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Introduction Temporomandibular-joint osteoarthritis (TMJOA) management is a major challenge. Minimally invasive therapies (based mainly on injections) have been developed to increase local efficacy and limit adverse systemic effects. However, the requirement for repeat injections due to a short duration of action and expensive healthcare costs have pushed researchers to develop, via tissue engineering, drug-delivery systems (DDSs). In this literature systematic review, we aim to provide an overview of studies that tested DDSs on a TMJOA model. Material and methods We searched on PubMed for articles published from November 1965 to March 2021 on DDSs using a TMJOA model. We highlighted the different DDSs and the active molecule employed. Route of drug administration, model type, test duration, and efficacy duration were assessed. To evaluate the quality of each study, a protocol bias was tested using QUADAS-2™. Results Of the 10 studies that were full text-screened, four used a poly(lactic-co-glycolic acid)-based delivery system. The other DDSs employed chitosan-based hydrogels, microneedles patches, nanostructured lipid carriers, or poloxamer micelles. Hyaluronic acid, nonsteroidal anti-inflammatory drugs, and analgesics were used as active molecules in five studies. The main way to administer DDSs was intra-articular injection and the most used model was the rat. Discussion Various DDSs and active molecules have been studied on a TMJOA model that could aid TMJOA management. Further works using longer test durations are necessary to validate these advances.

Cycling has grown in popularity over the past 20 to 30 years, serving as transportation, fitness, and sport. Cycling is unique for several reasons: it is a non-weight-bearing sport, nearly all of the motion is in the sagittal plane, and it is one of the only sports where an individual remains attached to a machine for a long duration. As such, the cycling athlete has unique needs compared with other endurance-based athletes. The complex biomechanical interaction of bicycle and rider requires a systematic process for assessment, which provides the framework for understanding, evaluating, and treating overuse injury in cyclists.

[EN] Objective To model the evolution of peak temperature and volume of damaged esophagus during and after radiofrequency (RF) ablation using low power-moderate duration (LPMD) versus high power-short duration (HPSD) or very high power-very short duration (VHPVSD) settings. Methods An in silico simulation model of RF ablation accounting for left atrial wall thickness, nearby organs and tissues, as well as catheter contact force. The model used the Arrhenius equation to derive a thermal damage model and estimate the volume of esophageal damage over time during and after RF application under conditions of LPMD (30 W, 20 s), HPSD (50 W, 6 s), and VHPVSD (90 W, 4 s). Results There was a close correlation between maximum peak temperature after RF application and volume of esophageal damage, with highest correlation (R-2 = 0.97) and highest volume of esophageal injury in the LPMD group. A greater increase in peak temperature and greater relative increase in esophageal injury volume in the HPSD (240%) and VHPSD (270%) simulations occurred after RF termination. Increased endocardial to esophageal thickness was associated with a longer time to maximum peak temperature (R-2 > 0.92), especially in the HPSD/VHPVSD simulations, and no esophageal injury was seen when the distances were >4.5 mm for LPMD or >3.5 mm for HPSD. Conclusion LPMD is associated with a larger total volume of esophageal damage due to the greater total RF energy delivery. HPSD and VHPVSD shows significant thermal latency (resulting from conductive tissue heating after RF termination), suggesting a requirement for fewer esophageal temperature cutoffs during ablation., Ministerio de Ciencia, Innovación y Universidades, Grant/Award Number: RTI2018-094357-B-C21

The ideal length of podcasts for undergraduate medical education is unclear. Although many medical schools post full-lecture podcast recordings, there is increasing evidence that podcasts of shorter duration may be a more effective educational tool. Data on podcast utilization for psychiatry education in particular remain limited. This study aimed to compare traffic statistics (views and downloads) of both moderate- and long-duration podcasts. Resident-driven, 5- to 15-min, moderate-duration audiovisual podcasts (“summary podcasts”) were created to supplement the existing full-lecture podcast recordings (“long podcasts”) during the 22-day University of Calgary medical school pre-clerkship psychiatry curriculum from November to December 2019. The authors compared traffic statistics including number of views and downloads of summary podcasts against long podcasts. Six lectures during the curriculum had both long podcasts and summary podcasts available to students. Overall, there was no statistically significant difference between the mean combined views and downloads of the summary podcasts compared to the long podcasts. When looking at views and downloads across the span of the curriculum, the long podcasts were predominantly accessed in the days following the lecture, with the summary podcasts being accessed more frequently in the days preceding the final examination. This study suggests that both long podcasts and summary podcasts were accessed by students. The differing patterns of when each type of podcast was accessed may indicate a preference for the summary podcasts being used as review tools, rather than as a primary means of learning the material.

Objective The aim of this study was to investigate cases with ocular complications associated with intravesical BCG therapy in terms of clinical features, demographic features and type of ocular involvement. Methods PubMed database was scanned for relevant publications using the keywords. Thirty-seven publications and 147 reported cases were identified related to the development of ocular complications due to intravesical BCG treatment. Results As a result of the analysis performed according to eye involvement, there were 17 cases of conjunctivitis, 7 uveitis, and 5 endophthalmitis. Only 27 (18.3%) cases were of primary ocular involvement and Reiter's syndrome was present in 120 (81.6%) of all cases. Conclusions Most of the side-effects of BCG therapy are minor and of short duration. Although rare, it has been reported that potentially serious ocular complications can develop after treatment. Physicians must keep these facts in mind and be alert to the development of ocular symptoms following BCG therapy.

Background: Application of high power radiofrequency (RF) energy for a short duration (HPSD) to isolate pulmonary vein (PV) is an emerging technique. But power and duration settings are very different across different centers. Moreover, despite encouraging preclinical and clinical data, studies measuring acute effectiveness of various HPSD settings are limited. Methods: Twenty-five consecutive patients with symptomatic atrial fibrillation (AF) were treated with pulmonary vein isolation (PVI) using HPSD. PVI was performed with a contact force catheter (Thermocool SF Smart-Touch) and Carto 3 System. The following parameters were used: energy output 50 W, target temperature 43°C, irrigation 15 mL/min, targeted contact force of > 10 g. RF energy was applied for 6–10 s. Required minimal interlesion distance was 4 mm. Twenty minutes after each successful PVI adenosine provocation test (APT) was performed by administrating 18 mg adenosine to unmask dormant PV conduction. Results: All PVs (100 PVs) were successfully isolated. RF lesions needed per patient were 131 ± 41, the average duration for each RF application was 8.1 ± 1.7 s. Procedure time was 138 ± 21 min and average of total RF energy duration was 16.3 ± 5.2 min and average amount of RF energy was 48209 ± 12808 W. APT application time after PVI was 31.1 ± 8.3 min for the left sided PVs and 22.2 ± 4.6 min (p = 0.005) for the right sided PVs. APT was transiently positive in 18 PVs (18%) in 8 (32%) patients. Conclusions: Pulmonary vein isolation with high power for 6–10 s is feasible and shortens the procedure and ablation duration. However, acute effectiveness of the HPSD seems to be lower than expected. Further studies combining other ablation parameters are needed to improve this promising technique.

