Use of apixaban in adults with congenital heart disease and atrial arrhythmias: The PROTECT-AR study.

BACKGROUND: Adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) face an increased risk of thromboembolic events. Limited data exist on the use of non-vitamin K oral anticoagulants for thromboprophylaxis in ACHD. We aimed to assess the effectiveness and safety of apixaban in ACHD patients with AA. METHODS: PROTECT-AR (NCT03854149) was a prospective, multicenter, observational study conducted from 2019 to 2023. ACHD patients with atrial fibrillation, atrial flutter, or intra-atrial re-entrant tachycardia on routine apixaban treatment were included. The historical control group consisted of patients previously on vitamin K antagonist (VKA), who were analyzed prior to their transition to apixaban. The primary effectiveness endpoint was the composite of stroke or thromboembolism. The primary safety endpoint was major bleeding. RESULTS: The study enrolled 218 ACHD patients with AA on apixaban, of which 73 were previous VKA users. The analysis covered 527 patient-years of prospective exposure to apixaban and 169 patient-years of retrospective exposure to VKA. The annualized rate of stroke or thromboembolism was 0.6% in the apixaban group and 1.8% in the VKA group (absolute difference - 1.2%; upper limit of one-sided 95% confidence interval [CI] 0.9%, lower than the predefined non-inferiority margin of +1.8%, Pnon-inferiority < 0.001). The annualized rate of major bleeding was 1.5% in the apixaban group and 2.4% in the VKA group (hazard ratio 0.64; 95% CI 0.19-2.10, P = 0.48). CONCLUSION: In ACHD patients with AA, routine apixaban use exhibited a non-inferior rate of stroke or thromboembolism compared to historical VKA use, alongside a similar rate of major bleeding.

Neuromuscular diseases and their cardiac manifestations under the spectrum of cardiovascular imaging.

Neuromuscular diseases (NMDs) include a broad spectrum of disorders that affect motor unit in every possible site, extending from the cell body of peripheral nerves to the muscle. The different lesion sites make this group of inherited disorders difficult to diagnose. Many NMDs, especially those involving skeletal muscles, can present significant cardiovascular complications, ranging from rhythm disturbances to the development of dilated or hypertrophic cardiomyopathy. Heart disease represents a major cause of morbidity and mortality among NMD patients, underlining the vital need for further familiarization with the pathogenesis and assessment of cardiac involvement. Cardiovascular imaging is the cornerstone for the evaluation of heart disorders in NMDs, with conventional echocardiography still offering a portable, affordable, and easily accessible solution. Meanwhile, newer echocardiographic techniques such as speckle tracking imaging in combination with cardiac magnetic resonance add new insights into further substrate characterization. The purpose of this review is to offer a brief presentation of the main NMDs and their cardiovascular complications, as well as the presentation of data that highlight the importance of cardiovascular imaging in early diagnosis, monitoring, and prognosis of these patients. Lastly, the authors provide a simple guide about which clinical features, imaging findings, and follow-up plan to adopt in each myopathic disorder.

Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis.

BACKGROUND: Blunt head trauma is a common presentation to emergency departments (EDs). Identifying skull fractures in children is important as they are known factor of risk for traumatic brain injury (TBI). Currently, CT is the reference standard for diagnosing skull fractures and TBIs in children. Identifying skull fractures with point-of-care ultrasound (POCUS) may help risk-stratify children for TBI following blunt trauma. The purpose of this study is to evaluate the sensitivity, specificity, positive predictive value and negative predictive value of POCUS in identifying skull fractures in children. METHODS: A systematic search was performed on 17 July 2020 in Ovid Medline, Cochrane Library, Google Scholar, Web of Science and Embase. Prospective studies reporting skull fractures diagnosed with ultrasound in children younger than 18 years due to blunt head injury were included. Studies that did not confirm the fracture with CT were excluded. The quality of studies was evaluated using the QUADAS-2 tool. Data were extracted from the eligible studies to calculate outcomes such as sensitivity and specificity; when possible overall outcomes were calculated. RESULTS: Seven studies were included. All eligible studies included patients for whom the decision to perform a CT scan was made in advance. Overall, the included studies demonstrated low risk of bias or had minor concerns regarding risk of bias. The pooled data (n=925) demonstrated a sensitivity of 91%, specificity of 96%, positive predictive value of 88% and negative predictive value of 97%. CONCLUSION: The included studies demonstrate minor methodological limitations. Overall, the evidence suggests that POCUS is a valid option for diagnosing skull fractures in children visiting the ED after blunt head injury.

