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Heart failure (HF) is a chronic and progressive disease that often progresses to an advanced stage where conventional therapy is insufficient to relieve patients' symptoms. Despite the availability of advanced therapies such as mechanical circulatory support or heart transplantation, the complexity of defining advanced HF, which requires multiple parameters and multimodality assessment, often leads to delays in referral to dedicated specialists with the result of a worsening prognosis. In this review, we aim to explore the role of cardiac magnetic resonance (CMR) in advanced HF by showing how CMR is useful at every step in managing these patients: from diagnosis to prognostic stratification, hemodynamic evaluation, follow-up and advanced therapies such as heart transplantation. The technical challenges of scanning advanced HF patients, which often require troubleshooting of intracardiac devices and dedicated scans, will be also discussed., (© 2024 The Author(s). Echocardiography published by Wiley Periodicals LLC.)

Mitral valve prolapse is a common valve disorder that usually has a benign prognosis unless there is significant regurgitation or LV impairment. However, a subset of patients are at an increased risk of ventricular arrhythmias and sudden cardiac death, which has led to the recognition of "arrhythmic mitral valve prolapse" as a clinical entity. Emerging risk factors include mitral annular disjunction and myocardial fibrosis. While echocardiography remains the primary method of evaluation, cardiac magnetic resonance has become crucial in managing this condition. Cine magnetic resonance sequences provide accurate characterization of prolapse and annular disjunction, assessment of ventricular volumes and function, identification of early dysfunction and remodeling, and quantitative assessment of mitral regurgitation when integrated with flow imaging. However, the unique strength of magnetic resonance lies in its ability to identify tissue changes. T1 mapping sequences identify diffuse fibrosis, in turn related to early ventricular dysfunction and remodeling. Late gadolinium enhancement sequences detect replacement fibrosis, an independent risk factor for ventricular arrhythmias and sudden cardiac death. There are consensus documents and reviews on the use of cardiac magnetic resonance specifically in arrhythmic mitral valve prolapse. However, in this article, we propose an algorithm for the broader use of cardiac magnetic resonance in managing this condition in various scenarios. Future advancements may involve implementing techniques for tissue characterization and flow analysis, such as 4D flow imaging, to identify patients with ventricular dysfunction and remodeling, increased arrhythmic risk, and more accurate grading of mitral regurgitation, ultimately benefiting patient selection for surgical therapy., (© 2024 Wiley Periodicals LLC.)

Aim: This study aims to translate the English version of the 'caring ability of family caregivers of patients with cancer scale (CAFCPCS)' into Chinese and validate its psychometric properties in the family caregivers of elderly patients with cancer. Design: A methodological study. Methods: Based on the Brislin translation model, the original scale will be translated and back‐translated, the Delphi expert consultation method will be adopted for cross‐cultural adaptation, and the pilot will be carried out in 20–30 family caregivers of elderly patients with cancer. Then, a dual‐centre prospective study will be conducted by recruiting 371–542 family caregivers of elderly patients with cancer to validate the psychometric properties of the Chinese version of CAFCPCS. Results: The scale's content validity will be evaluated using the Delphi expert inquiry method, and the face validity will be evaluated using a pre‐experiment. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to assess structural validity, while internal consistency reliability and split‐half reliability will be used to assess reliability. Patient or Public Contribution: Public involvement is of great significance for this study. Participants will be used in a pre‐test to give feedback on whether the contents of the clinical pilot version of CAFCPCS after expert consultation can reflect real problems and whether the sentences can be well understood. Based on their opinions, the research group will further refine the scale. [ABSTRACT FROM AUTHOR]

Management of patients with acute chest pain poses a significant challenge in identifying those requiring urgent coronary reperfusion. Electrocardiogram (ECG) constitutes the cornerstone in making prompt clinical decisions by identifying ST‐segment elevation, commonly associated with ST‐segment elevation myocardial infarction. It is important to note that ST‐segment elevation can also be a manifestation of various cardiac and non‐cardiac conditions, from acute myocarditis, early repolarization syndrome, acute pericarditis, and left bundle branch block to unknown origins. The similarity of ECG changes among these conditions complicates clinical differential diagnosis, necessitating a detailed medical history and thorough examinations. Here, we presented a case of a 52‐year‐old female with chest pain and unidentified convex ST‐segment elevation. Considering the negative emergent coronary angiography results, normal echocardiography, and long‐lasting ST‐segment elevation for the following 1 year, the final diagnosis was non‐myocardial infarction, probably related to a prior cerebral haemorrhage. [ABSTRACT FROM AUTHOR]

Aims: The aim of this systematic literature review was to provide updated information on human papillomavirus (HPV) prevalence in locally and regionally advanced (LA) and recurrent/metastatic (RM) head and neck cancer (HNC) worldwide. Methods: Electronic searches were conducted on clinicaltrials.gov, MEDLINE/PubMed, Embase, and ASCO/ESMO journals of congresses for interventional studies (IS; Phase I–III trials) as well as MEDLINE and Embase for non‐interventional studies (NIS) of LA/RM HNC published between January 01, 2010 and December 31, 2020. Criteria for study selection included: availability of HPV prevalence data for LA/RM HNC patients, patient enrollment from January 01, 2010 onward, and oropharyngeal cancer (OPC) included among HNC types. HPV prevalence per study was calculated as proportion of HPV+ over total number of enrolled patients. For overall HPV prevalence across studies, mean of reported HPV prevalence rates across studies and pooled estimate (sum of all HPV+ patients over sum of all patients enrolled) were assessed. Results: Eighty‐one studies (62 IS; 19 NIS) were included, representing 9607 LA/RM HNC cases, with an overall mean (pooled) HPV prevalence of 32.6% (25.1%). HPV prevalence was 44.7% (44.0%) in LA and 24.3% (18.6%) in RM. Among 2714 LA/RM OPC patients from 52 studies with available data, mean (pooled) value was 55.8% (50.7%). The majority of data were derived from Northern America and Europe, with overall HPV prevalence of 46.0% (42.1%) and 24.7% (25.3%) across studies conducted exclusively in these geographic regions, respectively (Northern Europe: 31.9% [63.1%]). A "p16‐based" assay was the most frequently reported HPV detection methodology (58.0%). Conclusion: Over the last decade, at least one quarter of LA/RM HNC and half of OPC cases studied in IS and NIS were HPV+. This alarming burden is consistent with a potential implication of HPV in the pathogenesis of at least a subgroup of HNC, underscoring the relevance of HPV testing and prophylaxis to HNC prevention and management. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy., (© 2024 Wiley Periodicals LLC.)

