669 research outputs found
Clinical magnetocardiography: the unshielded betâpast, present, and future
Magnetocardiography (MCG), which is nowadays 60 years old, has not yet been fully accepted as a clinical tool. Nevertheless, a large body of research and several clinical trials have demonstrated its reliability in providing additional diagnostic electrophysiological information if compared with conventional non-invasive electrocardiographic methods. Since the beginning, one major objective difficulty has been the need to clean the weak cardiac magnetic signals from the much higher environmental noise, especially that of urban and hospital environments. The obvious solution to record the magnetocardiogram in highly performant magnetically shielded rooms has provided the ideal setup for decades of research demonstrating the diagnostic potential of this technology. However, only a few clinical institutions have had the resources to install and run routinely such highly expensive and technically demanding systems. Therefore, increasing attempts have been made to develop cheaper alternatives to improve the magnetic signal-to-noise ratio allowing MCG in unshielded hospital environments. In this article, the most relevant milestones in the MCG's journey are reviewed, addressing the possible reasons beyond the currently long-lasting difficulty to reach a clinical breakthrough and leveraging the authorsâ personal experience since the early 1980s attempting to finally bring MCG to the patient's bedside for many years thus far. Their nearly four decades of foundational experimental and clinical research between shielded and unshielded solutions are summarized and referenced, following the original vision that MCG had to be intended as an unrivaled method for contactless assessment of the cardiac electrophysiology and as an advanced method for non-invasive electroanatomical imaging, through multimodal integration with other non-fluoroscopic imaging techniques. Whereas all the above accounts for the past, with the available innovative sensors and more affordable active shielding technologies, the present demonstrates that several novel systems have been developed and tested in multicenter clinical trials adopting both shielded and unshielded MCG built-in hospital environments. The future of MCG will mostly be dependent on the results from the ongoing progress in novel sensor technology, which is relatively soon foreseen to provide multiple alternatives for the construction of more compact, affordable, portable, and even wearable devices for unshielded MCG inside hospital environments and perhaps also for ambulatory patients
The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis
No abstrac
Letter by Fenici et al Regarding Articles, "Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation: Insights From a Registry Study of 2169 Patients" and "The Asymptomatic Wolff-Parkinson-White Patient: Time to be More Proactive?"
IT is a letter, no abstract availabl
When Manual Analysis of 12-Lead ECG Holter Plays a Critical Role in Discovering Unknown Patterns of Increased Arrhythmogenic Risk: A Case Report of a Patient Treated with Tamoxifen and Subsequent Pneumonia in COVID-19
Several medicines, including cancer therapies, are known to alter the electrophysiological function of ventricular myocytes
resulting in abnormal prolongation and dispersion of ventricular repolarization (quantified by multi-lead QTc measurement).
This effect could be amplified by other concomitant factors (e.g., combination with other drugs affecting the QT, and/or electrolyte
abnormalities, such as especially hypokalemia, hypomagnesaemia, and hypocalcemia). Usually, this condition results
in higher risk of torsade de point and other life-threatening arrhythmias, related to unrecognized unpaired cardiac ventricular
repolarization reserve (VRR). Being VRR a dynamic phenomenon, QT prolongation might often not be identified during the
10-s standard 12-lead ECG recording at rest, leaving the patient at increased risk for life-threatening event. We report the case of a 49-year woman, undergoing tamoxifen therapy for breast cancer, which alteration of ventricular repolarization reserve,
persisting also after correction of concomitant recurrent hypokalemia, was evidenced only after manual measurements of the
corrected QT (QTc) interval from selected intervals of the 12-lead ECG Holter monitoring. This otherwise missed finding
was fundamental to drive the discontinuation of tamoxifen, shifting to another âsaferâ therapeutic option, and to avoid the use of potentially arrhythmogenic antibiotics when treating a bilateral pneumonia in recent COVID-19
BMI Reduction Decreases AF Recurrence Rate in a Mediterranean Cohort
It's a letter, no abstract is availabl
Predictive value of unshielded magnetocardiographic mapping to differentiate atrial fibrillation patients from healthy subjects
Background: Pâwave duration, its dispersion and signalâaveraged ECG, are currently
used markers of vulnerability to atrial fibrillation (AF). However, since tangential atrial
currents are better detectable at the body surface as magnetic than electric signals,
we investigated the accuracy of magnetocardiographic mapping (MCG), recorded in
unshielded clinical environments, as predictor of AF occurrence.
