Descending Aorta Rupture after Transcatheter Aortic Valve Embolization.

BACKGROUND: To report a case of rupture of the descending aorta after aortic migration during transcatheter aortic valve replacement (TAVR). METHODS: An 85-year-old man with a severe and symptomatic aortic stenosis underwent elective TAVR, which complicated with embolization into the ascending aorta. While repositioning into the descending aorta, the procedure complicated with aortic rupture. RESULTS: The patient required urgent thoracic intravalve stent-graft implantation (thoracic endovascular aortic repair [TEVAR]). Reintervention with other stent graft was required 2 days after initial procedure as proximal rupture was again diagnosed. Patient was discharged 50 days later because of other medical complications. He remains stable at 1 year of follow-up. CONCLUSIONS: TEVAR is a valid and safe option in the treatment of iatrogenic acute aortic rupture due to TAVR.

Remote Dielectric Sensing Before and After Discharge in Patients With ADHF: The ReDS-SAFE HF Trial.

BACKGROUND: Incomplete treatment of congestion often leads to worsening heart failure (HF). The remote dielectric sensing (ReDS) system is an electromagnetic energy-based technology that accurately quantifies changes in lung fluid concentration noninvasively. OBJECTIVES: This study sought to assess whether an ReDS-guided strategy during acutely decompensated HF hospitalization is superior to routine care for improving outcomes at 1 month postdischarge. METHODS: ReDS-SAFE HF (Use of ReDS for a SAFE discharge in patients with acute Heart Failure) was an investigator-initiated, multicenter, single-blind, randomized, proof-of-concept trial in which 100 patients were randomized to a routine care strategy, with discharge criteria based on current clinical practice, or an ReDS-guided decongestion strategy, with discharge criteria requiring an ReDS value of ≤35%. ReDS measurements were performed daily and at a 7-day follow-up visit, with patients and treating physicians in the routine care arm blinded to the results. The primary outcome was a composite of unplanned visits for HF, HF rehospitalization, or death at 1 month after discharge. RESULTS: The mean age was 67 ± 14 years, and 74% were male. On admission, left ventricular ejection fraction was 37% ± 16%, and B-type natriuretic peptide was 940 pg/L (Q1-Q3: 529-1,665 pg/L). The primary endpoint occurred in 10 (20%) patients in the routine care group and 1 (2%) in the ReDS-guided strategy group (log-rank P = 0.005). The ReDS-guided strategy group experienced a lower event rate, with an HR of 0.094 (95% CI: 0.012-0.731; P = 0.003), and a number of patients needed to treat of 6 to avoid an event (95% CI: 3-17), mainly resulting from a decrease in HF readmissions. The median length of stay was 2 days longer in the ReDS-guided group vs the routine care group (8 vs 6; P = 0.203). CONCLUSIONS: A ReDS-guided strategy to treat congestion improved 1-month prognosis postdischarge in this proof-of-concept study, mainly because of a decrease of the number of HF readmissions. (Use of ReDS for a SAFE discharge in patients with acute Heart Failure [ReDS-SAFE HF]; NCT04305717).

Long-term outcomes of percutaneous tricuspid annuloplasty with Cardioband device.

AIMS: Severe tricuspid regurgitation (TR) has adverse effects on outcomes, with limited therapeutic options. We report the outcomes of patients undergoing percutaneous annuloplasty as a treatment of ≥severe functional TR in a single centre. METHODS AND RESULTS: Prospective, single-arm, single-centre study that enrolled 24 consecutive patients with at least severe functional TR undergoing percutaneous annuloplasty with Cardioband system between 2019 and 2021. Clinical and echocardiographic data were prospectively collected, with a mean follow-up of 279 ± 246 days. At baseline, 66.6% were in New York Heart Association (NYHA) Classes III and IV and 100% had significant oedema. Technical success was 91.6%. At the end of follow-up, there was one death. Echocardiography showed a significant reduction in septolateral annular diameter of 10.4 mm (P < 0.001) that remained stable at the end of follow-up. The severity of the TR was also reduced. About 81.8% of patients were in NYHA Classes I and II. The number of patients with significant oedema decreased to 46% (P = 0.01). Six-minute walk distance improved by 68.8 m (P = 0.12). CONCLUSION: Percutaneous annuloplasty with Cardioband system is an effective and safe treatment for patients with symptomatic, ≥severe functional TR. Annular reduction and TR severity reduction remained significant and sustained for 1 year. Patients experienced improvements in quality of life and exercise capacity.