Deubiquitylating enzymes (DUBs) maintain relative homeostasis of the cellular ubiquitome by removing the post‐translational modification ubiquitin moiety from substrates. Numerous DUBs have been demonstrated specificity for cleaving a certain type of ubiquitin linkage or positions within ubiquitin chains. Moreover, several DUBs perform functions through specific protein–protein interactions in a catalytically independent manner, which further expands the versatility and complexity of DUBs' functions. Dysregulation of DUBs disrupts the dynamic equilibrium of ubiquitome and causes various diseases, especially cancer and immune disorders. This review summarizes the Janus‐faced roles of DUBs in cancer including proteasomal degradation, DNA repair, apoptosis, and tumor metastasis, as well as in immunity involving innate immune receptor signaling and inflammatory and autoimmune disorders. The prospects and challenges for the clinical development of DUB inhibitors are further discussed. The review provides a comprehensive understanding of the multi‐faced roles of DUBs in cancer and immunity. [ABSTRACT FROM AUTHOR]

Natural killer cell‐derived extracellular vesicles (NK‐EVs) have shown promising potential as biotherapeutics for cancer due to their unique attributes as cytotoxic nanovesicles against cancer cells and immune‐modulatory activity towards immune cells. However, a biomanufacturing workflow is needed to produce clinical‐grade NK‐EVs for pre‐clinical and clinical applications. This study established a novel biomanufacturing workflow using a closed‐loop hollow‐fibre bioreactor to continuously produce NK‐EVs from the clinically relevant NK92‐MI cell line under serum‐free, Xeno‐free and feeder‐free conditions following GMP‐compliant conditions. The NK92 cells grown in the bioreactor for three continuous production lots resulted in large quantities of both NK cell and NK‐EV biotherapeutics at the end of each production lot (over 109 viable cells and 1013 EVs), while retaining their cytotoxic payload (granzyme B and perforin), pro‐inflammatory cytokine (interferon‐gamma) content and cytotoxicity against the human leukemic cell line K562 with limited off‐target toxicity against healthy human fibroblast cells. This scalable biomanufacturing workflow has the potential to facilitate the clinical translation of adoptive NK cell‐based and NK‐EV‐based immunotherapies for cancer with GMP considerations. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to explore the predictive value of wall thickness measured by cardiac magnetic resonance (CMR) for all‐cause mortality in dilated cardiomyopathy (DCM) patients. Methods and results: DCM patients who underwent CMR and completed the regular follow‐up were included in this study. The left ventricular end‐diastolic diameter (LVDd), left ventricular end‐diastolic volume (LVEDV), left ventricular posterior wall thickness (PWT), interventricular septum thickness (IVST), left ventricular ejection fraction, and left ventricular mass (LVM) were measured by CMR. The presence and extent of late gadolinium enhancement (LGE) were also assessed. The relative posterior wall thickness (RWTPW) and relative interventricular septum wall thickness (RWTIVS) were defined by the following equations: RWTPW = (2 × PWT)/LVDd, and RWTIVS = (2 × IVST)/LVDd. All patients received regular telephone and outpatient follow‐up. The primary endpoint was all‐cause mortality. A total of 161 patients were enrolled in this study, including 126 (78.3%) males. The mean age was 52.3 ± 13.6 years. During the median follow‐up of 47 months (interquartile range 32–57 months), 41 (24.8%) patients died. Compared with the non‐death group, LVDd (75.2 ± 11.9 vs. 70.5 ± 8.8 mm; P = 0.025) was greater in the death group, while PWT [5.2 mm (3.7–6.8) vs. 6.9 mm (5.3–8.6); P < 0.001], IVST [8.2 mm (6.5–9.5) vs. 9.3 mm (7.4–10.5); P = 0.005], RWTPW [0.15 (0.11–0.19) vs. 0.20 (0.15–0.25); P < 0.001], RWTIVS [0.22 (0.17–0.26) vs. 0.26 (0.22–0.31); P < 0.001], and LVM/LVEDV ratio (0.5 ± 0.2 vs. 0.7 ± 0.2 g/mL; P < 0.001) were lower. The presence of LGE [LGE(+)] was more frequent in the death group (75.6% vs. 58.3%; P = 0.048). However, the LGE extent was not significantly different between the two groups [4 (1–7) vs. 2 (0–6); P = 0.096]. Multivariate Cox regression analysis showed that PWT [hazard ratio (HR) 0.086, 95% confidence interval (CI) 0.665–0.976; P < 0.05] and RWTPW (HR 0.001, 95% CI 0.000–0.502; P < 0.05) were independent predictors of all‐cause death. In contrast, IVST, RWTIVS, and the presence of LGE were not clearly associated with death. Conclusions: PWT measured by CMR is an independent predictor of all‐cause mortality in DCM patients. However, there was no significant correlation between septum wall thickness and mortality. [ABSTRACT FROM AUTHOR]

Purpose: To develop a free‐running 3D radial whole‐heart multiecho gradient echo (ME‐GRE) framework for cardiac‐ and respiratory‐motion‐resolved fat fraction (FF) quantification. Methods: (NTE = 8) readouts optimized for water–fat separation and quantification were integrated within a continuous non‐electrocardiogram‐triggered free‐breathing 3D radial GRE acquisition. Motion resolution was achieved with pilot tone (PT) navigation, and the extracted cardiac and respiratory signals were compared to those obtained with self‐gating (SG). After extra‐dimensional golden‐angle radial sparse parallel‐based image reconstruction, FF, R2*, and B0 maps, as well as fat and water images were generated with a maximum‐likelihood fitting algorithm. The framework was tested in a fat–water phantom and in 10 healthy volunteers at 1.5 T using NTE = 4 and NTE = 8 echoes. The separated images and maps were compared with a standard free‐breathing electrocardiogram (ECG)‐triggered acquisition. Results: The method was validated in vivo, and physiological motion was resolved over all collected echoes. Across volunteers, PT provided respiratory and cardiac signals in agreement (r = 0.91 and r = 0.72) with SG of the first echo, and a higher correlation to the ECG (0.1% of missed triggers for PT vs. 5.9% for SG). The framework enabled pericardial fat imaging and quantification throughout the cardiac cycle, revealing a decrease in FF at end‐systole by 11.4% ± 3.1% across volunteers (p < 0.0001). Motion‐resolved end‐diastolic 3D FF maps showed good correlation with ECG‐triggered measurements (FF bias of −1.06%). A significant difference in free‐running FF measured with NTE = 4 and NTE = 8 was found (p < 0.0001 in sub‐cutaneous fat and p < 0.01 in pericardial fat). Conclusion: Free‐running fat fraction mapping was validated at 1.5 T, enabling ME‐GRE‐based fat quantification with NTE = 8 echoes in 6:15 min. [ABSTRACT FROM AUTHOR]

