Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction

We aimed to characterize the independent predictors of LVT following STEMI and the association with outcomes. The clinical predictors of left ventricular thrombus (LVT) formation after ST-segment elevation myocardial infarction (STEMI) are not well-defined in the contemporary era. We performed a retrospective analysis of STEMI patients at Duke from 2000 to 2011 who had a transthoracic echocardiogram within 90 days post-STEMI and compared patients with and without LVT (LVT+ vs. LVT?). Univariate Cox proportional hazards regression models of baseline characteristics were examined and significant variables were used in a multivariable model to assess adjusted relationships with LVT. A multivariable Cox PH survival model with covariate adjustments was used for assessment of LVT and long-term mortality. Of all eligible patients, 1734 patients met inclusion criteria and 4.3 % (N = 74) had a LVT. LVT+ patients tended to have a history of heart failure (HF) and higher initial troponin compared to LVT- patients. After adjustment, higher heart rate, non-white race, HF severity, and presence of left anterior descending artery (LAD) disease were independent predictors of LVT. There was a trend toward an association between LVT and increased all-cause mortality (HR 1.36; 95 % CI 0.84–2.21, P = 0.22), however this was not statistically significant. LVT was seen in over 4 % of this contemporary post-STEMI population. Several baseline characteristics were independently associated with LVT: Heart rate, HF severity, LAD disease, and non-white race. Prospective studies are warranted to determine whether anticoagulation in patients at increased risk for LVT improves outcomes.     

Performance Evaluation of Time-Frequency Distributions for ECG Signal Analysis

The non-stationary and multi-frequency nature of biomedical signal activities makes the use of time-frequency distributions (TFDs) for analysis inevitable. Time-frequency analysis provides simultaneous interpretations in both time and frequency domain enabling comprehensive explanation, presentation and interpretation of electrocardiogram (ECG) signals. The diversity of TFDs and specific properties for each type show the need to determine the best TFD for ECG analysis. In this study, a performance evaluation of five TFDs in term of ECG abnormality detection is presented. The detection criteria based on extracted features from most important ECG signal components (QRS) to detect normal and abnormal cases. This is achieved by estimating its energy concentration magnitude using the TFDs. The TFDs analyse ECG signals in one-minute interval instead of conventional time domain approach that analyses based on beat or frame containing several beats. The MIT-BIH normal sinus rhythm ECG database total records of 18 long-term ECG sampled at 128 Hz have been analysed. The tested TFDs include Dual-Tree Wavelet Transform, Spectrogram, Pseudo Wigner-Ville, Choi-Williams, and Born-Jordan. Each record is divided into one-minute slots, which is not considered previously, and analysed. The sample periods (slots) are randomly selected ten minutes interval for each record. This result with 99.44% detection accuracy for 15,735 ECG beats shows that Choi-Williams distribution is most reliable to be used for heart problem detection especially in automated systems that provide continuous monitoring for long time duration.     

Discontinuation of anticoagulant therapy for a month in a patient with HeartMate III continuous-flow left ventricular assist device without thromboembolic events

The recommended anticoagulation regimen for continuous-flow left ventricular assist device (LVAD) systems is warfarin and aspirin with a targeted international normalized ratio (INR) of 2.0–3.0. Our patient is a 58-year-old male who underwent surgical HeartMate III continuous-flow LVAD implantation 3?months ago outside the country. The patient mistakenly stopped taking warfarin for 1?month prior to presenting to our center for a routine visit. Luckily, the patient was doing very well without any complication despite the fact that his INR was 1.0.     

“Doll #135 with vitiligo”: Are alopecia and vitiligo Barbie worth the hype?

Toy manufacturer Mattel released a new line of diverse Barbie dolls earlier this year, including dolls with alopecia and vitiligo. The new dolls have been widely celebrated, with both media and dermatologists proposing that the dolls could provide significant benefits for the low self-esteem and societal exclusion suffered by children with similar dermatoses. However, the reality may be very different. Here, we present existing research on the impact of diverse dolls on children’s play and psychology to argue that the dolls’ proposed benefits for children with alopecia and vitiligo are unlikely to materialize; rather, alopecia and vitiligo Barbie could prove more harmful than beneficial.     

Fertility preservation for boys and adolescents facing sterilizing medical therapy

Improvements in childhood cancer survival have allowed boys and their families to increasingly focus on quality of life after therapy, particularly their future ability to father children. Treatments should maintain comprehensive cancer care goals and consider the long-term quality of life of these children. While semen cryopreservation is a well-established method of fertility preservation for post-pubertal children, the use of cryopreserved pre-treatment testicular tissue represents a promising, yet experimental method of fertility preservation for prepubertal males facing sterilizing therapy. Healthcare providers should counsel families about the fertility risks of therapy, discuss or refer patients for standard fertility preservation options, and consider experimental approaches to fertility preservation while being mindful of the ethical questions these treatments raise.     

Unusual suspects: Real-time physiological evaluation of stressors during laparoscopic donor nephrectomy

IntroductionThe purpose of this study was to document the variability of faculty surgeon electrodermal activity (EDA) peaks during laparoscopic donor nephrectomy (LDN) to determine the effect of case difficulty and learner expertise on the stress response.MethodsEDA for a single faculty surgeon was captured over 15 LDN cases using an Empatica E4 wristband. During each case, one of three transplant fellows (novice, intermediate, or expert level LDN expertise) participated. Difficulty was rated preoperatively as “low/moderate/high” by the faculty. EDA peaks were collected and analyzed; the frequency and magnitude of EDA peaks, case difficulty, and fellow expertise were compared using a two-way factorial ANOVA.ResultsThe main effects of learner expertise (F[2, 308]=11.27, p<0.001) and difficulty rating (F[2, 414]=15.13, p<0.001) were significant. The interaction between difficulty and expertise on faculty EDA peaks was also significant (F[3, 391]=14.29, p<0.001). The novice fellow resulted in higher faculty EDA levels compared to intermediate and expert fellows on low-difficulty cases, but not moderate- or high-difficulty cases.ConclusionsThis is the first report examining faculty surgeon EDA across cases of varying difficulty and varying learner expertise during a high-stakes operation. EDA levels were inversely proportional to the expertise of the learner and case difficulty, suggestive of a significant impact of learner autonomy on faculty stress response.