Diagnosis of multiple sclerosis using optical coherence tomography supported by explainable artificial intelligence

BACKGROUND/OBJECTIVES

Study of retinal structure based on optical coherence tomography (OCT) data can facilitate early diagnosis of relapsing-remitting multiple sclerosis (RRMS). Although artificial intelligence can provide highly reliable diagnoses, the results obtained must be explainable.

SUBJECTS/METHODS

The study included 79 recently diagnosed RRMS patients and 69 age matched healthy control subjects. Thickness (Avg) and inter-eye difference (Diff) features are obtained in 4 retinal layers using the posterior pole protocol. Each layer is divided into six analysis zones. The Support Vector Machine plus Recursive Feature Elimination with Leave-One-Out Cross Validation (SVM-RFE-LOOCV) approach is used to find the subset of features that reduces dimensionality and optimises the performance of the classifier.

RESULTS

SVM-RFE-LOOCV was used to identify OCT features with greatest capacity for early diagnosis, determining the area of the papillomacular bundle to be the most influential. A correlation was observed between loss of layer thickness and increase in functional disability. There was also greater functional deterioration in patients with greater asymmetry between left and right eyes. The classifier based on the top-ranked features obtained sensitivity = 0.86 and specificity = 0.90.

CONCLUSIONS

There was consistency between the features identified as relevant by the SVM-RFE-LOOCV approach and the retinotopic distribution of the retinal nerve fibres and the optic nerve head. This simple method contributes to implementation of an assisted diagnosis system and its accuracy exceeds that achieved with magnetic resonance imaging of the central nervous system, the current gold standard. This paper provides novel insights into RRMS affectation of the neuroretina.

Attitudes scale toward cancer-related cognitive changes - an initial Colombian validation

OBJECTIVE

The aim of this study was to develop an initial valid tool to measure attitudes toward cancer-related cognitive changes.

SUBJECTS AND METHODS

After revising the literature, three main dimensions were hypothesized. Eight judges were contacted to obtain content validity evidence. A robust Exploratory Factor Analysis (EFA) was performed via a parallel analysis with an Unweighted Least Squares (ULS) estimator and polychoric correlations. The results were crossed with sociodemographic variables to find possible statistical differences and estimate the size effect. Analysis was performed in the software Factor and the statistical package R.

RESULTS

A sample of 374 participants was obtained, involving oncology patients, their caregivers, and people from the general community. A statistical fit was found in two dimensions: Awareness and Judgments [root mean squared error of approximation (RMSEA) = 0.042, standardized root mean square residual (SRMR) = 0.02, comparative fit index (CFI) = 0.99, Tucker-Lewis index (TLI) = 0.98] with a moderate correlation between them (r = 0.612). Optimal reliability indices were obtained for the total scale and its dimensions. No real statistical difference was found between sociodemographic variables; the interpretation norms were established via the quartiles.

CONCLUSIONS

The first attempt to measure the construct of interest was developed with two primary validity evidence based on the content and its internal structure. This instrument could help strengthen the prevention of cancer-related cognitive changes. More research is needed to adhere more valid evidence to the scale.

Transfer Learning with CNN Models for Brain-Machine Interfaces to command lower-limb exoskeletons: A Solution for Limited Data. Annu Int Conf IEEE Eng Med Biol Soc 2023;2023:1-4. [PMID: 38083615 DOI: 10.1109/embc40787.2023.10340008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

This study evaluates the performance of two convolutional neural networks (CNNs) in a brain-machine interface (BMI) based on motor imagery (MI) by using a small dataset collected from five participants wearing a lower-limb exoskeleton. To address the issue of limited data availability, transfer learning was employed by training models on EEG signals from other subjects and subsequently fine-tuning them to specific users. A combination of common spatial patterns (CSP) and linear discriminant analysis (LDA) was used as a benchmark for comparison. The study's primary aim is to examine the potential of CNNs and transfer learning in the development of an automatic neural classification system for a BMI based on MI to command a lower-limb exoskeleton that can be used by individuals without specialized training.Clinical Relevance- BMI can be used in rehabilitation for patients with motor impairment by using mental simulation of movement to activate robotic exoskeletons. This can promote neural plasticity and aid in recovery.

