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Background: The efficacy of pulmonary vein isolation for the treatment of atrial fibrillation may be limited by the ability to make continuous and transmural lesions utilizing an ablation catheter. Gaps often persist between ablation lesions leading to failed electrical isolation and thus failed ablation. Recently, a deflectable fiberoptic endocardial visualization catheter has been introduced for use in imaging the coronary sinus using light in the visible spectrum. We utilize this catheter to visualize the endocardial surface and examine radiofrequency ablation lesions in porcine endocardium to determine the presence of gaps between radiofrequency lesions.Methods: Videos were taken of the lesions and shown to two readers who were asked to identify the gaps ranging from less than 0.1 mm-9.8 mm.Results: Ninety-four lesion gaps were reviewed. The readers demonstrated a combined accuracy of 98.4% at identifying gaps.Conclusions: Gaps between ablation lesions can be accurately identified down to less than 1 mm distances in vitro using a direct visualization catheter. Further studies are warranted to confirm these finding in vivo. [ABSTRACT FROM AUTHOR]

Background: The precise reasons for failure to cannulate the coronary sinus during biventricular device implantation are unknown. Visualization of the coronary sinus ostium during electrophysiology procedures may enhance understanding of how unusual anatomy can affect successful cannulation of the coronary sinus. Objectives: The aim of this study was to describe the morphology of valves at the coronary sinus ostium (CSO) visualized directly with an illuminated fiberoptic endoscope during implantation of biventricular devices. Methods: The coronary sinus anatomy of one hundred consecutive patients undergoing implantation of biventricular devices was investigated using a fiberoptic endocardial visualization catheter (EVC). Results: The CSO was clearly visualized in 98 patients using the EVC. A Thebesian valve was seen in 54% of these. Almost all Thebesian valves were positioned at the inferior (61%) or posterior (33%) aspect of the CSO. Only six patients had Thebesian valves that covered more than 70% of the CSO, but all were successfully implanted with a transvenous left ventricular pacing lead after cannulating the coronary sinus under direct visualization. Conclusions: Over half of patients undergoing biventricular device implantation have identifiable Thebesian valves. Even valves covering the majority of the ostial area may be traversed using direct visualization and modern catheterization techniques. [ABSTRACT FROM AUTHOR]

Background: Sinus rhythm activation time is useful to assess infarct border zone substrate., Objective: We sought to further investigate sinus activation in ventricular tachycardia (VT)., Methods: Canine postinfarction data were analyzed retrospectively. In each experiment, an infarct was created in the left ventricular wall by left anterior descending coronary artery ligation. At 3 to 5 days after ligation, 196-312 bipolar electrograms were recorded from the anterior left ventricular epicardium overlapping the infarct border zone. Sustained monomorphic VT was induced by premature electrical stimulation in 50 experiments and was noninducible in 43 experiments. Acquired sinus rhythm and VT electrograms were marked for electrical activation time, and activation maps of representative sinus rhythm and VT cycles were constructed. The sinus rhythm activation signature was defined as the cumulative number of multielectrode recording sites that had activated per time epoch, and its derivative was used to predict VT inducibility and to define the sinus rhythm slow/late activation sequence., Results: Plotting mean activation signature derivative, a best cutoff value was useful to separate experiments with reentrant VT inducibility (sensitivity, 42/50) vs noninducibility (specificity, 39/43), with an accuracy of 81 of 93. For the 50 experiments with inducible VT, recording sites overlying a segment of isochrone encompassing the sinus rhythm slow/late activation sequence spanned the VT isthmus location in 32 cases (64%), partially spanned it in 15 cases (30%), but did not span it in 3 cases (6%)., Conclusion: The sinus rhythm activation signature derivative is assistive to differentiate substrate supporting reentrant VT inducibility vs noninducibility and to identify slow/late activation for targeting isthmus location., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Type 2 diabetes mellitus (T2DM) and its related complications are associated with schizophrenia. However, the relationship between antipsychotic medications (APs) and T2DM risk remains unclear. In this population-based, retrospective cohort study across the country, we investigated schizophrenia and the effect of APs on the risk of T2DM, and glucose homeostasis-related gene expression., Methods: We used information from the Longitudinal Health Insurance Database of Taiwan for individuals newly diagnosed with schizophrenia (N = 4,606) and a disease-free control cohort (N = 4,606). The differences in rates of development of T2DM between the two cohorts were assessed using a Cox proportional hazards regression model. The effects of APs on the expression of glucose homeostasis-related genes in liver and muscle cell lines were assessed using quantitative real-time PCR., Results: After controlling potential associated confounding factors, the risk of T2DM was higher in the case group than that in the control group [adjusted hazard ratio (aHR), 1.80, p < 0.001]. Moreover, the likelihood of T2DM incidence in patients with schizophrenia without AP treatment (aHR, 2.83) was significantly higher than that in non-schizophrenia controls and those treated with APs (aHR ≤ 0.60). In an in vitro model, most APs did not affect the expression of hepatic gluconeogenesis genes but upregulated those beneficial for glucose homeostasis in muscle cells., Conclusion: This study demonstrates the impact of schizophrenia and APs and the risk of developing T2DM in Asian populations. Unmeasured confounding risk factors for T2DM may not have been included in the study. These findings may help psychiatric practitioners identify patients at risk of developing T2DM., (© 2024. The Author(s).)

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: Diagnosing maxillary occlusal cant involves varied methods, yet classification remains incomplete. This includes determining if the cant results from equal faults on both sides or if one side exhibits overdevelopment while the other underdevelops. This study introduces an innovative average 3D skull template for classifying maxillary occlusal cant instances., Methods: Sixty adult patients were divided into two groups: 30 with a mesoprosopic facial type and 30 with a leptoprosopic facial type. Using seven pairs of anatomical landmarks (N, Or (L, R), Lo (L, R), Zy (L, R)), the average skull models were aligned and superimposed onto the patients' skull models. Image resizing facilitated optimal registration area fitting. Vertical distances from the U6 mesial buccal cusp tip to the FH plane were measured to analyze occlusal cant, classified into three classes: overdevelopment (Class A), underdevelopment (Class B) and equal fault on both sides (Class C)., Results: In the mesoprosopic group, Class B t was most common (40%), followed by Class A (27%) and Class C (33%). In the leptoprosopic facial type group, Class B remained prevalent (50%), followed by Class A (43%) and Class C (7%). Statistical analysis revealed a significant association between facial types and the three classes., Conclusions: Contrary to expectations, equal fault patterns were not predominant; instead, underdevelopment of the maxilla constituted the majority of occlusal cant cases. Utilizing average 3D skeletofacial models as templates emerges as an effective tool and alternative for diagnosing the instance of maxillary occlusal cant., Risk Studies/level of Evidence: Therapeutic, II., Competing Interests: Conflicts of Interest: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 by the American Society of Plastic Surgeons.)

