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Despite its frequent use for pain relief, no experimental pain research has tested the analgesic effects of cannabidiol (CBD) in humans. The goal of this study was to experimentally test the effects of CBD and expectancies for receiving CBD on human pain reactivity. Using a crossover, 2 × 2 factorial balanced placebo design, drug administration (given inactive substance or given active CBD) and verbal instruction sets (told inactive substance or told active CBD) were experimentally manipulated. Fifteen healthy adults each completed four separate experimental sessions. Participants were randomly assigned to different counterbalanced manipulation conditions at each session: control (told inactive-given inactive); expectancy (told active CBD-given inactive); drug (told inactive-given active CBD); and expectancy + drug (told active CBD-given active CBD). Primary outcomes were pain threshold, tolerance, intensity, unpleasantness, conditioned pain modulation (CPM), and offset analgesia (OA). There was a significant main effect of instructions on OA, such that the OA response was significantly larger when participants were told that they received CBD, regardless of drug content. Pain unpleasantness was significantly reduced in the drug, expectancy, and expectancy + drug conditions, relative to the control condition. The drug and expectancy conditions separately improved CPM, whereas the expectancy + drug and control conditions produced the lowest CPM change scores. We did not detect significant effects for pain threshold, tolerance, or intensity. Our results indicated that separate pain outcomes can be differentially affected by CBD and/or expectancies for receiving CBD. Future investigations of the psychological and pharmacological mechanisms underlying CBD analgesia are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Purpose Cardiac myxoma (CM), the most common cardiac tumor in adults, accounts for 50–75% of benign cardiac tumors. The diagnosis of CM is often elusive, especially in young stroke survivors and transthoracic echocardiography (TTE) is the initial technique for the differential diagnostics of CM. Less invasive cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are not available for the majority of cardiac patients. Here, a robust imaging approach, ortho-Positronium (o-Ps) imaging, is presented to determine cardiac myxoma extracted from patients undergoing urgent cardiac surgery due to unexpected atrial masses. We aimed to assess if the o-Ps atom, produced copiously in intramolecular voids during the PET imaging, serves as a biomarker for CM diagnosing. Methods Six perioperative CM and normal (adipose) tissue samples from patients, with primary diagnosis confirmed by the histopathology examination, were examined using positron annihilation lifetime spectroscopy (PALS) and micro-CT. Additionally, cell cultures and confocal microscopy techniques were used to picture cell morphology and origin. Results We observed significant shortening in the mean o-Ps lifetime in tumor with compare to normal tissues: an average value of 1.92(02) ns and 2.72(05) ns for CM and the adipose tissue, respectively. Microscopic differences between tumor samples, confirmed in histopathology examination and micro-CT, did not influenced the major positronium imaging results. Conclusions Our findings, combined with o-Ps lifetime analysis, revealed the novel emerging positronium imaging marker (o-PS) for cardiovascular imaging. This method opens the new perspective to facilitate the quantitative in vivo assessment of intracardiac masses on a molecular (nanoscale) level.

Objective Quantitative sensory testing is an expanding pain research domain with numerous clinical and research applications. There is a recognized need for brief reliable quantitative sensory testing protocols that enhance assessment feasibility. This study aimed to integrate static (pain threshold, tolerance, suprathreshold) and dynamic (conditioned pain modulation, offset analgesia, temporal summation) pain reactivity measures into a brief 20-minute protocol that uses a single portable device. The test-retest performance of this optimized protocol was evaluated. Design Using a test-retest design, the brief quantitative sensory testing assessment was administered to participants on two occasions separated by exactly 7 days. Setting A clinical psychology research laboratory at Syracuse University. Subjects Participants were 33 healthy adults recruited from Syracuse University’s online research participation pool. Methods A portable computerized quantitative sensory testing device delivered contact-heat pain to assess static and dynamic pain measures in participants. Dynamic responses were continuously recorded using a computerized visual analog scale. Results Pain threshold, tolerance, and suprathreshold exhibited excellent reliability (intraclass correlations ranged from 0.80 to 0.83). Conditioned pain modulation, offset analgesia, temporal summation yielded reliability in the good to excellent range (intraclass correlations ranged from 0.66 to 0.71). Conclusions Findings suggested that this brief integrated QST protocol may reliably monitor human pain reactivity over brief periods. This protocol may enhance quantitative sensory testing feasibility in clinical and research settings.

His bundle pacing and left bundle branch pacing are complementary implantation techniques that combine into conduction system pacing, which allows maintaining or recovering physiological activation of the heart. We selected cases from the electrophysiological laboratory of the University Hospital in Krakow to present theoretical and practical aspects of conduction system pacing using fluoroscopy images, ECG and EGM recordings.

Introduction: Rheumatoid arthritis is a chronic, inflammatory, systemic complex disease involving joints and periarticular tissues, leading to disability and premature death. The most common and earliest locations of the inflammatory process involves hands. In addition to pharmacotherapy, therapeutic management includes physiotherapy, psychotherapy and patient education. Among the physical therapy methods, the role of laser therapy and magnetotherapy in achieving analgesic effects and improving functions is emphasized. AIM: The aim of the study was to compare the impact of low frequency magnetic field and laser therapy on pain reduction, quality of life and function improvement as well as range of motion hands joints in patients with RA. Material and Methods: The study involved 30 outpatient in the Rehabilitation Clinic of the University Clinical Hospital in Bialystok. Among all patients they were selected into two groups in which they were applied accordingly in the first group a laser stimulation and in the second group a low frequency magnetic field. There were performed 10 treatments in each group with a Saturday - Sunday break. Before and after rehabilitation was conducted a physical and subjective examination, which used: pain examination (VAS scale, Laitinen questionnaire), examination of hand range of motion and functional evaluation according to questionnaires: bMHQ, DASH, AIMS-2. Results: After used of physical therapy in both groups the results were obtained that pain was decreased. Moreover, the magnetotherapy improved the range of motion as well as the quality of life and functionality of patients measured according to the questionnaires: Laitinen, Breif MHQ, DASH, AIMS-2 more favorably than laser therapy. Conclusions: Both treatment: laser therapy and magnetotherapy provide an analgesic effect in patients with RA. It has been shown that magnetotherapy is more effective in improving hand joints mobility and patient’s quality of live.

