Cryo vs RF p-wave Characteristics Comparative Analysis

Introduction: Atrial fibrillation is one of the leading causes of heart failure and stroke in the US, meaning that optimizing treatment is essential. There are two catheter based PVI techniques used to treat drug-refractory AF patients: radiofrequency and cryo-balloon ablation. The goal of this study is to determine if there is a difference in efficacy between these two procedures. Methods: The study consisted of a retrospective chart review and ECG analysis of approximately 130 patients. The criteria for involvement is patients diagnosed with drug-refractory paroxysmal AF and who have undergone an ablation procedure in the past two years. Baseline characteristics were measured from EPIC and p-wave parameters were measured on ECG’s using MUSE. Statistical analysis was done to determine if there is any significant difference in p wave parameters between the two groups of patients. Results: At this point in time, there remains data to be collected, but we are able to share preliminary results. The only significant finding was when we looked at p-wave duration, specifically the change in V1 duration, which showed that patients were less likely to have an AF recurrence if their p-wave duration lengthened after the procedure. Discussion: These results are important, as the change of lead V1 duration could be used as a predictor of AF recurrence. However, at this point we are unable to find a difference in efficacy between cryo-ablation and RF ablation and so our main objective is incomplete. the hope is upon completing data collection, we will be able to answer our research question

Cryo vs RF p-wave Characteristics Comparative Analysis

Introduction: Atrial fibrillation (AF) is the leading cause of stroke. Patients with drug-refractory AF are managed with Radiofrequency (RF) or Cryoballoon (Cryo) pulmonary vein isolation (PVI). Approximately 30% of PVIs result in AF recurrences. There is clinical utility in identifying patients at higher risk of AF recurrence with readily available ECG parameters. Methods: This retrospective study analyzed the ECG characteristics and AF recurrence of 86 paroxysmal AF patients who underwent PVI. Baseline characteristics were collected by chart review and p-wave parameters were measured with electronic calipers in the MUSE (GE) ECG database. AF recurrence was defined as any documented atrial tachyarrhythmia. Statistical analyses performed in SPSS included t-tests and ROC curves to compare group means and to select parameter cutoffs to predict AF recurrence, respectively. Results: There were no differences in % AF recurrences (Cryo: 26% vs RF: 37%; P = 0.25) or Dp-wave parameters (pre-PVI values - post-PVI values) except for DPwD(III) (Cryo: 11ms vs RF: -3ms; P = 0.023). Patients with AF recurrences had greater CHA2DS2-VASc scores (P = 0.014), Left atrial volume (P = 0.031), Pre-PR-intervals (P = 0.006), Pre-PwD(III) (P = 0.013), Pre-PwD(V1) (P = 0.001), Pre-PwD(V2) (P = 0.02), Pre-PwD-terminal (P = 0.0002), Post-PR-intervals (P = 0.038), Post-PwD(III) (P = 0.002), and Post-PwD(aVF) (P = 0.009). Patients whose p-wave duration (PwD) increased in V1 were less likely to have a recurrence (P = 0.01). Pre-PwD(V1) \u3e 120ms yielded a sensitivity of 68.4% and specificity of 67.6% for predicting AF recurrence. Discussion: Cryo is non-inferior to RF regarding AF recurrence. This finding is further supported by similar PVI-induced Dp-wave parameters between the two modalities. Pre-PwD(V1), along with other parameters can be used in combination to reasonable predict recurrence and to guide clinical management of AF

Human Glial Progenitor Cells Effectively Remyelinate the Demyelinated Adult Brain

Neonatally transplanted human glial progenitor cells (hGPCs) can myelinate the brains of myelin-deficient shiverer mice, rescuing their phenotype and survival. Yet, it has been unclear whether implanted hGPCs are similarly able to remyelinate the diffusely demyelinated adult CNS. We, therefore, ask if hGPCs could remyelinate both congenitally hypomyelinated adult shiverers and normal adult mice after cuprizone demyelination. In adult shiverers, hGPCs broadly disperse and differentiate as myelinating oligodendrocytes after subcortical injection, improving both host callosal conduction and ambulation. Implanted hGPCs similarly remyelinate denuded axons after cuprizone demyelination, whether delivered before or after demyelination. RNA sequencing (RNA-seq) of hGPCs back from cuprizone-demyelinated brains reveals their transcriptional activation of oligodendrocyte differentiation programs, while distinguishing them from hGPCs not previously exposed to demyelination. These data indicate the ability of transplanted hGPCs to disperse throughout the adult CNS, to broadly myelinate regions of dysmyelination, and also to be recruited as myelinogenic oligodendrocytes later in life, upon demyelination-associated demand

Pediatric polysomnography-flagging etiologies and impact on the clinical timeline