This study aimed to enhance the evaluation of facial symmetry crucial for planning and assessing outcomes of orthognathic surgery (OGS). An innovative approach combining three-dimensional (3D) facial contour lines with hyperdimensional (HD) computing was developed for this purpose. Data were collected using 3D cone beam computed tomography (CBCT) at Chang Gung Memorial Hospital from 2016 to 2021. A comprehensive dataset was compiled, including images from 150 normal individuals and 2500 patients, totaling 5150 preoperative and postoperative facial images. A machine learning model was trained to analyze these images, and 3D contour data were used to create a facial symmetry quantification system with HD computing. Additionally, 3D CBCT data from 200 patients before and after OGS were retrospectively reviewed for clinical application. The developed facial symmetry algorithm demonstrated an overall accuracy of 84.1 %. Postoperative facial symmetry scores improved significantly, with a mean score increase of 53 %, from 2.40 to 3.63. The study culminated in the creation of a web-based system that leverages HD computing and 3D contour mapping to automate facial symmetry assessment. This system offers a user-friendly interface for rapid and accurate evaluations, facilitating better communication between clinicians and patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Corrosion protection technology plays a crucial role in preserving infrastructure, ensuring safety and reliability, and promoting long-term sustainability. In this study, we combined experiments and various analyses to investigate the mechanism of corrosion occurring on the epoxy-based anticorrosive coating containing the additive of two-dimensional (2D) and water-stable zirconium-based metal - organic frameworks (Zr-MOFs). By using benzoic acid as the modulator for the growth of the MOF, a 2D MOF constructed from hexazirconium clusters and BTB linkers (BTB = 1,3,5-tri(4-carboxyphenyl)benzene) with coordinated benzoate (BA-ZrBTB) can be synthesized. By coating the BA-ZrBTB/epoxy composite film (BA-ZrBTB/EP) on the surface of cold-rolled steel (CRS), we found the lowest coating roughness (RMS) of BA-ZrBTB/EP is 2.83 nm with the highest water contact angle as 99.8°, which represents the hydrophobic coating surface. Notably, the corrosion rate of the BA-ZrBTB/EP coating is 2.28 × 10 -3 mpy, which is 4 orders of magnitude lower than that of the CRS substrate. Moreover, the energy barrier for oxygen diffusion through BA-ZrBTB/EP coating is larger than that for epoxy coating (EP), indicating improved oxygen resistance for adding 2D Zr-MOFs as the additive. These results underscore the high efficiency and potential of BA-ZrBTB as a highly promising agent for corrosion prevention in various commercial applications. Furthermore, this study represents the first instance of applying 2D Zr-MOF materials in anticorrosion applications, opening up new possibilities for advanced corrosion-resistant coatings.

Background: Oxaliplatin-associated shock (referred to as shock) is a rare but life-threatening adverse event., Objectives: This pioneering cohort study aimed to quantitatively investigate the association between oxaliplatin use and shock in patients with stage III colorectal cancer (CRC), identify potential independent risk factors for shock, and assess the cycle-to-shock during oxaliplatin treatment., Design: The study utilized a nested case-control (NCC) design to assess the association between oxaliplatin and shock and employed a case-crossover approach to address unmeasured confounders., Methods: All newly diagnosed stage III CRC patients were identified from the CRC Health Database (2012-2016). Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for oxaliplatin's link to shock incidence., Results: Among 6932 oxaliplatin recipients, 331 suffered shock. In all, 3309 controls were selected via risk-set sampling for the shock cases. Oxaliplatin use is associated with a doubled risk of shock (adjusted OR: 2.08, 95% CI: 1.23-3.52). Two independent risk factors were male sex (adjusted OR: 1.33, 95% CI: 1.05-1.69) and heart diseases (adjusted OR: 1.65, 95% CI: 1.17-2.32). The case-crossover analysis revealed a more than fourfold risk (OR: 4.4, 95% CI: 1.67-11.62). In total, 22 of 331 shock cases were exposed to oxaliplatin within 2 days of shock onset, with a median cycle-to-shock time at the seventh cycle., Conclusion: Oxaliplatin use significantly increased shock risk in stage III CRC patients. Male sex and heart disease are two independent risk factors., (© The Author(s), 2024.)

Background: Despite the advances of therapies, multiple myeloma (MM) remains an incurable hematological cancer that most patients experience relapse. Tumor angiogenesis is strongly correlated with cancer relapse. Human leukocyte antigen G (HLA-G) has been known as a molecule to suppress angiogenesis. We aimed to investigate whether soluble HLA-G (sHLA-G) was involved in the relapse of MM., Methods: We first investigated the dynamics of serum sHLA-G, vascular endothelial growth factor (VEGF) and interleukin 6 (IL-6) in 57 successfully treated MM patients undergoing remission and relapse. The interactions among these angiogenesis-related targets (sHLA-G, VEGF and IL-6) were examined in vitro. Their expression at different oxygen concentrations was investigated using a xenograft animal model by intra-bone marrow and skin grafts with myeloma cells., Results: We found that HLA-G protein degradation augmented angiogenesis. Soluble HLA-G directly inhibited vasculature formation in vitro. Mechanistically, HLA-G expression was regulated by hypoxia-inducible factor-1α (HIF-1α) in MM cells under hypoxia. We thus developed two mouse models of myeloma xenografts in intra-bone marrow (BM) and underneath the skin, and found a strong correlation between HLA-G and HIF-1α expressions in hypoxic BM, but not in oxygenated tissues. Yet when stimulated with IL-6, both HLA-G and HIF-1α could be targeted to ubiquitin-mediated degradation via PARKIN., Conclusion: These results highlight the importance of sHLA-G in angiogenesis at different phases of multiple myeloma. The experimental evidence that sHLA-G as an angiogenesis suppressor in MM may be useful for future development of novel therapies to prevent relapse., (© 2024. The Author(s).)

Background: Where activation wavefront curvature is convexly shaped, functional conduction block can occur., Objective: The purpose of this study was to determine whether left ventricular (LV) wall thickness determined from contrast-enhanced computed tomography (CT) is useful in localizing such areas in clinical postinfarction reentrant ventricular tachycardia (VT)., Methods: We evaluated data from 6 patients who underwent catheter ablation for postinfarction VT. CT imaging with inHEART processing was conducted 1-3 days before electrophysiological (EP) study to determine LV wall thickness (T). Activation wavefront curvature was approximated as ΔT/T, where ΔT represents wall thickness change. During EP study, bipolar LV VT electrograms were acquired using a high-density mapping catheter, and activation times were determined. Maps of T, ΔT/T, and VT activation were subsequently compared using statistical analyses., Results: Two of 6 cases exhibited dual circuit morphologies, resulting in a total of 8 VT morphologies analyzed. The LV wall near the VT isthmus location tended to be thin, on the order of a few hundred micrometers. Regions of largest ΔT/T partially coincided with the lateral isthmus boundaries where electrical conduction block occurred during VT. ΔT/T at the boundaries, measured from imaging, was significantly larger compared to values at the isthmus midline and to the global LV mean value (P <.001)., Conclusion: Wavefront curvature measured by ΔT/T and caused by source-sink mismatch is dependent on ventricular wall thickness. Areas of high wavefront curvature partly coincide with and may be helpful in locating the VT isthmus in infarct border zones using preprocedural imaging analysis., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

High-temperature-requirement protein A (HtrA) family proteins play important roles in controlling protein quality and are recognized as virulence factors in numerous animal and human bacterial pathogens. The role of HtrA family proteins in plant pathogens remains largely unexplored. Here, we investigated the HtrA family protein, DegQ, in the crucifer black rot pathogen Xanthomonas campestris pathovar campestris (Xcc). DegQ is essential for bacterial attachment and full virulence of Xcc. Moreover, the degQ mutant strain showed increased sensitivity to heat treatment and sodium dodecyl sulfate. Expressing the intact degQ gene in trans in the degQ mutant could reverse the observed phenotypic changes. In addition, we demonstrated that the DegQ protein exhibited chaperone-like activity. Transcriptional analysis displayed that degQ expression was induced under heat treatment. Our results contribute to understanding the function and expression of DegQ of Xcc for the first time and provide a novel perspective about HtrA family proteins in plant pathogen., (© 2024 Wiley‐VCH GmbH.)