Objectives: Fatigue due to cancer is a challenging symptom that might be long‐lasting after cancer treatment. The aim of this study was to follow the development of fatigue among head and neck cancer (HNC) patients prospectively and longitudinally and to analyze predictors for acute and chronic fatigue. Methods: HNC patients treated with curative intent were included at diagnosis and completed the following questionnaires multiple times, up to 5 years after treatment: the EORTC QLQ‐FA12 for fatigue, EORTC QLQ‐C30, and HNC‐specific EORTC QLQ‐H&N35 together with an anxiety and depression questionnaire. Predictors of fatigue were evaluated at 3 months and 5 years after treatment. Results: Of the 311 study participants, 74% responded at the 5‐year follow‐up. Physical fatigue was significantly worse 3 months after treatment, while emotional and cognitive fatigue were the worst at diagnosis and at 3 months. All fatigue domains were significantly better after 1 year, and the fatigue scores remained stable from 1 until 5 years after treatment. Three months after chemoradiotherapy, physical fatigue was more significant, but no long‐term differences due to treatment modalities were found. Depression and anxiety were predictors for chronic emotional fatigue, and local HN pain and swallowing problems were predictors for chronic physical fatigue. Better global quality of life at diagnosis was associated with less physical and emotional fatigue. Conclusion: Fatigue was worst in the short term for HNC patients and improved after 1 year, and long‐term fatigue remained stable up to 5 years after treatment. A few predictors for chronic fatigue were found. Level of Evidence: 3 Laryngoscope, 133:2211–2221, 2023 [ABSTRACT FROM AUTHOR]

Aims: The HeartLogic algorithm combines multiple implantable defibrillator (ICD) sensor data and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation in cardiac resynchronization therapy (CRT‐D) patients. We evaluated the performance of this algorithm in non‐CRT ICD patients and in the presence of co‐morbidities. Methods and results: The HeartLogic feature was activated in 568 ICD patients (410 with CRT‐D) from 26 centres. The median follow‐up was 26 months [25th–75th percentile: 16–37]. During follow‐up, 97 hospitalizations were reported (53 cardiovascular) and 55 patients died. We recorded 1200 HeartLogic alerts in 370 patients. Overall, the time IN the alert state was 13% of the total observation period. The rate of cardiovascular hospitalizations or death was 0.48/patient‐year (95% CI: 0.37–0.60) with the HeartLogic IN the alert state and 0.04/patient‐year (95% CI: 0.03–0.05) OUT of the alert state, with an incidence rate ratio of 13.35 (95% CI: 8.83–20.51, P < 0.001). Among patient characteristics, atrial fibrillation (AF) on implantation (HR: 1.62, 95% CI: 1.27–2.07, P < 0.001) and chronic kidney disease (CKD) (HR: 1.53, 95% CI: 1.21–1.93, P < 0.001) independently predicted alerts. HeartLogic alerts were not associated with CRT‐D versus ICD implantation (HR: 1.03, 95% CI: 0.82–1.30, P = 0.775). Comparisons of the clinical event rates in the IN alert state with those in the OUT of alert state yielded incidence rate ratios ranging from 9.72 to 14.54 (all P < 0.001) in all groups of patients stratified by: CRT‐D/ICD, AF/non‐AF, and CKD/non‐CKD. After multivariate correction, the occurrence of alerts was associated with cardiovascular hospitalization or death (HR: 1.92, 95% CI: 1.05–3.51, P = 0.036). Conclusions: The burden of HeartLogic alerts was similar between CRT‐D and ICD patients, while patients with AF and CKD seemed more exposed to alerts. Nonetheless, the ability of the HeartLogic algorithm to identify periods of significantly increased risk of clinical events was confirmed, regardless of the type of device and the presence of AF or CKD. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) is a minimally invasive intervention for the treatment of severe aortic valve stenosis. The main cause of failure is the structural deterioration of the implanted prosthetic leaflets, possibly inducing a valvular re‐stenosis 5–10 years after the implantation. Based solely on pre‐implantation data, the aim of this work is to identify fluid‐dynamics and structural indices that may predict the possible valvular deterioration, in order to assist the clinicians in the decision‐making phase and in the intervention design. Patient‐specific, pre‐implantation geometries of the aortic root, the ascending aorta, and the native valvular calcifications were reconstructed from computed tomography images. The stent of the prosthesis was modeled as a hollow cylinder and virtually implanted in the reconstructed domain. The fluid‐structure interaction between the blood flow, the stent, and the residual native tissue surrounding the prosthesis was simulated by a computational solver with suitable boundary conditions. Hemodynamical and structural indicators were analyzed for five different patients that underwent TAVI – three with prosthetic valve degeneration and two without degeneration – and the comparison of the results showed a correlation between the leaflets' structural degeneration and the wall shear stress distribution on the proximal aortic wall. This investigation represents a first step towards computational predictive analysis of TAVI degeneration, based on pre‐implantation data and without requiring additional peri‐operative or follow‐up information. Indeed, being able to identify patients more likely to experience degeneration after TAVI may help to schedule a patient‐specific timing of follow‐up. [ABSTRACT FROM AUTHOR]

We discuss the balancing acts of inclusion and exclusion by analysing how Somali migrants in Germany attempt to manoeuvre between various norms, individual interests and various social networks. Building on Glick Schiller and Caglar (2016), whose work on urban sociabilities emphasizes social relations in which people act as equals, we argue that ethnic (self‐)identification is important as it serves as a basis for boundary‐making and for bonding within and bridging and linking between groups. Thus, a focus on sociability and ethnic identification (as a category of praxis) can, in some cases, go hand in hand. Moreover, we argue that inclusion into local Somali communities, which is often discussed in public discourse as leading to exclusion from German society, helps to establish connections. Simultaneously, exclusion through racism can lead to (self‐)isolation of Somalis, but also places pressure on younger Somalis in particular to forge alliances with non‐Somali Germans to stabilize their situation. Balancing social inclusion and exclusion among Somali migrants in Germany therefore can have ambiguous and at times paradoxical outcomes. [ABSTRACT FROM AUTHOR]

We describe the application of time‐resolved chemically induced dynamic nuclear polarization (TR CIDNP) in the determination of the bimolecular rate constants of triplet quenching. This method is based on the use of a CIDNP‐active reference triplet quencher with a known quenching rate constant. The quenching reaction of the triplet excited photosensitizer, 3,3′,4,4′‐tetracarboxy benzophenone (TCBP), was considered as the reaction under study. In each experiment, geminate CIDNP spectra were obtained during irradiation of the solution containing: (i) TCBP and a reference quencher; (ii) TCBP, a reference quencher, and a quencher whose triplet quenching rate constant was to be determined. The degree of decrease in the signal intensity of the reference quencher for the case (ii) compared to the case (i) depended on the desired quenching rate constant which made it possible to calculate the latter. Thus, the rate constants were determined for quenching of triplet TCBP by histidine‐containing compounds. [ABSTRACT FROM AUTHOR]