Aims Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in recent years due to proposed benefits, including a lower risk of dislocation and improved early functional recovery. This study investigates the dislocation rate in a non-selective, consecutive cohort undergoing THA via the DAA without any exclusion or bias in patient selection based on habitus, deformity, age, sex, or fixation method. Methods We retrospectively reviewed all patients undergoing THA via the DAA between 2011 and 2017 at our institution. Primary outcome was dislocation at minimum two-year follow-up. Patients were stratified by demographic details and risk factors for dislocation, and an in-depth analysis of dislocations was performed. Results A total of 2,831 hips in 2,205 patients were included. Mean age was 64.9 years (24 to 96), mean BMI was 29.2 kg/m2 (15.1 to 53.8), and 1,595 patients (56.3%) were female. There were 11 dislocations within one year (0.38%) and 13 total dislocations at terminal follow-up (0.46%). Five dislocations required revision. The dislocation rate for surgeons who had completed their learning curve was 0.15% compared to 1.14% in those who had not. The cumulative periprosthetic infection and fracture rates were 0.53% and 0.67%, respectively. Conclusion In a non-selective, consecutive cohort of patients undergoing THA via the DAA, the risk of dislocation is low, even among patients with risk factors for instability. Our data further suggest that the DAA can be safely used in all hip arthroplasty patients without an increased risk of wound complications, fracture, infection, or revision. The inclusion of seven surgeons increases the generalizability of these results. Cite this article: Bone Joint J 2021;103-B(7 Supple B):38–45.

Background Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment. Objective In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome. Methods Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD/MS discriminators. Results Four subgroups were identified. Patients from Group 1 termed “MS-like” (n = 6) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 (“spinal MS-like”, 8) had short-segment myelitis and no MS-like brain lesions. Group 3 (“classic NMO-like”, 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 (“NMO-like with brain involvement”, 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49, p = 0.003) and decreased thalamus volume (0.84 vs. 0.98, p = 0.04). Conclusions NMOSD/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients.

IntroductionOne of the challenges of left bundle branch (LBB) pacing is to place the pacing lead deep enough in the septum to obtain capture of the LBB, yet not too deep to avoid perforation. We hypothesized that the occurrence of the ectopic beats of qR/rsR’ morphology in V1 lead (fixation beats) during the lead fixation would predict that the final desired intraseptal lead depth was just reached, while the lack of fixation beats would indicate too shallow position, and need for more lead rotations.MethodsConsecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of the fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB capture area depth was reached versus during the events before intermediate/unsuccessful positions.ResultsA total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, the fixation beats were observed in 327/339 of final lead positions and in 9/939 of intermediate lead positions (pConclusionsMonitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.

The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21–50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant’s own or study-provided mobile phone. Individual differences variables were measured by participants’ completing questionnaires measuring effortful control and urgency, and the participant’s self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol’s effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol’s effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.

Objectives The aim of this study was to assess the feasibility and outcomes of left bundle branch area pacing (LBBAP) in patients eligible for cardiac resynchronization therapy (CRT) in an international, multicenter, collaborative study. Background CRT using biventricular pacing is effective in patients with heart failure and left bundle branch block (LBBB). LBBAP has been reported as an alternative option for CRT. Methods LBBAP was attempted in patients with left ventricular ejection fraction (LVEF) Results LBBAP was attempted in 325 patients, and CRT was successfully achieved in 277 (85%) (mean age 71 ± 12 years, 35% women, ischemic cardiomyopathy in 44%). QRS configuration at baseline was LBBB in 39% and non-LBBB in 46%. Procedure and fluoroscopy duration were 105 ± 54 and 19 ± 15 min, respectively. LBBAP threshold and R-wave amplitudes were 0.6 ± 0.3 V at 0.5 ms and 10.6 ± 6 mV at implantation and remained stable during mean follow-up of 6 ± 5 months. LBBAP resulted in significant QRS narrowing from 152 ± 32 to 137 ± 22 ms (p Conclusions LBBAP is feasible and safe and provides an alternative option for CRT. LBBAP provides remarkably low and stable pacing thresholds and was associated with improved clinical and echocardiographic outcomes.

Introduction: Lumbar back pain (LBP) is still a frequent health problem. LBP decreases quality of life in many domains, including physical, social and mental. It was proved in previous studies that LB massage has a significant impact on pain reduction. Träbert current (TC) is common physical modality used in LBP treatment. Aim: The aim of study was to assess the effectiveness of manual massage in comparison to TC in patients with LBP. Materal and Methods: 60 patients with LBP were enrolled. The subjects were randomly assigned to two groups: massage (I=30) and TC (II=30) therapy. The procedures were performed for ten days. The pain intensity was assessed by Numerical Rating Scale. Quality of life and the degree of disability were evaluated by Oswestry Disability Index and Roland-Morris Questionnaire. Results: In both groups pain reduction and functional improvement were observed after therapy. However, better results were observed in group I. Conclusion: Both of the studied LBP treatment modalities have positive effect in studied groups, however manual massage seems to be more efficient.

Our study aimed to explore the association between serum C-reactive protein (CRP) and post-stroke depressive symptoms. We prospectively recruited 572 patients with ischemic stroke or transient ischemic attack in whom serum CRP level was measured within 48 h after stroke onset. Depressive symptoms were assessed at day 8 and 3 months after stroke in 405 and 306 patients, respectively. Patients with greater depressive symptoms at day 8 and patients with greater depressive symptoms 3 months after stroke had higher CRP level (median: 7.9 vs 4.3 mg/L, P 9.2 mg/L was associated with depressive symptoms at day 8 (OR: 2.06, 95%CI: 1.30–3.28, P 4.3 mg/L was associated with depressive symptoms 3 months after stroke (OR: 1.79, 95%CI: 1.06–3.02, P = 0.03). In the multivariate analysis, higher CRP level was related to depressive symptoms at day 8 (OR: 2.23, 95%CI: 1.28–3.90, P

