Notes

Examination regarding morphological features regarding IDH-mutant/wildtype human brain growths using whole-lesion phenotype evaluation.
USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.
CEUS proved to be a valid and accurate method for identifying malignant tumors of parotid gland; the combination of B-mode US with CEUS showed similar diagnostic accuracy, but better sensitivity than CEUS taken alone. USE did not improve the diagnostic performance of the B-mode US, alone or in association with CEUS; however, it revealed the highest diagnostic accuracy in the differentiation between benign lesions. FNAC demonstrated lower values in comparison with CEUS and with USE. check details Therefore, according to our study, MPUS could be proposed as a valid alternative to FNAC.
Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany.

In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analysed.

Overall evaluation on acceptance received above-average results with a median of 4 or 5 (IQR 1-2) on Likert scale (1=completely disagree, 5=completely agree). In the post-test self-rated EUS skills improved from 4 to 2 on the Likert scale (IQR=1, p=0.001, 1=excellent EUS skills, 5=no EUS skills). Results of the MC-test of all trainees showed significant improvement in theoretical knowledge from 7.9±1.9 to 8.8±1.9 points (mean±SD, p=0.001).

Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.
Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.Type II diabetes mellitus (T2DM) is a significant public health concern with multiple known risk factors (e.g., body mass index (BMI), body fat distribution, glucose levels). Improved prediction or prognosis would enable earlier intervention before possibly irreversible damage has occurred. Meanwhile, abdominal computed tomography (CT) is a relatively common imaging technique. Herein, we explore secondary use of the CT imaging data to refine the risk profile of future diagnosis of T2DM. In this work, we delineate quantitative information and imaging slices of patient history to predict onset T2DM retrieved from ICD-9 codes at least one year in the future. Furthermore, we investigate the role of five different types of electronic medical records (EMR), specifically 1) demographics; 2) pancreas volume; 3) visceral/subcutaneous fat volumes in L2 region of interest; 4) abdominal body fat distribution and 5) glucose lab tests in prediction. Next, we build a deep neural network to predict onset T2DM with pancreas imaging slices. Finally, motivated by multi-modal machine learning, we construct a merged framework to combine CT imaging slices with EMR information to refine the prediction. We empirically demonstrate our proposed joint analysis involving images and EMR leads to 4.25% and 6.93% AUC increase in predicting T2DM compared with only using images or EMR. In this study, we used case-control dataset of 997 subjects with CT scans and contextual EMR scores. To the best of our knowledge, this is the first work to show the ability to prognose T2DM using the patients' contextual and imaging history. We believe this study has promising potential for heterogeneous data analysis and multi-modal medical applications.
Since 1996, it has been recognized that catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) may require an approach through the left atrium.

The purposes are to present a case report and to provide a comprehensive narrative review on this topic.

A literature review of all articles that provided detailed information on patients who underwent catheter ablation via the left atrium for AVNRT was performed. The primary search queried PubMed using Medical Subject Headings (MeSH) terms "atrioventricular nodal reentrant tachycardia" and "left." The secondary search was performed by manual review of reference lists and Google Scholar citations of manuscripts retrieved by the primary search. The review was limited to the English language.

The searches yielded 30 articles that described 79 patients. A case report was added. Therefore, the final review consisted of 80 patients. The prevalence of left atrial ablation for patients with AVNRT undergoing catheter ablation at tertiary care centers was approximately 1%. Failed right atrial ablation, with or without coronary sinus ablation, was the most common indication for left atrial ablation. Pooled data from 3 cohort studies estimated the acute success rate for radiofrequency ablation of the slow pathway at the septal or inferoparaseptal segments of the mitral valve annulus after failed right-sided ablation to be 90%. There were no reports of atrioventricular block requiring permanent pacemaker implantation.

