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Purpose: This clinical fluoroscopy study investigated knee kinematics of two different cemented fixed-bearing, posterior-stabilised (PS) total knee arthroplasty (TKA) designs: an asymmetric tibial component including an asymmetric insert designed to optimise personalised balance and fit and its precursor symmetrical design with symmetric insert., Methods: A consecutive series of patients (16 TKAs from each treatment group) participating in a randomised controlled trial comparing TKA migration was included. The exclusion criterion was the use of walking aids. Flat-panel fluoroscopic recordings of step-up and lunge motions were acquired 1-year postoperatively. Medial and lateral contact points (CPs) were determined to calculate CP displacement, femoral axial rotation and pivot position. Using linear mixed-effects modelling techniques, kinematics between TKA designs were compared., Results: During knee extension between 20° flexion and full extension, the CPs moved anteriorly combined with a small internal femoral rotation (a screw-home mechanism). Whereas CP movement was reversed: femoral rollback, external femoral rotation while flexing the knee between full extension and 20° knee flexion, At larger flexion angles, femoral axial rotation (FAR) occurred around a lateral pivot point both during step-up and lunge. The symmetric design had a 2.3° larger range of FAR compared to the asymmetric design during lunge (p = 0.02). All other kinematics were comparable., Conclusion: Despite the differences in design, this study showed that the asymmetric and symmetric PS TKA designs had mostly comparable knee kinematics during step-up and lunge motions. It is therefore expected that the functionality of the successor TKA design is similar to that of its precursor design., Level of Evidence: Level II, prospective comparative study., (© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Fluoroscopic knee kinematics have historically been quantified at least 1 year after total knee arthroplasty (TKA). The purpose of this study was to longitudinally assess knee kinematics at 6–12 weeks, 6 months, and 1 year after TKA to determine if earlier evaluation may be justified. Methods: Twenty-one patients participated after undergoing TKA with a posterior cruciate ligament-retaining fixed-bearing prosthesis. Fluoroscopic examinations of lunge, kneel, and step-up activities were performed at 12 ± 4 weeks (V1), 7 ± 2 months (V2), and 13 ± 2 months (V3) postoperatively. Images were analyzed using a three-dimensional to two-dimensional image registration technique. Maximum flexion poses for lunging and kneeling were compared between visits with repeated-measures statistical tests. For the step-up activity, mixed-effects linear models were constructed for condylar anteroposterior (AP) contact points and tibial internal rotation throughout flexion. Estimated marginal means of fitted values were plotted with 95% confidence intervals and used to compare mean kinematics between visits. Results: There were no significant changes in maximum lunging flexion over time (p = 0.405), though significant increases in maximum kneeling flexion were observed between V1 (106 ± 8°) and V2 (110 ± 9°) (p = 0.006), and V1 and V3 (113 ± 9°) (p = 0.0003). While statistical differences were calculated for lunging medial condyle AP translation and kneeling tibial internal rotation, absolute differences in condylar AP contact locations were less than ~ 2 mm between all visits during both movements. For the step-up activity, tibial internal rotation increased with flexion, and there were pair-wise significant differences at all flexion angles between V1-V2 (p < 0.001) and V1-V3 (p < 0.001). Anterior medial condylar translation was observed with flexion, with pair-wise significant differences present for V1-V3 (p = 0.005) and V2-V3 (p < 0.001). The lateral condyle exhibited initial posterior translation followed by anterior translation with increasing flexion, with pair-wise differences between all visits (p < 0.005 for all comparisons). Conclusion: Though statistical differences were observed between visits for all activities, variations in estimated mean condylar positions were within ~ 2 mm from ~ 12 weeks to 1 year. Considering measurement error averages approximately 1 mm for sagittal plane translations, these results indicate that knee kinematics during kneel, lunge, and step-up activities may be sustained from as early as 12 weeks after TKA. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is an irregular heart rhythm, characterised by chaotic atrial activation, which is promoted by remodelling. Once initiated, AF can also propagate the progression of itself in the so-called "AF begets AF". Several lines of investigation have shown that signalling molecules, including reactive oxygen species, angiotensin II, and phosphoinositide 3-kinases (PI3Ks), in presence or absence of cardiovascular disease risk factors, stabilise and promote AF maintenance. In particular, reduced cardiac-specific PI3K activity that is not associated with oncology is cardiotoxic and increases susceptibility to AF. Atrial-specific PI3K(p110α) transgene can cause pathological atrial enlargement. Highlighting the crucial importance of the p110α protein in a clinical problem that currently challenges the professional health care practice, in over forty (40) transgenic mouse models of AF (Table1), currently existing, of which some of the models are models of human genetic disorders, including PI3K(p110α) transgenic mouse model, over 70% of them reporting atrial size showed enlarged, greater atrial size. Individuals with minimal to severely dilated atria develop AF more likely. Left atrial diameter and volume stratification are an assessment for follow-up surveillance to detect AF. Gene therapy to reduce atrial size will be associated with a reduction in AF burden. In this overview, PI3K(p110α), a master regulator of organ size, was investigated in atrial enlargement and in physiological determinants that promote AF. Table 1 Transgenic and Knockout Mouse Models of AF Gene Alteration Atrial enlargement Fibrosis Thrombus Ventricular dysfunction based on echo and/or catheter Conduction abnormalities by ECG APD Alteration AF pattern/other major cellular and molecular mechanisms References Rho GDIα TG Cardiac-specific overexpression of Rho GDP dissociation inhibitor (GDI)α with α-myosin heavy chain (α-MHC) promoter Atrial weight 0.6-fold increase vs NTg at 4 months but no changes at 4 weeks ✔ no significant increase in atrial and ventricle Not reported ↔ Sinus bradycardia, varying degrees of AV block, prolongation of P-wave duration, and PR interval at 7 months Not reported Spontaneous Other mechanisms oreduced Connexin 40 expression oincreased expression of RhoA, Rac1, and Cdc42 [58] RhoA Cardiac-specific overexpression of RhoA with α-MHC promoter Atrial weight threefold increase vs NTg ✔ in ventricle Not reported ✔ Bradycardia and AV block Not reported Spontaneous Other mechanisms oincreased expression of hypertrophic genes oInflammation [59] Junction TG Cardiac-specific overexpression of junctin protein with α-MHC promoter Atrial weight, more than tenfold increase vs WT for right atrium ✔ in atrial and ventricle ✔ in left and right atria ✔ Bradycardia Atrial and ventricle APD70, phase 3 ↑ Spontaneous Other mechanisms oreduced triadin, RYR2, diastolic Ca2+, and Ca2+ transient amplitude [60] Junctate 1 TG Cardiac-specific SR-located Ca2+-binding protein junctate 1 overexpression with α-MHC promoter Atrial weight, fourfold increase for left atrium and about fivefold increase for right atrium vs WT ↑ in atria and ventricle ✔ Intra-atrial thrombi ✔ Ventricular bigeminy, sinus pause, and bradycardia APD90, phase 4 ↑ Spontaneous Other mechanisms oreduced phospholamban phosphorylation, troponin I phosphorylation, Calreticulin, and RyR2 channel oreduced SR Ca2+ content, Ca2+ transient amplitude oincreased ICa,L [61] AMPK TGN488I Cardiac-specific PRKAG2 (AMPK γ2 subunit) overexpression with missense mutation Not reported Not reported Not reported ✔ Reduced PR interval, persistent sinus bradycardia without AV block Not reported Spontaneous and paroxysmal Other mechanisms ocardiac glycogen accumulation [62] A1AR TG Cardiac-specific overexpression of A1 adenosine receptor (A1AR) with α-MHC No difference No fibrosis Not reported ✔ Slow AV conduction APD90, phase 4 ↔ APD50, phase 2 ↔ APD70, phase 2 ↔ Spontaneous [63] A3tg TG Cardiac-specific overexpression of A3 adenosine receptor (A3AR) with α-MHC promoter Atrial size onefold and twofold increase at 12 weeks and 21 weeks, respectively, vs NTg Not present in atria and ventricle Not reported ✔ Absence of normal sinus rhythm, bradycardia, and intermittently complete Not reported Spontaneous Other mechanisms oreduced SERCA mRNA levels [64] RTEF1 TG Cardiac-specific overexpression of Transcription enhancer factor-1-related factor (RTEF1) with α-MHC promoter Atrial weight 4–sixfold increase vs control Not present in atria and ventricle ✔ Organised Not reported Slow conduction in working myocardium, prolonged PR interval, and QRS duration Not reported Spontaneous Mechanisms oincreased PP1β phosphatase ochronic dephosphorylation of cardiac connexin [65] ACE 8/8 TG Cardiac-restricted angiotensin-converting enzyme (ACE) Overexpression with α-MHC Ang II concentration was 4.3-fold higher in ACE mice compared to WT Atrial weight, about threefold increase vs WT ✔ in atria but not in ventricle Not reported ✔ AV block Not reported Spontaneous [66] Kir2.1 TG Kir2.1 IK1 channel subunit cardiac-specific overexpression with α-MHC promoter Atrial weight, left and right atrial to body weight 65% and 141% increase, respectively, vs control Not reported Not reported ✔ Absence of T wave and reduced QT interval APD90, phase 4 ↓ APD50, phase 2 ↔ APD75, phase 3 ↔ MAP90 Phase 4 ↓ MAP75 phase 3 ↓ MAP50, phase 2 ↔ Spontaneous [67] Kcne1−/− K+-channel KCNE1 subunit global protein deletion in mouse Normal atrial size Not present in atria and ventricle Not reported ↔ AV block APD50, phase 2 ↓ APD90, phase 4 ↓ Spontaneous [68] hKCNE1-hKCNQ1 TG Human (h)KCNE1-hKCNQ1 Cardiac-specific overexpression with α-MHC promoter in mouse Not reported Not reported Not reported Not reported Complex atrial and irregular ventricular excitation β-AR mediated APD50, phase 2 ↑ APD90, phase 4 ↓ Spontaneous Other mechanisms oIncreased IKs density [69] Des−/− Desmin global knockout Not reported Not reported Not reported Not reported Supraventricular premature beats, spontaneous ventricular premature beats, and Wenckebach periodicity Not reported Spontaneous Other