Search Results (148)

Background: This study aimed to evaluate the effectiveness of right and left atrial strain reservoir (RASr and LASr) in predicting the recurrence of atrial arrhythmias (AAs) following cavotricuspid isthmus ablation (CTIA) for typical atrial flutter (AFL). Methods: We retrospectively enrolled consecutive patients with AFL who had undergone CTIA. Transthoracic echocardiography was conducted within one month before the procedure, and atrial two-dimensional speckle tracking analysis was performed offline. Results: Sixty-two subjects were evaluated (mean age 64.8 ± 13.2 years, 29% females). At a median follow-up of 12.1 months, AA recurrence occurred in 21 subjects (33.8%). The study endpoint occurred mainly among females (p = 0.021) and patients with lower RASr and LASr values (both p < 0.001). In Cox regression analysis, RASr and LASr remained independent predictors of AA recurrence (p = 0.02 and p = 0.03, respectively). In ROC curve analysis, RASr and LASr showed a similar and satisfactory ability to predict AA recurrence with optimal cut-off values of 16.8% and 17.7%, respectively. In survival analysis, RASr > 16.8% and LASr > 17.7% were associated with significantly higher freedom from AAs during follow-up (log rank p = 0.001 and p = 0.002, respectively). Conclusions: The results of this study suggest that pre-CTIA atrial speckle tracking analysis may aid in identifying AFL patients at an increased risk of AA recurrence, allowing for more frequent follow-up visits and extended antiarrhythmic therapy. Full article

Background: Atypical atrial flutter (AFL) is a complex clinical challenge, particularly in patients with prior atrial fibrillation (AF) treated with pulmonary vein isolation (PVI). Arrhythmias involving the vein of Marshall (VOM) often require extensive lesion sets, including ethanol infusion, to effectively target the epicardial substrate. To minimize tissue damage, an alternative strategy has been proposed, emphasizing advanced electroanatomical mapping, entrainment maneuvers, and highly targeted ablation techniques. Case Presentation: We describe a 72-year-old woman with recurrent atrial arrhythmias following pulmonary vein isolation (PVI), who presented with palpitations as her primary symptom. After ineffective pharmacological therapy, she underwent a catheter ablation procedure. Electroanatomical mapping revealed significant left atrial scarring and suggested a macroreentrant circuit involving the VOM. Entrainment maneuvers confirmed the VOM’s involvement. A single targeted endocardial ablation guided by the ablation index terminated the arrhythmia within 12 s, without the need for ethanol infusion or extensive lesion sets. Discussion: This case underscores the VOM’s role in sustaining atypical AFL post-PVI and highlights the effectiveness of precise electroanatomical mapping combined with targeted endocardial ablation. Unlike broader ablation or ethanol infusion strategies, a focused lesion at the critical isthmus achieved arrhythmia termination with minimal tissue damage. Conclusions: Endocardial ablation at the site of entrainment can safely and effectively treat VOM-related AFL, offering symptom relief and restoration of sinus rhythm. This approach may reduce procedural risks and expand the feasibility of VOM-related arrhythmia management in centers without access to ethanol infusion. Full article

Triatoma dimidiata is a widely distributed vector of Trypanosoma cruzi in Mexico and Central America, found across a range of habitats from sylvatic to domestic. Vector control has relied heavily on indoor residual spraying with pyrethroids; however, reinfestation and emerging resistance have limited its long-term effectiveness. In this study, we analyzed the genetic diversity and population structure of T. dimidiata from Veracruz, Oaxaca, and Yucatan using mitochondrial markers (cyt b and ND4) and screened for knockdown resistance (kdr)-type mutations in the voltage-gated sodium channel (VGSC) gene. High haplotype diversity and regional differentiation were observed, with most genetic variation occurring between populations. The ND4 marker provided greater resolution than cyt b, revealing ten haplotypes and supporting evidence of recent population expansion. Haplotype networks showed clear geographic segregation, particularly between populations east and west of the Isthmus of Tehuantepec. The L925I mutation, highly associated with pyrethroid resistance, was detected for the first time in Mexican populations of T. dimidiata, albeit at low frequencies. These findings highlight the importance of integrating population genetic data and resistance surveillance into regionally adapted vector control strategies for Chagas disease. Full article