Analysis of Error Potentials generated by a lower limb exoskeleton feedback in a BMI for gait control. Annu Int Conf IEEE Eng Med Biol Soc 2023;2023:1-4. [PMID: 38083187 DOI: 10.1109/embc40787.2023.10340275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Brain-machine interfaces (BMIs) based on motor imagery (MI) for controlling lower-limb exoskeletons during the gait have been gaining importance in the rehabilitation field. However, these MI-BMI are not as precise as they should. The detection of error related potentials (ErrP) as a self-tune parameter to prevent wrong commands could be an interesting approach to improve their performance. For this reason, in this investigation ErrP elicited by the movement of a lower-limb exoskeleton against subject's will is analyzed in the time, frequency and time-frequency domain and compared with the cases where the exoskeleton is correctly commanded by motor imagery (MI). The results of the ErrP study indicate that there is statistical significative evidence of a difference between the signals in the erroneous events and the success events. Thus, ErrP could be used to increase the accuracy of BMIs which commands exoskeletons.Clinical Relevance- This investigation has the purpose of improving brain-machine interfaces (BMIs) based on motor imagery (MI) by means of the detection of error potentials. This could promote the adoption of robotic exoskeletons commanded by BMIs in rehabilitation therapies.

A new bathyal species of Pardaliscoides (Amphipoda, Amphilochidea, Pardaliscidae) from off the southwestern Gulf of Mexico

A new species of pardaliscid amphipod is described and illustrated from a single male specimen collected from bathyal sediments (2125 m depth) in the southern Gulf of Mexico. The new species is morphologically closest to Pardaliscoides fictotelson Barnard, 1966, previously documented from Southern California, at 218 m depth. The new pardaliscid differs from other species in the genus in having antenna 1 with a 10-articulate accessory flagellum; maxilliped palp very long; pereopods 5-7 elongate, slender; basis pereopod 7 expanded; telson with a short U-shaped cleft and pointed lobes; uropods 1-2 outer ramus curved, peduncle flat, longer than rami; uropod 3 rami flat, fleshy-lined, with marginal distal short robust setae. An identification key for all known species in the Pardaliscoides genus is also provided. The new species increase the number of Pardaliscoides species documented to six worldwide.

Homeopathy for seasonal allergic rhinitis: rationale, design and methods of the three-armed randomized controlled HOMEOSAR trial

BACKGROUND

Patients with seasonal allergic rhinitis (SAR) frequently use homeopathic therapy. Although there is some evidence that homeopathy may be effective in treating symptoms of SAR, there is a lack of high-quality clinical trials. Therefore, the aim of the homeopathy for SAR (HOMEOSAR) trial is to determine the efficacy of individualized or standardized homeopathic drug treatment compared to placebo regarding rhinitis-related quality of life in patients with SAR.

METHODS

This randomized, placebo-controlled, double-blind, three-armed intervention study will be conducted at two university hospital outpatient clinics for complementary and integrative medicine in Berlin and in 12 office-based practices specializing in homeopathic treatment in Germany. A total of 270 patients with clinical symptoms of SAR and positive allergy test to birch and grass pollen will receive homeopathic anamnesis and subsequently be randomized into (a) standardized homeopathic drug treatment with Galphimia Glauca (potency D6), (b) individualized homeopathic drug treatment (D6), or (c) placebo. All three groups can receive on-demand rescue medication as needed. Treatment will consist of two consultations and daily intake of the study medication for 4 weeks during the pollen season. The primary outcome is the mean overall score of the Rhinitis Quality of Life Questionnaire (RQLQ) in weeks 3 and 4, analyzed using analysis of covariance (adjusted for baseline RQLQ overall score and study center). A closed testing procedure will be used to control the overall type I error comparing the 3 treatment groups. Secondary outcomes include the overall RQLQ and its seven domain scores, responder status (decrease in RQLQ overall score of at least 0.5 points compared to the baseline value), use of rescue medication, intensity of total and individual SAR symptoms based on visual analog scale, generic health-related quality of life, safety, utilization of health care resources and associated costs. In addition, a qualitative data analysis is planned.