mechanisms oHypokalemia, oReduced refractory period [70] CREM-IbΔC-X Human cAMP-response element modulator (CREM) heart-directed overexpression with α-MHC promoter Atrial weight, about 5–sevenfold increase vs NTg at 12–16 weeks Not present in left atrium and ventricle ✔ Organised thrombi in left and right atria ✔ Not reported Not reported Spontaneous Other mechanisms oReduced phosphorylation of CREB and of PLB oIncreased phosphorylation of SERCA2, PP1, and mRNA levels of ANP [71] CREM-IbΔC-X Human cAMP-CREM heart-directed Overexpression with α-MHC promoter Left atrial size, twofold increase vs WT at 13–17 weeks ↑ in atria Not reported Not reported Ectopic beats APD25, phase 1 ↑ APD50, phase 2 ↑ APD90 phase 4 ↑ Spontaneous and persistent Other mechanisms oLeaky SR Ca2+ stores oDownregulation of connexin 40 [72] CREM-IbΔC-X Human cAMP- CREM and reduced RyR2-S2814A phosphorylation heart-directed overexpression with germline transmission and Meox2-Cre crossing Atrial weight, sixfold increase vs WT at 3 months ↑ in atria and ventricle Not reported ↔ Spontaneous atrial ectopy APD80, phase 4 ↑ Spontaneous at 3-month paroxysmal and persistent at 4–5 months Other mechanisms oincreased SR Ca2+ leak and CaMKII activity oreduced connexin 40 [73] JDP TG Heart-restricted c-Jun dimerization protein 2 overexpression with α-MHC promoter Atrial cell diameter 1.4-fold increase vs WT Not present in the atrial and ventricle Not reported ↔ Increased PR interval, AV block and Wenckebach periodicity Not reported Spontaneous Other mechanisms oreduced expression of connexin 40 and 43 oAng II signalling [74] RacET Heart-restricted constitutively active Rac1 Rho GTPase overexpression with α-MHC promoter Atrial weight, fourfold increase vs WT ↑ in atria and ventricle Not reported ✔ No observable conduction defects except AF Not reported Spontaneous and persistent Other mechanisms oincreased NADPH oxidase activity [75] Anxa7−/− Annexin global knockout Not reported Not reported Not reported ↔ at basal AV block, ventricular tachyarrhythmia, shorter P-wave and QRS duration, and abnormal conduction velocity Not reported Spontaneous Other mechanisms oreduced protein expression of SERCA2a oincrease expression of NCX protein oβ1-adrenergic signalling [76] TNF1.6 TG Heart-directed overexpression of tumour necrosis factor-α with α-MHC promoter Isolated atrial area 3.6-fold increase from 6 to 9 months in female vs NTg ✔ in atria ✔ Organised thrombi in atria Not reported Episodes of second degree AV block, premature beats, and Ventricular ectopy APD75 Phase 4 ↔ Spontaneous Other mechanisms oimpaired Ca2+ loading oreduced intracellular Ca2+ transients [77] MHCsTNF TG Cardiac-specific overexpression of tumour necrotic factor with α-MHC promoter Not reported Not reported Not reported ✔ AV junctional rhythm, short PR interval and wide QRS complex Not reported Spontaneous Other mechanisms oreduced connexion 40 expression oinflammation [78] MURCTG Cardiac-specific overexpression of muscle-related coiled-coil protein with α-MHC promoter Enlarged atrial compared to NTg ↑ in atria and ventricle Thrombus in the left atrial ✔ Complete AV block and prolongation of the PR interval Not reported Spontaneous Other mechanisms oreduced SERCA2, increased ANP, BNP, βMHC, TGF-β1, TGF-β2, and TGF-β3 [79] Nup155± Reduced nuclear envelope permeability by nucleoporin (NUP) 155 gene missense mutation on R391H Not reported Not reported Not reported Not reported Irregular RR intervals APD90, phase 4 ↓ Spontaneous Other mechanisms oreduced HSP70 nuclear localization [80] a1D−/− L-type Ca2+ channel (Cav1.3) subunit global knockout Not reported Not reported Not reported Not reported SA and AV nodes conduction defects Not reported Spontaneous Other mechanisms olack of Cav1.3, and reduced ICa,L [81] LTCC (α1D−/−) L-type Ca2+ channel α1D subunit global knockout Smaller compared with WT Not reported Not reported Not reported Sinus bradycardia and AV block Not reported Spontaneous Other mechanisms oreduced ICa,L, Ca2+ transient amplitude, and SR Ca2+ content [82] dnPI3K-DCM Cardiac-specific dominant negative phosphoinositide 3-kinase p110α (dnPI3K) DCM due to overexpression of mammalian sterile 20-like kinase 1 expression with α-MHC promoter Atrial size 3.45-fold increase vs NTg ↑ in atria and ventricle ✔ Chronic thrombi in the left atrium ✔ Prolonged PR intervals, double peak P-wave, and second and third degree AV block Not reported Spontaneous Other mechanisms oaltered expression of metabolic genes and K+ channels oreduced HSP70 [16] Dct−/− Melanin synthesis enzyme dopachrome tautomerase global knockout Not reported No Not reported ↔ No observable conduction defects except for AF APD50, phase 2 ↔ APD90, phase 4 ↔ Spontaneous Other mechanisms oplasma membrane caveolae accumulation oenlargement of mitochondria [83] RyR2R176Q/+ R176Q mutation in RYR2 gene through germline transmission and Meox2-Cre crossing Normal atrial size No fibrosis in atrial and ventricle Not reported Not reported RR interval variability, absence of P-wave APD50 phase 2 ↔ APD80 phase 4 ↔ Spontaneous Other mechanisms oincreased CaMKII-dependent phosphorylation of RyR2 oelevated SR Ca2+ leak [84] Gαq TG Overexpression of activated Gαq cardiac protein with α-MHC promoter Left atrial size, 2.5-fold increase vs WT ↑ in atria but not in ventricle ✔ Left atrial, unorganised thrombus Not reported Premature atrial contraction and irregular RR interval APD80, phase 4 ↑ Spontaneous [85] NppaCre+Pitx2−/− Atrial and ventricular-restricted loss of function of paired-like homeodomain transcription factor 2 (PITX2) Atrial length about 1.6-fold increase for left atrium and 1.2-fold increase for right atrium vs WT ↑ in ventricle but not in atria Not reported Not reported AV block APD20 phase 1, ↔ APD50 phase 2, ↔ APD90 phase 4, ↔ Spontaneous Other mechanisms oreduced expression of Pitx2, oreduced expression of Nav1.5 oreduced expression of Kir2.1 [86] AnkB± Ankyrin-B (ANK2) heterologous null mutation Not reported Not reported Not reported ✔ Spontaneous bradycardia and abnormal ventricular response APD90 phase 4, ↓ Spontaneous Other mechanisms oreduced ICa,L oreduced Cav1.3 expression, osignalling interaction between ankyrin-B and Cav1.2 [87] D1275N-Nav1.5 Human sodium channel Nav1.5 global missense mutation Not reported No Not reported ✔ prolongation of P-wave and QRS duration PR interval and AV block APD50, phase 2 ↑ APD90, phase 4 ↑ Spontaneous Other mechanisms oreduced peak INa oincreased late INa [88] SLN−/− Sarcolipin global knockout No difference ↑ in atria but not in ventricle Not reported Not reported Small oscillatory waves APD50, phase 2 ↔ APD90, phase 4 ↑ Spontaneous Other mechanisms oSR Ca2+ overload oDADs oincreased phosphorylation of RyR2 [89] FKBP12.6−/− FK506-binding protein deficiency with reduced RYR2 phosphorylation at S2814 Not reported Not reported Not reported Not reported Absence of P-waves and irregular RR intervals APD30, phase 2 ↔ APD50, phase 2 ↔ Spontaneous Other mechanisms oLack of FK506-binding protein 12.6 oDADs oSR Ca2+ leak oincreased INCX oCaMKII phosphorylation of RYR2 and PLB [90] MHC-TGFcys33ser Cardiac-restricted constitutively active TGFβ1 overexpression with αMHC promoter Not reported ↑ in atria Not reported Not reported Activation wavefront APD80, phase 4 ↓ for both left and right atria Spontaneous Other mechanisms oincreased Ca2+ transient [91] DN-MSTN TG13 TG Heart-directed overexpression of the N-terminal pro-peptide with α-MHC promoter Atrial weight 3.7-fold increase vs NTg ↑ in atria Appears present ↔ AV block, Bradycardia Increased P-waves and QRS duration Not reported Spontaneous Other mechanisms oreduced connexin 40 expression [92] Casq2−/− Calsequestrin 2 global knockout Atria tissue area, about 1.8–2.0-fold increase vs WT No differences Not reported ✔ Atrial ectopic activity, bradycardia APD80, phase 4↑ Spontaneous [93] LKB1 knockout Cardiac-specific AMPK-activating liver kinase B1 (LKB1) knockout with α-MHC promoter Atria size, about twofold increase for paroxysmal at 4–6 weeks and threefold increase for persistent AF over 6 weeks vs WT ↑ in atria ✔ Intra-atrial thrombi ↔ Increased PR interval and QRS duration in paroxysmal AF Not reported Paroxysmal and persistent Other mechanisms oreduced expression of AMPK oincreased in connexin 40 and 43 expression oROS and inflammation [94] F1759A-Nav1.5-dTG Human sodium channel Nav1.5 cardiac-specific expression with α-MHC promoter Right and left atria area increase by 52% and 54%, respectively, vs control ↑ in atria and ventricle Not reported ✔ Premature ventricular complexes and non-sustained polymorphic VT APD80, phase 4 ↑ for both right and left atria Spontaneous Other mechanisms oincreased late INa oincreased glycogen accumulation omyofibril disorganisation omitochondria injury oNCX regulation of Na+ entry [95] LKB1/CTR LKB1/CT atrial-specific knockdown Not reported ↑ in atria Not reported ↔ Irregularly irregular R–R intervals Not reported Spontaneous Other mechanisms oAtrial cardiomyocyte produces calcitonin oCalcitonin receptor and its ligand signalling governs fibroblast roles oParacrine signalling between atrial cardiomyocyte released calcitonin and fibroblast [96] PLK2 deficiency PLK2 Knockout Greater left atrial area ↑ in atria Not reported ↔ ventricular tachycardia APD ↔ ERP ↔ Spontaneous Other mechanisms oPLK2/ERK/OPN is a dominant structural remodelling axis for AF generation [97] Mouse models that have been used to study the pathophysiology of AF, including atrial enlargement, electrophysiological alterations, apoptosis, functional and molecular underpinnings, and anatomical, transgenic; RYR2, ryanodine receptor 2; SR, sarcoplasmic reticulum; APD, action potential; SERCA mRNA, sarco/endoplasmic reticulum Ca2+-ATPase messenger ribonucleic acid; CTR, calcitonin receptor; KCNE1, potassium voltage-gated channel subfamily E member 1; AV, Atrioventricular block; MAP, monophasic action potential; PLB, phospholamban; ANP, atrial natriuretic peptide; β-AR, beta adrenergic receptor; PPβ1, protein phosphatase type 1β; NADPH, nicotinamide adenine dinucleotide phosphate; CaMKII, Ca2+/calmodulin-dependent protein kinase II; NCX, sodium–calcium exchanger; SERCA2a, Sarco/endoplasmic reticulum calcium (Ca2+) ATPase gene; TGF- β, Transforming growth factor beta; BNP, brain natriuretic peptide; HSP70, heat shock protein 70; DCM, dilated cardiomyopathy; AMPK, 5' adenosine monophosphate-activated protein kinase; PLK2, polo-like kinase 2; OPN, osteopontin; ERK1/2, extracellular signal-regulated kinase ½. ↔ unchanged in that condition; ✔ present in that condition; ↑ increased in that condition; ↓ reduced in that condition [ABSTRACT FROM AUTHOR]