Catheter ablation of the slow pathway via the left atrium is an important technique for AVNRT cases that are refractory to conventional ablation.
Catheter ablation of the slow pathway via the left atrium is an important technique for AVNRT cases that are refractory to conventional ablation.Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice. Radiofrequency and cryoballoon catheter ablation are therapeutic options in addition to antiarrhythmic drug therapy for the treatment of AF. Ablation is effective at reducing recurrent atrial arrhythmias and also in the reduction of AF burden. Besides arrhythmia control, improvement in quality of life and clinical outcomes are also desirable goals with AF treatment. Randomized clinical trials have evaluated ablation in several patient populations, including symptomatic patients as first-line or second-line therapy, asymptomatic patients, and patients with heart failure. These trials clarify the durability of ablation in arrhythmia control, clarify quality-of-life improvement, and identify patient populations in whom ablation may be expected to improve clinical outcomes. In this review, we summarize the major clinical trials involving ablation; discuss the strengths, weakness, and clinical implications of these trials; and highlight the knowledge gaps in our current understanding of AF ablation for future clinical studies.
The heart rate increases by 10-20 beats per minute (bpm) throughout pregnancy in women, reaching maximum heart rate in the third trimester. During pregnancy, important changes in thyroid hormones also occur, with increases of up to 50% in the levels of triiodothyronine (T
), the biological active thyroid hormone. In addition, T
has been shown to regulate cardiac electrophysiology.

Thus, in the present study the potential contribution of T
in pregnancy-induced increased heart rate was explored.

We compared the heart rate between nonpregnant and pregnant mice under control conditions and after altering thyroid hormone levels with T
and propylthiouracil (PTU, an antithyroid drug) treatments.

Consistent with the clinical data, we found a 58% rise in T
levels during pregnancy in mice. Although pregnant mice had a higher baseline heart rate (607 ± 8 bpm,
= .004) and higher T
levels (1.9 ± 0.4 nM,
= .0005) than nonpregnant mice (heart rate 546 ± 16 bpm; T
levels 1.2 ± 0.1 nM), their heart rate responded similarly to T
treatment as nonpregnant mice (nonpregnant Δ130 ± 22 bpm; pregnant Δ126 ± 17 bpm,
= .858). Additionally, the heart rate remained significantly elevated (607 ± 11 bpm,
= .038) and comparable to untreated pregnant mice, after the use of the antithyroid drug PTU, although T
levels (1.3 ± 0.2 nM,
= .559) returned to nonpregnant values.

Based on these results, it is unlikely that T
contributes significantly to the pregnancy-induced increased heart rate.
Based on these results, it is unlikely that T3 contributes significantly to the pregnancy-induced increased heart rate.
Fetal tachyarrhythmia is a condition that may lead to cardiac dysfunction, hydrops, and death. Despite a transplacental treatment, failure to obtain or maintain sinus rhythm may occur.

We aimed to analyze the perinatal outcomes of sustained fetal tachyarrhythmias after in utero treatment.

We performed a retrospective evaluation of 69 cases with sustained fetal tachyarrhythmia. We compared the perinatal and long-term outcomes of prenatally converted and drug-resistant fetuses. Tachyarrhythmia subtypes were also evaluated.

Conversion to sinus rhythm was obtained in 74% of cases; 26% of cases were drug-resistant and delivered arrhythmic. Three perinatal deaths occurred in both groups (6.7% vs 17%,
= .34). Neonates delivered arrhythmic were more frequently admitted to neonatal intensive care units (75% vs 31%,
< .01), and their hospital stay was longer (20.9 vs 6.64 days,
< .001). Multiple neonatal recurrences (81% vs 11%,
< .001), temporary hemodynamic dysfunction or heart failure (5 overrepresentation of PJRT in the drug-resistant population.
Adult long QT syndrome (LQTS) patients have inadequate corrected QT interval (QTc) shortening and an abnormal T-wave response to the sudden heart rate acceleration provoked by standing. In adults, this knowledge can be used to aid an LQTS diagnosis and, possibly, for risk stratification. However, data on the diagnostic value of the standing test in children are currently limited.

To determine the potential value of the standing test to aid LQTS diagnostics in children.

In a prospective cohort including children (≤18 years) who had a standing test, comprehensive analyses were performed including manual and automated QT interval assessments and determination of T-wave morphology changes.

We included 47 LQTS children and 86 control children. At baseline, the QTc that identified LQTS children with a 90% sensitivity was 435 ms, which yielded a 65% specificity. A QTc ≥ 490 ms after standing only slightly increased sensitivity (91%, 95% confidence interval [CI] 80%-98%) and slightly decreased specificity (58additional value. The standing test for LQTS should only be used with caution in children.
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