A Knowledge-Based Deep Learning Architecture for Aspect-Based Sentiment Analysis.

The task of sentiment analysis tries to predict the affective state of a document by examining its content and metadata through the application of machine learning techniques. Recent advances in the field consider sentiment to be a multi-dimensional quantity that pertains to different interpretations (or aspects), rather than a single one. Based on earlier research, the current work examines the said task in the framework of a larger architecture that crawls documents from various online sources. Subsequently, the collected data are pre-processed, in order to extract useful features that assist the machine learning algorithms in the sentiment analysis task. More specifically, the words that comprise each text are mapped to a neural embedding space and are provided to a hybrid, bi-directional long short-term memory network, coupled with convolutional layers and an attention mechanism that outputs the final textual features. Additionally, a number of document metadata are extracted, including the number of a document's repetitions in the collected corpus (i.e. number of reposts/retweets), the frequency and type of emoji ideograms and the presence of keywords, either extracted automatically or assigned manually, in the form of hashtags. The novelty of the proposed approach lies in the semantic annotation of the retrieved keywords, since an ontology-based knowledge management system is queried, with the purpose of retrieving the classes the aforementioned keywords belong to. Finally, all features are provided to a fully connected, multi-layered, feed-forward artificial neural network that performs the analysis task. The overall architecture is compared, on a manually collected corpus of documents, with two other state-of-the-art approaches, achieving optimal results in identifying negative sentiment, which is of particular interest to certain parties (like for example, companies) that are interested in measuring their online reputation.

Fibrosis in hypertrophic cardiomyopathy: role of novel echo techniques and multi-modality imaging assessment.

Hypertrophic cardiomyopathy (HCM) represents one of the primary cardiomyopathies and may lead to heart failure and sudden cardiac death. Among various histologic features of the disease examined, assessment of myocardial fibrosis may offer valuable information, since it may be considered the common nominator for all HCM connected complications. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) has emerged as the reference noninvasive method for visualizing and quantifying myocardial fibrosis in patients with HCM. T1 mapping, a promising new CMR technique, may provide an advantage over conventional LGE-CMR, by permitting a more valid quantification of diffuse fibrosis. On the other hand, echocardiography offers a significantly more portable, affordable, and easily accessible solution for the study of fibrosis. Various echocardiographic techniques ranging from integrated backscatter and contrast-enhanced ultrasound to two- (2D) or three-dimensional (3D) deformation and shear wave imaging may offer new insights into substrate characterization in HCM. The aim of this review is to describe thoroughly all different modalities that may be used in everyday clinical practice for HCM fibrosis evaluation (with special focus on echocardiographic techniques), to concisely present available evidence and to argue in favor of multi-modality imaging application. It is essential to understand that the role of various imaging modalities is not competitive but complementary, since the information provided by each one is necessary to illuminate the complex pathophysiologic pathways of HCM, offering a personalized approach and treatment in every patient.

Localizing Perturbations in Pressurized Water Reactors Using One-Dimensional Deep Convolutional Neural Networks.