To compare the safety and effectiveness of surgical treatment of jugular paragangliomas (JPs) following the application of our modified surgical techniques. Fifty-six patients with JPs were analyzed for tumor classification, surgical outcomes, and intratumor blood vessels. The gross total resection in C1–2 (100%) was significantly greater than that in C3 and D (66.7%). Good postoperative facial nerve (FN) function (House–Brackmann I–II) was achieved in 89.5% C1–2 cases, which was not significantly different from C3 and D (93.3%) (P = 0.694). Preoperative and postoperative lower cranial nerve (LCN) deficits correlated with the Fisch's classification of tumors (P < 0.05), and intraoperative blood loss was greater in advanced tumors (P = 0.050). Further study showed that the cross-sectional area of intratumor blood vessels was positively associated with intraoperative blood loss (P < 0.001). Surgical excision of JPs is a safe and effective strategy, and early surgical treatment is a good option for patients with C1–2 tumors without surgical contraindications. [ABSTRACT FROM AUTHOR]

Introduction: The main goal of our research was to explore the effect of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) on left atrial (LA) phasic function in hypertrophic cardiomyopathy (HCM). Methods: The study included 13 patients who underwent PIMSRA at our hospital. The function of LA including reservoir, conduit, and booster pump was analyzed and compared before and 6 months after PIMSRA in HCM patients. LA reservoir function parameters contain maximal LA volume, minimal LA volume (LAV min), LA ejection fraction (LAEF), LA expansion index (LAEI), and reservoir strain; LA conduit function includes LA volume before atrial systole, LA passive volume, LA passive ejection fraction, and conduit strain; LA booster function involves LA booster volume, LA active ejection fraction, and LA contraction strain. Additionally, 20 healthy controls were selected to compare the LA function of HCM patients. Results: The preoperative LA reservoir and conduit function in HCM patients were significantly impaired compared with the control group, while the change in booster pump function was not obvious. HCM patients at 6 months after PIMSRA had remarkably enhanced reservoir and conduit functions which were manifested by lower LAV min, higher LAEF, LAEI, reservoir, and conduit strain than before the operation, and the differences among these parameters between patients after PIMSRA and the healthy control group were not significant. However, with regard to LA contraction function, there was no significant improvement at 6 months after PIMSRA compared with before operation. Conclusion: PIMSRA is effective in the amelioration of LA reservoir and conduit function in patients with HCM but not in a marked improvement of LA contraction function in these individuals in short term. [ABSTRACT FROM AUTHOR]

The present study emphasizes the importance of promptly referring ccTGA patients experiencing ventricular arrhythmias for advanced HF treatments. DIAGRAM: Graphical abstract Sankey diagram illustrates the contemporary clinical trajectories of patients with congenitally corrected transposition of the great arteries. The first study focused on long-term outcomes in 183 adult patients with ccTGA from 19 centres and highlighted the high prevalence of SRV dysfunction and congestive heart failure (CHF).[5] By the age of 45 years, 67% of patients with ccTGA and associated lesions and 27% of those without associated lesions experienced this complication. [Extracted from the article]

