Detection and Mosaicing Techniques for Low-Quality Retinal Videos.

Ideally, to carry out screening for eye diseases, it is expected to use specialized medical equipment to capture retinal fundus images. However, since this kind of equipment is generally expensive and has low portability, and with the development of technology and the emergence of smartphones, new portable and cheaper screening options have emerged, one of them being the D-Eye device. When compared to specialized equipment, this equipment and other similar devices associated with a smartphone present lower quality and less field-of-view in the retinal video captured, yet with sufficient quality to perform a medical pre-screening. Individuals can be referred for specialized screening to obtain a medical diagnosis if necessary. Two methods were proposed to extract the relevant regions from these lower-quality videos (the retinal zone). The first one is based on classical image processing approaches such as thresholds and Hough Circle transform. The other performs the extraction of the retinal location by applying a neural network, which is one of the methods reported in the literature with good performance for object detection, the YOLO v4, which was demonstrated to be the preferred method to apply. A mosaicing technique was implemented from the relevant retina regions to obtain a more informative single image with a higher field of view. It was divided into two stages: the GLAMpoints neural network was applied to extract relevant points in the first stage. Some homography transformations are carried out to have in the same referential the overlap of common regions of the images. In the second stage, a smoothing process was performed in the transition between images.

Evaluation of Prognostic Factors of Severity in Acute Biliary Pancreatitis.

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas that, when classified as severe, is associated with high morbidity and mortality. Promptly identifying the severity of AP is of extreme importance for improving clinical outcomes. The aim of this study was to compare the prognostic value of serological biomarkers, ratios, and multifactorial scores in patients with acute biliary pancreatitis and to identify the best predictors. In this observational and prospective study, the biomarkers, ratios and multifactorial scores were evaluated on admission and at 48 h of the symptom onset. On admission, regarding the AP severity, the white blood count (WBC) and neutrophil-lymphocyte ratio (NLR), and regarding the mortality, the WBC and the modified Marshall score (MMS) showed the best predictive values. At 48 h, regarding the AP severity, the hepcidin, NLR, systemic inflammatory response index (SIRI) and MMS and regarding the mortality, the NLR, hepcidin and the bedside index for severity in AP (BISAP) score, showed the best predictive values. The present study enabled the identification, for the first time, of SIRI as a new prognostic tool for AP severity, and validated hepcidin and the NLR as better prognostic markers than C-reactive protein (CRP) at 48 h of symptom onset.

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice.

Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP. This review provides an overview of the available multifactorial scoring systems and biochemical markers for predicting severe AP with a special focus on their advantages and limitations.

Murine Models of Acute Pancreatitis: A Critical Appraisal of Clinical Relevance.

Acute pancreatitis (AP) is a severe disease associated with high morbidity and mortality. Clinical studies can provide some data concerning the etiology, pathophysiology, and outcomes of this disease. However, the study of early events and new targeted therapies cannot be performed on humans due to ethical reasons. Experimental murine models can be used in the understanding of the pancreatic inflammation, because they are able to closely mimic the main features of human AP, namely their histologic glandular changes and distant organ failure. These models continue to be important research tools for the reproduction of the etiological, environmental, and genetic factors associated with the pathogenesis of this inflammatory pathology and the exploration of novel therapeutic options. This review provides an overview of several murine models of AP. Furthermore, special focus is made on the most frequently carried out models, the protocols used, and their advantages and limitations. Finally, examples are provided of the use of these models to improve knowledge of the mechanisms involved in the pathogenesis, identify new biomarkers of severity, and develop new targeted therapies.

Pollination networks from natural and anthropogenic-novel communities show high structural similarity.

The Anthropocene is marked by an unprecedented homogenisation of the world's biota, confronting species that never co-occurred during their evolutionary histories. Interactions established in these novel communities may affect ecosystem functioning; however, most research has focused on the impacts of a minority of aggressive invasive species, while changes inflicted by a less conspicuous majority of non-invasive alien species on community structure are still poorly understood. This information is critical to guide conservation strategies, and instrumental to advance ecological theory, particularly to understand how non-native species integrate in recipient communities and affect the interactions of native species. We evaluated how the structure of 50 published pollination networks changes with the proportion of alien plant species and found that network structure is largely unaffected. Although some communities were heavily invaded, the proportion of alien plant species was relatively low (mean = 10%; max. = 38%). We further characterized the pollination network in a botanic garden with a plant community dominated by non-invasive alien species (85%). We show that the structure of this novel community is also not markedly different from native-dominated communities. Plant-pollinator interactions revealed no obvious differences regarding plant origin (native vs. alien) or the native bioregion of the introduced plants. This overall similarity between native and alien plants is likely driven by the contrasting patterns of invasive plants (promoting generalism), and non-invasive aliens, suggested here to promote specialization.