Background Inflammation is associated with poor outcome after stroke. A relationship between ex vivo cytokine synthesis and stroke outcome remains unclear. We explored an association between ex vivo cytokine release, circulating interleukin (IL)-6 as a marker of systemic inflammation, and stroke prognosis. We assessed the utility of ex vivo synthesized cytokines for predicting stroke outcome. Methods We collected blood from 248 ischemic stroke patients and stimulated it ex vivo with lipopolysaccharide. We measured concentration of synthesized cytokines (TNFα, IP-10, IL-1β, IL-6, IL-8, IL-10, and IL-12) and plasma IL-6. We assessed functional outcome 3 months after stroke using the modified Rankin Scale. To assess the prognostic ability of cytokines, we applied multivariate logistic regression, cluster analysis, and construction of multimarker score. Results Decreased release of IP-10, TNFα, IL-1β, and IL-12; increased release of IL-10 and IL-8; and higher plasma IL-6 level were associated with poor outcome. Cluster analysis identified three groups of patients with distinct cytokine profiles. The group with the worst outcome demonstrated high synthesis of IL-10, IL-8, IL-1β, and IL-6 and low synthesis of IL-12, IP-10, and TNFα accompanied by high circulating IL-6 level. The group with the best prognosis showed high synthesis of TNFα, IP-10, IL-12, IL-1β, and IL-6; low synthesis of IL-10 and IL-8; and low plasma IL-6. Patients with intermediate outcome had low synthesis of all cytokines accompanied by low circulating IL-6. We constructed a multimarker score composed of ex vivo released IL-12, IL-10, TNFα, and plasma IL-6. Addition of this score to clinical variables led to significant increase in c-statistic (0.81 vs 0.73, p = 0.02) and net reclassification improvement. Conclusion The decreased ex vivo release of pro-inflammatory cytokines and increased release of IL-10 and IL-8 are related to poor outcome after stroke. Cytokine-based multimarker score adds prognostic value to clinical model for predicting stroke outcome.

BACKGROUND Cardiac resynchronization therapy (CRT) based on the conventional biventricular pacing (BiV-CRT) technique sometimes results in broad QRS complex and suboptimal response. OBJECTIVE We aimed to assess the feasibility and outcomes of CRT based on left bundle branch area pacing (LBBAP, in lieu of the right ventricular lead) combined with coronary venous left ventricular pacing in an international multicenter study. METHODS LBBAP-optimized CRT (LOT-CRT) was attempted in nonconsecutive patients with CRT indications. Addition of the LBBA (or coronary venous) lead was at the discretion of the implanting physician, who was guided by suboptimal paced QRS complex, and/or on clinical grounds. RESULTS LOT-CRT was successful in 91 of 112 patients (81%). The baseline characteristics were as follows: mean age 70 +/- 11 years, female 22 (20%), left ventricular ejection fraction 28.7% +/- 9.8%, left ventricular end-diastolic diameter 62 +/- 9 mm, N-terminal pro-B-type natriuretic peptide level 5821 +/- 8193 pg/mL, left bundle branch block 47 (42%), nonspecific intraventricular conduction delay 25 (22%), right ventricular pacing 26 (23%), and right bundle branch block 14 (12%). The procedure characteristics were as follows: mean fluoroscopy time 27.3 +/- 22 minutes, LBBAP capture threshold 0.8 +/- 0.5 V @ 0.5 ms, and R-wave amplitude 10 mV. LOT-CRT resulted in significantly greater narrowing of QRS complex from 182 +/- 25 ms at baseline to 144 +/- 22 ms (P < .0001) than did BiV-CRT (170 +/- 30 ms; P < .0001) and LBBAP (162 +/- 23 ms; P < .0001). At follow-up of >= 3 months, the ejection fraction improved to 37% +/- 12%, left ventricular end-diastolic diameter decreased to 59 +/- 9 mm, N-terminal pro-B-type natriuretic peptide level decreased to 2514 +/- 3537 pg/mL, pacing parameters were stable, and clinical improvement was noted in 76% of patients (New York Heart Association class 2.9 vs 1.9). CONCLUSION LOT-CRT is feasible and safe and provides greater electrical resynchronization as compared with BiV-CRT and could be an alternative, especially when only suboptimal electrical re synchronization is obtained with BiV-CRT. Randomized controlled trials comparing LOT-CRT and BiV-CRT are needed.

Aims We hypothesized that during left bundle branch (LBB) area pacing, the various possible combinations of direct capture/non-capture of the septal myocardium and the LBB result in distinct patterns of right and left ventricular activation. This could translate into different combinations of R-wave peak time (RWPT) in V1 and V6. Consequently, the V6-V1 interpeak interval could differentiate the three types of LBB area capture: non-selective (ns-)LBB, selective (s-)LBB, and left ventricular septal (LVS). Methods and results Patients with unquestionable evidence of LBB capture were included. The V6-V1 interpeak interval, V6RWPT, and V1RWPT were compared between different types of LBB area capture. A total of 468 patients from two centres were screened, with 124 patients (239 electrocardiograms) included in the analysis. Loss of LVS capture resulted in an increase in V1RWPT by ≥15 ms but did not impact V6RWPT. Loss of LBB capture resulted in an increase in V6RWPT by ≥15 ms but only minimally influenced V1RWPT. Consequently, the V6-V1 interval was longest during s-LBB capture (62.3 ± 21.4 ms), intermediate during ns-LBB capture (41.3 ± 14.0 ms), and shortest during LVS capture (26.5 ± 8.6 ms). The optimal value of the V6-V1 interval value for the differentiation between ns-LBB and LVS capture was 33 ms (area under the receiver operating characteristic curve of 84.7%). A specificity of 100% for the diagnosis of LBB capture was obtained with a cut-off value of >44 ms. Conclusion The V6-V1 interpeak interval is a promising novel criterion for the diagnosis of LBB area capture.

Background Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming. Objectives We aimed to calculate strength-duration curves and chronaxies of the HB and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs). Methods Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4, and 1.0 ms were determined. Results In the whole group (N = 127), the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie 0.47 ms vs RV chronaxie 0.79 ms). The strength-duration curve for the HB had a lower rheobase and its steep portion started at shorter PDs, thus creating wider distance—zone of programmable selective HB pacing—between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1–0.4 ms vs 1.0 ms. Chronaxie-adjusted PDs offered the lowest current drain. Conclusion For the first time, the strength-duration curves for permanent selective and nonselective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer greater safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.