A quantitative monitoring system for fractional exhaled nitric oxide (FENO) in homes is very important for the control of respiratory diseases such as asthma. To this end, this paper proposes a small bionic sensing system for NO detection in an electronic nose based on analysis of the structure of the canine olfactory system and the airflow pattern in the nasal cavity. The proposed system detected NO at different FENO concentration levels with different bionic sensing systems in the electronic nose, and analyzed the data comparatively. Combined with a backpropagation neural network algorithm, the bionic canine sensing system improved the recognition rate for FENO detection by up to 98.1%. Moreover, electronic noses with a canine bionic sensing system can improve the performance of trace gas detection. [ABSTRACT FROM AUTHOR]

Background: To investigate the differential contribution of the left atrial (LA) function and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure (PASP) in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and reperfused acute myocardial infarction (AMI).Methods: Data of 370 patients with HCM (n = 133), DCM (n = 114) and reperfused AMI (n = 123) who underwent both echocardiography and cardiovascular magnetic resonance (CMR) were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), LA stiffness index, defined as E/e'/LA-GLS and extracellular volume fraction (ECV) of LV were measured using CMR.Results: E/e' was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The LA stiffness index was related to PASP in HCM (p = 0.01) and DCM (p = 0.03) independent of LA volume index and E/e', but not in AMI. In DCM, ECV was significantly related to PASP (p < 0.001) independent of LA volume index and E/e'. When subdivided according to the linear regression between PASP and E/e', patients in the discrepantly high PASP group had lower total emptying fraction and reservoir fraction of left atrium in HCM and DCM but not in AMI.Conclusions: The LA function in HCM and DCM and LV fibrosis in DCM correlated with PASP independent of E/e' and LA size, contrary to that in AMI. These results suggest the presence of LA dysfunction in non-ischemic cardiomyopathies and usefulness of ECV measurement in DCM for the comprehensive evaluation of LV diastolic function. [ABSTRACT FROM AUTHOR]

Background: Treatment of pertrochanteric femoral fractures is often associated with significant blood loss. It has already been demonstrated that the administration of tranexamic acid (TXA) for endoprosthetic procedures reduces blood losses and leads to a decreased frequency of postoperative complications. The aim of this study is to demonstrate whether the administration of TXA as part of osteosynthesis treatment for pertrochanteric fractures using a proximal femoral nail reduces perioperative blood losses and haemorrhage-related complications.Methods: In a two-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 294 patients who had suffered from pertrochanteric femoral fractures. The subjects were compared clinically to a historical control group who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, transfusion requirement, and occurrence of complications.Results: The TXA group showed evidence of a reduction in blood loss (TXA = 0.97 ± 0.47 l; nonTXA = 1.06 ± 0.47 l; p = 0.004) and a lower frequency of transfusion (TXA = 20%; nonTXA = 31%; p = 0.032) as compared to the nonTXA group. However, evidence of this therapeutic effect could only be demonstrated at one of the centres on subgroup comparison between the two centres. At the second centre, the data did not show a significant difference. A trend could be seen towards a reduction in postoperative renal failure. No complications occurred resulting from the administration of tranexamic acid.Conclusion: Preoperative administration of TXA does not lead to an increased rate of thromboembolic complications when applied for treatment of pertrochanteric femoral fractures. Evidence of a positive effect could be seen in principle in relation to the reduction in perioperative blood loss and the frequency of transfusion. The difference in effect between the two centres remains to be clarified: for this reason, it is possible to assume that further factors influencing the efficacy of TXA administration are at play which were not taken into account in this study. [ABSTRACT FROM AUTHOR]

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Despite their anatomical differences, congenitally corrected (ccTGA) and complete transposition of the great arteries (d-TGA) post-atrial switch are frequently studied together and managed similarly from a medical standpoint due to the shared systemic right ventricle (sRV). The aim was to assess differences in their underlying hemodynamics. The study is a retrospective review of 138 adults with ccTGA or d-TGA post-atrial switch undergoing cardiac catheterization at Mayo Clinic, MN between 2000 and 2021. ccTGA was categorized into isolated or complex ccTGA depending on concomitant ventricular septal defect and/or left ventricular outflow obstruction. There were 53 patients with d-TGA (91% post-Mustard procedure), 51 with complex and 34 with isolated ccTGA. Isolated ccTGA patients were older (51.8 ± 13.1 years) than those with d-TGA (37.5 ± 8.3 years) or complex ccTGA (40.8 ± 13.4 years). There were no differences in sRV or left ventricular size and function across groups. The ccTGA group more commonly had ≥ moderate tricuspid regurgitation than those with d-TGA; ≥ moderate mitral and ≥ moderate pulmonary regurgitation were most prevalent in complex ccTGA. There were no differences in sRV end-diastolic pressure (sRVEDP) or PAWP between groups. However, the ratio of PAWP:sRVEDP was higher in those with d-TGA compared to those with ccTGA. Cardiac index was higher in the d-TGA group than both groups of ccTGA patients with the latter showing higher indices of ventricular afterload. In conclusion, despite sharing a sRV, adults with d-TGA and ccTGA have substantial differences in hemodynamics and structural/valvular abnormalities. Further investigation regarding disease-specific responses to heart failure therapy in those with d-TGA and ccTGA is warranted., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Diagnosis of Clostridioides difficile infection (CDI) can be challenging. First of all, there has been debate on which of the two reference assays, cell cytotoxicity neutralization assay (CCNA) or toxigenic culture (TC), should be considered the gold standard for CDI detection. Although the CCNA suffers most from suboptimal storage conditions and subsequent toxin degradation, TC is reported to falsely increase CDI detection rates as it cannot differentiate CDI patients from patients asymptomatically colonised by toxigenic C. difficile. Several rapid assays are available for CDI detection and fall into three broad categories: (1) enzyme immunoassays for glutamate dehydrogenase, (2) enzyme immunoassays or single-molecule array assays for toxins A/B and (3) nucleic acid amplification tests detecting toxin genes. All three categories have their own limitations, being suboptimal specificity and/or sensitivity or the inability to discern colonised patients from CDI patients. In light of these limitations, multi-step algorithmic testing has been advocated by international guidelines (IDSA/SHEA and ESCMID) in order to optimize diagnostic accuracy. As a result, a survey performed in 2018-2019 in Europe revealed that most of all hospital sites reported using more than one test to diagnose CDI. CDI incidence rates are also influenced by sample selection criteria, as several studies have shown that if not all unformed stool samples are tested for CDI, many cases may be missed due to an absence of clinical suspicion. Since methods for diagnosing CDI remain imperfect, there has been a growing interest in alternative testing strategies like faecal microbiota biomarkers, immune modulating interleukins, cytokines and imaging methods. At the moment, these alternative methods might play an adjunctive role, but they are not suitable to replace conventional CDI testing strategies., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

An automatic system in equipment can be recognized as a systematic control system to minimize human tasks or automatically complete repetitive tasks without human involvement. This review paper focused on the dispensing machines in the medical field particularly the design development of the automated dispensing machines which can be considered as one of the important technologies in pharmacy. This paper also briefly describes the main criteria for fabricating the dispensing machine. Next, different fabrication methods of the dispensing machine such as simple fabrication and 3D printing as well as the materials used in 3D printing are also thoroughly discussed. The last section consisted of the evaluation methods to justify the developed devices by comparing the performance of fabricated products and also through surveys and feedback from patients and medical staff. Based on the performance evaluation of automated dispensing machines as reported in the literature, it can be concluded that the implementation of an automated dispensing machine is necessary for the high-quality guarantee of community healthcare. Graphical Abstract [ABSTRACT FROM AUTHOR]

Aim: Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon.Methods and Results: This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different.Conclusions: The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to assess adherence to system‐level performance measures measuring retention in rheumatology care and disease modifying anti‐rheumatic drug (DMARD) treatment in rheumatoid arthritis (RA). Methods: We used a validated health administrative data case definition to identify individuals with RA in Ontario, Canada, between 2002 and 2014 who had at least 5 years of potential follow‐up prior to 2019. During the first 5 years following diagnosis, we assessed whether patients were seen by a rheumatologist yearly and the proportion dispensed a DMARD yearly (in those aged ≥66 for whom medication data were available). Multivariable logistic regression analyses were used to estimate the odds of remaining under rheumatologist care. Results: The cohort included 50,883 patients with RA (26.1% aged 66 years and older). Over half (57.7%) saw a rheumatologist yearly in all 5 years of follow‐up. Sharp declines in the percentage of patients with an annual visit were observed in each subsequent year after diagnosis, although a linear trend to improved retention in rheumatology care was seen over the study period (P < 0.0001). For individuals aged 66 years or older (n = 13,293), 82.1% under rheumatologist care during all 5 years after diagnosis were dispensed a DMARD annually compared with 31.0% of those not retained under rheumatology care. Older age, male sex, lower socioeconomic status, higher comorbidity score, and having an older rheumatologist decreased the odds of remaining under rheumatology care. Conclusion: System‐level improvement initiatives should focus on maintaining ongoing access to rheumatology specialty care. Further investigation into causes of loss to rheumatology follow‐up is needed. [ABSTRACT FROM AUTHOR]

