Mild aortic insufficiency following transcatheter aortic valve replacement: A systematic review and meta-analysis.

BACKGROUND: Post-procedural aortic insufficiency (AI) continues to be prevalent following transcatheter aortic valve replacement (TAVR). While several studies have assessed the outcomes of moderate-severe AI following TAVR, the incidence, predictors, and outcomes of mild AI remain unclear. METHODS: A systematic literature review was performed to identify studies reporting on mild AI following TAVR. The primary outcome was pooled incidence of post-TAVR mild AI. Secondary outcomes included pooled incidence of mild AI at 30 days and long term. The pooled incidence of midterm mortality in patients with post-TAVR mild AI was also evaluated. The random effect generalized linear mixed-effects model with logit-transformed proportions and Hartung-Knapp adjustment was used to calculate pooled incidence rates. Meta-regression was performed to identify predictors of mild AI. RESULTS: The pooled analysis included 19,241 patients undergoing TAVR across 50 studies. The mean age of patients ranged from 73 to 85 years, and female patients ranged from 20.0% to 83.3%. The overall pooled incidence of post-TAVR mild AI was 56.1% (95% confidence interval [CI] 0.31-0.64). The pooled incidence of mild AI at 30 days was 33.7% (95% CI 0.12-0.37). At mean follow-up of 1.15 years, the pooled incidence of mild AI was 37.0% (95% CI 0.16-0.45). The overall pooled incidence of Midterm mortality (mean follow-up 1.22 years) in patients with mild AI was 14.8% (95% CI 0.10-0.25). At meta-regression, none of the explored variables correlated with a difference in mild AI incidence. CONCLUSIONS: In published studies to date, 50% of patients undergoing TAVR develop mild AI postoperatively. In 37% of patients, this persists in long term. Though the incidence of AI is likely improving with newer generation TAVR valves, the prevalence and outcomes of mild AI should be closely monitored as TAVR volume and indications expand to younger patients with long life expectancy. The long-term outcomes of mild AI remain unclear. Further dedicated studies on post-TAVR mild AI are needed.

Linguistic initiation signals increase auditory feedback error correction.

Previous research has shown that speakers can adapt their speech in a flexible manner as a function of a variety of contextual and task factors. While it is known that speech tasks may play a role in speech motor behavior, it remains to be explored if the manner in which the speaking action is initiated can modify low-level, automatic control of vocal motor action. In this study, the nature (linguistic vs non-linguistic) and modality (auditory vs visual) of the go signal (i.e., the prompts) was manipulated in an otherwise identical vocal production task. Participants were instructed to produce the word "head" when prompted, and the auditory feedback they were receiving was altered by systematically changing the first formants of the vowel /ε/ in real time using a custom signal processing system. Linguistic prompts induced greater corrective behaviors to the acoustic perturbations than non-linguistic prompts. This suggests that the accepted variance for the intended speech sound decreases when external linguistic templates are provided to the speaker. Overall, this result shows that the automatic correction of vocal errors is influenced by flexible, context-dependant mechanisms.

Hypermucoviscous Klebsiella syndrome it's in the community!

Hypermucoviscous Klebsiella syndrome is a unique syndrome caused by a new variant of Klebsiella pneumoniae (KP), characterized by abscess formation at distant body sites. This emerging KP strain is different from the usual classic strains in having the rmp gene which increases capsule formation making this strain resistant to phagocytosis and helping in its dissemination to distant organs. A 50 years old diabetic man presented with facial swelling after dental procedure which progressively increased despite being on antibiotics. On examination he was febrile, had neck swelling with signs of inflammation and tender hepatomegaly. Ultrasonography showed submental and liver abscesses which were subsequently drained and both cultures isolated KP with hypermucoid colonies on agar plate and a positive string test indicating the presence of this new hypervirulent strain of KP. Therefore, a diagnosis of Hypermucoviscous Klebsiella syndrome should be considered in all patients who present with KP infection with multiple organ abscesses..

Assessment of online information on robotic cardiac and thoracic surgery.

