Search

Introduction: Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making., Aim: To evaluate the diagnostic accuracy of POCUS, operated by medical students with the assistance of an AI-based tool for assessing the left ventricular ejection fraction (LVEF) of patients admitted to a cardiology department., Methods: Eight students underwent a 6-hour didactic and hands-on training session. Participants used a hand-held ultrasound device (HUD) equipped with an AI-based tool for the automatic evaluation of LVEF. The clips were assessed for LVEF by three methods: visually by the students, by students + the AI-based tool, and by the cardiologists. All LVEF measurements were compared to formal echocardiography completed within 24 hours and were evaluated for LVEF using the Simpson method and eyeballing assessment by expert echocardiographers., Results: The study included 88 patients (aged 58.3 ± 16.3 years). The AI-based tool measurement was unsuccessful in 6 cases. Comparing LVEF reported by students' visual evaluation and students + AI vs. cardiologists revealed a correlation of 0.51 and 0.83, respectively. Comparing these three evaluation methods with the echocardiographers revealed a moderate/substantial agreement for the students + AI and cardiologists but only a fair agreement for the students' visual evaluation., Conclusion: Medical students' utilization of an AI-based tool with a HUD for LVEF assessment achieved a level of accuracy similar to that of cardiologists. Furthermore, the use of AI by the students achieved moderate to substantial inter-rater reliability with expert echocardiographers' evaluation., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Ziv Dadon et al.)

We study the magnetic field response of millimeter scale fractal Sierpinski gaskets (SG) assembled of superconducting equilateral triangular patches. Directly imaged quantitative induction maps reveal hierarchical periodic filling of enclosed void areas with multiquanta magnetic flux, which jumps inside the voids in repeating bundles of individual flux quanta Φ 0 . The number N s of entering flux quanta in different triangular voids of the SG is proportional to the linear size s of the void, while the field periodicity of flux jumps varies as 1/s. We explain this behavior by modeling the triangular voids in the SG with effective superconducting rings and by calculating their response following the London analysis of persistent currents, J s , induced by the applied field H a and by the entering flux. With changing H a , J s reaches a critical value in the vertex joints that connect the triangular superconducting patches and allows the giant flux jumps into the SG voids through phase slips or multiple Abrikosov vortex transfer across the vertices. The unique flux behavior in superconducting SG patterns, may be used to design tunable low-loss resonators with multi-line high-frequency spectrum for microwave technologies., (© 2023. Springer Nature Limited.)

Since the discovery of X-rays by Roentgen in 1895, its use has been ubiquitous, from medical and environmental applications to materials sciences 1-5 . X-ray characterization requires a large number of atoms and reducing the material quantity is a long-standing goal. Here we show that X-rays can be used to characterize the elemental and chemical state of just one atom. Using a specialized tip as a detector, X-ray-excited currents generated from an iron and a terbium atom coordinated to organic ligands are detected. The fingerprints of a single atom, the L 2,3 and M 4,5 absorption edge signals for iron and terbium, respectively, are clearly observed in the X-ray absorption spectra. The chemical states of these atoms are characterized by means of near-edge X-ray absorption signals, in which X-ray-excited resonance tunnelling (X-ERT) is dominant for the iron atom. The X-ray signal can be sensed only when the tip is located directly above the atom in extreme proximity, which confirms atomically localized detection in the tunnelling regime. Our work connects synchrotron X-rays with a quantum tunnelling process and opens future X-rays experiments for simultaneous characterizations of elemental and chemical properties of materials at the ultimate single-atom limit., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Metasurfaces offer a versatile platform for engineering the wavefront of light using nanostructures with subwavelength dimensions and hold great promise for dramatically miniaturizing conventional optical elements due to their small footprint and broad functionality. However, metasurfaces so far have been mainly demonstrated on bulky and planar substrates that are often orders of magnitude thicker than the metasurface itself. Conventional substrates not only nullify the reduced footprint advantage of metasurfaces, but also limit their application scenarios. The bulk substrate also determines the metasurface dielectric environment, with potentially undesired optical effects that undermine the optical performance. Here we develop a universal polymer-assisted transfer technique to tackle this challenge by decoupling the substrate employed on the fabrication of metasurfaces from that used for the target application. As an example, Huygens' metasurfaces with 120 nm thickness in the visible range (532 nm) are demonstrated to be transferred onto a 100 nm thick freestanding SiNx membrane while maintaining excellent structural integrity and optical performance of diffraction-limited focusing. This transfer method not only enables the thinnest dielectric metalens to the best of our knowledge, but also opens up new opportunities in integrating cascaded and multilayer metasurfaces, as well as the heterogeneous integration with nonconventional substrates and various electronic/photonic devices., Competing Interests: Conflict of interest statement: The authors declare no conflicts of interest regarding this article.

