Feasibility of three-dimensional artificial intelligence algorithm integration with intracardiac echocardiography for left atrial imaging during atrial fibrillation catheter ablation.

AIMS: Intracardiac echocardiography (ICE) is a useful but operator-dependent tool for left atrial (LA) anatomical rendering during atrial fibrillation (AF) ablation. The CARTOSOUND FAM Module, a new deep learning (DL) imaging algorithm, has the potential to overcome this limitation. This study aims to evaluate feasibility of the algorithm compared to cardiac computed tomography (CT) in patients undergoing AF ablation. METHODS AND RESULTS: In 28 patients undergoing AF ablation, baseline patient information was recorded, and three-dimensional (3D) shells of LA body and anatomical structures [LA appendage/left superior pulmonary vein/left inferior pulmonary vein/right superior pulmonary vein/right inferior pulmonary vein (RIPV)] were reconstructed using the DL algorithm. The selected ultrasound frames were gated to end-expiration and max LA volume. Ostial diameters of these structures and carina-to-carina distance between left and right pulmonary veins were measured and compared with CT measurements. Anatomical accuracy of the DL algorithm was evaluated by three independent electrophysiologists using a three-anchor scale for LA anatomical structures and a five-anchor scale for LA body. Ablation-related characteristics were summarized. The algorithm generated 3D reconstruction of LA anatomies, and two-dimensional contours overlaid on ultrasound input frames. Average calculation time for LA reconstruction was 65 s. Mean ostial diameters and carina-to-carina distance were all comparable to CT without statistical significance. Ostial diameters and carina-to-carina distance also showed moderate to high correlation (r = 0.52-0.75) except for RIPV (r = 0.20). Qualitative ratings showed good agreement without between-rater differences. Average procedure time was 143.7 ± 43.7 min, with average radiofrequency time 31.6 ± 10.2 min. All patients achieved ablation success, and no immediate complications were observed. CONCLUSION: DL algorithm integration with ICE demonstrated considerable accuracy compared to CT and qualitative physician assessment. The feasibility of ICE with this algorithm can potentially further streamline AF ablation workflow.

Comparative effectiveness of catheter ablation devices in the treatment of atrial fibrillation: a network meta-analysis.

Atrial fibrillation (AF) ablation is most commonly performed using radiofrequency (RF) and cryoballoon (CB) catheters. Ablation Index is a novel lesion-quality marker associated with improved outcomes in RF ablation. Due to lack of direct comparative evidence between the latest generations of technologies, there is uncertainty regarding the best treatment option. Aim: To conduct a network meta-analysis to evaluate the comparative effectiveness of RF with Ablation Index to other catheter ablation devices in the treatment of AF. Methods: Searches for randomized and nonrandomized prospective comparative studies of ablation catheters were conducted in multiple databases. The outcome of interest was 12-month freedom from atrial arrhythmias after a single ablation procedure. Studies were grouped as high-, low- and unclear-quality based on study design and balanced baseline patient characteristics. Bayesian hierarchical network meta-analysis was conducted and results presented as relative risk ratios with 95% credible intervals (CrIs). Results: 12 studies evaluating five different catheter ablation devices were included. Radiofrequency ablation with Ablation Index was associated with statistically significantly greater probability of 12-month freedom from atrial arrhythmias than Arctic Front (relative risk: 1.77; 95% CrI: 1.21-2.87), Arctic Front Advance™ (1.41; 1.06-2.47), THERMOCOOL™ (1.34; 1.17-1.48) and THERMOCOOL SMARTTOUCH™ (1.09; 1-1.3). Results were robust in multiple sensitivity analyses. Conclusion: Radiofrequency catheter with Ablation Index is superior to currently available options for 12-month freedom from atrial arrhythmias after AF ablation. This study provides decision-makers with robust, pooled, comparative evidence of the latest ablation technologies.

Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation.

