Turnerpadilla8268

n medicine can be effective, inclusive and equitable through the COVID-19 era and beyond.The purpose of this study is to investigate the effect of varying coronary flow reserve (CFR) values on the calculation of computationally-derived fractional flow reserve (FFR). CFR reflects both vessel resistance due to an epicardial stenosis, and resistance in the distal microvascular tissue. Patients may have a wide range of CFR related to the tissue substrate that is independent of epicardial stenosis levels. Most computationally based virtual FFR values such as FFRCT do not measure patient specific CFR values but use a population-average value to create hyperemic flow conditions. In this study, a coronary arterial computational geometry was constructed using magnetic resonance angiography (MRA) data acquired in a patient with moderate CAD. Coronary flow waveforms under rest and stress conditions were acquired in 13 patients with phase-contrast magnetic resonance (PCMR) to calculate CFR, and these flow waveforms and CFR values were applied as inlet flow boundary conditions to determine FFR based on computational fluid dynamics (CFD) simulations. The stress flow waveform gave a measure of the functional significance of the vessel when evaluated with the physiologically-accurate behavior with the patient-specific CFR. The resting flow waveform was then scaled by a series of CFR values determined in the 13 patients to simulate how hyperemic flow and CFR affects FFR values. We found that FFR values calculated using non-patient-specific CFR values did not accurately predict those calculated with the true hyperemic flow waveform. This indicates that both patient-specific anatomic and flow information are required to accurately non-invasively assess the functional significance of coronary lesions.Background Long-term morbidity and mortality data among ischemic heart disease (IHD) patients of different ethnicities are conflicting. We sought to determine the independent association of ethnicity and all-cause mortality over two decades of follow-up of Israeli patients. Methods Our study comprised 15,524 patients including 958 (6%) Arab patients who had been previously enrolled in the Bezafibrate Infarction Prevention (BIP) registry between February 1, 1990, and October 31, 1992, and subsequently followed-up for long-term mortality. We compared clinical characteristics and outcomes of Israeli Arabs and Jews. Propensity score matching (PSM) (12 ratios) was used for validation. Results Arab patients were significantly younger (56 ± 7 years vs. 60 ± 7 years; p less then 0.001; respectively), and had more cardiovascular disease (CVD) risk factors. Kaplan-Meier survival analysis showed that all-cause mortality was significantly higher among Arab patients (67 vs. 61%; log-rank p less then 0.001). Multivariate adjusted analysis showed that mortality risk was 49% greater (HR 1.49; 95% CI 1.37-1.62; p less then 0.001) among Arabs. Conclusions Arab ethnicity is independently associated with an increased 20-year all-cause mortality among patients with established IHD.Background Patients with diabetes represent 20-30% of the population considered for percutaneous coronary intervention (PCI) and associate with more deleterious clinical outcome, which requires the optimal strategy of dual antiplatelet therapy (DAPT). The meta-analysis aims to compare clinical outcomes between very short (1-3 months) and standard (12 months) DAPT after implanting the second-generation drug-eluting stents in patients with or without diabetes following PCI. Methods and Analysis PubMed, Embase, Web of Science, Ovid, Cochrane Library, and ClinicalTrials.gov were searched for studies comparing the very short term and standard DAPT in patients with or without diabetes following PCI. Risk ratio with 95% confidence intervals was used to evaluate the pooled effect of discontinuous variables, and the pooled analyses were performed with RevMan 5.3 and Stata SE 14.0 software. Results A total of 38,864 patients were randomized to the very short term DAPT (N = 19,423) vs. standard DAPT (N = 19,441). Among ared to standard DAPT. Meanwhile, the very short term DAPT can also reduce the incidence of major and minor bleeding without increasing the risk of ischemia in patients with or without diabetes (Registered by PROSPERO, CRD42020192133). Systematic Review Registration https//www.crd.york.ac.uk/prospero/, Identifier CRD42020192133.Objectives The aim of this study is to develop a scar detection method for routine computed tomography angiography (CTA) imaging using deep convolutional neural networks (CNN), which relies solely on anatomical information as input and is compatible with existing clinical workflows. find more Background Identifying cardiac patients with scar tissue is important for assisting diagnosis and guiding interventions. Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is the gold standard for scar imaging; however, there are common instances where it is contraindicated. CTA is an alternative imaging modality that has fewer contraindications and is faster than Cardiovascular magnetic resonance imaging but is unable to reliably image scar. Methods A dataset of LGE MRI (200 patients, 83 with scar) was used to train and validate a CNN to detect ischemic scar slices using segmentation masks as input to the network. MRIs were segmented to produce 3D left ventricle meshes, which were sampled at points along the short to triage images, reduce reading times, and guide clinical decision-making.Introduction Valve-in-valve TAVR (ViV-TAVR) is an established treatment for failing surgical aortic valves in patient at high surgical risk. Elevated transprosthetic gradients are common after ViV-TAVR. Previously, bench tests showed feasibility of bioprosthetic valve fracturing (VF) using high-pressure balloons. Small case series show reduced transprosthetic gradients using VF. We present our clinical experience and outcome of VF. Material and Methods Consecutive ViV-TAVR patients were identified from our