Cephalad fluid shifts in space have been hypothesized to cause the spaceflight-associated neuro-ocular syndrome (SANS) by increasing the intracranial-ocular translaminal pressure gradient. Lower body negative pressure (LBNP) can be used to shift upper-body blood and other fluids toward the legs during spaceflight. We hypothesized that microgravity would increase jugular vein volume (JVvol), portal vein cross-sectional area (PV), and intracranial venous blood velocity (MCV) and that LBNP application would return these variables toward preflight levels. Data were collected from 14 subjects (11 males) before and during long-duration International Space Station (ISS) spaceflights. Ultrasound measures of JVvol, PV, and MCV were acquired while seated and supine before flight and early during spaceflight at day 45 (FD45) and late at day 150 (FD150) with and without LBNP. JVvol increased from preflight supine and seated postures (46 ± 48% and 646 ± 595% on FD45 and 43 ± 43% and 702 ± 631% on FD150, P < 0.05), MCV increased from preflight supine (44 ± 31% on FD45 and 115 ± 116% on FD150, P < 0.05), and PV increased from preflight supine and seated (51 ± 56% on FD45 and 100 ± 74% on FD150, P < 0.05). Inflight LBNP of −25 mmHg restored JVvol and MCV to preflight supine level and PV to preflight seated level. Elevated JVvol confirms the sustained neck-head blood engorgement inflight, whereas increased PV area supports the fluid shift at the splanchnic level. Also, MCV increased potentially due to reduced lumen diameter. LBNP, returning variables to preflight levels, may be an effective countermeasure. NEW & NOTEWORTHY Microgravity-induced fluid shifts markedly enlarge jugular and portal veins and increase cerebral vein velocity. These findings demonstrate a marked flow engorgement at neck and splanchnic levels and may suggest compression of the cerebral veins by the brain tissue in space. LBNP (−25 mmHg for 30 min) returns these changes to preflight levels and, thus, reduces the associated flow and tissue disturbances.

Background Concentration and physical strength are essential for the long duration of hair transplant surgery. Because both the patient and the doctor must maintain certain postures for long periods, the importance of ergonomics cannot be understated. Aims To review the devices, instruments, and techniques developed for ergonomic follicular unit excision surgery, to present our experience with various ergonomic modifications, and to evaluate the effectiveness of the related devices, novel concepts, and methods. Methods We evaluated the scientific evidence supporting the ideas, methods, devices, and systems to help create a better ergonomic environment, and we investigated how these elements can be fine-tuned to improve efficiency when performing follicular unit excision graft harvesting. Results Through innovative methods, ideas, devices, and instruments, the authors achieved a high-quality ergonomic environment for performing follicular unit excision. Conclusion Follicular unit excision is a widely used technique in hair restoration surgery. However, follicular unit excision is a very laborious and time-consuming procedure and mandates the best ergonomic conditions for both the surgeon and the patient. Therefore, it is crucial that the physician understands and appropriately adopts the various means and techniques to provide an ergonomic environment.

We propose herein a mathematical model to predict the COVID-19 evolution and evaluate the impact of governmental decisions on this evolution, attempting to explain the long duration of the pandemic in the 26 Brazilian states and their capitals well as in the Federative Unit. The prediction was performed based on the growth rate of new cases in a stable period, and the graphics plotted with the significant governmental decisions to evaluate the impact on the epidemic curve in each Brazilian state and city. Analysis of the predicted new cases was correlated with the total number of hospitalizations and deaths related to COVID-19. Because Brazil is a vast country, with high heterogeneity and complexity of the regional/local characteristics and governmental authorities among Brazilian states and cities, we individually predicted the epidemic curve based on a specific stable period with reduced or minimal interference on the growth rate of new cases. We found good accuracy, mainly in a short period (weeks). The most critical governmental decisions had a significant temporal impact on pandemic curve growth. A good relationship was found between the predicted number of new cases and the total number of inpatients and deaths related to COVID-19. In summary, we demonstrated that interventional and preventive measures directly and significantly impact the COVID-19 pandemic using a simple mathematical model. This model can easily be applied, helping, and directing health and governmental authorities to make further decisions to combat the pandemic.

Purpose: To characterize the acute effects of a long-duration adventure race on knee extensor (KE) fatigue and the knee functional ratio in adolescent athletes. Methods: Twenty trained male adolescents (aged 14–17 y) performed an adventure race of 68.5 km. Maximal voluntary isometric contraction (MVIC) KE and knee flexor torques were measured before and immediately after the race. Central and peripheral components of neuromuscular fatigue were quantified from the maximal voluntary activation level and the doublet peak torque (Tw100), respectively. The peak eccentric knee flexor torque to concentric KE torque ratio was also measured to determine functional ratio. Results: The race completion time was 05:38 (00:20) hours. Significant reductions in MVICKE (−14.7%, P KF (−17.0%, P P 100 remained unchanged. Peak eccentric knee flexor torque decreased 16.0% (P P Conclusion: The adventure race induced a moderate fatigue, which was mainly explained by central factors without significant peripheral fatigue. However, particular attention should be paid to the knee muscular imbalance incurred by the race, which could increase the risk of ligament injury in adolescent athletes.

Background The typical natural history of optic neuritis is subjected to important exceptions. Recognition of these exceptions has led to valuable insights regarding specific etiologies of optic neuritis. Exceptions to the natural history of recovering optic neuritis are well-defined (e.g., chronic relapsing inflammatory optic neuropathy), but exceptions to the natural history of evolving optic neuritis are less so. Methods Medical records of patients illustrating an atypical course of evolving optic neuritis were reviewed in a retrospective manner. Each patient was treated by at least one of the authors. Results Four patients were identified who illustrated an atypical natural history of incipient optic neuritis. Diagnoses included idiopathic optic neuritis, seropositive neuromyelitis optica spectrum disease, anti-myelin oligodendrocyte glycoprotein antibody disease, and multiple sclerosis in 1 patient each. Features of interest included an atypical temporal relationship between development of pain and onset of clinical optic neuropathy, an unusually protracted duration of pain, and an unusually long duration of worsening optic neuropathy before stabilization. Conclusions This case series illustrates the substantial clinical heterogeneity which may be observed in the evolution of optic neuritis. The temporal relationship between development of pain and onset of clinical optic neuropathy, the duration of pain, and duration of worsening optic neuropathy before stabilization are all subjected to significant variability. Although most patients with optic neuritis present with painful vision loss which progresses over 1 week or less, careful attention to the exceptions described herein may facilitate earlier recognition of diagnostically challenging cases.