INTRODUCTION: Ablation Index, also known as VISITAG SURPOINT™, is a novel lesion-quality marker that improves outcomes in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). There is no direct evidence on the comparative effectiveness of RF ablation with Ablation Index and cryoballoon (CB). The objective of the present study was to conduct a matching-adjusted indirect comparison (MAIC) using individual patient-level data (IPD) to compare the effectiveness of RF ablation with Ablation Index to that of CB on recurrence of atrial arrhythmias 12 months after catheter ablation in patients with paroxysmal AF (PAF). METHODS: Individual patient-level data for RF ablation with Ablation Index were obtained from two studies: Solimene et al. [J Interv Card Electrophysiol 54(1):9-15, 2019] and Hussein et al. [J Cardiovasc Electrophysiol 28(9):1037-1047, 2017]. Comparable CB studies identified from a systematic literature review were pooled. Prognostic variables for adjustment were ranked a priori by several practicing electrophysiologists. In the absence of a common treatment arm between the Ablation Index and CB studies, an unanchored MAIC was conducted. Primary analysis compared the Solimene et al. study to pooled CB studies. A secondary analysis compared pooled RF ablation with Ablation Index studies to pooled CB studies. Several scenario and sensitivity analyses were conducted. RESULTS: Primary analyses showed statistically significant reductions in the rate of arrhythmia recurrence with RF ablation with Ablation Index compared to CB in unmatched, unadjusted (HR 0.50, 95% CI 0.27-0.95) and matched (0.42, 0.21-0.86) analyses. Greater reductions in the rate of arrhythmia recurrence that favored RF ablation with Ablation Index were observed after matching and adjusting for age (0.41, 0.20-0.85), age and left ventricular ejection fraction (0.37, 0.16-0.88), and age, sex, and left ventricular ejection fraction (0.30, 0.13-0.71). Secondary and sensitivity analyses showed similar reductions. CONCLUSIONS: Radiofrequency ablation with Ablation Index was associated with reductions in recurrence of atrial arrhythmias at 12 months compared to CB in unmatched and unadjusted, matched, and matched and adjusted comparisons.

Rheumatic hand's clinical, functional and imagiological correlations following metacarpophalangeal joint silicone arthroplasty.

OBJECTIVE: Evaluation of rheumatoid hand-associated metacarpophalangeal joint silicone arthroplasty most often relies on functional scores alone. This study aimed to understand the correlation between perceived and observed function, strength, and alignment. METHODS: Cross-sectional study including all 11 women (15 hands) submitted to second to fifth metacarpophalangeal joint arthroplasty due to rheumatoid arthritis involvement for a time period of seven years. Measurements relied on the Michigan Hand Outcomes Questionnaire, Lafayette Purdue Pegboard, pinch and grip strength, and analysis of a lateral "OK-sign" X-ray view. Correlation analysis used Spearman's coefficient, assuming statistical significance for p-values < 0.05. RESULTS: Objective function was strongly correlated with all other variables (p < 0.05), while perceived function failed to correlate with articular alignment in both measurements (p = 0.240 and p = 0.354). Strength and alignment were also strongly correlated (p < 0.05). CONCLUSIONS: Most measurements strongly correlate with each other, with emphasis on objective dexterity measurement.

OBJETIVO: Na maioria das vezes, a avaliação da artroplastia da articulação metacarpofalangeana com implante de silicone é feita apenas por meio de escores funcionais. Este estudo teve como objetivo compreender a correlação entre função, força e alinhamento percebidos e observados. MÉTODOS: Este estudo transversal incluiu todas as 11 mulheres (15 mãos) que foram submetidas a artroplastia metacarpofalangeana no segundo ao quinto dedo devido a artrite reumatoide em um período de sete anos. As medições basearam-se no Michigan Hand Outcomes Questionnaire, no Lafayette Purdue Pegboard e nas forças de pinça e preensão, além da análise de radiografia da mão em leque. O coeficiente de Spearman foi usado para avaliar a correlação; valores de p < 0,05 foram considerados estatisticamente significantes. RESULTADOS: A função objetiva foi fortemente correlacionada a todas as outras variáveis (p < 0,05). Por outro lado, a função percebida não foi correlacionada ao alinhamento articular em ambas as medições (p = 0,240 e p = 0,354). A força e o alinhamento também estiveram fortemente correlacionados (p < 0,05). CONCLUSÕES: A maioria das medições se correlacionou fortemente entre si, com ênfase na medição objetiva da destreza.

Rheumatic hand's clinical, functional and imagiological correlations following metacarpophalangeal joint silicone arthroplasty / Correlações clínicas, funcionais e imagiológicas após artroplastia da articulação metacarpofalangiana com implante de silicone na mão reumatoide

ABSTRACT Objective: Evaluation of rheumatoid hand-associated metacarpophalangeal joint silicone arthroplasty most often relies on functional scores alone. This study aimed to understand the correlation between perceived and observed function, strength, and alignment. Methods: Cross-sectional study including all 11 women (15 hands) submitted to second to fifth metacarpophalangeal joint arthroplasty due to rheumatoid arthritis involvement for a time period of seven years. Measurements relied on the Michigan Hand Outcomes Questionnaire, Lafayette Purdue Pegboard, pinch and grip strength, and analysis of a lateral "OK-sign" X-ray view. Correlation analysis used Spearman's coefficient, assuming statistical significance for p-values < 0.05. Results: Objective function was strongly correlated with all other variables (p < 0.05), while perceived function failed to correlate with articular alignment in both measurements (p = 0.240 and p = 0.354). Strength and alignment were also strongly correlated (p < 0.05). Conclusions: Most measurements strongly correlate with each other, with emphasis on objective dexterity measurement.

