Electrocardiographic imaging to guide ablation of ventricular arrhythmias and agreement between two different systems.

BACKGROUND AND AIM: A recent study using an epicardial-only electrocardiographic imaging (ECGI), suggests that the agreement of ECGI activation mapping and that of the contact mapping for ventricular arrhythmias (VA) is poor. The aim of this study was to assess the diagnostic value of two endo-epicardial ECGI systems using different cardiac sources and the agreement between them. METHODS: We performed 69 ECGI procedures in 52 patients referred for ablation of VA at our center. One system based on the extracellular potentials was used in 26 patients, the other based on the equivalent double layer model in 9, and both in 17 patients. The first uses up to 224 leads and the second just the 12­lead ECG. The localization of the VA was done using a segmental model of the ventricles. A perfect match (PM) was defined as a predicted location within the same anatomic segment, whereas a near match (NM) as a predicted location within the same segment or a contiguous one. RESULTS: 44 patients underwent ablation, corresponding to 58 ECGI procedures (37 with the first and 21 with the second system). The percentage of PMs and NMs was not significantly different between the two systems, respectively 76% and 95%, p = 0.077, and 97% and 100%, p = 1.000. In 14 patients that underwent ablation and had the ECGI performed with both systems, raw agreement for PMs was 79%, p = 0.250 for disagreement. CONCLUSIONS: ECGI systems were useful to identify the origin of the VAs, and the results were reproducible regardless the cardiac source.

Patterns of Medication Management and Associated Medical and Clinical Features among Home-Dwelling Older Adults: A Cross-Sectional Study in Central Portugal.

Ageing is frequently associated with multimorbidity and polypharmacy. The present study aimed to identify the current medication management patterns and the profiles of home-dwelling older adults and to find any association with their conditions, including frailty and cognitive impairment. Within the scope of this cross-sectional study, 112 older adults living in the community were assessed via face-to-face structured interviews. Frailty, cognitive status, medication management and clinical and sociodemographic variables were evaluated. Descriptive and inferential statistics were calculated. The mean participant age was 76.6 ± 7.1 years, 53.6% of participants were women, and 40.2% of participants lived alone. More than half were classified as having frailty (58.9%), almost one-fifth (19.6%) presented with a moderate cognitive impairment had more than one disease, and 60.7% were polymedicated. No associations were found between polymedication and medication self-management, the use of over-the-counter medications, living alone, having a poor understanding of pharmacological therapy and/or pathology, or having more than one prescriber. Self-management was associated with age, the number of medications, frailty and cognitive status. Binary logistic regressions showed that cognitive impairment had statistically significant differences with medication management, having a poor understanding of pharmacological therapy and/or pathology, having one prescriber and the use of medications not prescribed by physicians. Interventions to prevent medication-related problems in home-dwelling older adults are recommended.

A simplified approach to radiofrequency catheter ablation of idiopathic ventricular outflow tract premature ventricular contractions.

INTRODUCTION: Frequently, low voltage areas (LVAs) and diastolic potentials (DPs) are present at ablation sites in sinus rhythm in patients with idiopathic premature ventricular contractions (PVCs). OBJECTIVE: Validate these findings as substrates for PVCs and evaluate the feasibility of a simplified substrate approach based on LVAs and DPs for ablation of idiopathic outflow tract PVCs, in patients with a low PVC burden during the procedure. METHODS: Prospective single-arm clinical trial at two centers with comparison with a historical group, matched to age and gender. The study group consisted of consecutive patients referred for ablation of frequent idiopathic PVCs with inferior axis, that presented with less than two PVCs/min in first 5 min of the procedure. The ablation was based on fast mapping of the right ventricular outflow tract in sinus rhythm looking for LVAs and DPs, defined as isolated small amplitude potentials occurring after the T wave of the surface echocardiogram. The area with LVAs and DPs was tagged, and a simplified activation mapping of the PVCs was done in that area. The procedure time, success rate, and recurrence rate were compared with the historical group in whom ablation was performed based on activation and pace mapping only. A validation group without PVCs was also studied to assess the prevalence of LVAs and DPs in the general population. RESULTS: The study (n = 38), historical (n = 38), and validation (n = 38) groups did not differ in relation to age or gender. Prevalence of LVAs and DPs was significantly higher in the study group in comparison with the validation group, respectively, 71% versus 11%, p < 0.0001 and 87% versus 8%, p < 0.0001. Procedure time was significantly lower in the study group when comparing to the historical group, 130 (100-164) versus 183 (160-203) min, p < 0.0001 and the success rate was significantly higher, 90% versus 64%, p = 0.013. The recurrence rate in patients with a successful ablation was not significantly different between both groups, Log-rank = 0.125. CONCLUSION: The prevalence of LVAs and DPs was significantly higher in the study group than in the validation group. The proposed approach proved to be feasible, faster, and more efficient than the historical approach.

