University Hospital

Background: Pulmonary vein isolation (PVI) is key to atrial fibrillation (AF) ablation, but arrhythmia often recurs due to conduction gaps permitting pulmonary vein (PV) reconnection. Currently, gap identification requires invasive remapping. We evaluated whether deep learning applied to surface electrocardiograms (ECGs) could (i) detect the electrophysiologic signature of PVI and (ii) predict PV reconnection at redo ablation. Methods: We retrospectively studied 176 patients (2012?2023) who had initial PVI and repeat ablation. A total of 865 10-second 12-lead ECGs were extracted from GE MUSE and CardioLab systems, segmented into 1-2 second clips, and used to train ResNet-based convolutional neural networks. Separate models were developed for: (i) PVI detection (pre- vs. post-ablation ECGs) and (ii) gap prediction using pre-redo ECGs. Demographic features were tested alone and in multimodal fusion with ECGs. Performance was evaluated using Receiver Operating Characteristic (ROC) curves, sensitivity, and specificity with stratified cross-validation. Gradient-weighted class activation mapping (Grad-CAM) assessed feature importance. Results: The best PVI detection model distinguished ECGs before and after PVI with the area under the ROC (AUROC) = 0.879. Grad-CAM localized attention to the diastolic period and P-wave morphology. For gap prediction, the model trained on pre-redo ECGs achieved an AUROC of 0.819 (sensitivity 77.5%, specificity 75.8%). Adding demographics improved the AUROC to 0.830 (sensitivity 84%, specificity 72%), whereas demographics alone performed no better than chance (AUROC = <50%). Feature importance analysis highlighted P-wave onset and offset, inter-ablation time interval, left atrial volume index, age, and left ventricular ejection function as the strongest contributors in gap prediction. Conclusions: Deep learning identifies a consistent ECG biosignature of acute PVI and predicts PV reconnection before redo ablation with moderate accuracy, primarily using P-wave morphology. These models may inform patient selection, procedural planning, and counselling in patients with recurrent AF after PVI.

Abstract BackgroundDiabetes (DM), a common comorbidity, results in poorer cognition in people with multiple sclerosis (PwMS). Metformin may be a treatment option given cognitive benefits. Metformin represses monoacylglycerol lipase (Mgll), accompanied by improvements in cognition in animals.AimsTo determine 1) whether metformin represses Mgll in humans, 2) if Mgll correlates with cognition/emotion recognition, and 3) if cognition differs between groups.MethodsA convenience sample of seventeen PwMS and DM on metformin, 4 with MS and DM not on metformin, 10 with MS, and 21 healthy controls completed BICAMS and measures of premorbid ability, emotion recognition, mood and fatigue. Blood draw established Mgll levels. T-tests determined group differences in Mgll. Correlational analyses examined if Mgll correlated with cognition. ANCOVA evaluated differences in cognition/emotion recognition.ResultsGiven small samples, we combined groups to determine if metformin impacted Mgll regardless of diabetes status. Significant differences in Mgll (t= -2.07,p= .05), suggested that metformin suppresses Mgll. No relationship was found between Mgll and cognition/emotion recognition. Differences were found between PwMS and DM compared to controls in verbal learning (F= 5.85,p= .02) and memory (F= 5.62,p= .02).ConclusionsMetformin suppresses Mgll in humans suggesting metformin be evaluated as a potential MS treatment. Mgll did not correlate with cognition possibly due to sample size or methodology. Combined impact of MS and DM negatively impacts cognition, supporting literature demonstrating that vascular comorbidity increases risk of cognitive dysfunction. Findings support pursuing clinical trials evaluating metformin efficacy.

Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections. It causes a variety of diseases ranging from diarrhea to megatoxic colon and also death. Over the last twenty years, the frequency and severity of this infection have globally increased and this requires the implementation of its surveillance in hospitals. In this study, were enrolled all fecal samples arriving in the microbiology laboratory of the San Giovanni di Dio and Ruggi d'Aragona university hospital from January 2019 to December 2023 to be tested for Clostridium difficile toxins via an enzyme immunoassay. Then, were evaluated the positive samples, the gender and age group from which they came as well as the hospital departments in which the infection was mostly found. Out of a total of 3210 total samples, 10.4% tested positive and was mostly from female and the >75 age group. The medical wards (86.2%) are the largest fraction of departments from which the majority of positive samples were received. Since the transmission of CDI is mostly nosocomial, it is important to understand that the compliance of healthcare workers is the highlight of the measures to prevent transmission and that monitoring and surveillance of this infection is essential.

PurposeAcute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery.MethodsWe conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD.ResultsWe studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21–3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%.ConclusionOne in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors.

BackgroundFor acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry.MethodsImaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups.ResultsOf the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P=0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P=0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98]; P=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09]; P=0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18]; P=0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models.ConclusionIn this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.