OBJECTIVE: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. SUMMARY OF BACKGROUND DATA: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients. METHODS: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018. RESULTS: Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P

Background and aims: An inverse relationship between lipid levels and atrial fibrillation (AF) has been suggested, but whether the association is upheld for all age groups remains unclear. The aim of the study was to examine associations between lipid levels and AF by age groups in a nationwide study in Poland. Methods: Multivariate Poisson regression models were used to estimate prevalence ratios (PRs) for AF by lipid levels. Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), non-HDL-C and LDL-C/HDL-C ratios were grouped into quartiles. Results: Of the 13,724 participants, 5.2% (n = 708) had AF. People with AF were older with more comorbidities, but lower lipid levels (all p < 0.05). The prevalence of AF was inversely associated with LDL-C (Adjusted PR (95% Confidence Interval) highest versus lowest quartile: 0.60 (0.48, 0.75)), TC (0.61 (0.49, 0.75)) and non-HDL-C (0.63 (0.51, 0.78)). The prevalence of AF was inversely associated with HDL-C (0.58 (0.46, 0.74)), but this was not statistically significant for people aged 75 years and older. For the LDL-C/HDL-C ratio, the prevalence of AF was only inversely associated with higher levels for people aged 75 years and older (0.75 (0.61, 0.94)). There was no statistically significant difference in prevalence of AF by TG levels. Conclusions: The results suggest an inverse relationship between lipid levels and AF. The inverse association between higher HDL-C and AF was only significant for people aged

Objective: The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers. Summary Background Data: PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection. Methods: This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998). Results: Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%. Conclusion: These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.

Background Multimorbidity is an emerging challenge in older myasthenia gravis patients, which can have even greater impact on quality of life and outcome than symptoms of myasthenia. Aims of the study We aimed to investigate comorbidities in older population and compare early-onset (EOMG) and late-onset (LOMG) myasthenia patients. Methods We investigated clinical information of patients from Oxford Myasthenia Centre age 50 or older. Data on 60 chronic disorders were extracted. Results We included 327 myasthenia patients (30.9% EOMG and 69.1% LOMG) with a median age of 70 years. Comorbidities were present in 94.5% of patients and accumulated with age. Hypertension (58.4% vs. 31.7%), hypercholesterolemia (41.2% vs. 23.8%), diabetes (24.8% vs. 11.9%), cataract (15.5% vs. 5.0%) and prostate disorders (15.0% vs. 2.0%) were more common in LOMG than EOMG, but there were no differences between 70 EOMG and 70 LOMG patients matched according to age and sex. Conclusions Comorbidities in older patients with myasthenia are very common, increase with age, and do not differ between early- and late-onset disease.

BACKGROUND AND PURPOSE Delirium is a serious complication after stroke. It remains unclear whether different motor subtypes of delirium are associated with diverse risk factors and outcomes. The aim was to investigate if delirium subtypes differ in predisposing factors, clinical characteristics and outcomes. METHODS In all, 698 patients with ischaemic stroke or transient ischaemic attack (median age 73 years; 53.7% female) were prospectively included. Core features of delirium during the first 7 days after admission were examined. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for delirium were used. Pre-stroke characteristics were compared between different delirium subtypes and logistic regression and Cox proportional hazard models were used to explore the association between delirium, functional outcome and death. RESULTS Hyperactive, hypoactive and mixed delirium were diagnosed in 28, 75 and 66 patients, respectively. Patients with hyperactive delirium had less severe neurological deficit on admission and more often had transient ischaemic attack compared with patients with hypoactive and mixed delirium. Compared with patients with hypoactive delirium, those with hyperactive delirium more often suffered from irritability/lability prior to stroke. Hyperactive and hypoactive delirium did not differ in age, sex, comorbidities, pre-stroke dependency, cognitive decline and severity of delirium. Hyperactive, hypoactive and mixed delirium were associated with an increased risk of poor 3- and 12-month functional outcome compared with patients without delirium. Moreover, patients with hypoactive and mixed delirium had an elevated risk of death. CONCLUSIONS Hyperactive delirium is associated with less severe stroke and higher scores of pre-existing irritability/lability. All three motor subtypes of delirium are associated with poor outcome, although hyperactive delirium seems to have a less unfavourable prognosis.

» Glenoid component wear and loosening are the principal failure modes of anatomic total shoulder arthroplasty (aTSA). » The ream-and-run (RnR) procedure is an alternative glenohumeral arthroplasty for patients who wish to avoid the risks and limitations of a prosthetic glenoid component. » During the RnR procedure, the arthritic glenoid is conservatively reamed to a single concavity, while the prosthetic humeral component and soft tissues are balanced to provide both mobility and stability of the joint. » The success of the RnR procedure depends on careful patient selection, preoperative education and engagement, optimal surgical technique, targeted rehabilitation, and close postoperative communication between the surgeon and the patient. » While the RnR procedure allows high levels of shoulder function in most patients, the recovery can be longer and more arduous than with aTSA. » Patients who have undergone an RnR procedure occasionally require a second closed or open procedure to address refractory shoulder stiffness, infection, or persistent glenoid-sided pain. These second procedures are more common after the RnR than with aTSA.

IntroductionRheumatoid arthritis (RA) is a chronic, inflammatory, connective tissue disease, leading to foot deformities, impairment of locomotive functions, and reducing patients’ quality of life. Obesity prevalence is rising in early RA and is associated with worse disease activity, function and health-related quality of life, with a significant negative impact on achieving a low Disease Activity Score in 28 joints (DAS28). The aim of the study was to evaluate foot deformities in overweight RA patients according to the severity of the disease.Material and methodsThe study was performed on 50 overweight women with RA. The control group consisted of 50 overweight women free of any disorders. Plantography examination was carried out by means of a CQ ST 2K podoscope. Rheumatoid arthritis disease activity was assessed by DAS28. Activity limitation was assessed using the Health Assessment Questionnaire (HAQ) and foot posture by the Foot Posture Index (FPI-6). Body composition analysis was performed using In Body 220.ResultsHallux valgus was the most frequent deformation in RA patients with overweight. Longitudinal flat foot was much more frequent in RA patients than transverse flat foot. A relationship between fat tissue mass and presence of transverse flat foot in RA patients with overweight was found. In this group DAS28, VAS, and Clarke’s angle were correlated with increased value of HAQ.ConclusionsPlantar contourography showed a trend of an increase of α angle values and the Sztriter-Godunow index (KY) in overweight RA patients with increasing severity of radiological changes and DAS28, requiring use of proper prevention and therapeutic strategies of destructive changes.