RESUMO Objetivo: Na maioria das vezes, a avaliação da artroplastia da articulação metacarpofalangeana com implante de silicone é feita apenas por meio de escores funcionais. Este estudo teve como objetivo compreender a correlação entre função, força e alinhamento percebidos e observados. Métodos: Este estudo transversal incluiu todas as 11 mulheres (15 mãos) submetidas à artroplastia metacarpofalangeana no segundo ao quinto dedo devido a artrite reumatoide em um período de sete anos. As medições basearam-se no Michigan Hand Outcomes Questionnaire, no Lafayette Purdue Pegboard e nas forças de pinça e preensão, além da análise de radiografia da mão em leque. O coeficiente de Spearman foi usado para avaliar a correlação; valores de p < 0,05 foram considerados estatisticamente significantes. Resultados: A função objetiva foi fortemente correlacionada a todas as outras variáveis (p < 0,05). Por outro lado, a função percebida não foi correlacionada ao alinhamento articular em ambas as medições (p = 0,240 e p = 0,354). A força e o alinhamento também estiveram fortemente correlacionados (p < 0,05). Conclusões: A maioria das medições se correlacionou fortemente entre si, com ênfase na medição objetiva da destreza.

Ultrastructural and molecular characterization of Glugea serranus n. sp., a microsporidian infecting the blacktail comber, Serranus atricauda (Teleostei: Serranidae), in the Madeira Archipelago (Portugal).

A new microsporidian infecting the connective tissue of the coelomic cavity of the blacktail comber Serranus atricauda, in the Madeira Archipelago (Portugal), is described on the basis of morphological, ultrastructural, and molecular features. The microsporidian formed large whitish xenomas adhering to the peritoneal visceral organs of the host. Each xenoma consisted of a single hypertrophic cell, in the cytoplasm of which mature spores proliferated within parasitophorous vacuoles surrounded by numerous collagen fibers. Mature spores were ellipsoidal and uninucleated, measuring an average of 6.5 ± 0.5 µm in length and 3.4 ± 0.6 µm in width. The anchoring disk of the polar filament was subterminal, laterally shifted from the anterior pole of the spore. The isofilar polar filament coiled in 18-19 turns, forming two rows that surrounded the posterior vacuole. The latter occupied about one third of the spore length. The polaroplast surrounding the apical and uncoiled portion of the polar filament displayed two distinct regions: a lamellar region and an electron-dense globule. Molecular analysis of the rRNA genes, including the internal transcribed spacer region, and phylogenetic analysis using maximum likelihood and neighbor joining demonstrated that this microsporidian parasite clustered with some Glugea species. Based on the differences found both at the morphological and molecular levels, to other members of the genus Glugea, the microsporidian infecting the blacktail comber is considered a new species, thus named Glugea serranus n. sp.

Larval cestodes infecting the deep-water fish, Cataetyx laticeps (Pisces: Bythitidae) from Madeira Archipelago, Atlantic Ocean.

Parasites of deep-water fishes are less known in comparison to the parasites of fishes living in the demersal and epipelagic ocean zones. In the present research note we report the occurrence of larval trypanorhynch cestodes in a rare deep-water fish, the deep-water brotula, Cataetyx laticeps. Based on the 28S rDNA (region D1-D3) sequence homology and the phylogenetic analysis, the larval cestodes are putatively assigned to the genus Grillotia. It is suggested that the definitive host of this trypanorhynch is a batoid.

Endohelminth parasites of the leafscale gulper shark, Centrophorus squamosus (Bonnaterre, 1788) (Squaliformes:Centrophoridae) off Madeira Archipelago.

The endohelminth parasite fauna of a deep water shark, the leafscale gulper shark, Centrophorus squamosus, examined from Madeiran waters, from September 2009 to January 2010, consisted of larval and juvenile cestodes of two orders, namely Trypanorhyncha and Tetraphyllidea, and L3 stages of Anisakis spp. Infection with Anisakis spp. could be due to the shark's opportunistic feeding on squids and black-scabbard fish, Aphanopus carbo, which is heavily parasitized by Anisakis spp. in Madeira waters. The occurrence of larval and juvenile cestodes only, in this shark, suggests that the leafscale gulper shark features as a paratenic or a dead-end host for the parasites.

