Evaluation of the relationship between Knee Osteoarthritis and Meniscus Pathologies.

Background: Knee osteoarthritis is a common, degenerative joint disease that causes chronic pain that affects daily life. Our study aims to evaluate geriatric patients aged 65 and over with knee pain in terms of osteoarthritis with radiography and magnetic resonance imaging and to investigate its relationship with meniscal pathologies. Methods: Radiography and magnetic resonance imaging of patients aged 65-88 years with knee pain were evaluated in terms of knee osteoarthritis and staging was performed. Meniscal pathologies were evaluated in magnetic resonance imaging, and the prevalence of different meniscal lesion types was calculated. In addition, the relationship between knee osteoarthritis and meniscal pathologies was analyzed. Results: Radiographic evidence of knee osteoarthritis was found in 182 (84.2%) of the 216 cases in our study group. A strong correlation was found between the degrees of knee osteoarthritis on magnetic resonance imaging and radiography. At least one meniscus pathology was observed in all 182 radiography cases with knee osteoarthritis findings. At least one meniscus pathology was observed in 29 (85.3%) of those without osteoarthritis signs. It was determined that meniscus degeneration, tear, and extrusion were observed more frequently in patients with knee osteoarthritis than in patients without osteoarthritis. Meniscal extrusion and complex and horizontaltype tears were the most common lesions. Conclusions: Osteoarthritis was found to be common in geriatric patients with knee pain. A correlation was found between radiography and magnetic resonance imaging regarding knee osteoarthritis. It was observed that meniscal pathologies were detected more frequently in patients with knee osteoarthritis.

Does ponticulus posticus affect vertebral artery diameter.

PURPOSE: Ponticulus Posticus, atlantooccipital ligament ossification-induced anomaly, surrounds the vertebral artery and the first cervical nerve root. It is believed to wrap around the first cervical nerve root and the vertebral artery, causing compression. We hypothesized that it would also reduce the diameter of the vertebral artery. METHODS: Between January 1, 2022, and December 31, 2022, cervical spine CT scans taken for any reason were retrospectively reviewed. The images of 1365 patients suitable for evaluation were evaluated by two expert radiologists in 3 dimensions. Among patients with PP, those who underwent cervical angiography were identified for vertebral artery diameter measurement. RESULTS: The average age of the 1365 individuals included in the study (732 males, 633 females) was 55.78 (± 18.85) with an age range of 1-96. Among this group, PP was detected in 288 individuals, resulting in a total prevalence of 21.1%. Right and left vertebral artery diameters were significantly lower in patients with complete PP compared to the absent group (p < 0,001, p < 0,001, respectively). Additionally, it was observed that width and height diameters and artery diameters were positively correlated in patients with Complete PP. CONCLUSIONS: Ponticulus posticus can cause vertebrobasilar insufficiency by reducing the diameter of the vertebral artery. Therefore, imaging and detailed evaluation of this region are important in symptomatic patients.

Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry.

AIMS: Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. METHODS AND RESULTS: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. CONCLUSION: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry.

AIMS: Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. METHODS AND RESULTS: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. CONCLUSION: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

Evaluation of Sarcopenia by Psoas Muscle Measurements in Osteoporotic Patients with Vertebral Compression Fracture.

OBJECTIVE: To examine the effect of sarcopenia on osteoporotic vertebral compression fracture with psoas muscle measurements. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of Radiology, Sivas Cumhuriyet University, Sivas, Turkiye, from January 2020 to March 2023. METHODOLOGY: Measurements evaluating psoas muscle area (PMA), psoas muscle index (PMI), and psoas muscle density (PMD) were made at L2 vertebral corpus level for the diagnosis of sarcopenia from muscle mass with computed tomography (CT). The association between sarcopenia and osteoporotic compression fracture was examined with significance at p <0.05. RESULTS: Osteoporotic patients with 37 compression fractures and 37 without compression fractures were examined. PMA and PMI were statistically significantly lower in the study group (p <0.01). PMD was also found to be statistically significantly lower in the study group (p <0.05). Diagnostic performance (DP) was good for the discrimination of patients and control groups for psoas area (AUC = 0.88; 95% confidence interval (CI) 0.807 - 0.956 and PMI (AUC = 0.83; 95% CI 0.734 - 0.917. It was poor for psoas density (AUC = 0.66, 95% CI 0.531 - 0.782). CONCLUSION: Sarcopenia is an important risk factor for osteoporotic compression fracture. Psoas measurements show a significant association with osteoporosis and vertebral fracture and can be easily determined on CT scan. KEY WORDS: Sarcopenia, Osteoporotic compression fracture, Psoas muscle.

