Anatomy of the Ventricular Outflow Tracts: An Electrophysiology Perspective.

Outflow tract ventricular arrhythmias are the most common type of idiopathic ventricular arrhythmia. A systematic understanding of the outflow tract anatomy improves procedural efficacy and enables electrophysiologists to anticipate and prevent complications. This review emphasizes the three-dimensional spatial relationships between the ventricular outflow tracts using seven anatomical principles. In turn, each principle is elaborated on from a clinical perspective relevant for the practicing electrophysiologist. The developmental anatomy of the outflow tracts is also discussed and reinforced with a clinical case.

A Bibliometric Analysis of Most Cited Papers on Vesiculobullous Oral Lesions.

Aim: A well-known method for quantitatively evaluating scholarly work is bibliometric analysis. Best-cited papers raise awareness of the influential publications and patterns in the literature on a specific subject. The aim was to conduct bibliometric analysis to determine most cited articles on vesiculobullous oral lesions. This is the first study on citation analysis with respect to vesiculobullous oral lesions. Materials and Methods: A retrospective data search was explored on December 2022 using the Scopus database. The articles were evaluated, and fundamental data for bibliometric analysis was reviewed. Standard details about the author, linked organizations, publishing year, and place of origin were noted. Statistical analysis was performed using Chi-square analysis. VOSviewer software was used to determine the bibliometric network analysis for co-occurrence among coauthors and commonly used keywords. Results: A total of 344 articles published from 1971 to 2022 were included in the study. A total of 6680 citations and 19.41 citations per article were observed. The journal Archives of Dermatology received the most citation. There was a significant association between the number of citations and the journal type (open access vs. non-open access) (P < 0.05). Four to five highly related clusters with the help of VOSviewer software were found during co-occurrence network analysis. Conclusions: The top 10 articles on vesiculobullous oral lesions that received the most citations were listed in detail in the present study. This will be a valuable resource for academics, clinicians, and researchers in the fields of dermatology, general pathology, oral pathology, and oral medicine.

Atrial Fibrillation Substrate and Catheter Ablation Outcomes in MYBPC3- and MYH7-Mediated Hypertrophic Cardiomyopathy.

BACKGROUND: The effects of disease-causing MYBPC3 or MYH7 genetic variants on atrial myopathy, atrial fibrillation (AF) clinical course, and catheter ablation efficacy remain unclear. OBJECTIVES: The aim of this study was to characterize the atrial substrate of patients with MYBPC3- or MYH7-mediated hypertrophic cardiomyopathy (HCM) and its impact on catheter ablation outcomes. METHODS: A retrospective single-center study of patients with HCM who underwent genetic testing and catheter ablation for AF was performed. Patients with MYBPC3- or MYH7-mediated HCM formed the gene-positive cohort; those without disease-causative genetic variants formed the control cohort. High-density electroanatomical mapping was performed using a 3-dimensional mapping system, followed by radiofrequency ablation. RESULTS: Twelve patients were included in the gene-positive cohort (mean age 55.6 ± 9.9 years, 83% men, 50% MYBPC3, 50% MYH7, mean ejection fraction 59.3% ± 13.7%, mean left atrial [LA] volume index 51.7 ± 13.1 mL/m2, mean LA pressure 20.2 ± 5.4 mm Hg) and 15 patients in the control arm (mean age 61.5 ± 12.6 years, 60% men, mean ejection fraction 64.9% ± 5.1%, mean LA volume index 54.1 ± 12.8 mL/m2, mean LA pressure 19.6 ± 5.41 mm Hg). Electroanatomical mapping demonstrated normal voltage in 87.7% ± 5.03% of the LA in the gene-positive cohort and 94.3% ± 3.58% of the LA in the control cohort (P < 0.001). Of the abnormal regions, intermediate scar (0.1-0.5 mV) accounted for 6.33% ± 1.97% in the gene-positive cohort and 3.07% ± 2.46% in the control cohort (P < 0.01). Dense scar (<0.1 mV) accounted for 5.93% ± 3.20% in the gene-positive cohort and 2.61% ± 2.19% in the control cohort (P < 0.01). Freedom from AF at 12 months was similar between the gene-positive (75%) and control (73%) cohorts (P = 0.92), though a greater number of procedures were required in the gene-positive cohort. CONCLUSIONS: Patients with MYBPC3- or MYH7-mediated HCM undergoing AF ablation have appreciably more low-amplitude LA signals, suggestive of fibrosis. However, catheter ablation remains an effective rhythm-control strategy.