Background: Effective mask ventilation is a very important aspect of ensuring adequate oxygenation and ventilation. However, predicting difficult mask ventilation (DMV) using bedside clinical tests remains challenging due to poor sensitivity. Our objective was to determine the correlation between the preoperative ultrasonography of anterior neck anatomy and difficult mask ventilation in different obesity classes. Methods: A prospective, observational study enrolled 90 adult obese patients undergoing general anesthesia from December 2020 to November 2021 (30 patients for each class of obesity). Ultrasonography measurements were recorded for the distance of skin (DS) to hyoid bone (DSHB), epiglottis (DSEM), the anterior commissure of the vocal cords (DSAC), thyroid isthmus (DSTI), and trachea at jugular notch (DSTJ). The difficulty of bag mask ventilation was graded using the Han scale. The Kendall Tau correlation coefficient was used to correlate the different ultrasonography parameters to DMV. Receiver-operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the measured ultrasonography distances, and the Youden index was used to calculate the optimal cut-off values. Results: Results revealed twenty patients (22.2%) were categorized as having difficult mask ventilation. There was a statistically significant increase (p = 0.011) in the number of patients with Mallampati II in class III obesity compared to class I obesity. DSHB showed a statistically significant and strong correlation with difficult mask ventilation in patients with class II (p = 0.002, r = 0.464) and class III obesity (p = 0.002, r = 0.475). A DSHB cut-off value of 1.35 cm has a sensitivity of 83.3% and specificity of 78.8% for class III obesity. Similarly, a DSTJ cut-off value of 1.13 cm has a sensitivity of 83.3% and specificity of 66.7% for class III obesity. Conclusions: Notably, DSHB was the most specific parameter and equally as sensitive as DSTJ in predicting difficult mask ventilation in morbidly obese patients. Full article

Introduction: Previous neuroimaging studies have reported structural brain alterations and local network hyperexcitability in terms of increased slow-wave electroencephalography (EEG) activity in patients with borderline personality disorder (BPD). In particular, intermittent rhythmic delta and theta activity (IRDA/IRTA) has drawn attention in mental health contexts due to its links with metabolic imbalances, neuronal stress, and emotional dysregulation—processes that are highly pertinent to BPD. These functional disturbances may be reflected in corresponding structural brain changes. The current study investigated cortical thickness and subcortical volumes in BPD and examined their associations with IRDA/IRTA events per minute, symptom severity, and neuropsychological measures. Methods: Seventy female BPD patients and 36 age-matched female healthy controls (HC) were included (for clinical EEG comparisons even 72 patients were available). IRDA/IRTA rates were assessed using an automatic independent component analyses (ICA) approach. T1-weighted MRI data were obtained using a MAGNETOM Prisma 3T system and analyzed with FreeSurfer (version 7.2) for subcortical structures and CAT12 for cortical thickness and global volume measurements. Psychometric assessments included questionnaires such as Borderline Symptom List (BSL-23) and Inventory of Personality Organization (IPO). Neuropsychological performance was evaluated with the Test for Attentional Performance (TAP), Culture Fair Intelligence Test (CFT-20-R), and Verbal Learning and Memory Test (VLMT). Results: Between-group comparisons exhibited no significant increase in IRDA/IRTA rates or structural abnormalities between the BPD and HC group. However, within the BPD group, cortical thickness of the right isthmus of the cingulate gyrus negatively correlated with the IRDA/IRTA difference (after minus before hyperventilation, HV; p < 0.001). Furthermore, BPD symptom severity (BSL-23) and IPO scores positively correlated with the thickness of the right rostral anterior cingulate cortex (p < 0.001), and IPO scores were associated with the thickness of the right temporal pole (p < 0.001). Intrinsic alertness (TAP) significantly correlated with relative cerebellar volume (p = 0.01). Discussion: While no group-level structural abnormalities were observed, correlations between EEG slowing, BPD symptom severity, and alertness with cortical thickness and/or subcortical volumes suggest a potential role of the anterior cingulate cortex, temporal pole, and cerebellum in emotion regulation and cognitive functioning in BPD. Future research employing multimodal EEG-MRI approaches may provide deeper insights into the neural mechanisms underlying BPD and guide personalized therapeutic strategies. Full article