Online health resources are important for patients seeking perioperative information on robotic cardiac and thoracic surgery. The value of the resources depends on their readability, accuracy, content, quality, and suitability for patient use. We systematically assess current online health information on robotic cardiac and thoracic surgery. Systematic online searches were performed to identify websites discussing robotic cardiac and thoracic surgery. For each website, readability was measured by nine standardized tests, and accuracy and content were assessed by an independent panel of two robotic cardiothoracic surgeons. Quality and suitability of websites were evaluated using the DISCERN and Suitability Assessment of Materials tools, respectively. A total of 220 websites (120 cardiac, and 100 thoracic) were evaluated. Both robotic cardiac and thoracic surgery websites were very difficult to read with mean readability scores of 13.8 and 14.0 (p = 0.97), respectively, requiring at least 13 years of education to be comprehended. Both robotic cardiac and thoracic surgery websites had similar accuracy, amount of content, quality, and suitability (p > 0.05). On multivariable regression, academic websites [Exp (B)], 2.25; 95% confidence interval [CI], 1.60-3.16; P < 0.001), and websites with higher amount of content [Exp (B)],1.73; 95% CI, 1.24-2.41; P < 0.001) were associated with higher accuracy. There was no association between readability of websites and accuracy [Exp (B)], 1.04; 95% CI, 0.90-1.21; P = 0.57). Online information on robotic cardiac and thoracic surgery websites overestimate patients' understanding and require at least 13 years of education to be comprehended. As website accuracy is not associated with ease of reading, the readability of online resources can be improved without compromising accuracy.

Determining the Cause of Coronary Vasomotor Disorders in Patients With Ischemia and Nonobstructive Coronary Arteries: Design and Rationale of the DISCOVER INOCA Prospective, Multicenter Registry.

Background: Approximately 30% to 50% of patients who are referred for diagnostic coronary angiography are found to have no obstructive coronary artery disease (CAD). Ischemia and nonobstructive coronary arteries (INOCA) is increasingly recognized and encompasses coronary microvascular dysfunction, vasospastic angina, symptomatic myocardial bridging, and other vasomotor disorders. However, the prevalence of these disorders and whether underlying atherosclerotic plaque burden and morphology affect the long-term outcomes of each physiologic phenotype is unknown. Methods: The DISCOVER INOCA registry is ongoing at 8 centers in the United States and plans to enroll 500 patients with ischemic heart disease referred for angiography undergoing coronary function testing (CFT). All participants will complete patient-reported outcome measures and undergo protocol-guided angiography, acetylcholine provocation, coronary thermodilution, and intravascular imaging. Follow-up assessments occur at 30 days, 6 months, 1 year, and annually for 5 years. The primary short-term end point is the prevalence of INOCA phenotypes based on physiology and the degree of atherosclerosis based on intravascular ultrasound or optical coherence tomography (intravascular imaging). The primary long-term end point is the incidence of major adverse cardiovascular events, defined as a composite of cardiovascular death, myocardial infarction, hospitalization for cardiovascular causes, or coronary revascularization at a follow-up of 5 years. At the time of this publication, 100 participants have been enrolled. Conclusions: DISCOVER INOCA is the first prospective study of INOCA patients to integrate anatomic and physiologic measures of disease and correlate them with long-term outcomes. DISCOVER INOCA will report on the prevalence of INOCA phenotypes, the safety of comprehensive invasive CFT, and the impact of testing on diagnoses and medical therapy. Symptoms and cardiovascular adverse events at long-term follow-up will be determined in patients with no obstructive CAD undergoing angiography.

The Left Atrial Appendage and Atrial Fibrillation-A Contemporary Review.

In patients with atrial fibrillation, the left atrial appendage may serve as the site of thrombus formation due to stasis that occurs within the appendage because of its shape and trabeculations. Although thrombus formation can be reduced by using anticoagulants, this may be contraindicated in some patients. The need for a better alternative treatment prompted the study of left atrial appendage occlusion for thromboembolism prophylaxis. Due to this, procedures that excise or occlude the left atrial appendage have gained attention because of their ability to prevent thromboembolic events. This article provides a comprehensive review of the left atrial appendage and its associated procedures' clinical utility.

Encephalitis as a Clinical Manifestation of COVID-19: A Case Series.

COVID-19 is a novel virus which causes a variety of clinical manifestations in the body, some of which are yet to be discovered. The main aim of our study is to highlight the neurological manifestations of COVID-19 as it is still new to the medical world, and to emphasize the fact that the physicians have to be wary of the possibility that patients affected by COVID-19 can present with encephalitis. Only a few studies are available so far regarding the neurological manifestations of this novel virus which highlights the need for this study. We present a case series of 4 patients who were found to have COVID-19 encephalitis. There is still no disease-defining test for diagnosis so the mainstay of diagnosis is exclusion of all the common causes of encephalitis. Brain magnetic resonance imaging and cerebrospinal fluid analysis performs an ancillary in the diagnostic tools. Our study also supports the use of IV tocilizumab (4-8 mg/kg) and IV methylprednisolone (0.5-2 mg/kg) as possible treatment options with good results, as the patients described in our case series responded well to these medications.

