bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive value of clinical risk scores for determination of left atrial low voltage area and arrhythmia recurrences in patients undergoing atrial fibrillation ablation
Authors: Sezenoz B , Yorgun H Y , Kilic G S , Demirci M , Coteli C , Ates A H , Aytemir K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Presence of left atrial low voltage area (LVA) is an independent predictor of atrial tachyarhythmia (ATa) recurrences after atrial fibrillation (AF) ablation. Thus identifying patients with LVA by using non-invasive methods is an important endeavour.

Purpose

In this study; we investigated the predictors of LVA and postablation recurrences especially focusing on clinical risk scores.

Methods

We enrolled 328 consecutive patients who underwent initial AF ablation procedure using high density mapping. LVAs were assessed and segmental distribution was noted in each patient. CHA2DS2-VASc, HATCH, APPLE and SPEED scores were calculated. Predictive value and arrhythmia recurrences were evaluated.

Results

Two hundred and twenty one patients (67.37%) were paroxysmal AF and 107 (32.62%) patients were non-paroxysmal AF at the time of ablation. Mean CHA2DS2-VASc score was 1.88±1.66, mean APPLE score was 1.20±1.20, HATCH score was 0.93±1.00 and SPEED score was 1.54±1.27 in the whole study group. LVA was detected in 131 patients (39.93%). Female gender [OR:2.94, CI: 1.34-6.43, p=0.007), non-paroxsymal AF (OR: 2.49 CI:1.13-5.46, p=0.023), APPLE score ≥1 (OR:1.69 CI:1.12-2.55, p=0.012) and SPEED score ≥ 1 (OR: 1.47 CI:1.00-2.14, p=0.045] were independent predictors for the presence of LVA in multivariate analysis. Presence of LVA (OR:1.98; CI:1.13-4.15; p=0.017) and HT (OR:2.00; CI:1.19-3.38; p=0.009) were the independent predictors of recurrences.

Conclusion

Higher clinical scores are associated with more LVA which is associated with ATa recurrence. However the predictive value of these risk scores is limited. Better risk scoring systems are needed to precisely identify the underlying atrial substrate in this patient group.
Evaluation of insertable cardiac monitor placement and safety in the LUX-Dx PERFORM study
Authors: Richards M , Stolen C , Simon T , Stoltz T , Manyam H , Dukes J W , Bavikati V , Rosman J , Rogers J D , Garner J
Published: May 2023

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Boston Scientific Corporation

Background

The LUX-Dx PERFORM Study is designed to evaluate safety and performance of the LUX-Dx insertable cardiac monitor (ICM) in a general patient population. Enrollment and device insertions are complete, and all patients have completed 30 days of follow-up. This abstract describes the study population, characterizes device insertion, and reports on preliminary data for ICM system-related complications.

Methods

The LUX-Dx PERFORM study is a prospective, multi-center, single arm, post-market, observational study. The ICM system-related complication-free rate (CFR) at 30 days post-insertion was calculated using Kaplan-Meier methodology and the 97.5% one-side lower confidence limit (LCL) was compared to the prespecified performance target of 94%. All ICM system-related adverse events were adjudicated by independent physician reviewers.

Results

727 patients were enrolled at 24 centers in the United States from March 2021 to May 2022. The study population was 49% male, 91% white and 66+/-14 years old. 717 patients had device insertions and were successfully registered in the LATITUDE Clarity data management system. There were 9 withdrawals prior to insertion and 1 aborted procedure due to deployment difficulty. ICM insertion was performed in-hospital 76% of the time (N=547) and in-clinic 24% of the time (N=171). 96% were de novo device insertions. A variety of closure techniques were used including surgical glue (62%), adhesive strips (45%), sutures (42%), and staples (9%). Median procedure time was 4 minutes (range 1 - 37). There were 4 ICM system-related complications in the first 30 days (CFR 99%, LCL 99%) which meets the acute safety performance goal. The system-related complications include 1 case of ICM deployment difficulty, 1 case of device expulsion three days post insertion, and 2 infections that were treated with oral antibiotics and resolved without further mitigation.

Conclusion

The LUX-Dx ICM can be inserted quickly, in both hospital and clinic settings, with a very low complication rate.
Incremental value of maximum voltage and activation-guided ablation for cavotricuspid isthmus-dependent atrial flutter
Authors: Crocamo A , Notarangelo M F , Sciarroni R , Vrenozaj R , Dinatale A , Bearzot L , Gonzi G , Fioravanti M , Niccoli G , Ardissino D
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Radiofrequency (RF) catheter ablation is an effective method for treatment of typical cavo-tricuspid isthmus (CTI) dependent atrial flutter. However, despite the widespread use of contact force irrigated catheter, 11% of patients don’t achieve a first-pass CTI block, requiring additional RF applications or additional line during the same or a second procedure.

From an anatomical point of view, CTI is composed of discrete bundles of muscle with intervening connective tissue, suggesting that its conduction proprieties are dependent of the anatomic architecture of the bundles.

The maximum voltage-guided (MGV) ablation technique targets high-voltage electrograms along CTI to ablate the functionally active anatomic muscle bundle, without drawing a complete anatomic line. [1;2]

Purpose

The aim of this study was to evaluate the efficacy of maximum voltage and activation-guided ablation (MVG/LAT) for CTI atrial flutter in real-world setting.