Costa Rica is located along the narrow isthmus that connected South America to North America beginning in the mid-Cenozoic. The exchange of vertebrates between the two continents has received considerable study, but paleobotanical aspects are less known. The Pacific coast “ring of fire” volcanoes produced abundant hyaloclastic material that provided a source of silica for wood petrifaction, and the tropical forests contained diverse taxa. This combination resulted in the preservation of petrified wood at many sites in Costa Rica. Fossil wood ranges in age from Lower Miocene to Middle Pleistocene, but Miocene specimens are the most common. Our research involved the study of 54 specimens, with the goal of determining their mineral compositions and interpreting the fossilization processes. Data came from thin-section optical microscopy, SEM images, and X-ray diffraction. Two specimens were found to be mineralized with calcite, but most of the woods contained crystalline quartz and/or opal-CT. The preservation of anatomical detail is highly variable. Some specimens show evidence of decay or structural deformation that preceded mineralization, but other woods have well-preserved cell structures. This preliminary study demonstrates the abundance and botanical diversity of fossil wood in Costa Rica, hopefully opening a door into future studies that will consider the taxonomy and evolutionary aspects of the country’s fossil forests. Full article

Background: Atrial flutter (AFL) is a macro-reentrant tachycardia classified as cavotricuspid isthmus (CTI)-dependent or non-CTI-dependent based on its reliance on the CTI for conduction. CTI dependence can present as type I ECG (sawtooth flutter waves in inferior leads and positive P-waves in V1) or type II ECG (absence of these characteristics). This study aimed to identify clinical and electrophysiological parameters to improve CTI dependence prediction in AFL. Methods: Patients at the Ulm University Heart Center between 2010 and 2019 with AFL undergoing electrophysiological studies and ablation were enrolled. Clinical and electrophysiological parameters such as age, gender, prior comorbidities, interventions, and medication use were analyzed. Results: The study included 383 patients, with 70% presenting with type I ECG AFL. CTI dependence was observed in 242 (90.3%) type I ECG patients and 52 (45.2%) type II ECG patients. CTI-dependent AFL patients were younger and had fewer comorbidities. Predictors for CTI dependence in type I ECG included male gender (p = 0.006), absence of beta-blocker use (p = 0.031), no prior atrial fibrillation (p = 0.035), and no prior pulmonary vein isolation (p < 0.001). In type II ECG, predictors for CTI dependence included younger age (p = 0.016), male gender (p = 0.007), absence of arterial hypertension (p = 0.036), and longer atrial cycle length (p < 0.001). Conclusions: Identifying clinical and electrophysiological parameters enhances the ability to predict CTI dependence in AFL, offering valuable insights for tailored diagnostic and therapeutic approaches. Coupling these parameters with ECG findings holds promise for refining prediction accuracy and optimizing patient care. Full article