Obesity is a significant health concern that often leads to metabolic dysfunction and chronic diseases. This study introduces a novel approach to combat obesity using orally ingested self-powered electrostimulators. These electrostimulators consist of piezoelectric BaTiO 3 (BTO) particles conjugated with capsaicin (Cap) and aim to activate the vagus nerve. Upon ingestion by diet-induced obese (DIO) mice, the BTO@Cap particles specifically target and bind to Cap-sensitive sensory nerve endings in the gastric mucosa. In response to stomach peristalsis, these particles generate electrical signals. The signals travel via the gut-brain axis, ultimately influencing the hypothalamus. By enhancing satiety signals in the brain, this neuromodulatory intervention reduces food intake, promotes energy metabolism, and demonstrates minimal toxicity. Over a 3-week period of daily treatments, DIO mice treated with BTO@Cap particles show a significant reduction in body weight compared to control mice, while maintaining their general locomotor activity. Furthermore, this BTO@Cap particle-based treatment mitigates various metabolic alterations associated with obesity. Importantly, this noninvasive and easy-to-administer intervention holds potential for addressing other intracerebral neurological diseases., (© 2024 Wiley‐VCH GmbH.)

Background: The modified Look-Locker inversion recovery (MOLLI) sequence is commonly used for myocardial T1 mapping. However, it acquires images with different inversion times, which causes difficulty in motion correction for respiratory-induced misregistration to a given target image., Hypothesis: Using a generative adversarial network (GAN) to produce virtual MOLLI images with consistent heart positions can reduce respiratory-induced misregistration of MOLLI datasets., Study Type: Retrospective., Population: 1071 MOLLI datasets from 392 human participants., Field Strength/sequence: Modified Look-Locker inversion recovery sequence at 3 T., Assessment: A GAN model with a single inversion time image as input was trained to generate virtual MOLLI target (VMT) images at different inversion times which were subsequently used in an image registration algorithm. Four VMT models were investigated and the best performing model compared with the standard vendor-provided motion correction (MOCO) technique., Statistical Tests: The effectiveness of the motion correction technique was assessed using the fitting quality index (FQI), mutual information (MI), and Dice coefficients of motion-corrected images, plus subjective quality evaluation of T1 maps by three independent readers using Likert score. Wilcoxon signed-rank test with Bonferroni correction for multiple comparison. Significance levels were defined as P < 0.01 for highly significant differences and P < 0.05 for significant differences., Results: The best performing VMT model with iterative registration demonstrated significantly better performance (FQI 0.88 ± 0.03, MI 1.78 ± 0.20, Dice 0.84 ± 0.23, quality score 2.26 ± 0.95) compared to other approaches, including the vendor-provided MOCO method (FQI 0.86 ± 0.04, MI 1.69 ± 0.25, Dice 0.80 ± 0.27, quality score 2.16 ± 1.01)., Data Conclusion: Our GAN model generating VMT images improved motion correction, which may assist reliable T1 mapping in the presence of respiratory motion. Its robust performance, even with considerable respiratory-induced heart displacements, may be beneficial for patients with difficulties in breath-holding., Level of Evidence: 3 TECHNICAL EFFICACY: Stage 1., (© 2024 International Society for Magnetic Resonance in Medicine.)

Objectives: To examine the factors influencing health-promoting lifestyles and the changes in health behavior self-efficacy and health-promoting lifestyles among female breast cancer survivors over a 6-month period., Methods: A longitudinal design with purposive sampling was deployed. Data collection occurred at the baseline (T1), 3 months (T2), and 6 months (T3). In total, 53 breast cancer survivors agreed to participate. All participants completed the first two rounds of data collection, 49 participants completed data collection at the 6-month mark (T3). The Chinese versions of the Self-Rated Abilities for Health Practices Scale (SRAHP) and the Health-Promoting Lifestyle Profile (HPLP) were used., Results: Health behavior self-efficacy and health-promoting lifestyle scores increased over time. Age, impaired cardiac function, those taking a career break, psychological well-being, and responsible health practice in self-efficacy for health behaviors were significant predictors of health-promoting lifestyle., Conclusions: Younger breast cancer survivors, those taking a career break, and those with poor health behavior self-efficacy were less likely to engage in a health-promoting lifestyle and may require guidance in improving overall health behaviors., Implications for Nursing Practice: Healthcare providers should not only be aware of the suboptimal health promotion lifestyle in breast cancer survivors but also focus on enhancing health behavior self-efficacy. This is particularly crucial for younger breast cancer survivors or those currently unemployed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Collapsin response mediator protein 1 (CRMP1) is involved in semaphorin 3A signaling pathway, promoting neurite extension and growth cone collapse. It is highly expressed in the nervous system, especially the hippocampus. The crmp1 knockout (KO) mice display impaired spatial learning and memory, and this phenomenon seemingly tends to deteriorate with age. Here we investigated whether CRMP1 is involved in age-related cognitive decline in WT and crmp1 KO mice at adult, middle-aged and older stages. The results revealed that cognitive dysfunction in the Morris water maze task became more severe and decreased glutamate and glutamine level in middle-aged crmp1 KO mice. Additionally, increasing levels of extrasynaptic NMDA receptors and phosphorylation of Tau were observed in middle-aged crmp1 KO mice, leading to synaptic and neuronal loss in the CA3 regions of hippocampus. These findings suggest that deletion of CRMP1 accelerates age-related cognitive decline by disrupting the balance between synaptic and extrasynaptic NMDA receptors, resulting in the loss of synapses and neurons., Competing Interests: Disclosure statement The authors have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: A dual-function phantom designed to quantify the apparent diffusion coefficient (ADC) in different fat contents (FCs) and glass bead densities (GBDs) to simulate the human tissues has not been documented yet. We propose a dual-function phantom to quantify the FC and to measure the ADC at different FCs and different GBDs., Methods: A fat-containing diffusion phantom comprised by 30 glass-bead-containing fat-water emulsions consisting of six different FCs (0, 10, 20, 30, 40, and 50%) multiplied by five different GBDs (0, 0.1, 0.25, 0.5, and 1.0 g/50 mL). The FC and ADC were measured by the "iterative decomposition of water and fat with echo asymmetry and least squares estimation-IQ," IDEAL-IQ, and single-shot echo-planar diffusion-weighted imaging, SS-EP-DWI, sequences, respectively. Linear regression analysis was used to evaluate the relationship among the fat fraction (FF) measured by IDEAL-IQ, GBD, and ADC., Results: The ADC was significantly, negatively, and linearly associated with the FF (the linear slope ranged from -0.005 to -0.017, R 2 = 0.925 to 0.986, all p < 0.001). The slope of the linear relationship between the ADC and the FF, however, varied among different GBDs (the higher the GBD, the lower the slope). ADCs among emulsions across different GBDs and FFs were overlapped. Emulsions with low GBDs plus high FFs shared a same lower ADC range with those with median or high GBDs plus median or lower FFs., Conclusions: A novel dual-function phantom simulating the human tissues allowed to quantify the influence of FC and GBD on ADC., Relevance Statement: The study developed an innovative dual-function MRI phantom to explore the impact of FC on ADC variation that can affect clinical results. The results revealed the superimposed effect on FF and GBD density on ADC measurements., Key Points: • A dual-function phantom made of glass bead density (GBD) and fat fraction (FF) emulsion has been developed. • Apparent diffusion coefficient (ADC) values are determined by GBD and FF. • The dual-function phantom showed the mutual ADC addition between FF and GBD., (© 2024. The Author(s).)