Methods

This was a prospective observational study in which all patients undergoing CTI atrial flutter ablation at the Electrophysiology Laboratory of our Department from 01/2021 to 10/2022 were recruited. Patients who were undergoing the ablation procedure after having already made an unsuccessful attempt of the same were excluded from the study.

Substrate and activation mapping of CTI, both during flutter and during pacing from the proximal coronary sinus (CSp), was performed in all patients, identifying the earliest activated high-voltage channels, without the use of fluoroscopy, using the Smart-Touch SF catheter (CARTO 3, V7, Biosense Webster). High-voltage channels were validate also during lateral RA pacing. CTI ablation was performed only in channels with high voltage and early activation (W 45, AI 500). Bidirectional CTI block were validate by differential atrial pacing maneuvers and activation mapping during pacing from CSp.

Results

Procedural data of 39 patients were evaluated (mean age 68±13 years; men 92.6%; mean right atrium volume 149 mL). The mean number of points taken per map per patient was 1151. Bipolar thresholds were customized (0.5-2.5 mV) with the aim of better visualizing high-voltage channels. In 20/39(51.2%) patients ablation was performed during atrial flutter, in 19/39(48.8%) during pacing from proximal CS. In 19/39(48.8%) patients high-voltage channels were not detected at the central isthmus line (6 o'clock, LAO). The median number of RF applications to achieve bidirectional block of the CTI were 6 (1-20) in all patients (p=NS) (Figure 1,2). During a mean follow-up of 260 days (90-531) no recurrences were documented in any patient.

Conclusions

MVG/LAT-guided ablation, targeting selectively conductive muscle fibers, decreases the number of RF applications and improves efficacy, mostly in patients with challenging anatomies.
Omnipolar mapping improves substrate characterization and critical isthmus identification in atypical atrial flutters
Authors: China P , Quinto L , Vio R , Vitale R , Marras E , Themistoclakis S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Characterizing atrial substrate and conduction properties is crucial to treat complex arrhythmias during catheter ablations. Unipolar and bipolar electrogram signals are routinely used with significant limits due to low detailed mapping, the impact of poor contact and far-field electrical signals. Moreover, signals morphology is dependent on the relative orientation of the catheter inter-electrode axis to the direction of activation. Omnipolar signals try to overcome this direction-dependence by using three adjacent electrodes to infer directional information about the local electric field.

Purpose

We compared omnipolar mapping (OM) signals with the traditional high-density bipolar mapping (BM) ones.

Methods

All the procedures were performed using a high-density grid-designed mapping catheter. The atypical left atrial flutters were mapped using both OM and BM configuration. All the analysis about voltage and potential duration are related to the entire left atrial surface excluding pulmonary veins.

Results

Ten atypical atrial flutters were mapped in the left atrium in seven patients (median age 70 y, 5 males). OM identified 7 double loops and 3 triple loops while BM identified 7 double loops, 2 triple loops and 1 single loop, missing 2 critical circuits (an example is shown in figure 1) Significant differences were present also in potentials amplitude (peak-to-peak voltage amplitude) in the critical isthmus with OM higher than BM (OM median 0.22 mV IQR [0.16 – 0.30] vs BM median 0.19 mV IQR [0.13 – 0.24], P= 0.002). Dense scar area (defined as voltage amplitude <0.05 mV) identified with OM was smaller compared to BM (1.3 cm2 IQR [0.13-1.73] vs 1.7 cm2 IQR [0.23-3.10]; P= 0.06). OM showed longer signal duration (+10.1%) compared to BM in the entire left atrium and in particular the mean signal duration in the critical isthmus (OM median 79.1 ms IQR [70.7 – 88.9] vs BM median 62.5 ms IQR [55.2 – 85.2], P= 0.006). Percentage of tachycardia cycle lenght (TCL) mapped at the critical isthmus (maximum signal duration at the isthmus/ TCL) was greater with OM than BM (OM mean 60% ± 11%, BM mean 54% ± 12% (P= 0.02)(a summary of the results are shown in table 1).

Conclusions

OM identifies higher amplitude and longer signal duration especially in the critical isthmus region also reducing the extension of dense scar area. This finding may be crucial in the definition of complex and localized reentrant activities, leading to a faster and more precise catheter ablation.
A novel method to define critical isthmus of left atrial tachycardia; late potential mapping during sinus rhythm
Authors: Coteli C , Kilic S , Sezenoz B , Ates A , Yorgun H , Aytemir K
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial tachycardia (AT) is a commonly encountered rhythm disorder in patients with underlying atrial scar. The role of late potential (LP) based mapping in the detection of AT critical isthmus has yet to be systematically evaluated.

Purpose

We aimed to investigate the relationship between the atrial LPs (ALP) localization in sinus rhythm and the critical isthmus of re-entrant ATs in patients with underlying atrial low-voltage areas.