Diagnostic value of Achilles tendon shear wave elastography in patients with ankylosing spondylitis: A case-control study.

OBJECTIVES: Ankylosing spondylitis (AS) can cause peripheral arthritis, tendinitis, enthesitis, and axial skeletal involvement. This study aims to determine early tendon damage by shear wave elastography (SWE) for the Achilles tendon in AS patients. METHODS: 48 AS patients and 48 asymptomatic individuals were included in the study. Participants were systematically examined with B-mode, power Doppler, and SWE using a high-resolution linear 6-15 MHz probe. Bilateral Achilles tendon stiffness, thickness, and vascularity were evaluated. Measurements were taken from the middle third of the Achilles tendon in the sagittal plane. Difference between the two groups was evaluated with statistical methods. Receiver operating characteristic analysis was performed to test the diagnostic performance of Achilles tendon stiffness. Additionally, the Spearman correlation test examined the relationship between Achilles tendon stiffness and disease duration. RESULTS: The difference between the two groups regarding Achilles tendon stiffness was statistically significant (p < 0.05). It was observed that Achilles tendon stiffness decreased in the patient group compared with the control group. The diagnostic value of Achilles tendon stiffness measured by SWE was found to be high. A negative correlation was detected between disease duration and tendon stiffness (p < 0.05). CONCLUSION: In patients diagnosed with AS, deterioration in the Achilles tendon structure was observed, and a significant decrease in tendon stiffness compared with the healthy population. It has been determined that these changes in the Achilles tendon are related to the duration of the disease.

Leadless pacemaker implantation following tricuspid interventions: multicenter collaboration of feasibility and safety.

BACKGROUND: Permanent pacing is often required following valve intervention (either surgical or percutaneous); however, tricuspid interventions pose specific challenges to conventional pacing. Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention. PURPOSE: To report periprocedural outcomes and follow-up of patients undergoing implantation of a LP system following tricuspid valve interventions. METHODS: Patients with previous tricuspid valve intervention at the time of attempted implantation of a LP (MicraTM, Medtronic, Minneapolis, MN, USA) were included. RESULTS: Between 2019 and 2022, 40 patients underwent LP implantations following tricuspid interventions in 5 large tertiary centers. The mean age was 68.9 ± 13.7 years, and 48% patients were male. The indication for pacing was as following: AVB in 27 (68%) patients, AF with slow ventricular response in 10 (25%) patients, and refractory rapid atrial fibrillation (AF) referred to AV junction ablation in 3 (7%) patients. Most of the patients received Micra VR (78%). The procedure was successful in all patients. The mean procedural time is 58 ± 32 min, and the median fluoroscopy time is 7.5 min. Electrical parameters were within normal range (threshold: 1.35 ± 1.2 V@0.24 ms, impedance: 772 ± 245 Ohm, R-wave: 6.9 ± 5.4 mV). No acute complications were observed. During a mean follow-up of 10 months, electrical parameters remained stable, and 4 deaths were occurred (not related to the procedure). CONCLUSION: A LP is a safe and efficient option following tricuspid valve interventions.

Evaluation of the contralateral hemisphere with DWI in pediatric patients with Dyke-Davidoff-Masson syndrome.