Most chiral metamaterials and metasurfaces are designed to operate in a single wavelength band and with a certain circular dichroism (CD) value. Here, mid-infrared chiral metasurface absorbers with selective CD in dual-wavelength bands are designed and demonstrated. The dual-band CD selectivity and tunability in the chiral metasurface absorbers are enabled by the unique design of a unit cell with two coupled rectangular bars. It is shown that the sign of CD in each wavelength band can be independently controlled and flipped by simply adjusting the geometric parameters, the width and the length, of the vertical rectangular bars. The mechanism of the dual-band CD selection in the chiral metasurface absorber is further revealed by studying the electric field and magnetic field distributions of the antibonding and bonding modes supported in the coupled bars under circularly polarized incident light. Furthermore, the chiral resonance wavelength can be continuously increased by scaling up the geometric parameters of the metasurface unit cell. The demonstrated results will contribute to the advance of future mid-infrared applications such as chiral molecular sensing, thermophotovoltaics, and optical communication.

Objectives: Incorporating artificial intelligence (AI) into echocardiography operated by clinicians working in the emergency department to accurately assess left-ventricular ejection fraction (LVEF) may lead to better diagnostic decisions. This randomized controlled pilot study aimed to evaluate AI use as a didactic tool to improve noncardiologist clinicians' assessment of LVEF from the apical 4-chamber (A4ch) view., Methods: This prospective randomized controlled pilot study tested the feasibility and acceptability of the incorporation of AI as a didactic tool by comparing the ability of 16 clinicians who work in the emergency department to assess LVEF before and after the introduction of an AI-based ultrasound application. Following a brief didactic course, participants were randomly equally divided into an intervention and a control group. In each of the first and second sessions, both groups were shown 10 echocardiography A4ch clips and asked to assess LVEF. Following each clip assessment, only the intervention group was shown the results of the AI-based tool. For the final session, both groups were presented with a new set of 40 clips and asked to evaluate the LVEF., Results: In the "normal-abnormal" category evaluation, as related to own baseline accuracy assessment, the intervention group had an improvement in accuracy on 50 consecutive clip assessments compared with a decline in the control group (0.10 vs. -0.12, respectively, p  = 0.038). In the "significantly reduced LVEF" category, the intervention group showed significantly less decline in clip assessment as compared to the control group (-0.03 vs. -0.12, respectively, p  = 0.050)., Conclusions: A study involving AI incorporation as a didactic tool for clinicians working in the emergency department appears feasible and acceptable. The introduction of an AI-based tool to clinicians working in the emergency department improved the assessment accuracy of LVEF as compared to the control group., Competing Interests: There are no conflicts of interest on the part of any of the authors., (© 2022 The Authors. AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

One of the most common approaches for quenching single-photon avalanche diodes is to use a passive resistor in series with it. A drawback of this approach has been the limited recovery speed of the single-photon avalanche diodes. High resistance is needed to quench the avalanche, leading to slower recharging of the single-photon avalanche diodes depletion capacitor. We address this issue by replacing a fixed quenching resistor with a bias-dependent adaptive resistive switch. Reversible generation of metallic conduction enables switching between low and high resistance states under unipolar bias. As an example, using a Pt/Al 2 O 3 /Ag resistor with a commercial silicon single-photon avalanche diodes, we demonstrate avalanche pulse widths as small as ~30 ns, 10× smaller than a passively quenched approach, thus significantly improving the single-photon avalanche diodes frequency response. The experimental results are consistent with a model where the adaptive resistor dynamically changes its resistance during discharging and recharging the single-photon avalanche diodes., (© 2022. The Author(s).)

