The myocardial ischemia evaluated by real-time contrast echocardiography may predict the response to cardiac resynchronization therapy: a large animal study.

Evidence-based criteria for applying cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy are still scarce. The aim of the present study was to evaluate the predictive value of real-time myocardial contrast echocardiography (RT-MCE) in a preclinical canine model of ischemic cardiomyopathy who received CRT. Ischemic cardiomyopathy was produced by ligating the first diagonal branch in 20 beagles. Dogs were subsequently divided into two groups that were either treated with bi-ventricular pacing (CRT group) or left untreated (control group). RT-MCE was performed at baseline, before CRT, and 4 weeks after CRT. Two-dimensional speckle tracking imaging was used to evaluate the standard deviation of circumferential (Cir12SD), radial (R12SD), and longitudinal (L12SD) strains of left ventricular segments at basal as well as middle levels. Four weeks later, the Cir12SD, R12SD, and myocardial blood flow (MBF) of the treated group were significantly improved compared to their non-CRT counterparts. Furthermore, MBF values measured before CRT were significantly higher in responders than in non-responders to bi-ventricular pacing. Meanwhile, no significant differences were observed between the responder and non-responder groups in terms of Cir12SD, R12SD, and L12SD. A high degree of correlation was found between MBF values before CRT and LVEF after CRT. When MBF value>24.9 dB/s was defined as a cut-off point before CRT, the sensitivity and specificity of RT-MCE in predicting the response to CRT were 83.3% and 100%, respectively. Besides, MBF values increased significantly in the CRT group compared with the control group after 4 weeks of pacing (49.8±15.5 dB/s vs. 28.5±4.6 dB/s, p<0.05). Therefore, we considered that myocardial perfusion may be superior to standard metrics of LV synchrony in selecting appropriate candidates for CRT. In addition, CRT can improve myocardial perfusion in addition to cardiac synchrony, especially in the setting of ischemic cardiomyopathy

An Improved Extreme Learning Machine (ELM) Algorithm for Intent Recognition of Transfemoral Amputees With Powered Knee Prosthesis

To overcome the challenges posed by the complex structure and large parameter requirements of existing classification models, the authors propose an improved extreme learning machine (ELM) classifier for human locomotion intent recognition in this study, resulting in enhanced classification accuracy. The structure of the ELM algorithm is enhanced using the logistic regression (LR) algorithm, significantly reducing the number of hidden layer nodes. Hence, this algorithm can be adopted for real-time human locomotion intent recognition on portable devices with only 234 parameters to store. Additionally, a hybrid grey wolf optimization and slime mould algorithm (GWO-SMA) is proposed to optimize the hidden layer bias of the improved ELM classifier. Numerical results demonstrate that the proposed model successfully recognizes nine daily motion modes including low-, mid-, and fast-speed level ground walking, ramp ascent/descent, sit/stand, and stair ascent/descent. Specifically, it achieves 96.75% accuracy with 5-fold cross-validation while maintaining a real-time prediction time of only 2 ms. These promising findings highlight the potential of onboard real-time recognition of continuous locomotion modes based on our model for the high-level control of powered knee prostheses

Urethral cavernous hemangioma: a highly misdiagnosed disease (a case report of two patients and literature review)

Abstract Background Diagnosis of urethral cavernous hemangioma (UCH) is very rare. It can be easy to misdiagnose and mistreat due to its atypical clinical manifestations and a lack of relevant knowledge. The study is to explore the diagnosis, differential diagnosis, and treatment of UCH. Case presentation The first patient was a 15-year-old male, who was admitted to the hospital for more than 1 year with repeated hematuria. UCH was diagnosed by cystoscope biopsy, and cured with local injection of pingyangmycin. The second patient was a 49-year-old male, who was admitted for repeated painless gross hematuria and intermittent urethral bleeding after penile erection for more than 20 years. The case had been misdiagnosed as seminal vesiculitis, urethritis, or prostatitis, for over 20 years, until it was diagnosed as UCH by MR examination of the penis. It was treated by injection of pingyangmycin into the hemangioma’s lumen and base. A small incision in the ventral penile area was separated from the location of the hemangioma, which was injected with pingyangmycin again. A biopsy of resected tissue further confirmed the diagnosis of UCH. Conclusions UCH is an easily misdiagnosed disease. Intermittent painless hematuria is important characteristic of UCH. Local injection of pingyangmycin is a good option for treatment of UCH

The echocardiographic parameters of the two groups at baseline, before, and after CRT.

<p>*<i>p</i><0.05 compared to that before CRT;</p>†<p><i>p</i><0.05 compared to control group.</p><p>The echocardiographic parameters of the two groups at baseline, before, and after CRT.</p

The echocardiographic parameters between responders and non-responders.

<p>*<i>p</i><0.05 compared to that before CRT;</p>†<p><i>p</i><0.05 compared to non-response group.</p><p>The echocardiographic parameters between responders and non-responders.</p

An illustration of LVEF, LVEDV, LVESV, Cir12SD, R12SD, L12SD, and MBF between response group and non-response group.

<p>The MBF was significantly improved in response group. LVEF = left ventricular ejection fraction; LVEDV = left ventricular end diastolic volume; LVESV = left ventricular end systolic volume; Cir12SD = standard deviation of the time-to-peak of the transmural regional circumferential strain; R12SD = standard deviation of the time-to-peak of the transmural regional radial strain; L12SD = standard deviation of the time-to-peak of the transmural regional longitudinal strain; MBF = myocardial blood flow.</p