Background: Accurate annotation of electrogram local activation time (LAT) is critical to the functional assessment of ventricular tachycardia (VT) substrate. Contemporary methods of annotation include: 1) earliest bipolar electrogram (LAT earliest ); 2) peak bipolar electrogram (LAT peak ); 3) latest bipolar electrogram (LAT latest ); and 4) steepest unipolar -dV/dt (LAT -dV/dt ). However, no direct comparison of these methods has been performed in a large dataset, and it is unclear which provides the optimal functional analysis of the VT substrate., Objectives: This study sought to investigate the optimal method of LAT annotation during VT substrate mapping., Methods: Patients with high-density VT substrate maps and a defined critical site for VT re-entry were included. All electrograms were annotated using 5 different methods: LAT earliest , LAT peak , LAT latest , LAT-dV /dt , and the novel steepest unipolar -dV/dt using a dynamic window of interest (LAT DWOI ). Electrograms were also tagged as either late potentials and/or fractionated signals. Maps, utilizing each annotation method, were then compared in their ability to identify critical sites using deceleration zones., Results: Fifty cases were identified with 1,.813 ± 811 points per map. Using LAT latest , a deceleration zone was present at the critical site in 100% of cases. There was no significant difference with LAT earliest (100%) or LAT peak (100%). However, this number decreased to 54% using LAT -dV/dt and 76% for LAT DWOI . Using LAT-dV/dt, only 33% of late potentials were correctly annotated, with the larger far field signals often annotated preferentially., Conclusions: Annotation with LAT -dV/dt and LAT DWOI are suboptimal in VT substrate mapping. We propose that LAT latest should be the gold standard annotation method, as this allows identification of critical sites and is most suited to automation., Competing Interests: Funding Support and Author Disclosures Dr Hsia has received honoraria from Biosense Webster, FaraPulse, and Medtronic. Dr Kistler has received an investigator grant from the National Health and Medical Research Council of Australia; and speaker honoraria and fellowship support from Biosense Webster. Dr Kumar has received honoraria from Biosense Webster, Abbott Medical, Biotronik, and Sanofi. Dr Kalman has received a National Health and Medical Research Council of Australia practitioner fellowship; and research and fellowship support from Biosense Webster, Abbott, and Medtronic. Dr Lee has received consulting fees and speaker honoraria from Biosense Webster. Dr Gerstenfeld has received honoraria from Biosense Webster, Boston Scientific, Medtronic, and Abbott Medical; received research support from Abbott Medical; and served on the scientific advisory board for Biosense Webster, Farapulse/Boston Scientific, and Adagio medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Virtual planning has revolutionized orthognathic surgery. This study presents a computer-assisted method for constructing average three-dimensional skeletofacial models that can be applied as templates for surgical planning for maxillomandibular repositioning., Methods: The authors used the images of 60 individuals (30 women and 30 men) who had never undergone orthognathic surgery to construct an average three-dimensional skeletofacial model for male participants and one for female participants. The authors validated the accuracy of the newly developed skeletofacial models by comparing their images with 30 surgical simulation images (ie, skulls) that had been created using three-dimensional cephalometric normative data. The comparison was conducted by superimposing surgical simulation images created using the authors' models with the previously created images to analyze their differences, particularly differences in the jawbone position., Results: For all participants, the authors compared the jaw position in the surgical simulation images created using the authors' average three-dimensional skeletofacial models with that in the images created using three-dimensional cephalometric normative data. The results revealed that the planned maxillary and mandibular positions were similar in both images and that the differences between all facial landmarks were less than 1 mm, except for one dental position. Most studies have reported less than 2 mm to be the success criterion for the distance difference between planned and outcome images; thus, the authors' data indicate high consistency between the images in terms of jawbone position., Conclusion: The authors' average three-dimensional skeletofacial models provide an innovative template-assisted orthognathic surgery planning modality that can enhance the fully digital workflow for virtual orthognathic surgical planning., Clinical Question/level of Evidence: Therapeutic, V., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Virtual planning has revolutionized orthognathic surgery (OGS), marking a significant advancement in the field. This study aims to showcase the practical application of our established 3D average skull template as a guiding framework for surgical planning, and to share valuable insights from our clinical experience. We enrolled 30 consecutive Taiwanese patients (18 females and 12 males) who underwent two-jaw orthognathic surgery with surgical simulation, utilizing the average skull template for planning. Results indicate the method's applicability and precision. By adhering to the surgical plan, post-operative outcomes closely aligned with the average skull template, showing negligible deviations of less than 2 mm. Moreover, patients expressed high satisfaction with post-surgery facial changes, with the chin appearance receiving the highest satisfaction scores, while the lowest scores were attributed to nose appearance. Notably, the substantial change in lower jaw position post-mandibular setback surgery contributed to increased satisfaction with the chin position. In conclusion, this study does not seek to replace established surgical planning methods, but underscores that utilizing an average skull as a surgical design template provides a viable, accurate, and efficient option for OGS patients.