AimsDuring non-selective His bundle (HB) pacing, it is clinically important to confirm His bundle capture vs. right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture left ventricular lateral wall activation time, approximated by the V6R-wave peak time (V6RWPT), will not be longer than the corresponding activation time during native conduction.MethodsConsecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6RWPT and native HBpotential-V6RWPT. Difference between these two intervals (delta V6RWPT), diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis.ResultsA total of 723 ECGs (219 with native rhythm, 172 with selective HB, 215 with non-selective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6RWPT, non-selective-, and selective-HB paced V6RWPT were nearly equal, while RVS V6RWPT was 32.0 (±9.5) ms longer. The ROC curve analysis indicated delta V6RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion.ConclusionWe validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6RWPT indicates RVS capture.

In humans, chronic pain is often expressed as a spontaneous emotional response which can lead to fragmented sleep. Rat 50-kHz and 20-kHz ultrasonic vocalizations are well-established measures of positive and negative emotional states, respectively. The rat chronic constriction injury model was used to induce chronic pain, and ultrasonic vocalizations were measured in both the heterospecific rough-and-tumble play (i.e. tickling) test as well as during 24-hour home cage recordings. Rates of hedonic 50-kHz ultrasonic vocalizations during the non-stimulus periods of the tickling test, as well as the rewarding value of tickling, were reduced in chronic constriction injury rats compared to sham controls. In the 24-hour home cage recording study, chronic constriction injury animals showed a reduced amplitude in circadian activity, as well as reduced hedonic 50-kHz ultrasonic vocalizations and increased evoked and spontaneous aversive 20-kHz ultrasonic vocalizations. These data demonstrate that rat ultrasonic vocalizations can be used to capture core symptoms of chronic pain and may be useful in the elucidation of the neuronal mechanisms that underlie the affective component of pain.

Introduction. Return of spontaneous circulation (ROSC) of a patient with cardiac arrest is the main goal of carrying out cardiopulmonary resuscitation. Aim. Evaluation of frequency of return of spontaneous circulation depending on the heart rhythms in the first moment of heart electrical activity. Material and methods. Analysis of 105 cases of sudden cardiac arrest in out-of-hospital conditions on the premises of Brzozow Emergency Medical Service from September 2016 to the end of February 2018. The data was collected from intervention medical cards and medical rescue procedure cards. Statistical analysis was carried out using STATISTICA software. Statistical significance was assumed to be p Results. Sudden cardiac arrest in the analysed group applied to 62.9% of men. Return of spontaneous circulation was achieved only in 16 out of 105 cases (15.2%) of sudden cardiac arrest. The analysis has indicated that ROSC was successful among 66.67% of patients, who during the first analysis of the rhythm, represented cardiac arrest in VF/pVT, what constituted 75% of all ROSC cases in the analysed group. Comparison between ROSC and rhythm during the first evaluation of the rhythm showed statistical significance (p=0.00). Statistical significance was also shown in the relationship between ROSC and the average age of the patient (p=0.0155). Conclusions. Sudden cardiac arrest, when diagnosed in the first analysis of the rhythm VF/pVT, has bigger chances for return of spontaneous circulation than it has in other rhythms.

Background The purpose of this study is to (1) characterize the most common reasons of medical malpractice litigation against adult reconstruction surgeons and (2) report on the outcomes of these lawsuits. Methods The Westlaw legal research database was queried for cases between 2008 and 2018 related to total hip and knee arthroplasty (THA and TKA) in the United States. Causes of the lawsuit, patient characteristics, demographics, state/outcome of verdict or settlement, and indemnity payments were noted. Results A total of 148 records (81 females [55%], 67 males [45%]; 83 TKAs [56%], 65 THAs [44%]) were included in the final analysis. For all patients, infection was the leading cause for malpractice litigation (22%) followed by nerve injury (20%). For TKA, infection was the most common cause of lawsuit (33%). In THA cases, nerve injury was the most common reason for lawsuit (38%), followed by leg-length discrepancy (26%). Procedural errors were alleged in 72% of cases, while diagnostic and post-surgical errors were cited in 55% and 32% of cases. A defense verdict occurred in 74% of cases, plaintiff verdict in 21%, and parties settled in 5%. Conclusion Infection and nerve injury were the most common reasons for litigation in TKA and THA, respectively. The most likely outcome of these lawsuits was a jury verdict in favor of the surgeon. Regardless, surgeons should be cognizant of the potential for lawsuit due to these complications and should ensure they inform patients of these potential complications of TJA preoperatively.

Introduction. Transplantation (from Latin transplantare – transplant and plantare – plant), also called organ transplantation, is a safe, effective, and in some cases the only available treatment method giving hope for recovery for patients with end-stage organ failure (such as failure of heart, liver, lungs, kidneys, pancreas). It involves replacement of a diseased organ or tissue with healthy one obtained from another person. It is a specific treatment that requires social acceptance. Despite the efforts being made by the Polish transplantation community, low public awareness and lack of knowledge on organ donation are still significant barriers to the development of transplantation program in Poland [1]. Objective. Recognition of knowledge and attitudes of Subcarpathian Province’s inhabitants towards organ transplantation. Material and methods. The survey conducted in 2018 included 187 inhabitants of urban and rural areas of the Subcarpathian Province with non-medical background. A method of diagnostic survey with a questionnaire was used. The research tool was a proprietary questionnaire containing mostly single-choice questions. The questions in the survey were closed-ended. Results and conclusons. The level of knowledge of most respondents (56.9% of the respondents from urban areas and 57.4% of the respondents from rural areas) was moderate. High level of knowledge was presented by fewer respondents: 34.7% of those from urban areas and 31.3% of those from rural areas. Low level of knowledge was reported by 8.3% and 11.3% of the respondents from urban and rural areas, respectively. No significant differences in knowledge of organ transplantation were seen between the respondents from urban and rural areas. The results of this research show insufficient knowledge concerning organ transplantation in the surveyed population. Most respondents declare their willingness to donate organs when needed. Both our research presented in this paper and reports by other authors suggest the need for educating the public in order to encourage broad social acceptance for transplant medicine.