INTRODUCTION Ablation index (AI)-guided ablation according to the CLOSE protocol is very effective in terms of chronic pulmonary vein isolation (PVI). However, the optimal radiofrequency (RF) power remains controversial. Here, we thought to investigate the efficiency and safety of an AI-guided fixed circumferential 50 W high-power short-duration (HPSD) PVI using the CLOSE protocol. METHODS AND RESULTS In a single-center trial, 40 patients underwent randomized PVI using AI-guided ablation without esophageal temperature monitoring. In 20 patients a CLOSE protocol guided fixed 50 W HPSD was followed irrespective of the anatomical localization. Twenty subjects were treated according to the CLOSE protocol with standard power settings (20 W posterior and 40 W roof and anterior wall). In addition, 80 consecutive patients were treated according to the HPSD protocol to gather additional safety data. All patients underwent postprocedural esophagogastroduodenoscopy to reveal esophageal lesions (EDELs). The mean total procedural time was 80.3 ± 22.5 in HPSD compared to control 109.1 ± 27.4 min (p

The high power short duration (HPSD) approach was hoped to further improve the efficacy and safety in radiofrequency ablation of atrial fibrillation (AF), compared with Low power long duration (LPLD). However, the conclusion was controversial based on the previous limited data. The aim of this meta-analysis was to evaluate whether the clinical benefits of HPSD are superior to that of LPLD.The PubMed, OVID, the Cochrane Library, and Elsevier's ScienceDirect databases were searched for clinical studies to compare HPSD and LPLD approach by simple search strings benefiting to a wider screened scope.Fifteen trials with 3255 patients were included in this analysis. Pooled analyses suggested that HPSD was associated with a lower recurrence of atrial tachyarrhythmias (ATAs) at 1-year follow-up (OR: 0.49; 95% CI: 0.35 to 0.67,The HPSD approach was associated with decreasing post-ablation AF recurrence in the 1-year follow-up, ETI, acute PVR (increasing FPI correspondingly), procedural time, ablation number for PVI and fluoroscopy time, benefitted to improve clinical outcomes and procedural process with improved safety.

Restriction spectrum imaging-magnetic resonance imaging is a short duration enhanced diffusion-weighted technique that seeks to standardize sequences and predict upgrading. We test this technology for active surveillance biopsies. Our objective is to investigate the utility of restriction spectrum imaging-magnetic resonance imaging to improve upgrading detection in a prostate cancer active surveillance cohort.We prospectively enrolled men on active surveillance undergoing repeat biopsy from January 2016 to June 2019. Subjects underwent prostate multiparametric magnetic resonance imaging and restriction spectrum imaging-magnetic resonance imaging reviewed by a urological radiologist for PI-RADS® scored lesions, followed by magnetic resonance imaging-guided prostate biopsy by a urologist. Restriction spectrum imaging-magnetic resonance imaging analysis with proprietary research software (CorTechs Labs, San Diego, California) generated a restricted signal map. We compared the restricted signal map and apparent diffusion coefficient values using T-test, ANOVA, and logistic regression analyses for prediction of upgrading.Of 123 enrolled men we identified 74 restriction spectrum imaging-magnetic resonance imaging regions of interest (targeted lesions) in 110 subjects, with 105 subjects completing biopsy. The restricted signal map was significant per PI-RADS score for true-positive lesion detection (mean difference 28, SD 0.7, p=0.001), and better than apparent diffusion coefficient (mean difference -15, SD 55, p=0.6). Restriction spectrum imaging generated restricted signal map values50 improved sensitivity, specificity, positive predictive value and negative predictive value (81.0%, 81.8%, 54.2% and 94.2%) over PI-RADS ≥3 (71.4%, 38.9%, 23.7% and 83.7%, respectively) for Gleason upgrading. Overall restriction spectrum imaging is able to improve the AUC of 0.70 (95% CI 0.49-0.92, p=0.03) to 0.90 (95% CI 0.82-0.98, p0.001).Restriction spectrum imaging-magnetic resonance imaging enhances the standard PI-RADS system by providing a noninvasive radiological biomarker to predict upgrading in active surveillance.

Background. The aim of this study is to present the early results of hip joint arthroplasty with the EXCEPTION anatomical stem (BIOMET). Materials and methods. The study enrolled 173 patients (110 women and 63 men) who underwent a total of 190 hip joint arthroplasties with the EXCEPTION anatomical stem. The mean age of the patients at surgery was 58.2 years (range: 28-82 years). The mean follow-up period was 7.3 years (range: 5-10.1 years). Results. Pre-operative Merle d’Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 131 cases, good in 39, satisfactory in 13 and poor in 7 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 14 cases (7.4%). According to the Kaplan-Meier estimator, 5 years’ survival probability was 96.31% for the whole implant and 99.47% for the stem alone. Conclusions. 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the EXCEPTION anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the relatively short duration of follow-up, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

In 1868, Karl Vierordt discovered one type of errors in time perception-an overestimation of short duration and underestimation of long durations, known as Vierordt's law. Here we reviewed the original study in its historical context and asked whether Vierordt's law is a result of an unnatural experimental randomization protocol. Using iterative Bayesian updating, we simulated the original results with high accuracy. Importantly, the model also predicted that a slowly changing random-walk sequence produces less central tendency than a random sequence with the same durations. This was validated by a duration reproduction experiment from two sequences (random and random walk) with the same sampled distribution. The results showed that trial-wise variation influenced the magnitude of Vierordt's law. We concluded that Vierordt's law is caused by an unnatural yet widely used experimental protocol.

s Background This study aimed to clarify the interrelationship and additive effects of contact force (CF), power and application time in both conventional and high-power short-duration (HPSD) settings. Methods Among 38 patients with paroxysmal atrial fibrillation who underwent first-time pulmonary vein isolation, 787 ablation points were collected at the beginning of the procedure at separate sites. Energy was applied for 60 s under power outputs of 25, 30 or 35 W (conventional group), or 10 s when using 50 W (HPSD group). An impedance drop (ID) of 10 Ω was regarded as a marker of adequate lesion formation. Results ID ≥ 10 Ω could not be achieved with CF < 5 g under any power setting. With CF ≥ 5 g, ID could be enhanced by increasing power output or prolonging ablation time. ID for 30 and 35 W was greater than for 25 W (p < 0.05). Ablation with 35 W resulted in greater ID than with 30 W only when CF of 10–20 g was applied for 20–40 s (p < 0.05). Under the same power output, ID increased with CF level at different time points. The higher the CF, the shorter the time needed to reach ID of 10 Ω and maximal ID. ID correlated well with ablation index under each power, except for lower ID values at 25 W. ID with 50 W for 10 s was equivalent to that with 25 W for 40 s, but lower than that with 30 W for 40 s or 35 W for 30 s. Conclusions CF of at least 5 g is required for adequate ablation effect. With CF ≥ 5g, CF, power output, and ablation time can compensate for each other. Time to reach maximal ablation effect can be shortened by increasing CF or power. The effect of HPSD ablation with 50 W for 10 s is equivalent to conventional ablation with 25 W for 40 s and 30–35 W for 20–30 s in terms of ID.