Transmissible viral proventriculitis (TVP) and chicken proventricular necrosis virus (CPNV) affect the broiler industry globally and are emerging diseases of economic importance. Here, we present the findings of TVP from processed broiler carcasses in Argentina following marked condemnation at the processing plant. We studied a total of 122 abnormally presenting proventriculi at processing from 42-to-50-day-old, male Cobb500^™ broiler chicken carcasses from 11 farms belonging to the same company in 13 episodes of proventriculi–gizzards condemnation between December 2021 and April 2022. The proventriculi were enlarged and pale with a widened gastric isthmus. A histopathologic lesion score system was developed based on the presence of a combination of key microscopic findings, the distribution, and the severity of the lesions. Scoring of the affected proventriculi revealed 65% (79/122) with a score of 4, 23% (28/122) with a score of 3, and 12% (15/122) with a score of 2. Focal to multifocal immunoreactivity against the VP2-CPNV antigen within the necrotic glandular epithelial cells was noted in the affected proventriculi using immunohistochemistry. We found 84.4% (103/122) of the studied proventriculi with TVP lesions grossly and microscopically scored were positive for CPNV by RT-PCR. The sequencing results of the PCR product showed a high nucleotide sequence similarity (88.97%) to previously published VP1-CPNV sequences. We confirmed CPNV infection in most of the TVP affected proventriculi in all condemnation episodes at a broiler chicken processing plant in Argentina during the studied period. This study documents TVP associated with CPNV detection at processing plants in Argentina for the first time. Full article

Background/Objectives: Understanding sex-based differences in both the pathophysiology and clinical presentation of diseases is necessary to improve health care towards precision medicine. The endocrine system is deeply involved in human health, and endocrine diseases may be influenced by steroidal hormone exposure. Thyroid nodular disease and differentiated thyroid cancer, in particular, show a high prevalence in the female sex; however, little is known about sex-related differences in risk factors and clinical presentation. This study aims to assess whether morphological differences, which can be detected by ultrasound examination, can be related to sex in order to refine diagnostic approaches and oncological risk classification. Methods: A retrospective observational study on 1355 ultrasound images of thyroid nodules obtained from 2017 to 2020 at a single university center was conducted. The images were reviewed by a single observer blinded to the patient’s sex and the cytological nature of the nodules. The qualitative description, size, anatomical location and oncological risk classification were assessed. Results: A taller-than-wide shape (anteroposterior/craniocaudal axis ratio > 1) was found to be more frequent in men than in women (6.7% vs. 3.6%, p = 0.027); the nodular volume was significantly larger in males (p << 0.01) than in females. Significant tropism for the upper lobe and isthmus was described in women (26% vs. 16.5%, p = 0.011) and for medium–lower thyroid lobes in men (83.5% vs. 73.8%, p = 0.011). Background thyroiditis was more common in women, while the number of cytological diagnoses of malignant or likely malignant nodules was higher than expected in men (9% vs. 6%, p = 0.01). Conclusions: Thyroid nodules show different distributions, in terms of a larger volume, more frequent taller-than-wide shape and lobular caudal location, in men vs. women. These results should be confirmed by further investigations, and the underlying mechanism should be clarified. However, our explorative research is of interest due to its novelty and possible future clinical implications. Full article

Background and Objectives: Cognitive impairment, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD), is a growing public health concern. Early detection and an understanding of structural changes are crucial for accurate diagnosis and timely intervention. Cortical curvature, a morphometric measure derived from structural magnetic resonance imaging (MRI), has emerged as a potential biomarker for neurodegenerative processes. This study investigates the relationship between mean cortical curvature and cognitive impairment. Materials and Methods: A cross-sectional study was conducted with 58 participants, categorized into, first, cognitively impaired (CI) and non-cognitively impaired (NC) groups and, second, a normal cognitive group (NC), a mild cognitive performance group (MPG), and a low cognitive performance group (LPG) based on the Montreal Cognitive Assessment (MoCA) score. MRI data were acquired using a 3.0 Tesla scanner, and cortical reconstruction was performed using FreeSurfer 7.2.0. Mean cortical curvature values were extracted for 34 brain regions per hemisphere. Results: Significant differences in mean cortical curvature were found between the CI and NC groups. In the right hemisphere, statistically significant changes in mean curvature were observed in the isthmus cingulate (U = 188.5, p = 0.006), lingual (U = 202.5, p = 0.013), pars orbitalis (U = 221.5, p = 0.031), and posterior cingulate regions (U = 224.5, p = 0.035). In the left hemisphere, significant differences were detected in the cuneus (U = 226.5, p = 0.038) and posterior cingulate (U = 231.5, p = 0.046) regions. Analysis across three cognitive performance groups (NC, MPG, and LPG) showed significant curvature differences in the right isthmus cingulate (H(2) = 7.492, p = 0.024) and lingual regions (H(2) = 6.250, p = 0.044). Conclusions: Decreased mean cortical curvature in brain regions associated with cognitive function could be indicative of cognitive impairment and may reflect early neurodegenerative changes. These results highlight cortical curvature as a potential structural sign for cognitive impairment, showing the need for further investigation in longitudinal studies. Full article