Introduction: The prediction of ventricular tachyarrhythmias among patients with implantable cardioverter defibrillators is difficult with available clinical tools. We sought to assess whether in patients with heart failure (HF) and reduced ejection fraction with defibrillators, physiological sensor‐based HF status, as summarized by the HeartLogic index, could predict appropriate device therapies. Methods: Five hundred and sixty‐eight consecutive HF patients with defibrillators (n = 158, 28%) or cardiac resynchronization therapy‐defibrillators (n = 410, 72%) were included in this prospective observational multicenter analysis. The association of both HeartLogic index and its physiological components with defibrillator shocks and overall appropriate therapies was assessed in regression and time‐dependent Cox models. Results: Over a follow‐up of 25 (15–35) months, 122 (21%) patients received an appropriate device therapy (shock, n = 74, 13%), while the HeartLogic index crossed the threshold value (alert, HeartLogic ≥ 16) 1200 times (0.71 alerts/patient‐year) in 370 (65%) subjects. The occurrence of ≥1 HeartLogic alert was significantly associated with both appropriate shocks (Hazard ratios [HR]: 2.44, 95% confidence interval [CI]: 1.49–3.97, p =.003), and any appropriate defibrillator therapies. In multivariable time‐dependent Cox models, weekly IN‐alert state was the strongest predictor of appropriate defibrillator shocks (HR: 2.94, 95% CI: 1.73–5.01, p <.001) and overall therapies. Compared with stable patients, patients with appropriate shocks had significantly higher values of HeartLogic index, third heart sound amplitude, and resting heart rate 30–60 days before device therapy. Conclusion: The HeartLogic index is an independent dynamic predictor of appropriate defibrillator therapies. The combined index and its individual physiological components change before the arrhythmic event occurs. [ABSTRACT FROM AUTHOR]

Aim: To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between New York Heart Association (NYHA) class I and NYHA class II–III patients with non‐ischaemic cardiomyopathy (NICM). Methods and results: Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate implantable cardioverter defibrillator (ICD) therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death. Overall, 698 patients were included, 33% in NYHA class I. During a median follow‐up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA class I and NYHA class II–III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement (LGE) was the only independent predictor of the primary outcome both in NYHA class I and NYHA class II–III patients. LGE+ NYHA class I patients had a similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA class II–III (p = 0.92) and a significantly higher risk as compared to LGE– NYHA class II–III cases (p < 0.001). The risk of the secondary endpoint was significantly higher in patients in NYHA class II–III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001). Conclusions: Patients with NICM in NYHA class I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high risk. NYHA class I patients with high‐risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA class II–III with the same risk factors. [ABSTRACT FROM AUTHOR]

Background: Cancer patients are often malnourished pre‐operatively. The present study aimed to establish whether current screening was appropriate for use in prehabilitation and investigate any association between nutritional risk, functionality and quality of life (QoL). Methods: This cohort study used routinely collected data from September 2020 to August 2021 from patients in a Prehab4cancer programme. Included patients were aged ≥ 18 years, had colorectal, lung or oesophago‐gastric cancer and were scheduled for surgery. Nutritional assessment included Patient‐Generated Subjective Global Assessment (PG‐SGA) Short‐Form and QoL with a sit‐to‐stand test. Association between nutritional risk and outcomes was analysed using adjusted logistic regression. Results: From 928 patients referred to Prehab4Cancer service over 12 months, data on nutritional risk were collected from 526 patients. Pre‐operatively, 233 out of 526 (44%) patients were at nutritional risk (score ≥ 2). During prehabilitation, 31% of patients improved their PG‐SGA and 74% of patients maintained or improved their weight. Odds ratios (OR) with confidence intervals (CI) showed that patients with better QoL using EuroQol‐5 Dimensions (OR = 0.05, 95% CI = 0.01, 0.45, p = 0.01), EuroQol Visual Analogue Scale (OR = 0.96, 95% CI = 0.93, 1.00, p = 0.04) or sit‐to‐stand (OR = 0.96, 95% 0.93, 1.00, p = 0.04) were less likely to be nutritional at risk. Conclusions: Almost half of patients in Prehab4Cancer programme assessed using PG‐SGA were at risk of malnutrition. However, almost half of the sample did not have their risk assessed. Patients at risk of malnutrition were more likely to have a poorer QoL and sit‐to‐stand test than those who were not at risk. Key points: Colorectal, lung or oesopho‐gastric cancer patients referred to the Prehab4Cancer service underwent a nutritional assessment. Almost half of patients assessed using the Patient‐Generated Subjective Global Assessment (i.e., PG‐SGA) were at risk of malnutrition. Patients at risk of malnutrition were more likely to have a worse quality of life and sit‐to‐stand test indicating reduced physical function than those who were not at risk of malnutrition. This indicates that optimising the nutritional status of cancer patients in the prehabilitation period can maximise the nutritional status, functionality and quality of life of patients. [ABSTRACT FROM AUTHOR]

DNA sequence information has revealed many morphologically cryptic species worldwide. For animals, DNA‐based assessments of species diversity usually rely on the mitochondrial cytochrome c oxidase subunit I (COI) gene. However, a growing amount of evidence indicate that mitochondrial markers alone can lead to misleading species diversity estimates due to mito‐nuclear discordance. Therefore, reports of putative species based solely on mitochondrial DNA should be verified by other methods, especially in cases where COI sequences are identical for different morphospecies or where divergence within the same morphospecies is high. Freshwater amphipods are particularly interesting in this context because numerous putative cryptic species have been reported. Here, we investigated the species status of the numerous mitochondrial molecular operational taxonomic units (MOTUs) found within Echinogammarus sicilianus. We used an integrative approach combining DNA barcoding with mate selection observations, detailed morphometrics and genome‐wide double digest restriction site‐associated DNA sequencing (ddRAD‐seq). Within a relatively small sampling area, we detected twelve COI MOTUs (divergence = 1.8–20.3%), co‐occurring in syntopy at two‐thirds of the investigated sites. We found that pair formation was random and there was extensive nuclear gene flow among the ten MOTUs co‐occurring within the same river stretch. The four most common MOTUs were also indistinguishable with respect to functional morphology. Therefore, the evidence best fits the hypothesis of a single, yet genetically diverse, species within the main river system. The only two MOTUs sampled outside the focal area were genetically distinct at the nuclear level and may represent distinct species. Our study reveals that COI‐based species delimitation can significantly overestimate species diversity, highlighting the importance of integrative taxonomy for species validation, especially in hyperdiverse complexes with syntopically occurring mitochondrial MOTUs. [ABSTRACT FROM AUTHOR]