Assessment of wave front activation duration and speed across the right ventricular outflow tract using electrocardiographic imaging as predictors of the origin of the premature ventricular contractions: A validation study.

AIMS: Evaluate right ventricular outflow tract (RVOT) activation duration (AD) and speed, invasively and with the electrocardiographic imaging (ECGI), as predictors of the origin of the PVCs, validating the ECGI. METHODS: 18 consecutive patients, 8 males, median age 55 (35-63) years that underwent ablation of PVCs with inferior axis and had ECGI performed before ablation. Isochronal activation maps of the RVOT in PVC were obtained with the ECGI and invasively. Total RVOT AD was measured as the time between earliest and latest activated region, and propagation speed by measuring the area of the first 10 ms of activation. Cut-off values for AD, activation speed and number of 10 ms isochrones to predict the origin of the PVCs, were obtained with the ROC curve analysis. Agreement between methods was done with Pearson correlation test and Bland-Altman plot. RESULTS: PVCs originated from the RVOT in 11 (61%) patients. The stronger predictor of PVC origin was the AD. The median AD in PVCs from RVOT was significantly longer than from outside the RVOT, both with ECGI and invasively, respectively 62 (58-73) vs 37 (33-40) ms, p < 0.0001 and 68 (60-75) vs 35 (29-41) ms, p < 0.0001. Agreement between the two methods was good (r = 0.864, p < 0.0001). The cut-off value of 43 ms for AD measured with ECGI predicted the origin of the PVCs with a sensitivity and specificity of 100%. CONCLUSIONS: We found good agreement between ECGI and invasive map. The AD measured with ECGI was the best predictor of the origin of the PVCs.

Electrocardiographic imaging (ECGI): What is the minimal number of leads needed to obtain a good spatial resolution?

AIMS: Assess the minimal number of ECGI leads needed to obtain a good spatial resolution. METHODS: We enrolled 20 patients that underwent ablation of premature ventricular or atrial contractions using Carto and ECGI with AMYCARD. We evaluated the agreement regarding the site of origin of the arrhythmia between the ECGI and Carto, the area and diameter of the earliest activation site obtained with the ECGI (EASa and EASd). Based on previous studies with pacemapping, we considered a good spatial resolution of the ECGI when the EASd measured on the isopotential map was less than 18 mm. In presence of agreement the ECGI was reprocessed: a) with half the number of electrode bands (8 leads per electrode band) and b) with 6 electrode bands. RESULTS: The initial map was obtained with 23 (22-23) electrode bands per patient, corresponding to 143 (130-170) leads. Agreement rate was 85%, the median EASa and EASd were: 0.7 (0.5-1.3) cm2 and 9 (8-13) mm. With half the number of electrode bands including 73 (60-79) leads, agreement rate was 80%, the EASa and EASd were: 2.1 (1.5-6.2) cm2 and 16 (14 -28) mm. With only six electrode bands using 38 (30-42) leads, agreement rate was 55%, EASa and EASd were: 4.0 (3.3-5.0) cm2 and 23 (21-25) mm. The number of leads was a predictor of agreement with a good spatial resolution, OR (95% CI) of 1.138 (1.050-1.234), p = .002. According to the ROC curve, the minimal number of leads was 74 (AUC 0.981; 95% CI: 0.949-1.00, p < .0001). CONCLUSION: Reducing the number of leads was associated with a lower agreement rate and a significant reduction of spatial resolution. However, the number of leads needed to achieve a good spatial resolution was less than the maximal available.