Background: Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band. Methods: Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck–shaft angle (NSA), head–shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using t-test. Results: Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6–12.5) years, mean MP 22 ± 7% (range, 13–39%), PamMP 33 ± 7% (range, 18–46%), NSA 151 ± 7° (range, 140–161°), PamNSA 153 ± 4° (range, 142–163°), HSA 164 ± 12° (range, 142–175°), and PamHSA 169 ± 8° (range, 154–175°). MP decreased by 10.5% compared with PamMP (p < 0.001). NSA compared with PamNSA (p = 0.117) and HSA compared with PamHSA (p = 0.325) were not statistically different. Conclusions: This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged. Full article

Objective: We aimed to compare the forebrain length, corpus callosum sub-segment thickness, corpus callosum area, and corpus callosum index in the cerebral magnetic resonance imaging (MRI) of schizophrenia patients and healthy individuals. Materials and Methods: In this retrospective study, 137 schizophrenia patients who met the inclusion and exclusion criteria and were hospitalized in the Psychiatry Clinic of Mersin University Faculty of Medicine Hospital between January 2014 and January 2024 and 137 healthy individuals of the same age and gender without any mental disorders were included. The relationship between sociodemographic characteristics and disease-related variables obtained in the retrospective file review and the corpus callosum morphometric findings on brain MRI were analyzed with the SPSS 22 package program. p-values below 0.05 were considered statistically significant. Results: In the study, 274 individuals, including 137 schizophrenia patients (59 [43.1%] males; 78 [56.9%] females) and 137 healthy individuals (59 [43.1%] males; 78 [56.9%] females), were evaluated. There was no significant difference between the two groups in terms of age, gender, and mean age at the time of brain MRI. In brain MRI measurements, forebrain length, corpus callosum (CC) AP diameter, CC genu, body, splenium, rostrum and isthmus thicknesses, CC area, and CC index values were significantly lower in the patient group compared to healthy controls. It was also found that patients with multiple episodes in the patient group were diagnosed at an earlier age, had a longer duration of illness, had a history of more homicide and suicide attempts, had more hospitalizations, had a history of more psychotic disorders in their families, and had lower levels of functioning compared to patients with a single episode. Conclusions: Each of the corpus callosum subregion thickness, corpus callosum area, and corpus callosum index values shows a decrease in schizophrenia patients compared to healthy controls. These findings contribute to the understanding of the neurobiological basis of the disease and provide important evidence to elucidate its pathophysiology. The results need to be confirmed in studies with larger samples using a prospective study design in which clinical parameters related to the disease are also measured. Full article