Purpose Coronary sinus-related arrhythmias are common; however, it is difficult to perform radiofrequency (RF) ablation at these sites efficiently and safely. High-power, short-duration ablation (HPSD) is a proven alternative strategy for pulmonary vein isolation (PVI); whether it can be applied to ablation of the coronary sinus is unknown. The purpose of this preliminary study was to evaluate the feasibility and safety of HPSD ablation in the coronary sinus. Methods Firstly, we demonstrated 4 clinical cases of 3 types of arrhythmias who had unsuccessful ablation with standard power initially, but received successful ablations with HPSD. Secondly, RF ablation was performed in the coronary sinus ostium (CSO) and middle cardiac vein (MCV) of 4 in vitro swine hearts. Two protocols were compared: HPSD (45 W/5 S×5 rounds) and a conventional strategy that used low-power, long-duration ablation (LPLD: 25 W/10 S ×5 rounds). The total duration of HPSD protocol was 25 s, and which of LPLD was 50 s. Results A total of 28 lesions were created. HPSD can produce longer, wider, deeper, and larger lesions than LPLD. This difference was more pronounced when the ablation was in the MCV. One instance of steam pop occurred during LPLD in the MCV. Conclusions HPSD is an effective alternative strategy for ablation in coronary sinus according to clinical applications and preliminary animal study. However, the safety needs to be further evaluated based on more animal and clinical studies.

The feasibility of pancreas transplantation (PT) in older recipients remains a matter of debate. We examined the influence of recipient age on PT outcomes and identified the prognostic factors for older recipients. We compared the outcomes of PT in recipients aged

Treatment of symptomatic atrial fibrillation has seen important changes in the past decades. Advancements have especially been made in the field of non-pharmacological treatment of this disease. Patients in whom a rhythm control strategy is chosen the place of catheter ablation has become more frontline therapy in the past years. The procedure itself has also seen changes in technologies that can be used, either using point-by-point radiofrequency or one of the single-shot techniques. One of the major limitations that remain is that re-do procedures are often necessary due to incomplete pulmonary vein isolation and/or atrial fibrillation being initiated by other mechanisms than pulmonary vein triggers. Therefore, there is further need for developing ablation tools that reproducibly isolate the pulmonary vein transmurally. Furthermore, addressing the underlying conditions before and after catheter ablation has been shown to be of great importance. In this review, we will give an overview of the evolution of catheter ablation, highlight the latest technologies and their future endeavours, and lifestyle modifications are being discussed as part of the catheter ablation strategy.

Study Objective To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls who presented to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Design Retrospective cohort study. Setting Pediatric and adolescent gynecology clinic at a tertiary care children's hospital. Participants One hundred eighty-two premenarchal patients ages 2-14 years who presented to a pediatric gynecology specialty clinic with vulvar complaints and who were evaluated with a yeast and/or bacterial culture. Interventions None. Main Outcome Measures Chronic and short-duration vulvar symptoms, microbiology, and diagnosis. Results Patients with chronic symptoms were more likely to present with itching (59/102 (57.8%) vs 34/80 (42.5%); P = .04), redness or rash (53/102 (52.0%) vs 22/80 (27.5%); P = .0009), and discomfort (59/102 (57.8%) vs 30/80 (37.5%); P = .006), compared with patients with short-duration symptoms. Overall, 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared with those with short-duration symptoms (53/102 (52.0%) vs 28/80 (35.0%); P = .02). Despite a history of antifungal treatment in nearly half of the patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (38/71 (53.5%) vs 37/88 (42.1%); P = .15). Conclusion Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet-trained prepubertal girls.

Increased muscle stiffness of the pectoralis minor (PMi) could deteriorate shoulder function. Stretching is useful for maintaining and improving muscle stiffness in rehabilitation and sport practice. However, the acute and prolonged effect of stretching on the PMi muscle stiffness is unclear due to limited methodology for assessing individual muscle stiffness. Using shear wave elastography, we explored the responses of shear modulus to stretching in the PMi over time. The first experiment (n = 20) aimed to clarify the acute change in the shear modulus during stretching. The shear modulus was measured at intervals of 30 s × 10 sets. The second experiment (n = 16) aimed to observe and compare the prolonged effect of different durations of stretching on the shear modulus. Short and long stretching duration groups underwent 30s × 1 set and 30s × 10 sets, respectively. The assessments of shear modulus were conducted before, immediately after, and at 5, 10, and 15 min post-stretching. In experiment I, the shear modulus decreased immediately after a bout (30 s) of stretching (p < 0.001, change: -2.3 kPa, effect size: r = 0.72) and further decreased after 3 repetitions (i.e., 90 s) of stretching (p = 0.03, change: -1.0 kPa, effect size: r = 0.53). In experiment II, the change in the shear modulus after stretching was greater in the long duration group than in the short duration group (p = 0.013, group mean difference: -2.5 kPa, partial η2 = 0.36). The shear modulus of PMi decreased immediately after stretching, and stretching for a long duration was promising to maintain the decreased shear modulus. The acute and prolonged effects on the PMi shear modulus provide information relevant to minimum and persistent stretching time in rehabilitation and sport practice.

Catheter ablation using radiofrequency (RF) energy has been widely used to treat patients with atrial fibrillation (AF). The optimal levels of power and duration to increase the success rate while minimizing complications have not been fully established. Different centers continue to use various power protocols for catheter ablation of AF. Herein, we present a comprehensive review of the impact of power output on efficacy and safety of RF ablation for AF. High-power short-duration (HPSD) ablation can be performed safely with similar procedural efficacy as low-power long-duration ablation strategy. HPSD ablation has the potential to shorten procedural and RF times and create more durable and localized lesions.