An ultra-high-vacuum compatible X-ray chopper system has been designed, constructed and integrated into the XTIP beamline at the Advanced Photon Source at Argonne National Laboratory. The XTIP beamline can operate at soft X-ray energies from 400 eV to 1900 eV while providing a focused beam down to about 10 µm × 10 µm into the synchrotron X-ray scanning tunneling microscopy (SX-STM) endstation instrument. The X-ray chopper is a critical component for separating topographic information from chemical information in SX-STM through phase-sensitive current detection. Depending on the experimental needs, the modulation frequency can be controlled from 100 Hz to 10 kHz. In addition, the chopper system is fully bakeable and can achieve a base pressure of 10 -10  mbar. Facilities for active water cooling have been designed, but passive cooling through copper braids has been shown to be sufficient at standard chopping frequencies. Using an Fe/Al 2 O 3 /CoAl(111) sample, the separation of the SX-STM current into a chemical component and a stable feedback signal is demonstrated.

Plasmon-phonon coupling between metamaterials and molecular vibrations provides a new path for studying mid-infrared light-matter interactions and molecular detection. So far, the coupling between the plasmonic resonances of metamaterials and the phonon vibrational modes of molecules has been realized under linearly polarized light. Here, mid-infrared chiral plasmonic metasurfaces with high circular dichroism (CD) in absorption over 0.65 in the frequency range of 50 to 60 THz are demonstrated to strongly interact with the phonon vibrational resonance of polymethyl methacrylate (PMMA) molecules at 52 THz, under both left-handed and right-handed circularly polarized (LCP and RCP) light. The mode splitting features in the absorption spectra of the coupled metasurface-PMMA systems under both circular polarizations are studied in PMMA layers with different thicknesses. The relation between the mode splitting gap and the PMMA thickness is also revealed. The demonstrated results can be applied in areas of chiral molecular sensing, thermal emission, and thermal energy harvesting.

In recent years, there have been numerous efforts worldwide to develop the synchrotron X-ray scanning tunneling microscopy (SX-STM) technique. Here, the inauguration of XTIP, the world's first beamline fully dedicated to SX-STM, is reported. The XTIP beamline is located at Sector 4 of the Advanced Photon Source at Argonne National Laboratory. It features an insertion device that can provide left- or right-circular as well as horizontal- and vertical-linear polarization. XTIP delivers monochromatic soft X-rays of between 400 and 1900 eV focused into an environmental enclosure that houses the endstation instrument. This article discusses the beamline system design and its performance.

Strong circular dichroism in absorption in the near-infrared wavelength range is realized by designing binary-pattern chiral plasmonic metasurfaces via the micro-genetic algorithm optimization method. The influence of geometric parameter modifications in the binary-pattern nanostructures on the circular dichroism performance is studied. The strong circular dichroism in absorption is attributed to the simultaneous excitation and field interference of the resonant modes with relative phase delay under linearly polarized incident light. This work provides a universal design method toward the on-demand properties of chiral metasurfaces, which paves the way for future applications in chemical and biological sensing, chiral imaging and spectroscopy.

Chirality plays an essential role in the fields of biology, medicine and physics. However, natural materials exhibit very weak chiroptical response. In this paper, near-infrared chiral plasmonic metasurface absorbers are demonstrated to selectively absorb either the left-handed or right-handed circularly polarized light for achieving large circular dichroism (CD) across the wavelength range from 1.3 µm to 1.8 µm. It is shown that the maximum chiral absorption can reach to 0.87 and that the maximum CD in absorption is around 0.70. The current chiral metasurface design is able to achieve strong chiroptical response, which also leads to high thermal CD for the local temperature increase. The high-contrast reflective chiral images are also realized with the designed metasurface absorbers. The demonstrated chiral metasurface absorbers can be applied in many areas, such as optical filters, thermal energy harvesting, optical communication, and chiral imaging.

The originally published version of this Article contained an error in Equation 1. The two ℏ terms were missing from this equation. This has now been corrected in the PDF and HTML versions of the Article.

