bluuebunny/crossref_metadata_2025 huggingface dataset:
Left atrial appendage anatomical changes following radiofrequency-based ostial isolation
Authors: Della Rocca D , Magnocavallo M , Gianni C , Mohanty S , Vetta G , Bassiouny M , Pannone L , De Asmundis C , Lavalle C , Chierchia G B , Di Biase L , Burkhardt J D , Gallinghouse G , Horton R , Natale A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial appendage (LAA) electrical isolation (ei) may be achieved via radiofrequency (RF) energy applications at the level of the appendage ostium targeting the sites of earliest activation recorded by a mapping catheter. Notably, RF has long been used in vascular, orthopedic, and aesthetic surgery to promote thermal-induced collagen matrix contraction, fibrosis, and tissue retraction. LAA anatomical changes associated to RF-induced tissue retraction have never been reported.

Purpose

To quantify the anatomical changes of the LAA ostium following RF-based LAAei.

Methods

Thirty-four consecutive patients requiring AF ablation with LAAei underwent transesophageal echocardiography (TEE) within 7 days before (baseline TEE) and apx 6 months after (follow-up TEE) ablation. The diameter of LAA orifice and landing zone were measured at 4 different views (0°, 45°, 90°, 135°). Measurements were performed by two independent reviewers blinded to the patient’s identity.

Results

Among 43 AF patients (67±6yrs, 72.1% males), the LAA morphology was classified as chicken wing in 19 (44.2%) patients, windsock in 12 (27.9%), cactus in 8 (18.6%), and cauliflower in 4 (9.3%). At baseline TEE, the mean maximum and mean minimum ostial diameters were 25±4mm and 22±4mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 26±4mm and 23±3mm, respectively. On average, LAAei was achieved after 17±6 minutes of RF at a power of 45W. Follow-up TEE was performed 294±136 days after LAAei. The median LAA contraction velocity was 0.1 m/s (IQR: 0.02-0.18) and was significantly impaired in all patients. At follow-up TEE, the mean maximum and mean minimum ostial diameters were 19±4mm and 17±3mm, respectively. The mean maximum and mean minimum diameters of the landing zone were 20±4mm and 18±4mm, respectively. The mean relative reduction of the ostium and the landing zone was -24.4% and -22.5%, respectively. Box-Whisker plots of the maximum and minimum ostial diameters before and after LAAei are reported in Fig.1.

Conclusion

RF led to a >20% reduction of the diameters of the ostium and the landing zone. These changes may have important implications for a successful percutaneous occlusion procedure and justify a staged approach of isolation and occlusion.
Fluoroscopy integration module reduces radiation exposure without affecting procedure time in accessory pathway ablation
Authors: Ozcan E E , Yilancioglu R Y , Turan O E , Inevi U
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Conventional Accessory Pathway (AP) ablation is a straightforward approach with high success rates, but the fluoroscopy time is significantly higher. Electroanatomical mapping systems (EMS), reduce the fluoroscopy time, but anatomical reconstruction and activation mapping prolong the procedure time. The Fluoroscopy Integration Module (FIM) uses prerecorded fluoroscopy images and allows ablation similar to conventional technique without creating an anatomical map. In this study, we investigated the effects of combining the FIM with the traditional technique on procedure time, success, and radiation exposure.

Methods

112 patients who underwent AP ablation were included in our study. In 18 patients, right and left anterior oblique (RAO -LAO) images were recorded after the insertion of the catheters and integrated with FIM. Afterwards, ablation was performed similarly to the conventional technique but without using fluoroscopy. To accelerate the procedure anatomical and activation maps were not created. Contact-force catheters were not used. 94 patients were ablated conventionally using only fluoroscopy.

Results

Combining the FIM with the conventional method significantly reduced radiation exposure (Fluoroscopy time: 3,3±2,6 vs 11,5±11,6 sec, p: 0,001; Dose-area-product (DAP): 7,3±6,2 vs. 28,6±40,5 μGym2, p: 0,003) without affecting the total procedure time ( 64,4±15 vs. 62,6±28,7 sec, p: 0,272 ), time to successful ablation ( 33,2±13,9 vs. 29,7±29,5 sec p: 0,056) and radiofrequency application time ( 183,7±94,4 vs. 167,3±89,8 sec p: 0,336).

Conclusion

These findings suggest that FIM can be used for rapid and successful ablation of APs with reduced radiation exposure times.
Pulmonary vein reconnection rates and lesion regression during repeat procedures in patients with recurrent arrhythmias after pulsed field ablation pulmonary vein isolation
Authors: Kueffer T , Madaffari A , Muehl A , Seiler J , Thalmann G , Servatius H , Kozhuharov N A , Tanner H , Haeberlin A , Noti A , Baldinger S H , Roten L , Reichlin T
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

A novel multipolar pulsed-field ablation (PFA) catheter has recently been introduced for pulmonary vein isolation (PVI). Pre-market data showed high rates for PVI-durability during mandatory remapping studies 90 days after the first procedure. Post-market data on PVI durability and lesion regression, particularly in patients with recurrent atrial arrhythmias, are limited.

Purpose

To characterize the findings on redo cases after previous PFA procedures.

