RESUMEN
Left bundle branch pacing (LBBP) has been subject to increasing interest over the last few years due to its capacity for physiological conduction and its advantages compared to His bundle pacing. His bundle pacing has certain limitations, such as a small pacing area for the His bundle, a high threshold that leads to battery depletion, a low R-wave amplitude that may result in atrial or His oversensing, and ventricular signal undersensing. In this case series, four patients (two female and two male) aged 62.2 ± 8.4 years old with symptomatic sick sinus disease and no scar tissue in the interventricular septum underwent LBBP. All LBBPs were done with standard LBBP using a lumenless SelectSecure 3830 lead (Medtronic®, Minneapolis, USA) with a fixed helix. The lead parameters showed a good R-wave amplitudes (13 ± 7.4 mV) and a low threshold (0.77 ± 0.17 V @ 0.4 ms). All patients were discharged on the next day. During follow-up period of 13.3 ± 12.9 months, all patients were well and no complications were noted. In conclusion, LBBP may be as an alternative of novel conduction pacing techniques and can be done relatively easy and safe, even with limited experience center.
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Fascículo Atrioventricular , Estimulación Cardíaca Artificial , Electrocardiografía , Humanos , Femenino , Persona de Mediana Edad , Masculino , Fascículo Atrioventricular/fisiopatología , Estimulación Cardíaca Artificial/métodos , Anciano , Síndrome del Seno Enfermo/terapia , Resultado del Tratamiento , Marcapaso Artificial , Bloqueo de Rama/terapia , Bloqueo de Rama/fisiopatologíaRESUMEN
BACKGROUND: Five definitions of peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) are used in clinical trials; their clinical relevance in coronary bifurcation stenting remains unclear. OBJECTIVES: To understand the correlation between PMI and mortality in bifurcation lesions from the DKCRUSH studies. METHODS: PMI was defined using serum creatine kinase-myocardial band (CK-MB) values within 48 h of PCI according to the SYNTAX, Fourth Universal Definition of MI (4th UDMI), ISCHEMIA, SCAI, and EXCEL definitions. Overall, 1300 patients with both CK and CK-MB measurements pre- and post-stenting were evaluated. The association of each PMI type and all-cause death or cardiac death at a median of 5.58 years of follow-up was analyzed using Cox regression. RESULTS: In total, 56 (4.3%) patients had PMI. According to SYNTAX, 4th UDMI or ISCHEMIA, SCAI, and EXCEL definitions, PMI occurred in 21 (1.6%), 56 (4.3%), 29 (2.2%), and 32 (2.5%) patients, respectively. All definitions were significantly correlated with unadjusted mortality at the end of follow-up but not at 30 days or 1-year after stenting. PMI using SYNTAX, SCAI, and EXCEL definitions rather than 4th UDMI definition was strongly associated with adjusted all-cause death. By adjusted analysis, PMI according to 4th UDMI, SCAI, and EXCEL definitions but not SYNTAX definition was positively correlated with cardiac death at a median of 5.58 years of follow-up. CK-MB ≥ 5 x UNL strongly enhanced the correlation of CK-MB values with mortality. CONCLUSIONS: PMI rate varies with the definition following stenting for bifurcation lesions. PMI defined by SCAI and EXCEL definitions is strongly correlates with adjusted all-cause and cardiac death.
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Enfermedad de la Arteria Coronaria , Infarto del Miocardio , Intervención Coronaria Percutánea , Biomarcadores , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Análisis de Datos , Humanos , Intervención Coronaria Percutánea/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del TratamientoRESUMEN
Pallet racking is an essential element within warehouses, distribution centers, and manufacturing facilities. To guarantee its safe operation as well as stock protection and personnel safety, pallet racking requires continuous inspections and timely maintenance in the case of damage being discovered. Conventionally, a rack inspection is a manual quality inspection process completed by certified inspectors. The manual process results in operational down-time as well as inspection and certification costs and undiscovered damage due to human error. Inspired by the trend toward smart industrial operations, we present a computer vision-based autonomous rack inspection framework centered around YOLOv7 architecture. Additionally, we propose a domain variance modeling mechanism for addressing the issue of data scarcity through the generation of representative data samples. Our proposed framework achieved a mean average precision of 91.1%.