institutional TAVR database and utilization of bioprosthetic valve fracturing or intraprocedural postdilatation was reviewed. Surgical valves were categorized as responsive or not responsive to VF. Transprosthetic gradients were compared in procedures with VF and procedures with or without postdilatation. Results In 67 consecutive ViV-TAVR procedures between January 2018 and September 2020, VF was attempted in 15 cases with eight being successful. Standard postdilatation was performed in 21 patients and 31 cases were without postdilatation. Mean transprosthetic gradients (MPG) decreased from 34.2 + 12.5 to 12.7 + 7.4 mmHg (p less then 0.001) for all patients. MPG was 8.6 + 3.5 mmHg after VF, 12.9 + 8.5 mmHg after standard postdilatation (p = 0.18) and 13.4 + 6.8 mmHg in cases without postdilatation (p = 0.04). In small surgical valves with true inner diameter less then 21 mm MPG was 9.1 + 3.5 mmHg after VF, 14.2 + 8.9 after standard postdilatation (p = 0.068) and 16.2 + 9.2 mmHg without postdilatation (p = 0.152). Failed attempts with BVF occurred with the Perimount standard valve. Conclusion Bioprosthetic valve fracturing results in lower mean transprosthetic gradients after ViV-TAVR. Responsiveness of BVF in Perimount surgical valves, long-term hemodynamic outcome, and potential survival benefits need further evaluation.Parallel Continuum Robots (PCR) have several advantages over classical articulated robots, notably a large workspace, miniaturization capabilities and safe human-robot interactions. However, their low accuracy is still a serious drawback. Indeed, several conditions have to be met for PCR to reach a high accuracy, namely a repeatable mechanical structure, a correct kinematic model, and a proper estimation of the model's parameters. In this article, we propose a methodology that allows reaching a micrometer accuracy with a PCR. This approach emphasizes the importance of using a repeatable continuum mechanism, identifying the most influential parameters of an accurate kinematic model of the robot and precisely measuring them. The experimental results show that the proposed approach allows to reach an accuracy of 3.3 µm in position and 0.5 mrad in orientation over a 10 mm long circular path. These results push the current limits of PCR accuracy and make them good potential candidates for high accuracy automatic positioning tasks.Objectives We recently introduced a navigated, robot-driven laser beam craniotomy for use with stereoelectroencephalography (SEEG) applications. This method was intended to substitute the hand-held electric power drill in an ex vivo study. The purpose of this in vivo non-recovery pilot study was to acquire data for the depth control unit of this laser device, to test the feasibility of cutting bone channels, and to assess dura perforation and possible cortex damage related to cold ablation. Methods Multiple holes suitable for SEEG bone channels were planned for the superior portion of two pig craniums using surgical planning software and a frameless, navigated technique. The trajectories were planned to avoid cortical blood vessels using magnetic resonance angiography. Each trajectory was converted into a series of circular paths to cut bone channels. The cutting strategy for each hole involved two modes a remaining bone thickness mode and a cut through mode (CTR). The remaining bone thickness mode is an autoh cut through of the bone could be identified in 84%. Conclusion Inflowing cerebrospinal fluid disturbed OCT signals, and, therefore, the current CTR method could not be reliably applied. Video imaging is a candidate for observing a successful cut through. OCT and video imaging may be used for depth control to implement an updated SEEG bone channel cutting strategy in the future.As robots continue to acquire useful skills, their ability to teach their expertise will provide humans the two-fold benefit of learning from robots and collaborating fluently with them. For example, robot tutors could teach handwriting to individual students and delivery robots could convey their navigation conventions to better coordinate with nearby human workers. Because humans naturally communicate their behaviors through selective demonstrations, and comprehend others' through reasoning that resembles inverse reinforcement learning (IRL), we propose a method of teaching humans based on demonstrations that are informative for IRL. But unlike prior work that optimizes solely for IRL, this paper incorporates various human teaching strategies (e.g. scaffolding, simplicity, pattern discovery, and testing) to better accommodate human learners. We assess our method with user studies and find that our measure of test difficulty corresponds well with human performance and confidence, and also find that favoring simplicity and pattern discovery increases human performance on difficult tests. However, we did not find a strong effect for our method of scaffolding, revealing shortcomings that indicate clear directions for future work.Currently soft robots primarily rely on pneumatics and geometrical asymmetry to achieve locomotion, which limits their working range, versatility, and other untethered functionalities. In this paper, we introduce a novel approach to achieve locomotion for soft robots through dynamically tunable friction to address these challenges, which is achieved by subsurface stiffness modulation (SSM) of a stimuli-responsive component within composite structures. To demonstrate this, we design and fabricate an elastomeric pad made of polydimethylsiloxane (PDMS), which is embedded with a spiral channel filled with a low melting point alloy (LMPA). Once the LMPA strip is melted upon Joule heating, the compliance of the composite structure increases and the friction between the composite surface and the opposing surface increases. A series of experiments and finite element analysis (FEA) have been performed to characterize the frictional behavior of these composite pads and elucidate the underlying physics dominating the tunable friction.