Methods

Thirty-five symptomatic patients [mean age: 62 ±9, gender: 25 (71.4%) female] with left AT, who had undergone catheter ablation, were enrolled. Voltage and LP mapping were performed in sinus rhythm in both atriums. Low voltage areas and signals with continuous-fragmented morphology were tagged. Isochronal late activation mapping (ILAM) was also performed in all procedures. After induction of AT, activation mapping was performed during tachycardia in all patients to detect critical sites of the tachycardia.

Results

Activation mapping indicated single re-entry in 30 patients and ≥1 re-entry in 5 patients. Localized re-entry was observed in 20 (51.2%) patients, macro re-entry in 18 (46.1%), and biatrial re-entry in 1(2.5%). The mean fractionated electrogram duration in the AT termination site was calculated at 134.3±46.7 ms and the mean bipolar voltage at 0.17±0.12 mV. The ALPs were tagged in 25 (64.1%) patients on the anterior wall, 12 (34.3%) on the roof, 5 (12.8%) on the septal wall and 2 (5.7%) in the Bachmann’s Bundle region. All ALPs were in the latest activated zones of ILAM in patients with localized re-entry and predicted successful ablation sites to terminate the AT. Freedom from atrial tachyarrhythmias (ATAs) was 78.7% at six months during a mean follow-up duration of 338 ±226 days.

Conclusion

Our findings demonstrated the utility of ALPs during sinus rhythm to predict the successful termination sites for left ATs. These areas displayed continuous-fragmented signal morphology during sinus/paced rhythm in correlation with the critical isthmus of AT detected during activation mapping.
Local impedance changes are a suitable real time surrogate for lesion formation in RF-ablation
Authors: Bahlke F , Wachter A , Krafft H , Popa M , Erhard N , Englert F , Telishevska M , Lengauer S , Lennerz C , Reents T , Risse E , Hessling G , Deisenhofer I , Bourier F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency current remains one of the most important techniques for catheter ablation. Creating durable lesions is key for sufficient and safe procedures. Several possibilities were tested for estimating the progress of lesion formation. For instance, force-time-integral, ablation index and lesion size index are used to assess quality of RF-application and, therefore, lesion size and durability. Nevertheless, recovered conduction after acute conduction block remains an issue in RF-ablation. The aim of this study was to evaluate local impedance (LI) changes as real time surrogate for lesion formation.

Methods

RF-lesions were created using an ex vivo porcine cardiac model and a force and local impedance sensing catheter. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. RF power (20W, 30W, 40W, 50W) and level of electrode-tissue-coupling were also systematically varied between minor and full coupling. In minor ETC-level, only the distal end of the catheter is in contact with the tissue. In full ETC-level, the whole catheter tip is in contact with the tissue.

All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size. In case of an audible steam pop, RF application was stopped.

Results

Including a total of 8654 measurements into the analysis, maximum diameter and depth were 9.51 ± 1.91 mm and 7.29 ± 2.50 mm in average. Local impedance correlated well with lesion depth (r= 0,78, p<0,001), as well as lesion diameter (r=0,652, p<0,001, Figure 1).

After significant declines of LI at the beginning of RF-application, it slowly approximates a minimum. Lesion size on the other hand, rises exponentially in first seconds and gets closer to a maximum after more than 25 seconds. This relationship is illustrated in Figure 2. With decreasing lesion growth at the end of RF-application, LI changes decrease to low level (Figure 3).

Conclusion

Lesion formation in RF-ablation is not linear during application of RF current. Local impedance changes seem to be a suitable real-time surrogate for assessing changes in lesion size during ablation.
Prevalence of concealed arrhythmogenic substrate for sudden cardiac arrest in the general population
Authors: Chugh H , Kransdorf E , Chugh S
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): US National Heart Lung and Blood institute National Institute of Health.

Background

Individuals who present with SCA as the first manifestation of heart disease (Concealed Substrate) present the greatest challenge for clinical risk stratification but population-based information in the current era is lacking. We hypothesized that improved awareness and access to health care has resulted in a reduction in prevalence of Concealed Substrate.

Purpose

We compared the overall prevalence, secular trends and SCA etiologies of Concealed Substrate in two geographically distinct US populations.

Methods

Consecutive cases of SCA were ascertained prospectively from 2 large ongoing US studies, the Population Cohort A (PopulationCohortA, 2002-2018) and Population Cohort B (PopulationCohortB, 2015-2022), total population 1.85 million residents. All out-of-hospital SCA events attended by emergency medical services were determined following an established multi-source ascertainment and adjudication process, and detailed lifetime clinical record evaluation conducted for each individual. This included the comprehensive electronic health record, evaluation of SCA survivors as well as all available autopsy information. Concealed Substrate cases were defined as SCA with no prior heart disease diagnosis.

Results

From a total of 5708 SCA cases (age 66.5 ± 18.2, female 35%), n=3390 (age 64.3 ± 18.8, female 34%) were identified in PopulationCohortA and n=2318 (age 71.6 ± 15.7, female 36%) in PopulationCohortB. In PopulationCohortA, prevalence of Concealed Substrate was 39% (n=1282, age 58.6 ± 21.7, 32% female) and decreased modestly over time (Figure; 37% in 2002-06 vs. to 33% in 2014-18; p=0.001). In PopulationCohortB, overall prevalence of Concealed Substrate was 41% (n=949, age 68.3 ± 17.6, 33% female) and did not change significantly over time (Figure; 2015-2022; p=0.06). Etiology of SCA was determined in a subgroup of overall cases (n=3210, 56%) of which n=2727 (85%) were ischemic SCA and n=483 (15%) non-ischemic SCA. Non-ischemic SCA was more commonly identified in Concealed Substrate (29% vs. 11%; p<0001) and ischemic SCA was more common in Revealed Substrate (89% vs. 72%; p<0.0001).