CONCLUSION

The results of our study will contribute to clarifying the possible therapeutic effects of homeopathic drug treatment for patients with SAR.

TRIAL REGISTRATION

This study has been registered in the German Clinical Trial Registry with trial ID DRKS00018081 on June 09, 2020.

Biogeographical survey of soil microbiomes across sub-Saharan Africa: structure, drivers, and predicted climate-driven changes

BACKGROUND

Top-soil microbiomes make a vital contribution to the Earth's ecology and harbor an extraordinarily high biodiversity. They are also key players in many ecosystem services, particularly in arid regions of the globe such as the African continent. While several recent studies have documented patterns in global soil microbial ecology, these are largely biased towards widely studied regions and rely on models to interpolate the microbial diversity of other regions where there is low data coverage. This is the case for sub-Saharan Africa, where the number of regional microbial studies is very low in comparison to other continents.

RESULTS

The aim of this study was to conduct an extensive biogeographical survey of sub-Saharan Africa's top-soil microbiomes, with a specific focus on investigating the environmental drivers of microbial ecology across the region. In this study, we sampled 810 sample sites across 9 sub-Saharan African countries and used taxonomic barcoding to profile the microbial ecology of these regions. Our results showed that the sub-Saharan nations included in the study harbor qualitatively distinguishable soil microbiomes. In addition, using soil chemistry and climatic data extracted from the same sites, we demonstrated that the top-soil microbiome is shaped by a broad range of environmental factors, most notably pH, precipitation, and temperature. Through the use of structural equation modeling, we also developed a model to predict how soil microbial biodiversity in sub-Saharan Africa might be affected by future climate change scenarios. This model predicted that the soil microbial biodiversity of countries such as Kenya will be negatively affected by increased temperatures and decreased precipitation, while the fungal biodiversity of Benin will benefit from the increase in annual precipitation.

CONCLUSION

This study represents the most extensive biogeographical survey of sub-Saharan top-soil microbiomes to date. Importantly, this study has allowed us to identify countries in sub-Saharan Africa that might be particularly vulnerable to losses in soil microbial ecology and productivity due to climate change. Considering the reliance of many economies in the region on rain-fed agriculture, this study provides crucial information to support conservation efforts in the countries that will be most heavily impacted by climate change. Video Abstract.

IgA vasculitis with nephritis (Henoch-Schönlein purpura) after COVID-19: A case series and review of the literature

COVID-19 most related glomerular disease to date seems to be collapsing glomerulopathy, mostly in young Afroamerican patients with APOL1 gene risk alleles. However, in our population, predominant in elderly Caucasian patients, most biopsied pathology since the beginning of the pandemic has been IgA nephritis or Schönlein-Henoch purpura. Since the description of the first case of this entity after SARS-CoV-2 infection by our research group, three more cases have arisen, which are described in the following article. In contrast to the rest of IgA vasculitis cases reported, our patients presented more renal function deterioration and all of them required immunosupresive therapy. Moreover, some showed incomplete recovery of renal function. This case series strengthens the hypothesis that SARS-CoV-2 infection may be another trigger of this pathology.

Feasibility of whole genome and transcriptome profiling in pediatric and young adult cancers

The utility of cancer whole genome and transcriptome sequencing (cWGTS) in oncology is increasingly recognized. However, implementation of cWGTS is challenged by the need to deliver results within clinically relevant timeframes, concerns about assay sensitivity, reporting and prioritization of findings. In a prospective research study we develop a workflow that reports comprehensive cWGTS results in 9 days. Comparison of cWGTS to diagnostic panel assays demonstrates the potential of cWGTS to capture all clinically reported mutations with comparable sensitivity in a single workflow. Benchmarking identifies a minimum of 80× as optimal depth for clinical WGS sequencing. Integration of germline, somatic DNA and RNA-seq data enable data-driven variant prioritization and reporting, with oncogenic findings reported in 54% more patients than standard of care. These results establish key technical considerations for the implementation of cWGTS as an integrated test in clinical oncology.