Prolonged remission of dystonia occurs rarely; however, well-documented cases are lacking. We report the clinical characteristics and course of four patients with botulinum toxin (BoNT)-associated prolonged remission of idiopathic cervical dystonia. Mean age at onset was 40 years. All had a relatively short duration of symptoms (mean 10.3 months), and with remission occurring after ≤ 3 treatments with BoNT. At last examination, the remission duration was 2–5 years. In the two cases that subsequently relapsed after 4–5 years, there was an altered phenomenology and worsened severity than at the onset. Recognizing this rare phenomenon has valuable clinical implications.

Thygeson‘s superficial punctate keratitis (TSPK) is a chronic disorder with episodes of exacerbations and remissions which span over years to decades. Typical features of the disease include multiple, grayish white, intraepithelial corneal lesions with minimal or no conjunctival involvement. The exact etiopathogenesis of this entity is unknown. However, it may have a genetic association with HLA-DR3, an antigen proved to be associated with immunogenic responses. Treatment of the disease consists of artificial tears, topical corticosteroids, topical cyclosporine, topical tacrolimus, or usage of soft contact lenses. TSPK should be considered as a diagnosis of exclusion in cases of bilateral superficial punctate keratopathy of long duration. Thirteen patients of TSPK were examined during the last 6 years (2014–2019) at our Institute. Visual acuity was 20/20 to 20/30 in majority cases. All patients required lubricants.

Background/Objectives Spaceflight associated neuro-ocular syndrome (SANS), a health risk related to long-duration spaceflight, is hypothesized to result from a headward fluid shift that occurs with the loss of hydrostatic pressure gradients in weightlessness. Shifts in the vascular and cerebrospinal fluid compartments alter the mechanical forces at the posterior eye and lead to flattening of the posterior ocular globe. The goal of the present study was to develop a method to quantify globe flattening observed by magnetic resonance imaging after spaceflight. Subjects/Methods Volumetric displacement of the posterior globe was quantified in 10 astronauts at 5 time points after spaceflight missions of ~6 months. Results Mean globe volumetric displacement was 9.88 mm3 (95% CI 4.56–15.19 mm3, p 3 (95% CI 3.73–14.27 mm3, p = 0.001) at R + 30 days; 6.53 mm3 (95% CI 1.24–11.83 mm3, p 3 (95% CI −0.96 to 9.86 mm3, p = 0.12) at R + 180 days; and 7.21 mm3 (95% CI 1.82–12.60 mm3, p Conclusions There was a consistent inward displacement of the globe at the optic nerve, which had only partially resolved 1 year after landing. More pronounced globe flattening has been observed in previous studies of astronauts; however, those observations lacked quantitative measures and were subjective in nature. The novel automated method described here allows for detailed quantification of structural changes in the posterior globe that may lead to an improved understanding of SANS.

The development of peptide therapeutics has increased enormously in recent decades. Many of the peptide drugs and antibody fragments that lack Fc backbone have a short half-life in circulation. In general, the half-life supports the design of the dosing regimen and frequency of administration, which are key aspects in the discovery of peptide drugs intended for long duration of action. Less frequent administration such as weekly or monthly can improve compliance and adherence to therapy. Serum albumin binding is a key approach to extend the half-life of peptide drugs. Despite the evidence of half-life prolongation of a variety of peptide drugs via albumin, quantitative prediction for humans is still a key question. Challenges in the measurement of albumin binding and in understanding the clearance mechanisms can limit quantitative prediction. We integrated pharmacokinetic concepts and albumin binding across species in a quantitative model to be used as a tool for prediction of half-life. Preliminary validation on a limited dataset indicated a good correlation between predicted and observed values. Further development of more quantitative models is warranted.

Local anesthetics have the advantage of complete analgesia with fewer side effects compared to systemic analgesics. However, their clinical use is limited due to their short duration of action. Thus, local anesthetics with fast onset, long duration of action, selective nociceptive block, and low local and systemic toxicity are highly desirable. In the past electrophysiological studies, quaternary lidocaine derivatives (QLDs) showed these characteristics. Here, we review electrophysiological properties of QLDs and their pharmacodynamic characteristics to shed light on potential problems.

Background Expression and storage of mothers' own milk at home and its transportation to hospital neonatal units are a common practice worldwide when newborns are inpatients. Studies assessing adherence to hospital protocols and guidelines for this are not widely published. Purpose To explore the advice received and practices followed by mothers when expressing, storing, and transporting their milk from home to the hospital, with a substudy exploring the factors related to temperature maintenance of refrigerated milk at recommended values. Methods Cross-sectional descriptive study at the neonatal intensive care unit of Mercy Hospital for Women, Melbourne, Australia. Mothers who were discharged home after birth of the infant, but whose infant(s) remained in the neonatal unit for 7 days or more participated. All participants completed a self-administered questionnaire. In the substudy, home refrigerator temperature and surface temperature of milk on arrival to the hospital were recorded. Results The questionnaire was completed by 100 mothers; 38 participated in the substudy. Median travel time from home to the hospital was 32 minutes (range, 2-135 minutes). Lactation consultants were the largest group providing information, with 44 participants (45%) identifying them as the primary information source. Knowledge about recommended refrigerator storage times for expressed milk was correct in 53 mothers (54%). Coolness of milk was better maintained when transported in an insulated food container than nonuse (surface temperature: mean 9.1°C vs 12.2°C; P = .007). Distance and travel duration were not correlated with temperature. Implications for practice More diligent monitoring of conditions under which mothers' own milk is transported to hospital is required, and the use of an insulated food container for refrigerated/frozen milk, even for a short duration, should be strongly recommended. Staff to be trained and better equipped to provide uniform, concise information on expressed human milk management to mothers. Implications for research Further research to correlate factors associated with transporting human milk expressed at home and infant health outcome is needed.

Multiple drugs taken for long duration in tuberculosis (TB) treatment, especially drug resistant TB (DR-TB), may produce adverse drug reactions (ADRs). Although any anti-TB drug can cause ADRs, but these are more common with drugs used for treatment of DR-TB. However, most of ADRs with these drugs are mild or moderate and can be managed if adequate supervision and monitoring is done. However, few ADRs can be severe or potentially life-threatening and may require removal of the offending drug(s). TB patients having comorbidities and on treatment for them may experience drug interaction with anti TB drugs and may require dose modification or change of drug. For a good TB treatment outcome patient's compliance should be ensured, and adverse events and drug interactions should be appropriately addressed by the clinicians. This article outlines the majority of the possible ADRs to anti-TB drugs used for management of DR-TB and their common drug interactions with practical recommendations to identify the possible drug(s) responsible and the most adequate management in each situation.

