The heterogeneous anatomy of the left atrial appendage (LAA) necessitates preprocedural imaging essential for planning of percutaneous LAA occlusion (LAAO) procedures. While transoesophageal echocardiography (TOE) remains the gold standard, cardiac computed tomography (CT) is becoming increasingly popular. To address the lack of consensus on the optimal imaging modality, we compared the outcomes of preprocedural TOE versus CT for LAAO procedure planning. A retrospective single-center cohort study of all LAAO procedures was performed to compare the outcomes of patients receiving preprocedural TOE versus those receiving CT. The primary outcome was procedural success and rate of major adverse events. The secondary outcomes were total procedure time, rate of device size change, and maximum landing zone diameter. A total of 64 patients was included. Of these, 25 (39.1%) underwent TOE and 39 (60.9%) underwent CT. There was no significant difference in the procedural success rate (96.0% vs.100%, P = 0.39) or major adverse event rate (4.0% vs. 5.1%, P > 0.99) between TOE and CT patients. Compared with TOE, CT was associated with significantly shorter median procedure time (103 min vs. 124 min, P = 0.02) and a lower rate of device size change (7.7% vs. 28.0%, P = 0.04). Compared to CT, TOE was associated with a significantly smaller mean maximum landing zone diameter (20.8 mm vs. 25.8 mm, P < 0.01) and a higher rate of device upsizing (24.0% vs. 2.6%, P = 0.01). No significant difference in detected residual leak rates was found between TOE and CT (50.0% vs. 52.2%, P > 0.99). Planning of LAAO procedures with CT is associated with a shorter total procedure time and a lower rate of device size change and is less likely to underestimate the maximum landing zone diameter.

The heterogeneous anatomy of the left atrial appendage (LAA) necessitates preprocedural imaging essential for planning of percutaneous LAA occlusion (LAAO) procedures. While transoesophageal echocardiography (TOE) remains the gold standard, cardiac computed tomography (CT) is becoming increasingly popular. To address the lack of consensus on the optimal imaging modality, we compared the outcomes of preprocedural TOE versus CT for LAAO procedure planning. A retrospective single-center cohort study of all LAAO procedures was performed to compare the outcomes of patients receiving preprocedural TOE versus those receiving CT. The primary outcome was procedural success and rate of major adverse events. The secondary outcomes were total procedure time, rate of device size change, and maximum landing zone diameter. A total of 64 patients was included. Of these, 25 (39.1%) underwent TOE and 39 (60.9%) underwent CT. There was no significant difference in the procedural success rate (96.0% vs.100%, P = 0.39) or major adverse event rate (4.0% vs. 5.1%, P > 0.99) between TOE and CT patients. Compared with TOE, CT was associated with significantly shorter median procedure time (103 min vs. 124 min, P = 0.02) and a lower rate of device size change (7.7% vs. 28.0%, P = 0.04). Compared to CT, TOE was associated with a significantly smaller mean maximum landing zone diameter (20.8 mm vs. 25.8 mm, P < 0.01) and a higher rate of device upsizing (24.0% vs. 2.6%, P = 0.01). No significant difference in detected residual leak rates was found between TOE and CT (50.0% vs. 52.2%, P > 0.99). Planning of LAAO procedures with CT is associated with a shorter total procedure time and a lower rate of device size change and is less likely to underestimate the maximum landing zone diameter.

The heterogeneous anatomy of the left atrial appendage (LAA) necessitates preprocedural imaging essential for planning of percutaneous LAA occlusion (LAAO) procedures. While transoesophageal echocardiography (TOE) remains the gold standard, cardiac computed tomography (CT) is becoming increasingly popular. To address the lack of consensus on the optimal imaging modality, we compared the outcomes of preprocedural TOE versus CT for LAAO procedure planning. A retrospective single-center cohort study of all LAAO procedures was performed to compare the outcomes of patients receiving preprocedural TOE versus those receiving CT. The primary outcome was procedural success and rate of major adverse events. The secondary outcomes were total procedure time, rate of device size change, and maximum landing zone diameter. A total of 64 patients was included. Of these, 25 (39.1%) underwent TOE and 39 (60.9%) underwent CT. There was no significant difference in the procedural success rate (96.0% vs.100%, P = 0.39) or major adverse event rate (4.0% vs. 5.1%, P > 0.99) between TOE and CT patients. Compared with TOE, CT was associated with significantly shorter median procedure time (103 min vs. 124 min, P = 0.02) and a lower rate of device size change (7.7% vs. 28.0%, P = 0.04). Compared to CT, TOE was associated with a significantly smaller mean maximum landing zone diameter (20.8 mm vs. 25.8 mm, P < 0.01) and a higher rate of device upsizing (24.0% vs. 2.6%, P = 0.01). No significant difference in detected residual leak rates was found between TOE and CT (50.0% vs. 52.2%, P > 0.99). Planning of LAAO procedures with CT is associated with a shorter total procedure time and a lower rate of device size change and is less likely to underestimate the maximum landing zone diameter.