Non-invasive electrocardiographic imaging in patients with idiopathic premature ventricular contractions from the right ventricular outflow tract: New insights into arrhythmia substrate.

AIMS: The aim of this study was to use non-invasive electrocardiographic imaging (ECGI) to study the electrophysiological properties of right ventricular outflow tract (RVOT) in patients with frequent premature ventricular contractions (PVCs) from the RVOT and in controls. METHODS: ECGI is a combined application of body surface electrocardiograms and computed tomography or magnetic resonance imaging data. Unipolar electrograms are reconstructed on the epicardial and endocardial surfaces. Activation time (AT) was defined as the time of maximal negative slope of the electrogram (EGM) during QRS, recovery time (RT) as the time of maximal positive slope of the EGM during T wave, Activation recovery interval (ARI) was defined as the difference between RT and AT. ARI dispersion (Δ ARI) and RT dispersion (Δ RT) were calculated as the difference between maximal and minimal ARI and RT respectively. We evaluated those parameters in patients with frequent PVCs from the RVOT, defined as >10.000 per 24 h, and in a control group. RESULTS: We studied 7 patients with frequent RVOT PVCs and 17 controls. Patients with PVCs from the RVOT had shorter median RT than controls, in the endocardium and in the epicardium, respectively 380 (239-397) vs 414 (372-448) ms, p = 0.047 and 275 (236-301) vs 330 (263-418) ms, p = 0.047. The dispersion of ARI and of RT in the epicardium was higher than in controls, Δ ARI of 145 (68-216) vs 17 (3-48) ms, p = 0.001 and Δ RT of 201 (160-235) vs 115 (65-177), p = 0.019. CONCLUSION: In this group of patients we found a shorter median RT in the endocardium and in the epicardium of the RVOT and a higher dispersion of the ARI and RT across the epicardium in patients with PVCs from the RVOT when comparing to controls.

The Immediate Effects of a Dynamic Orthosis on Gait Patterns in Children With Unilateral Spastic Cerebral Palsy: A Kinematic Analysis.

This study analyzes the immediate effects of wearing a Therasuit on sagittal plane lower limb angular displacements during gait in children with unilateral spastic cerebral palsy (US-CP). Seven participants (median age = 7.00 years; ranging from 5.83 to 9.00 years) with US-CP, levels I and II of the Gross Motor Function Classification System, were assessed with kinematic gait analysis in three different conditions: (A) Baseline; (B) Therasuit without elastics and (C) Therasuit with elastics. Significant improvements were observed at the hip joint of both lower limbs during most of the gait cycle in participants wearing a Therasuit, including a decrease in the flexion pattern at the initial contact and swing phase in both lower limbs, and an increase in the extension pattern in the paretic lower limb during the stance phase. At the knee joint in the paretic lower limb, significant differences were found between the baseline and Therasuit with elastics conditions on the knee angle at initial contact, and between baseline and both Therasuit conditions on the flexion angle at swing phase. However, the inter-individual variability in kinematic patterns at the knee joint was high. At the ankle joint, decreased plantar flexion at initial contact and increased dorsiflexion during stance and swing phases were observed at the Therasuit with elastics condition, helping to correct the equinus-foot in the paretic lower limb during the whole gait cycle. The Z-values showed large effect sizes particularly for most of the angular hip variables in both lower limbs and for the angular ankle variables in the paretic lower limb. The Therasuit seems to have some positive immediate effects on gait kinematics in children with spastic unilateral cerebral palsy by providing a more functional and safer gait pattern. Future investigations with larger samples are recommended to further support these findings.