Cancer whole-genome and transcriptome sequencing (cWGTS) has been challenging to implement in clinical settings. Here, the authors develop a workflow to deliver robust cWGTS analyses and reports within clinically-relevant timeframes for paediatric, adolescent and young adult solid tumour patients.

MO470: Outcomes of Patients in Advanced Chronic Kidney Disease (ACKD) Consultation With Covid-19 Infection

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) has affected our patients not only in renal replacement therapy (RRT), but also in advanced chronic kidney disease (ACKD) consultation. Our aim is to assess the impact of COVID-19 in a group of patients of our ACKD consultation.

METHOD

Retrospective observational study in our centre of patients from ACKD consultation with hospitalization due to COVID-19 infection in the period from March to December 2020. We have studied demographic parameters, characteristics during hospitalization, analytics values (3 months before and 1, 3, 6 and 12 months after infection) and final status at the end of follow-up on 31 December 2021. A value comparison is made with the Wilcoxon test for paired data.

RESULTS

In an ACKD consultation with 90 patients, 12 (13%) required hospitalization due to COVID-19. 75% were male, with a mean age of 77.6 years (SD 7) (range 59–89 years) and 25% due to Diabetic Kidney Disease. Mean time in consultation 28 months (SD 14) (range 12–58). Mean Comorbidity Charlson Index 8.2 (SD 1.2) (range 7–11), all hypertensive, 42% treatment with insulin, 25% ischemic heart disease and 42% chronic obstructive pulmonary disease. In COVID-19 hospitalizations, 83% they had pneumonia, 50% steroid treatment, 75% hydroxychloroquine, 92% several antibiotics, 33% low molecular weight heparin, only two required tocilizumab, and none required admission to the intensive care unit. During hospitalization, 3 (25%) patients died, and one died during follow-up, all were males. The consequences after infection: 42% pneumology (cough, varying degrees of shortness of breath), 8% neurological (headaches, varying degrees of memory loss) and 8% loss of smell (from 1 to 6 moths). At the follow-up, only one patient needs RRT with haemodialysis (at 19 months after COVID-19).

Table 1 shows analytics comparison before and after COVID. From 6 months after COVID, the results are like 3 months after the disease.

CONCLUSION

With the important limitation of few patients and without a control group, ACKD patients with hospitalization to COVID-19 show similar patterns to those with RRT: more frequent in males, advanced age, lung comorbidity and diabetics, elevation of inflammatory parameters, anemia and increase in creatinine during hospitalization. Recovery to values prior to admission occurs from the first month after infection.

MO883: Cardiorenal Syndrome in Dialysis: Outcomes and Prognosis in Comparison With a Control Population

BACKGROUND AND AIMS

The interactions of both organs in Cardiorenal Syndrome (CRS) exacerbate the damage and determine a worse prognosis in these patients [1]. The aim of our study is to compare the development and prognosis of CRS patients compared with control patients.

METHOD: In a retrospective fashion, we assigned 60 patients with CRS who underwent dialysis, and we compared them with a control population of 60 patients without CRS in dialysis. We analyzed baseline characteristics of the patients and the dialysis parameters. Survival rates at 1 and 5 years were determined.

RESULTS

The baseline characteristics were similar between groups. The mean age was 72 ± 9 years in CRS and 68 ± 12 years in the control group. Men were more prevalent in both groups CRS (55%) and control (53%). Charlson's Score was 8 ± 2 points in the CRS group and 7 ± 3 points in the control group. Diabetic nephropathy was the most frequent etiology of end-stage renal disease in CRS patients (37%), followed by nephroangiosclerosis (20%). In the control group, the most common etiologies were nephroangiosclerosis (32%), diabetic (22%) and interstitial nephropathy (11%).