Postoperative nausea and vomiting (PONV) is a major cause of patient dissatisfaction following anesthesia. The difficulty in diagnosing nausea in much of the pediatric population has led to an emphasis on anti-emetic prophylaxis for all. Assessment scores and prognostic tools enable the anesthesiologist to identify patients who are at a greater risk and appropriately apply more aggressive prophylactic, multi-drug strategies. New antiemetics emerging from other medical disciplines, particularly oncology, may have potential use in prophylaxis and treatment of nausea and vomiting in the pediatric surgical population. New agents, many of which have a long duration of action, will augment the anesthesiologist's ability to adequately prevent PONV, and to treat persistent nausea and vomiting that extend beyond the immediate post-operative period.

Supplemental Digital Content is Available in the Text., BACKGROUND Real-world re-treatment intervals for botulinum toxins vary, but most subjects receive treatment less frequently than the manufacturer-recommended minimum intervals. In subjects receiving treatment with AbobotulinumtoxinA (ABO) less frequently, high levels of satisfaction and psychosocial improvements in well-being, self-confidence, and quality of life are observed. OBJECTIVE To evaluate subject satisfaction with a twice yearly re-treatment schedule. METHODS AND MATERIALS This open-label, multicenter, interventional study evaluated subject satisfaction following injections of ABO 50 U in the glabellar lines at baseline and 6 months. The primary end point was subject satisfaction at 12 months. Secondary endpoints included subject satisfaction, FACE-Q scales, and glabellar line severity scale (GLSS). RESULTS Ninety-five percent of the 120 subjects were “highly satisfied” or “satisfied” with their treatment outcomes at 12 months. FACE-Q total scores suggested that subjects were less bothered by glabellar lines and felt better about their facial appearance with each treatment versus baseline. Approximately half of subjects had ≥1-grade improvement from baseline in GLSS at 12 months. Median onset of effect was 2 days. CONCLUSION The majority of subjects (95%) were satisfied with ABO treatment every 6 months; results were supported by high subject satisfaction, long duration, rapid onset, natural-looking results, and overall psychological wellness and safety.

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Covid-19 pandemic began in the end of 2019 and spread all over the world in a short duration of time. Measures have been taken such as social distancing, compulsory lockdown and restriction of activities so as to prevent spread of virus. It has posed problem to both the antenatal women and maternity care workers. The care and management of pregnant women is an essential service to identify high-risk mothers and also to have good pregnancy outcome for both mother and baby. Any delay in this may lead to catastrophe, hence this issue needs to be addressed properly. This review briefs about the literature available on antenatal care during covid-19 pandemic. Pregnancy is not very adversely affected by the virus itself but extra caution should be taken to prevent and complications should they arise. The norms of social distancing by patients and wearing personal protective equipment by hospital staff, testing of pregnant women should be followed as per regional and national guidelines. This will help ensure safety of all people along with care to the expecting mother. The presence of covid-19 infection should not deter women from receiving antenatal care nor should the obstetric treatment be delayed during labor. Decision for timing and mode of delivery should be individualised based on obstetric indications and maternal-fetal status.

Acute febrile encephalopathy is a common syndrome in the tropics with high mortality encountered by emergency physicians. In order to study the aetiology of acute febrile encephalopathy and its mortality and functional outcome over one year, data on all patients >18 years of age with short duration of fever (

OBJECTIVES: The purpose of this study was to determine the factors predicting the success or failure of intratympanic dexamethasone (ITD) injection in the treatment of acute subjective tinnitus (AST). MATERIALS AND METHODS: We enrolled patients who were treated with ITD within 3 months of the onset of tinnitus, between 2013 and 2017. We compared the clinical characteristics and audiological data of the patients in the cured group (n=38, 45.6±13.3 years old) and the nonresponder group (n=40, 48.9±18.6 years old). RESULTS: The cured group was predominantly female (p=0.002). The mean duration of tinnitus before ITD was shorter in the cured group than the nonresponder group (p=0.002). The pure-tone averages in both sides were lower in the cured group than in the nonresponder group (p=0.018). The time of tinnitus awareness was shorter in the cured group than in the nonresponder group (p=0.014). Multivariable analysis showed that the duration of tinnitus (odds ratio [OR]=1.045), a history of exposure to noise just before tinnitus development (OR=7.766), and distortion product otoacoustic emissions results (OR=4.580) predicted the outcome of ITD treatment in AST. CONCLUSION: A short duration of tinnitus, no history of immediate noise exposure, and normal distortion product otoacoustic emissions could be favorable prognostic factors for AST treated with ITD injection.

BackgroundTo evaluate long-term efficacy of infliximab (IFX) in refractory uveoretinitis associated with Behçet’s disease (BD) depending on uveoretinitis duration.MethodsRecords of 16 patients with BD (32 eyes) followed for >5 years after starting IFX, were retrospectively reviewed. Long-term efficacy was compared between patients with short duration (≤18 months, n=7) versus long duration (>18 months, n=9) of their uveoretinitis prior to starting IFX.ResultsThe median follow-up after starting IFX was 132 months (76–146 months). Mean frequency of attacks and the 1-year Behçet’s Disease Ocular Attack Score 24 decreased significantly over 10 years. Overall, the percentage of eyes with a best-corrected visual acuity (BCVA) ≥1.0 increased from 47% at baseline to 59% at 5 years; the percentage of eyes with a BCVA ≤0.1 was 19% at both baseline and 5 years. The frequency of ocular attacks decreased similarly in both short duration and long duration groups; however, the percentage of eyes with a BCVA ≥1.0 at 5 years was 100% in the short duration group versus 28% in the long duration group. IFX was discontinued in four patients with an excellent response to IFX therapy; all were young male patients in the short duration group with good BCVA bilaterally, and none had inflammatory recurrences over a median follow-up of 56 months off IFX.ConclusionInitiation of IFX therapy in patients with BD within 18 months of their uveoretinitis onset was more effective in maintaining good BCVA than after 18 months.

Short duration sleep and somatic complaints (bodily complaints like aches/pains or GI distress) are common in adolescence and may be linked, yet no published studies have tested causation. In this study, healthy adolescents (n = 30; 14–18yrs) completed a three-week, within-subject cross-over experiment. Following a sleep stabilization week, adolescents were randomized (in counterbalanced order) to five nights of 6.5hrs in bed (Insufficient Sleep) or 9.5hrs in bed (Sufficient Sleep), each preceded by a two-night “washout.” Somatic complaints were assessed via the Children's Somatic Symptoms Inventory (CSSI-24) and the Pain and Symptom Assessment Tool (PSAT) concluding each condition. Adherence to experimental condition was confirmed via actigraphy. Adolescents slept two fewer hours and reported significantly greater frequency and severity of somatic complaints during the Insufficient Sleep (vs. Sufficient Sleep) condition. Restricting sleep opportunity to a level common in adolescence causally increased somatic complaints in otherwise healthy adolescents. Findings support clinical and preventative efforts to address pervasively inadequate sleep in adolescence.