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Industrias , Recolección de DatosRESUMEN
Highly oriented electrospun conductive nanofibrous biocomposites (CNBs) of polylactic acid (PLA) and polyaniline (PANi) are fabricated using electrospinning. At the percolation threshold (φc), the growth of continuous paths between PANi particles leads to a steep increase in the electrical conductivity of fibers, and the McLachlan equation is fitted to identify φc. Annealing generates additional conductive channels, which lead to higher conductivity for dynamic percolation. For the first time, dynamic percolation is investigated for revealing time-temperature superposition in oriented conductive nanofibrous biocomposites. The crystallinity (χc) displays a linear dependence on annealing temperature within the confined fiber of CNBs. The increase in crystallinity due to annealing also increases the Young's modulus E of CNBs. The present study outlines a reliable approach to determining the conductivity and elasticity of nanofibers that are highly desirable for a wide range of biological tissue applications.
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Nanofibras , Ingeniería de Tejidos , Elasticidad , Conductividad Eléctrica , Poliésteres/farmacología , Andamios del TejidoRESUMEN
INTRODUCTION: The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events. METHODS: A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI ≥28 kg/m2 . The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardio-cerebrovascular events. RESULTS: There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I2 : 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I2 : 23.9%). Meta-regression showed that the association varies by age (coefficient: -0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I2 : 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I2 : 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (pnonlinearity < 0.001), the curve became steeper at 30-35 kg/m2 . For adverse events, an increase of 1% for every 1 kg/m2 increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (pnonlinearity = 0.001). CONCLUSION: Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events. PROSPERO ID: CRD42020198787.
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Fibrilación Atrial/cirugía , Ablación por Catéter , Obesidad/epidemiología , Fibrilación Atrial/epidemiología , Índice de Masa Corporal , Humanos , Sobrepeso/epidemiología , Recurrencia , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: The COMBO drug eluting stent is a novel device with luminal endothelial progenitor cell capture technology for rapid homogeneous endothelialization. METHODS AND RESULTS: We examined for sex differences in 1-year outcomes after COMBO stenting from the COMBO collaboration, a pooled patient-level dataset from the MASCOT and REMEDEE multicenter registries. The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, target vessel-myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR). Secondary outcomes included stent thrombosis (ST). Adjusted outcomes were assessed using Cox regression methods. The study included 861 (23.8%) women and 2,753 (76.2%) men. Women were older with higher prevalence of several comorbidities including diabetes mellitus. Risk of 1-year TLF was similar in both sexes (3.8% vs. 3.9%, HR 0.92, 95% CI 0.59-1.42, p = .70), without sex differences in the incidence of cardiac death (1.6% vs. 1.5%, p = .78), TV-MI (1.5% vs. 1.1%, p = .32), or CD-TLR (2.0% vs. 2.2%, p = .67). Definite or probable ST occurred in 0.4% women and 1.0% men (HR 0.26, 95% CI 0.06-1.11, p = .069). CONCLUSIONS: Despite greater clinical risks at baseline, women treated with COMBO stents had similarly low 1-year TLF and other ischemic outcomes compared to men.
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Enfermedad de la Arteria Coronaria , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Masculino , Intervención Coronaria Percutánea/efectos adversos , Diseño de Prótesis , Factores de Riesgo , Caracteres Sexuales , Stents , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. METHODS AND RESULTS: In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent group) or provisional stenting (provisional group). The primary endpoint was the composite of target lesion failure (TLF) at the 1-year follow-up, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (TLR). The safety endpoint was definite or probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37 (11.4%) and 20 (6.1%) patients in the provisional and two-stent groups, respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.30-0.90; P = 0.019], largely driven by increased TVMI (7.1%, HR 0.43, 95% CI 0.20-0.90; P = 0.025) and clinically driven TLR (5.5%, HR 0.43, 95% CI 0.19-1.00; P = 0.049) in the provisional group. At the 1 year after indexed procedures, the incidence of cardiac death was 2.5% in the provisional group, non-significant to 2.1% in the two-stent group (HR 0.86, 95% CI 0.31-2.37; P = 0.772). CONCLUSION: For DEFINITION criteria-defined complex coronary bifurcation lesions, the systematic two-stent approach was associated with a significant improvement in clinical outcomes compared with the provisional stenting approach. Further study is urgently warranted to identify the mechanisms contributing to the increased rate of TVMI after provisional stenting. STUDY REGISTRATION: http://www.clinicaltrials.com; Identifier: NCT02284750.