Endohelminth parasites of the blacktail comber Serranus atricauda (Pisces: Serranidae), from Madeira Archipelago (Atlantic Ocean).

Four different endohelminth parasite taxa were found in the viscera of the blacktail comber Serranus atricauda Günther, 1874 caught in the Madeira Archipelago. Nematodes were the dominant group, represented by 2 different taxa, Hysterothylacium spp. Ward & Magath, 1917 and Procamallanus (Spirocamallanus) halitrophus Fusco & Overstreet, 1978 comb. n. Plerocerci of the trypanorhynch Pseudogrillotia epinepheli (synonym: Grillotia epinepheli) Scholz, Garippa & Scala, 1993, and cystacanths of the acanthocephalan Bolbosoma vasculosum Rudolphi, 1819 were found in the visceral cavity. New host records for P. (S.) halitrophus and P. epinepheli and the extension of the geographic distribution of these 2 parasite species provide evidence of parasite transference between the Madeira Archipelago, the Mediterranean and the Gulf of Mexico. The paucity of the parasite fauna of blacktail comber reflect a combination of fish host selective feeding on particular dietary items and its territorial behaviour.

Famílias imigrantes e escolas em Barcelona: expectativas e realidades / Immigrant families and schools in Barcelona: expectations and realities

O presente artigo apresenta alguns dos resultados da pesquisa de doutorado intitulada “Diálogo família e escola em contexto de diversidade”, realizada no Departamento de Didática e Organização Educativa da Universidade de Barcelona. O foco principal da pesquisa foi analisar as formas de comunicação entre famílias latinoamericanas e escolas catalanas para alcançar o apoio educativo dos menores imigrantes; descrever, compreender e interpretar as representações das famílias e de professores/a de educação primária acerca da comunicação em contexto de diversidade cultural e as implicações destas representações para o processo de construção do diálogo intercultural. O estudo de uma temática desta natureza se faz relevante dentro do âmbito das políticas global, nacional e local, através do desafio posto para a convivência e o diálogo intercultural em âmbito geral, em particular, no âmbito da educação.(AU)

This article presents some of the results of the PhD thesis entitled, “Dialogue, family, and school in the context of diversity”, done at the Department of Didactics and Educational Organization of the University of Barcelona. The main focus of the research was to analyze the forms of communication between Latin-American families and Catalan schools in order to gain educational support for immigrant minors; to describe, understand and interpret the representations of families and primary school teachers on communication in a context of cultural diversity and the implications of these representations for the construction process of intercultural dialogue. The study of a theme of this nature is relevant within the context of global, national and local policies, due to the challenge of coexistence and intercultural dialogue at a general level, particularly in education.(AU)

Chronic hepatitis C--assessment in civil law: a case study.

This article describes the case of a 58-year-old man who asked for an assessment of physical damage of a civil nature, having been diagnosed with chronic hepatitis C for which he blamed a blood transfusion, supposedly contaminated with hepatitis C virus (HCV). After studying the documentary information, a number of presuppositions were drawn up with a view to determining the causal nexus, but this could not be proved. The assessment of situations like this is not common in civil law. This article is intended to add to the body of information on the forensic assessment of similar cases.

Helminth parasites from the stomach of conger eel, Conger conger, from Madeira Island, Atlantic Ocean.

Geographic variations in the diversity and prevalence of helminth parasites of fish can provide important clues as to the relatedness of fish populations. In the present work, the stomachs of 64 conger eels, Conger conger, collected during 1999 and 2000, were examined for the presence of parasites. Four fish were infected with L3 stages of the nematode Anisakis simplex s.l. (Anisakidae), 1 with the nematode Cristitectus congeri (Cystidicolidae), 1 with the acanthocephalan Rhadinorhynchus pristis, 17 with postlarvae of Sphyriocephalus tergestinus (Eucestoda: Trypanorhyncha), and 55 with Lecithochirium spp. (Digenea: Hemiuridae). The hemiurids were the most abundant parasites, with a total of 385 individuals recovered. Strong aggregated distributions were found for both the digeneans, Lecithochirium musculus and Lecithochirium fusiforme, with variance-to-mean ratios (s2/x) and index of discrepancy (D) 13.98 and 0.672 (for L. musculus) and 8.08 and 0.90 for L. fusiforme, respectively. Intensity of L. musculus, L. fusiforme, and S. tergestinus showed significant relationships with depth of capture. Differences in number of species and prevalence were found between Madeira and the Atlantic coasts of the Iberian Peninsula.