Background: Pulsed field ablation [PFA] is a novel ablation technique for pulmonary vein isolation [PVI] in patients with paroxysmal and persistent atrial fibrillation. However, data for the efficacy and safety of PFA for left atrial substrate modification using a single shot PFA system, in patients with long-standing persistent atrial fibrillation [AF] and left atrial macro- as well as micro-reentrant atrial tachycardia [LAMRT], are scarce. Here, we provide a small, single-center case series regarding the efficacy and safety of left atrial substrate modification using a single-shot PFA system. Methods: Nine patients with long-standing persistent AF and LAMRT underwent redo-PVI and left atrial substrate modification using a single-shot PFA system. Patients were subsequently followed up for 1 year. Results: The median age was 64 years [IQR 55.5–75], with 44% of the participants being female. The median time since the first diagnosis of AF was 7 years [IQR 4–15.5]. After re-PVI, posterior wall isolation was performed in five patients, roof isolation in six patients, and anterior wall ablation between the superior mitral annulus and the right superior pulmonary vein [RSPV] in five patients. In two patients, cavotricuspid isthmus ablation was additionally performed to treat typical atrial flutter. The acute procedural success rate was 100%, with all LAMRTs and typical flutters successfully terminating by ablation. At 1-year follow-up, four patients [44%] experienced a recurrence of any atrial arrhythmia. Median time to recurrence was 164 days [138–212.8]. Importantly, no acute or chronic complications were observed. Conclusions: In this small, single-center case series, left atrial substrate modification for long-standing persistent AF and AT using a single-shot PFA system was safe and showed an excellent acute success rate. Full article

Objectives: The purpose was to quantitatively examine brain structures using 7 Tesla MRI in the presence of visual loss caused by retinitis pigmentosa (RP) related to retinitis pigmentosa GTPase regulator (RPGR) gene pathogenic variants. Methods: Twelve male patients with RP (mean visual acuity 0.4) related to confirmed RPGR pathogenic variants and fifteen healthy volunteers were examined with 7 Tesla MRI of the brain. Measures of the lateral geniculate nucleus (LGN) volume were performed manually by three independent investigators (radiologists) using ITK-SNAP (Insight Segmentation and Registration Toolkit) software. Other brain structures were evaluated using the open-source automated software package FreeSurfer. Prior to the 7 Tesla MRI, patients underwent an ophthalmic examination and a 1.5 Tesla MRI. Results: The mean LGN volume (right—100 mm³, left—96 mm³) and left lingual gyrus volume (6162 mm³) were significantly lower in RPGR patients in comparison to the control group (129 mm³, 125 mm³, and 7310 mm³, respectively), whilst some brain regions related to other sensory information such as the left isthmus cingulate (3690 mm³) and entorhinal cortex (right—1564 mm³, left 1734 mm³) were significantly or almost significantly higher in the RPGR group than in the control group (2682 mm³, 960 mm³, and 1030 mm³, respectively). Moreover, compared to the control group, the RPGR group’s thalamus-to-LGN ratio was substantially higher. Conclusions: The use of the 7 Tesla MRI revealed numerous structural abnormalities of the visual pathway in patients with RPGR-related RP. The reorganization of the structures of the brain demonstrated in patients with RPGR-related RP reveals a certain degree of plasticity in response to visual loss. These findings may help improve diagnostic and therapeutic strategies for RP patients and contribute to the development of precision medicine. Full article

The arrival of psittacine in North America is well known but undefined. It is widely accepted that these birds originated in South America, and it has been suggested that different factors have promoted the biodiversity of birds in Mexico. However, in general, for North American psittacine, there are no proposed divergence times, and the possible influence of different geological events on these processes is unknown. In this study, phylogenetic relationships, divergence times, and ancestral areas of the genera Aratinga, Eupsittula, and Psittacara and related genera were estimated to propose hypotheses of the origin, diversification, and dispersal of groups under a Bayesian inference framework based on mitochondrial molecular markers. Of seven monophyletic clades within the Arini tribe, four coincided with the genera Psittacara, Eupsittula, Rhynchopsitta, and Pyrrhura, while Aratinga was grouped with Conuropsis and Cyanopsitta. Diversification of the analyzed genera probably occurred during the Miocene and around the Miocene–Pliocene boundary. The results suggest that the most likely origin of these genera is the Amazonian or Chaco regions. The diversification of these groups seems to be related to geoclimatic events associated with the uplift of the central and northern portions of the Andes and the closure of the Isthmus of Panama. We propose routes from south to north in the Neotropics and the use of the Greater and Lesser Antilles as a northward path. Full article