The study investigates the economic dimensions of war. It considers empirical literature through structure review to explore the different effects of war on businesses. The scope of the study covers all geographical areas and studies dealing with any respective event in the 20th and 21st centuries. However, the study caters for quality, relevance, and recentness in publications. Hence, publications in 4*, 4, and 3 stars journals that are placed in Association of Business Schools of UK Guidelines in 2015 are reviewed. The study with its extant literature presents an important realization that against the stereo‐typed opinion about war being devastating to businesses indicates that war affects in various dimensions, that is, positive, negative, or even no effects depending on the nature and place of business. Whereas businesses, in general, may be negatively affected in wartime, businesses critical to war may get an unprecedented boost. The study also indicates a dire need of developing a framework for investigating this important relationship on sound footings. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the predictive value of left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LARS) on adverse events in chronic coronary artery disease (CAD) patients with reduced systolic function., Methods: A total of 192 consecutive patients clinically diagnosed with chronic CAD and left ventricular ejection fraction (LVEF) ≤ 50% were finally included. Multiple strain parameters were analyzed with speckle tracking echocardiography. The composite endpoint included all-cause mortality, rehospitalization due to heart failure, myocardial infarction, and stroke., Results: Patients experiencing the endpoint showed lower LVEF, lower absolute GLS and LARS than those without events. Both GLS (AUC = 0.82 [GLS] vs. 0.58 [LVEF], p < 0.001) and LARS (AUC = 0.71 [LARS] vs. 0.58 [LVEF], p = 0.033) were superior to LVEF in predicting adverse events. Multivariate cox regression analysis showed that both GLS (hazard ratio, 0.71; 95% CI, 0.63-0.79; p < 0.001) and LARS (hazard ratio, 0.96; 95% CI, 0.93-0.98; p < 0.001) were independent predictors for the endpoint. The addition of LARS (global chi-squared, 35.7 vs. 17.4; p < 0.05), GLS (global chi-squared, 58.6 vs. 17.4; p < 0.05) or both LARS and GLS (global chi-squared, 79.6 vs. 17.4; p < 0.05) to LVEF in the prediction model significantly improved its performance. The same significant improvement was also shown in the subgroups of mild (30% < LVEF ≤ 50%) and severe (LVEF ≤ 30%) reduced systolic function., Conclusions: Regarding CAD patients with reduced LVEF, both GLS and LARS are superior to LVEF in predicting adverse events, providing significant incremental value to LVEF., (© 2024 Wiley Periodicals LLC.)

Speckle tracking echocardiography (STE) is a reliable imaging technique of recognized clinical value in several settings. This method uses the motion of ultrasound backscatter speckles within echocardiographic images to derive myocardial velocities and deformation parameters, providing crucial insights on several cardiac pathological and physiological processes. Its feasibility, reproducibility, and accuracy have been widely demonstrated, being myocardial strain of the various chambers inserted in diagnostic algorithms and guidelines for various pathologies. The most important parameters are Global longitudinal strain (GLS), Left atrium (LA) reservoir strain, and Global Work Index (GWI): based on large studies the average of the lower limit of normality are -16%, 23%, and 1442 mmHg%, respectively. For GWI, it should be pointed out that myocardial work relies primarily on non-invasive measurements of blood pressure and segmental strain, both of which exhibit high variability, and thus, this variability constitutes a significant limitation of this parameter. In this review, we describe the principal aspects of the theory behind the use of myocardial strain, from cardiac mechanics to image acquisition techniques, outlining its limitation, and its principal clinical applications: in particular, GLS have a role in determine subclinical myocardial dysfunction (in cardiomyopathies, cardiotoxicity, target organ damage in ambulatory patients with arterial hypertension) and LA strain in determine the risk of AF, specifically in ambulatory patients with arterial hypertension., (© 2024 Wiley Periodicals LLC.)

Background and Aim: Our aim was to evaluate the fluoroscopy time (FT), procedure time (PT) safety and efficacy when using intracardiac echocardiography (ICE) in comparison to transesophageal echocardiography (TEE) guidance for transcatheter closure of Ostium Secundum Atrial Septal Defect (OS-ASD)., Method: Ninety patients (n = 90) diagnosed with OS-ASD underwent transcatheter closure between March 2006 and October 2021. Fifty-seven patients were treated under ICE guidance, while 33 patients were treated under TEE guidance., Results: Mean age was 43 ± 15 years and 42 ± 10 years in the ICE and TEE groups, respectively. The majority of patients had a centrally placed defect. Median FT was 8.40 min versus 11.70 min (p < .001) in the ICE group compared to the TEE group, respectively. Median PT was 43 min versus 94 min (p < .001) in the ICE group compared to the TEE group, respectively. Both ICE and TEE provided high quality images. All interventions were completed successfully, except for one patient in the ICE group who experienced a device migration, the development of atrial tachycardia in one patient and atrial fibrillation in two patients in the ICE group which spontaneously cardioverted. There were no other complications., Conclusion: This study on a consistent cohort of patients with OS-ASD undergoing percutaneous closure suggests that use of ICE is safe and efficacious. Compared to TEE, ICE demonstrated significantly shorter FT and PT, decreasing the entire duration of the procedure and x-ray exposure. No relevant differences were observed in terms of success rate and complications., (© 2023 Wiley Periodicals LLC.)

Background: Interventions for head/neck cancer (HNC) survivors may not address their cancer‐related and general health needs. Methods: Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guided this systematic review of studies from 2000 to 2021 of interventions targeting cancer survivors treated with curative‐intent, using MEDLINE, Embase, Emcare, and PsycINFO. Interventions were categorized into domains of the Quality of Cancer Survivorship Care Framework to characterize the scope and quality of interventions. Results: We identified 28 studies for inclusion: 13 randomized and 15 non‐randomized. Most targeted surveillance/management of physical effects (n = 24) including 13 that also targeted psychosocial effects. Four studies addressed prevention/surveillance for recurrence/new cancers, one addressed health promotion/disease prevention, and one addressed chronic medical conditions. Most studies (n = 27) had medium‐high risk of bias. Conclusions: There are few high‐quality studies addressing HNC survivorship. Future rigorously designed studies should address broader areas of care, including chronic disease management and health promotion/disease prevention. [ABSTRACT FROM AUTHOR]