Methods

Consecutive patients undergoing a redo procedure after an index PFA PVI between May 2021 and October 2022 were included. 3-D electro-anatomical maps (3D-EAM) were acquired in sinus rhythm at the beginning of the redo procedure and compared to the 3D-EAM acquired after ablation during the index procedure. PV-reconnection was assessed on a per-vein and per-patient level and the sites of reconnections were identified. Furthermore, lesions extent was compared between the two maps.

Results

Of 265 patients undergoing their first PFA PVI between May 2021 and August 2022, 26 (9.8%) patients with recurrent atrial tachyarrhythmia underwent a redo ablation. The phenotype prior to the first PVI was paroxysmal AF in three patients (12%), persistent AF in 85 patients (85%), and left atrial flutter in one (4%) patient. A 31 mm device was used in 81% of the patients. Posterior wall ablation in addition to PVI was performed in three patients. At the end of the first PFA procedure, 100/102 veins (98%, two common ostia) were isolated as evidenced by post ablation 3D-EAM (two LIPV’s could not be isolated). The recurring arrhythmias were AF, atypical flutter, both, and atrial tachycardia in 14 patients (54%), 5 patients (19%), 6 patients (23%) and 1 (4%) respectively. High-density 3D-EAM identified 65/100 (65%) PVs with persistent isolation. In 7 (27%) patients, all PVs were isolated. Reconnection occurred most frequently in the right inferior PV (11, 42%) followed by the left superior PV (9, 36%), the right superior PV (8, 31%), the left inferior PV (6, 27%), and the left common ostium (1, 50%). The predominant reconnection sites were located anterior of the superior veins, and on the inferior aspect of the right inferior PV (Figure). On the posterior wall, the distance between the lesions of the left pulmonary veins and the right pulmonary veins increased by a median of 5 mm [0, 10] between the index and Redo procedure.

Conclusion

In patients with recurrent atrial arrhythmias after PFA PVI, PV reconnections were found in 73% of the patients and in 35% of the veins. The reconnections were most prevalent on the anterior aspects of the upper veins, as well as on the inferior aspect of the right inferior vein.
Safety and effectiveness of very-high-power, short-duration ablation in patients with atrial fibrillation: Preliminary results
Authors: Lodzinski P , Mitrzak K , Peller M , Krzowski B , Maciejewski C , Balsam P , Marchel M , Grabowski M
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein isolation (PVI) is at the forefront of rhythm control strategies in patients with atrial fibrillation (AF). A very-high-power, short-duration (vHPSD) catheter was designed to improve the effectiveness of AF ablation within a shorter procedure time. We aimed to compare the effectiveness and safety of PVI ablation between this vHPSD ablation mode (90W/4s) and conventional index-guided ablation (up to 40W/indexed).

Methods

This single-center, retrospective, observational study enrolled 148 patients with AF, referred for catheter ablation between December 16, 2019 and July 29, 2022. In 77 procedures (mean age: 59.7±12.0 years; 61.0% male; 74.0% paroxysmal), a vHPSD catheter was used (vHPSD-group), and 71 patients (mean age: 58.1±11.6 years; 70.4% male; 67.6% paroxysmal) were treated with a ablation index catheter (AI-group). The study assessed the recurrence of AF at 3- and 6-months after ablation. The outcomes also included the amount of opioids administered during the procedure and the incidence of treatment-emergent adverse events. Additionally, procedural factors, such as total procedure time, fluoroscopy time and radiofrequency application time were compared between the groups.

Results

At 3 months, AF was found to recur in 14.29% (11/77) of patients in the vHPSD-group and in 30.99% (22/71) of patients in the AI-group (p=0.02). At 6 months, 18.31% (13/71) patients reported AF recurrence in the vHPSD-group and 32.73 % (18/55) in the AI-group (p=0.09). There was no difference in treatment-emergent adverse events between the two groups (3.9% vs. 2.8%; p=1.00). One severe adverse event (a cerebral vascular accident) was observed in the vHPSD-group. The mean dose of remifentanil was reported to be lower during vHPSD-based PVI (p<0.0001). The vHPSD-based PVI was associated with shorter radiofrequency application time (p<0.0001), fluoroscopy time (p<0.0001), and total procedure time (p<0.0001).

Conclusions

This study suggests that the vHPSD-quided PVI is equally effective and safe with reference to short-term clinical observation as conventional ablation. Also, the vHPSD ablation may allow to reduce the dosage of analgesics during significantly shorter procedures.
Cavotricuspid isthmus ablation by means of very high power short duration temperature controlled lesions: acute and mid term outcome
Authors: Schillaci V , Poggi S , Strisciuglio T , Arestia A , Salito A , Iuliano A , Shopova G , Spiniello G , De Simone A , Stabile G , Solimene F
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation minimizes conductive heating and increase resistive heating, achieving uniform and transmural lesion while reducing the risk of collateral tissue damages. The shape of the vHPSD lesion, wider and shallower than standard radiofrequency, raises some concerns during atrial flutter ablation (AFL).

Purpose

We evaluated the feasibility, efficacy and safety of the vHPSD ablation of the

cavotricuspid isthmus (CTI) in patients presenting with typical AFL.