Artificial intelligence-enhanced electrocardiogram for arrhythmogenic right ventricular cardiomyopathy detection.

Aims: ECG abnormalities are often the first signs of arrhythmogenic right ventricular cardiomyopathy (ARVC) and we hypothesized that an artificial intelligence (AI)-enhanced ECG could help identify patients with ARVC and serve as a valuable disease-detection tool. Methods and results: We created a convolutional neural network to detect ARVC using a 12-lead ECG. All patients with ARVC who met the 2010 task force criteria and had disease-causative genetic variants were included. All case ECGs were randomly assigned in an 8:1:1 ratio into training, validation, and testing groups. The case ECGs were age- and sex-matched with control ECGs at our institution in a 1:100 ratio. Seventy-seven patients (51% male; mean age 47.2 ± 19.9), including 56 patients with PKP2, 7 with DSG2, 6 with DSC2, 6 with DSP, and 2 with JUP were included. The model was trained using 61 case ECGs and 5009 control ECGs; validated with 7 case ECGs and 678 control ECGs and tested in 22 case ECGs and 1256 control ECGs. The sensitivity, specificity, positive and negative predictive values of the model were 77.3, 62.9, 3.32, and 99.4%, respectively. The area under the curve for rhythm ECG and median beat ECG was 0.75 and 0.76, respectively. Conclusion: Our study found that the model performed well in excluding ARVC and supports the concept that the AI ECG can serve as a biomarker for ARVC if a larger cohort were available for network training. A multicentre study including patients with ARVC from other centres would be the next step in refining, testing, and validating this algorithm.

Publication Trends and Collaborative Patterns in Periodontics Research from Saudi Arabia: A Bibliometric Analysis.

Aim: To perform a comprehensive bibliometric analysis encompassing all articles published on periodontics from Saudi Arabia. Materials and Methods: Using the Scopus database on June 8, 2023, the search term "Periodontic*" was entered in the primary search bar to extract all documents published on periodontics. Following, the year filter was applied to include articles published from the earliest available date until the date of data collection, excluding 2023. Next, we used the country/region filter to limit our documents to Saudi Arabia (n = 1929). We used Microsoft Excel (v.16) to examine periodical growth, collaboration patterns, influential institutions, frequently used sources, international research collaboration, and most-cited papers. Results: Saudi Arabia ranked 11th in periodontics research, contributing 3.43% to the global research output, reaching a peak of 7.63% in 2022. Notably, there was significant growth observed during the last 5 years of the study, with an average of 232.8 documents per year. The analysis of citations revealed that the selected documents received an average of 13.39 citations per document. Indigenous literature received less citation on average compared to internationally collaborated documents. King Saud University ranked first among the most productive institutions in Saudi Arabia, accounting 40.74% of the total output. The Journal of Contemporary Dental Practice published the highest number of documents, followed by the Saudi Dental Journal and the Journal of Periodontology. In terms of citation impact, the Journal of Periodontology emerged as the most influential, with an average of 32.83 citations per document. Research collaboration was most prevalent with researchers from the United States (22.03%), although Germany ranked first in terms of citation impact. Conclusion: Saudi Arabia's contribution to periodontics research has shown significant growth in recent years. The collaborative efforts with international researchers, particularly those from the United States, have played a crucial role in fostering advancements within the field.

Research Performance of Saudi Arabia in Endodontics: A Bibliometric Analysis.

