Event reconstruction for KM3NeT/ORCA using convolutional neural networks

The KM3NeT research infrastructure is currently under construction at two locations in the Mediterranean Sea. The KM3NeT/ORCA water-Cherenkov neutrino detector off the French coast will instrument several megatons of seawater with photosensors. Its main objective is the determination of the neutrino mass ordering. This work aims at demonstrating the general applicability of deep convolutional neural networks to neutrino telescopes, using simulated datasets for the KM3NeT/ORCA detector as an example. To this end, the networks are employed to achieve reconstruction and classification tasks that constitute an alternative to the analysis pipeline presented for KM3NeT/ORCA in the KM3NeT Letter of Intent. They are used to infer event reconstruction estimates for the energy, the direction, and the interaction point of incident neutrinos. The spatial distribution of Cherenkov light generated by charged particles induced in neutrino interactions is classified as shower- or track-like, and the main background processes associated with the detection of atmospheric neutrinos are recognized. Performance comparisons to machine-learning classification and maximum-likelihood reconstruction algorithms previously developed for KM3NeT/ORCA are provided. It is shown that this application of deep convolutional neural networks to simulated datasets for a large-volume neutrino telescope yields competitive reconstruction results and performance improvements with respect to classical approaches

Event reconstruction for KM3NeT/ORCA using convolutional neural networks

The KM3NeT research infrastructure is currently under construction at two locations in the Mediterranean Sea. The KM3NeT/ORCA water-Cherenkov neutrino de tector off the French coast will instrument several megatons of seawater with photosensors. Its main objective is the determination of the neutrino mass ordering. This work aims at demonstrating the general applicability of deep convolutional neural networks to neutrino telescopes, using simulated datasets for the KM3NeT/ORCA detector as an example. To this end, the networks are employed to achieve reconstruction and classification tasks that constitute an alternative to the analysis pipeline presented for KM3NeT/ORCA in the KM3NeT Letter of Intent. They are used to infer event reconstruction estimates for the energy, the direction, and the interaction point of incident neutrinos. The spatial distribution of Cherenkov light generated by charged particles induced in neutrino interactions is classified as shower-or track-like, and the main background processes associated with the detection of atmospheric neutrinos are recognized. Performance comparisons to machine-learning classification and maximum-likelihood reconstruction algorithms previously developed for KM3NeT/ORCA are provided. It is shown that this application of deep convolutional neural networks to simulated datasets for a large-volume neutrino telescope yields competitive reconstruction results and performance improvements with respect to classical approaches

Application of echocardiography in oncology – practical remarks

The paper presents the contemporary use of echocardiography in diagnosis of primary and metastatic tumors of the heart as well as in assessment of cardiovascular risk related to medical and interventional oncological therapy. Authors described the role of echocardiography in qualification for pericardiocentesis, cancer surgery and chemotherapy. The accuracy of echocardiography in evaluation of cardiac function was discussed in the context of recognizing cardiotoxicity of anticancer therapy. The historical and current definitions of iatrogenic myocardial damage and dysfunction were summarized. Finally, key recommendations derived from polish and foreign clinical guidelines for the use of echocardiography in patients with cancer were presented.Artykuł przedstawia współczesne zastosowanie echokardiografii w wykrywaniu pierwotnych i przerzutowych nowotworów serca oraz w ocenie ryzyka sercowo-naczyniowego związanego z farmakologicznym i zabiegowym leczeniem nowotworów. Omówiono w nim rolę echokardiografii w kwalifikacji do perikardiocentezy, onkologicznych zabiegów operacyjnych oraz chemioterapii. Krytycznie przedstawiono dokładność echokardiograficznej oceny funkcji mięśnia sercowego w kontekście rozpoznawania kardiotoksyczności leczenia przeciwnowotworowego. Zestawiono historyczne i obowiązujące definicje jatrogennej dysfunkcji skurczowej serca. Przedstawiono obecnie obowiązujące polskie i zagraniczne rekomendacje dotyczące zastosowań echokardiografii u chorych z nowotworami

Arytmogenna kardiomiopatia prawej komory u chorego z anomalią tętnic wieńcowych i częstoskurczem komorowym wywołanym wysiłkiem fizycznym

A 18-year-old patient with abnormal origin of right coronary artery and ventricular tachycardia during exercises is presented. Myocardial biopsy revealed arrhythmogenic right ventricular cardiomyopathy.A 18-year-old patient with abnormal origin of right coronary artery and ventricular tachycardia during exercises is presented. Myocardial biopsy revealed arrhythmogenic right ventricular cardiomyopathy