Vestibular voice includes participation of larynx structures which are absent in physiological process. Vestibular phonation may be desired when vocal folds are damaged as in paralytic dysphonia, or undesired in marginal hyperfunction. Vestibular voice may result from psychogenic dysphonia – phononeurosis. The aim of the study is perceptive evaluation of vestibular voice, objective larynx visualization, acoustic and aerodynamic examination. The study included 40 patients: 20 with vestibular voice, 20 with euphonic voice. Voice quality has been evaluated using perceptual GRBAS scale. Endoscopic and stroboscopic larynx examination used Endo-STROB-EL-Xion GmbH with visual tract. High-Speed Digital Imaging (HSDI) and High Speed (HS) camera registered true vocal folds vibrations. Acoustic evaluation of voice with DiagnoScope Specjalista, DiagNova Technologies included analysis of F0, Jitter, Shimmer, NHR, nonharmonic components. MPT has been analyzed. In examined group, hoarseness (95%), roughness (75%) and voice strain (55%) have been recorded. Endoscopy revealed edema of vestibular folds with dilation of vessels covering glottis. Stroboscopy and HSDI confirmed coexistence of hyperfunctional (95%) or paralytic (5%) dysphonia. Acoustic assessment revealed increase in Jitter, Shimmer, NHR and decrease in F0 and MPT. The vestibular voice is observed most frequently in women with hyperfunctional dysphonia (phononeuroses) or in paralytic dysphonia. Visualization techniques confirm the coexistence of vestibular folds hypertrophy and edema with vibration disorders. In the perceptual assessment, vestibular voice was hoarse, rough and strained. Acoustic examination showed increase of Jitter, Shimmer, NHR, presence of nonharmonic components and decrease of F0 and MPT.

Gross trunnion failure (GTF) leading to dissociation at the femoral head-trunnion interface is an uncommon complication after total hip arthroplasty (THA). The incidence of this complication is currently unknown due to the limited number of reported cases but it is significantly more common in the context of a recalled femoral head. This report details the case of a gross trunnion failure and secondary polyethylene failure of a non-recalled metal-on-polyethylene primary THA from a taper type previously reported to be associated with an increased prevalence of mechanically assisted crevice corrosion (MACC). This case describes a 77-year-old man who was 10 years status post right THA presenting with acute-onset right hip pain after trying to rise from a seated position. Radiographs showed that the right femoral head was dissociated from the femoral component. At the time of surgical revision, there was extensive dark metallic debris in the hip joint. A revision THA was performed using a modular revision system. Clinicians must be aware that MACC can eventually lead to GTF, which can result in dissociation at the femoral head-trunnion interface in metal-on-polyethylene primary THA. Further research is needed to determine patient and implant factors that make patients susceptible to MACC/GTF so that adequate screening and patient counseling can be performed. Keywords: Total hip arthroplasty, Gross trunnion failure (GTF), Mechanically assisted crevice corrosion (MACC), Metallosis, Corrosion, Femoral head-trunnion dissociation

Newer generation cementless total knee arthroplasty (TKA) implants continue to develop with demonstrated clinical success in multiple recent reports. The purpose of this study was to investigate (1) survivorship, (2) complications, and (3) clinical outcomes of a newer generation cementless and highly porous titanium-coated base plate manufactured using three-dimensional (3D) printing technology. We reviewed a single-surgeon, longitudinally maintained database of patients who underwent primary TKA using cementless, highly porous titanium-coated base plate implants from July 1, 2013 to December 31, 2016. A total of 523 patients were identified. Of this cohort, 496 patients had a minimum of 2-year follow-up and were included in our final analysis. Among these patients, 72 had bilateral TKA yielding a total of 568 TKAs. There were 133 men and 363 women who had a mean body mass index of 33 kg/m2 (range, 20–61 kg/m2). The mean age was 66 years (range, 33–88 years). Average follow-up was 36 months (range, 24–48 months). Indications for TKA included osteoarthritis in 432 patients (87%), rheumatoid arthritis in 40 patients (8%), and knee osteonecrosis in 24 (5%) patients. Implant survivorship was defined as any revision leading to explantation of the base plate for any reason. Kaplan–Meier analysis was performed to determine all-cause implant survivorship at final follow-up for every patient. Complications were assessed using the Knee Society standardized list of TKA complications. Clinical outcomes were determined using the Knee Society pain and function scores. Range-of-motion values were also collected. There were a total of four failures, all were due to aseptic loosening with a survivorship rate of 99% at mean follow-up of 3 years (95% confidence interval = 0.984–0.999). In addition, there were a total of 12 surgical and 10 medical complications. Surgical complications did not affect the base plate or result in any additional implant revisions. A total of nine patients had thromboembolic disease complications; all received medical treatment and recovered adequately. Radiological evaluation did not show any signs of loosening or failures in other patients at final follow-up. Knee Society Scores for pain and function improved from 55 and 56 points preoperatively to 92 and 84 points at 2 years postoperatively. Our results are in concordance with the excellent clinical outcomes and survivorship demonstrated for the newer generation cementless TKA implants. In our experience, 3D printed titanium base plates demonstrated clinical success and excellent survivorship at minimum follow-up of 2 years.

Introduction: Ailments located in the cervical spine are a serious clinical problem. The aim of the study was to evaluate the effectiveness of Postisometric Relaxation (PIR) and Classical Massage (CM) in analgesic therapy in patients with neck chronic increased muscle tension. Material and methods: The study was carried out in a group of 36 adults (mean age 49.5±8.59 years, 29 women) with neck increased muscle tension due to overload changes. Patients were randomly assigned into two groups. The therapy consisted of 10 PIR or CM procedures. VAS (Visual Analogue Scale), NDI (Neck Disability Index), SF-MPQ (McGill Pain Questionnaire-Short Form by Melzack) were used. The trigger points were assessed and the mobility of the cervical spine was measured. Results: A statistically significant reduction in pain was obtained in both groups (improvement in the PIR group: 70%±29, CM 55%±27). In the PIR group, trigger points were completely eliminated in 50% of subjects and in the CM group in 38.9%. There was a statistically significant reduction in the NDI in both groups (improvement in the PIR group 70%±26, CM 48%±29). In both groups, a statistically significant increase in the mobility of the cervical spine in all directions was observed (extension, lateral flexion and rotation were statistically significantly better in the PIR group). Conclusions: PIR and CM statistically significantly reduce pain, improve health, effectively eliminate trigger points and increase the mobility of the cervical spine. PIR better increases the range of extension, lateral flexion and rotation of the cervical spine.