Methods: MCG recordings, in sinus rhythm (SR), of 71 AF patients and 75 controls
were retrospectively analyzed. Beside electric and magnetic Pâwave and PR interval
duration, two MCG Pâwave subintervals, defined Pâdep and Pârep, were measured,
basing on the point of inversion of atrial magnetic field (MF). Eight parameters were
calculated from inverse solution with âEffective Magnetic Dipole (EMD) modelâ and
5 from âMF Extremaâ analysis. Discriminant analysis (DA) was used to assess MCG
predictive accuracy to differentiate AF patients from controls.
Results: All but one (Pârep) intervals were significantly longer in AF patients. At univariate
analysis, three EMD parameters differed significantly: in AF patients, the dipoleâ
angleâelevation angular speed was lower during Pâdep (p < 0.05) and higher
during Pârep (p < 0.001) intervals. The spaceâtrajectory during Pârep and the angledynamics
during Pâdep were higher (p < 0.05), whereas ratioâdynamics Pâdep was
lower (p < 0.01), in AF. At DA, with a combination of MCG and clinical parameters,
81.5% accuracy in differentiating AF patients from controls was achieved. At Coxâregression,
the angleâdynamics Pâdep was an independent predictor of AF recurrences
(p = 0.037).
Conclusions: Quantitative analysis of atrial MF dynamics in SR and the solution of
the inverse problem provide new sensitive markers of vulnerability to AF
Treating chronic anal fissure with botulinum neurotoxin
Recent reports confirm that the management of chronic anal fissure has undergone extensive re-evaluation during the past few years. This rejuvenation of interest is attributable to the application of neurochemical treatment, which has contributed to the tendency to treat the disease on an outpatient basis. The use of botulinum neurotoxin seems to be a promising and safe approach for the treatment of chronic anal fissure, particularly in patients at high risk for incontinence. Indeed, botulinum neurotoxin has been successfully used selectively to weaken the internal anal sphincter as a treatment for chronic anal fissure. It is also more efficacious than nitrate therapy, and is not related to the patient's willingness to complete treatment
Anastomotic leakage in colorectal cancer surgery
The safety of colorectal surgery for oncological disease is steadily improving, but anastomotic leakage is still the most feared and devastating complication from both a surgical and oncological point of view. Anastomotic leakage affects the outcome of the surgery, increases the times and costs of hospitalization, and worsens the prognosis in terms of short- and long-term outcomes. Anastomotic leakage has a wide range of clinical features ranging from radiological only finding to peritonitis and sepsis with multi-organ failure. C-reactive protein and procalcitonin have been identified as early predictors of anastomotic leakage starting from postoperative day 2â3, but abdominal-pelvic computed tomography scan is still the gold standard for the diagnosis. Several treatments can be adopted for anastomotic leakage. However, there is not a universally accepted flowchart for the management, which should be individualized based on patient's general condition, anastomotic defect size and location, indication for primary resection and presence of the proximal stoma. Nonâoperative management is usually preferred in patients who underwent proximal faecal diversion at the initial operation. Laparoscopy can be attempted after minimal invasive surgery and can reduce surgical stress in patients allowing a definitive treatment. Reoperation for sepsis control is rarely necessary in those patients who already have a diverting stoma at the time of the leak, especially in extraperitoneal anastomoses. In patients without a stoma who do not require abdominal reoperation for a contained pelvic leak, there are several treatment options, including laparoscopic diverting ileostomy combined with trans-anal anastomotic tube drainage, percutaneous drainage or recently developed endoscopic procedures, such as stent or clip placement or endoluminal vacuumâassisted therapy. We describe the current approaches to treat this complication, as well as the clinical tests necessary to diagnose and provide an effective therapy
Magnetocardiographic evaluation of nonarrhythmogenic flecainide-induced electrocardiographic T-wave inversion
No abstract availabl
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