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Artificial Intelligence in the Prevention and Detection of Cardiovascular Disease
No full textFor more than 60 years, artificial intelligence (AI) has served as a mainstay in augmenting and assisting the lives of individuals across a wide array of interests and professional fields. Functioning to create deep computer simulations, analyze data, solve problems, and synthesize human behavior/ emotion, AI has recently become a topic of popular interest in many fields of medicine. Despite decades of usage, modern AI—and its newer branch of machine learning (ML)—have yet to find a fully established and regulated niche in medicine. Understanding the clinical implications that AI and ML might be able to play in cardiovascular medicine, studies have sought to understand and compare how this technology compares with human rationality and diagnostics. Utilizing AI and ML in an array of cardiovascular medical techniques, analyses, and predictive measurements seems to have produced accurate results while also saving healthcare providers time and enabling them to expand their reach to further populations. Although current research and literature might hypothesize AI’s potential clinical applications, it is nearly impossible to fully understand the breadth and scope that this new technology can play in the future. In this article, we attempt to analyze a few of the potential applications of AI and ML for the detection, prevention, and treatment of cardiovascular disease. Additionally, we discuss how AI might make cardiovascular care more equitable and highlight a few precautions for utilizing this technology
Stem Cells Associated With Adult Skeletal Muscle Can Form Beating Cardiac Tissue in Vitro in Response to Media Containing Heparin, Dexamethasone, Growth Factors and Hydrogen Peroxide
No full textBoth cardiac and skeletal muscles originate from the mesoderm, although the two tissues develop from distinct primordia within the early embryo. The shared, albeit distinctive muscle phenotype of these two cell types have led many researchers to investigate whether stem cells from adult skeletal muscle have the capacity to generate cells with a contractile, cardiac phenotype. To date, most of those studies have relied on multistep protocols requiring tissue engineering, co-cultures or transplantation experimentation. In this report, we describe a simple, cell culture method for obtaining contractile, cardiogenic aggregates from skeletal muscle-derived stem cells (MDSCs). Combining in vitro conditions used for promoting the differentiation of cardiac progenitor cells and the long-term maintenance of heart tissue fragments, we have been able to convert MDSCs to myocardial cells that aggregate into beating myospheres. These selective and optimized culture conditions continued to support a contractile cardiogenic phenotype for over four months in vitro. This culture protocol provides a model for future insights into the pathways responsible for the divergence of skeletal and cardiac phenotypes, as well as a source of easily obtained myocardial tissue for subsequent scientific investigations into cardiac function and biology
Noninvasive Optical Monitoring of Cerebral Hemodynamics in a Preclinical Model of Neonatal Intraventricular Hemorrhage
No full textIntraventricular hemorrhage (IVH) is a common complication in premature infants and is associated with white matter injury and long-term neurodevelopmental disabilities. Standard diagnostic tools such as cranial ultrasound and MRI are widely used in both preclinical drug development and clinical practice to detect IVH. However, these methods are limited to endpoint assessments of blood accumulation and do not capture real-time changes in germinal matrix blood flow leading to IVH. This limitation could potentially result in missed opportunities to advance drug candidates that may have protective effects against IVH. In this pilot study, we aimed to develop a noninvasive optical approach using diffuse correlation spectroscopy (DCS) to monitor real-time hemodynamic changes associated with hemorrhagic events and pre-hemorrhagic blood flow in a preclinical rabbit model of IVH. DCS measurements were conducted during the experimental induction of IVH, and results were compared with ultrasound and histological analysis to validate findings. Significant changes in hemodynamics were detected in all animals subjected to IVH-inducing procedures, including those that did not show clear positive results on ultrasound 18 h later. The study revealed progressively elevated coefficients of variation in blood flow, largely driven by temporal fluctuations in the \u3c0.25 Hz range. Our findings suggest that real-time optical monitoring with DCS can provide critical insights heralding pathological blood flow changes, offering a more sensitive and informative tool for evaluating potential therapeutics that may help avert the progression to IVH
Top-100 Highest Cited Articles on Posterior Communicating Artery Aneurysms: A Bibliometric Analysis
No full textObjective: The aim of this study is to evaluate the 100 most highly cited articles assessing posterior communicating artery aneurysms. Methods: In May 2024, a comprehensive search was conducted in the Scopus database using the keyword “posterior communicating artery aneurysm” The top-100 most impactful articles were ranked by citation count and analyzed for relevant factors. Citations per year were calculated to minimize the risk of bias. Google Scholar (GS) and Web of Science (WOS) citations were also included. Results: The top-100 articles were published between 1978 and 2022, with a total of 2935 citations in Scopus, 3988 in GS, and 2508 in WOS. The mean number of citations was 29.4 (range 12–158) on Scopus, 40.7 (range 10–216) on GS, and 26.9 (range 9–120) on WOS. The most contributing country was the United States, while the leading institution was the Second Military Medical University in China. The most productive journal was World Neurosurgery, producing 15 articles. The most prolific author was Liu J.-M with 10 published articles. The funding body with the most funded publication was the National Natural Science Foundation of China. Subcategory analysis revealed that the majority of articles focused on treatment options and postsurgical outcomes, oculomotor nerve palsy, and clinical features. Conclusions: This study offers a detailed overview of the most cited articles on posterior communicating artery aneurysms. It demonstrates key contributions made by different countries, institutions, journals, and authors, providing a valuable framework for understanding the evidence supporting the management of these aneurysms
Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy
No full textBACKGROUND: The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. METHODS: We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0-36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. RESULTS: Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. CONCLUSIONS: The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities
Improved Perceived Health Status Among Persons Practicing Yoga for Pain Management
No full textPurpose of the Study: The purpose of this research was to examine the relationship between yoga practice and perceived health status, and to evaluate the benefits of yoga as a pain management strategy for low-income individuals.