Three-dimensional (3D) planning of orthognathic surgery (OGS) improves the treatment of facial asymmetry and malocclusion, but no consensus exists among clinicians regarding technical details. This study verified the consistency of authors' workflow and strategies between 3D planning and surgical execution for facial asymmetry. This retrospective study recruited consecutive patients (n=54) with nonsyndromic facial asymmetry associated with malocclusion. The stepwise workflow included orthodontic treatment, 3D imaging-based evaluation, planning, and transferring the virtual of single-splint 2-jaw OGS to actual surgery in all patients. Seven landmark-based measurements were selected for postoperative assessment of facial symmetry. Fifty patients had no anesthetic/surgical-related episode and procedure-related complications. Others experienced wound infection (n=1), transient TMJ discomfort (n=1), and facial numbness (n=3). Two cases had minor residual asymmetry (cheek and chin, respectively), but did not request revisionary bone or soft tissue surgery. Comparisons between the planned and postoperative 3D images with quantitative measurement revealed acceptable outcome data. The results showed a significant increase in facial symmetry at 7 landmark-based postoperative measurements for both male and female. This 3D-assisted pathway of OGS permitted achievement of consistent satisfactory results in managing facial asymmetry, with low rate of complications and secondary management., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Background: To evaluate the effect of the weighting of input imaging combo and ADC threshold on the performance of the U-Net and to find an optimized input imaging combo and ADC threshold in segmenting acute ischemic stroke (AIS) lesion., Methods: This study retrospectively enrolled a total of 212 patients having AIS. Four combos, including ADC-ADC-ADC (AAA), DWI-ADC-ADC (DAA), DWI-DWI-ADC (DDA), and DWI-DWI-DWI (DDD), were used as input images, respectively. Three ADC thresholds including 0.6, 0.8 and 1.8 × 10 -3 mm 2 /s were applied. Dice similarity coefficient (DSC) was used to evaluate the segmentation performance of U-Nets. Nonparametric Kruskal-Wallis test with Tukey-Kramer post-hoc tests were used for comparison. A p < .05 was considered statistically significant., Results: The DSC significantly varied among different combos of images and different ADC thresholds. Hybrid U-Nets outperformed uniform U-Nets at ADC thresholds of 0.6 × 10 -3 mm 2 /s and 0.8 × 10 -3 mm 2 /s (p < .001). The U-Net with imaging combo of DDD had segmentation performance similar to hybrid U-Nets at an ADC threshold of 1.8 × 10 -3 mm 2 /s (p = .062 to 1). The U-Net using the imaging combo of DAA at the ADC threshold of 0.6 × 10 -3 mm 2 /s achieved the highest DSC in the segmentation of AIS lesion., Conclusions: The segmentation performance of U-Net for AIS varies among the input imaging combos and ADC thresholds. The U-Net is optimized by choosing the imaging combo of DAA at an ADC threshold of 0.6 × 10 -3 mm 2 /s in segmentating AIS lesion with highest DSC., Key Points: • Segmentation performance of U-Net for AIS differs among input imaging combos. • Segmentation performance of U-Net for AIS differs among ADC thresholds. • U-Net is optimized using DAA with ADC = 0.6 × 10 -3 mm 2 /s., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Ventricular tachycardias involving the fascicular system are amongst the most challenging and intriguing arrhythmias for cardiac electrophysiologists. Although some of the more common forms have been recognized clinically for decades, other variants continue to be characterized. Moreover, considerable uncertainty persists to date with regards to the mechanisms underpinning these arrhythmias. In this state-of-the-art review, we discuss the seminal historical and contemporary observations that have collectively advanced our understanding of fascicular ventricular tachycardias. From this base, we canvas the basic and clinical evidence supporting a potential role for the septal fascicular network and propose a new schema hypothesizing involvement of this fascicle. Although we focus primarily on the most common left posterior fascicular ventricular tachycardia, our discussion and proposal have mechanistic and therapeutic implications for the spectrum of fascicular arrhythmias., Competing Interests: Funding Support and Author Disclosures Dr Wong is supported by a Mid-Career Fellowship from the Hospital Research Foundation and a Postdoctoral Fellowship from the National Heart Foundation of Australia; and his institution has received on his behalf lecture, travel, and/or research funding from Abbott Medical, Bayer, Boehringer Ingelheim, Medtronic, Novartis, Servier, St. Jude Medical, and Vifor Pharma. Dr Nogami has received honoraria from Abbott and Biosense Webster; and has received an endowment from Medtronic and DVx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Three-dimensional (3D) imaging technologies are increasingly used in craniomaxillofacial (CMF) surgery, especially to enable clinicians to get an effective approach and obtain better treatment results during different preoperative and postoperative phases, namely during image acquisition and diagnosis, virtual surgical planning (VSP), actual surgery, and treatment outcome assessment. The article presents an overview of 3D imaging technologies used in the aforementioned phases of the most common CMF surgery. We searched for relevant studies on 3D imaging applications in CMF surgery published over the past 10 years in the PubMed, ProQuest (Medline), Web of Science, Science Direct, Clinical Key, and Embase databases. A total of 2094 articles were found, of which 712 were relevant. An additional 26 manually searched articles were included in the analysis. The findings of the review demonstrated that 3D imaging technology is becoming increasingly popular in clinical practice and an essential tool for plastic surgeons. This review provides information that will help researchers and clinicians consider the use of 3D imaging techniques in CMF surgery to improve the quality of surgical procedures and achieve satisfactory treatment outcomes., Competing Interests: Conflicts of interest The authors have no financial conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Understanding underlying mechanism(s) and identifying critical circuit components are fundamental to successful ventricular tachycardia (VT) ablation. Directed graph mapping (DGM) offers a novel technique to identify the mechanism and critical components of a VT circuit., Objectives: This study sought to evaluate the accuracy of DGM in VT ablation compared with traditional mapping techniques and a commercially available automated conduction velocity mapping (ACVM) tool., Methods: Patients with structural heart disease who had undergone a VT ablation with entrainment-proven critical isthmus and a high-density electroanatomical activation map were included. Traditional mapping (TM) consisted of a combination of local activation time and entrainment mapping and was considered the gold standard for determining the VT mechanism, circuit, and isthmus location. The same local activation time values were then processed using DGM and a commercially available ACVM (Coherent Mapping, Biosense Webster) tool. The aim of this study was to compare TM vs DGM and ACVM in their ability to identify the VT mechanism, characterize the VT circuit, and locate the critical isthmus., Results: Thirty-five cases were identified. TM classified the VT mechanism as focal in 7 patients and re-entrant in 28 patients. TM classified 11 VTs as single-loop re-entry, 15 as dual-loop re-entry, 1 as complex, and 1 case was indeterminant. The overall agreement between DGM and TM for determining VT mechanism and circuit type was strong (kappa value = 0.79; P < 0.01), as was the agreement between ACVM and TM (kappa value = 0.66; P < 0.01). Both DGM and ACVM identified the putative VT isthmus in 25 (89%) of the re-entrant cases. Focal activation was correctly identified by both techniques in all cases., Conclusions: DGM is a rapid automated algorithm that has a strong level of agreement with TM for manually re-annotated VT maps., Competing Interests: Funding Support and Author Disclosures Dr Kistler has received fellowship support from Biosense Webster. Dr Kumar has received honoraria from Biosense Webster, Abbott Medical, Biotronik, and Sanofi-Aventis. Dr Kalman is supported by a National Health and Medical Research Council of Australia practitioner fellowship; and has received research and fellowship support from Biosense Webster, Abbott, and Medtronic. Dr G. Lee has received consulting fees and speaker honoraria from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: High-power, short duration (HPSD) radiofrequency ablation (RFA) is a commonly used strategy for pulmonary vein isolation (PVI)., Objectives: This study sought to compare HPSD with standard power, standard duration (SPSD) RFA in patients undergoing PVI., Methods: Patients with paroxysmal or persistent (<1 year) atrial fibrillation (AF) were randomized to HPSD (50 W) or SPSD (25-30 W) RFA to achieve PVI. Outcomes assessed included time to achieve PVI (primary), left atrial dwell time, total procedure time, first-pass isolation, PV reconnection with adenosine, procedure complications including asymptomatic cerebral emboli (ACE), and freedom from atrial arrhythmias., Results: Sixty patients (median age 66 years; 75% male) with paroxysmal (57%) or persistent (43%) AF were randomized to HPSD (n = 29) or SPSD (n = 31). Median time to achieve PVI was shorter with HPSD vs SPSD (87 minutes vs 126 minutes; P = 0.003), as was left atrial dwell time (157 minutes vs 180 minutes; P = 0.04). There were no differences in first-pass isolation (79% vs 76%; P = 0.65) or PV reconnection with adenosine (12% vs 20%; P = 0.26) between groups. At 12 months, recurrent atrial arrhythmias occurred less in the HPSD group compared with the SPSD group (n = 3 of 29 [10%] vs n = 11 of 31 [35%]; HR: 0.26; P = 0.027). There was a trend toward more ACE with HPSD RFA (40% HPSD vs 17% SPSD; P = 0.053)., Conclusions: In patients undergoing AF ablation, HPSD compared with SPSD RFA results in shorter time to achieve PVI, greater freedom from AF at 12 months, and a trend toward increased ACE., Competing Interests: Funding Support and Author Disclosures The study was funded by the Tod Spieker philanthropic fund. Dr Gerstenfeld has served on the advisory board for Biosense Webster and Farapulse, Inc; and received lecture honoraria from Biosense Webster and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Clinical trials investigating the effects of beta-blockers (BBs) on cancer are underway. Evidence from preclinical research suggests that BBs could serve as anticancer agents and immune boosters. There is conflicting evidence regarding the effect of BB use on clinical outcomes in patients with breast cancer., Objectives: The study aimed to determine whether BB use is associated with progression-free survival (PFS) and overall survival (OS) in patients receiving anti-human epidermal growth factor receptor 2 (HER2) treatment for advanced breast cancer., Design: Retrospective hospital-based study., Methods: The participants enrolled were breast cancer patients with advanced HER2-positive status who initiated trastuzumab monotherapy or concomitant therapy with trastuzumab and any dose of BB. The patients were enrolled between January 2012 and May 2021 and divided into three groups based on whether they received a BB or not in the therapeutic regimen: BB-/trastuzumab+, BB+ (non-selective)/trastuzumab+, and BB+ (selective)/trastuzumab+. PFS and OS were the primary and secondary endpoints, respectively., Results: The estimated median PFS in the BB-/trastuzumab+, BB+ (non-selective)/trastuzumab+, and BB+ (selective)/trastuzumab+ groups was 51.93, 21.50, and 20.77 months, respectively. The corresponding OS was 56.70, 29.10, and 27.17 months. The intergroup differences in these durations were significant. Both PFS [adjusted hazard ratio (HR): 2.21, 95% confidence interval (CI): 1.56-3.12; p  < 0.001]) and OS (adjusted HR: 2.46, 95% CI: 1.69-3.57; p  < 0.001) were worse when BBs were used., Conclusion: Our study provides important evidence that BB use potentially has a negative effect on patients with HER2-positive advanced breast cancer. Nevertheless, despite the study's results, cardiovascular disease (CVD) should be appropriately treated in patients with HER2-positive advanced breast cancer. Other types of drugs can be used to treat CVD, but BB use should be avoided. Large real-world database and prospective studies should be conducted to validate the results of this study., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2023.)