Methods

Sixty-one consecutive patients, with typical AFL, underwent CTI ablation using the QDot Micro catheter and vHPSD (90 w for 4 s). Patients were followed-up by means of visits and ECG in the outpatient clinic 1, 6 and 12 months after the procedure

and later on with telephone interviews or by 24-h Holter monitoring in case of symptoms.

Results

Acute CTI bidirectional block was achieved in all patients (91% of first-pass block) with a mean fluoroscopy time of 114±29 s and a mean procedure time of 37±9 min. Two steam pops were observed. Two patients had groin hematoma, no further complications were observed. During a mean follow-up of 14±7 months, two (3.2%) patient had typical AFL recurrence, and four (6.5%) patients had an atrial fibrillation recurrence.

Conclusions

The vHPSD ablation represents an effective and safe ablation strategy to achieve bidirectional block for the treatment of typical AFL.
Radiofrequency ablation for longstanding persistent atrial fibrillation: long-term outcome of a prospective randomized comparison of mapping with multipolar catheter vs. 4-pole ablation catheter
Authors: Fiala M , Cernosek M , Bulkova V , Rybka L , Manousek J , Lehar F , Toman O , Kala P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with longstanding persistent atrial fibrillation (LSPAF), mapping with multipolar catheter can enhance identification of arrhythmogenic sources during ongoing AF/converted atrial tachycardia (AT), reduce procedure time, and improve outcome of catheter ablation.

Purpose

To compare procedural characteristics and long-term outcome of radiofrequency catheter ablation (RFA) for LSPAF between two mapping approaches in a prospective randomized bi-centric study.

Methods

Between 1/2019-9/2021, RFA was performed in in 172 patients with LSPAF. Mapping with multipolar catheter Pentaray (group 1, n=85) vs. mapping with ablation catheter Navistar STSF (group 2, n=87) were compared. Stepwise ablation to the desired AF termination included pulmonary vein isolation (PVI), electrogram guided left atrial (LA) ablation, CS isolation, and right atrial electrogram guided ablation. PVI, mitral isthmus, LA roof, and CTI block were Intermediate endpoints proved at the procedure end. Sinus rhythm (SR) restoration by ablation was the desired procedure endpoint. Follow-up included 7-day ECG monitoring every 3 months during the first year, and every 6 months afterwards.

Results

In groups 1 vs. 2, AF was terminated (into SR or AT) in 70 (82%) vs. 68 (78%) patients (p=0.81); and SR was restored by ablation in 54 (64%) vs. 46 (53%) patients(p=0.46), respectively. Procedure, fluoroscopy, and RF delivery times (min) were 251±46 vs. 257±45 (p=0.35); 10,4±2,8 vs. 11,0±3,1 (p=0.17), and 70±21 vs. 70±24 (p=0.98), respectively. At the end of 13-45 months follow-up, stable SR was present in 72 (85%) vs. 69 (79%), patients following repeat ablation in 42 (49%) vs. 42 (48%) patients. Only 29 (34%) vs. 26 (30%) patients remained free from any AF/AT recurrence (>30 s) after single ablation (all p=NS).

Conclusion

Mapping with multipolar catheter vs. standard ablation catheter was associated with nonsignificant differences in procedural characteristics and clinical results of RF catheter ablation for LSPAF.
Pulsed field ablation for atrial tachycardia following prior persistent atrial fibrillation ablation and resistant to radiofrequency energy
Authors: Fiala M , Cernosek M , Bulkova V , Bahnik J , Lehar F , Rybka L , Manousek J , Toman O , Kala P
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

There is a limited knowledge of immediate and long-term efficacy of pulsed field ablation for residual atrial tachycardia (AT) following (longstanding) persistent atrial fibrillation (AF) ablation and resistant to prior radiofrequency ablation (RFA).

Purpose

To present immediate effects of PFA (Farapulse) in a series of patients with repeat ablation for residual atrial tachycardia (AT) resistant to prior RFA.

Methods and results

In 5-11/2022, of 23 patients scheduled for PFA, 19 patients (64±7 years, 3 females) underwent PFA for left atrial (LA) AT resistant to RFA in first (n=4), second (n=11), third (n=3), and fourth (n=1) repeat ablation, respectively, after primary persistent AF ablation (4 patients were redirected to RFA for septal/right atrial AT source found by 3D mapping). At the procedure onset, persistent AT was ongoing (n=15) or was induced (n=4; AF induced and subsequently converted into AT in 3 patients). Mapping/ablation strategy was directed according to CS activation/entrainment to: 1) no 3D mapping and direct PFA (n=11); 2) PFA directly after 3D LA mapping (n=5); 3) PFA following RFA after 3D LA mapping (n=3). Total of 29 ATs was found (1,2, and 3 ATs in 12, 4, and 3 patients, respectively). Localized AT sources (n=16) dominated over macroreentry (MR) ATs (8 perimitral, 4 roof-dependent, 1 typical flutter). Only MR ATs, only localized ATs, and both MR+localized ATs were present in 7, 4, and 8 patients, respectively. All ATs were stopped with 5±9 PFA applications at the site of AT source and remained non-inducible. In 3 patients with initial ineffective RFA (6, 11, 6 minutes) within the same procedure, subsequent PFA terminated the AT with 1, 4, and 1 application respectively. Procedure and fluoroscopy times were 104±29 and 12±4 minutes, no complication occurred.