O armário: Fruiting phenology data for 4,462 plant taxa in Portugal (1926-2013).

Species phenology - the timing of key life events - is being altered by ongoing climate changes with yet underappreciated consequences for ecosystem stability. While flowering is generally occurring earlier, we know much less about other key processes such as the time of fruit ripening, largely due to the lack of comprehensive long-term datasets. Here we provide information on the exact date and site where seeds of 4,462 taxa were collected for the Index Seminum (seed exchange catalogue) of the Botanic Garden of the University of Coimbra, between 1926 and 2013. Seeds were collected from spontaneous and cultivated individuals across Portugal, including both native and introduced taxa. The database consists of 127,747 curated records with information on the species, or infraspecific taxa (including authority), and the day and site where seeds were collected. All records are georeferenced and provided with a confidence interval for the collection site. Taxonomy was first curated manually by in-house botanists and then harmonized according to the GBIF backbone taxonomy.

How do hospital characteristics and ties relate to the uptake of second-generation biosimilars? A longitudinal analysis of Portuguese NHS hospitals, 2015-2021.

BACKGROUND: There is limited evidence on within-country discrepancies in biosimilar uptake. This study analyzes differences in timing and diffusion of biosimilar uptake across Portuguese NHS hospitals and explores possible determinants. RESEARCH DESIGN AND METHODS: We analyzed publicly accessible consumption data of originator biologic and biosimilar drugs for adalimumab, etanercept, infliximab, rituximab, and trastuzumab, by hospital and month for the years 2015-2021 (N = 9,467). We modeled the time to biosimilar adoption using survival regression models and the share of biosimilar consumption using generalized estimated equations with random hospital effects. RESULTS: Academic hospitals were characterized by a quicker uptake of adalimumab and infliximab biosimilars but lower shares for other drugs. A higher total consumption of biologics was related to a lower share of biosimilar uptake. A stronger participation in randomized controlled trials was linked to higher biosimilar shares and quicker uptake, except for rituximab. If all NHS hospitals had biosimilar shares equal to the highest ones, potential annual savings could reach 13.9 million euros. CONCLUSION: The findings suggest a need for capacity-building on biosimilar prescribing, including for doctors of academic hospitals and those working in settings where high biosimilar use would be expected.

Algorithms for automated diagnosis of cardiovascular diseases based on ECG data: A comprehensive systematic review.

The prevalence of cardiovascular diseases is increasing around the world. However, the technology is evolving and can be monitored with low-cost sensors anywhere at any time. This subject is being researched, and different methods can automatically identify these diseases, helping patients and healthcare professionals with the treatments. This paper presents a systematic review of disease identification, classification, and recognition with ECG sensors. The review was focused on studies published between 2017 and 2022 in different scientific databases, including PubMed Central, Springer, Elsevier, Multidisciplinary Digital Publishing Institute (MDPI), IEEE Xplore, and Frontiers. It results in the quantitative and qualitative analysis of 103 scientific papers. The study demonstrated that different datasets are available online with data related to various diseases. Several ML/DP-based models were identified in the research, where Convolutional Neural Network and Support Vector Machine were the most applied algorithms. This review can allow us to identify the techniques that can be used in a system that promotes the patient's autonomy.

Extraction of notable points from ECG data: A description of a dataset related to 30-s seated and 30-s stand up.

It is increasingly possible to acquire Electrocardiographic data with featured low-cost devices. The proposed dataset will help map different signals for various diseases related to Electrocardiography data. The dataset presented in this paper is related to the acquisition of electrocardiography data during the standing up and seated positions. The data was collected from 219 individuals (112 men, 106 women, and one other) in different environments, but they are in the Covilhã municipality. The dataset includes the 219 recordings and corresponds to the sensors' recordings of a 30 s sitting and a 30 s standing test, which checks to approximately 1 min for each one. This dataset includes 3.7 h (approximately) of recordings for further analysis with data processing techniques and machine learning methods. It will be helpful for the complementary creation of a robust method for identifying the characteristics of individuals related to Electrocardiography signals.