Background: Transseptal puncture is a necessary component of many electrophysiology and structural heart procedures. Improving this technique has broad ramifications for the overall efficiency and safety of these interventions. A new technology uses a specialized introducer wire to cross the septum with radiofrequency (RF) energy, eliminating the need for a transseptal needle and wire/needle exchanges., Objectives: This study sought to compare the efficacy and safety of an RF needle versus RF wire approach for transseptal puncture., Methods: Individuals ≥18 years of age undergoing double transseptal puncture for atrial fibrillation or left atrial flutter ablation were randomized to a transseptal approach with either an RF needle or RF wire. The primary outcome was time to achieve first transseptal puncture. Secondary outcomes included second and combined transseptal puncture time, fluoroscopy time, number of equipment exchanges, and complications., Results: A total of 75 participants were enrolled (36 RF needle, 39 RF wire). No crossovers occurred. Randomization to the RF wire resulted in a significant reduction in first transseptal time compared with the RF needle (median 9.2 [IQR: 5.7-11.2] minutes vs 6.9 [IQR: 5.2-8.4] minutes, P = 0.03). Second and combined transseptal times, and number of equipment exchanges, were also reduced with the RF wire. One participant in the RF needle group experienced transient atrioventricular block due to mechanical trauma from the sheath/dilator assembly. There were no complications in the RF wire group., Conclusions: The RF wire technique resulted in faster time to transseptal puncture and fewer equipment exchanges compared with an RF needle with no difference in complications., Competing Interests: Funding Support and Author Disclosures This was an investigator-initiated study funded by Baylis Medical. The funding entity played no role in the design, implementation, analysis, or presentation of the study. Dr Marcus is a consultant for Johnson & Johnson and InCarda; and holds equity in InCarda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Confirming the presence and participation of concealed nodo-ventricular (cNV) or concealed His-ventricular (cHV) pathways in tachyarrhythmias is challenging. We describe novel observations to aid in diagnosing cNV or cHV pathways., Methods: We present 7 cases of cNV and cHV pathway-mediated arrhythmias and focus on several laboratory observations: (1) differential ventricular overdrive pacing (VOD) from the base versus apex, (2) response to His refractory premature ventricular complexes, (3) paradoxical atriohisian response (shorter atriohisian interval during tachycardia than that during sinus rhythm) in long RP tachycardia, and (4) the role of adenosine to aid in the diagnosis., Results: Three cases underwent differential VOD during tachycardia. All demonstrated a shorter postpacing interval minus tachycardia cycle length during basal pacing than apical pacing with one case exhibiting apical VOD results compatible with atrioventricular nodal reentrant tachycardia. Basal VOD was useful for localizing the ventricular connection in a case with cHV pathway. In 3 cases, His refractory premature ventricular complexes reset the tachycardia without conduction to the atrium, which excluded the involvement of an atrioventricular pathway or atrial tachycardia, or atrioventricular nodal reentrant tachycardia alone. One case had His refractory premature ventricular complexes followed by subsequent constant AA interval and then tachycardia termination, suggesting a bystander cNV pathway involvement. Two cNV pathway cases presented with long RP tachycardia had paradoxical atriohisian shortening of >15 ms, suggesting parallel activation of the atrium and the atrioventricular node. Adenosine terminated the tachycardia with retrograde block in 2 cases with cNV pathways but had no response on a cHV pathway., Conclusions: cNV and cHV pathways mediated tachyarrhythmias can present with variable clinical presentations. We emphasize the important role of differential VOD sites, His refractory premature ventricular complexes that reset or terminate the tachycardia without conduction to the atrium, paradoxical atriohisian response in long RP tachycardia, and the use of adenosine for diagnosing cNV and cHV pathways., Competing Interests: Disclosures None.

Background: The myocardial kinetic energy (KE) and its association with pulmonary regurgitation (PR) have yet to be investigated in repaired tetralogy of Fallot (rTOF) patients., Purpose: To evaluate the adaptation of myocardial KE in rTOF patients by tissue phase mapping (TPM)., Study Type: Prospective., Population: A total of 49 rTOF patients (23 ± 5 years old; male = 32), 47 normal controls (22 ± 1 year old; male = 29)., Field Strength/sequence: 3-T/2D dark-blood three-directional velocity-encoded gradient-echo sequence., Assessment: Left and right ventricle (LV, RV) myocardial KE in radial (KE r ), circumferential (KE ø ), longitudinal (KE z ) directions. The proportions of KE in each direction to the sum of all KE (KE røz ): %KE r , %KE ø , %KE z . PR fraction., Statistical Test: Student's t test, multivariable regression. Statistical significance: P < 0.05., Results: In rTOF group, LV KE z remained normal in systole (P = 0.565) and diastole (P = 0.210), whereas diastolic LV %KE z (62% ± 14% vs. 72% ± 7%) and systolic LV %KE ø (9% ± 6% vs. 20% ± 7%) were significantly decreased. The KE r and %KE r of both ventricles significantly increased in the rTOF group (RV in diastole: 6 ± 3 vs. 3 ± 1 μJ and 54% ± 13% vs. 27% ± 7%). The rTOF group exhibited significantly higher RV/LV ratios of %KE r (systole: 1.3 ± 0.3 vs. 1.0 ± 0.3) and %KE ø (systole: 1.6 ± 0.8 vs. 1.0 ± 0.3) and significantly lower ratios of %KE z in systole (0.7 ± 0.2 vs. 1.0 ± 0.1) and diastole (0.5 ± 0.2 vs. 0.9 ± 0.1). In multivariable regression analysis, the RV peak systolic KE røz , RV systolic KE z , and LV diastolic %KE ø were independently associated with PR fraction in the rTOF group (adjusted R 2  = 0.479)., Data Conclusion: In rTOF patients, the adaptation of the KE proportion occurred earlier than that of the KE amplitude, and the biventricular balance of %KE was disrupted. PR may cause differential KE adaptation in RV and LV. TPM-derived KE may be useful in investigation of myocardial adaptation in rTOF patients., Evidence Level: 2 TECHNICAL EFFICACY: Stage 3., (© 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

An important consideration in medical plastic surgery is the evaluation of the patient's facial symmetry. However, because facial attractiveness is a slightly individualized cognitive experience, it is difficult to determine face attractiveness manually. This study aimed to train a model for assessing facial attractiveness using transfer learning while also using the fine-grained image model to separate similar images by first learning features. In this case, the system can make assessments based on the input of facial photos. Thus, doctors can quickly and objectively treat patients' scoring and save time for scoring. The transfer learning was combined with CNN, Xception, and attention mechanism models for training, using the SCUT-FBP5500 dataset for pre-training and freezing the weights as the transfer learning model. Then, we trained the Chang Gung Memorial Hospital Taiwan dataset to train the model based on transfer learning. The evaluation uses the mean absolute error percentage (MAPE) value. The root mean square error (RMSE) value is used as the basis for experimental adjustment and the quantitative standard for the model's predictive. The best model can obtain 0.50 in RMSE and 18.5% average error in MAPE. A web page was developed to infer the deep learning model to visualize the predictive model.