CRS patients had more diabetes mellitus (55% versus 35%; P < 0.05), dyslipidemia (63% versus 38%; P < 0.05), ischemic cardiopathy (50% versus 31%; P < 0.05), atrial fibrillation (66% versus 21%; P < 0.05) and valvular heart disease (27% versus 6%; P < 0.05). There were no differences in hypertension (80% versus 76%; P = 0.58), ictus (31% versus 23%; P = 0.30) and peripheral arterial disease (40% versus 33%; P = 0.44) between groups. CRS patients had more hospitalizations due to heart failure before starting dialysis than the control group (52% versus 1.7%; P < 0.05)

Haemodialysis was the most common technique in both groups CRS (98%) and control (95%). The use of permanent tunneled catheters as definite vascular access was more common in CRS patients (60% versus 26%; P < 0.05). There were no differences in the duration of haemodialysis sessions (252 ± 18 versus 257 ± 23 min),  neither in interdialytic weight gain (2.3 ± 0.7 versus 2.4 ± 0.9 Kg). CRS patients had worse ultrafiltration tolerance with a hypotension rate of 48% in CRS versus 10% in the control group (P < 0.05).

The median time in dialysis was inferior in the CRS group [24 (8–42) versus 61 (26–106) months; P < 0.05] compared with controls and the survival rates at 1 and 5 years were worse in the CRS group (71% versus 93%; P < 0.05) and (15% versus 50%; P < 0.05), respectively.

The main cause of death was the cardiovascular events in both groups (35% versus 20%; P = 0.06). However, tumor as a cause of death was superior in the control group (18% versus 0%; P < 0.05).

CONCLUSION

CRS patients have more cardiovascular risk factors and cardiovascular disease as expected, as well as more hospitalizations caused by heart failure before starting dialysis. They have more frequent use of a permanent tunneled catheter. It could be explained because of worse tolerance to the use of arteriovenous fistula in these patients.

- The survival rates at 1 and 5 years are significantly inferior in the CRS group, which highlights the poor prognosis of these patients [2,3].

- The tumor as a cause of death was superior in the control group due to greater time in dialysis of these patients compared with CRS patients

Neurocognition, functional outcome, and quality of life in remitted and non-remitted schizophrenia: A comparison with euthymic bipolar I disorder and a control group

There are discrepancies about if the severity of the symptomatology in schizophrenia is related to neurocognitive performance, functional outcome, and quality of life (QoL). Also, there are controversial data about the comparison between euthymic bipolar patients and different subgroups of schizophrenia in neurocognition, functioning, and QoL level. The present study aimed to compare the neurocognitive performance, functional outcome, and QoL of remitted and non-remitted patients with SC with respect to a group of euthymic patients with BD, and a control group. It included 655 subjects: 98 patients with schizophrenia in remission (SC-R), 184 non-remitted patients with schizophrenia (SC-NR), 117 euthymic patients with bipolar I disorder (BD), and 256 healthy subjects. A comprehensive clinical, neurocognitive (six cognitive domains), functional, and QoL assessment was carried out. Remission criteria of Andreasen were used to classify schizophrenia patients as remitted or non-remitted. Compared with control subjects all groups of patients showed impaired neurocognitive performance, functioning and QoL. SC-R patients had an intermediate functioning between control subjects and SC-NR, all at a neurocognitive, functional, or QoL level. There were no significant differences between SC-R and BD. These results suggest that reaching clinical remission is essential to achieve a better level of psychosocial functioning, and QoL. Likewise, the results of this study suggest that euthymic patients with bipolar disorder and patients with schizophrenia in remission are comparable at the neurocognitive and functional levels, which might have implications in the pathophysiology of both disorders.