Persistent arthritis pain after resolution of joint inflammation represents a huge health burden in patients with rheumatoid arthritis (RA). However, the underling mechanisms are poorly understood. We and other groups recently revealed that FcγRI, a key immune receptor, is functionally expressed in joint nociceptors. Thus, we investigated a potential role of sensory neuron expressed FcγRI in postinflammatory arthritis pain in a mouse model of collagen antibody-induced arthritis (CAIA). Here, we show that global deletion of Fcgr1 significantly attenuated mechanical hyperalgesia in the ankle and hind paw of female mice in both inflammatory and postinflammatory phases of CAIA. No obvious differences in cartilage destruction were observed after resolution of joint inflammation between genotypes. In situ hybridization (ISH) revealed that a larger proportion of dorsal root ganglion (DRG) neurons expressed Fcgr1 mRNA signal in the late phase of CAIA. Conditional deletion of Fcgr1 in primary sensory neurons produced similar analgesic effects without affecting joint swelling. Knockdown of Fcgr1 expression within DRG in the postinflammatory phase of CAIA alleviated persistent pain. Inflammation within DRG after resolution of joint inflammation in the CAIA model was evidenced by T cell and neutrophil infiltration and upregulated mRNA expression of numerous inflammatory mediators. Yet, such changes were not altered by genetic deletion of Fcgr1. We suggest that neuroinflammation within the DRG after resolution of joint inflammation might upregulate FcγRI signaling in DRG neurons. Sensory neuron expressed FcγRI thus merits exploration as a potential target for the treatment of arthritis pain that persists in RA patients in remission. [ABSTRACT FROM AUTHOR]

Ehlers-Danlos syndrome and hypermobility spectrum disorder affect daily life. There is a lack of research that investigates how the disease affects aspects of participation. This study investigates whether there is a difference in the level of participation in society in persons with vascular EDS (N = 18), hypermobile EDS (N = 20), classical EDS (N = 4) and Hypermobility Spectrum Disorder (N = 27), compared to a healthy control group (N = 69) and fibromyalgia (N = 69). In this retrospective case-control study, the Ghent Participation Scale was completed by all participants. Each patient with EDS and HSD was matched by age and sex to healthy controls. The hEDS and HSD group were compared with the healthy control group and a positive control group (persons with fibromyalgia). The results show that there was a significant lower overall participation score for persons with hEDS/HSD compared to the healthy control group. In addition, significant differences were observed in the subscores self-performed activities and delegated activities in the hEDS/HSD group compared to healthy controls, being HEDS/HSD patients who obtained the lower scores. Further research is needed to obtain representative results of the participation level for the EDS/HSD population. In this way, interventions can be set up for patients with EDS in an evidence-based way and that are appropriate to the patient's level of participation. [ABSTRACT FROM AUTHOR]

Objective: Semaphorin 3B (Sema3B) decreases the migratory and invasive capacities of fibroblast‐like synoviocytes (FLS) in rheumatoid arthritis (RA) and suppresses expression of matrix metalloproteinases. We undertook this study to examine the role of Sema3B in a mouse model of arthritis and its expression in RA patients. Methods: Clinical responses, histologic features, and FLS function were examined in wild‐type (WT) and Sema3B−/− mice in a K/BxN serum transfer model of arthritis. Protein and messenger RNA expression of Sema3B in mouse joints and murine FLS, as well as in serum and synovial tissue from patients with arthralgia and patients with RA, was determined using enzyme‐linked immunosorbent assay, immunoblotting, quantitative polymerase chain reaction, and RNA sequencing. FLS migration was determined using a wound closure assay. Results: The clinical severity of serum‐induced arthritis was significantly higher in Sema3B−/− mice compared to WT mice. This was associated with increased expression of inflammatory mediators and increased migratory capacity of murine FLS. Administration of recombinant mouse Sema3B reduced the clinical severity of serum‐induced arthritis and the expression of inflammatory mediators. Sema3B expression was significantly lower in the synovial tissue and serum of patients with established RA compared to patients with arthralgia. Serum Sema3B levels were elevated in patients with arthralgia that later progressed to RA, but not in those who did not develop RA; however, these levels drastically decreased 1 and 2 years after RA development. Conclusion: Sema3B expression plays a protective role in a mouse model of arthritis. In RA patients, expression levels of Sema3B in the serum depend on the disease stage, suggesting different regulatory roles in disease onset and progression. [ABSTRACT FROM AUTHOR]

Objective: To find out the frequency of Helicobacter Pylori infection in children with recurrent abdominal pain. Study Design: Cross Sectional study. Setting: Pediatric Medicine, Children Hospital and Institute of Child Health, Multan. Period: November 2020 to May 2021. Material & Methods: A total of 148 children of both genders aged 4-12 years presenting with recurrent abdominal pain were included. Detailed history and physical examination was conducted. Frequency of helicobacter pylori was noted and it association with characteristics of the children studied was noted employing chi square test considering p-value<0.05 as significant. Results: In a total of 148 children with RAP, 83 (56.1%) were male. Overall, mean age was noted to be 7.6±1.9 years while 103 (69.6%) children were aged below 8 years. There were 77 (52%) children who belonged to rural areas whereas 103 (69.6%) were having poor socioeconomic status. Frequency of H. pylori was noted to be positive in 78 (52.7%) children with RAP. Male gender (p=0.001), age between 4-8 years (p=0.012) and poor socioeconomic status (p=0.001) were noted to have significant association with the frequency of H. pylori. Conclusion: Among children with RAP, frequency of H. pylori was very high. The H. pyloi infection was linked with male gender, younger age and low socioeconomic status. [ABSTRACT FROM AUTHOR]

Autoimmune coagulation factor deficiency (AiCFD) is characterized by sudden excessive bleeding due to autoantibodies against coagulation factors. This occurs primarily in elderly patients with no family history or previous clotting issues. However, the detailed mechanisms underlying autoantibody development are not well understood. Here, we evaluated the plasma proteome in patients with AiCFD and compared it with that of 22 healthy controls and 17 patients with non-autoimmune acquired factor XIII deficiency (acF13D). We identified eighteen proteins whose plasma levels were higher in AiCFD than in either healthy controls or patients with acF13D. Most of these proteins were found to be acute-phase reactants or immunoglobulins. Patients with acF13D had lower levels of nine of these proteins and higher levels of the remaining nine compared to healthy controls. However, in all cases, these protein levels were much higher in patients with AiCFD than in those with acF13D. These results suggest that an inflammatory response independent of the acute inflammation caused by bleeding can occur, which may lead to the development of AiCFD. Therefore, we believe that severe and/or chronic inflammation, probably due to an underlying disease or aging, is the most important factor in autoantibody development. [ABSTRACT FROM AUTHOR]

Background: Angiography derived fractional flow reserve (angio-FFR) has been proposed. This study aimed to assess its diagnostic performance with cadmium-zinc-telluride single emission computed tomography (CZT-SPECT) as reference., Methods and Results: Patients underwent CZT-SPECT within 3 months of coronary angiography were included. Angio-FFR computation was performed using computational fluid dynamics. Percent diameter (%DS) and area stenosis (%AS) were measured by quantitative coronary angiography. Myocardial ischemia was defined as a summed difference score ≥ 2 in a vascular territory. Angio-FFR ≤ 0.80 was considered abnormal. 282 coronary arteries in 131 patients were analyzed. Overall accuracy of angio-FFR to detect ischemia on CZT-SPECT was 90.43%, with a sensitivity of 62.50% and a specificity of 98.62%. The diagnostic performance (= area under ROC = AUC) of angio-FFR [AUC = 0.91, 95% confidence intervals (CI) 0.86-0.95] was similar as those of %DS (AUC = 0.88, 95% CI 0.84-0.93, p = 0.326) and %AS (AUC = 0.88, 95% CI 0.84-0.93 p = 0.241) by 3D-QCA, but significantly higher than those of %DS (AUC = 0.59, 95% CI 0.51-0.67, p < 0.001) and %AS (AUC = 0.59, 95% CI 0.51-0.67, p < 0.001) by 2D-QCA. However, in vessels with 50-70% stenoses, AUC of angio-FFR was significantly higher than those of %DS (0.80 vs. 0.47, p < 0.001) and %AS (0.80 vs. 0.46, p < 0.001) by 3D-QCA and %DS (0.80 vs. 0.66, p = 0.036) and %AS (0.80 vs. 0.66, p = 0.034) by 2D-QCA., Conclusion: Angio-FFR had a high accuracy in predicting myocardial ischemia assessed by CZT-SPECT, which is similar as 3D-QCA but significantly higher than 2D-QCA. While in intermediate lesions, angio-FFR is better than 3D-QCA and 2D-QCA in assessing myocardial ischemia., (© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.)