INTRODUCTION: Dyke-Davidoff-Masson Syndrome (DDMS) is a clinical syndrome that causes different clinical symptoms and is defined by volume decrement in one cerebral hemisphere. In this study, we aimed to evaluate the involvement of the normal-appearing contralateral hemisphere in 16 pediatric patients with DDMS using diffusion-weighted imaging (DWI). MATERIALS AND METHODS: Brain MRIs were retrospectively reviewed between January 2014 and January 2023. Sixteen pediatric patients radiologically compatible with DDMS were included in the study. Sixteen children who had undergone brain MRI, most commonly for headaches and whose MRI findings had been completely normal, were included as the control group. Apparent diffusion coefficient (ADC) values of the deep gray and white matter of the normal-appearing hemisphere in the patient group were calculated and compared with that of the control group. RESULTS: The ADC values of the gray and white matters of the patient and control groups were not statistically different. However, in the patient group, the ADC values of the gray and white matters in males were remarkably lower than in females (p = 0.038, p = 0.037, respectively). CONCLUSION: The difference in the ADC values of the contralateral hemisphere between females and males in the patient group suggests that the normal-appearing hemisphere may have been affected by DDMS. Although, the exact mechanism of this effect is not known. Therefore, in patients with DDMS, contralateral hemisphere involvement in cerebral hemiatrophy and hemispherectomy should be evaluated clinically and radiologically.

Pacemaker-induced Cardiomyopathy in Patients with Coronary Artery Disease: A Report of Three Cases.

Pacing-induced cardiomyopathy (PICM) is defined as a drop in left ventricular ejection fraction (LVEF) in the setting of chronic, high-burden right ventricular pacing. Cardiac resynchronization therapy (CRT) and conduction system pacing (CSP) have been proposed to manage PICM. Although acute myocardial infarction has been described as a predictor of PICM, there are no guideline recommendations for CRT or CSP in patients with coronary artery disease (CAD) and preserved LVEF. In this report, we present and discuss three cases of PICM in patients with CAD and preserved LVEF.

Perforation of the Pulmonary Vein During Ablation of Atrial Fibrillation: A Rare Complication of Cryoballoon Ablation.

A 58-year-old man admitted for a cryoballoon ablation due to a history of symptomatic paroxysmal atrial fibrillation experienced pericardial effusion and cardiac tamponade intraoperatively. A longitudinal left superior pulmonary vein perforation was confirmed by emergency thoracotomy and repaired. He developed atrial fibrillation 2 days postoperatively, which was terminated with colchicine and oral steroids the following day.

Brugada phenocopy associated with multiple psychotic drugs.

Brugada phenocopy (BrP) is a clinical condition characterized by transient ECG changes of Brugada syndrome (BrS), which can be due to various clinical conditions. We describe a case report of BrP due to psychotic drugs.

Multiparametric Cardiac Magnetic Resonance and Arrhythmias in Myocarditis.

Myocarditis is an inflammatory disease of the myocardium with a wide range of potential etiological factors, including a variety of infectious agents (mainly viral), systemic diseases, drugs, and toxins.

Retrograde Snaring for Left Ventricular Lead Placement in the Presence of a Persistent Left Superior Vena Cava.

Left ventricular lead positioning is technically demanding in cardiac resynchronization therapy (CRT) device implantation, especially in patients with complex cardiac venous anatomies. We report a case in which retrograde snaring was employed to successfully deliver the left ventricular lead through a persistent left superior vena cava for CRT implantation.

Captagon-induced Brugada phenocopy: A report of two cases.

Brugada phenocopies (BrP) represent electrocardiogram changes identical to those of true congenital Brugada syndrome but are induced by reversible clinical conditions. Previous cases have been reported in patients following recreational drug use. This report presents two cases of type 1B BrP associated with Fenethylline abuse, a recreational drug known by its trade name, Captagon.

Hybrid Generalized Regularized Extreme Learning Machine Through Gradient-Based Optimizer Model for Self-Cleansing Nondeposition with Clean Bed Mode of Sediment Transport.