Conclusion

There was a modest reduction in prevalence over time, 33-41% of individuals continued to present with Concealed Substrate, with higher likelihood of non-ischemic SCA. These findings suggest that widely available and inexpensive tests such as the 12-lead ECG warrant further evaluation as a pre-screening method in the general population.
Relative tachycardia at admission as a predictor of mortality in severe and critical COVID-19, a tertiary centre study
Authors: Bistrovic P , Lucijanic M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Relative tachycardia is the phenomenon of disproportionate tachycardia in response to fever, originally described in the context of systemic inflammatory response syndrome (SIRS) (1). Systemic COVID-19 has shown similarities to SIRS, as well as arrhythmogenic effects and other cardiovascular complications. Relative tachycardia is associated with increased mortality in SIRS, however currently there is no data on effects of relative tachycardia in COVID-19.

Purpose

Our goal was to determine whether relative tachycardia impacted clinical outcomes of COVID-19 patients.

Methods

We retrospectively analyzed data on 3490 COVID patients hospitalized at our institution from March 2020 to June 2021. Inclusion criteria were age over 18 and positive polymerase chain reaction test to SARS-CoV-2 virus. Exclusion criteria were beta blocker use and atrial fibrillation. We stratified our patients into four quartiles according to their heart rate to body temperature ratio at admission. We defined the fourth quartile as relative tachycardia.

Results

Most patients were male (57.5%), median age was 69 years, median Charlson comorbidity index was 3, 69% had severe COVID and 15% had critical COVID at admission. Median heart rate was 90 beats per minute, median body temperature was 38 degrees Celsius and median pulse-to-temperature radio was 2.36 at admission. Patients whose heart rate-to-fever ratio at admission indicated relative tachycardia were significantly more likely to require mechanical ventilation (OR 1.48, CI 1,22-1,80), be transferred to an intensive care unit (OR 1.62, CI 1.36 to 1.93), to experience venous thromboembolisms (OR 1.50, CI 1.12-1.99) and increased intrahospital mortality (OR 1.63, CI 1.39-1.92) compared to those in first three quartiles. After adjustment for age (OR 1.04, CI 1.03-1.05), sex (OR 1.36, CI 1.14-1.61), Charlson comorbidity index (OR 1.24, CI 1.19-1.29) and COVID severity (OR 28.81, CI 14.68-56.55), death during hospitalization was significantly higher in the relative tachycardia group (OR 1.86, CI 1.47-2.35).

Conclusions

COVID patients with excessive tachycardic response to fever at admission seem to have lower chances of survival. Further research is necessary to establish a cut-off value for this easily measured clinical parameter.
Changes in Anti–SARS-CoV-2 Antibody Titers of Pooled Plasma Derived From Donors in Japan: A Potential Tool for Mass-Immunity Evaluation
Authors: Yunoki Mikihiro , Kubota-Koketsu Ritsuko , Imada Teruaki , Furuyama Kazuhiro , Sasaki Takahiro , Ohashi Shinichi , Shioda Tatsuo
Published: May 2023

The anti-spike (S), anti-nucleocapsid (N), and neutralizing activities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of pooled plasma derived from donors in Japan from January 2021 to April 2022 were evaluated. Anti-S titers and neutralizing activities showed a wave-like trend affected by daily vaccinations and/or the number of reported cases of SARS-CoV-2 infections, whereas anti-N titers remained at negative levels. These results suggest that anti-S and neutralizing titers would fluctuate in pooled plasma in the future. Pooled plasma may be potentially used for mass-immunity evaluation, and titer estimation in intravenous immunoglobulin, a derivative of pooled plasma.
A Herpes Simplex Virus 1 DNA Polymerase Multidrug Resistance Mutation Identified in a Patient With Immunodeficiency and Confirmed by Gene Editing
Authors: Schalkwijk Hanna Helena , Georgala Aspasia , Gillemot Sarah , Temblador Arturo , Topalis Dimitri , Wittnebel Sebastian , Andrei Graciela , Snoeck Robert
Published: May 2023

Background

Herpes simplex virus 1 can cause severe infections in individuals who are immunocompromised. In these patients, emergence of drug resistance mutations causes difficulties in infection management.

Methods

Seventeen herpes simplex virus 1 isolates were obtained from orofacial/anogenital lesions in a patient with leaky severe combined immunodeficiency over 7 years, before and after stem cell transplantation. Spatial/temporal evolution of drug resistance was characterized genotypically—with Sanger and next-generation sequencing of viral thymidine kinase (TK) and DNA polymerase (DP)—and phenotypically. CRISPR/Cas9 was used to introduce the novel DP Q727R mutation, and dual infection-competition assays were performed to assess viral fitness.