Background/objectiveThere is a paucity of literature regarding “flagging” abnormal sleep studies for expedited review. This single-center retrospective analysis (n = 266) of flagged polysomnography studies from 2019 to 2022 aimed to investigate flagging and its impact on the clinical timeline.MethodsTwo hundred sixty-six flagged polysomnography studies from 2019 to 2022 were retrospectively reviewed.ResultsFlagged study etiologies included repetitive brief oxygen desaturations (46.6%), sustained desaturations (32.3%), sustained hypercapnia (5.6%), or other concerning events (15.5%). The median time between a flagged study and scoring report finalization, medical intervention, and surgical intervention were 0 (2) days, 2 (3) days, 5 (11.25) days, and 44 (73) days, respectively. Patients with apnea–hypopnea index >30 had less time between a flagged study and surgical intervention (65.3 ± 96.7 days vs. 112 ± 119 days, p = 0.044).ConclusionAs anticipated, the time to surgical intervention was longer than to medical intervention. Patients with a higher disease severity experienced quicker scoring, report finalization, and surgical intervention

Genome-wide association study identifies a variant in HDAC9 associated with large vessel ischemic stroke

Genetic factors have been implicated in stroke risk but few replicated associations have been reported. We conducted a genome-wide association study (GWAS) in ischemic stroke and its subtypes in 3,548 cases and 5,972 controls, all of European ancestry. Replication of potential signals was performed in 5,859 cases and 6,281 controls. We replicated reported associations between variants close to PITX2 and ZFHX3 with cardioembolic stroke, and a 9p21 locus with large vessel stroke. We identified a novel association for a SNP within the histone deacetylase 9(HDAC9) gene on chromosome 7p21.1 which was associated with large vessel stroke including additional replication in a further 735 cases and 28583 controls (rs11984041, combined P = 1.87×10−11, OR=1.42 (95% CI) 1.28-1.57). All four loci exhibit evidence for heterogeneity of effect across the stroke subtypes, with some, and possibly all, affecting risk for only one subtype. This suggests differing genetic architectures for different stroke subtypes

Differing clinical features between Japanese and Caucasian patients with myelodysplastic syndromes:Analysis from the International Working Group for Prognosis of MDS

Clinical features of myelodysplastic syndromes (MDS) could be influenced by many factors, such as disease intrinsic factors (e.g., morphologic, cytogenetic, molecular), extrinsic factors (e.g, management, environment), and ethnicity. Several previous studies have suggested such differences between Asian and European/USA countries. In this study, to elucidate potential differences in primary untreated MDS between Japanese (JPN) and Caucasians (CAUC), we analyzed the data from a large international database collected by the International Working Group for Prognosis of MDS (300 and 5838 patients, respectively). JPN MDS were significantly younger with more severe cytopenias, and cytogenetic differences: less del(5q) and more +1/+1q, -1/del(1p), der(1;7), -9/del(9q), del(16q), and del(20q). Although differences in time to acute myeloid leukemia transformation did not occur, a significantly better survival in JPN was demonstrated, even after the adjustment for age and FAB subtypes, especially in lower, but not in higher prognostic risk categories. Certain clinical factors (cytopenias, blast percentage, cytogenetic risk) had different impact on survival and time to transformation to leukemia between the two groups. Although possible confounding events (e.g., environment, diet, and access to care) could not be excluded, our results indicated the existence of clinically relevant ethnic differences regarding survival in MDS between JPN and CAUC patients. The good performance of the IPSS-R in both CAUC and JP patients underlines that its common risk model is adequate for CAUC and JP

Time-dependent changes in mortality and transformation risk in MDS

In myelodysplastic syndromes (MDSs), the evolution of risk for disease progression or death has not been systematically investigated despite being crucial for correct interpretation of prognostic risk scores. In a multicenter retrospective study, we described changes in risk over time, the consequences for basal prognostic scores, and their potential clinical implications. Major MDS prognostic risk scoring systems and their constituent individual predictors were analyzed in 7212 primary untreated MDS patients from the International Working Group for Prognosis in MDS database. Changes in risk of mortality and of leukemic transformation over time from diagnosis were described. Hazards regarding mortality and acute myeloid leukemia transformation diminished over time from diagnosis in higher-risk MDS patients, whereas they remained stable in lower-risk patients. After approximately 3.5 years, hazards in the separate risk groups became similar and were essentially equivalent after 5 years. This fact led to loss of prognostic power of different scoring systems considered, which was more pronounced for survival. Inclusion of age resulted in increased initial prognostic power for survival and less attenuation in hazards. If needed for practicability in clinical management, the differing development of risks suggested a reasonable division into lower- and higher-risk MDS based on the IPSS-R at a cutoff of 3.5 points. Our data regarding time-dependent performance of prognostic scores reflect the disparate change of risks in MDS subpopulations. Lower-risk patients at diagnosis remain lower risk whereas initially high-risk patients demonstrate decreasing risk over time. This change of risk should be considered in clinical decision making

Cytopenia levels for aiding establishment of the diagnosis of Myelodysplastic Syndromes

We recommend that standard hematologic values be used to define cytopenias in MDS and believe a modification of the WHO definition of cytopenias as 1 of the criteria (in addition to definitive morphologic and/or cytogenetic findings) to diagnose MDS would be valuable and most accurate