Corrigendum to "Extraction of notable points from ECG data: A description of a dataset related to 30-s seated and 30-s stand up" [Data in Brief, volume 46 (2023) 108874].

[This corrects the article DOI: 10.1016/j.dib.2022.108874.].

Experimental and Numerical Simulation of a Radiant Floor System: The Impact of Different Screed Mortars and Floor Finishings.

The radiant floor system market is growing rapidly because Europe is moving toward a low-carbon economy and increased awareness about environmental sustainability and energy efficiency, stimulated by the ambitious EU Energy Efficient Directive and nZEB challenge. The high growth rate of the market share is due to the involvement of homeowners in the specifications of their living commodities, so they are thus willing to invest more at the initial stage to obtain long-term benefits and lower energy exploration costs. We performed an experimental campaign over three slabs with a hydronic radiant floor system of equal dimensions, shape, and pipe pitch with different screed mortar formulations to assess their performance throughout a heating/cooling cycle. The temperature at different heights within the interior of the screed mortars and at the surface were monitored. The results revealed that an improved screed mortar has a relevant impact on the efficiency of the system. Moreover, a three-dimensional transient heat transfer model was validated using the experimental data. The model was used to evaluate the impact of different finishing materials, namely wood, cork, ceramic, and linoleum, on the floor surface temperatures. The results showed differences of 15% in the surface temperature when using different floor finishing solutions.

[Bouveret's Syndrome: A Case Report and a Brief Literature Review]. / Síndrome de Bouveret: Apresentação de Um Caso Clínico e Breve Revisão da Literatura.

Bouveret's syndrome is a rare cause of gastric outlet obstruction. We report a case of a 68-year-old woman admitted with upper digestive obstruction. A few months later, and after several diagnostic tests and clinical surveillance, a cholecystoduodenal fistula was suspected. During exploratory laparotomy, the diagnosis of Bouveret's syndrome was confirmed and a pyelolithotomy, pyloroplasty and a cholecystectomy were performed. The patient was asymptomatic 7 months after the operation. This syndrome represents only 1% - 3% of all cases of gallstone ileus, being more frequent in women and in the elderly. The presentation is quite nonspecific, but in most cases the symptomatology suggests an upper digestive occlusion. Treatment can be achieved by lithotripsy, but most patients require a surgical approach.

Apesar de rara, a síndrome de Bouveret é uma das causas descritas de obstrução ao esvaziamento gástrico. Apresentamos o caso clínico de uma doente do género feminino com 68 anos, admitida por quadro sugestivo de 'obstrução digestiva alta'. Após avaliação clínica e realização de estudo complementar, viria a ser colocada, alguns meses mais tarde, a suspeita de fístula colecistoduodenal. A doente foi submetida a laparotomia exploradora, que confirmou o diagnóstico de síndrome de Bouveret, com realização de pilorolitotomia, piloroplastia e colecistectomia. Aos sete meses, encontrava-se assintomática. Esta síndrome representa apenas 1% - 3% de todos os íleos biliares, sendo mais frequente em mulheres e indivíduos mais idosos. A forma de apresentação é bastante inespecífica, mas na maioria dos casos a sintomatologia sugere um quadro de oclusão digestiva alta. O tratamento pode ser realizado através de litotrícia, mas na grande maioria dos doentes é necessária uma abordagem cirúrgica do problema.

Low frequency of MAP kinase pathway alterations in KIT and PDGFRA wild-type GISTs.

AIMS: Gastrointestinal stromal tumours (GISTs) are commonly driven by oncogenic mutations in KIT and PDGFRA. However, 10-40% of these patients are wild-type for these genes. The prognostic significance of wild-type GISTs is controversial, and they rarely respond to imatinib. The aim of this study was to elucidate the molecular lesions underlying wild-type GISTs tumorigenesis. METHODS AND RESULTS: Twenty-nine KIT and PDGFRA wild-type GISTs were re-assessed for the presence of 'cryptic'KIT exon 11 duplications. Using a specific polymerase chain reaction assay, three previously undetected mutations were identified. In the remaining 26 wild-type GISTs, KIT, stem cell factor (SCF), phospho-KIT and phospho-ERK expression was evaluated by immunohistochemistry. Samples were screened for gain-of-function mutations in the mitogen-activated protein kinase (MAPK) cascade. KIT and SCF co-expression associated with KIT activation was observed in approximately 30% of cases. Furthermore, phospho-ERK expression showed that MAPK is activated in approximately 30% of cases. None of RAS family (H-, K- and N-RAS) oncogenes exhibited activating mutations, whereas BRAF mutations were found in approximately 4% of cases. CONCLUSIONS: In the absence of RAS mutations, MAPK could be activated through SCF/KIT autocrine/paracrine mechanisms and/or mutated BRAF in a subset of KIT/PDGFRA wild-type GISTs.