Endodontics is a subdivision of dentistry that deals with diseases and injury of the soft tissues inside the teeth. The current study aimed to investigate the bibliometric properties of endodontics publications contributed by Saudi Arabia from 2010 to 2022. The quantitative bibliometric research method was applied to the meta-data retrieved from the Web of Science on December 7, 2022. The word Endodonti* was written in the main search bar, and from the year's filter, selected starting year 2010 to the date of data collection. In the first phase, to access the global publication growth of endodontics, no country/region filter was used. After getting the summary of the global intellectual landscape, we selected Saudi Arabia from the country/region filter to analyze certain characteristics of endodontics documents. Periodical growth, accessibility modes, collaboration patterns, influential institutions, frequently used sources, international research collaboration, and most-cited documents were analyzed by using Microsoft Excel (v.16) and SPSS (v.20). The authors affiliated with Brazil contributed the highest number of documents and Saudi Arabia stood in the eighth rank in endodontics research. The growing tendency was observed in Saudi Arabia from 1.29% in 2010 to 7.60% in 2022 from a global perspective. The quality of nonopen-accessed documents was higher than open-accessed as per citation impact, similarly, the documents written on international collaboration got a higher ratio of citations compared with national collaboration. King Saud University was found the most prolific institution and the Journal of Endodontics was the most preferred source of publications. The maximum research collaboration at the international level was performed with the authors of the United States. Fifteen most-cited papers obtained 21.42% of the citations. The findings show that endodontics research in Saudi Arabia has increased significantly over the years. The research collaboration at the national level has increased, which shows that teams of national researchers in endodontics have been prepared and conducting valuable research in a national context.

Artificial Intelligence in Cardiovascular Medicine: Current Insights and Future Prospects.

Cardiovascular disease (CVD) represents a significant and increasing burden on healthcare systems. Artificial intelligence (AI) is a rapidly evolving transdisciplinary field employing machine learning (ML) techniques, which aim to simulate human intuition to offer cost-effective and scalable solutions to better manage CVD. ML algorithms are increasingly being developed and applied in various facets of cardiovascular medicine, including and not limited to heart failure, electrophysiology, valvular heart disease and coronary artery disease. Within heart failure, AI algorithms can augment diagnostic capabilities and clinical decision-making through automated cardiac measurements. Occult cardiac disease is increasingly being identified using ML from diagnostic data. Improved diagnostic and prognostic capabilities using ML algorithms are enhancing clinical care of patients with valvular heart disease and coronary artery disease. The growth of AI techniques is not without inherent challenges, most important of which is the need for greater external validation through multicenter, prospective clinical trials.

Safety and efficacy outcomes of atrial fibrillation ablation in patients with rheumatoid arthritis.

Background: Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease associated with atrial fibrillation (AF) and stroke. Objective: The purpose of this study was to evaluate the safety and efficacy of AF ablation in patients with RA. Methods: All patients with RA undergoing AF ablation at our institution from 2010 to 2021 were propensity matched to patients without RA using 9 baseline characteristics. The primary outcome was procedural efficacy defined by clinical AF recurrence, the need for antiarrhythmic drugs (AADs), and repeat catheter ablation. Secondary outcome was safety. Results: A total of 45 patients with RA (age 66.3 ± 7.7 years) were matched to 45 patients without a history of RA (age 68.0 ± 7.3 years). Both groups had similar procedural and periprocedural characteristics. Before ablation, RA patients had statistically higher C-reactive protein (CRP) levels (P ≤.01) and erythrocyte sedimentation rates (ESRs) (P <.05) compared to non-RA patients. After ablation, RA patients had statistically significant higher rates of AF recurrence (P = .006), were more likely to be taking AADs (P <.05), and more likely to undergo repeat ablations (P <.05). The use of immunosuppression or corticosteroids at the time of ablation did not influence the primary endpoint of AF recurrence, AADs, or repeat ablation. Multivariate regression analysis showed CRP and ESR were independent predictors of AF recurrence. CRP was an independent predictor of repeat ablation. Conclusion: Patients with RA are at higher risk of clinical AF recurrence, and are more likely to be taking AADs and require repeat ablation. Preablation CRP and ESR are independent predictors of AF recurrence, and CRP is an independent predictor of repeat catheter ablation.