Secure and secret cooperation in robot swarms.

The importance of swarm robotics systems in both academic research and real-world applications is steadily increasing. However, to reach widespread adoption, new models that ensure the secure cooperation of large groups of robots need to be developed. This work introduces a method to encapsulate cooperative robotic missions in an authenticated data structure known as a Merkle tree. With this method, operators can provide the "blueprint" of the swarm's mission without disclosing its raw data. In other words, data verification can be separated from data itself. We propose a system where robots in a swarm, to cooperate toward mission completion, have to "prove" their integrity to their peers by exchanging cryptographic proofs. We show the implications of this approach for two different swarm robotics missions: foraging and maze formation. In both missions, swarm robots were able to cooperate and carry out sequential tasks without having explicit knowledge about the mission's high-level objectives. The results presented in this work demonstrate the feasibility of using Merkle trees as a cooperation mechanism for swarm robotics systems in both simulation and real-robot experiments, which has implications for future decentralized robotics applications where security plays a crucial role.

Quantification of H217O by 1H-MR imaging at 3 T: a feasibility study.

BACKGROUND: Indirect 1H-magnetic resonance (MR) imaging of 17O-labelled water allows imaging in vivo dynamic changes in water compartmentalisation. Our aim was to describe the feasibility of indirect 1H-MR methods to evaluate the effect of H217O on the MR relaxation rates by using conventional a 3-T equipment and voxel-wise relaxation rates. METHODS: MR images were used to calculate the R1, R2, and R2* relaxation rates in phantoms (19 vials with different H217O concentrations, ranging from 0.039 to 5.5%). Afterwards, an experimental animal pilot study (8 rats) was designed to evaluate the in vivo relative R2 brain dynamic changes related to the intravenous administration of 17O-labelled water in rats. RESULTS: There were no significant changes on the R1 and R2* values from phantoms. The R2 obtained with the turbo spin-echo T2-weighted sequence with 20-ms echo time interval had the higher statistical difference (0.67 s-1, interquartile range 0.34, p < 0.001) and Spearman correlation (rho 0.79). The R2 increase was adjusted to a linear fit between 0.25 and 5.5%, represented with equation R2 = 0.405 concentration + 0.3215. The highest significant differences were obtained for the higher concentrations (3.1-5.5%). The rat brain MR experiment showed a mean 10% change in the R2 value after the H217O injection with progressive normalisation. CONCLUSIONS: Indirect 1H-MR imaging method is able to measure H217O concentration by using R2 values and conventional 3-T MR equipment. Normalised R2 relative dynamic changes after the intravenous injection of a H217O saline solution provide a unique opportunity to map water pathophysiology in vivo, opening the analysis of aquaporins status and modifications by disease at clinically available 3-T proton MR scanners.

New-onset atrial fibrillation during COVID-19 infection predicts poor prognosis.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to a paradigm shift in healthcare worldwide. Little is known about the impact on the cardiovascular system, and the incidence and consequences of new onset of atrial fibrillation (AF) in infected patients remain unclear. The aim of this study was to analyze the cardiovascular outcomes of patients with newonset AF and coronavirus disease 2019 (COVID-19) infection. METHODS: This observational study analyzed a sample of 160 consecutive patients hospitalized due to COVID-19. A group with new-onset AF (n = 12) was compared with a control group (total: n = 148, sinus rhythm: n = 118, previous AF: n = 30). New-onset AF patients were significantly older and hypertensive, as well as presenting more frequently with a history of acute coronary syndrome and renal dysfunction. This group showed a higher incidence of thromboembolic events (41.7% vs. 4.1%; p < 0.001), bleeding (33.3% vs. 4.7%, p = 0.005), a combined endpoint of thrombosis and death (58.3% vs. 19.6%, p = 0.006) and longer hospital stays (16.4 vs. 8.6 days, p < 0.001), with no differences in all-cause mortality. RESULTS: In multivariate analysis, adjusted by potential confounding factors, new-onset AF demonstrated a 14.26 odds ratio for thromboembolism (95% confidence interval 2.86-71.10, p < 0.001). CONCLUSIONS: New-onset AF in COVID-19 patients presumably has a notable impact on prognosis. The appearance of new-onset AF is related to worse cardiovascular outcomes, considering it as an independent predictor of embolic events. Further studies are needed to identify patients with COVID-19 at high risk of developing "de novo" AF, provide early anticoagulation and minimize the embolic risk of both entities.