Severe aortic stenosis in a patient with breast cancer

We present a case of 68-year-old female with severe symptomatic aortic stenosis and locally advanced breast cancer disqualified from mastectomy due to heart failure and from aortic valve replacement due to malignant neoplasm. The patient received neoadjuvant chemotherapy without anthracyclines. The aortic valve replacement was performed and then mastectomy and lymphadenectomy were made without hemodynamic complications. Adjuvant hormonotherapy was started. During 42 months of follow-up the patient remained free of recurrent cancer disease as well as no progression of heart failure was observed

Assessment of Clinical Usefulness of Resting Electrocardiogram (PH-ECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Background: Balloon pulmonary angioplasty (BPA) is a form of therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The study objective is to assess the clinical usefulness of resting ECG (PH-ECG score) in monitoring the efficacy of BPA in CTEPH patients. Methods and results: Ninety-four (n = 94) CTEPH patients were included in the analysis. A standard 12-lead-ECG was performed before the first BPA session and after completion of treatment. The whole analysed population (n = 94) was divided into the following two groups: derivation cohort (n = 41) and validation cohort (n = 53). The derivation cohort was divided into the following two subgroups: patients with mean pulmonary artery pressure (mPAP) after the completion of therapy < 25 mmHg (n = 21) and patients with mPAP after the completion of therapy ≥ 25 mmHg (n = 20). In the first subgroup, four (R-wave V1 + S-wave V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave V1 > S-wave V1, SIQIII pattern) of the six ECG parameters of overload of the right cardiac chambers showed statistically significant differences (p < 0.005). That was followed by a determination of the sensitivity and specificity, positive (PPV) and negative predictive value (NPV), and ROC curve (AUC 0.9; 95% CI: 0.792–1.000) for the variable that was a sum of the above four ECG parameters (PH-ECG score). The absence of all of the four ECG parameters at rest (PH-ECG score = 0) well reflected patients with mPAP < 25 mmHg (sensitivity, 100%; specificity, 80%; PPV, 84%; NPV, 100%). In the validation cohort with mPAP < 25 mmHg and PH-ECG score = 0, sensitivity, specificity, PPV, and NPV were 86%, 77%, 73%, and 89%, respectively. Conclusions: Resting ECG trace is clinically useful in the monitoring of therapeutical effects of BPA in CTEPH patients

Pericardiocentesis and pericardial therapy aspects in cancer patients – a case report

The malignancy related pericardial effusion has variable dynamics, and the clinical presentation and severity of symptoms are directly related to the degree of hemodynamic conditions and the rate of fluid accumulation in the pericardial cavity. Neoplastic pericardial effusion often leads to cardiac tamponade, usually is recurrent, may cause constrictive pericarditis, and sometimes is the first symptom of the neoplastic disease. We present a case report of female patient with malignant pericardial effusion, cardiac tamponade, in which oncologists and cardiologists collaboration led to effective pericardiocentesis and catheter drainage of pericardium. The patient was qualified for local chemotherapy with cisplatin. The intrapericardial treatment resulted in relieving symptoms, reducing recurrence of pericardial effusion and allowed to the continuation of systemic chemotherapy. The following sections discuss the current possibilities of intrapericardial pharmacotherapy.Przebieg procesu nowotworowego z towarzyszącym wysiękiem płynu do worka osierdziowego ma zmienną dynamikę, a obraz kliniczny i nasilenie objawów związane są bezpośrednio ze stopniem zaburzeń hemodynamicznych i szybkością narastania płynu w jamie osierdzia. Wysięk nowotworowy do worka osierdziowego prowadzi niejednokrotnie do tamponady serca, przeważnie ma charakter nawracający i może powodować konstrykcję osierdziową, a nierzadko bywa pierwszym objawem samej choroby nowotworowej. Prezentujemy przypadek pacjentki z nowotworowym wysiękiem do osierdzia i tamponadą serca, u której współpraca onkologów z kardiologami zaowocowała szybkim ustaleniem wskazań do perikardiocentezy i drenażu cewnikowego osierdzia. Chora była leczona doosierdziowo cisplatyną, z dobrym efektem w postaci ustąpienia objawów, braku nawrotów płynu w worku osierdziowym, co umożliwiło kontynuowanie chemioterapii. Dokonano przeglądu aktualnych możliwości farmakoterapii doosierdziowej

Assessment of electrocardiographic markers of acute and long‐term hemodynamic improvement in patients with pulmonary hypertension