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Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Stents , Factores de Tiempo , Resultado del TratamientoRESUMEN
The present study outlines a reliable approach to determining the electrical conductivity and elasticity of highly oriented electrospun conductive nanofibers of biopolymers. The highly oriented conductive fibers are fabricated by blending a high molar mass polyethylene oxide (PEO), polycaprolactone (PCL), and polylactic acid (PLA) with polyaniline (PANi) filler. The filler-matrix interaction and molar mass (M) of host polymer are among governing factors for variable fiber diameter. The conductivity as a function of filler fraction (φ) is shown and described using a McLachlan equation to reveal the electrical percolation thresholds (φc) of the nanofibers. The molar mass of biopolymer, storage time, and annealing temperature are significant factors for φc. The Young's modulus (E) of conductive fibers is dependent on filler fraction, molar mass, and post-annealing process. The combination of high orientation, tunable diameter, tunable conductivity, tunable elasticity, and biodegradability makes the presented nanofibers superior to the fibers described in previous literature and highly desirable for various biomedical and technical applications.
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Biopolímeros/química , Nanofibras/química , Polímeros/química , Compuestos de Anilina/química , Módulo de Elasticidad/fisiología , Conductividad Eléctrica , Electricidad , Poliésteres/química , Polietilenglicoles/química , Ingeniería de Tejidos/métodos , Andamios del Tejido/químicaRESUMEN
A 60-year old male with paroxysmal atrial fibrillation underwent a combined procedure of left atrial appendage occlusion and pulmonary vein isolation. However, an acute intraprocedural 24-mm Watchman device dislodgement occurred, and thus a decision for urgent surgery was made. However, it was noted during the surgery that the device had migrated further to the descending aorta, just distal to the left subclavian artery. Since a right sternotomy access for retrieval was not feasible, a percutaneous approach was justified. A homemade snare was created using a combination of a long sheath, J-wire, and a regular snare, and the device was successfully retrieved without significant difficulty.
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Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/tendencias , Remoción de Dispositivos/instrumentación , Dispositivo Oclusor Septal/efectos adversos , Aorta Torácica/cirugía , Cateterismo Cardíaco/métodos , Procedimientos Quirúrgicos Cardíacos/métodos , Terapia Combinada/métodos , Humanos , Masculino , Persona de Mediana Edad , Venas Pulmonares/cirugía , Arteria Subclavia/cirugía , Resultado del TratamientoRESUMEN
AIMS: There is growing evidence that magnetic resonance imaging (MRI) scanning in patients with non-conditional cardiac implantable electronic devices (CIEDs) can be performed safely. Here, we aim to assess the safety of MRI in patients with non-conditional CIEDs. METHODS AND RESULTS: English scientific literature was searched using PubMed/Embase/CINAHL with keywords of 'magnetic resonance imaging', 'pacemaker', 'implantable defibrillator', and 'cardiac resynchronization therapy'. Studies assessing outcomes of adverse events or significant changes in CIED parameters after MRI scanning in patients with non-conditional CIEDs were included. References were excluded if the MRI conditionality of the CIEDs was undisclosed; number of patients enrolled was <10; or studies were case reports/series. About 35 cohort studies with a total of 5625 patients and 7196 MRI scans (0.5-3 T) in non-conditional CIEDs were included. The overall incidence of lead failure, electrical reset, arrhythmia, inappropriate pacing and symptoms related to pocket heating, or torque ranged between 0% and 1.43%. Increase in pacing lead threshold >0.5 V and impedance >50Ω was seen in 1.1% [95% confidence interval (CI) 0.7-1.8%] and 4.8% (95% CI 3.3-6.4%) respectively. The incidence of reduction in P- and R-wave sensing by >50% was 1.5% (95% CI 0.6-2.9%) and 0.4% (95% CI 0.06-1.1%), respectively. Battery voltage reduction of >0.04 V was reported in 2.2% (95% CI 0.2-6.1%). CONCLUSION: This meta-analysis affirms the safety of MR imaging in non-conditional CIEDs with no death or implantable cardioverter-defibrillator shocks and extremely low incidence of lead or device-related complications.
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Arritmias Cardíacas , Desfibriladores Implantables , Imagen por Resonancia Magnética , Marcapaso Artificial , Arritmias Cardíacas/terapia , Corazón , HumanosRESUMEN
The existence of the upper common pathways is not well-established yet. This case describes atrioventricular nodal reentry tachycardia with persistent ventriculoatrial dissociation that proof of upper common pathway existence.