Background: No consensus exists regarding the timing or technique of rhinoplasty for correction of the unilateral cleft lip nose deformity, with few studies examining the long-term effects of a single technique. This study appraised the long-term outcomes of primary rhinoplasty using the Tajima technique for overcorrection in a cohort of patients with unilateral cleft lip nose deformity after attaining skeletal maturity., Methods: Consecutive nonsyndromic patients with unilateral cleft lip nose deformity ( n = 103) who underwent primary rhinoplasty with overcorrection by a single surgeon between 2000 and 2005 were reviewed. Patients with unilateral cleft lip and nasal deformity who underwent primary rhinoplasty (but with no overcorrection) ( n = 30) and noncleft individuals ( n = 27) were recruited for comparison. Outcomes were assessed through FACE-Q scales evaluating satisfaction with appearance of nose and nostrils (two scales) and computer-based objective photogrammetric analysis of nasal symmetry (nostril height, nostril width, nostril area, alar height, and alar width parameters)., Results: Significant differences (all P < 0.001) were observed between the Tajima and non-Tajima groups for all but one photogrammetric nasal parameter (nostril area), with the Tajima group demonstrating closer mean values to the noncleft group. The Tajima and noncleft groups demonstrated no significant difference (all P > 0.05) for scores of FACE-Q nose and nostrils scales., Conclusion: This study indicated that the patients who underwent primary rhinoplasty with overcorrection had improved results with no necessity for intermediate rhinoplasty, emphasizing that the procedure is an effective approach to correct the unilateral cleft nose deformity., Clinical Question/level of Evidence: Therapeutic, III., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Background: This retrospective cohort study examined the impact of tetracyclines (TCs) and proton pump inhibitors (PPIs) alone or in combination on the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with non-small cell lung cancer (NSCLC)., Methods: Patients with NSCLC treated with gefitinib or erlotinib for at least 1 week between January 2009 and October 2021 were enrolled and divided into four groups based on the presence/absence of TC and/or PPI in the therapeutic regimen: TC-/PPI-, TC + /PPI-, TC-/PPI + , TC + /PPI + . Progression-free survival (PFS) and overall survival (OS) were the primary and secondary endpoints, respectively., Results: The estimated median PFS and OS of 347 included patients with NSCLC were 8.57 (95% confidence interval [CI]: 7.66-9.48) months and 13.10 (95% CI: 11.03-15.17) months, respectively. Co-administration of EGFR-TKIs with PPIs decreased the PFS and OS, while that with TCs improved the PFS and OS. However, the concomitant use of EGFR-TKIs, TCs, and PPIs yielded survival rates similar to that of EGFR-TKI therapy alone., Conclusions: The administration of EGFR-TKIs with other drugs poses a challenge in managing patients with NSCLC. Therefore, reassessing the indications and necessity of TC or PPI therapy is essential for patients receiving erlotinib or gefitinib. The benefits and risks of possible discontinuation due to the clinical relevance of this interaction should be considered., (© 2023. The Author(s).)

Background: The difference between the right ventricular (RV) apical stimulus-atrial electrogram (SA) interval during resetting of supraventricular tachycardia (SVT) versus the ventriculoatrial (VA) interval during SVT (ΔSA-VA apex ) is an established technique for discerning SVT mechanisms but is limited by a significant diagnostic overlap., Objectives: This study hypothesized that the difference between the RV SA interval during resetting of SVTs versus the VA interval during SVTs (ΔSA-VA) would yield a more robust differentiation of atrioventricular nodal re-entrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) when using the RV basal septal stimulation (ΔSA-VA base ) as compared to the RV apical stimulation (ΔSA-VA apex ). Moreover, it was predicted that the ΔSA-VA base might distinguish septal from free wall accessory pathways (APs) effectively., Methods: In this prospective study, 105 patients with AVNRTs (age 48 ± 20 years, 44% male) and 130 with AVRTs (age 26 ± 18 years, 54% male) underwent programmed ventricular extrastimuli delivered from both the RV basal septum and RV apex. The ΔSA-VA values were compared between the 2 sites., Results: The ΔSA-VA base was shorter than the ΔSA-VA apex during AVRT (44 ± 30 ms vs 58 ± 29 ms; P < 0.001), and the opposite occurred during AVNRT (133 ± 31 ms vs 125 ± 25 ms; P = 0.03). A ΔSA-VA base of ≧85 milliseconds had a sensitivity of 97% and specificity of 96% for identifying AVNRT. Furthermore, a ΔSA-VA base of 45-85 milliseconds identified AVRT with left free wall APs (sensitivity 86%, specificity 95%), 20-45 milliseconds for posterior septal APs (sensitivity 72%, specificity 96%), and <20 milliseconds for right free wall or anterior/mid septal APs (sensitivity 86%, specificity 98%)., Conclusions: The ΔSA-VA base during programmed ventricular extrastimuli produced a robust differentiation between AVNRT and AVRT regardless of the AP location with ≧85 milliseconds as an excellent cutoff point. This straightforward technique further allowed localizing 4 general AP sites., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

SsrA and SmpB are known to play important roles in translational quality control and are essential for virulence in many human and animal pathogenic bacteria. The physiological roles and contribution of SsrA and SmpB to plant pathogen are unclear. Here, we present evidence to show that ssrA and smpB are involved in pathogenesis of Xanthomonas campestris pathovar campestris, the cause of black rot diseases in crucifers. The ssrA and smpB mutants exhibited defects in bacterial attachment, cell motility, and extracellular enzyme activity. The mutation of ssrA and smpB also resulted in a reduction in temperature tolerance. These altered phenotypes of the ssrA and smpB mutants could be complemented to wild-type levels by the intact ssrA and smpB genes. This is the first demonstration of the roles of SsrA and SmpB in phytopathogen., (© The Author(s) 2023. Published by Oxford University Press on behalf of FEMS.)

Background: Non-cancer drugs are currently being repurposed for cancer treatment. Mounting evidence highlights the influence of calcium channels on tumorigenesis and progression. Hence, inhibition of calcium signaling may be a promising cancer treatment strategy., Objective: In this study, we aimed to examine whether calcium channel blockers (CCBs) affect the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with non-small cell lung cancer (NSCLC)., Design: We conducted a retrospective analysis., Methods: In this study, conducted between January 2009 and June 2021, patients with NSCLC treated with erlotinib, or gefitinib for at least 1 week were enrolled and divided into 2 groups: CCBs-/EGFR-TKIs+ and CCBs+/EGFR-TKIs+, depending on whether they received CCB therapy. Progression-free survival (PFS) and overall survival (OS) were determined as the primary and secondary endpoints, respectively., Result: : The estimated median PFS and OS for the CCBs-/EGFR-TKIs+group were 7.70 and 12.17 months, respectively, and they were significantly different from those of the CCBs+/EGFR-TKIs+ group (10.43 and 18.07 months, respectively). CCB use was associated with improved PFS (adjusted hazard ratios [HR] 0.77, 95% confidence interval [CI]: 0.61-0.98; P  = .035) and OS (adjusted HR 0.66, 95% CI: 0.51-0.84; P  < .001)., Conclusion: Calcium channels have been implicated in cancer pathogenesis. Our findings revealed the potential additive anticancer effects of CCBs when used concomitantly with EGFR-TKIs. However, study limitations, including the retrospective nature and small number of patients, necessitate large-scale prospective studies on the therapeutic potential of CCB as an adjunctive therapy with EGFR-TKIs in patients with NSCLC.