Influence of Cooling Methods on the Residual Mechanical Behavior of Fire-Exposed Concrete: An Experimental Study.

This work reports the main conclusions of a study on the mechanical behavior of concrete under ISO 834 fire with different cooling methods. The aim of this research was to provide reliable data for the analysis of structures damaged by fire. The experimental program used cylindrical concrete test specimens subjected to ISO 834 heating in a furnace up to maximum gas temperatures of 400, 500, 600, 700, and 800 °C. The compressive strength was measured in three situations: (a) at the different temperature levels reached in the furnace; (b) after a natural cooling process; and (c) after aspersion with water at ambient temperature. The results indicate that the concrete residual compressive strength is fairly dependent on the maximum temperature reached in the furnace and revealed that concrete of a lower strength preserved relatively higher levels of strength. The cooling method significantly influenced the strength, albeit at a lower intensity. In all cases, the residual strength remained in the range of 38% to 67% of the strength at ambient temperature. The statistical analysis showed that the data obtained by the experimental program are significant and confirmed the influence of the conditions imposed on the residual strength.

Improved Morphine-Loaded Hydrogels for Wound-Related Pain Relief.

The use of morphine applied topically to painful wounds has potential advantages, such as dose reduction, fewer side effects and compound formulations, have been proposed for this purpose. Given the potential high impact of drug product quality on a patient's health, the aim of the present study was to develop two stable sterile hydrogels containing morphine hydrochloride, intended for topical application on painful wounds. Two carboxymethylcellulose sodium-based hydrogels were prepared containing 0.125% w/w (F1-MH semi-solid formulation) and 1.0% w/w (F2-MH fluid formulation) morphine hydrochloride (MH), respectively. Studies included a risk assessment approach for definition of the quality target product profile (QTPP) and assessment of critical quality attributes (CQA) of the hydrogels to support product quality and safety. Safe, odourless, yellowish, translucent and homogeneous gels were obtained, with suitable microbiological and pharmaceutical characteristics. The active substance concentration was adapted according to the characteristics of the dose-metering device. Release profiles were investigated using Franz diffusion cells, and characterised by different kinetic models. Increasing gel viscosity prolonged drug release, with rates of 17.9 ± 2.2 µg·cm-2·h-1 (F1-MH) and 258.0 ± 30.4 µg·cm-2·h-1 (F2-MH), allowing for the reduction of the number of applications and improving patient compliance. The gels proved to be stable for up to 60 days at room temperature. The semi-solid and fluid MH-containing hydrogel formulations are safe, stable and suitable for use in hospital settings, which is rather important for wound-related pain management in cancer palliative care or burn patients.

Betamethasone dipropionate compounding for cutaneous T-cell lymphoma management.

BACKGROUND: Primary cutaneous lymphomas (extranodular non-Hodgkin lymphomas) are rare (incidence 1:100 000). Mycosis fungoides is the most common cutaneous T-cell lymphoma (CTCL) subtype. Treatment options are based on the diagnosis and the stage of the disease. Skin-directed therapies are useful for the initial stages and include topical treatments such as corticosteroids. Betamethasone dipropionate (BD) is a synthetic glucocorticoid with high anti-inflammatory activity, potency and immunosuppressant effects. It is used for topical treatment of CTCL within the following dosage 0.025-0.1% (w/w). In the Portuguese market only one topical cream contains BD at 0.05% (w/w). OBJECTIVES: To develop a new and stable emulsion containing 0.1% of BD. METHODS: To accomplish this aim, development, stability, in vitro release and clinical studies of a new topical water-in-oil emulsion containing BD 0.1% w/w were assessed for the topical treatment of CTCL. RESULTS: The three batches prepared were physically, chemically and microbiologically stable over a period of 90 days. 40% of BD was released over 6 hours and evaluation of skin lesions showed a favourable clinical effect (less itching, less infiltration, fewer patches and a reduced area of plaque). CONCLUSIONS: The clinical results show the effective cutaneous improvement of skin barrier conditions during the study.