Background and purpose — Indication for lumbar disc herniation (LDH) surgery is usually to relieve sciatica. We evaluated whether back pain also decreases after LDH surgery. Patients and methods — In the Swedish register for spinal surgery (SweSpine) we identified 14,097 patients aged 20–64 years, with pre- and postoperative data, who in 2000–2016 had LDH surgery. We calculated 1-year improvement on numeric rating scale (rating 0–10) in back pain (Nback) and leg pain (Nleg) and by negative binomial regression relative risk (RR) for gaining improvement exceeding minimum clinically important difference (MCID). Results — Nleg was preoperatively (mean [SD]) 6.7 (2.5) and Nback was 4.7 (2.9) (p < 0.001). Surgery reduced Nleg by mean 4.5 (95% CI 4.5–4.6) and Nback by 2.2 (CI 2.1–2.2). Mean reduction in Nleg) was 67% and in Nback 47% (p < 0.001). Among patients with preoperative pain ≥ MCID (that is, patients with significant baseline pain and with a theoretical possibility to improve above MCID), the proportion who reached improvement ≥ MCID was 79% in Nleg and 60% in Nback. RR for gaining improvement ≥ MCID in smokers compared with non-smokers was for Nleg 0.9 (CI 0.8–0.9) and ­Nback 0.9 (CI 0.8–0.9), and in patients with preoperative duration of back pain 0–3 months compared with > 24 months for Nleg 1.3 (CI 1.2–1.5) and for Nback 1.4 (CI 1.2–1.5). Interpretation — LDH surgery improves leg pain more than back pain; nevertheless, 60% of the patients with significant back pain improved ≥ MCID. Smoking and long duration of pain is associated with inferior recovery in both Nleg and Nback.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting both the upper and lower motor neurons. Although ALS typically leads to death within 3 to 5 years after initial symptom onset, approximately 10% of patients with ALS live more than 10 years after symptom onset. We set out to determine similarities and differences in clinical presentation and neuropathology in persons with ALS with long vs. those with standard duration. Participants were United States military Veterans with a pathologically confirmed diagnosis of ALS (n = 179), dichotomized into standard duration (

Calderon Pellegrino, G, Paredes-Hernandez, V, Sanchez-Sanchez, J, Garcia-Unanue, J, and Gallardo, L. Effect of the fatigue on the physical performance in different small-sided games in elite football players. J Strength Cond Res 34(8): 2338-2346, 2020-Football players need to be able to perform high-intensity efforts of short duration with brief recovery periods. The aim of this study was to analyze the influence of the pitch dimension on high-intensity actions and the effect of a repeated sprint ability (RSA) test on the physical performance in different 4-against-4 (4v4) small-sided games (SSG) dimensions. Sixteen U-18 elite football players performed an RSA test between two 4v4 SSGs (pre and post) to induce fatigue and compare physical data. Speed, sprint number, accelerations, sprint distance, total distance covered, and total distance covered of the players at different intensities were evaluated in 3 different SSGs (125, 150, 250, and 300 m). Results revealed a significant detriment of physical performance in the 125-m SSG after RSA, mostly in number of sprints (-6.56; confidence interval [CI] 95%: -10.13 to -3.00; effect size [ES]: 1.13 p < 0.001), accelerations (-2.69; CI 95%: -5.13 to -0.24; ES: 0.68; p = 0.032), and sprint distance (-65.44 m; CI 95%: -103.73 to -27.16; ES: 1.20; p = 0.001). In bigger SSGs (250 and 300 m), higher distance at high intensity was covered and Vmax, Vmean, and sprint distance were greater. In summary, accelerations, sprint number, and fatigue were higher in smaller pitches, and higher velocities were reached in bigger SSGs. Football players should be aware that changes in pitch size can modify the physical performance on high-intensity actions in SSGs.

The goal of this study was to compare lesion durability between high-power short-duration (HP-SD) and moderate-power moderate-duration (MP-MD) ablation strategies.HP-SD radiofrequency ablation (RFA) was developed to improve pulmonary vein isolation (PVI) by reducing the effect of catheter instability inherent to MP-MD ablation strategies. However, its long-term effect on lesion durability for the treatment of atrial fibrillation is unknown.Patients with atrial fibrillation (n = 112) underwent PVI using HP-SD ablation (45 to 50 W, 8 to 15 s) with contact force-sensing open irrigated catheter. Cavotricuspid isthmus, mitral annular, and roof lines were permitted. A control group (n = 112) underwent ablation using MP-MD ablation (20 to 40 W, 20 to 30 s) with similar technology. Chronic PV reconnection was examined in patients who required a redo procedure (HP-SD ablation, n = 18; MP-MD ablation, n = 23).The rate of PVI at the completion of the initial encirclement was similar between the HP-SD and MP-MD ablation strategies (90.2% vs. 83.0%; p = 0.006). The HP-SD strategy required shorter RFA time (17.2 ± 3.4 min vs. 31.1 ± 5.6 min; p 0.001). The incidence of chronic PV reconnection was lower with HP-SD ablation (16.6% vs. 52.2%; p = 0.03). Areas of chronic reconnection were associated with catheter motion ≥1 mm for ≥50% application duration. In a higher proportion of HP-SD applications, catheter motion was 1 mm during ≥50% duration (88.6% vs. 72.8%; p 0.001), allowing energy delivery with greater stability. Both ablation strategies were effective for cavotricuspid isthmus; however, the HP-SD strategy was less effective for mitral annular lines, requiring ablation at lower power for longer duration to avoid steam pops.HP-SD ablation may improve PVI durability, and it shortens RFA time. However, ablation in thicker myocardium often requires lower power applied for longer duration, allowing deeper lesions without tissue overheating.