Results

Isolates had identical genetic backgrounds, suggesting that orofacial/anogenital infections derived from the same virus lineage. Eleven isolates proved heterogeneous TK virus populations by next-generation sequencing, undetectable by Sanger sequencing. Thirteen isolates were acyclovir resistant due to TK mutations, and the Q727R isolate additionally exhibited foscarnet/adefovir resistance. Recombinant Q727R mutant virus showed multidrug resistance and increased fitness under antiviral pressure.

Conclusions

Long-term follow-up of a patient with severe combined immunodeficiency revealed virus evolution and frequent reactivation of wild-type and TK mutant strains, mostly as heterogeneous populations. The DP Q727R resistance phenotype was confirmed with CRISPR/Cas9, a useful tool to validate novel drug resistance mutations.
Successful Detection of Delta and Omicron Variants of SARS-CoV-2 by Veterinary Diagnostic Laboratory Participants in an Interlaboratory Comparison Exercise
Authors: Deng Kaiping , Nemser Sarah M , Frost Kirstin , Goodman Laura B , Ip Hon S , Killian Mary Lea , Ulaszek Jodie , Kiener Shannon , Kmet Matthew , Uhlig Steffen , Hettwer Karina , Colson Bertrand , Nichani Kapil , Schlierf Anja , Tkachenko Andriy , Miller Megan R , Reddy Ravinder , Tyson Gregory H
Published: May 2023

Background

Throughout the COVID-19 pandemic, veterinary diagnostic laboratories have tested diagnostic samples for SARS-CoV-2 both in animals and over 6 million human samples. An evaluation of the performance of those laboratories is needed using blinded test samples to ensure that laboratories report reliable data to the public. This interlaboratory comparison exercise (ILC3) builds on 2 prior exercises to assess whether veterinary diagnostic laboratories can detect Delta and Omicron variants spiked in canine nasal matrix or viral transport medium.

Methods

The ILC organizer was an independent laboratory that prepared inactivated Delta variant at levels of 25 to 1000 copies per 50 µL of nasal matrix for blinded analysis. Omicron variant at 1000 copies per 50 µL of transport medium was also included. Feline infectious peritonitis virus (FIPV) RNA was used as a confounder for specificity assessment. Fourteen test samples were prepared for each participant. Participants used their routine diagnostic procedures for RNA extraction and real-time reverse transcriptase-PCR. Results were analyzed according to International Organization for Standardization (ISO) 16140–2:2016.

Results

Overall, laboratories demonstrated 93% detection for Delta and 97% for Omicron at 1000 copies per 50 µL. Specificity was 97% for blank samples and 100% for blank samples with FIPV. No differences in Cycle Threshold (Ct) values were significant for samples with the same virus levels between N1 and N2 markers, nor between the 2 variants.

Conclusions

The results indicated that all ILC3 participants were able to detect both Delta and Omicron variants. The canine nasal matrix did not significantly affect SARS-CoV-2 detection.
The Systemic Risk Council in Denmark: Assessing Strengths and Weaknesses
Authors: Jensen Svend E Hougaard , Sangill Thomas
Published: May 2023

Like similar bodies in several other countries, the Systemic Risk Council in Denmark was established in response to the global financial crisis. This article first outlines the Council’s design and performance, and then discusses the need for changes to the Council’s remit, governance, powers, and communication with the public. While the design of systemic risk councils varies a lot across countries, and without a consensus on what constitutes an optimal design of a macroprudential policy framework, the Danish experience contributes to the literature on what works, and what does not, in relation to managing systemic risks.
What is Sexual about Sexual Violence?
Authors: Laverty Ciara
Published: May 2023

Responding to the wider concern with how to understand the connections between sex and violence in the context of conflict-related sexual violence, this article examines how international criminal law constructs what is sexual about sexual violence. The article adopts a narrative expressivist approach to the knowledge generating effects of international criminal proceedings, using a discourse analysis of judgments and trial transcripts to demonstrate how ‘the sexual’ in sexual violence emerges in the judgments of international criminal courts primarily as a social question, in how sexual violence injures the conjugal order of the community to which victims belong. Drawing on the concept of sexual subjectivity, the article nevertheless reveals how some testimonies during the proceedings of international criminal trials go beyond this dominant narrative, offering instead a perspective that captures the specifically sexualized harm inflicted on individuals by sexual violation. The article ultimately exposes how the dominant narrative of sexual violence that emerges through the judgments of international criminal courts tends to overlook the injury to individual sexual subjectivity inflicted by sexual violence and, in doing so, functions to discount victims’ full subjectivity, including in their sexual lives.
Secondary extramedullary plasmacytoma in the absence of active multiple myeloma: a rare cause of small bowel obstruction
Authors: Boyapati Nikitha , Trivedi Anand
Published: May 2023

A 75-year-old woman with a history of multiple myeloma in remission presented with signs, symptoms and imaging findings consistent with a small bowel obstruction secondary to an intussusception. She underwent operative management, and intraoperative findings were consistent with an intussusception of mid small bowel as the cause of the small bowel obstruction. The offending portion of small bowel was resected, and histopathology confirmed a plasmacytoma deposit in the small bowel at the lead point of the intussusception.