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Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia Supraventricular/fisiopatología , Adulto , Ablación por Catéter , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia Supraventricular/cirugíaRESUMEN
AIMS: Ideal positioning of left ventricular (LV) pacing lead in cardiac resynchronization therapy (CRT) is technically demanding. This case aims to place LV lead in anterolateral branch of coronary sinus (CS) using collateral route blindly. METHODS AND RESULTS: Externalization via the CS ostium using collaterals retrogrogradely, which was not visible in initial balloon occlusion venography, through one delivery sheath with the support of commonly used micro-guide catheter and subsequent successful LV lead placement in anterolateral branch of CS. CONCLUSION: This innovative retrograde approach for LV pacing lead implantation in anterolateral branch of CS obviated the need for snare technique to capture the distal end of the wire when antegrade route was not successful.
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Aleteo Atrial/cirugía , Bloqueo Atrioventricular/terapia , Dispositivos de Terapia de Resincronización Cardíaca , Seno Coronario , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos , Implantación de Prótesis/métodos , Disfunción Ventricular Izquierda/terapia , Aleteo Atrial/complicaciones , Bloqueo Atrioventricular/complicaciones , Terapia de Resincronización Cardíaca , Ablación por Catéter , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Flebografía , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicacionesRESUMEN
BACKGROUND: Atrial-based pacing is associated with lower risk of atrial fibrillation (AF) in sick sinus syndrome compared with ventricular pacing; nevertheless, the impact of site and rate of atrial pacing on progression of AF remains unclear. We evaluated whether long-term atrial pacing at the right atrial (RA) appendage versus the low RA septum with (ON) or without (OFF) a continuous atrial overdrive pacing algorithm can prevent the development of persistent AF. METHODS AND RESULTS: We randomized 385 patients with paroxysmal AF and sick sinus syndrome in whom a pacemaker was indicated to pacing at RA appendage ON (n=98), RA appendage OFF (n=99), RA septum ON (n=92), or RA septum OFF (n=96). The primary outcome was the occurrence of persistent AF (AF documented at least 7 days apart or need for cardioversion). Demographic data were homogeneous across both pacing site (RA appendage/RA septum) and atrial overdrive pacing (ON/OFF). After a mean follow-up of 3.1 years, persistent AF occurred in 99 patients (25.8%; annual rate of persistent AF, 8.3%). Alternative site pacing at the RA septum versus conventional RA appendage (hazard ratio=1.18; 95% confidence interval, 0.79-1.75; P=0.65) or continuous atrial overdrive pacing ON versus OFF (hazard ratio=1.17; 95% confidence interval, 0.79-1.74; P=0.69) did not prevent the development of persistent AF. CONCLUSIONS: In patients with paroxysmal AF and sick sinus syndrome requiring pacemaker implantation, an alternative atrial pacing site at the RA septum or continuous atrial overdrive pacing did not prevent the development of persistent AF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. UNIQUE IDENTIFIER: NCT00419640.
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Fibrilación Atrial/prevención & control , Estimulación Cardíaca Artificial/métodos , Síndrome del Seno Enfermo/complicaciones , Anciano , Anciano de 80 o más Años , Algoritmos , Apéndice Atrial , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Enfermedades Cardiovasculares/mortalidad , Progresión de la Enfermedad , Cardioversión Eléctrica , Femenino , Tabiques Cardíacos , Humanos , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Estudios Prospectivos , Síndrome del Seno Enfermo/terapia , Accidente Cerebrovascular/etiología , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high risk of stroke. Apixaban, a novel factor Xa inhibitor, may be an alternative treatment for such patients. METHODS: In a double-blind study, we randomly assigned 5599 patients with atrial fibrillation who were at increased risk for stroke and for whom vitamin K antagonist therapy was unsuitable to receive apixaban (at a dose of 5 mg twice daily) or aspirin (81 to 324 mg per day), to determine whether apixaban was superior. The mean follow up period was 1.1 years. The primary outcome was the occurrence of stroke or systemic embolism. RESULTS: Before enrollment, 40% of the patients had used a vitamin K antagonist. The data and safety monitoring board recommended early termination of the study because of a clear benefit in favor of apixaban. There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (hazard ratio with apixaban, 0.45; 95% confidence interval [CI], 0.32 to 0.62; P<0.001). The rates of death were 3.5% per year in the apixaban group and 4.4% per year in the aspirin group (hazard ratio, 0.79; 95% CI, 0.62 to 1.02; P=0.07). There were 44 cases of major bleeding (1.4% per year) in the apixaban group and 39 (1.2% per year) in the aspirin group (hazard ratio with apixaban, 1.13; 95% CI, 0.74 to 1.75; P=0.57); there were 11 cases of intracranial bleeding with apixaban and 13 with aspirin. The risk of a first hospitalization for cardiovascular causes was reduced with apixaban as compared with aspirin (12.6% per year vs. 15.9% per year, P<0.001). The treatment effects were consistent among important subgroups. CONCLUSIONS: In patients with atrial fibrillation for whom vitamin K antagonist therapy was unsuitable, apixaban reduced the risk of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00496769.).
