Mollerupjuul0258

Background - Transition zones between healthy myocardium and scar form a spatially complex substrate that may give rise to reentrant ventricular arrhythmias (VA). We sought to assess the utility of a novel machine learning (ML) approach for quantifying 3D spatial complexity of grayscale patterns on late gadolinium enhanced cardiac magnetic resonance images (LGE-CMR) to predict VA in patients with ischemic cardiomyopathy (ICM). Methods - 122 consecutive ICM patients with left ventricular ejection fraction ≤35% without prior history of VA underwent LGE-CMR. From raw grayscale data, we generated graphs encoding the 3D geometry of the left ventricle (LV). A novel technique, adapted to these graphs, assessed global regularity of signal intensity patterns using Fourier-like analysis and generated a substrate spatial complexity (SSC) profile for each patient. An ML statistical algorithm was employed to discern which SSC profiles correlated with VA events (appropriate ICD firings and arrhythmic sudden cardiac death) at 5 years of follow-up. From the statistical ML results, a complexity score (CS) ranging from 0-1 was calculated for each patient and tested using multivariable Cox regression models. Results - At 5 years of follow-up, 40 patients had VA events. The ML algorithm classified with 81% overall accuracy and correctly classified 86% of those without VA. Overall negative predictive value was 91%. Average CS was significantly higher in patients with VA events versus those without (0.5 ± 0.5 vs 0.1 ± 0.2; p less then 0.0001) and was independently associated with VA events in a multivariable model (hazard ratio = 1.5 [1.2- 2.0]; p=0.002). Conclusions - SSC analysis of LGE-CMR images may be helpful in refining VA risk in patients with ICM, particularly to identify low risk patients who may not benefit from prophylactic ICD therapy.We report the first case of spinal cord atrophy developing 16 months after resection of multiple intraspinal arachnoid cysts. The patient presented with back pain and the cysts were successfully resected. Sixteen months later, her back pain recurred. Magnetic resonance imaging showed severe atrophy of the spinal cord.Background - Vagal hyperactivity is directly related to several clinical conditions as reflex/functional bradyarrhythmias and vagal atrial fibrillation (AF). Cardioneuroablation provides therapeutic vagal denervation through endocardial RF ablation for these cases. Main challenges are neuro-myocardium interface identification and the denervation control and validation. The finding that the AF-Nest (AFN) ablation eliminates the atropine response and decreases RR variability suggests that they are related to the vagal innervation. Method - Prospective, controlled, longitudinal, non-randomized study enrolling 62 patients in two groups AFN group (AFNG-32 patients) with functional or reflex bradyarrhythmias or vagal AF treated with AFN ablation, and a control group (CG-30 patients) with anomalous bundles, ventricular premature beats, atrial flutter, AV-nodal reentry and atrial tachycardia, treated with conventional ablation (non-AFN ablation). In AFNG, ablation delivered at AFN detected by fragmentation/fractionatest that AF-Nests are intrinsically related to vagal innervation. ECVS was fundamental to stepwise vagal denervation validation during cardioneuroablation.INTRODUCTION The broad aim of this study was to compare the safety and efficacy of using barbed sutures and running closure versus interrupted placement of standard of care sutures for closure of the arthrotomy during total hip arthroplasty (THA). Specifically, we compared duration of arthrotomy closure, the number of sutures utilised for arthrotomy closure, and 90-day outcomes including wound-related readmission, reoperation, and complications. METHODS A total of 60 patients undergoing 60 THAs were enrolled in a prospective, single-blinded trial and randomised to receive either running closure of the arthrotomy with barbed sutures (n = 30) or interrupted closure with standard of care sutures (n = 30). Patients were eligible if they were undergoing primary THA for osteoarthritis and excluded if they had a BMI > 45 kg/m2 or age > 80 years or less then 18 years. RESULTS Arthrotomy closure duration was significantly shorter in the barbed suture group (3 minutes ± 9 seconds) versus the standard of care group (8 minutes ± 26 seconds, p less then 0.001). The suture utilisation for arthrotomy closure was 1 suture in the barbed sutured group 28/30 (93%) patients versus 2-4 sutures in 27/30 (90%) in the standard of care group (p less then 0.001). The overall number of wound-related complications in the barbed suture group was 1/30 (3%) versus 1/30 (3%) in the standard of care group (p = 1.00). The rate of suture abscesses was 1/30 (3%) in barbed suture group versus the standard of care (p = 1.00). There was trochanter bursitis 1/30 (3%) in the standard of care group versus zero in the barbed suture group (p = 1.00). CONCLUSIONS These results suggest that barbed suture utilisation may be faster and more resource efficient than use of standard of care sutures for arthrotomy closure in THA. ClinicalTrials.gov Identifier NCT03285555.We developed and pilot tested the effectiveness of a physically active academic program, Active Breaks (AB), whose objective is to increase school time moderate/vigorous physical activity (MVPA) among first graders, through daily 15-minute bouts of MVPA, at the beginning of the first lesson. Initially, 240 cards including one game each were developed and tested in first-grade students from 16 schools in Santiago. Trained observers and school teachers assessed the time, ease, and feasibility of implementation for each card. Barriers and facilitators to implementation were obtained from semistructured interviews to 14 teachers (out of 16). In eight schools (n = 556 students), we compared school time MVPA (with accelerometers) at baseline and follow-up, using test of proportions. One-hundred and twenty cards (games) complied with all aspects. Autophagy phosphorylation AB were implemented 50% of the time with a duration of 14 minutes (SD = 5). More than 90% of the time, teachers felt competent to conduct AB, and children understood the instructions and enjoyed the activity.