Secondary extramedullary plasmacytomas in the gastrointestinal system are rare but can have significant consequences like small bowel obstruction requiring operative management. We present a rare case that emphasizes the need to be highly suspicious for uncommon sequelae of multiple myeloma like secondary extramedullary plasmacytomas when managing patients with history of multiple myeloma in remission with concerning abdominal symptoms.
Not just a GIST: an unclassifiable neoplasm in the genomics era
Authors: Martin Olivia A , Sopha Sabrina C , Boutros Cherif N
Published: May 2023

Unclassifiable primary tumors despite adequate tissue for pathologic examination are quite rare. We present a case of a 72-year-old female who was found to have an abdominal mass after she reported to the emergency department with complaints of abdominal pain with spasms, bloating and nausea. Computed tomography scan demonstrated a 12.3 × 15.7 × 15.9 large multilobulated mass, abutting and compressing the stomach, compatible with neoplasm. She underwent esophagogastroduodenoscopy with findings concerning for gastrointestinal stromal tumor. The patient underwent en bloc resection of the mass. The neoplasm was unable to be classified on pathologic examination despite a comprehensive workup and multiple consultations with specialized pathologists from local institutions, as well as national specialists. Final pathology was unclassified malignant neoplasm displaying calretinin expression only. This presents a difficult clinical entity to treat. Even in the genomics era, there are tumors that cannot be even broadly classified on pathologic examination.
(014) Impact of Vaginal Prasterone on the Rate of Urinary Tract Infections in GSM Patients and those on Aromatase Inhibitors: A Retrospective Cohort Analysis
Authors: Rubin R S , Moyneur E , Dea K , Labrie F , Dury A
Published: May 2023

Introduction

The Genitourinary Syndrome of Menopause (GSM) is attributed to a decline in the levels of circulating sexual steroids which often results in increased vaginal pH, atrophic urogenital changes, elevated amount of post-void residual urine, and changes in the vaginal microbiome with a shift towards a predominance of fecal gram-negative bacteria rather than lactobacilli, which is believed to create a potential reservoir for recurrent urinary tract infections (UTIs). Current guidelines to prevent recurrent UTIs include vaginal estrogens. Intravaginal prasterone is converted locally in the vaginal tissue into androgens which are subsequently aromatised into estrogens. It is indicated to treat moderate to severe dyspareunia in postmenopausal women in the US.

Objective

The objective of this study was to assess, through real world evidence data, the potential of vaginal prasterone to be used in postmenopausal GSM women with recurrent UTIs as prophylaxis to reduce the future UTI risk. As a sensitivity analysis, women using aromatase inhibitors, medications that stop the production of estrogen in postmenopausal women typically prescribed to women with a history of breast cancer, were analyzed.

Methods

This retrospective matched-cohort study was conducted using the Integrated Dataverse (IDV®) - an open-source claims database from Symphony Health Solutions with data from February 2015 through January 2020. 22,245 women treated with prasterone for a minimum of 12 weeks were matched to women without any prescribed VVA-related treatment. Within each of these two groups, 286 matched patients were taking aromatase inhibitors.

Results

Across all age groups, women treated with prasterone have a significantly lower UTI prevalence compared to those untreated (6.58% and 12.3%, respectively; p˂0.0001). The highest difference in UTI prevalence among the prasterone treated and untreated women was observed in those aged 65-74 (7.15% and 16.2% respectively; p˂0.0001). Consistent with the above, among aromatase inhibitor users, women treated with prasterone have a significantly lower UTI prevalence (4.90% vs. 9.79%; p=0.008).

Conclusions

This study suggests that intravaginal prasterone may be a good candidate for prophylaxis in postmenopausal women with recurrent UTIs to reduce future UTI risk, including for patients taking aromatase inhibitors and having contraindications for estrogen-based therapies. This study is however based on real-world evidence and warrants further investigation in a prospective clinical setting.

Disclosure

Yes, this is sponsored by industry/sponsor: Endoceutics

Clarification: Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Endoceutics
(016) Outpatient, Multimodal Neuromuscular Treatment Reduces Pain and Improves Functionality for Patients with Chronic Pelvic Pain and Vulvodynia
Authors: Augusta Shrikhande A , Rains A , Ahmed T , Mamsaang M , Vyas R , Natarajan J , Moody E , Reutter C , Leishear K , Tailor Y , Sandhu-restaino S , Liu L , James N , Filart R , Kapaida R , Haverland R , Zirolli M , Park D
Published: May 2023

Introduction

Characterized by chronic pain and/or discomfort around the opening of the vulva, Vulvodynia is known to affect up to 16% of adult women. Vulvodynia may present as constant or intermittent pain which negatively impacts patients’ personal and working lives, as well as mental health and relationships. The cause of Vulvodynia is unknown, and treatment is not widely agreed upon.

Objective

The purpose of this study was to test the effectiveness of a multimodal neuromuscular treatment protocol in treating the symptoms of Chronic Pelvic Pain and Vulvodynia, improving pain and function.

Methods

59 patients ages 20-79 who presented to an outpatient clinic for treatment of pelvic pain and Vulvodynia symptoms. These symptoms had persisted for an average of 6 years. All patients underwent a once weekly, six-week treatment consisting of ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks. To measure the effects of this treatment, a 0-10 Visual Analogue Scale (VAS) was used to measure pelvic pain intensity, and the Functional Pelvic Pain Scale (FPPS) was used to measure function across multiple areas. These measures were taken at patients’ first visit to a clinic, and three months after treatment began.