This work outlines an approach for localizing anomalies in nuclear reactor cores during their steady state operation, employing deep, one-dimensional, convolutional neural networks. Anomalies are characterized by the application of perturbation diagnostic techniques, based on the analysis of the so-called "neutron-noise" signals: that is, fluctuations of the neutron flux around the mean value observed in a steady-state power level. The proposed methodology is comprised of three steps: initially, certain reactor core perturbations scenarios are simulated in software, creating the respective perturbation datasets, which are specific to a given reactor geometry; then, the said datasets are used to train deep learning models that learn to identify and locate the given perturbations within the nuclear reactor core; lastly, the models are tested on actual plant measurements. The overall methodology is validated on hexagonal, pre-Konvoi, pressurized water, and VVER-1000 type nuclear reactors. The simulated data are generated by the FEMFFUSION code, which is extended in order to deal with the hexagonal geometry in the time and frequency domains. The examined perturbations are absorbers of variable strength, and the trained models are tested on actual plant data acquired by the in-core detectors of the Temelín VVER-1000 Power Plant in the Czech Republic. The whole approach is realized in the framework of Euratom's CORTEX project.

Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes.

PURPOSES: Calcaneal fractures are known to influence patients' quality of life negatively. The type of calcaneal fracture might have a relation with the patient outcome. To inform patients in an early stage on how their calcaneal fracture may affect their lives, knowledge of the fracture characteristics is necessary. This study evaluates the association of type of calcaneal fracture, measurement of conventional radiograph angles, and the Sanders classification with patient-reported outcomes. MATERIAL AND METHODS: This is a retrospective study based on a prospective trauma database including all patients aged 16 years or older with a calcaneal fracture admitted in one of the participating trauma level I or II hospitals. Patients, trauma, and fracture characteristics were collected. The conventional radiographs were evaluated in which type of fracture, and Böhler's, Gissane's, and calcaneal compression angles were determined. Also, the CT images were classified according to Sanders. In addition, displaced intra-articular calcaneal fractures were separately analyzed. A questionnaire was sent to the included patients that consisted of the EQ-6D, patient-specific characteristics, satisfaction with foot appearance and wearable shoe range, complications, and capability to work. RESULTS: A total of 396 patients with 442 calcaneal fractures were eligible for follow-up. Two hundred fifteen patients with 246 calcaneal fractures participated. Patients with a calcaneal fracture into the talar surface reported a worse quality of life (p = 0.010), were less satisfied with their feet (p < 0.001), and had more complications (p = 0.001-0.006); extra-articular fractures had significantly opposite result. A negative Böhler's or calcaneal compression angle was related with unfavourable outcomes. Sanders classification was not related with any patient-reported outcome. CONCLUSION: Our study implies that patients with an intra-articular calcaneal fracture into the talar surface have a lower health-related quality of life, will be less satisfied with the outcome of their feet, and have more complications compared to patients with other type of calcaneal fractures. Furthermore, the Sanders classification was not associated with the patient-reported outcomes.

Functional outcomes and quality of life in patients with subtalar arthrodesis for posttraumatic arthritis.

INTRODUCTION: Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis, a condition frequently seen in patients who suffered major trauma. Functional outcomes in trauma patients may be influenced by concomitant injuries and the severity of the initial trauma. The aim of this study was to evaluate quality of life and functional outcomes of subtalar arthrodesis for posttraumatic arthritis in patients with severe or complex foot injuries. MATERIALS AND METHODS: This is a retrospective single center study with prospective follow-up. Patients who underwent subtalar arthrodesis for posttraumatic arthritis between 2000 and 2016 were included and invited to complete a Maryland Foot Score (MFS), a EuroQol five-dimensional (EQ-5D™) and Visual Analog Scale (EQ-VAS™) questionnaire, and four additional questions. RESULTS: Forty patients were included in the study, functional outcome scores were available for 30 patients (response rate 75%). Additional surgery of the fused foot was performed in 29 patients and 15 suffered multiple lower extremity injuries. Six patients were polytraumatized. Ninety percent of all patients would recommend the procedure to others, walking abilities improved in 69% and less pain was experienced in 76%. Median MFS score was 61 (IQR 53-72). Quality of life was significantly lower when compared to a reference population (p<0.001). CONCLUSION: Satisfaction was high, as 90% of all patients would recommend subtalar fusion to others, even though the relatively poor outcome measures would suggest differently. Existing functional outcomes measures were influenced by concomitant injuries and additional procedures. This demands development of instruments suitable for severely injured patients with multiple or complex injuries.