Objective:Human leukocyte antigen(HLA)B27 is a susceptibility allele of ankylosing spondylitis(AS),and HLA-B27 antigen typing is an important indicator for clinical diagnosis of AS,but current typing methods such as sequence specific primer polymerase chain reaction(PCR-SSP)still possess limitation.Therefore,this study aims to analyze the correlation between B27 subtypes and susceptibility to AS in Hunan Province by applying high-resolution polymerase chain reaction-sequence-based typing(PCR-SBT). Methods:Peripheral blood of 116 patients with suspected AS(suspected AS group)and 121 healthy volunteers(control group)admitted to the Second Xiangya Hospital from January 2020 to December 2020 were collected for HLA-B genotyping by PCR-SBT.Among the patients in the suspected AS group,23 patients were finally diagnosed with AS(confirmed AS group),and the remaining 93 undiagnosed patients served as the non-confirmed AS group.PCR-SBT and PCR-SSP were used to detect HLA-B27 typing in 116 patients with suspected AS,and the results of the 2 methods were compared. Results:The HLA-B27 allele frequency in the suspected AS group was significantly higher than that in the control group[11.63%vs 2.48%;P<0.001,odds ratio(OR)=5.18,95%confidence interval(CI)2.097 to 12.795].B*27:04,B*27:05,B*27:06,and B*27:07 were detected in the suspected AS group and the control group.The frequency of the B*27:04 allele in the suspected AS group was significantly higher than that in the control group(9.48%vs 1.24%;P<0.001,OR=8.346,95%CI 2.463 to 28.282).The positive rate of B27 in the suspected AS group and the confirmed AS group(B27+/+ and B27+/-)was significantly higher than that in the control group(χ2=16.579,P<0.001;χ2=94.582,P<0.001,respectively).Among the confirmed AS group,21 were HLA-B27 carriers,and the B27 positive rate in the confirmed AS group was 91.3%.PCR-SBT could achieve high resolution typing of the HLA-B gene locus,with higher sensitivity,specificity,positive predictive value,negative predictive value,and accuracy than PCR-SSP. Conclusion:PCR-SBT typing analysis shows a strong correlation between HLA-B * 27:04 and AS in Hunan province.The PCR-SBT method can be used as the preferred option for the auxiliary diagnosis of clinical AS.

Child ; Humans ; Speech ; Physicians, Primary Care ; Language Development Disorders/diagnosis* ; Speech Disorders

Background: and Purpose To explore the causal relationships of elements of the exposome with ischemic stroke and its subtypes at the omics level and to provide evidence for stroke prevention. Methods We conducted a Mendelian randomization study between exposure and any ischemic stroke (AIS) and its subtypes (large-artery atherosclerotic disease [LAD], cardioembolic stroke [CE], and small vessel disease [SVD]). The exposure dataset was the UK Biobank involving 361,194 subjects, and the outcome dataset was the MEGASTROKE consortium including 52,000 participants. Results: We found that higher blood pressure (BP) (systolic BP: odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01 to 1.04; diastolic BP: OR, 1.03; 95% CI, 1.01 to 1.05; pulse pressure: OR, 1.03; 95% CI, 1.00 to 1.06), atrial fibrillation (OR, 1.18; 95% CI, 1.13 to 1.25), and diabetes (OR, 1.13; 95% CI, 1.07 to 1.18) were significantly associated with ischemic stroke. Importantly, higher education (OR, 0.69; 95% CI, 0.60 to 0.79) decreased the risk of ischemic stroke. Higher systolic BP (OR, 1.06; 95% CI, 1.02 to 1.10), pulse pressure (OR, 1.08; 95% CI, 1.02 to 1.14), diabetes (OR, 1.28; 95% CI, 1.13 to 1.45), and coronary artery disease (OR, 1.58; 95% CI, 1.25 to 2.00) could cause LAD. Atrial fibrillation could cause CE (OR, 1.90; 95% CI, 1.71 to 2.11). For SVD, higher systolic BP (OR, 1.04; 95% CI, 1.00 to 1.07), diastolic BP (OR, 1.06; 95% CI, 1.01 to 1.12), and diabetes (OR, 1.22; 95% CI, 1.10 to 1.36) were causal factors. Conclusions The study revealed elements of the exposome causally linked to ischemic stroke and its subtypes, including conventional causal risk factors and novel protective factors such as higher education.