Objectives: We aimed to determine the prevalence of anti-carbamylated protein (anti-CarP) antibodies in Mexican Hispanics with established rheumatoid arthritis (RA) and to assess their relationship with disease activity. Methods: A cohort study was conducted in 278 patients with established RA during an 18-month follow-up. We measured IgG/IgM/IgA rheumatoid factor (RF), IgG anticitrullinated protein antibodies (ACPA) and IgG/IgM/IgA anti-CarP antibodies using enzyme-linked immunosorbent assay (ELISA). For disease activity, we performed the 28-joint disease activity score with erythrocyte sedimentation rate (DAS28-ESR). Repeated measures one-way ANOVA was used to test the association between anti-CarP IgG antibody status and longitudinal DAS28-ESR scores. Patients were evaluated at baseline and at 6, 12, and 18 months during follow-up. Results: Anti-CarP IgG antibodies were positive in 47.8% of patients and, accounting for all isotypes, in 9.5% of patients with negative RF and ACPA. Triple antibody positivity was present in 42.6% of patients in our sample. Anti-CarP IgG antibody positivity did not show statistically significant differences in mean DAS28-ESR when compared to anti-CarP IgG antibody negative patients at baseline, 6, 12 or 18 months. Conclusion: Anti-CarP IgG antibodies are not associated to a higher disease activity in Hispanic patients with established RA. Our findings suggest that the clinical value of measuring anti-CarP anti-bodies in RA diminishes over time. [ABSTRACT FROM AUTHOR]

Aims A byproduct of left atrial (LA) strain analysis is the automated measurement of LA maximal volume (LAVmax), which may decrease the time of echocardiography reporting, and increase the reproducibility of the LAVmax measurement. However, the automated measurement of LAVmax by two-dimensional speckle-tracking analysis (2DSTE) has never been validated. Accordingly, we sought to (i) assess the feasibility of automated LAVmax measurement by 2DSTE; (ii) compare the automated LAVmax by 2DSTE with conventional two-dimensional (2DE) biplane and three-dimensional echocardiography (3DE) measurements; and (iii) evaluate the accuracy and reproducibility of the three echocardiography techniques. Methods and results LAVmax (34–197 mL) were obtained from 198/210 (feasibility 94%) consecutive patients (median age 67 years, 126 men) by 2DSTE, 2DE, and 3DE. 2DE and 2DSTE measurements resulted in similar LAVmax values [bias = 1.5 mL, limits of agreement (LOA) ± 7.5 mL], and slightly underestimated 3DE LAVmax (biases = −5 mL, LOA ± 17 mL and −6 mL, LOA ± 16 mL, respectively). LAVmax by 2DSTE and 2DE were strongly correlated to those obtained by cardiac magnetic resonance (CMR) (r  = 0.946 and r  = 0.935, respectively; P  < 0.001). However, LAVmax obtained by 2DSTE (bias = −9.5 mL, LOA ± 16 mL) and 2DE (bias = −8 mL, LOA ± 17 mL) were significantly smaller than those measured by CMR. Conversely, 3DE LAVmax were similar to CMR (bias = −2 mL, LOA ± 10 mL). Excellent intra- and inter-observer intraclass correlations were found for 3DE (0.995 and 0.995), 2DE (0.990 and 0.988), and 2DSTE (0.990 and 0.989). Conclusion Automated LAVmax measurement by 2DSTE is highly feasible, highly reproducible, and provided similar values to conventional 2DE calculations in consecutive patients with a wide range of LAVmax. [ABSTRACT FROM AUTHOR]

Copyright of Izmir Katip Celebi University Faculty of Health Sciences Journal / İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi is the property of Izmir Katip Celebi University, Faculty of Health Sciene Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiomyopathy comprises a heterogeneous group of myocardial abnormalities, structural or functional in nature, in the absence of coronary artery disease and other abnormal loading conditions. These myocardial pathologies can result in premature death or disability from progressive heart failure, arrhythmia, stroke, or other embolic events. The European Cardiomyopathy Registry reports a high stroke risk in cardiomyopathy patients ranging from 2.1% to 4.5%, as well as high prevalence of atrial fibrillation ranging from 14.0% to 48.5%. There is a growing interest in evaluating the risk of thromboembolism depending on the type of cardiomyopathy, as well as if anticoagulation is indicated in patients with cardiomyopathy without atrial fibrillation. Data available do not unequivocally support anticoagulation therapy in all of these patients; the management of these patients remains challenging. Many published reports pertaining to the risk of thromboembolism and consecutive treatment strategies mainly focus on single cardiomyopathy subtype. We summarize essential pathophysiological knowledge and review current literature associated with thromboembolism in various cardiomyopathy subtypes, providing recommendations for the diagnostic evaluation as well as clinical management strategies in this field. Certain cardiomyopathy subtypes require anticoagulation independent of atrial fibrillation or CHA2DS2‐VASc score. Despite the scarcity of evidence regarding the choice of anticoagulation regimen (vitamin K antagonist vs. non‐vitamin K oral anticoagulants) in cardiomyopathy, it is discussed and reviewed in this article. Each patient should receive a tailored strategy based on thorough clinical evaluation, published evidence, and clinical experience, due to the current recommendations mostly developed on small‐sample studies or empirical evidence. The future research priorities in this area are also addressed in this article. [ABSTRACT FROM AUTHOR]

Background: Automated dose dispensing (ADD) services have been implemented in many health care systems internationally. However, the ADD service itself is a logistic process that requires integration with medication risk management interventions to ensure safe and appropriate medication use. National policies and regulations guiding ADD in Finland have recommended medication reconciliation, review, and follow-up for suitable risk management interventions. This implementation study aimed to develop a medication management process integrating these recommended risk management interventions into a regular ADD service for older home care clients.Methods: This study applied an action research method and was carried out in a home care setting, part of primary care in the City of Lahti, Finland. The systems-approach to risk management was applied as a theoretical framework.Results: The outcome of the systems-based development process was a comprehensive medication management procedure. The medication risk management interventions of medication reconciliation, review and follow-up were integrated into the medication management process while implementing the ADD service. The tasks and responsibilities of each health care professional involved in the care team became more explicitly defined, and available resources were utilized more effectively. In particular, the hospital pharmacists became members of the care team where collaboration between physicians, pharmacists, and nurses shifted from parallel working towards close collaboration. More efforts are needed to integrate community pharmacists into the care team.Conclusion: The transition to the ADD service allows implementation of the effective medication risk management interventions within regular home care practice. These systemic defenses should be considered when national ADD guidelines are implemented locally. The same applies to situations in which public home care organizations responsible for services e.g., municipalities, purchase ADD services from private service providers. [ABSTRACT FROM AUTHOR]

Aims: To assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings.Methods and Results: We conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only.Results: Overall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up.Conclusion: Persistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) and heart failure (HF) represent clinical turning points, altering the natural history of HCM and influencing long-term outcome of the disease. The aim of this study was to evaluate the ability of left ventricular (LV) and left atrial (LA) myocardial deformation parameters to predict new-onset AF and HF outcomes in patients with HCM. This was a prospective study that included HCM patients without severe valvular heart disease, prior myocardial infarction or history of AF. The study sample consisted of 250 patients (mean age 50.8 ± 15.8, 67.2% male). Two-dimensional (2D) speckle tracking deformation parameters including global longitudinal strain (GLS), radial strain, circumferential strain, LA reservoir strain (LAεres), LA conduit strain (LAεcon) and LA booster strain(LAεboost) were examined. During a mean follow-up of 2.5 ± 1.2 years, 44 patients developed new-onset AF. All the LV and LA deformation parameters were significant univariate predictors of AF. GLS and LAεres had the highest C statistic among the LV and LA functional indices. In multivariable analysis, only LAεres remained an independent predictor of the arrhythmia (HR 0.91, 95% CI 0.85–0.98, p: 0.008). Similarly, GLS and LAεres had the highest predictive value among the 2D speckle tracking parameters for HF outcomes. LAεres remained an independent predictor after adjusting for significant covariates. GLS and LAεres demonstrated high predictive value for the development of AF and HF in HCM. LAεres was the only independent predictor of both outcomes. Clinical trial registration: ClinicalTrials.gov identifier: NCT04112511 [ABSTRACT FROM AUTHOR]