Conclusion

PFA with catheter Farapulse can affect complex/epicardial AT sources resistant to RFA in prior or present ablation procedure.
Epicardial ablation of left atrial flutter
Authors: Martinez Cossiani M , Castrejon Castrejon S , Jauregui Abularach M , Escobar Cervantes C , Guido Lopez L E , Merino D , Ugueto Rodrigo C , Carton A , Cobarro Galvez L , Severo Sanchez A , Martinez Maldonado M E , Merino J L
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial flutter (LAFL) may have epicardial components not accessible to endocardial ablation by radiofrequency (RF) application. Subxiphoid access to the pericardial space has been reported in isolated cases.

Purpose

to prospectively evaluate the efficacy and safety of subxiphoid access to the pericardial space to map and ablate LAFL refractory to endocardial RF application.

Methods

Patients with LAFL confirmed by activation and entrainment mapping and refractory to endocardial RF application were consecutively enrolled. An epicardial component of the tachycardia circuit was suspected when parts of the AFL activation, channels of slow conduction or conduction gaps on previous ablation lines intersecting the AFL circuit were not found. Pericardial access was obtained by subxiphoid puncture performed conventionally or facilitated by saline infusion or CO2 insufflation into the pericardial space. Following pericardial access, epicardial mapping and ablation was performed with a conventional RF irrigated tip ablation catheter. All procedures were performed under oral anticoagulation and during following heparin infusion for 350 sec activation clotting time target.

Results

15 patients with 18 LAFL were included (61.0 ± 8.8 years, 80% male). 14 patients have had a previous atrial fibrillation (AF) ablation. Epicardial ablation was attempted after a previous LAFL endocardial ablation procedure in 6 patients and during the same endocardial ablation procedure in the last 9 patients. Pericardial access was not achieved in 1 patient due to pericardial adhesions (after prior cardiac surgery). Ablation was successfully performed in 11 patients (73.33%) and failed in 4 patients with perimitral AFL (1 patient also had a peri-left appendage AFL). The successful ablation site was found in the transverse sinus of Theile over the Bachmann bundle in 14 patients with perimitral, septal and anterior-wall LAFL and in the oblique sinus in a posterior-wall LAFL. No patient presented relevant complications except for 2 patients who presented hemopericardium and 1 with delayed cardiac tamponade following accidental RV puncture and who required pericardiocentesis. No patient presented AFL recurrences at 19.8 months (range 6-34 months) follow-up except for 2 patients in whom ablation failed or pericardial access was not achieved.

Conclusions

Epicardial ablation of LAFL refractory to endocardial ablation is successful in most patients following successful pericardial access. This approach appears associated with low risk of significant complications.
Defibrillation test in paediatric patients: should be done?
Authors: Sarquella Brugada G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

The defibrillation test (DFT) of an implantable cardioverter-defibrillator (ICD) is performed to evaluate ventricular fibrillation detection and termination. In adults, routine defibrillation testing for transvenous ICD is less usually done as some studies found no advantages but some potentially risks associated with. On the other hand, implantation of ICDs in paediatric patients has different characteristics than in adults. The position of the defibrillation coil will change with the body’s growth and could reflect changes in the defibrillation vector. Also, the reasons of implantation of an ICD are different (ventricular arrhythmias frequently associated with adult’s myocardial infarction vs channelopathies, non-ischemic myocardiopathies and congenital heart defects in children and young). There is still lack of information about the utility of the DFT in paediatric patients.

Objective

To describe the characteristics of paediatric patients who underwent implantation of an ICD , results of DFT and follow-up.

Methodology

Retrospective cohort study of patients less than 21 years old who underwent implantation of an ICD in the lasts 10 years at a reference paediatric hospital. In DFT, VF was induced by T wave shock, fast burst pacing or continuous direct current. Response of ICD to VF was evaluated. Patients with failure to terminate VF by ICD were defibrillated with external defibrillator.

Results

68 patients with 73 ICD implantations (five replacements). Median age was 13 years old. The youngest patient was 2 years old and the oldest 21 years old. 72.6% (53/73) of patients underwent DFT. In 90.6% (48/53) of them, a VF was induced. In two patients (4%, 2/48) the ICD did not terminate the VF. One of these patients had Danon syndrome and the VF did not terminate despite of maximum energy discharged and changes in the vector of defibrillation; the problem was fixed with replacement of the single coil lead by a dual coil system. The other patient had arrhythmogenic cardiomyopathy and the ICD did not detect the VF. During the follow up, there were 20 shocks in 13 patients. 13 shocks were appropriate (and successful). One patient died because of non-arrhythmic illness.

Conclusions

In paediatric patients, the defibrillation test is useful to ensure both adequate detection of malignant ventricular arrhythmias, as well as their ability to reverse them. Its lack of performance could affect 4% of the implants. Therefore, its performance in paediatric patients is recommended. There could be greater utility in patients with hypertrophic cardiomyopathy.
Left cardiac sympathetic denervation in children. A matter of facts
Authors: Sarquella Brugada G
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac sympathectomy (CS) is a second-line treatment for drug-refractory adrenalin-sensitive channelopathies. We present our series of paediatric sympathectomies for long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) as adjunctive treatment.