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Fibrilación Atrial/tratamiento farmacológico , Embolia/prevención & control , Inhibidores del Factor Xa , Fibrinolíticos/uso terapéutico , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Accidente Cerebrovascular/prevención & control , Anciano , Anciano de 80 o más Años , Aspirina/efectos adversos , Aspirina/uso terapéutico , Fibrilación Atrial/complicaciones , Método Doble Ciego , Embolia/epidemiología , Femenino , Fibrinolíticos/efectos adversos , Hemorragia/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Pirazoles/efectos adversos , Piridonas/efectos adversos , Factores de Riesgo , Accidente Cerebrovascular/epidemiologíaRESUMEN
In skeletal muscle tissue engineering, innervation and vascularization play an essential role in the establishment of functional skeletal muscle. For adequate three-dimensional assembly, biocompatible aligned nanofibers are beneficial as matrices for cell seeding. The aim of this study was to analyze the impact of Schwann cells (SC) on myoblast (Mb) and adipogenic mesenchymal stromal cell (ADSC) cocultures on poly-É-caprolactone (PCL)-collagen I-nanofibers in vivo. Human Mb/ADSC cocultures, as well as Mb/ADSC/SC cocultures, were seeded onto PCL-collagen I-nanofiber scaffolds and implanted into the innervated arteriovenous loop model (EPI loop model) of immunodeficient rats for 4 weeks. Histological staining and gene expression were used to compare their capacity for vascularization, immunological response, myogenic differentiation, and innervation. After 4 weeks, both Mb/ADSC and Mb/ADSC/SC coculture systems showed similar amounts and distribution of vascularization, as well as immunological activity. Myogenic differentiation could be observed in both groups through histological staining (desmin, myosin heavy chain) and gene expression (MYOD, MYH3, ACTA1) without significant difference between groups. Expression of CHRNB and LAMB2 also implied neuromuscular junction formation. Our study suggests that the addition of SC did not significantly impact myogenesis and innervation in this model. The implanted motor nerve branch may have played a more significant role than the presence of SC.
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Nanofibras , Andamios del Tejido , Ratas , Humanos , Animales , Ingeniería de Tejidos/métodos , Diferenciación Celular , Músculo Esquelético , Colágeno Tipo I/metabolismo , Desarrollo de Músculos/genéticaRESUMEN
Introduction: Initiated in June 2019, this collaborative effort involved 15 public and private sector hospitals in Pakistan. The primary objective was to enhance the capacity for pediatric neuro-oncology (PNO) care, supported by a My Child Matters/Foundation S grant. Methods: We aimed to establish and operate Multidisciplinary Tumor Boards (MTBs) on a national scale, covering 76% of the population (185.7 million people). In response to the COVID-19 pandemic, MTBs transitioned to videoconferencing. Fifteen hospitals with essential infrastructure participated, holding monthly sessions addressing diagnostic and treatment challenges. Patient cases were anonymized for confidentiality. Educational initiatives, originally planned as in-person events, shifted to a virtual format, enabling continued implementation and collaboration despite pandemic constraints. Results: A total of 124 meetings were conducted, addressing 545 cases. To augment knowledge, awareness, and expertise, over 40 longitudinal lectures were organized for healthcare professionals engaged in PNO care. Additionally, two symposia with international collaborators and keynote speakers were also held to raise national awareness. The project achieved significant milestones, including the development of standardized national treatment protocols for low-grade glioma, medulloblastoma, and high-grade glioma. Further protocols are currently under development. Notably, Pakistan's first pediatric neuro-oncology fellowship program was launched, producing two graduates and increasing the number of trained pediatric neuro-oncologists in the country to three. Discussion: The initiative exemplifies the potential for capacity building in PNO within low-middle income countries. Success is attributed to intra-national twinning programs, emphasizing collaborative efforts. Efforts are underway to establish a national case registry for PNO, ensuring a comprehensive and organized approach to monitoring and managing cases. This collaborative initiative, supported by the My Child Matters/Foundation S grant, showcases the success of capacity building in pediatric neuro-oncology in low-middle income countries. The establishment of treatment protocols, fellowship programs, and regional tumor boards highlights the potential for sustainable improvements in PNO care.