[Breast Cancer: Value-Based Healthcare, Costs and Financing]. / Cancro de Mama: Valor em Saúde, Custos e Financiamento.

INTRODUCTION: Breast cancer is the second most common oncological disease worldwide. To analyse the new disease specific funding programme (breast cancer) implemented at the Francisco Gentil Portuguese Institute of Oncology, Lisbon Center (Instituto Português de Oncologia de Lisboa Francisco Gentil), the actual costs of the patients were examined using activity-based costing as a costing methodology. This study addresses the following question: "How much does it cost to treat breast cancer per 'patient-month' compared to the monthly fixed 'funding envelope'?". MATERIALS AND METHODS: The study cohort consisted of 807 patients, corresponding to all the patients eligible for the new disease specific funding programme and who were enrolled during the first year of implementation. Activity-based costing was used to calculate the total real costs per stage of disease and per 'patient-month' as well as the deviation from the monthly fixed 'funding envelope'. RESULTS: The total costs were 6.6 M€, whereas the total funding was 5.2 M€ for a total of 5648 'patient-months'. In 2014, the balance difference between the funding obtained and the actual costs was -1.4 €M for the cohort of 807 patients. DISCUSSION: The extreme cases of differences in cost per 'patient-month' compared to the monthly fixed 'funding envelope' were (i) stage 0/Tis, with higher funding at 415.23 € per 'patient-month', and (ii) stage IIIC, with lower funding at 1062.79 € per 'patient-month'. CONCLUSION: The 'patient-month' cost, regardless of disease stage was 1170.29 €. The median deviation per 'patient-month' was negative (241.21 €) compared to the monthly fixed 'funding envelope' of 929.08 € in the first year. Establishing activity-based costing - funding models will be crucial for the future sustainability of the healthcare sector.

Introdução: O cancro de mama é a segunda doença oncológica mais comum no mundo. Com o propósito de estudar o novo financiamento por patologia ­ cancro de mama ­ implementado no Instituto Português de Oncologia de Lisboa Francisco Gentil, foram analisados os custos reais dos doentes, através da metodologia de custeio activity based costing. Pretendeu-se dar resposta à pergunta de investigação: "Quanto custa tratar o cancro de mama por 'mês*doente' face ao 'envelope financeiro' fixo mensal?". Material e Métodos: O universo foi constituído por 807 doentes correspondendo a todos os doentes elegíveis no novo programa de financiamento por patologia e entrados ao longo do primeiro ano de implementação. Através do activity based costing foram apurados os custos reais totais por estádio da doença e por 'mês*doente' e o desvio relativamente ao 'envelope financeiro' fixo mensal. Resultados: Total de custos (6,6 M€), total de financiamento (5,2 M€) para um total de 5648 'meses*doente'. Em 2014, o saldo entre o financiamento obtido e os custos reais, foi negativo em 1,4 M€ para o universo de 807 doentes. Discussão: As situações extremas em termos de custos por 'mês*doente' face ao 'envelope financeiro' mensal fixo foram: (i) o estádio 0/TIS com financiamento superior em 415,23 € por 'mês*doente'; (ii) o estádio IIIC com um financiamento inferior em 1062,79 € por 'mês*doente'. Conclusão: O custo 'mês*doente', independentemente do estádio da doença, foi de 1170,29 €. O desvio médio 'mês*doente' foi negativo (241,21 €) face ao 'envelope financeiro' mensal fixo de 929,08 € no primeiro ano. Estabelecer modelos de financiamento com base no activity based costing será crucial para a sustentabilidade futura do sector da saúde.

Low frequency of TERT promoter mutations in gastrointestinal stromal tumors (GISTs).

Somatic mutations in the promoter region of telomerase reverse transcriptase (TERT) gene, mainly at positions c.-124 and c.-146 bp, are frequent in several human cancers; yet its presence in gastrointestinal stromal tumor (GIST) has not been reported to date. Herein, we searched for the presence and clinicopathological association of TERT promoter mutations in genomic DNA from 130 bona fide GISTs. We found TERT promoter mutations in 3.8% (5/130) of GISTs. The c.-124C>T mutation was the most common event, present in 2.3% (3/130), and the c.-146C>T mutation in 1.5% (2/130) of GISTs. No significant association was observed between TERT promoter mutation and patient's clinicopathological features. The present study establishes the low frequency (4%) of TERT promoter mutations in GISTs. Further studies are required to confirm our findings and to elucidate the hypothetical biological and clinical impact of TERT promoter mutation in GIST pathogenesis.