The creation of energetic electrons through plasmon excitation of nanostructures before thermalization has been proposed for a wide number of applications in optical energy conversion and ultrafast nanophotonics. However, the use of "nonthermal" electrons is primarily limited by both a low generation efficiency and their ultrafast decay. We report experimental and theoretical results on the use of broadband plasmonic nanopatch metasurfaces comprising a gold substrate coupled to silver nanocubes that produce large concentrations of hot electrons, which we measure using transient absorption spectroscopy. We find evidence for three subpopulations of nonthermal carriers, which we propose arise from anisotropic electron-electron scattering within sp-bands near the Fermi surface. The bimetallic character of the metasurface strongly impacts the physics, with dissipation occurring primarily in the gold, whereas the quantum process of hot electron generation takes place in both components. Our calculations show that the choice of geometry and materials is crucial for producing strong ultrafast nonthermal electron components.The creation of energetic electrons through plasmon excitation has implications in optical energy conversion and ultrafast nanophotonics. Here, the authors find evidence for three subpopulations of nonthermal carriers which arise from anisotropic electron-electron scattering near the Fermi surface.

Aims: Left ventricular (LV) two-dimensional longitudinal strain (2DLS) analysis by echocardiography has been suggested as a useful tool for the detection of acute coronary syndromes (ACS). Our aim was to determine whether 2DLS analysis could assist in triage of patients with chest pain (CP) in the emergency department (ED)., Methods and Results: We prospectively enrolled patients presenting to the ED with CP and suspected ACS but without a diagnostic ECG or elevated troponin. An echocardiogram was performed within 24 h of CP. For each patient, a histogram of LV myocardial peak systolic strain (PSS) was generated and the value identifying the 20% worst strain values (PSS20%) was determined. A predefined value of greater than -17% was considered abnormal. 2DLS analysis was available for 605 patients (mean age 58 ± 9 years, 70% males), of which 74 (12.2%) had ACS. During a 6-month follow-up, MACE occurred in 4 (5.8%) patients with and in 3 (0.6%) without ACS. An abnormal PSS20% was present in 60/74 patients with ACS (sensitivity 81%, negative predictive value 91%), but also in 391/531 patients without ACS (specificity 26%, positive predictive value 13%). Similar results were found for global longitudinal strain (GLS). Receiver-operating characteristic curves showed an area under curve of 0.59 for PSS20% and 0.6 for GLS (P= 0.3). Independent predictors of abnormal 2DLS were male gender, body mass index, heart rate, and mean tissue Doppler e', but not ACS., Conclusion: In this large multicentre prospective study, 2DLS was not a useful tool to rule out ACS in the ED., Clinical Trial Registration: http://clinicaltrials.gov., Unique Identifier: NCT01163019., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Structural color printing based on all-aluminum plasmonic V-groove metasurfaces is demonstrated under both bright field and dark field illumination conditions. A broad visible color range is realized with the plasmonic V-groove arrays etched on an aluminum surface by simply varying the groove depth while keeping the groove period as a constant. Polarization dependent structural color printing is further achieved with interlaced V-groove arrays along both the horizontal and vertical directions. These results pave the way towards the use of an all-aluminum structural color printing platform for many practical applications such as security marking and information storage.

Neostigmine is a cholinesterase inhibitor which does not cross the blood brain barrier and a commonly used for reversal of nondepolarizing muscle relaxants. In the following case report, we present a patient who developed coronary artery spasm, after the administration of repeated doses of neostigmine. Ours is the first case to demonstrate such a longstanding coronary artery vasospasm that lasted several hours in response to neostigmine, resulting in myocardial damage and left ventricular dysfunction. We would like to draw the attention of the anesthesiologists to this rare effect that may lead to perioperative cardiac complications., Competing Interests: There are no conflicts of interest.

In an electronic triode, the electron current emanating from the cathode is regulated by the electric potential on a grid between the cathode and the anode. Here we demonstrate a triode for single quantum magnetic field carriers, where the flow of individual magnetic vortices in a superconducting film is regulated by the magnetic potential of striae of soft magnetic strips deposited on the film surface. By rotating an applied in-plane field, the magnetic strip potential can be varied due to changes in the magnetic charges at the strip edges, allowing accelerated or retarded motion of magnetic vortices inside the superconductor. Scaling down our design and reducing the gap width between the magnetic stripes will enable controlled manipulation of individual vortices and creation of single flux quantum circuitry for novel high-speed low-power superconducting electronics.

An all-metal structural color printing platform based on aluminum plasmonic metasurfaces is proposed and demonstrated with high color performance using only a one-step etching process on aluminum surface. A wide visible color range is realized with the designed metallic square-shaped disk arrays by simply adjusting the geometrical parameters of the disk etching depth, disk width and unit cell period. The demonstrated all-metal microscale structural color printing on aluminum surface offers great potential for many practical color related applications.