Methods

Between 2011 and 2021, 30 CS (28 left, 2 right) were performed by videothoracoscopy in 28 patients (21 LQTS and 7 CPVT), aged 8 days to 21 years. The mean follow-up was 29 months. All patients were treated pharmacologically before surgery, three had an implantable cardiac defibrillator (ICD). Indications for CS in patients with CPVT included previous cardiac arrest (3/7) and sustained VT induced by emotion/stress despite medication (4/7). In LQTS, indications included syncope (4/21), VT despite medication (7/21) and high risk of malignant arrhythmias (10/21).

Results

There were no intraoperative complications or deaths. Four patients had transient palpebral ptosis with mild miosis, 23/28 patients were monitored by ICD or subcutaneous holter. After sympathectomy, 24/28 remain asymptomatic; three patients experienced syncope and one received appropriate discharge. Seven patients experienced VT (3/7 due to pharmacological non-compliance) of which three required ICD and four improved with medication. During follow-up, five high-risk patients received ICDs for primary prevention.

Conclusion

CS is an effective and safe technique in children as an adjunctive treatment for severe arrhythmias due to channelopathies. After CS, 85% remained asymptomatic. Medication non-compliance is an important cause of VT after CS, although ICD was occasionally required. In our experience, long-term remote monitoring is key to effective follow-up.
Minkowski Inequality in Cartan–Hadamard Manifolds
Authors: Ghomi Mohammad , Spruck Joel
Published: May 2023

Using harmonic mean curvature flow, we establish a sharp Minkowski-type lower bound for total mean curvature of convex surfaces with a given area in Cartan-Hadamard $3$-manifolds. This inequality also improves the known estimates for total mean curvature in hyperbolic $3$-space. As an application, we obtain a Bonnesen-style isoperimetric inequality for surfaces with convex distance function in nonpositively curved $3$-spaces, via monotonicity results for total mean curvature. This connection between the Minkowski and isoperimetric inequalities is extended to Cartan–Hadamard manifolds of any dimension.
Changes in Inflammatory Markers in Patients Treated for Buruli Ulcer and Their Ability to Predict Paradoxical Reactions
Authors: Phelippeau Michael , Marion Estelle , Robbe-Saule Marie , Ganlanon Line , Chauty Annick , Adeye Ambroise , Blanchard Simon , Johnson Christian , Marsollier Laurent , Dubee Vincent
Published: May 2023

Mycobacterium ulcerans causes Buruli ulcer, the third most frequent mycobacterial disease after tuberculosis and leprosy. Transient clinical deteriorations, known as paradoxical reactions (PRs), occur in some patients during or after antibiotic treatment. We investigated the clinical and biological features of PRs in a prospective cohort of 41 patients with Buruli ulcer from Benin. Neutrophil counts decreased from baseline to day 90, and interleukin 6 (IL-6), granulocyte colony-stimulating factor, and vascular endothelial growth factor were the cytokines displaying a significant monthly decrease relative to baseline. PRs occurred in 10 (24%) patients. The baseline biological and clinical characteristics of the patients presenting with PRs did not differ significantly from those of the other patients. However, the patients with PRs had significantly higher IL-6 and tumor necrosis factor alpha (TNF-α) concentrations on days 30, 60, and 90 after the start of antibiotic treatment. The absence of a decrease in IL-6 and TNF-α levels during treatment should alert clinicians to the possibility of PR onset.
Patient-centered Care: Value Added by Breast Radiologists in the Management of Breast Pain
Authors: Dodelzon Katerina , Shah Shreena , Prasad Lona , Atallah Juliana , Katzen Janine T
Published: May 2023

With the shift of the healthcare system toward patient-centered, value-based care, the role of the breast radiologist is essential and increasingly multifaceted. Beyond sole image interpreters, breast radiologists serve as subject matter experts within multidisciplinary care teams, acting as advocates and initiators into the healthcare system and providing patient-centered care through effective communication and patient education. These vital roles are well demonstrated through the imaging evaluation and management of the most common breast symptom that affects the majority of the patient population—mastalgia. By leveraging the opportunities provided during the evaluation of the symptomatic breast to optimize patient communication and education, as well as integration of care delivery, breast radiologists add significant value to patient care and ultimately improve patient outcomes.
An improved YOLOX approach for low-light and small object detection: PPE on tunnel construction sites
Authors: Wang Zijian , Cai Zixiang , Wu Yimin
Published: May 2023