Results

VAS scores improved by an average of 51%. Before treatment, the mean VAS score was 7.93 (SD=1.61) (a=0.05; CI 7.52-8.34) and the posttreatment mean VAS score was 3.9 (SD=2.19) (a=0.05; CI 3.34-4.46) (P<0.0001). Pelvic pain functionality improved by 23% after three months. Pretreatment FPPS scores averaged at 12.34 (SD=5.8) (a=0.05; CI 10.86-13.82), decreasing to 9.53 (SD=5.43) (a=0.05; CI 8.14-10.91) after treatment (P<0.0001). FPPS functions which showed the greatest improvement were Sleep, which improved by 39%, Intercourse, which improved by 28%, and Walking, which improved by 28%.

Conclusions

These results indicate that a six-week treatment consisting of once-weekly ultrasound-guided pelvic floor musculature trigger-point injections and peripheral nerve blocks combined with once-weekly pelvic floor physical therapy was very effective at relieving pain and improving function for patients with Vulvodynia.

Disclosure

No
(046) Postpartum Sexuality: Gender Inequality in Scientific Research
Authors: Choucroun D
Published: May 2023

Introduction

Sexuality in the postpartum period is very important and may be involved in global future dysfunctions of the couple. Studies are numerous, improving the knowledge of functioning and vulnerabilities of the female body at this time. But what about the male partner? What are his desires, fears and expectations? Scientific research on postpartum sexuality overwhelmingly concerns the woman's body, placing the responsibility for couple sexual distress on her.

Objective

Highlight the gender inequality in the scientific research about postpartum sexuality Demonstrate that the almost interest in the woman's body in the postpartum period can be deleterious to the woman, potentially ignoring a male sexual dysfunction secondary to birth, change in family status, change in the partner's body, or due to another cause.

Methods

Literature review on PubMed with the keywords: for the past year women, sex, postpartum and men, sex, post partum intercourse in postpartum sexual dysfunction in women in postpartum sexual dysfunction in men in postpartum

Results

the keywords sexual dysfunction in men in postpartum found no result for the past year For the research with the keywords women, sex, postpartum and intercourse in postpartum, the literature review finds 85% to 93% of the results concerning only the women.

Conclusions

Female sexual dysfunction is quite wellknown for the postpartum period: lower sexual desire and lower sexual satisfaction, less orgasms and more dyspareunia, physical and psychological change such bad self-esteem because of the body's change, sadness, vaginal dryness and decreased sexual response. Dyadic coping exists, and sometimes the couple can find himself some answers to this difficult period: acceptance, self-care, couple time, good communication. But no relevant element is really found in the scientific research to assess the role of the male partner in this situation: what are his emotions and his feelings, how is his erection after attending the birth? What is his desire when the female body is so different and when the woman is becoming a mother? All these questions are mostly important, and the future answers will allow the woman to feel less alone in the ordeal of matrescence, learning that the man is also not spared by this stage of the couple.

Disclosure

No
(051) Can Vibrator use Improve Well-being?
Authors: Dubinskaya A , Kohli P , Shoureshi P , Breese C , Eilber K
Published: May 2023

Introduction

Sexual, pelvic, and mental health are important and interconnected components of overall health and well-being. As such, the function of one area of health can affect health in general. It has been shown that vibrator use improves sexual function in females.

Objective

This study aimed to investigate the effect of regular topical vibrator use on sexual, pelvic, and mental health and overall well-being.

Methods

We performed a prospective pilot study among women aged 18 and 99 years recruited from our urogynecology clinic. Study participants were instructed to use a vibrator for five to ten minutes two to three times a week for three months on their external genitalia with a focus on the duration of application. Demographics, pelvic floor function, and mental health were assessed at the initial and 3- months follow-up appointments using physical exams and validated questionnaires. To determine the effect of vibrator use on pelvic and mental health, statistical analysis was performed with paired t-tests (continuous data) or McNemar’s test (dichotomous data).

Results

Of 79 women enrolled in the study, 57 (72.2%) women completed the study. The mean age of participants was 54.7 years (range 19 – 80 years), and most were Caucasian (74.7%), menopausal (60.8%), and not on systemic hormone replacement therapy (79.7%) or vaginal estrogen therapy (79.7%). Half (53.2%) of the participants were engaged in partnered sexual activity, and 49.4% used or had used vibrators in the past. Sexual function domains such as arousal (p=0.007), orgasm (p=0.018), and satisfaction (p=0.027) were significantly improved after the completion of the study, as well as genitourinary pain scores (p=0.037). However, symptoms related to pelvic organ prolapse (p=0.59), urinary incontinence (p=0.15), and fecal incontinence (p=0.15) were not significantly improved. Rates of depression significantly decreased (p=0.020), while health-related quality of life significantly improved (p=0.014).