Background: The understanding of the real flow profiles through a dry powder inhaler (DPI), generated by asthma patients, is a prerequisite for satisfactory drug delivery to the lungs. The aims of the study were to assess the relationship between spirometric measures and inhalation profiles through a low-resistance DPI, and to compare parameters of those profiles between optimal and suboptimal inhalation technique type. Methods: Both healthy adult volunteers and patients with asthma were included in the study. Spirometry was conducted along with modified flow-volume test to detect expiratory levels (maximum "100%" exhalation to residual volume [RV] and halfway "50%" to RV). These were the reference levels of the depth of exhalation for each patient to simulate the effect of incomplete exhalation. Individual inhalation profiles were recorded using spirometry in-house software as the volumetric airflow through the inhaler versus time. Inspiratory flow parameters were extracted: time to peak inspiratory flow through inhaler (PIFinh), time at which peak inspiratory flow occurs (tPIFinh), total inhalation time (T), and inhaled volume during maneuver (V). Results and Conclusions: There are significant relationships between spirometric indices and parameters of inhalation through a low-resistance, cyclohaler-type DPI (assessed by single-factor analysis of Spearman's rank correlation coefficient). Multiple regression models were constructed, predicting inspiratory flow parameters (including spirometric indices, demographic parameters, and inhaler's usage history as determinants). The exhalation halfway to RV before inhalation did not affect significantly PIFinh and tPIFinh (and, thus, initial flow dynamics) in asthma patients. T and V parameters were then significantly decreased, but seemed sufficient for successful DPI performance. Both exhalation to RV and incomplete exhalation halfway to RV preceding inhalation allow for effective usage of low-resistance DPI.

Objectives Apathy after stroke is common and has a negative impact on functional recovery. Neuroimaging correlates of poststroke apathy remain unclear. We aimed to investigate microstructural changes associated with the severity of poststroke apathy symptoms. Methods We assessed 67 patients with cerebral ischaemia who underwent magnetisation transfer brain imaging 12-15 months after stroke. We used magnetisation transfer ratio (MTR) to represent microstructural integrity. We performed whole-brain voxel-based analysis and subsequent region of interest analysis to investigate the association between MTR and symptoms of poststroke apathy. To assess apathy symptoms, we used clinician-reported version of the Apathy Evaluation Scale. Results Voxel-based analysis showed the association between symptoms of apathy and decreased MTR in areas overlapping with structures located in both hemispheres: left thalamus, bilateral hippocampus, bilateral fornix/stria terminalis, right amygdala, splenium of the corpus callosum, the retrolenticular part of left internal capsule and left sagittal stratum. In the region of interest analysis, only lower MTR in right fornix/stria terminalis was associated with greater poststroke apathy symptoms in a multivariate logistic model (odds ratio: 1.25, 95% CI: 1.09-1.46, p = 0.003). These associations were independent of depressive symptoms. Conclusion Magnetisation transfer brain imaging 12-15 months after stroke revealed changes in microstructural integrity associated with apathy symptoms in brain areas related to processing emotional information and reward valuation.

Introduction We aimed to compare the acute differences in left ventricular (LV) function and mechanical synchrony during nonselective His bundle pacing (ns-HBP) versus selective His bundle pacing (s-HBP) using strain echocardiography. Methods and results Consecutive patients with permanent His bundle pacing, in whom it was possible to obtain both s-HBP and ns-HBP, were studied in two centers. In each patient, echocardiography was performed sequentially during s-HBP and ns-HBP. Speckle-tracking echocardiography parameters were analyzed: Global longitudinal strain (GLS), the time delay between peak systolic strain in the basal septal and basal lateral segments (BS-BL delay), peak strain dispersion (PSD) and strain delay index. Right ventricle function was assessed using tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler velocity of the lateral tricuspid annulus (S'). A total of 69 patients (age: 75.6 ± 10.5 years; males: 75%) were enrolled. There were no differences in LV ejection fraction and GLS between s-HBP and ns-HBP modes: 59% versus 60%, and -15.6% versus -15.7%, respectively; as well as no difference in BS-BL delay and strain delay index. The PSD value was higher in the ns-HBP group than in the s-HBP group with the most pronounced difference in the basal LV segments. No differences in right ventricular function parameters (TAPSE and S') were found. Conclusion The ns-HBP and s-HBP modes seem comparable regarding ventricular function. The dyssynchrony parameters were significantly higher during ns-HBP, however, the difference seems modest and clarification of its impact on LV function requires a larger long-term study.

BackgroundDuring left bundle branch (LBB) area pacing, it is important to confirm that the capture of the LBB is achieved, not just the capture of only the adjacent left ventricular myocardium (LV septal capture). Our aim was to establish ECG criteria for LBB capture by analyzing ECGs with confirmed LBB capture and non-capture. We hypothesized that since LBB pacing results in physiologic depolarization of the left ventricle then the native QRS can serve as a reference for the diagnosis of LBB capture in the same patient.MethodsOnly patients with direct evidence of LBB capture (output-dependent or refractoriness-dependent QRS morphology transition) were included. Several QRS characteristics were compared between the native rhythm and different types of LBB area capture. Receiver-operator characteristics analysis was performed to determine the optimal V6 R-wave peak time (RWPT) cut-off for LBB diagnosis.ResultsA total of 357 ECG tracing (124 patients) were analyzed: 118 with native rhythm, 124 with non-selective LBB capture, 69 with selective LBB capture and 46 with LV septal capture. Our hypotheses that during LBB capture the paced V6 RWPT (measured from QRS onset) equals the native V6 RWPT and that the paced V6 RWPT (measured from the stimulus) equals the LBB potential to V6 R-wave peak interval were positively validated. Criteria based on these rules had sensitivity and specificity of 98.0–88.2% and 85.7–95.4%, respectively. The optimal and 100% specific V6 RWPT values for differentiation between LBB capture and LV septal capture in patients with narrow QRS / right bundle branch block were 83 ms and 74 ms, respectively; while in patients with left bundle branch block/asystole/ventricular escape the optimal and 100% specific V6 RWPT values were 101 ms and 80 ms, respectively.ConclusionsNovel criteria for LBB capture were developed and optimal V6 RWPT cut-offs were determined.What this study addsWe showed that LBB pacing truly reproduce the physiological depolarization of the left ventricle since the paced V6 RWPT equals the native conduction V6 RWPT.Individualized LBB capture criteria, that use the native QRS as a reference, were developed.The optimal V6 RWPT values for differentiation between LBB capture and LV septal capture were determined, separately for patients with healthy and diseased LBB.