Methods: An observational cross-sectional study was conducted and analyzed using 2022 National Health Interview Survey (NHIS) data. Logistic regression analyses examined whether the practice of yoga affected perceived health status, and whether low-income individuals were more likely to practice yoga for pain management.
Results: Analyses revealed that individuals who practiced yoga were 1.7 times more likely to report their health status positively than those who do not practice yoga. A higher prevalence of yoga practice for pain management was found among individuals at or below the poverty line than those with higher incomes, showing that a decrease in income was correlated with an increase in practicing yoga to manage pain symptoms
Conclusion: The findings showed that regular yoga practice was associated with improved perceived health status among individuals with chronic pain. Given the substantial burden of chronic pain in the US, yoga may be a beneficial adjunct to medical therapy that boosts physical and mental health, enhancing quality of life. It is especially beneficial for low-income populations as an affordable and accessible intervention that supports both physical and mental well-being
Review and Key Takeaways of the 2021 Percutaneous Coronary Intervention Guidelines
No full textThe 2021 Percutaneous Coronary Intervention guidelines completed by American College of Cardiology/American Heart Association/ Society for Cardiovascular Angiography and Interventions provide a set of guidelines regarding revascularization strategies. With emphasis on equity of care, multidisciplinary heart team use, revascularization for acute coronary syndrome, and stable ischemic heart disease, the guidelines create a thorough framework with recommendations regarding therapeutic strategies. In this comprehensive review, our aim is to summarize the 2021 revascularization guidelines and analyze key points regarding each recommendation
Complex Bentall Operation: Clinical Pearls to Standardize the Procedure
No full textBackground: A straightforward Bentall operation can be performed safely with low mortality, but some challenging cases require a more complex operation. We discuss here the steps of the Bentall procedure. Methods: We reviewed specific scenarios, such as acute aortic dissection, native valve or prosthetic valve endocarditis, redo Bentall after aortic root replacement, calcified aortic root, and patients with prior coronary artery bypass grafting, mechanical aortic valve replacement, stentless aortic valve replacement, and prior extensive aortic arch repair with proximalization of neck vessels. Results: A variety of techniques were reported regarding reconstruction of aortic annulus (eg, Dacron [DuPont] graft is everted to create 5 to 6 crimps when sewing a bioprosthesis, and the height of the skirt can be adjusted depending on tissue defect) and reimplantation of coronary buttons. (Interposition of Dacron graft for coronary button reimplantation [original Cabrol technique], short interposition of Dacron graft is known as the Piehler technique, and technique in redo Bentall after prior aortic root replacement.) In patients with a history of coronary artery bypass grafting, direct reimplantation of a previous vein graft patch to the Dacron graft or interposition of a short Dacron graft were introduced. In addition, repair of coronary button in type A dissection or calcified aortic root were also described. Conclusions: Various techniques are available in modified Bentall operation. Surgeons should be familiar with the setup, anatomy of aortic root and surrounding structures, ways to treat tissue defect and prepare coronary buttons, and the various bailout procedures
Unveiling the Impact of Trauma During Pregnancy
No full textBackground: Pregnant trauma patients present unique challenges in terms of assessment and management. This study assesses the impact of traumatic injuries on pregnant patients using a national trauma database. Methods: ACS-TQIP (2020–2021) identified traumatically injured females aged ≥15 and ≤ 55. Propensity score matching compared pregnant and not-pregnant patients. Primary outcome was mortality, with secondary outcomes including length of stay (LOS), emergency department and discharge disposition, interventions, and complications. Results: Of 947,000 traumatically injured females, 8421 (0.9 %) were pregnant. Pregnant patients (6.0 %) sustained firearm injuries more than not-pregnant patients (5.4 %) (p = 0.02). Pregnant patients had more severe thoracic (47.2%vs.9.4 %) and abdominal injuries (7.1%vs.4.8 %) compared to not-pregnant patients (p \u3c 0.001). Among pregnant patients, 5.6 % had preterm labor, 2.6 % had cesarean sections, and 1.9 % had abortions. After matching, there was no significant difference in mortality between both groups (p = 0.40). Pregnant patients had longer ICU LOS (p \u3c 0.05) and higher rates of unplanned return to ICU (p \u3c 0.05). Conclusions: Pregnant patients are more often victims of firearm violence, sustaining critical thoracic and abdominal injuries. These injuries demand increased interventions, introduce complications, and can be fatal
How Does Drug Abuse Affect Outcomes After Trauma? a Trauma Quality Improvement Program Study
No full textBackground: The protective effects of drug abuse on ICU admissions and ventilator weaning after trauma are debated. This study examines the impact of drug abuse on mortality, ICU admissions, and complications. Methods: Trauma patients ≥16 years from the TQIP database (2020–2022) with admission toxicology testing (TOX) were analyzed. The primary outcome was mortality; secondary outcomes included in-hospital complications. Results: Among 861,450 patients, decreased mortality odds were noted with cannabinoid (OR = 0.842), amphetamine (OR = 0.800), cocaine (OR = 0.851), opioid (OR = 0.625), and benzodiazepine (OR = 0.843) (P \u3c 0.001). Reduced ICU admission odds were linked to opioid (OR = 0.882), barbiturate (OR = 0.824), oxycodone (OR = 0.829), ecstasy (OR = 0.811), and methadone (OR = 0.809). Lower intubation odds were seen with opioid (OR = 0.663), barbiturate (OR = 0.733), oxycodone (OR = 0.754), and ecstasy (OR = 0.627). Methamphetamine (OR = 0.682) was associated with reduced ARDS odds. Conclusions: Recreational drugs may independently reduce ICU admissions, intubation, and mortality, warranting further investigation. Level of evidence: Level III retrospective study