Myocardial remodelling and tissue characterisation by cardiovascular magnetic resonance (CMR) in endurance athletes

Our purpose was to evaluate by cardiovascular magnetic resonance (CMR) the presence of diffuse as well as focal MF in a series of high-performance veteran endurance athletes. Thirty-four veteran healthy male endurance athletes, still being in regular training, with more than 10 years of training underwent a CMR. A cardiopulmonary exercise test was also performed to assess their maximal physical performance. The control group consisted in 12 non-trained normal individuals. We found an increase in both, right and left ventricular (LV) volumes in the athlete's group when compared with controls. There was no increase in indexed LV myocardial mass despite of a significantly increased maximal myocardial wall thickness in comparison to controls. Native T1 values and extracellular volume (ECV) were normal in all cases. We did not find differences in native T1 values and ECV between both groups. In three athletes (9%), non-ischaemic late gadolinium enhancement (LGE) was observed. We did not find a correlation between total training volume and presence of LGE or with the ECV value. Our results show that the majority of veteran endurance athletes present with myocardial remodelling without MF as a physiological adaptive phenomenon. In the only three athletes with focal MF, the LGE pattern observed suggests an intercurrent event not related with the remodelling phenomenon

Resistance to autosomal dominant Alzheimer's disease in an APOE3 Christchurch homozygote: a case report.

We identified a PSEN1 (presenilin 1) mutation carrier from the world's largest autosomal dominant Alzheimer's disease kindred, who did not develop mild cognitive impairment until her seventies, three decades after the expected age of clinical onset. The individual had two copies of the APOE3 Christchurch (R136S) mutation, unusually high brain amyloid levels and limited tau and neurodegenerative measurements. Our findings have implications for the role of APOE in the pathogenesis, treatment and prevention of Alzheimer's disease

Deciphering multiple sclerosis disability with deep learning attention maps on clinical MRI

Deep learning; Disability; Structural MRIAprendizaje profundo; Discapacidad; Resonancia magnética estructuralAprenentatge profund; Discapacitat; Ressonància magnètica estructuralThe application of convolutional neural networks (CNNs) to MRI data has emerged as a promising approach to achieving unprecedented levels of accuracy when predicting the course of neurological conditions, including multiple sclerosis, by means of extracting image features not detectable through conventional methods. Additionally, the study of CNN-derived attention maps, which indicate the most relevant anatomical features for CNN-based decisions, has the potential to uncover key disease mechanisms leading to disability accumulation. From a cohort of patients prospectively followed up after a first demyelinating attack, we selected those with T1-weighted and T2-FLAIR brain MRI sequences available for image analysis and a clinical assessment performed within the following six months (N = 319). Patients were divided into two groups according to expanded disability status scale (EDSS) score: ≥3.0 and < 3.0. A 3D-CNN model predicted the class using whole-brain MRI scans as input. A comparison with a logistic regression (LR) model using volumetric measurements as explanatory variables and a validation of the CNN model on an independent dataset with similar characteristics (N = 440) were also performed. The layer-wise relevance propagation method was used to obtain individual attention maps. The CNN model achieved a mean accuracy of 79% and proved to be superior to the equivalent LR-model (77%). Additionally, the model was successfully validated in the independent external cohort without any re-training (accuracy = 71%). Attention-map analyses revealed the predominant role of frontotemporal cortex and cerebellum for CNN decisions, suggesting that the mechanisms leading to disability accrual exceed the mere presence of brain lesions or atrophy and probably involve how damage is distributed in the central nervous system.MS PATHS is funded by Biogen. This study has been possible thanks to a Junior Leader La Caixa Fellowship awarded to C. Tur (fellowship code is LCF/BQ/PI20/11760008) by “la Caixa” Foundation (ID 100010434). The salaries of C. Tur and Ll. Coll are covered by this award

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.

Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus. This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively. IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102). In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up

Short communication. First field assessment of Bacillus thuringiensis subsp. kurstaki aerial application on the colony performance of Apis mellifera L. (Hymenoptera: Apidae)

<p>Honeybee populations around the world are experiencing a decrease in colony numbers probably due to a combination of different causes, such as diseases, poor nutrition and frequent applications of insecticides to control pests. Previous studies about the effect of pesticide <em>Bacillus thuringiensis</em> subsp. <em>kurstaki</em> (<em>Btk</em>) on <em>Apis mellifera</em> L. report different results.<em> </em>The aim of this study was to analyze the effect of field aerial applications of <em>Btk</em> on bee colony performance, specifically on the brood cell percentage evolution, which can be used as an indicator of queen health and brood development breeding rates. To achieve it, the brood cell surface was photographed in every sampling, and data were analyzed using a method based on image treatment software. A total of 480 pictures were examined from two groups of four nucleus hives in two areas, one receiving aerial spraying with <em>Btk</em> and the other without treatment. A mixed factorial design was realized to analyse the data showing no differences in colony performance between the two groups of colonies either before the treatment, during and at the end of the assay. Furthermore, the brood surface ratio of <em>Btk-</em>treated/untreated increased along the experiment. Therefore, the results of the present study suggest that <em>Btk</em> aerial applications did not affect the brood development of honeybees under natural conditions. Nevertheless further field studies are required to ascertain a safe use of <em>Btk</em> in forest pest management.</p

First field assessment of Bacillus thuringiensis subsp. kurstaki aerial application on the colony performance of Apis mellifera L. (Hymenoptera: Apidae: short communication

Honeybee populations around the world are experiencing a decrease in colony numbers probably due to a combination of different causes, such as diseases, poor nutrition and frequent applications of insecticides to control pests. Previous studies about the effect of pesticide Bacillus thuringiensis subsp. kurstaki (Btk) on Apis mellifera L. report different results. The aim of this study was to analyze the effect of field aerial applications of Btk on bee colony performance, specifically on the brood cell percentage evolution, which can be used as an indicator of queen health and brood development breeding rates. To achieve it, the brood cell surface was photographed in every sampling, and data were analyzed using a method based on image treatment software. A total of 480 pictures were examined from two groups of four nucleus hives in two areas, one receiving aerial spraying with Btk and the other without treatment. A mixed factorial design was realized to analyse the data showing no differences in colony performance between the two groups of colonies either before the treatment, during and at the end of the assay. Furthermore, the brood surface ratio of Btktreated/ untreated increased along the experiment. Therefore, the results of the present study suggest that Btk aerial applications did not affect the brood development of honeybees under natural conditions. Nevertheless further field studies are required to ascertain a safe use of Btk in forest pest managemen

App-based supplemental exercise during inpatient orthopaedic rehabilitation increases activity levels: a pilot randomised control trial

Abstract Background There is a known positive relationship between time in therapy and therapy outcomes. Effective rehabilitation should therefore include larger doses of therapy. However, individuals participating in inpatient rehabilitation have low levels of activity throughout the day. This level of inactivity may limit rehabilitation potential. New technologies which deliver personalised exercise programs and track time spent on exercises may lead to greater activity levels and therefore improve functional outcomes in rehabilitation. This pilot randomised control trial aimed to investigate whether an app-based supplemental exercise program in orthopaedic rehabilitation will be feasible and acceptable to participants, increase activity levels and improve functional outcomes. Methods Participants were randomised to receive supplemental exercise via an app (PTPal™) on a tablet device additional to usual care or usual care alone. Primary outcome measures were participant satisfaction with app-based supplemental exercise, total repetitions of each activity and time in supplemental exercise programs. Secondary measures were 10-m walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG), Functional Independence Measure and length of stay assessed by a blinded assessor. Results Twenty individuals admitted into an inpatient private general rehabilitation unit for orthopaedic rehabilitation over a 4-week duration were included in this study. High acceptance of the app-based supplemental exercise program was demonstrated. Those using the app completed an additional 549 exercise repetitions during their admission (694 supplemental app-based repetitions vs 146 supplemental paper-based repetitions in the control group, mean difference [MD] 549, 95% CI 95 to 1002, p = 0.02) and an additional 157 min in supplemental exercise throughout their admission (195.3 min vs 38.7 min, MD 157 min, 95% CI 0.9–312.3 min, p = 0.05). There was insufficient power to demonstrate statistical significance in functional outcomes, but a trend towards improved functional outcomes was observed in the intervention group. Conclusion An app-based exercise program increases activity levels, is feasible and is a safe intervention with the potential to improve functional outcomes. This pilot study should be followed with a larger study powered to demonstrate functional effects with more participants having greater impairment. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR); trial number ACTRN12617000817347. This study was retrospectively registered (registration date 05/06/2017)

Wick action in concrete

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