This study evaluated the effects of partial-sleep-deprivation (SDN) and a 30 min nap opportunity on physical and cognitive performances and mood states. Fourteen physically active students (BMI = 232.8 ± 0.4 kg/m

Objective: As myotonic dystrophy type 1(DM1) evolves slowly and interventional trials often have a short duration, responsive outcomes in DM1 are needed. The objective of this study was to determine the responsiveness of muscle strength, balance, and functional mobility measurements after a 1-year follow-up period in individuals with DM1. Methods: Sixty-three adults with noncongenital DM1 completed the following assessments at baseline and at 1-year follow-up: Handheld dynamometry (lower limbs), stationary dynamometry (lower limbs), step test, timed-up-and-go test (TUG), modified clinical test of sensory integration and balance (mCTSIB), feet-together stance, tandem stance, one-leg stance, 10-meter walk test, and sit-to-stand test. Results: Change was captured by stationary dynamometry (proximal flexor and extensor muscles), handheld dynamometry (proximal flexor and distal extensor muscles), TUG, and mCTSIB (P ≤ 0.04). Ceiling or floor effects were shown for most static balance tests. Interpretation: Overall, adequate responsiveness was shown for both muscle strength dynamometers, TUG and mCTSIB. These outcomes are therefore likely candidate endpoints for clinical trials lasting 1 year. Most static balance tests are not responsive and not recommended in a heterogeneous DM1 population.

The effects of acute ingestion of nitrate on short-duration repeated sprint performance (RSP) are unclear. This study investigated the effect of acute ingestion of beetroot juice on a test of RSP in team sport athletes. Sixteen male team sport athletes undertook four trials using a 40 m maximum shuttle run test (MST), which incorporates 10 × 40 m shuttle sprints with 30 s between the start of each sprint. Two familiarisation trials, followed by nitrate-rich beetroot juice (BR; ~6 mmol nitrate) and nitrate-depleted beetroot juice (PLA; ~0.0034 mmol nitrate) trials were completed in a randomised, double-blind manner. Ingestion of beetroot juice 3 h prior to exercise elevated plasma nitrate concentrations ~6-fold in BR (BR, 413 ± 56 μM; PLA, 69 ± 30 μM; P 0.001). RSP, assessed by sprint performance decrement (S

Time-of-day dependent fluctuations in exercise performance have been documented across different sports and seem to affect both endurance and resistance modes of exercise. Most of the studies published to date have shown that the performance in short-duration maximal exercises (i.e. less than 1 min - e.g. sprints, jumps, isometric contractions) exhibits diurnal fluctuations, peaking between 16:00 and 20:00 h. However, the time-of-day effects on short duration exercise performance may be minimized by the following factors: (1) short exposures to moderately warm and humid environments; (2) active warm-up protocols; (3) intermittent fasting conditions; (4) warming-up while listening to music; or (5) prolonged periods of training at a specific time of day. This suggests that short-duration maximal exercise performance throughout the day is controlled not only by body temperature, hormone levels, motivation and mood state but also by a versatile circadian system within skeletal muscle. The time of day at which short-duration maximal exercise is conducted represents an important variable for training prescription. However, the literature available to date lacks a specific review on this subject. Therefore, the present review aims to (1) elucidate time-of-day specific effects on short-duration maximal exercise performance and (2) discuss strategies to promote better performance in short-duration maximal exercises at different times of the day.

Data collected from standardized clinical practices can be valuable in evaluating the real-world therapeutic benefit of skin substitutes in the treatment of venous leg ulcers (VLU). Utilizing such a dataset, this study aimed to validate the effectiveness of a bioactive human split-thickness skin allograft for the treatment of VLU in the real-world setting and to understand how certain variables impacted healing rates. From a pool of 1474 VLU treated with allograft, 862 ulcers in 742 patients were selected from a large wound EMR database and analyzed. All patients received standard wound care prior to allograft application. Impact of ulcer duration, number of applications, ulcer size, and time to application were analyzed. The VLU, on average, were of 189 days duration with a mean ulcer size of 19.3 cm2 . During treatment, 70.7% of wounds healed, with an average time to closure of 15 weeks (SD = 14.1 weeks). The percentage of VLU less than one-year duration that healed was significantly higher (72.3%) than the percentage of VLU with duration of greater than 1 years (51.5%) ( χ2 = 18.17; P < .001). Ulcers less than 10 cm2 in size were more likely to heal (73.9%) than those larger than 10 cm2 (67.9%) ( χ2 = 8.65, P = .03). VLU receiving allograft within 90 days of initial presentation are 1.4 times more likely to heal vs those receiving their first BSA application after 90 days of standard of care (95% CI: [1.05, 1.86], P = .02). Allograft used in wound clinics healed a majority of refractory VLU, even in large ulcers of long duration, which are more difficult to heal. Smaller wound, size, and shorter wound duration were associated with greater likelihood of healing. VLUs treated earlier with allograft had better healing outcomes. Clinicians may consider more aggressive and timely treatment with allograft for refractory VLU.

Background Detection of atrial fibrillation (AF) occurrence over a long duration has been a challenge in the screening and follow-up of AF patients. Wearable devices may be an ideal solution. Objective The purpose of this study was to measure the sensitivity, specificity, and accuracy of a recently developed smart wristband device that is equipped with both photoplethysmographic (PPG) and single-channel electrocardiogram (ECG) systems and an AF-identifying, artificial intelligence (AI) algorithm, used in the short term. Methods Use of the Amazfit Health Band 1S, which records both PPG and single-channel ECG data, was assessed in 401 patients (251 normal individuals and 150 ECG-diagnosed AF patients). Results ECG and PPG readings could not be judged in 15 and 18 subjects, respectively. Subjects who were unable to be judged were defined as either false negative or false positive. The sensitivity, specificity, and accuracy of wristband PPG readings were 88.00%, 96.41%, and 93.27%, respectively, and those of wristband ECG readings were 87.33%, 99.20%, and 94.76%, respectively. When the original wristband ECG records were judged by physicians, the sensitivity, specificity, and accuracy were 96.67%, 98.01%, and 97.51%, respectively. Conclusion This promising new combination of PPG, ECG, and AI algorithm has the potential to facilitate AF detection.

BACKGROUND Use of lesion metric indices is a proposed strategy to support pulmonary vein isolation procedures and these indices show good correlations with lesion sizes. The aim of this in silico study is to provide a detailed analysis of radiofrequency (RF) settings, including high-power short-duration (HPSD) settings, and resulting lesion metric indices. METHODS AND RESULTS A software program was designed which simulated virtual RF ablations. Lesion metric indices (Ablation index: AI, Lesion size index: LSI) were calculated based on underlying RF settings (contact force [CF], power, duration). In series of calculations, the applied settings were varied within defined ranges (CF: 1-80 g, power: 1-60 W, duration: 1-60 seconds). Overall, n = 388 000 virtual ablations were calculated. The resulting lesion metric indices were compared with each other and analyzed in relation to respective RF settings. Increasing contact force from 1 to 10 g resulted in a 4.4-fold LSI value, whilst increasing contact force from 10 to 20g resulted in a 1.5-fold value (P