Sediment transport modeling is an important problem to minimize sedimentation in open channels that could lead to unexpected operation expenses. From an engineering perspective, the development of accurate models based on effective variables involved for flow velocity computation could provide a reliable solution in channel design. Furthermore, validity of sediment transport models is linked to the range of data used for the model development. Existing design models were established on the limited data ranges. Thus, the present study aimed to utilize all experimental data available in the literature, including recently published datasets that covered an extensive range of hydraulic properties. Extreme learning machine (ELM) algorithm and generalized regularized extreme learning machine (GRELM) were implemented for the modeling, and then, particle swarm optimization (PSO) and gradient-based optimizer (GBO) were utilized for the hybridization of ELM and GRELM. GRELM-PSO and GRELM-GBO findings were compared to the standalone ELM, GRELM, and existing regression models to determine their accurate computations. The analysis of the models demonstrated the robustness of the models that incorporate channel parameter. The poor results of some existing regression models seem to be linked to the disregarding of the channel parameter. Statistical analysis of the model outcomes illustrated the outperformance of GRELM-GBO in contrast to the ELM, GRELM, GRELM-PSO, and regression models, although GRELM-GBO performed slightly better when compared to the GRELM-PSO counterpart. It was found that the mean accuracy of GRELM-GBO was 18.5% better when compared to the best regression model. The promising findings of the current study not only may encourage the use of recommended algorithms for channel design in practice but also may further the application of novel ELM-based methods in alternative environmental problems.

Online sequential, outlier robust, and parallel layer perceptron extreme learning machine models for sediment transport in sewer pipes.

Sediment transport is a noteworthy task in the design and operation of sewer pipes. Decreasing sewer pipe hydraulic capacity and transport of pollution are the main consequences of continuous sedimentation. Among different design approaches, the non-deposition with deposited bed (NDB) method can be used for the design of large sewer pipes; however, existing models are established on limited data ranges and mostly applied conventional regression methods. The current study improves the NDB sediment transport modeling by utilizing wide data ranges, and furthermore, applying robust machine learning techniques. In the present study, the conventional extreme learning machine (ELM) technique and its advanced versions, namely the online sequential-extreme learning machine (OS-ELM), outlier robust-extreme learning machine (OR-ELM), and parallel layer perceptron-extreme learning machine (PLP-ELM) are used for the modeling. In the studies conducted in the literature, sediment deposited bed thickness (ts) or deposited bed width (Wb) was used in the model structure as a deposited sediment variable, and therefore, different parameters in terms of ts and Wb can be incorporated into the model structure. However, an uncertainty arises in the selection of the appropriate parameter among Wb/Y, ts/Y, Wb/D, and ts/D (Y is flow depth and D circular pipe diameter). In order to define the most appropriate parameter to best describe the impact of deposited sediment at the channel bottom in the modeling procedure, four various scenarios using four different parameters that incorporate deposited sediment variables at their structures as Wb/Y, ts/Y, W/D, and ts/D are considered for model development. It is found that models that incorporate sediment bed thickness (ts) provide better results than those which use deposited bed width (Wb) in their structures. Among four different scenarios, models that utilized ts/D dimensionless parameter, give superior results in contrast to their alternatives. Based on the outcomes, the OR-ELM approach outperformed ELM, OS-ELM, and PLP-ELM techniques. The results obtained from applied methods are compared to their corresponding models in the literature, indicating the superiority of the OR-ELM model. It is figured out that the thickness of the deposited bed is an effective variable in modeling NDB sediment transport in sewer pipes.

Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings.

BACKGROUND: Cardiac magnetic resonance (CMR) is a unique tool for non-invasive tissue characterization, especially for identifying fibrosis. AIM: To present the existing data regarding the association of electrocardiographic (ECG) markers with myocardial fibrosis identified by CMR - late gadolinium enhancement (LGE). METHODS: A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021. In addition, we conducted a relevant search by Reference Citation Analysis (RCA) (https://www.referencecitationanalysis.com). RESULTS: A total of 32 studies were included. In hypertrophic cardiomyopathy (HCM), fragmented QRS (fQRS) is related to the presence and extent of myocardial fibrosis. fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients, while fQRS has also been related to fibrosis in myocarditis. Selvester score, abnormal Q waves, and notched QRS have also been associated with LGE. Repolarization abnormalities as reflected by increased Tp-Te, negative T-waves, and higher QT dispersion are related to myocardial fibrosis in HCM patients. In patients with Duchenne muscular dystrophy, a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed. In atrial fibrillation patients, advanced inter-atrial block is defined as P-wave duration ≥ 120 ms, and biphasic morphology in inferior leads is related to left atrial fibrosis. CONCLUSION: Myocardial fibrosis, a reliable marker of prognosis in a broad spectrum of cardiovascular diseases, can be easily understood with an easily applicable ECG. However, more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.