Background: Accurate annotation of local activation time is crucial in the functional assessment of ventricular tachycardia (VT) substrate. A major limitation of modern mapping systems is the standard prospective window of interest (sWOI) is limited to 490 to 500 milliseconds, preventing annotation of very late potentials (LPs). A novel retrospective window of interest (rWOI), which allows annotation of all diastolic potentials, was used to assess the functional VT substrate., Objectives: This study sought to investigate the utility of a novel rWOI, which allows accurate visualization and annotation of all LPs during VT substrate mapping., Methods: Patients with high-density VT substrate maps and a defined isthmus were included. All electrograms were manually annotated to latest activation using a novel rWOI. Reannotated substrate maps were correlated to critical sites, with areas of late activation examined. Propagation patterns were examined to assess the functional aspects of the VT substrate., Results: Forty-eight cases were identified with 1,820 ± 826 points per map. Using the novel rWOI, 31 maps (65%) demonstrated LPs beyond the sWOI limit. Two distinct patterns of channel activation were seen during substrate mapping: 1) functional block with unidirectional conduction into the channel (76%); and 2) wave front collision within the channel (24%). In addition, a novel marker termed the zone of early and late crowding was studied in the rWOI substrate maps and found to have a higher positive predictive value (85%) than traditional deceleration zones (69%) for detecting critical sites of re-entry., Conclusions: The standard WOI of contemporary mapping systems is arbitrarily limited and results in important very late potentials being excluded from annotation. Future versions of electroanatomical mapping systems should provide longer WOIs for accurate local activation time annotation., Competing Interests: Funding Support and Author Disclosures Dr Kistler has received fellowship support from Biosense Webster. Dr Kalman is supported by a National Health and Medical Research Council of Australia practitioner fellowship and by fellowship support from Biosense Webster. Dr Hsia has received honoraria from Biosense Webster. Dr Kalman has received research support from Biosense Webster. Dr Lee has received speaker honoraria from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Recently, a data-driven regression analysis method was developed to utilize the resting-state (rs) blood oxygenation level-dependent signal for cerebrovascular reactivity (CVR) mapping (rs-CVR), which was previously optimized by comparing with the CO 2 inhalation-based method in health subjects and patients with neurovascular diseases., Purpose: To investigate the agreement of rs-CVR and the CVR mapping with breath-hold MRI (bh-CVR) in patients with gliomas., Study Type: Retrospective., Population: Twenty-five patients (12 males, 13 females; mean age ± SD, 48 ± 13 years) with gliomas., Field Strength/sequence: Dynamic T2*-weighted gradient-echo echo-planar imaging during a breath-hold paradigm and during the rs on a 3-T scanner., Assessment: rs-CVR with various frequency ranges and resting-state fluctuation amplitude (RSFA) were assessed. The agreement between each rs-based CVR measurement and bh-CVR was determined by voxel-wise correlation and Dice coefficient in the whole brain, gray matter, and the lesion region of interest (ROI)., Statistical Tests: Voxel-wise Pearson correlation, Dice coefficient, Fisher Z-transformation, repeated-measure analysis of variance and post hoc test with Bonferroni correction, and nonparametric repeated-measure Friedman test and post hoc test with Bonferroni correction were used. Significance was set at P < 0.05., Results: Compared with bh-CVR, the highest correlations were found at the frequency bands of 0.04-0.08 Hz and 0.02-0.04 Hz for rs-CVR in both whole brain and the lesion ROI. RSFA had significantly lower correlations than did rs-CVR of 0.02-0.04 Hz and a wider frequency range (0-0.1164 Hz). Significantly higher correlations and Dice coefficient were found in normal tissues than in the lesion ROI for all three methods., Data Conclusion: The optimal frequency ranges for rs-CVR are determined by comparing with bh-CVR in patients with gliomas. The rs-CVR method outperformed the RSFA. Significantly higher correlation and Dice coefficient between rs- and bh-CVR were found in normal tissue than in the lesion., Level of Evidence: 3 TECHNICAL EFFICACY STAGE: 2., (© 2022 International Society for Magnetic Resonance in Medicine.)

Deep learning allows automatic segmentation of teeth on cone beam computed tomography (CBCT). However, the segmentation performance of deep learning varies among different training strategies. Our aim was to propose a 3.5D U-Net to improve the performance of the U-Net in segmenting teeth on CBCT. This study retrospectively enrolled 24 patients who received CBCT. Five U-Nets, including 2Da U-Net, 2Dc U-Net, 2Ds U-Net, 2.5Da U-Net, 3D U-Net, were trained to segment the teeth. Four additional U-Nets, including 2.5Dv U-Net, 3.5Dv5 U-Net, 3.5Dv4 U-Net, and 3.5Dv3 U-Net, were obtained using majority voting. Mathematical morphology operations including erosion and dilation (E&D) were applied to remove diminutive noise speckles. Segmentation performance was evaluated by fourfold cross validation using Dice similarity coefficient (DSC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). Kruskal-Wallis test with post hoc analysis using Bonferroni correction was used for group comparison. P < 0.05 was considered statistically significant. Performance of U-Nets significantly varies among different training strategies for teeth segmentation on CBCT (P < 0.05). The 3.5Dv5 U-Net and 2.5Dv U-Net showed DSC and PPV significantly higher than any of five originally trained U-Nets (all P < 0.05). E&D significantly improved the DSC, accuracy, specificity, and PPV (all P < 0.005). The 3.5Dv5 U-Net achieved highest DSC and accuracy among all U-Nets. The segmentation performance of the U-Net can be improved by majority voting and E&D. Overall speaking, the 3.5Dv5 U-Net achieved the best segmentation performance among all U-Nets., (© 2022. The Author(s).)

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Objectives: To examine the role of ADC threshold on agreement across observers and deep learning models (DLMs) plus segmentation performance of DLMs for acute ischemic stroke (AIS)., Methods: Twelve DLMs, which were trained on DWI-ADC-ADC combination from 76 patients with AIS using 6 different ADC thresholds with ground truth manually contoured by 2 observers, were tested by additional 67 patients in the same hospital and another 78 patients in another hospital. Agreement between observers and DLMs were evaluated by Bland-Altman plot and intraclass correlation coefficient (ICC). The similarity between ground truth (GT) defined by observers and between automatic segmentation performed by DLMs was evaluated by Dice similarity coefficient (DSC). Group comparison was performed using the Mann-Whitney U test. The relationship between the DSC and ADC threshold as well as AIS lesion size was evaluated by linear regression analysis. A p < .05 was considered statistically significant., Results: Excellent interobserver agreement and intraobserver repeatability in the manual segmentation (all ICC > 0.98, p < .001) were achieved. The 95% limit of agreement was reduced from 11.23 cm 2 for GT on DWI to 0.59 cm 2 for prediction at an ADC threshold of 0.6 × 10 -3 mm 2 /s combined with DWI. The segmentation performance of DLMs was improved with an overall DSC from 0.738 ± 0.214 on DWI to 0.971 ± 0.021 on an ADC threshold of 0.6 × 10 -3 mm 2 /s combined with DWI., Conclusions: Combining an ADC threshold of 0.6 × 10 -3 mm 2 /s with DWI reduces interobserver and inter-DLM difference and achieves best segmentation performance of AIS lesions using DLMs., Key Points: • Higher Dice similarity coefficient (DSC) in predicting acute ischemic stroke lesions was achieved by ADC thresholds combined with DWI than by DWI alone (all p < .05). • DSC had a negative association with the ADC threshold in most sizes, both hospitals, and both observers (most p < .05) and a positive association with the stroke size in all ADC thresholds, both hospitals, and both observers (all p < .001). • An ADC threshold of 0.6 × 10 -3 mm 2 /s eliminated the difference of DSC at any stroke size between observers or between hospitals (p = .07 to > .99)., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)