Conclusions

Vibrator use was associated with improved sexual health, genitourinary pain, and health-related quality of life. Depression was subjectively improved, along with a positive trend in depression scores. Recommendation of regular vibrator use should be considered for certain conditions as it might have a significant influence on women’s well-being.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Abbvie, Coloplast.
(115) Prevalence of Clitoral Adhesions in Patients who have Undergone Breast Cancer Care
Authors: Burris B , Hoelscher G , Brown J , Lees B , Davenport S
Published: May 2023

Introduction

The incidence of female sexual dysfunction (FSD) in patients who have undergone breast cancer care is approximately 66-83% 1,2. Clitoral phimosis is a congenital or acquired condition in which the clitoral hood cannot be fully retracted and can be associated with sexual pain and impaired orgasmic capability. A paper by Aerts et al. in 2018 demonstrated a prevalence of clitoral adhesions/phimosis in patients presenting to their sexual medicine practice to be 22%3. Our sexual health clinic has observed that a large majority of patients who are diagnosed with FSD after treatment for breast cancer also have clitoral phimosis. This may remain underdiagnosed and undertreated since examination of the clitoris and clitoral hood is still not considered a routine portion of the gynecologic examination.

Objective

There is an increased prevalence of clitoral adhesions in patients who underwent breast cancer care.

Methods

This was a retrospective observational study. Data was collected from our IRB approved Sexual Health Clinic registry from August 2021 to November 2022. All female patients presenting to our clinic over the age of 18 with a diagnosis of breast cancer who underwent a pelvic exam were included. Patients who did not undergo treatment with an estrogen modulator for their breast cancer were excluded.

Results

A total of 25 patients presented to the clinic during this time period with a diagnosis of breast cancer. 24 patients underwent a pelvic exam. 23 patients previously underwent treatment with an estrogen modulator. Of these 23 patients, 15 patients (65%) had findings of clitoral adhesions, whereas 8 patients (35%) did not have evidence of clitoral adhesions. Table 1 presents severity of adhesions and associated diagnoses in patients with findings of clitoral adhesions.

Conclusions

This study serves as preliminary data from our clinic that would indicate that those with a diagnosis of breast cancer that were treated with an estrogen modulator have a higher incidence of clitoral adhesions than the general population. It is therefore our recommendation that all women who have a diagnosis of breast cancer should have a comprehensive vulvar exam including an inspection of the clitoral glans and prepuce. If the prepuce cannot be easily retracted, a diagnosis of clitoral adhesions should be considered. A pilot grant application has been submitted to further investigate prevalence, associated symptoms, severity and treatment efficacy over a longer period.

Disclosure

No
Master Surgical Scheduling via Answer Set Programming
Authors: Mochi Marco , Galatà Giuseppe , Maratea Marco
Published: May 2023

The problem of finding a Master Surgical Schedule (MSS) consists of scheduling different specialties to the operating rooms (ORs) of a hospital clinic. To produce a proper MSS, each specialty must be assigned to some ORs, where the number of assignments is different for each specialty and can also vary during the considered planning horizon. The problem is enriched by considering resource availability such as beds, surgical teams and nurses. Realizing a satisfying schedule is of upmost importance for a hospital clinic, since a poorly scheduled MSS may lead to unbalanced specialties availability and increase patients’ waiting list, thus negatively affecting both the administrative costs of the hospital and the patient satisfaction. In this paper, we present compact solutions based on Answer Set Programming (ASP) to the MSS problem. We tested our solutions on different scenarios: experiments show that our ASP solutions provide satisfying results in short time, also when compared to other logic-based formalisms. Finally, we describe a web application we have developed for easy usage of our solution.
The effect of noise artefacts on gravitational-wave searches for neutron star post-merger remnants
Authors: Panther F H , Lasky P D
Published: May 2023

Gravitational waves from binary neutron star post-merger remnants have the potential to uncover the physics of the hot nuclear equation of state. These gravitational-wave signals are high frequency (∼kHz) and short-lived ($\mathcal {O}(10\, \mathrm{ms})$), which introduces potential problems for data analysis algorithms due to the presence of non-stationary and non-Gaussian noise artefacts in gravitational-wave observatories. We quantify the degree to which these noise features in LIGO data may affect our confidence in identifying post-merger gravitational-wave signals. We show that the combination of vetoing data with non-stationary glitches and the application of the Allen χ2 veto (usually reserved for long-lived lower frequency gravitational-wave signals), allows one to confidently detect post-merger signals with signal-to-noise ratio ρ ≳ 8. We discuss the need to incorporate the data quality checks and vetoes into realistic post-merger gravitational-wave searches, and describe their relevance to calculating realistic false-alarm and false-dismissal rates.
Zarlino’sComporre di fantasiaand Canon
Authors: Schubert Peter
Published: May 2023

In the Istitutioni harmoniche, Zarlino describes a compositional process in which a countermelody that is introduced against a principal soggetto can itself become a soggetto for the next phrase, and the process can be repeated in subsequent phrases. This study shows how comporre di fantasia functions in passages from Martini, Févin, Isaac, and Josquin. The technique can also inform our understanding of canon composition, which is illustrated with two examples by Pierre de la Rue. For the study of canons at different time intervals, I also invoke the neglected theories of Robert Morris, Robert Gauldin, and Immanuel Ott. Comporre di fantasia is a structural category that provides insight into compositional process in Renaissance polyphony.