Tunnel construction sites pose a significant safety risk to workers due to the low-light conditions that can affect visibility and lead to accidents. Therefore, identifying personal protective equipment (PPE) is critical to prevent injuries and fatalities. A few researches have addressed the challenges posed by tunnel construction sites whose light conditions are lower and images are captured from a distance. In this study, we proposed an improved YOLOX approach and a new dataset for detecting low-light and small PPE. We modified the YOLOX architecture by adding ConvNeXt modules to the backbone for deep feature extraction and introducing the fourth YOLOX head for enhancing multiscale prediction. Additionally, we adopted the CLAHE algorithm for augmenting low-light images after comparing it with eight other methods. Consequently, the improved YOLOX approach achieves a mean average precision of 86.94%, which is 4.23% higher than the original model and outperforms selected state-of-the-art. It also improves the average precision of small object classes by 7.17% on average and attains a real-time processing speed of 22 FPS (Frames Per Second). Furthermore, we constructed a novel dataset with 8285 low-light instances and 6814 small ones. The improved YOLOX approach offers accurate and efficient detection performance, which can reduce safety incidents on tunnel construction sites.
Investigating fracture toughness of graphene epoxy nanocomposites using single edge notched bending specimens
Authors: Chuang Po-Chun , Yu Chao Chen- , Yang Mi , Tsai Jia-Lin
Published: May 2023

The purpose of this study was to examine the fracture toughness of epoxy-based graphene nanocomposites. The single edge notched bending (SENB) samples with precrack tips were created by either tapping or sliding methods. For the tapping method, a single tap was conducted on a razor blade such a crack with a length of 2 mm was instantly propagated. For the sliding method, a razor blade was slid forward and backward into the samples, and a crack was generated with the blade edge. The SENB samples with graphene loadings (0.15 and 0.3 wt%) were subjected to three-point bending tests to evaluate fracture toughness. Results indicated that the graphene loading did not considerably affect the fracture toughness of the samples with tapping-induced precrack tips. However, the fracture toughness of the samples with sliding-induced precrack tips decreased as the graphene loading increased. For the 0.3 wt% graphene nanocomposites, the fracture toughness levels of the samples with sliding- and tapping-induced precrack tips were equal. In order to explicate the experimental results, the plastic zone sizes around the crack tip were evaluated using finite element analysis. For the sharp precrack tips (tapping method), the plastic zone was comparatively small (brittle behavior); hence, the effect of graphene on the inception of crack extension was minimal. Nevertheless, for blunt crack tips (sliding method), the plastic zone was larger and the size decreased as graphene loading increased; thus, the fracture behavior measured from the sliding method was dramatically influenced by the graphene loading.
(015) Sexual Health and Relationship Enhancement (SHARE) for Women with Breast Cancer: Results from a Clinical Trial
Authors: Carpenter K , Holmes H , Conroy K , Black L
Published: May 2023

Introduction

Sexual difficulties in the context of cancer survivorship remains an important, unsolved problem. Interventions must be efficacious and disseminable. Interventions that can be delivered to heterogeneous survivor groups can maximize impact on patients' quality of life.

Objective

Test a group psychosexual intervention -- Sexual Health and Relationship Enhancement (SHARE) -- designed for gynecologic cancer survivors in a sample of breast cancer survivors to determine feasibility and efficacy.

Methods

Participants were breast cancer survivors (N = 28). The majority (53.6%) was diagnosed at stage I (stage II: 35.7%, stage III: 10.7%). The participants were primarily Caucasian (75%) with an average age of 50.6 years (SD = 11.7, range = 29-79) and the majority were partnered (75%). Intent-to-treat (IIT) analyses were conducted for treatment outcomes. Using all available data, mixed effects modeling tested for change in treatment outcomes from the initial assessment to 3-, 6-, and 9-month assessments. Cohen’s d effect sizes were reported at post-treatment (6 months) and follow-up (9 months). The reliable change index was used to determine whether reliable clinical change had been achieved for each patient.

Results

The 12-session attendance rate was 23%. The mean number of SHARE sessions attended was 9 (SD=3.2). The rate therapy dropout was 10% (n=3). The patients viewed the treatment as helpful; average helpfulness ratings were 2.5 out of 3.0 (SD=0.4) and 84% of ratings fell in the moderately to very helpful range. Using a 0 to 10 point scale for cohesion, the means were 8.0 (SD=1.1) for involvement in the therapy experience and 9.2 (SD=1.1) for felt support. Significant linear effects of time (improvements) were seen for sexual function, satisfaction, and distress (p<.001); sexual behavior did not change. Effect sizes of change from baseline to post-treatment and follow-up on significant outcome measures were large (d=0.75-1.06). Most participants’ improvement in sexual function (65.2%) and sexual distress (66.7%) was reliable. Almost half of participants reported clinical levels of sexual distress at baseline that decreased to sub-clinical levels at follow-up, and 16.7% of participants had baseline clinical sexual dysfunction that was sub-clinical at follow-up.

Conclusions

SHARE-B is feasible and efficacious for addressing sexual morbidity following breast cancer, indicating it is likely possible to deliver to women with a variety of disease sites improving scalability of the intervention.

Disclosure

No
(022) Durability of Vestibulectomy Surgery for Neuroproliferative Vestibulodynia
Authors: Yee A , Goldstein S , Drian A , Goldstein I
Published: May 2023

Introduction

In 2006, Goldstein et al reported on 134 patients who underwent complete vestibulectomy surgery with vaginal advancement flap reconstruction for neuroproliferative vestibulodynia (NPV). Ninety-seven of 104 participants (93%) noted being satisfied/very satisfied with surgical outcome. The mean duration of follow up was 26 months (12 – 72 months). NPV is a genital pain condition hypothesized to be caused by an accumulation of excess mast cells in the vestibular epithelium and sub-epithelial stroma that release nerve growth factor. This promotes sub-epithelial stromal nerve ending proliferation (Figure 1). The excess nerve endings result in bothersome, persistent provoked vestibular allodynia and hyperalgesia. Durability of post-operative outcomes past 72 months has not been previously characterized. It is yet unknown if the immunohistochemical pathologic findings of excess mast cells and nerve endings ever reaccumulate in the vestibule, causing recurrent allodynia, hyperalgesia and entrance dyspareunia.