Blockchain Technology Secures Robot Swarms: A Comparison of Consensus Protocols and Their Resilience to Byzantine Robots.

Consensus achievement is a crucial capability for robot swarms, for example, for path selection, spatial aggregation, or collective sensing. However, the presence of malfunctioning and malicious robots (Byzantine robots) can make it impossible to achieve consensus using classical consensus protocols. In this work, we show how a swarm of robots can achieve consensus even in the presence of Byzantine robots by exploiting blockchain technology. Bitcoin and later blockchain frameworks, such as Ethereum, have revolutionized financial transactions. These frameworks are based on decentralized databases (blockchains) that can achieve secure consensus in peer-to-peer networks. We illustrate our approach in a collective sensing scenario where robots in a swarm are controlled via blockchain-based smart contracts (decentralized protocols executed via blockchain technology) that serve as "meta-controllers" and we compare it to state-of-the-art consensus protocols using a robot swarm simulator. Additionally, we show that our blockchain-based approach can prevent attacks where robots forge a large number of identities (Sybil attacks). The developed robot-blockchain interface is released as open-source software in order to facilitate future research in blockchain-controlled robot swarms. Besides increasing security, we expect the presented approach to be important for data analysis, digital forensics, and robot-to-robot financial transactions in robot swarms.

Evaluación pre y post implante del paciente con hipoacusia neurosensorial / Pre and post implant evaluation of the patient with sensorineural hearing loss

En la actualidad para el diagnostico de hipoacusia neurosensorial en niños recién nacidos se realizan una pruebas de tamizaje auditivo. Posteriormente para confirmar la perdida auditiva se realizan una batería de pruebas audiológicas con las cuales se obtienen los umbrales auditivos. Todos los pacientes deben ser valorados por el grupo interdisciplinario de implante coclear con el propósito de identificar el compromiso sensorial o neural donde se origina la lesión del paciente, los umbrales y habilidades auditivas, el nivel de desarrollo del lenguaje, su entorno familiar y la evaluación anatómica coclear que permita la inserción de un cable de electrodos y la estimulación eléctrica de la vía auditiva. El objetivo principal de un diagnostico temprano de la hipoacusia, es realizar una intervención inmediata con estimulación auditiva, preparándolos para el momento de la colocación del implante coclear. Una vez implantado, al paciente se le debe realizar un seguimiento tanto audiológico como del desarrollo de la percepción auditiva y del lenguaje para de esta forma determinar el beneficio del implante y realizar las modificaciones pertinentes tanto en la programación del implante como en las estrategias de rehabilitación.

Auditory screening tests are being performed nowadays in order to diagnose sensorineural hearing loss in new born babies. Later on and to be able to confirm the hearing loss, a set of auditory tests is conducted to obtain the auditory thresholds. It is necessary for the interdisciplinary cochlear implant group to appraise all patients in order to identify the extent of the sensory or neural damage where the patient’s lesion has been originated, the auditory thresholds and skills, the level of development of the language, his / her family environment and the cochlear anatomic appraisal that allows for the insertion of an electrode array as well as the electric stimulation of the auditory way. The main objective of an early diagnose of hearing loss, is to perform an immediate intervention with auditory stimulation, preparing them for the moment when the cochlear implant is to be inserted. Once having received the implant, it is important to follow up on the patient both, from the auditory point of view and the development of the auditory and language perception so that it can be determined the extent to which the implant has brought benefits and perform the corresponding modifications both in the implant programming and the rehabilitation strategies.