Introduction: Osteoporosis is often not clinically recognized until after a fracture occurs. Individuals who have 1 fracture are at increased risk of future fractures. Prompt initiation of osteoporosis treatment following fracture is critical to reducing the rate of future fractures. Antiresorptives are the most widely used class of medications for the prevention and treatment of osteoporosis. Many providers are hesitant to initiate antiresorptives in the acute post-fracture period. Concerns include interference with bone remodeling necessary for successful fracture healing, which would cause increased rates of non-union, malunion, and refracture. While such concerns should not extend to anabolic medications, physicians may also hesitate to initiate anabolic osteoporosis therapies due to high cost and/or lack of familiarity. This article aims to briefly review the available data and present a digestible narrative summary to familiarize practicing orthopaedic surgeons with the essential details of the published research on this topic. Results: The results of 20 clinical studies and key pre-clinical studies related to the effect of anti-resorptive medications for osteoporosis on fracture healing are summarized in the body of this narrative review. Discussion & Conclusions: While few level I studies have examined the impact of timing of initiation of osteoporosis medications in the acute post-fracture period, the few that have been published do not support these concerns. Specifically, data from level I clinical trials indicate that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion. By reviewing the available data, we hope to give clinicians the confidence to initiate osteoporosis treatment promptly post-fracture.

Background Rehabilitation plays an important role in the management of patients with pulmonary arterial hypertension (PAH) and current guidelines recommend implementation of a monitored individualized exercise training program as adjuvant therapy for stable PAH patients on optimal medical treatment. An optimal rehabilitation model for this group of patients has not yet been established. This randomized prospective study assessed the effectiveness and safety of a 6-month home-based caregiver-supervised rehabilitation program among patients with pulmonary arterial hypertension. Methods A total of 39 patients with PAH were divided into two groups: intervention group (16 patients), subjected to a 6-month home-based physical training and respiratory rehabilitation program adapted to the clinical status of participants, and control group (23 patients) who did not perform physical training. The 6-min walk test (6MWT), measurement of respiratory muscle strength, quality of life assessment (SF-36, Fatigue Severity Scale – FSS) were performed before study commencement, and after 6 and 12 months. Adherence to exercise protocol and occurrence of adverse events were also assessed. Results Physical training significantly improved 6MWT distance (by 71.38 ± 83.4 m after 6 months (p = 0.004), which remained increased after 12 months (p = 0.043), and respiratory muscle strength after 6 and 12 months (p p p = 0.015; Vitality, p = 0.022; Role Emotional, p = 0.029; Physical Component Summary, p = 0.005), but it did not persist after study completion. Adherence to exercise protocol was on average 91.88 ± 14.1%. No serious adverse events were noted. Conclusion According to study results, the home-based rehabilitation program dedicated to PAH patients is safe and effective. It improves functional parameters and quality of life. Strength of respiratory muscles and 6MWD remain increased 6 months after training cessation. Trial registration ClinicalTrials.gov, NCT03780803. Registered 12 December 2018

Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of our study was to compare microvascular changes examined by nailfold videocapillaroscopy (NVC) examination with serum concentrations of vascular endothelial growth factor (VEGF), soluble thrombomodulin (sTM) and endothelin-1 (ET-1) in people with Type 1 diabetes with and without microangiopathy.The study included 106 people with Type 1 diabetes and 40 healthy controls. All participants were evaluated by extensive clinical, laboratory and capillaroscopic studies. NVC was performed using a stereomicroscope SZ 4045 (Olympus, Germany). The intensity of morphological changes was graded from 0 to 3. Serum levels of VEGF, sTM and ET-1 were determined by an enzyme-linked immunosorbent assay (ELISA).Morphological changes were observed by NVC in 86 out of 106 (81%) people with Type 1 diabetes mellitus. Severe capillaroscopic changes (score 3) were seen in 32 out of 54 (59%) people with microangiopathy, but in only seven out of 52 (13%) individuals without microangiopathy. Higher serum concentration of VEGF (p0.001), ET-1 (p0.001) and sTM (p0.05) were demonstrated in people with diabetes complicated with microangiopathy compared to healthy controls. Moreover, comparison between people with and without microangiopathic complications showed a significantly higher capillaroscopic score and sTM serum concentration in the group with retinopathy (p0.001) nephropathy (p0.001) and neuropathy (p0.01).Our results suggest that abnormalities in NVC may reflect the extent of microvascular involvement and associated with higher VEGF, sTM and ET-1 serum levels, as well as with microangiopathic complications in diabetic people.

Introduction. The aim of the study is the evaluation of the usefulness of High-Speed Digital Imaging (HSDI) in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes of vocal fold mucosa, morphologically confirmed by Transmission Electron Microscopy (TEM) method in patients working with voice occupationally. Material and methods. The group consisted of 30 patients working with voice occupationally with oedematous-hypertrophic changes of vocal fold mucosa. Parameters of vocal folds vibrations were evaluated using HSDI technique with a digital HS camera, HRES Endocam Richard Wolf GmbH. The image of vocal folds was recorded with a rate of 4000 frames per second. Postoperative material of the larynx was prepared in a routine way and observed in transmission electron microscope OPTON 900–PC. Results. HSDI technique allows to assess the real vibrations of vocal folds and determine many parameters. The results of TEM in the postoperative material showed destruction of epithelial cells with severe vacuolar degeneration, the enlargement of intercellular spaces and a large number of blood vessels in the stroma, which indicates the presence of oedematous-hypertrophic changes of the larynx. Discussion. The ultrastructural assessment confirm the particular usefulness of HSDI method in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes. Key words: High-Speed Digital Imaging, oedematous-hypertrophic changes, vocal fold mucosa, larynx