Intrapersonal Behavioral Coordination and Expressive Accuracy During First Impressions.

What factors influence how accurately we express our personalities? Here, we investigated the role of targets' nonverbal expressivity or the intrapersonal coordination between head and body movements. To do so, using a novel movement quantification method, we examined whether variability in a person's behavioral coordination was related to how accurately their personality was perceived by naive observers. Targets who exhibited greater variability in intrapersonal behavior coordination, indicating more expressive behavior, were perceived more accurately on high observability personality items, such as how energetic and helpful they are. Moreover, these associations held controlling for other indicators of overall movement, self- and perceiver-rated extroversion, as well as how engaging and likable targets were perceived to be. This provides preliminary evidence that variability in intrapersonal behavioral coordination may be a unique behavioral indicator of expressive accuracy, although further research that replicates these findings and examines the causal associations is needed.

Joint engagement and movement: Active ingredients of a music-based intervention with school-age children with autism.

BACKGROUND: The effectiveness of music-based interventions (MI) in autism has been attested for decades. Yet, there has been little empirical investigation of the active ingredients, or processes involved in music-based interventions that differentiate them from other approaches. OBJECTIVES: Here, we examined whether two processes, joint engagement and movement, which have previously been studied in isolation, contribute as important active ingredients for the efficacy of music-based interventions. METHODS: In two separate analyses, we investigated whether (1) joint engagement with the therapist, measured using a coding scheme verified for reliability, and (2) movement elicited by music-making, measured using a computer-vision technique for quantifying motion, may drive the benefits previously observed in response to MI (but not a controlled non-MI) in children with autism. RESULTS: Compared to a non-music control intervention, children and the therapist in MI spent more time in triadic engagement (between child, therapist, and activity) and produced greater movement, with amplitude of motion closely linked to the type of musical instrument. CONCLUSIONS: Taken together, these findings provide initial evidence of the active ingredients of music-based interventions in autism.

Patient and Physician Perspective on Sperm Banking to Overcome Post-Treatment Infertility in Young Cancer Patients in Pakistan.

BACKGROUND: Cancer survivor rates have increased over the past few decades leading to a growing interest in research related to quality of life (QoL). We attempted to explore the unique barriers that might prevent adult male cancer patients from accessing sperm cryopreservation in Pakistan. METHODS: Semi-structured interviews of male cancer patients aged 18-45 years were audio-recorded in Urdu and translated to English and were transcribed ad verbatim. The topics included information regarding risk of infertility following chemotherapy, future reproductive choices, and barriers to sperm cryopreservation. Questionnaire to physicians containing four content domains of knowledge, attitude, practice, and barriers to sperm banking was also delivered. Data were entered and analyzed on SPSS. RESULTS: Of the 25 patients interviewed, there were 10 cases of leukemia, 3 cases of lymphoma, 2 cases each of colorectal carcinoma and multiple myeloma, 1 case each of neuroblastoma and osteosarcoma, and solitary cases involving the lung, breast, thymus, brain, jaw, and testis. Four patients knew about the risk of infertility. All patients were aware of the option of sperm cryopreservation. Two patients had their sperm preserved before the initiation of chemotherapy. Perceived treatment-related expenses appeared to be the major barrier to sperm cryopreservation in nine patients. This was followed by lack of information, which was cited by eight patients, and religious reasons (n = 2 patients). Other barriers were female gender of the doctor and patient's preferences. Four patients stated no barriers. Nine physicians responded to the questionnaire. Seventy-eight percent of physicians agreed that cancer treatment increases the risk of infertility. 33.3% strongly agreed and 55.6% agreed that infertility can have an adverse impact on QoL. CONCLUSIONS: There is a significant lack of awareness among male cancer patients regarding infertility following cancer treatment. It is imperative that physicians inform them of this and discuss treatment options, along with addressing potential barriers.

Taking it out of context: The role of contextual coherence during social event segmentation.