Left bundle branch area pacing in patients with atrioventricular conduction disease: A prospective multicenter study.

BACKGROUND: The reported success rate of His-bundle pacing (HBP) in patients with infranodal atrioventricular (AV) conduction disease is only 52%-76%. The success rate of left bundle branch area pacing (LBBAP) in this cohort is not well studied. OBJECTIVE: The purpose of this study was to evaluate the feasibility, safety, and electrophysiological characteristics of LBBAP in patients with AV conduction disease. METHODS: Patients with AV conduction disease referred for pacemaker implantation at 2 centers between February 2019 and June 2021 were considered for LBBAP. Baseline demographic characteristics, procedural success rates, electrophysiological parameters, and complications were assessed. RESULTS: LBBAP was successful in 340 of 364 patients (93%). Mean age was 72 ± 13 years, and mean follow-up was 331 ± 244 days. Pacing indications were Mobitz I in 27 patients (7%), Mobitz II or 2:1 AV block or high-grade AV block in 94 patients (26%), complete heart block in 199 patients (55%), and sick sinus syndrome with isolated bundle branch block in 44 patients (12%). Left bundle branch block and right bundle branch block were present in 57 patients (16%) and 140 patients (38%), respectively. Procedural success rates did not differ between indications (92.6%, 93.6%, 92.9%, and 95%, respectively) or between patients with narrow (<120 ms) vs wide QRS (≥120 ms). Mean LBBAP threshold was 0.77 ± 0.34 V at 0.4 ms at implant and remained stable during follow-up. There were 4 (1.2%) acute LBBAP lead dislodgments. CONCLUSION: LBBAP is safe and feasible with high success rates for patients with AV conduction disease. In contrast to HBP, LBBAP success rates remain high over the entire spectrum of AV conduction disease, and lead parameters remain stable during follow-up.

Ablation Index Outcome in Redo Persistent Atrial Fibrillation Ablation: Results of a Short-Term Study.

Background: Ablation index (AI) is a novel catheter-based parameter that has improved the outcome and safety of radiofrequency (RF) ablation of pulmonary vein isolations (PVIs). This index incorporates contact force (CF) (g), time (s), and power (W) parameters. The role of AI in redo ablations for persistent atrial fibrillation (peAF) has not been fully investigated. Hence, the impact of AI on the success of the redo PVI during the short-term follow-up period is the aim of this study. Methods: A retrospective analysis of 39 consecutive patients who underwent redo PVI ablations for peAF was carried out between January 2016 and December 2018. Target values for AI were 500 - 550 for anterior and roof and 400 - 380 for posterior and inferior regions. We compared outcomes between AI-guided and catheter CF ablations (i.e., forced time integral (FTI) of more than 400 g/s) during a follow-up of 24 months. Results: Pulmonary vein reconnections at redo procedure were similar in both groups (P = 0.1). AF free burden period was non-significant (mean 15.53 ± 2.4 months in AI group vs. 15.22 ± 1.9 months in CF group, P = 0.79) at 24 months. The AI group demonstrated greater numbers of patients for whom anti-arrhythmic therapy could be de-escalated over 1 year (n = 11 (65%) in AI vs. n = 6 (27%) in CF, P = 0.02). Fewer patients underwent escalation of their anti-arrhythmic therapy (n = 2 (12%) in AI vs. n = 7 (32%) in CF, P = 0.15). The AI group trended towards a shorter procedure time (111.6 ± 27 min) compared to the CF group (133 ± 40 min) (P = 0.06). Other procedural details were comparable. Conclusion: Redo PVI interventions using AI lead to a significant de-escalation in medication during follow-up. Procedure time and radiation dose using AI tends to be shorter. Both techniques are safe with minimal complications.