Diagnosis of multiple sclerosis using multifocal ERG data feature fusion

The purpose of this paper is to implement a computer-aided diagnosis (CAD) system for multiple sclerosis (MS) based on analysing the outer retina as assessed by multifocal electroretinograms (mfERGs). MfERG recordings taken with the RETI-port/scan 21 (Roland Consult) device from 15 eyes of patients diagnosed with incipient relapsing-remitting MS and without prior optic neuritis, and from 6 eyes of control subjects, are selected. The mfERG recordings are grouped (whole macular visual field, five rings, and four quadrants). For each group, the correlation with a normative database of adaptively filtered signals, based on empirical model decomposition (EMD) and three features from the continuous wavelet transform (CWT) domain, are obtained. Of the initial 40 features, the 4 most relevant are selected in two stages: a) using a filter method and b) using a wrapper-feature selection method. The Support Vector Machine (SVM) is used as a classifier. With the optimal CAD configuration, a Matthews correlation coefficient value of 0.89 (accuracy = 0.95, specificity = 1.0 and sensitivity = 0.93) is obtained. This study identified an outer retina dysfunction in patients with recent MS by analysing the outer retina responses in the mfERG and employing an SVM as a classifier. In conclusion, a promising new electrophysiological-biomarker method based on feature fusion for MS diagnosis was identified.

Survival analysis in hypertrophic cardiomyopathy caused by the three most common pathogenic TPM1 variants

Purpose

To evaluate survival free of cardiovascular events in carriers of the three most frequent TPM1 pathogenic hypertrophic cardiomyopathy (HCM) variants.

Methods

Clinical and genetic data on families carrying TPM1 variants in the literature and identified in our center were systematically revised and collected in a database. Classification of variant's pathogenicity was in accordance with ACMG criteria. We evaluated available follow-up data and constructed Kaplan-Meier survival curves to cardiovascular death (sudden death, appropriate cardiodefibrillator shock, heart failure death, and stroke-related death) or heart transplant. Long-rank test was used to compare event-free survival time.

Results

562 carriers (343 HCM-probands and 219 relatives; 51.3% male carriers) were identified carrying 73 missense variants considered disease causing. TPM1 p.Asp175Asn (87 probands, 109 relatives, 6 unaffected), p.Arg21Leu (52 probands, 25 relatives, 16 unaffected), and p.Met281Val (37 probands, 8 relatives, 9 unaffected) were the most prevalent HCM-variants. Among these three variants, survival data was reported for 508 individuals. Eight-nine carriers had suffered events: 74 sudden deaths (55% males), nine heart failure deaths (44% males), two transplants (50% males), and five stroke-related death (25% males). Incidence of cardiovascular death or transplant was similar between TPM1 p.Arg21Leu and p.Met281Val (p=0.75) and different than p.Asp175Asn (p=0.03 and p=0.06, respectively) and all TPM1 variants (p=0.004 and p=0.04). Analysis by sex showed TPM1 p.Arg21Leu female carriers had better prognosis than p.Asp175Asn male carriers (p=0.048) and all TPM1 male and female carriers (p=0.02 and p=0.04) (curves not showed in the graph).

Conclusion

TPM1 p.Arg21Leu and p.Met281Val could have a better prognosis than p.Asn175Asn and all other TPM1 missense variants in HCM. No marked difference was observed between male and female carriers. More than 80% of the events were arrhythmic deaths.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): HEALTH IN CODE SL

Molecular characterization of a cohort of individuals referred to genetic testing with suspected CPVT

Background

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is one of the most lethal inherited arrhythmogenic diseases and it mainly affects the young, in the absence of structural heart disease. This condition is difficult to diagnose and the first expression of disease can be an arrhythmic death. In the last years, genetic testing has become a useful tool in the challenging task of CPVT diagnosis.

The diagnostic yield of the genetic study is highly variable and dependent on the phenotypic characteristics of the individuals evaluated.

Purpose

This study aimed to address the clinical characteristics and genetic testing (GT) results in a cohort of individuals referred to genetic analysis with a non-definitive diagnosis of CPVT, in a real world-setting.