Objective

We assessed the long-term surgical outcome durability (>6 years) of resolution of pain from total vestibulectomy with vaginal advancement flap reconstruction.

Methods

We routinely perform post-operative follow-up of surgical patients who undergo complete vestibulectomy surgery with vaginal advancement flap reconstruction for NPV. We identified patients who claimed successful resolution of their entrance dyspareunia at least 72 months after complete vestibulectomy surgery. We contacted them to determine whether or not they continued to have resolution of their entrance dyspareunia.

Results

57 patients have had complete vestibulectomy surgery with vaginal advancement flap reconstruction from 2007 – 2016 (> 6 years ago). 41 patients responded to long term follow-up contact. 34 patients (78%) were satisfied/very satisfied with surgical outcome in the first 72 months post-operatively. All 34 (100%) continued to note excellent durability of their surgical result, still claiming being satisfied/very satisfied with surgical outcome, a mean of 9.3 years post-op (range 5-14 years).

Conclusions

Based on this small series, it appears that if a patient is a treatment responder to complete vestibulectomy surgery, there is strong durability of the surgical result. These data suggest that in treatment responders, there is no evidence of re-accumulation of excess mast cells and nerve endings in the introitus. These data support that the pathology of NPV lies in the endodermal vestibule and that complete excision is an important long term treatment strategy in many NPV patients.

Disclosure

No
(043) “I’m Coming!” (No, She’s Not): Inequitable Pleasure
Authors: Watson K , Collina S , Park D Y , Rowen T
Published: May 2023

Introduction

Gendered differences in pleasure can be observed in pornography, individual pleasure (masturbation), and pleasure with partners.

Objective

This project intends to synthesize and review current research on gendered differences in various forms of pleasure.

Methods

This study is a narrative review of peer-reviewed journal articles, each of which reinforced and contextualized the existence of the pleasure gap. We considered articles that collected and analyzed data from pornography sites as well as epidemiologic data gathered from researchers studying pornography and sexual activity.

Results

The pleasure gap in one of pornography’s largest tube sites, Pornhub, was 60 percentage points wide: 78 percent of men were shown reaching orgasm, as compared to 18 percent of women. Regarding gender disparities in masturbation, one article found that among a sample of college students, men were twice as likely as women to have ever masturbated. Additionally, the men that had masturbated during early adolescence did so with a frequency three times higher than their female counterparts. It must be noted that, for both of these studies, the categories “men” and “women” are not clearly defined. Partnered pleasure is primarily measured by orgasm frequency within sexual partnerships. Overall, more than 90 percent of men reach orgasm during sex, as compared to 50 percent of women (note that, in this research, “men” and “women” are not defined). For self-identified men, orgasm frequency was similar across sexual orientation, whereas for self-identified women, sexual orientation dramatically influenced the occurrence of orgasms. Notably, lesbian women had a significantly higher orgasm frequency (74.7 percent), as compared to bisexual women (58 percent) and heterosexual women (61.6 percent).

Conclusions

This review indicates a significant gap between orgasm and masturbation rates (as proxies for pleasure) in self-identified men and women. Future directions are twofold, 1) conduct experiments on the pleasure gap to better understand its etiologies, and 2) begin to investigate pleasure beyond the constructs of orgasm, as pleasure can and does exist beyond the climax of sexual stimulation.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Blueberry Hill Strategies.
(049) Blue Balls: Fact or Fiction? Experiences of Genitopelvic Pain and Sexual Coercion Among People with Penises and Vulvas
Authors: Henkelman M , Levang S , Neish R , Zukerman W , Terrel B , Jackman V , Coyle S , Brahmbhatt J , Pukall C
Published: May 2023

Introduction

The term “blue balls”, formally known as epididymal hypertension, is often used in public discourse to describe scrotal pain following sexual arousal that did not result in orgasm. Even though many health-related and popular online sources feature information on its potential causes and treatments, only one interview-based study and one case report exist on this phenomenon in the scientific literature. Controversy exists around the factual nature of blue balls/vulva considering its use for sexual coercion.

Objective

This cross-sectional, mixed-methods, online study aimed to characterize and evaluate the experience and prevalence of discomfort/pain following sexual arousal without orgasm, and assess whether individuals have been pressured to continue sexual activity because of a partner’s fears of experiencing discomfort/pain without orgasm.

Methods

A total of 2621 individuals with a penis (N = 1483) or vagina (N = 1138) were recruited for an online survey on the experience of “blue balls/vulva”. Analyses included descriptive statistics, between-group chi-squared analyses, and thematic analysis on several open-ended questions.