X-linked dystonia-parkinsonism (XDP) is an adult-onset debilitating neurodegenerative disorder presenting with motor and nonmotor symptoms. The treatment options for XDP are limited. We described a patient with XDP who underwent a unilateral transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) pallidothalamic tractotomy with a one-year follow-up. The patient reported an immediate improvement in his pain after the procedure. Compared to baseline, there was an improvement in his scores in the dystonia (31%), parkinsonism (35.1%), and activities of daily living (71%) subscales at 1-year follow up. The overall improvement at one year was 46%. There were no adverse events noted. Additional studies with larger sample size and follow-up would be needed to document its long-term safety and efficacy.
Dystonia 3, Torsion, X-Linked ; Dystonic Disorders ; Genetic Diseases, X-Linked

Introduction: In recent years, many unresolved issues pertaining to house officers in Malaysia have led to a longer waiting time and a ‘glut’ of medical graduates with a surprising 20% dropout amongst those who join the housemanship programme. This appears to reflect the changing times, mindsets and work expectations of millennials who comprise this cohort reflecting a need to consider possibilities of career shifts especially so in these uncertain times. This study explores the perceptions, awareness and interest in alternative career options amongst recent graduates and house officers. Materials and Methods: This was a study done between 2018 and 2019 using a questionnaire which was shared on various social platforms. Data analysis was done using Excel spreadsheet. Results: A total of 450 house officers and 657 medical graduates responded. Expectedly 66.8% claimed lifelong passion whilst another 12.1% claimed family influence as their reason to do medicine. Most were aware of their career challenges and 40% of them were keen to consider career change and reskilling indicating a possible shift from traditional expectations of a medical career. Conclusion: Whilst medicine is often considered a true calling, current challenges will require mental and emotional flexibility to explore other career opportunities. Thus, engagement programmes should be directed at medical graduates and house officers to identify and support those open to career transitions. This will help address current issues of internship bottleneck and rising dropout rates amongst internees. Early career change engagements will give them insight into their true career goals whilst opening up opportunities for those who wish to change.

Objective: To investigate the influence of qigong on late positive potential, which was elicited by affective pictures.Methods: College students who met the inclusion criteria were enrolled and randomly allocated to the qigong group, which received a four-week training (n=41) or the control group (n=41). All participants were assessed before and after the training for event-related potential, which was elicited by negative, neutral, and positive pictures. Electrodes at the centerline position of the frontal area (FCz), parietal area (Pz), and occipital area (Oz) were analyzed. Results: Negative, neutral, and positive pictures demonstrated statistically significant differences on FCz (P<.001), Pz (P<.001), and Oz (P<.001). The interaction between the group factor and time factor was statistically significant on Pz (P =.028). The pairwise comparison of Pz on the time factor and group factor showed that the amplitudes of the qigong group after training were smaller than before (P<.001), and the amplitudes of the control group were not statistically significant (P=.355). Conclusion: Our results supported the conclusion that qigong practices could affect the emotional regulation of college students. Qigong exercise weakens the emotional regulation of late positive po-tential, which is sensitive to top-down affective modulation. The findings imply that the regulating effect of qigong on emotions may be part of the reason why it is effective in reducing depression and anxiety symptoms.

Contrast agents are currently used during echocardiography for enhancement of structure and function, as well as for perfusion imaging. The next frontiers in contrast ultrasonography are targeted imaging, and using microbubbles for therapeutic purposes. Targeted imaging is the detection of specific components of cardiovascular disease in vivo, with microbubbles which may non-specifically attach to diseased endothelial cells, or with microbubbles which have been specifically designed to detect a pathologic process. Therapeutic applications of contrast ultrasonography include the use of microbubbles to enhance delivery of agents (like drugs, genes, growth factors, etc.) to the endothelium or perivascular cells. This review will discuss differences in contrast agents used for current applications versus targeted imaging, technical considerations required to achieve site-specific imaging, and potential applications of this technology. The potential for contrast ultrasonography to enhance drug and gene delivery to tissue will also be discussed.
Cardiovascular Diseases ; Contrast Media ; Echocardiography ; Endothelial Cells ; Endothelium ; Intercellular Signaling Peptides and Proteins ; Microbubbles ; Molecular Imaging ; Perfusion Imaging