Objective: This study applied a synovitis score obtained during routine care from ultrasound (US)–guided biopsies of synovial tissue (ST) in patients with rheumatoid arthritis (RA) and patients with other inflammatory and noninflammatory joint diseases to identify pretreatment synovial biomarkers associated with disease characteristics, and to integrate the findings into a multiparameter nomogram for use in baseline prediction of diagnosis and treatment response in treatment‐naive rheumatoid arthritis (RA) patients. Methods: The study enrolled a total of 1,015 patients with various autoimmune diseases (545 patients with RA, 167 patients with psoriatic arthritis [PsA], 199 patients with undifferentiated peripheral inflammatory arthritis [UPIA], 18 patients with crystal‐induced arthritis, 26 patients with connective tissue diseases, and 60 patients with osteoarthritis [OA] [as part of the SYNGem cohort]). All patients underwent a US‐guided ST biopsy at baseline, and patients were then stratified according to disease phase. The KSS, along with disease characteristics and clinical outcomes, were incorporated into a nomogram for prediction of achievement of clinical remission in RA patients who were previously naive to treatment. In patients in whom a treat‐to‐target strategy was applied, remission was defined as change in the Disease Activity Score in 28 joints (DAS28) at 6 months after treatment initiation. Results: The KSS significantly differed among RA patients, as well as PsA patients and UPIA patients, when compared to OA patients. In RA, the KSS directly correlated with the DAS28 and was related to autoantibody positivity in treatment‐naive RA patients. Moreover, at baseline, treatment‐naive RA patients achieving 6‐month remission according to DAS28 had a lower KSS, shorter duration of symptoms (very early RA [VERA]), and lower disease activity than treatment‐naive RA patients not achieving remission according to DAS28. Results of logistic regression analysis identified the following synergistic predictive factors of achievement of DAS28‐based disease remission at 6 months: having a short disease duration (VERA), not having high disease activity, and having a KSS of <5 at baseline. A nomogram integrating these baseline clinical and histologic characteristics in treatment‐naive RA patients yielded an up to 81.7% probability of achieving 6‐month remission according to the DAS28. Conclusion: The KSS is a reliable tool for synovitis assessment on US‐guided ST biopsy, contingent on the phase of the disease and the autoimmune profile of each patient. This tool could be integrated within a therapeutic response–predictive nomogram for the prediction of treatment response in RA patients who were previously naive to treatment. [ABSTRACT FROM AUTHOR]

Background: Femoral neck fractures (FNF) are frequent in the elderly population, and surgical management is indicated in the vast majority of cases. Osteosynthesis is an alternative to arthroplasty for non-displaced FNF. Triple screw construct (TS) and the dynamic hip screw system (DHS) are considered gold standards for osteosynthesis. The newly available femoral neck system (FNS) currently lacks evidence as to whether it is a valid alternative to TS and DHS. The purpose of this study was to evaluate the short-term clinical and radiological outcomes after non-displaced (Garden I and II) FNF osteosynthesis using TS, DHS, and FNS. Methods: All the patients of the author's institution aged ≥ 75 years with a non-displaced (Garden I and II) FNF eligible for osteosynthesis between November 2015 and December 2019 were included in this single-center retrospective non-randomized study. Patients were treated with either TS, DHS, or FNS depending on the surgeon's preference. Clinical data (age, gender, ASA score, duration of surgery, need for blood transfusion and number of packed red blood cells transfused, surgical site complications, length of stay, discharge location, postoperative medical complications and readmission within 30 days, and mortality within 3 months) were extracted from the patients' charts. The radiological analysis assessed the fracture classification, fracture impaction, and proximal femur shortening at 3 and 6 months using the institutional imaging software. Results: Baseline characteristics in the TS (n = 32), DHS (n = 16), and FNS (n = 15) groups were similar with respect to age (mean 85 years), gender (female to male ratio 4:1), and ASA score. There were no significant differences across the groups for the need for blood transfusion, surgical site complications, length of stay, postoperative medical complications and readmission within 30 days, discharge location, and mortality within 3 months. The duration of surgery was significantly lower in the FNS group (43.3 vs 68.8 min; p < 0.001). The radiological assessment found similar impaction (5.2 mm ± 4.8) and shortening (8.6 mm ± 8.2) in all groups that did not seem to progress after 3 months. Conclusion: The FNS appears to be a valid alternative implant for FNF osteosynthesis and is associated with a shorter operative time than TS and DHS. Short-term clinical and radiological outcomes of FNS are similar to TS and DHS implants. Further long-term multicenter randomized studies are however necessary to confirm these first results. [ABSTRACT FROM AUTHOR]

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The aim of the present study was to identify the independent risk factors and prognostic indicators for atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) and to develop predictive nomogram models. This retrospective study included a total of 286 patients with COPD who were admitted to the Second Affiliated Hospital of Guilin Medical College between January 2020 and May 2022. The average age of the patients was 77.11±8.67 years. Based on the presence or absence of AF, the patients were divided into two groups: The AF group (n=87) and the non-AF group (n=199). Logistic regression analysis was conducted to identify variables with significant differences between the two groups. Nomogram models were constructed to predict the occurrence of AF in COPD patients and to assess prognosis. Survival analysis was performed using the Kaplan-Meier method. The follow-up period for the present study extended until April 31, 2023. Survival time was defined as the duration from the date of the interview to the date the participant succumbed or the end of the follow-up period. In the present study, age, uric acid (UA) and left atrial diameter (LAD) were found to be independent risk factors for the development of AF in patients diagnosed with COPD. The stepwise logistic regression analysis revealed that age had an odds ratio (OR) of 1.072 [95% confidence interval (CI): 1.019-1.128; P=0.007], UA had an OR of 1.004 (95% CI: 1.001-1.008; P=0.010) and LAD had an OR of 1.195 (95% CI: 1.098-1.301; P<0.001). Univariate and multivariate Cox regression analysis revealed that LAD and UA were independent prognostic factors for long-term mortality in COPD patients with AF. LAD had a hazard ratio (HR) of 1.104 (95% CI: 1.046-1.165; P<0.001) and UA had an HR of 1.004 (95% CI: 1.000-1.008; P=0.042). Based on these findings, predictive nomogram models were developed for AF in COPD patients, which demonstrated good discrimination ability with an area under the curve of 0.886. The prognostic nomogram for COPD patients with AF also showed good predictive accuracy with a concordance index of 0.886 (95% CI: 0.842-0.930). These models can provide valuable information for risk assessment and prognosis evaluation in clinical practice. Age, UA and LAD are independent risk factors for AF in COPD patients. The developed nomogram models provide a reliable tool for predicting AF in COPD patients and for prognosis assessment. [ABSTRACT FROM AUTHOR]

Summary: A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the superiority of operative management. Nonoperative management should be only considered when surgery is not an option. Purpose: Reasons underpinning hip fracture (HF) nonoperative management (NOM) are seldom analysed. This study aims to identify the reasons behind NOM and assess the accuracy of these decisions using these patients' survival compared with those treated with operative management (OM). Methods: This is a retrospective cohort study based on population-wide administrative health data, including patients aged ≥ 50 with an index HF diagnosis between January 2009 and September 2017. NOM patients were subgrouped according to their expected prognoses, and their survival up to 36 months was compared with those treated surgically. Results: From a total of 11,210 included patients, 6.8% (766) received NOM. Varying reasons lead to NOM, dividing them further into five distinct subgroups: (I) 46% NOM decision due to poor expected prognosis with OM; (II) 29% NOM decision due to poor expected prognosis for mixed reasons; (III) 15% NOM decision due to good expected prognosis with NOM; (IV) 8.0% NOM decision due to patient's refusal of OM; and (V) 1.3% NOM decision due to occult HF. Only poor prognosis and patients who refused OM (I, II, IV) had worse survival than OM patients. However, a relatively high proportion of the poor prognosis patients survived 1 year (29%). Conclusion: Although there was high variability in reasons underpinning HF NOM, none of these practices conclusively outweigh OM's superiority. NOM should be considered with utmost care and only for patients for whom OM is out of the question — well-defined medical unfitness or carefully considered refusal by understanding the increased mortality risk. [ABSTRACT FROM AUTHOR]