Tissue Doppler imaging assessment of long axis left ventricular function in hypertensive patients with concentric left ventricular hypertrophy: differential diagnosis with hypertrophic cardiomyopathy.

BACKGROUND: The differential diagnosis between hypertrophic cardiomyopathy and hypertensive heart disease has clinical, therapeutic and prognostic implications, but is not always easy with conventional echocardiography. Tissue Doppler imaging of the mitral annulus allows the detailed study of long axis left ventricular function in hypertrophic cardiomyopathy and may be useful in the differential diagnosis. METHODS: 23 patients with non-obstructive hypertrophic cardiomyopathy and 25 hypertensive patients with concentric left ventricular hypertrophy with similar age, body surface and heart rate were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. In each wave (systolic-s, rapid filling-e, atrial contraction-a) we analyzed velocities, time intervals and velocity-time integrals, as well as heterogeneity and asynchrony. Data were compared among the different sides in each group, between groups and with conventional Doppler data. RESULTS: In contrast to hypertensive patients, hypertrophic cardiomyopathy patients showed: 1--Systolic function: lower "s" wave velocities and integrals, higher systolic heterogeneity, longer isovolumic relaxation time and higher PEP/LVET (pre ejection period/left ventricular ejection time). 2--Diastolic function: lower "e" and "a" wave, higher "a" and "e/a" heterogeneity index, higher percentage of annular sides with e/a > or = l, longer isovolumic relaxation time and time to peak e, and higher diastolic asynchrony. Some of these abnormalities occurred in annular sides adjacent to non-hypertrophied walls. CONCLUSIONS: This study shows that: 1--Long axis systolic and diastolic left ventricular function are significantly different between hypertrophic cardiomyopathy patients and hypertensive patients with concentric left ventricular hypertrophy. 2--These functional differences occur in the velocity domain (with heterogeneity), in the time domain (with asynchrony) and also in velocity time integrals. 3--Long axis systolic and diastolic dysfunction occur in annular sides contiguous to hypertrophied and non-hypertrophied walls, enhancing the role of tissue Doppler imaging in the differential diagnosis between these diseases.

Tissue Doppler imaging in hypertrophic cardiomyopathy: impact of intraventricular obstruction on longitudinal left ventricular function.

BACKGROUND: In non-obstructive hypertrophic cardiomyopathy, tissue Doppler imaging of the mitral annulus shows severe systolic and diastolic dysfunction, with marked heterogeneity and asynchrony. In obstructive forms, the complexity of pathophysiological interactions makes conventional echocardiographic functional assessment extremely difficult and complex. OBJECTIVE: To study longitudinal left ventricular function with tissue Doppler imaging in the obstructive forms of hypertrophic cardiomyopathy. METHODS: Twenty-six patients with hypertrophic obstructive cardiomyopathy and 23 patients with the non-obstructive form of the disease, matched by age, were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. In each wave (systolic-s, rapid filling-e, atrial contraction-a) we analyzed velocities, time intervals and velocity-time integrals, as well as heterogeneity and asynchrony indexes. Data were compared between the different sides in each group, between groups and with conventional Doppler data. RESULTS: In contrast to the non-obstructive forms, patients with intraventricular obstruction showed: Systolic function: similar velocities and integrals, the relations between the different sides of the annulus usually being preserved; longer isovolumic contraction time, time to peak s and PEP/LVET. Diastolic function: similar rapid filling and e/a velocities and integrals, lower atrial contraction velocity and integral, similar number of sides with e/a higher than or equal to 1 on the lateral and inferior side of the annulus; similar diastolic time intervals, except diastolic time. CONCLUSIONS: This study shows that the presence of dynamic intraventricular obstruction and the loading conditions of obstructive forms of hypertrophic cardiomyopathy do not significantly influence most annular tissue Doppler imaging parameters, showing the relative load independence of the technique. So, in obstructive hypertrophic cardiomyopathy patients: 1--Longitudinal systolic function (velocities) is similar to the non-obstructive forms--longitudinal systolic dysfunction. 2--Longitudinal diastolic function (velocities and time intervals) is similar to the non-obstructive forms--longitudinal diastolic dysfunction. 3--Left atrial dysfunction is more severe than in non-obstructive forms. 4--The inferior and lateral sides of the annulus should be those selected in order to identify pseudonormalization of the transmitral flow.