Mediastinal radiation therapy for breast cancer in female patients is an independent risk factor for atrial fibrillation recurrence post-catheter ablation.

BACKGROUND: The aim of this study was to assess the safety, efficacy, and predictors of outcomes for atrial fibrillation (AF) ablation in patients with a history of breast cancer. METHODS: Consecutive patients with a history of breast cancer undergoing AF ablation from January 2010 to December 2021 were propensity matched in a 1:1 ratio to patients without a history of any cancer. The primary outcome was procedural efficacy, defined by clinical AF recurrence and repeat catheter ablation. The secondary outcome was an assessment of safety looking at eight peri-procedural events. RESULTS: Our cohort was comprised of 82 female patients, 41 patients with a history of breast cancer (mean age, 74.6 ± 7.4 years), and 41 patients with no history of cancer (76.7 ± 8.1 years). Both groups had similar echocardiographic, baseline, and arrhythmia characteristics. Breast cancer patients were at an increased risk of AF recurrence post-ablation compared to non-cancer patients (OR 2.68, 95% CI 1.05-6.86, p = 0.04). Multivariate analysis found prior mediastinal radiotherapy (OR 4.79, 95% CI 1.34-17.1) and AF diagnosis to ablation time (OR 1.2, 95% CI 1.03-1.29) were both independent predictors of AF recurrence post-ablation. CONCLUSION: Our study suggests that female patients with a history of breast cancer are at a higher risk of developing AF recurrence after catheter ablation. Multivariate analysis showed that patients with a history of prior mediastinal radiation therapy and AF diagnosis to time to ablation were both independent risk factors.

Detection of four novel polymorphisms in PrP gene of Pakistani sheep (Damani and Hashtnagri) and goats (Kamori and Local Hairy) breeds.

Scrapie is a fatal neurodegenerative disorder of sheep and goats caused by post-translational conformational change in the host-encoded prion protein (PrPC). Susceptibility or resistance to scrapie has been associated with the presence of polymorphisms in the prion protein (PrP) gene. In the present study, we analyzed the PrP gene sequence to determine the frequency of polymorphisms in 56 sheep (28 each from Damani and Hashtnagri breeds) and 56 goats (28 each from Kamori and Local Hairy breeds). A total of 7 amino acid polymorphisms were detected in the PrP gene for sheep and 4 for goats. These amino acid polymorphisms were combined in 13 alleles and 15 genotypes in sheep and 5 alleles and 6 genotypes in goats. The overall frequency of the most sheep scrapie-resistant polymorphism (Q171R) was calculated to be 0.107. The most scrapie-susceptible polymorphism (A136V) was not detected in any of the studied sheep. The overall frequency of scrapie-associated polymorphism (H143R) in goats was found to be 0.152. Along with already known amino acid polymorphisms, two novel polymorphisms were also detected for each of sheep (Q171N and T191I) and goats (G22C and P63L). However, the overall frequency of these polymorphisms was extremely low.

Pre-course cognitive training using a smartphone application in orthopaedic intern surgical skills "boot camps".

BACKGROUND: We evaluated a cognitive task analysis-based application, Touch Surgery. METHODS: Orthopaedic surgery interns completed a simulated ankle open reduction and internal fixation and a lag screw fixation before starting the boot camp. Surveys were administered before the simulation and after the boot camp. RESULTS: Fourteen of 19 interns completed the study. Ten interns thought the application improved their baseline understanding. Nine thought the application accelerated the learning process. Eight thought the application made the procedures easier to learn. CONCLUSIONS: Touch Surgery enhanced the surgical skills curriculum, was well-received, and has the potential to supplement training of interns.