Most of the Helicobacter pylori infections occur in developing countries. The risk factors for H. pylori infections are poverty, overcrowding, and unhygienic conditions, which are common problems in under-privileged countries such as Nepal. Despite having a high risk of H. pylori infections, no national level study has been conducted to assess prevalence and correlates of H. pylori infection in Nepal. Therefore, we hypothesized that micronutrients such as iron, vitamin B12 deficiency, socio-economic status, and nutritional status correlate with the prevalence of H. pylori infection in Nepal. We studied prevalence and correlates of H. pylori infection among under-five children, adolescents aged 10–19 years and married women of reproductive age (aged 20–49 years) using data from the Nepal National Micronutrient Status Survey 2016 (NNMSS-2016). H. pylori infection was examined in stool specimens of 6–59 months old children, and 20–49 years old non-pregnant women by using a rapid diagnostic kit while blood samples was used to assess the H. pylori infection among adolescent boys and girls. Prevalence of H. pylori infection was 18.2% among 6–59 months old children, 14% among adolescent boys and 16% among adolescent girls aged 10–19 years; and 40% among 20–49 years non-pregnant women. Poor socioeconomic status, crowding, and unhygienic condition were found to be positively associated with higher incidence of H. pylori infections. No significant correlation was observed between nutritional and micronutrients status (iron or risk of folate deficiency) and H. pylori infection. Findings from this study suggest that poverty-associated markers are primary contributors of H. pylori infections in Nepalese communities. To control acquisition and persistence of H. pylori infection in Nepal, we suggest improved management of safe drinking water and implementation of sanitation and hygiene programs, with a focus on those of lower socioeconomic status. Author summary: Helicobacter pylori is associated with a wide spectrum of gastrointestinal diseases and is a common problem in tropical region where inter-human contact is the primary mode of disease transmission. Poor socio-economic status is a crucial fueling factor of H. pylori infection. In this study, the authors present data from Nepal national micronutrient status survey 2016 (NNMSS-2016) and investigated the risk factors associated with H. pylori infections among under-five years old children, 10–19 years old adolescent boys and girls, and 20–49 years non-pregnant women nationwide. Study findings corroborate that poverty-associated markers are the key driving factor of H. pylori infections in Nepal, which can have a manifold effect on nutrition and subsequent child growth retardation. Management of safe drinking water and implementation of sanitation and hygiene practices to decrease acquisition of H. pylori infection is a pressing need in rural parts of Nepal and among marginalized communities. The findings of this study highlight the varied prevalence of H. pylori by age group, gender, place of residence, ethnic group, and ecological zone of the country. Moreover, no significant correlation was observed between nutritional and micronutrients status and H. pylori infection. [ABSTRACT FROM AUTHOR]

Aims Atrial fibrillation (AF) is frequently observed in hypertrophic cardiomyopathy (HCM) and is associated with poor clinical outcome. Total atrial conduction time, estimated by tissue Doppler imaging (TDI), the so-called PA-TDI duration, reflects the left atrial (LA) structural and electrical remodelling. The aim of this study was to evaluate the association between PA-TDI and new-onset AF in patients with HCM. Methods and results From a large cohort of patients with HCM, 208 patients (64% male, mean age 53 ± 14 years) without AF were selected. PA-TDI duration was measured from the onset P wave on electrocardiogram to the peak A ′ wave of the lateral LA wall using TDI. The incidence of new-onset AF was 20% over a median follow-up of 7.3 (3.5–10.5) years. Patients with incident AF had longer PA-TDI duration when compared with patients without AF (133.7 ± 23.0 vs. 110.5 ± 30.0 ms, P  < 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, P  < 0.001). Conclusion Prolonged PA-TDI duration was independently associated with new-onset AF in patients with HCM. This novel parameter could be useful to risk-stratify patients with HCM who are at risk of having AF. [ABSTRACT FROM AUTHOR]

Some studies have shown that left ventricular structure and function play an important role in the risk stratification and prognosis of cardiovascular disease. The clinical application of left atrial function in cardiovascular disease has gradually attracted attention in the cardiovascular field. There are many traditional methods to evaluate left atrial function. Left atrial function related indexes measured by echocardiography has been identified as a powerful predictor of cardiovascular disease in recent years, but they have some limitations. The left atrial function index has been found to evaluate left atrial function more effectively than traditional parameters. Furthermore, it is a valuable predictor of the risk stratification and prognosis in patients with clinical cardiovascular disease such as heart failure, atrial fibrillation, hypertension, and coronary heart disease. [ABSTRACT FROM AUTHOR]

Breath analysis is a relatively recent field of research with much promise in scientific and clinical studies. Breath contains endogenously produced volatile organic components (VOCs) resulting from metabolites of ingested precursors, gut and air-passage bacteria, environmental contacts, etc. Numerous recent studies have suggested changes in breath composition during the course of many diseases, and breath analysis may lead to the diagnosis of such diseases. Therefore, it is important to identify the disease-specific variations in the concentration of breath to diagnose the diseases. In this review, we explore methods that are used to detect VOCs in laboratory settings, VOC constituents in exhaled air and other body fluids (e.g., sweat, saliva, skin, urine, blood, fecal matter, vaginal secretions, etc.), VOC identification in various diseases, and recently developed electronic (E)-nose-based sensors to detect VOCs. Identifying such VOCs and applying them as disease-specific biomarkers to obtain accurate, reproducible, and fast disease diagnosis could serve as an alternative to traditional invasive diagnosis methods. However, the success of VOC-based identification of diseases is limited to laboratory settings. Large-scale clinical data are warranted for establishing the robustness of disease diagnosis. Also, to identify specific VOCs associated with illness states, extensive clinical trials must be performed using both analytical instruments and electronic noses equipped with stable and precise sensors., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: Autofluorescence is an image enhancement technique used for the detection of cancer precursor lesions in pulmonary and gastrointestinal endoscopy. This study evaluated the feasibility of addition of autofluorescence to ductoscopy for the detection of intraductal breast cancer precursor lesions. Methods: An autofluorescence imaging system, producing real-time computed images combining fluorescence intensities, was coupled to a conventional white light ductoscopy system. Prior to surgery, ductoscopy with white light and autofluorescence was evaluated under general anaesthesia in women scheduled for therapeutic or prophylactic mastectomy. Endoscopic findings in both modes were compared, marked and correlated with histology of the surgical specimen. Results: Four breast cancer patients and five high-risk women, with a median age of 47 years (range 23–62) were included. In autofluorescence mode, two intraductal lesions were seen in two breast cancer patients, which had an increase in the red-to-green fluorescence intensity compared with the surrounding tissue. One lesion had initially been missed by white light ductoscopy but was clearly visible in subsequent autofluorescence mode. One endoscopic finding was classified as suspicious by white light, but was negative in autofluorescence mode and showed normal histology. Conclusions: This study demonstrates for the first time the in vivo feasibility of autofluorescence ductoscopy to detect pathologically confirmed breast cancer precursor lesions in both breast cancer patients and high-risk women that were occult under white light. [ABSTRACT FROM AUTHOR]

Introduction: Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. Methods: Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. Results: A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. Conclusion: The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions. [ABSTRACT FROM AUTHOR]

In this tutorial, we focus on the problem of how to define and estimate treatment effects when some patients develop a contraindication and are thus ineligible to receive a treatment of interest during follow‐up. We first describe the concept of positivity, which is the requirement that all subjects in an analysis be eligible for all treatments of interest conditional on their baseline covariates, and the extension of this concept in the longitudinal treatment setting. We demonstrate using simulated datasets and regression analysis that under violations of longitudinal positivity, typical associational estimates between treatment over time and the outcome of interest may be misleading depending on the data‐generating structure. Finally, we explain how one may define "treatment strategies," such as "treat with medication unless contraindicated," to overcome the problems linked to time‐varying eligibility. Finally, we show how contrasts between the expected potential outcomes under these strategies may be consistently estimated with inverse probability weighting methods. We provide R code for all the analyses described. [ABSTRACT FROM AUTHOR]