The diagnosis of acute myocarditis often involves several noninvasive techniques that can provide information regarding volumes, ejection fraction, and tissue characterization. In particular, echocardiography is extremely helpful for the evaluation of biventricular volumes, strain and ejection fraction. Cardiac magnetic resonance, beyond biventricular volumes, strain, and ejection fraction allows to characterize myocardial tissue providing information regarding edema, hyperemia, and fibrosis. Contemporary cardiac computed tomography angiography (CCTA) can not only be extremely important for the assessment of coronary arteries, pulmonary arteries and aorta but also tissue characterization using CCTA can be an additional tool that can explain chest pain with a diagnosis of myocarditis. [ABSTRACT FROM AUTHOR]

Aortic regurgitation (AR) is a common valvular pathology. Multimodality noninvasive cardiovascular imaging is routinely used to assess the mechanism of AR, degree, and its hemodynamic impact on the cardiovascular system. Collecting this information is crucial in establishing the prognosis and in guiding patient management and follow-up. While echocardiography remains the primary test to assess AR, a comprehensive assessment of this valvulopathy can be obtained by combining the information from different techniques. This state-of-the-art review is intended to provide an update ed overview of the applications, strengths, and limits of transthoracic echocardiography, cardiac magnetic resonance, and cardiac computed tomography in patients with AR. [ABSTRACT FROM AUTHOR]

Objective: Inadvertently ingested grill brush bristles can lodge in various locations and lead to a variety of injuries. They can also be difficult to identify and remove. Our primary objective was to perform a systematic review of cases reported in the literature, with analysis of trends in clinical presentation and success of diagnostic modalities and treatment approaches.Data Sources: Cases of reported grill brush bristle ingestion reported in PubMed, PubMed Central, and Google Scholar databases through April 30, 2021.Review Methods: Databases were searched for the following terms: ("ingestion" OR "injury" OR "barbeque" OR "BBQ" OR "grill" OR "foreign body" OR "brush" AND "wire" OR "bristle"). Data were collected on patient demographics, clinical presentation, and treatment course. Statistical analysis was performed on characteristics with low risk of confounding.Results: An overall 57 studies involving 91 patients were included. Grill brush bristles presented most commonly in the upper aerodigestive tract (48/91), followed by the abdomen (26/91) and deep neck (17/91). Computed tomography was the most accurate imaging modality for initial diagnosis, identifying 92.8% of bristles. Less invasive or adjunctive techniques such as endoscopy, intraoperative imaging, or minimally invasive surgery may be useful particularly for bristles located in the head and neck given the low rate of success of transoral surgery (66.7%).Conclusion: Although this review of retained bristle may be biased toward complex cases, retained grill brush bristles represent an underrecognized and difficult-to-manage hazard. When cases are suspected, clinicians should obtain computed tomography imaging based on presentation and tailor management appropriately. [ABSTRACT FROM AUTHOR]

Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%–2.4% in general population and it is characterized by a benign course. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) as ultimate expressions, are the most worrying. The estimated risk of SCD in MVP is between 0.2% and 1.9% per year including both MVP patients with left ventricular (LV) dysfunction due to severe MR and MVP patients without significant MR. The latter ones constitute a particular phenotype called "malignant MVP" characterized by bileaflet myxomatous prolapse, ECG repolarization abnormalities and complex VAs (c‐VAs) with polymorphic/right bundle branch block morphology (RBBB) and LV fibrosis of the papillary muscles (PMs) and inferobasal wall secondary to mechanical stretching visualized as late gadolinium enhancement (LGE) areas by cardiac magnetic resonance (CMR). In MVP, the first diagnostic approach is transthoracic echocardiography (TTE) that defines the presence of mitral annular disjunction (MAD) which seems to be associated with "arrhythmic MVP" (AMVP). From an ECG point of view, AMVP is characterized by frequent premature ventricular contractions (PVCs) arising from one or both PMs, fascicular tissue, and outflow tract, as well as by T‐wave inversion in the inferolateral leads. The aim of the present paper is to describe TTE red flags that could identify MVP patients at high risk to develop complex arrhythmias as supported by the corresponding findings of LGE‐CMR and anatomy studies. TTE could be a co‐partner in phenotyping high‐risk arrhythmic MVP patients. [ABSTRACT FROM AUTHOR]

Since the beginning of the 21st century, the fields of astronomy and astrophysics have experienced significant growth at observational and computational levels, leading to the acquisition of increasingly huge volumes of data. In order to process this vast quantity of information, artificial intelligence (AI) techniques are being combined with data mining to detect patterns with the aim of modeling, classifying or predicting the behavior of certain astronomical phenomena or objects. Parallel to the exponential development of the aforementioned techniques, the scientific output related to the application of AI and machine learning (ML) in astronomy and astrophysics has also experienced considerable growth in recent years. Therefore, the increasingly abundant articles make it difficult to monitor this field in terms of which research topics are the most prolific or novel, or which countries or authors are leading them. In this article, a text‐mining‐based scientometric analysis of scientific documents published over the last three decades on the application of AI and ML in the fields of astronomy and astrophysics is presented. The VOSviewer software and data from the Web of Science (WoS) are used to elucidate the evolution of publications in this research field, their distribution by country (including co‐authorship), the most relevant topics addressed, and the most cited elements and most significant co‐citations according to publication source and authorship. The obtained results demonstrate how application of AI/ML to the fields of astronomy/astrophysics represents an established and rapidly growing field of research that is crucial to obtaining scientific understanding of the universe. This article is categorized under:Algorithmic Development > Text MiningTechnologies > Machine LearningApplication Areas > Science and Technology [ABSTRACT FROM AUTHOR]

Background: To prevent ovarian hyperstimulation syndrome, in vitro maturation (IVM) allows the oocytes for infertility treatment without hormone therapy. Although many oocytes matured during IVM, some deficiencies in the culture conditions lead to inhibition of the growth and development of the cumulus cells and the oocyte nuclear and cytoplasmic maturation. Objectives: The challenge of improving the oocyte culture conditions prompted us to use greater omentum (GOM), full of growth factors and proteins, as a rich supplement to the base culture medium. Methods: Cumulus‐oocyte complexes were recovered from rabbits and divided into 3D and 2D conditions cultured for 12 and 24 h. In 3D cultures, the oocytes embedded in alginate containing FBS decellularized GOM. Corresponding supplements were also added in 2D conditions—maturation of the oocytes evaluated by Aceto‐Orcein, TEM, and RT‐PCR for MAP2K1 and Cdk2. Results: DNA quantification, Hoechst, and H&E staining confirmed cell depletion from GOM, and SEM showed the preservation of ultra‐architecture after decellularization. Histochemical staining methods showed appropriate extracellular matrix preservation. ELISA assessment showed retention of VEGF content. MTT assessment indicated decellularized GOM was non‐toxic. Both Aceto‐Orcein assessment and ultra‐structure study of the oocytes showed that supplementation of 2D or 3D cultures with decellularized omentum promoted oocyte maturation. Expression of MAP2K1 and Cdk2 also increased in the presence of GOM. Conclusions: GOM supplementation has a beneficial impact on oocyte maturation, probably due to the presence of growth factors and proteins. [ABSTRACT FROM AUTHOR]