Results

Results from a chi-square test of independence suggested significantly more individuals with a penis than a vagina reported believing blue balls are real, and significantly more individuals with a vagina than a penis reported being pressured into engaging sexually because of a partner’s fear of getting blue balls. Descriptive statistics indicated that for the individuals who disclosed experiencing blue balls/vulva, the experience of pain/discomfort is reportedly mild, with few participants rating the experience as severe. Thematic analysis results indicated that overall, participants felt people with vulvas are expected to engage in sexual acts to prevent their partner’s experience of blue balls despite endorsing that it shouldn’t be used as a sexual coercion tactic.

Conclusions

Despite public discourse that “blue balls” is extremely painful and common, this study suggests that severe pain exists in a minority of people, that solitary sexual and nonsexual activities can alleviate discomfort/pain, and that pain experiences are not a valid reason to pressure others into engaging sexually.

Disclosure

No
(084) A Case Report of Alcohol-Induced Vestibule Pain, Resolved in the Setting of Vestibular Anesthesia Test
Authors: Martin A , Rubin R
Published: May 2023

Introduction

Vestibulodynia is a term to denote pain in the vestibule, which encompasses the vulvar tissue beginning within the labia minora at Hart’s line to the hymen, extending anteriorly just inferior to the clitoris and to the posterior fourchette. Three subtypes of vestibulodynia exist including neuroproliferative, hormonally-mediated and inflammatory. All three subtypes can cause a constellation of symptoms including dyspareunia, dysuria, and discomfort with wearing tight clothes or wiping.

Objective

Described here are two patients who note pain in the vestibule within seconds of drinking alcohol. Notably, in the setting of a vestibular anesthesia test, in which the entire vestibule was completely numbed, they noticed resolution of their typical symptoms and were able to drink alcohol without vestibular pain.

Methods

This first patient is a 40 year old female with endometriosis, adenomyosis, PMDD, POTS, pelvic pain and 19 year history of unprovoked vestibulodynia with multiple failed treatment modalities. Upon consumption of alcohol, notices immediate pain in the vestibule. The second patient is a 27 year old female with provoked neuroproliferative vestibulodynia s/p vestibulectomy. Notes that four minutes after drinking any type of alcohol has worsening stinging and burning of the vestibule. A vestibular anesthesia test was performed, coating the vestibule in 30% Benzocaine, 8% Lidocaine and 6% Tetracaine, allowing it to sit for 10 minutes.

Results

Both patients drank alcohol after the 10 minutes and noted no symptoms at the tissue level whatsoever. They both still had hypertonic pelvic floors. The second patient went on to vestibulectomy and still had symptoms present, though they had decreased.

Conclusions

These cases indicate that alcohol may play a role in inciting vestibulodynia symptoms, and numbing of the vestibule can negate those symptoms. Possible pathophysiology may be due to the vasodilation effects of alcohol on the vestibular tissue, or a histamine response, but further research is needed to determine any potential link.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout
(094) Sexual Emergencies in Women
Authors: Dominguez-Bali A , Rey C , Dominguez-bali C , Baqer A , Sharma R , Hassan Z , Marquez L
Published: May 2023

Introduction

Sexual emergencies in female patients are more common than people think. They represent medical curiosities more than pathologies for which we should be prepared to treat. This review and the presentation of our cases shows how extensive and important is this area in the medical practice and why every single physician should be prepared to confront them. Gynecologist, surgeons, sexologists, and ER physicians are familiarized with some of the sexual emergencies in women that called the attention of the medical community. However, the broad spectrum of those disorders is not well-known.

Objective

1. Show the magnitude of sexual emergencies in women nationally and internationally. 2. Describe how they can vary according with the place, culture, and societies. 3. To learn the methods of diagnosis and treatment of these ample variety of conditions.

Methods

Based on the multiple cases seen in the ER of our facility, an extensive review of the literature was done, and the cases are presented to show the magnitude, variety, and diversity of cases in the different areas of the medical field.

Results

The review includes: I. The common coital emergencies in neurology (benign coital headache, subarachnoid hemorrhage, intracerebral bleeding, subdural hemorrhage, cerebral vascular accidents), urology (ureterovesical foreign bodies, obstructive uropathies), cardiology (sudden cardiac death, myocardial infarction), gynecology (vaginal lacerations and/or evisceration and death with/without previous gynecological surgeries), obstetrical (postpartum dyspareunia secondary or not to episiotomy or vaginal lacerations; postcoital preterm labor), immunological (local or systemic, anaphylactic allergic reactions). II. Common autoerotic emergencies in gastroenterology (foreign objects in rectum, vagina, oropharyngeal/mandibular lesions), as well as “body packers” cases (swallowed latex balloons for smuggling in the GI tract, rectum, or vagina). III. Sexual assault IV. Sexual dysfunction: Hyperactive arousal disorders (compulsive hunt for orgasms with/without attempt or real suicide, hypersexuality related to SSRI use). V. Sociosexual issues: Killings for jealousy during sex, infidelity, castration like Lorena Bobbitt case.

Conclusions

The epidemiology of these pathologies varies from country to country, and state to state, and includes women of any age, race, religion, and culture. Finally, a review of these diagnostic methods and treatment are presented.

Disclosure

No