The degradation of intrinsic properties of graphene during the transfer process constitutes a major challenge in graphene device fabrication, stimulating the need for direct growth of graphene on dielectric substrates. Previous attempts of metal-induced transformation of diamond and silicon carbide into graphene suffers from metal contamination and inability to scale graphene growth over large area. Here, we introduce a direct approach to transform polycrystalline diamond into high-quality graphene layers on wafer scale (4 inch in diameter) using a rapid thermal annealing process facilitated by a nickel, Ni thin film catalyst on top. We show that the process can be tuned to grow single or multilayer graphene with good electronic properties. Molecular dynamics simulations elucidate the mechanism of graphene growth on polycrystalline diamond. In addition, we demonstrate the lateral growth of free-standing graphene over micron-sized pre-fabricated holes, opening exciting opportunities for future graphene/diamond-based electronics.

Novel techniques that enable reagent free detection and analysis of single cells are of great interest for the development of biological and medical sciences as well as point-of-care health service technologies. Highly sensitive and broadband radio-frequency (RF) sensors are promising candidates for such a technique. In this work, we present a highly sensitive and tunable RF sensor, which is based on interference processes and built with a 100 nm slotline structure. The highly concentrated RF fields, up to ~1.76×10 7 V/m, enable strong interactions between Giant unilamellar vesicles (GUVs) and fields for high sensitivity operations. We also provide two modeling approaches to extract cell dielectric properties from measured scattering parameters. GUVs of different molecular compositions are synthesized and analyzed with the RF sensor at ~2 GHz, ~2.5 GHz, and ~2.8 GHz with an initial | S 21 | min of ~-100 dB. Corresponding GUV dielectric properties are obtained. A one-dimensional scanning of single GUV is also demonstrated.

Localized spectroscopy with simultaneous topographic, elemental and magnetic information is presented. A synchrotron X-ray scanning tunneling microscope has been employed for the local study of the X-ray magnetic circular dichroism at the Fe L2,3-edges of a thin iron film grown on Cu(111). Polarization-dependent X-ray absorption spectra have been obtained through a tunneling smart tip that serves as a photoelectron detector. In contrast to conventional spin-polarized scanning tunneling microscopy, X-ray excitations provide magnetic contrast even with a non-magnetic tip. Intensity variations in the photoexcited tip current point to chemical variations within a single magnetic Fe domain.

A high-resolution and angle-insensitive structural color generation platform is demonstrated based on triple-layer aluminum-silica-aluminum metamaterials supporting surface plasmon resonances tunable across the entire visible spectrum. The color performances of the fabricated aluminum metamaterials can be strongly enhanced by coating a thin transparent polymer layer on top. The results show that the presence of the polymer layer induces a better impedance matching for the plasmonic resonances to the free space so that strong light absorption can be obtained, leading to the generation of pure colors in cyan, magenta, yellow and black (CMYK) with high color saturation.

We report a structural color printing platform based on aluminum plasmonic metamaterials supporting near perfect light absorption and narrow-band spectral response tunable across the visible spectrum to realize high-resolution, angle-insensitive color printing with high color purity and saturation. Additionally, the fabricated metamaterials can be protected by a transparent polymer thin layer for ambient use with further improved color performance. The demonstrated structural color printing with aluminum plasmonic metamaterials offers great potential for relevant applications such as security marking and information storage.

Near-field optical techniques exploit light-matter interactions at small length scales for mechanical sensing and actuation of nanomechanical structures. Here, we study the optical interaction between two mechanical oscillators--a plasmonic nanofocusing probe-tip supported by a low frequency cantilever, and a high frequency nanomechanical resonator--and leverage their interaction for local detection of mechanical vibrations. The plasmonic nanofocusing probe provides a confined optical source to enhance the interaction between the two oscillators. Dynamic perturbation of the optical cavity between the probe-tip and the resonator leads to nonlinear modulation of the scattered light intensity at the sum and difference of their frequencies. This double-frequency demodulation scheme is explored to suppress unwanted background and to detect mechanical vibrations with a minimum detectable displacement sensitivity of 0.45 pm/Hz(1/2), which is limited by shot noise and electrical noise. We explore the demodulation scheme for imaging the bending vibration mode shape of the resonator with a lateral spatial resolution of 20 nm. We also demonstrate the time-resolved aspect of the local optical interaction by recording the ring-down vibrations of the resonator at frequencies of up to 129 MHz. The near-field optical technique is promising for studying dynamic mechanical processes in individual nanostructures.