Introduction: Coronary computed tomography angiography (CCTA) is known to have a high negative predictive value (NPV) in identifying coronary artery disease (CAD). This study aimed to examine whether resting echocardiographic parameters could exclude significant CAD on CCTA., Methods: We recruited 142 patients who had undergone both CCTA and echocardiography within a 3-month window. Based on the CCTA findings, patients were divided into two groups: Group A (non-significant CAD, defined as all coronary segments having <50% stenosis) and Group B (significant CAD). Resting echocardiographic parameters were compared between the two groups to identify predictors of non-significant CAD on CCTA., Results: A total 92 patients (mean age, 68 ± 13 years; males, 62%) were eligible for this study; 50 in Group A and 42 in Group B. Among the various echo parameters, left atrial volume index (LAVI) and left ventricular (LV) global longitudinal strain (GLS) were significantly lower in Group A (23.5 ± 7.6 vs. 33.6 ± 7.4 mL/m 2 , p < .001; -20.2 ± 1.8% vs. -16.8 ± 2.0%, p < .001, respectively). Analysis of the receiver operating characteristic curve revealed that the cutoff value to exclude significant CAD on CCTA was 29.0 mL/m 2 for LAVI (NPV 80.8%) and -18.1% for GLS (NPV 80.7%). The NPV increased to 95.0% when these parameters were combined (LAVI < 29.0 mL/m 2 and GLS < -18.1%)., Conclusion: The combination of resting LAVI and GLS was clinically useful in excluding significant CAD via CCTA., (© 2023 The Authors. Echocardiography published by Wiley Periodicals LLC.)

MBOAT7 is a protein anchored to endomembranes by several transmembrane domains. It has a catalytic dyad involved in remodelling of phosphatidylinositol with polyunsaturated fatty acids. Genetic variants in the MBOAT7 gene have been associated with the entire spectrum of non-alcoholic fatty liver (NAFLD), recently redefined as metabolic dysfunction-associated fatty liver disease (MAFLD) and, lately, steatotic liver disease (SLD), and to an increasing number of extrahepatic conditions. In this review, we will (a) elucidate the molecular mechanisms by which MBOAT7 loss-of-function predisposes to MAFLD and neurodevelopmental disorders and (b) discuss the growing number of genetic studies linking MBOAT7 to hepatic and extrahepatic diseases. MBOAT7 complete loss of function causes severe changes in brain development resulting in several neurological manifestations. Lower MBOAT7 hepatic expression at both the mRNA and protein levels, due to missense nucleotide polymorphisms (SNPs) in the locus containing the MBOAT7 gene, affects specifically metabolic and viral diseases in the liver from simple steatosis to hepatocellular carcinoma, and potentially COVID-19 disease. This body of evidence shows that phosphatidylinositol remodelling is a key factor for human health., (© 2023 The Authors. Liver International published by John Wiley & Sons Ltd.)

Until recently, cardiotoxicity in the setting of a malignant disease was attributed solely to the detrimental effects of chemo‐ and/or radio‐therapy to the heart. On this account, the focus was on the evaluation of well‐established cardiac biomarkers for the early detection of myocardial damage. Currently, this view has been revised. Cardiotoxicity is not restricted to a single organ but instead affects the endothelium as a whole. Indeed, it has come into light that not only cancer therapy but also malignant cells per se can impair the cardiovascular system, through a paracrine and endocrine mode of action. Even more intriguingly, a clear interplay between molecular pathways involved in cancer and cardiovascular disease has become prevalent, suggesting a common nominator that governs the pathophysiology of these two entities. Taken together, our strategy in the quest of novel biomarkers in the emerging field of cardio‐oncology should be critically reshaped. [ABSTRACT FROM AUTHOR]

Background: The study objective is to identify risk factors associated with fatigue among long‐term OPC survivors. Methods: This cross‐sectional study included disease‐free OPC survivors treated curatively between 2000 and 2013 who were surveyed from September 2015 to July 2016. The outcome variable was patient‐reported fatigue. Multivariable logistic regression was used to identify factors associated with moderate to severe fatigue. Results: Among 863 OPC survivors, 17.4% reported moderate to severe fatigue. Self‐reported thyroid problems (OR: 2.01; p = 0.003), current cigarette smoking at time of survey (OR: 3.85; p = 0.001), late lower cranial neuropathy (OR: 3.44; p = 0.002), and female sex (OR: 1.91; p = 0.010) were concurrent risk factors of reporting moderate to severe fatigue. Ipsilateral intensity‐modulated radiotherapy (OR: 0.18; p = 0.014) was associated with lower risk of reporting moderate to severe fatigue. Conclusions: Our study identified thyroid problems, smoking, and late lower cranial neuropathy as associated with moderate to severe fatigue. These findings should be further validated in prospective studies to address fatigue among OPC survivors. [ABSTRACT FROM AUTHOR]

Global climate models (GCMs) are essential for investigating climate change, but their coarse scale limits their efficacy for climate adaptation planning at the regional scales where climate impacts manifest. Dynamical downscaling of GCM outputs better resolves regional climate and thus provides improved guidance for climate policy at regional scales. Being expensive to run, downscaling uses a subset of GCMs, necessitating careful GCM selection. This evaluation identifies a suitable subset of CMIP6 GCMs for downscaling over Australia by assessing individual GCMs against three criteria: (a) performance simulating daily climate variable distributions, climate means, extremes, and modes; (b) model independence; and (c) climate change signal diversity. Over Australia, GCMs are generally biased cold (warm) for maximum (minimum) temperature, with larger biases for minimum temperature. GCMs are generally wet biased, especially over the monsoonal north, but dry biased over eastern regions. Most GCMs show larger biases for temperature and precipitation over geographically complex, heavily populated eastern regions, relative to other regions. Evaluations identify a distinct group of 11 GCMs that perform consistently poorly across climate variables, statistics, and timescales with widespread, statistically significant biases, versus 13 GCMs that show consistent adequate‐to‐good performance with substantially reduced errors. Assessment of model independence highlights the lack of independence between several high‐performing GCMs, particularly from allied modeling groups, demonstrating the importance of careful ensemble selection when making selective samples of climate space. Once GCM climate signal diversity is considered, 6–8 mid‐to‐high‐performing, independent GCMs occupy the full range of the future climate space and, thus, are suitable for dynamical downscaling over CORDEX‐Australasia. Key Points: Per‐global climate model (GCM) performances varied markedly, though the best‐performing GCMs simulated consistently well across temperature variables and statisticsAssessment of model independence highlights the lack of independence between several high‐performing GCMsSix to eight mid‐to‐high‐performing, independent GCMs capturing a broad range of the future climate space are identified as suitable for downscaling [ABSTRACT FROM AUTHOR]