Social event segmentation, or parsing of the ongoing dynamic content into discrete social events, is thought to represent a mechanism that supports the expert human ability to navigate complex social environments. Here, we examined whether this ability is influenced by the temporal coherence of the context and by different sources of perceptual information. To do so, we created two video clips, one in which several situations unfolded in a contextually consistent manner, and the other in which the order of these situations was scrambled using a random sequence. Participants viewed each clip and were asked to mark social and nonsocial events in counterbalanced blocks of trials. We analyzed key-press behaviour as well as visual and auditory signals within the clips. Results showed that participants agreed on similar social and nonsocial events regardless of context availability, with greater agreement for social relative to nonsocial events. Context, however, modulated the reliance on sources of perceptual information, such that visual and auditory information was used differently when context was unavailable. Together, these data show that contextual coherence does not determine social event segmentation but serves a modulatory role in perceivers' reliance on perceptual sources of information when identifying events in complex social environments.

Knowing when to respond: the role of visual information in conversational turn exchanges.

When engaging in conversation, we efficiently go back and forth with our partner, organizing our contributions in reciprocal turn-taking behavior. Using multiple auditory and visual cues, we make online decisions about when it is the appropriate time to take our turn. In two experiments, we demonstrated, for the first time, that auditory and visual information serve complementary roles when making such turn-taking decisions. We presented clips of single utterances spoken by individuals engaged in conversations in audiovisual, auditory-only or visual-only modalities. These utterances occurred either right before a turn exchange (i.e., 'Turn-Ends') or right before the next sentence spoken by the same talker (i.e., 'Turn-Continuations'). In Experiment 1, participants discriminated between Turn-Ends and Turn-Continuations in order to synchronize a button-press response to the moment the talker would stop speaking. We showed that participants were best at discriminating between Turn-Ends and Turn-Continuations in the audiovisual condition. However, in terms of response synchronization, participants were equally precise at timing their responses to a Turn-End in the audiovisual and auditory-only conditions, showing no advantage of visual information. In Experiment 2, we used a gating paradigm, where increasing segments of Turns-Ends and Turn-Continuations were presented, and participants predicted if a turn exchange would occur at the end of the sentence. We found an audiovisual advantage in detecting an upcoming turn early in the perception of a turn exchange. Together, these results suggest that visual information functions as an early signal indicating an upcoming turn exchange while auditory information is used to precisely time a response to the turn end.

Looking, seeing and believing in autism: Eye movements reveal how subtle cognitive processing differences impact in the social domain.

Adults with High Functioning Autism Spectrum Disorders (ASD) viewed scenes with people in them, while having their eye movements recorded. The task was to indicate, using a button press, whether the pictures were normal, or in some way weird or odd. Oddities in the pictures were categorized as violations of either perceptual or social norms. Compared to a Typically Developed (TD) control group, the ASD participants were equally able to categorize the scenes as odd or normal, but they took longer to respond. The eye movement patterns showed that the ASD group made more fixations and revisits to the target areas in the odd scenes compared with the TD group. Additionally, when the ASD group first fixated the target areas in the scenes, they failed to initially detect the social oddities. These two findings have clear implications for processing difficulties in ASD for the social domain, where it is important to detect social cues on-line, and where there is little opportunity to go back and recheck possible cues in fast dynamic interactions. Autism Res 2016, 9: 879-887. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

The art of gaze guidance.

An ongoing challenge in scene perception is identifying the factors that influence how we explore our visual world. By using multiple versions of paintings as a tool to control for high-level influences, we show that variation in the visual details of a painting causes differences in observers' gaze despite constant task and content. Further, we show that by switching locations of highly salient regions through textural manipulation, a corresponding switch in eye movement patterns is observed. Our results present the finding that salient regions and gaze behavior are not simply correlated; variation in saliency through textural differences causes an observer to direct their viewing accordingly. This work demonstrates the direct contribution of low-level factors in visual exploration by showing that examination of a scene, even for aesthetic purposes, can be easily manipulated by altering the low-level properties and hence, the saliency of the scene.

Movement coordination during conversation.

Behavioral coordination and synchrony contribute to a common biological mechanism that maintains communication, cooperation and bonding within many social species, such as primates and birds. Similarly, human language and social systems may also be attuned to coordination to facilitate communication and the formation of relationships. Gross similarities in movement patterns and convergence in the acoustic properties of speech have already been demonstrated between interacting individuals. In the present studies, we investigated how coordinated movements contribute to observers' perception of affiliation (friends vs. strangers) between two conversing individuals. We used novel computational methods to quantify motor coordination and demonstrated that individuals familiar with each other coordinated their movements more frequently. Observers used coordination to judge affiliation between conversing pairs but only when the perceptual stimuli were restricted to head and face regions. These results suggest that observed movement coordination in humans might contribute to perceptual decisions based on availability of information to perceivers.