It is widely believed that the reflection minimum in a Kretschmann-Raether experiment results from direct coupling into surface plasmon polariton modes. Our experimental results provide a surprising discrepancy between the leakage radiation patterns of surface plasmon polaritons (SPPs) launched on a layered gold/germanium film compared to the K-R minimum, clearly challenging this belief. We provide definitive evidence that the reflectance dip in K-R experiments does not correlate with excitation of an SPP mode, but rather corresponds to a particular type of perfectly absorbing (PA) mode. Results from rigorous electrodynamics simulations show that the PA mode can only exist under external driving, whereas the SPP can exist in regions free from direct interaction with the driving field. These simulations show that it is possible to indirectly excite propagating SPPs guided by the reflectance minimum in a K-R experiment, but demonstrate the efficiency can be lower by more than a factor of 3. We find that optimal coupling into the SPP can be guided by the square magnitude of the Fresnel transmission amplitude.

Near-infrared epsilon-near-zero (ENZ) metamaterial slabs based on silver-germanium (Ag-Ge) multilayers are experimentally demonstrated. Transmission, reflection and absorption spectra are characterized and used to determine the complex refractive indices and the effective permittivities of the ENZ metamaterial slabs, which match the results obtained from both the numerical simulations and the optical nonlocalities analysis. A rapid post-annealing process is used to reduce the collision frequency of silver and therefore decrease the optical absorption loss of multilayer metamaterial slabs. Furthermore, multilayer grating structures are studied to enhance the optical transmission and also tune the location of ENZ wavelength. The demonstrated near-infrared ENZ multilayer metamaterial slabs are important for realizing many exotic applications, such as phase front shaping and engineering of photonic density of states.

Aims: Assessing the quality of wall motion (WM) on echocardiograms remains a challenge. Previously, we validated an automated application used by experienced echocardiographers for WM classification based on longitudinal two-dimensional (2D) strain. The aim of this study was to show that the use of this automatic application was independent of the user's experience., Methods and Results: We compared the WM classifications obtained by the application when used by 12 highly experienced readers (Exp-R) vs. 11 inexperienced readers (InExp-R). Both classifications were compared with expert consensus classifications using the standard visual method. Digitized clips of cardiac cycles from three apical views in 105 patients were used for these analyses. Reproducibility of both groups was high (overall intra-class correlation coefficient: InExp-R = 0.89, Exp-R = 0.83); the lowest was noted for hypokinetic segments (InExp-R = 0.79, Exp-R = 0.72). InExp-R scores were concordant with Exp-R mode scores in 88.8% of segments; they were overestimated in 5.8% and underestimated in 3.2%. The sensitivity, specificity, and accuracy of InExp-R vs. Exp-R for classifying segments as normal/abnormal were identical (87, 85, and 86%, respectively)., Conclusion: Classification of WM from apical views with an automatic application based on longitudinal 2D strain by InExp-R vs. Exp-R was similar to visual classification by Exp-R. This application may be useful for inexperienced echocardiographers/technicians and may serve as an automated 'second opinion' for experienced echocardiographers.

Background: Identification and quantification of segmental left ventricular wall motion abnormalities on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain., Methods and Results: Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers. Visual segmental scores (VSS) and peak systolic longitudinal strain were assigned to each of 18 segments per patient. Ranges of peak systolic longitudinal strain that best fit VSS (by receiver operating characteristic analysis) were used to generate automatic segmental scores (ASS). Comparisons of ASS and VSS were performed on 1952 analyzable segments. There was agreement of wall motion scores between both methods in 89.6% of normal, 39.5% of hypokinetic, and 69.4% of akinetic segments. Correlation between methods was r=0.63 (P<0.0001). Interobserver and intraobserver reliability using interclass correlation for scoring segmental wall motion into 3 scores by ASS was 0.82 and 0.83 and by VSS 0.70 and 0.69, respectively. Compared with VSS (majority rule), ASS had a sensitivity, specificity, and accuracy of 87%, 85%, and 86%, respectively. ASS and VSS had similar success rates for correct identification of wall motion abnormalities in territories supplied by culprit arteries. VSS had greater specificity and positive predictive values, whereas ASS had higher sensitivity and negative predictive values for identifying the culprit artery., Conclusions: Automatic quantification of wall motion on echocardiograms by this tool performs as well as visual analysis by experienced echocardiographers, with a greater reliability and similar agreement to angiographic findings.

