aortic valve flow velocity, mean pressure gradient of 56 mm Hg (Panel C), and severe aortic regurgitation; the regurgitant volume was 61 mL/beat, and vena contracta width was 6.1 mm (Panel D; Supplementary data online, Video S3). Multi-detector row computed tomography confirmed the QAV and showed no dilatation of the ascending aorta (diameter, 34 mm) (Panels E and F). Four-dimensional flow cardiovascular magnetic resonance was confirmed that blood flow in the ascending aorta had a normal flow pattern; peak systolic wall shear stress values were not high, and symmetrical helical flow was observed (Panels G and H; Supplementary data online, Videos S4 and S5). Based on these results, TAVI was also considered, but we determined that simultaneous intervention for atrial fibrillation was necessary. Therefore, surgical aortic valve replacement (bioprosthetic valve), pulmonary vein isolation, and left atrial appendage closure were performed (Panels I and J). This case underlines the importance of multimodality approach to the diagnosis and treatment strategy of QAV.

MitraClip single-leaflet detachment and consequent migration in atrial functional mitral regurgitation.

An 84-year-old woman with symptomatic severe functional mitral regurgitation (MR) due to long standing atrial fibrillation underwent percutaneous edge-to-edge repair using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) (see Supplementary data online, Video S1). Following deployment of an XTR clip in the A2-P2 segment, a second MitraClip XT device was deployed laterally to prevent recurrence of MR caused by stretching of left atrium and mitral leaflets. However, single leaflet detachment of the anterior leaflet occurred immediately (Panel A, Supplementary data online, Video S2). Since only mild MR was observed after the procedure, additional clipping was not performed, and her symptoms were relieved. However, at 2 weeks after discharge, she presented with right inguinal pain and aggravated dyspnea. The lateral clip was not observed on chest x-ray (Panels B and C). Computed tomography revealed the migrated MitraClip at the right common iliac artery bifurcation (yellow arrows in Panel D). Transesophageal echocardiogram showed recurrence of severe MR with newly developed small chordae rupture (Panel E, Supplementary data online, Video S3). The embolized MitraClip was successfully retrieved using 10- and 15-mm Amplatz GooseNeck® snares (Ev3, Plymouth, MN, USA) through a 16-French Check-Flo® Introducer sheath (Cook Medical, Bloomington, IN, USA) (Panels F, G, and H, Supplementary data online, Video S4), and another NTW clip was deployed. Post-procedure transesophageal echocardiogram confirmed residual mild to moderate MR (Panel I, Supplementary data online, Video S5). Images from this case show the complications of MitraClip single leaflet detachment and distal migration, and how this problem was solved.

Phlegmasia cerulea dolens with lower leg compartment syndrome.

A 57-year-old man with a history of human immunodeficiency virus infection presented with sudden pain and swelling of the right leg that had developed over the preceding thirty minutes (Panel A). He reported having been taking antiretroviral drugs. Computed tomography (CT) demonstrates partial pulmonary artery embolism and massive deep vein thrombosis extending from the right external iliac to the popliteal veins. Despite commencing anticoagulation, he had severe pain and intense dysesthesia of the right leg. The intramuscular pressure in his right leg was 98 mmHg (reference: <10 mmHg), and his right dorsalis pedis pulse was not palpable. A clinical diagnosis of compartment syndrome secondary to phlegmasia cerulea dolens was made, and he underwent immediate fasciotomy (Panel B). As the dysesthesias did not improve by fasciotomy, catheter-directed venous thrombectomy was performed on day 5 of hospitalization using a 10-French Heartrail ST01 catheter (Terumo, Tokyo, Japan) via a cross-over 12-French DrySeal (WL Gore, Flagstaff, Arizona, USA) from the contralateral femoral vein after placing an inferior vena cava (IVC) filter. Although the final venography revealed restored venous flow, the filter could not be retrieved because of trapped thrombi (Panel C-E, see supplementary data online, Videos S1–S3). Postprocedural CT demonstrated complete thrombosis of the right external iliac vein, and swelling in the right thigh was persistent despite anticoagulation and intermittent pneumatic compression. After the second venous thrombectomy on day 15, the venous flow was completely restored, and the filter was retrieved (see supplementary data online, Videos S4 and S5). He was discharged on apixaban without symptoms of post-thrombotic syndrome (Panel F).

Mechanical extraction of a pulmonary valve vegetation in a patient with endocarditis.

A 44-year-old male known with small ventricular septal defect, but no previous history of intravenous drug abuse presented to an outside hospital with fever, chills, and back pain. A chest computed tomography showed multifocal nodular and consolidative pulmonary opacities with borderline enlarged mediastinal lymph nodes (Panel, A). Blood cultures grew Staphylococcus lugdunensis; given suspicion of infective endocarditis causing septic pulmonary emboli, he was transferred to our hospital. Transoesophageal echocardiography (TEE) on admission showed highly mobile masses attached to the native tricuspid (B) and to the sub-pulmonary area of the right ventricular outflow tract along with posterior leaflet perforation of the tricuspid valve with mild-to-moderate regurgitation (C). The sub-pulmonary lesion was in the path of the high-velocity left-to-right jet through the ventricular septal defect (D; Supplementary data online, Video S1), explaining the unusual location. Patient had persistent bacteremia despite appropriate antibiotic therapy and eventually developed haemoptysis and acute respiratory failure requiring intubation. At repeat TEE showed interval increase in the size of the sub-pulmonic vegetations. In the absence of haemodynamically significant lesions, the multidisciplinary team recommended percutaneous transcatheter mechanical vegectomy rather than surgical intervention.

Doppler flow velocity profile of the left anterior descending in a patient with hypertrophic cardiomyopathy and markedly elevated left ventricular end-diastolic pressure: a novel observation.

Left anterior descending (LAD) coronary artery blood flow predominantly occurs in diastole and depends on the pressure differential across the myocardium, referred to as the coronary perfusion pressure (CPP). LAD flow can be visualized using two-dimensional/Doppler echocardiography. Restrictive diastolic filling patterns were previously described in the coronary artery Doppler profile as the ‘Doppler square root sign’ [EHJ CVI. 2017; 18(9):1067. doi: 10.1093/ehjci/jex061]. We present a case of a 44-year-old male with hypertrophic cardiomyopathy and no left ventricular outflow tract obstruction. The echocardiogram demonstrated septal wall thickness of 35 mm (Panel A), normal left ventricular ejection fraction (75%), impaired global longitudinal strain (−10%) (Panel B), and grade II diastolic dysfunction with a left atrial volume index of 56 mL/m2, E/A ratio 1.9 (Panel C), and septal e’ velocity 0.05 m/s. Further assessment of diastology revealed a mitral A wave duration of 120 ms (Panel D) and a pulmonary venous A wave duration of 220 ms (Panel E). The difference between the venous and transmitral A wave durations was 100 ms (normal < 30 ms). This degree of difference in the duration of flows is consistent with and indicative of a marked increase in left ventricular end-diastolic pressure (LVEDP). The LAD pulsed wave doppler flow (Panel F) profile (Panel G, see Supplementary data online, Video S1) demonstrated a transient reduction in end-diastolic velocity (‘a’ dip), which correlated with a decrease in CPP secondary to elevated LVEDP from a powerful atrial contraction, indeed a novel observation. Also noted is a small systolic flow reversal.