Aims: Epicardial adipose tissue (EAT) is increasingly recognized as an important factor in the pathophysiology of heart failure (HF). Cardiac magnetic resonance (CMR) imaging is the gold‐standard imaging modality to evaluate EAT size, but in contrast to echocardiography, CMR is costly and not widely available. We investigated EAT thickness on echocardiography in relation to EAT volume on CMR, and we assessed the agreement between observers for measuring echocardiographic EAT. Methods and results: Patients with HF and left ventricular ejection fraction >40% were enrolled. All patients underwent CMR imaging and transthoracic‐echocardiography. EAT volume was quantified on CMR short‐axis cine‐stacks. Echocardiographic EAT thickness was measured on parasternal long‐axis and short‐axis views. Linear regression analyses were used to assess the association between EAT volume on CMR and EAT thickness on echocardiography. Intraclass correlation coefficient (ICC) was used to assess the interobserver agreement as well as the intraobserver agreement. EAT on CMR and echocardiography was evaluated in 117 patients (mean age 71 ± 10 years, 49% women and mean left ventricular ejection fraction 54 ± 7%). Mean EAT volume on CMR was 202 ± 64 mL and ranged from 80 to 373 mL. Mean EAT thickness on echocardiography was 3.8 ± 1.5 mm and ranged from 1.7 to 10.2 mm. EAT volume on CMR and EAT thickness on echocardiography were significantly correlated (junior‐observer: r = 0.62, P < 0.001, senior‐observer: r = 0.33, P < 0.001), and up to one‐third of the variance in EAT volume was explained by EAT thickness (R2 = 0.38, P < 0.001). The interobserver agreement between junior and senior observers for measuring echocardiographic EAT was modest [ICC, 0.65 (95% confidence interval (CI) 0.47–0.77], whereas the intraobserver agreement was good (ICC 0.98, 95% CI 0.84–0.99). Conclusions: There was a modest correlation between EAT volume on CMR and EAT thickness on echocardiography. Limited agreement between junior and senior observers for measuring echocardiographic EAT was observed. EAT thickness on echocardiography is limited in estimating EAT volume. [ABSTRACT FROM AUTHOR]

Aims: Cardiac implanted electronic devices (CIEDs) can detect atrial high‐rate episodes (AHREs) and challenge current management of subclinical atrial fibrillation (AF). Methods: To characterize the anatomic and functional remodeling of cardiac structures between patients with subclinical AF (SCAF) and clinical AF. The predictors for AHREs ≥6 min were also investigated. Results: We compared the atrial volume, dynamic function, and peri‐atrial fat between 104 CIEDs (AHREs = 0, n = 12; SCAF, n = 66; CIEDs with AF, n = 26) and 40 paroxysmal AF patients who were planning for catheter ablation (AF for ablation) using 256‐slice multidetector computed tomography for the duration of the AHREs. The maximal volume of the left atrium (LA) and LA appendage (LAA) were significantly smaller; the total emptying fraction (EF) and active EF of the LA and LAA were significantly better in the patients with SCAF than in those with clinical AF. Less peri‐atrial fat (p < 0.001) and a greater LAA/ascending aorta (AA) Hounsfield unit (HU) ratio (p < 0.05) were noted in the patients with SCAF. Significantly increased volume reduced the total EF of LA and LAA and a reduced LAA/AA HU ratio (0.91 ± 0.18 vs 0.98 ± 0.03 vs 0.97 ± 0.05, p < 0.05) were demonstrated in patients with AHREs ≥6 min compared to those with AHREs <6 min and without AHRE. Multivariate analysis showed the reduced LAA/AA HU ratio is an independent predictor for the development of AHREs ≥6 min. Conclusion: As compared to clinical AF, patients with SCAF show a more favorable LA remodeling process. Among the patients with device‐detected AHREs, worse LA remodeling and a reduced LAA/AA HU ratio were associated with the occurrence of AHREs ≥6 min. These findings may provide an incremental value for understanding SCAF. [ABSTRACT FROM AUTHOR]

Objective: Refeeding syndrome is a feared complication of refeeding patients with anorexia nervosa. There are now a number of controlled studies showing that refeeding with an initial high calorie count is more beneficial than cautious refeeding and is safe under continuous monitoring. However, there have yet not been studies in severe anorexia nervosa. Method: We present an observational study in two different samples. The first sample consists of those 1075 out of a total of 3230 patients with anorexia nervosa treated in our hospital within 4 years for whom a complete admission laboratory was available and who had an age of at least 18 years at admission. A risk score was calculated from the number of pathological laboratory values out of 12 parameters indicating either refeeding syndrome or health hazards related to malnutrition. The second sample was obtained from a special ward for patients with eating disorders medically at‐risk. During the period in question, 410 patients with anorexia nervosa were treated there. 142 patients had a BMI of 13 or less and at the same time a complete data set with the mentioned 12 laboratory parameters at admission and weekly in the following 4 weeks after admission. Results: The risk represented by the laboratory parameters is significantly and negatively correlated to BMI and much higher for the group of patients with a BMI below 13 than for those with a higher BMI (χ2 sig < 0.000). The 142 patients in the special care unit gain an average of more than 4.1 kg within 4 weeks on the high‐calorie diet. With this rapid weight gain, the risk score decreases highly significantly. Neither hypophosphatemia nor rhabdomyolysis is found under phosphate substitution. Hyperhydration occurred often, which manifests itself in the drop in haematocrit by the second week. Discussion: Under thorough medical surveillance, supplementation of phosphate and thiamine, and substitution of electrolytes whenever necessary rapid renutrition appeared to be save even in extremely malnourished inpatients with anorexia nervosa. As measured by the laboratory values, the health status of the severely malnourished patients improves significantly on a high‐calorie diet. Except for hyperhydration, there was no evidence of a refeeding syndrome. Key points: The risk, assessed by significant laboratory parameters, increases considerably with increasingly low weight.Rapid refeeding under medical supervision leads to rapid stabilization of health.Under these conditions, there was no evidence of a threatening refeeding syndrome.Even in extremely underweight patients with anorexia nervosa, rapid refeeding appears to significantly improve the risk profile. [ABSTRACT FROM AUTHOR]