BackgroundThe thymus, a primary lymphoid organ, plays a crucial role in immune system homeostasis [1,2]. Although several studies of an association between radiographic thymus variants and serological features in systemic autoimmune diseases such as systemic scleroderma, have been reported [3-6], information in patients with other systemic autoimmune disease, especially in primary Sjögren’s syndrome (pSS) or polymyositis/dermatomyositis (PM/DM) patients, is quite limited.ObjectivesWe investigated the association between radiographic thymus variants and clinical and immunological features in patients with pSS and PM/DM, and clarified its significance.MethodsPatients with pSS and PM/DM were randomly selected from all patients who had visited our department and underwent chest CT scan between April 2009 and March 2019. Patients with thymoma or thymic cyst and those aged less than 30 years were excluded. Thymic enlargement and thymus attenuation score in axial images of CT scans were quantitatively interpreted. We defined thymic enlargement as a thickness of more than 13 mm and graded the score by a four-point scale (score 0-3) according to previous studies [7, 8]. Association with radiographic thymus variants and clinical and immunological features was statistically analyzed.Results72 pSS and 47 PM/DM patients were enrolled. 90% and 63.8% were women and mean age was 62.7 ± 12.2 and 56.2 ± 13.7 years in pSS and PM/DM patients, respectively. Thymic enlargement was found in 16 (22.2%) and 14 (29.8%) patients with pSS and PM/DM, respectively. Thymus attenuation (score ≥ 2) was found in 11 (15.3%) and 9 (19.1%) patients with pSS and PM/DM, respectively. These findings were more frequent than in non-connective tissue diseases patients (9.1% and 9.1%, respectively). In pSS patients, radiographic thymus variants, both thymic enlargement and the thymus attenuation score, were significantly positively associated with body weight (P < 0.0073 and 0.037, respectively). Although there was no significant difference between immunological features such as titres of serum RF, the ratio of RF-positivity, SS-A antibody-positivity or SS-B antibody-positivity, and radiographic thymus variants, titres of serum RF tended to be positively associated with thymic enlargement (P = 0.057). In PM/DM patients, thymic enlargement was significantly positively associated with titres of serum RF (P = 0.046), and the thymus attenuation score was significantly positively associated with titres of serum IgG (P = 0.042) and significantly negatively associated with age (P = 0.033). There was no significant difference between the ratio of myositis specific antibody-positivity and radiographic thymus variants.ConclusionRadiographic thymus variants were frequently observed in pSS and PM/DM patients, and particularly, in case of PM/DM, may reflect an abnormal immune response involved in the pathogenesis.

Purpose The purpose of this study was to quantify changes in acoustic distinctiveness in two groups of talkers with Parkinson's disease as they modify across a wide range of speaking rates. Method People with Parkinson's disease with and without deep brain stimulation and older healthy controls read 24 carrier phrases at different speech rates. Target nonsense words in the carrier phrases were designed to elicit stop consonants and corner vowels. Participants spoke at seven self-selected speech rates from very slow to very fast, elicited via magnitude production. Speech rate was measured in absolute words per minute and as a proportion of each talker's habitual rate. Measures of segmental distinctiveness included a temporal consonant measure, namely, voice onset time, and a spectral vowel measure, namely, vowel articulation index. Results All talkers successfully modified their rate of speech from slow to fast. Talkers with Parkinson's disease and deep brain stimulation demonstrated greater baseline speech impairment and produced smaller proportional changes at the fast end of the continuum. Increasingly slower speaking rates were associated with increased temporal contrasts (voice onset time) but not spectral contrasts (vowel articulation). Faster speech was associated with decreased contrasts in both domains. Talkers with deep brain stimulation demonstrated more aberrant productions across all speaking rates. Conclusions Findings suggest that temporal and spectral segmental distinctiveness are asymmetrically affected by speaking rate modifications in Parkinson's disease. Talkers with deep brain stimulation warrant further investigation with regard to speech changes they make as they adjust their speaking rate.

Amaç: Çalışmada, aile hekimliği polikliniğine başvuran hastaların sağlık okuryazarlığı seviyelerini ve etkileyen durumları değerlendirmek planlanmıştır.Yöntem: Bu tanımlayıcı-kesitsel çalışma Mart-Haziran 2020 arasında gerçekleştirildi. Çalışma grubunu, Pamukkale Üniversitesi Tıp Fakültesi aile hekimliği polikliniğine başvuran 18 yaş üstü, okuryazar, iletişim kurulabilen ve çalışmaya katılmaya onay veren kişiler oluşturmaktadır. Anket formu 15 soruluk demografik özellikler ile sağlık okuryazarlığını değerlendirmek için Türkiye Sağlık Okuryazarlığı Ölçeği-32’den oluşmaktadır.Bulgular: Çalışmaya katılan 211 kişinin %55,5’i (n=117) kadın ve yaş ortalamaları 31,9±10,4 idi. Katılımcıların %17,1’i (n=36) yetersiz, %28,9’u (n=61) ise sorunlu-sınırlı sağlık okuryazarlığına sahipti. Yetersiz sağlık okuryazarlık düzeyi lise altı eğitimi olanlarda, evlilerde, fazla kilolu ve obezlerde anlamlı olarak daha yüksek saptandı (sırasıyla p=0,003; p=0,011; p=0,042). Sağlık okuryazarlık ortalama puanı ve alt grup puanlarında ile yaş ve beden kitle indeksi (BKİ) arasında negatif yönde zayıf düzeyde ilişki bulundu (sağlık okuryazarlık toplam puanı sırasıyla r=-0,291 p=&amp;lt;0,001; r=-0,194 p=0,005).Sonuç: Sağlık okuryazarlık düzeyi medeni durum, eğitim durumu, BKİ düzeyinden etkilenmekteydi. Ayrıca genç yaş grubu ve düşük BKİ ile sağlık okuryazarlık ortalama puanı ve alt grup puanları ilişkiliydi.