A Casa da Misericórdia no contexto da arquitetura portuguesa da saúde na centúria do oitocentos em Portugal / The House of Mercy in the context of the Portuguese architecture of health in the century of eight hundred in Portugal

Este capítulo pretende estudar a Casa da Misericórdia no contexto da arquitetura da saúde promovida em Portugal durante o século XIX. A Casa da Misericórdia enquadra-se na tipologia de arquitetura assistencial, incluindo finalidades como o acolhimento e tratamento de doentes, mais relevante em Portugal na época moderna. O conceito foi desenvolvido com base na análise da realidade arquitetônica das Misericórdias do século XVI e é, igualmente, válido para os séculos XVII e XVIII. Todavia, uma vez que a realidade do século XIX é bastante mais complexa, pelos motivos que explicitaremos mais à frente, interessa-nos avaliar o papel da Casa da Misericórdia nesse período no âmbito das restantes tipologias de arquitetura da saúde.(AU)

Genomic Resources Notes Accepted 1 June 2015-31 July 2015.

This article documents the public availability of (i) microbiomes in diet and gut of larvae from the dipteran Dilophus febrilis using massive parallel sequencing, (ii) SNP and SSR discovery and characterization in the transcriptome of the Atlantic mackerel (Scomber scombrus, L) and (iii) assembled transcriptome for an endangered, endemic Iberian cyprinid fish (Squalius pyrenaicus).

Influence of aesthetic appreciation of wildlife species on attitudes towards their conservation in Kenyan agropastoralist communities.

The influence of human aesthetic appreciation of animal species on public attitudes towards their conservation and related decision-making has been studied in industrialized countries but remains underexplored in developing countries. Working in three agropastoralist communities around Amboseli National Park, southern Kenya, we investigated the relative strength of human aesthetic appreciation on local attitudes towards the conservation of wildlife species. Using semi-structured interviewing and free listing (n = 191) as part of a mixed methods approach, we first characterized local aesthetic judgments of wildlife species. With a Generalized Linear Mixed Models (GLMM) approach, we then determined the influence of perceiving four species as beautiful on local support for their protection ("rescuing them"), and of perceiving four other species as ugly on support for their removal from the area, while controlling for informant personal and household socioeconomic attributes. Perceiving giraffe, gazelles and eland as beautiful is the strongest variable explaining support for rescuing them. Ugliness is the strongest variable influencing support for the removal of buffalo, hyena, and elephant (but not lion). Both our qualitative and quantitative results suggest that perceptions of ugly species could become more positive through direct exposure to those species. We propose that protected areas in developing countries facilitate visitation by local residents to increase their familiarity with species they rarely see or most frequently see in conflict with human interests. Since valuing a species for its beauty requires seeing it, protected areas in developing countries should connect the people who live around them with the animals they protect. Our results also show that aesthetic appreciation of biodiversity is not restricted to the industrialized world.

Global analysis of the small RNA transcriptome in different ploidies and genomic combinations of a vertebrate complex--the Squalius alburnoides.

The Squalius alburnoides complex (Steindachner) is one of the most intricate hybrid polyploid systems known in vertebrates. In this complex, the constant switch of the genome composition in consecutive generations, very frequently involving a change on the ploidy level, promotes repetitive situations of potential genomic shock. Previously in this complex, it was showed that in response to the increase in genome dosage, triploids hybrids could regulate gene expression to a diploid state. In this work we compared the small RNA profiles in the different genomic compositions interacting in the complex in order to explore the miRNA involvement in gene expression regulation of triploids. Using high-throughput arrays and sequencing technologies we were able to verify that diploid and triploid hybrids shared most of their sequences and their miRNA expression profiles were high correlated. However, an overall view indicates an up-regulation of several miRNAs in triploids and a global miRNA expression in triploids higher than the predicted from an additive model. Those results point to a participation of miRNAs in the cellular functional stability needed when the ploidy change.