Abstract Background The remodeling of the right heart in patients with chronic pulmonary hypertension (cPH) is associated with the appearance of electrocardiographic (ECG) abnormalities. We investigated the resolution of ECG markers of right ventricular hypertrophy (RVH) caused by acute and long‐term hemodynamic improvement. Methods Twenty‐nine (29) patients with chronic thromboembolic pulmonary hypertension (CTEPH) and seven patients with pulmonary arterial hypertension (PAH) were included in the analysis. Patients with CTEPH achieved a significant long‐term hemodynamic improvement following the treatment with balloon pulmonary angioplasty (BPA); all the patients with PAH reported significant acute hemodynamic relief after a single inhalation of iloprost, fulfilling the criteria of responder. Standard 12‐lead ECG was performed before and after intervention. Results The interval between baseline and control ECG in CTEPH and PAH groups was 28 (IQR: 17–36) months and 15 min (IQR: 11–17), respectively. Despite similar hemodynamic improvement in both groups, only the CTEPH group presented significant changes in most analyzed ECG parameters: T‐wave axis (p = .002), QRS‐wave axis (p = .012), P‐wave amplitude (p < .001) and duration in II (p = .049), R‐wave amplitude in V1 (p = .017), R:S ratio in V1 (p = .046), S‐wave amplitude in V5 (p = .004), R‐wave amplitude in V5 (p = .044), R:S ratio in V5 (p = .004), S‐wave amplitude in V6 (p = .026), R‐wave amplitude in V6 (p = .01), and R‐wave amplitude in aVR (p = .031). In patients with PAH, significant differences were found only for P wave in II (duration: p = .035; amplitude: p = .043) and QRS axis (p = .018). Conclusions The effective treatment of cPH ensures improvement in ECG parameters of RVH, but it requires extended time

Zmiana strategii balonowej angioplastyki tętnic płucnych zmniejsza częstość powikłań u chorych z przewlekłym zakrzepowo-zatorowym nadciśnieniem płucnym. Doświadczenia jednego europejskiego ośrodka

Background and aim: To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve “web” and “ring” lesions using reduced tip load guidewires and less intensive anticoagulation. Results: There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with &gt; 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p &lt; 0.001). Conclusions: Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.Wstęp i cel: Celem pracy była ocena bezpieczeństwa i skuteczności udoskonalonej strategii przezskórnej angioplastyki balonowej (BPA) u pacjentów z przewlekłym zakrzepowo-zatorowym nadciśnieniem płucnym (CTEPH). Metody: Wykonano 157 zabiegów BPA u 56 osób z CTEPH (wiek 58,6 ± 17,9 roku; 28 kobiet). Pierwszych 50 zabiegów polegało na rewaskularyzacji przewlekłych niedrożności w tętnicach płucnych i zapobieganiu nawrotom zwężeń poprzez intensywną antykoagulację w okresie pozabiegowym. Kolejnych 107 zabiegów polegało na leczeniu zmian o typie „sieci” i „obrączkowatych przewężeń” przy użyciu prowadników ze zredukowanym tip load i zastosowaniu mniej intensywnej antykoagulacji. Wyniki: Po zmianie strategii uzyskano istotną redukcję w zakresie krwioplucia (22% vs. 7%, p = 0,01), uszkodzenia naczynia (30% vs. 13%; p = 0,01), desaturacji (30% vs. 20%; p = 0,02) i uszkodzenia płuca związanego z BPA (38% vs. 22%; p = 0,041). 14-dniowa śmiertelność także uległa redukcji (6% vs. 0%; p = 0,05). Wskaźnik skumulowanego przeżycia wynosił 94,6% po 24 miesiącach od pierwszego zabiegu BPA i był znacznie korzystniejszy w porównaniu z przeżyciem historycznej grupy leczonej farmakologicznie. U 31 chorych, u których wykonano ponad trzy zabiegi BPA, stwierdzono istotną redukcję naczyniowego oporu płucnego (10,3 ± 3,7 vs. 5,9 ± 2,8 jedn. Wooda; p = 0,01), średnie ciśnienie w tętnicy płucnej (50,7 ± 10,8 vs. 35,6 ± 9,3 mm Hg; p=0,01) i poprawę klasy czynnościowej wg Światowej Organizacji Zdrowia (3,19 ± 0,48 vs. 1,97 ± 0,80; p &lt; 0,001). Wnioski: Angioplastyka balonowa tętnic płucnych poprawia parametry hemodynamiczne i czynnościowe, ale wymaga udoskonalenia strategii w celu zmniejszenia częstości groźnych powikłań