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BACKGROUND: Several studies have shown that lipid-lowering therapy to address hypercholesterolemia is generally inadequate because the target cholesterol goal is not achieved. Our study reviews the cholesterol goal attainment among patients receiving lipid lowering therapy in Indonesian hypercholesterolemic patients. METHODS: This surveywas part of the Pan-Asian CEPHEUS (CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia) study, involving hypercholesterolemic patients ≥ 18 years of age, who were on lipid- lowering treatment for ≥ 3 months. Lipid concentrations were measured, demographic and other clinically relevant information were collected. Definitions and criteria set by the updated 2004 National Cholesterol Education Program - Adult Treatment Program III was applied. RESULTS: In this survey, 149 physicians enrolled 979 patients, of whom only 834 were included in the final analysis. The mean age was 56.5 years, 53.5% male, and 82.3% were on statin monotherapy. The LDL-C goal attainment rate amongst Indonesians (31.3%)was belowthat of the overall Asian rate (49.1%). The lowest attainment (12.1%)was found in patients with a therapeutic target < 70 mg/dL. Additionally, the goal attainment rate in patients with metabolic syndrome (28%) was significantly lower than in patients without metabolic syndrome (37.5%, p = 0.006). Goal attainment was inversely related to cardiovascular risk and baseline LDL-C (p < 0.001). It was also noted that approximately 65.1% of patients believed he/she could miss a dosage without affecting his/her blood cholesterol concentration. CONCLUSIONS: High proportions of Indonesian hypercholesterolemic patients on lipid-lowering drug are not at the recommended LDL-C levels, and remain at risk for cardiovascular disease. KEY WORDS: Cardiovascular disease; Dyslipidemia; Hypercholesterolemia; Indonesian; LDL cholesterol.
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Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI. This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multicentered studies published between January 2005 and December 2021. We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89, P < 0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53, P < 0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10, P < 0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00, Pâ¯=â¯0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables. The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.
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Oclusión Coronaria , Infarto del Miocardio , Intervención Coronaria Percutánea , Humanos , Resultado del Tratamiento , Oclusión Coronaria/cirugía , Intervención Coronaria Percutánea/métodos , Estudios Retrospectivos , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Stents/efectos adversos , Infarto del Miocardio/etiología , Enfermedad CrónicaRESUMEN
Rice is a widely consumed food across the world. Whilst the world recovers from COVID-19, food manufacturers are looking to enhance their quality inspection processes for satisfying exportation requirements and providing safety assurance to their clients. Rice cultivation is a significant process, the yield of which can be significantly impacted in an adverse manner due to plant disease. Yet, a large portion of rice cultivation takes place in developing countries with less stringent quality inspection protocols due to various reasons including cost of labor. To address this, we propose the development of lightweight convolutional neural network architecture for the automated detection of rice leaf smut and rice leaf blight. In doing so, this research addresses the issue of data scarcity via a practical variance modeling mechanism (Domain Feature Mapping) and a custom filter development mechanism assisted through a reference protocol for filter suppression.
RESUMEN
Background: Provisional stenting (PS) is the main treatment for a majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent. However, the treatment difference between PS with 1-stent and with 2-stent remains unclear in patients with the acute coronary syndrome (ACS) and coronary bifurcation lesions. Materials and methods: Overall, 820 ACS patients with Medina 1,1,1 or 0,1,1 coronary bifurcation lesion who had completed 3-year follow-up were included and assigned to the PS with 1-stent (n = 519) or the PS with 2-stent (n = 301) according to the use of final stenting technique. The primary endpoint was the target lesion failure (TLF) at 3 years since stenting procedures. Results: At 3-year follow-up, TLF occurred in 85 (16.4%) patients in the PS with 1-stent group and 69 (22.9%) in the PS with 2-stent group (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.06-2.17, p = 0.021), mainly driven by a higher rate of target lesion revascularization (TLR) in the PS with 2-stent group (13.0% vs. 8.3%, HR 1.65, 95% CI 1.04-2.61, p = 0.033). Complex bifurcations, side branch (SB) pretreatment, intravascular imaging guidance, and hyperlipidemia were the four predictors for 3-year TLF. SB pretreatment was associated with increased 3-year TLR, leading to an extremely higher 3-year TLF. Conclusion: Provisional with 2-stent for patients with ACS is associated with a higher rate of 3-year TLF, mainly due to increased requirement of revascularization. SB pretreatment should be avoided for simple bifurcation lesion.