Background: Cerebroavascular complications after percutaneous coronary interventions, although rare, need immediate diagnostic and treatment in order to minimize the possible sequelae., Case Report: At the end of a percutaneous coronary intervention a 63-year old man, long standing migraineur, developed severe headache, confusion, nausea, photophobia, slow speech and left hemiparesis. In the presence of hyperdensity of the right parietal area in the brain CT, he was suspected to suffer from intracerebral hemorrhage, and treatment with platelet glycoprotein IIb/IIIa inhibitors was immediately stopped. Revision of the CT and disappearance of the clinical and radiological signs were concordant with the diagnosis of intraparenchymal extravasation of the contrast media., Conclusions: We report a very rare complication of contrast media after coronary angiography with extravasation unilaterally in the anterior circulation. Recognition of this complication can avoid unnecessary investigations.

Background: Prior studies have suggested that women are at higher risk for morbidity and mortality during coronary angioplasty, although long-term prognosis is similar after successful procedures., Objectives: To examine the role of gender in coronary stenting, including immediate procedural success as well as early and late outcomes., Methods: The study group comprised 560 consecutive patients (119 women and 441 men) who had undergone stenting over a 3 year period., Results: The indications for coronary stenting were similar among women and men, and stents were successfully deployed at similar rates without complications (92 vs. 90% respectively). Cardiac death or myocardial infarction within 30 days of the procedure was observed in 5% of women and men, whereas none of the women, compared to 1.4% of men, had early revascularization. Bleeding complications occurred in 4% of women and 2% of men. During 10 +/- 2.8 months of follow-up, 58% of women and men underwent repeat cardiac catheterization, revealing similar rates of restenosis, 36 vs. 32% respectively. During the study period, 3.3% of women as compared to 0.9% of men had a cardiac death (not significant). Cardiac death or myocardial infarction was observed in 7% of women and 8% of men, and the combined endpoint of death, myocardial infarction or revascularization, was noted in 24% and 26% respectively. Multivariate Cox analyses of the clinical, angiographic and procedural characteristics revealed that multiple stent deployment was the only predictor of major adverse cardiac event among men, whereas none of these characteristics predicted outcome in women., Conclusion: Coronary stenting is performed with similar success rates among women and men, with similar restenosis rates as well as early and late major adverse cardiac events.

Aims: This study investigated the clinical and physiological significance of the dynamic left ventricle outflow gradient observed in some patients during dobutamine stress echocardiography., Methods: Three hundred and ninety-four consecutive patients completed dobutamine stress echocardiography using Doppler echocardiography to assess the presence of myocardial ischaemia and left ventricular outflow gradient. The prevalence of left ventricular outflow gradient was evaluated and correlated with echocardiographic and clinical findings. Fifteen patients with left ventricular outflow gradient during dobutamine infusion underwent exercise echocardiography for appearance of left ventricular outflow gradient., Results: Sixty-nine of 394 (17.5%) patients developed a left ventricular outflow gradient of more than 36 mmHg. In nine of them (13%) the anterior mitral valve leaflet had a systolic anterior motion. In 60 of the 69 patients (87%) there was a dynamic obstruction at the level of the papillary muscles. The mean intracavitary gradient was 75.4 (range 36-175) mmHg. There was no correlation between the presence or absence of a dobutamine stress echocardiography-induced left ventricle outflow gradient and chest pain or shortness of breath. In patients who developed a left ventricular outflow gradient ischaemic wall motion abnormalities occurred at a significantly lower frequency during dobutamine stress echocardiography (2.9 vs 16.4% P<0.001). None of the 15 patients who underwent exercise echocardiography developed significant left ventricular outflow gradient., Conclusion: Left ventricular outflow gradient occurs occasionally during dobutamine stress echocardiography examination. Its presence is of no physiological or clinical significance.