Helminth component community of the loggerhead sea turtle, Caretta caretta, from Madeira Archipelago, Portugal.

The helminth fauna of pelagic-stage loggerhead sea turtles, Caretta caretta, is still poorly known. Here, we describe the helminth-component community of healthy, free-ranging juvenile loggerhead sea turtles captured in the waters around Madeira Island, Portugal. Fifty-seven were used in this study. The esophagus, stomach, intestine, liver, gallbladder, spleen, kidneys, trachea, bronchi, urinary bladder, heart, left and right aortas, and coelomic cavity were macroscopically inspected; organs and tissues were removed and washed through a sieve. A search for parasites was made using a stereoscopic microscope; recovered parasites were fixed and stored in 70% alcohol until staining and identification. Prevalence, mean intensity, and mean abundance values were recorded. In total, 156 parasite specimens belonging to 9 species were found: nematodes included Anisakis simplex s.l. (larvae) and an unidentified species; digenetic trematodes present were Enodiotrema megachondrus, Rhytidodes gelatinosus, Pyelosomum renicapite, and Calycodes anthos; acanthocephalans included Bolbosoma vasculosum and Rhadinorhynchus pristis; a single cestode, Nybelinia sp., was present. Parasite infections were found to have both low prevalences and intensities. Possible reasons for this include the oligotrophic conditions of the pelagic habitat around Madeira; a 'dilution effect' because of the vastness of the area; and the small size, and thus ingestion rate, of the turtles. Results are discussed in terms of the various turtle populations that may use the waters surrounding Madeira. This work provides valuable information on the parasite fauna of a poorly known stage in the life of loggerhead sea turtles, thereby filling a fundamental gap with regard to features of the parasite fauna in this species.

Ultrastructural description of Ceratomyxa tenuispora (Myxozoa), a parasite of the marine fish Aphanopus carbo (Trichiuridae), from the Atlantic coast of Madeira Island (Portugal).

The first ultrastructural description of Ceratomyxa tenuispora Kabata, 1960 (Myxozoa, Bivalvulida) from Madeira Island (Portugal), a parasite found in the gall bladder of the commercially important black-scabbard fish, Aphanopus carbo Lowe is presented. This parasite possesses spherical to ellipsoidal disporous trophozoites. Spores have a central crescent-shaped body averaging 11.0 microm in length, 28.5 microm in thickness and 12.1 microm in width. The valves have two long opposite lateral processes (ribbon-like structures or tails), each averaging 173 microm in length. The total thickness of the spore averages 375 microm. The spore has two sub-spherical polar capsules (approximately 5.2 x 4.1 microm), each with a polar filament with 7 to 8 coils. Some ultrastructural aspects of the sporogonic stages are described. The trophozoites develop without contact with epithelial cells. The cytoplasmic membrane has numerous evenly distributed external slender projections about 0.3 to 0.7 microm long. The sporogenesis produces two spores without pansporoblast formation. In the matrix of the capsular primordium, microtubules with an unusual organisation were observed. A binucleate sporoplasm that contains several sporoplasmosomes and dense bodies fills the spore cavity and extends to the tails without penetrating them.

Molecular characterization of larval anisakid nematodes from marine fishes of Madeira by a PCR-based approach, with evidence for a new species.

One-hundred and fifteen anisakid larvae from 3 different fish hosts, Aphanopus carbo, Scomber japonicus, and Trachurus picturatus, caught in Madeiran waters, were identified by PCR-RFLP. Three distinct species were identified in A. carbo, namely Anisakis simplex sensu srricto, Anisakis pegreffii, and Anisakis ziphidarum; 5 in S. japonicus, i.e., A. simplex s.s., A. pegreffii, Anisakis physeteris, Anisakis typica, and A. ziphidarum; and 3 in T. picturatus, i.e., A. simplex s.s., A. pegreffii, and A. typica. Anisakis simplex s.s. was the most frequent species in both A. carbo and S. japonicus (54% and 23.5%, respectively). Anisakis pegreffii and A. physeteris occurred with a frequency of 20.6% in S. japonicus, whereas in T. picturatus the most frequent species was A. typica (41.9%), followed by A. simplex s.s. (32.3%). Furthermore, A. carbo and S. japonicus were infected by an apparently undescribed taxon, provisionally named Anisakis sp. A. Based on estimations of the genetic distance, this new taxon seems to be more similar to A. ziphidarum (0.0335) than to other species of the genus.