Methods

This is a retrospective cohort study of patients referred for GT with clinical suspicion of CPVT, but who did not strictly meet the diagnostic criteria for this disease (according to current guidelines). NGS genotyping was performed with a library of 251 genes. NGS-based genomic testing was performed with classification of identified variants according to American College of Medical Genetics and Genomics guidelines.

Results

One hundred and sixteen unrelated patients with available clinical information (patients' characteristics are summarized in TABLE1) were included in the analysis. Mean age at GT was 36 y/o (±19), 47% were women and 18% had a familial history of sudden cardiac death.

The first clinical manifestation was: exercise or stress induced syncope in 36%, exercise induced ventricular tachycardia in 30% and sudden cardiac arrest in 15.5% (78% during emotional or physical stress - 89% aborted sudden death). Mean age at sudden death was 20 y/o (±14).

GT was positive in 49.1% (n=57), negative in 37.9% (n=44) and inconclusive in 12.9% (n=15). We had identified pathogenic/likely pathogenic variants in CPVT-related genes in 40% of the referred patients: RYR2 (70.2%-n: 40), KCNJ2 (8.8%-n: 5), CASQ2 in homozygous/compound heterozygous carriers (3.5%-n: 2). In the RYR2 gene we detected 36 different genetic variants (13 were novel) in 40 different individuals. In addition, relevant variants were also identified in other genes associated with channelopathies (SCN5A, 3.5%, n: 2 and KCNQ1, 1.7%, n: 1) and in genes associated with structural heart disease: desmosomal genes (6.8%-DSP n: 1 and PKP2 n: 3) and sarcomeric genes (5.1%- MYBPC3 and MYH7) (figure 1A-B).

Conclusions

In our cohort of patients with non-definitive diagnosis of CPVT, the diagnostic yield of genetic testing was almost 50%. GT allowed confirmation of the suspicion of CPVT in 40% of the patients and, in addition, we were able to detect relevant genetic variants in other genes not associated with CPVT in 10% (differential diagnosis). The use of wide genetic panels would be useful in this context.

Funding Acknowledgement

Type of funding sources: None. Suspected CPVT. Genetic Testing.

Condylar morphometry in adults with sagittal intermaxillary relationship class I, II and III using Cone Beam Computed Tomography in a Colombian population

OBJECTIVE

This study established the morphometry of the mandibular condyle in individuals with complete craniofacial growth and sagittal intermaxillary relationships class I, II and III using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

Cone beam computed tomography was obtained for orthodontics diagnostic purposes. The sample was divided taking into account the ANB angle in sagittal classes I, II and III (age ranged from 18 to 40 years old). Linear measurements and shapes of 144 mandibular condyles were analyzed.

RESULTS

Statistically significant differences were found in measurements of the mediolateral diameter when compared with gender (P 0.000) being larger for males. Statistically significant differences between the mediolateral diameter and the coronal shape for the right as well as the left sides with P values of 0.000 and 0.47 respectively were found.

CONCLUSION

In this sample, it was not possible to conclusively determine the relationship between the skeletal class and the mediolateral diameter. However, more studies are required.

[Ig a vasculitis with nephritis (henoch-schönlein purpura) after covid-19: a case series and review of the literature.]

La patología glomerular más relacionada con enfermedad COVID-19 hasta la fecha parece ser la glomerulopatía colapsante, principalmente en pacientes de raza afroamericana y con alelos de riesgo para el gen APOL1. No obstante, en nuestra población, conformada por pacientes adultos mayores de raza caucásica, la patología más biopsiada desde el inicio de la pandemia ha sido la nefritis IgA o púrpura de Schönlein-Henoch.

Desde la descripción del primer caso de esta entidad tras infección por SARS-CoV-2 por nuestro grupo de investigación hemos objetivado otros tres, los cuales se describen a continuación. En contraste con el resto de los casos publicados de vasculitis IgA, nuestros pacientes presentaban mayor deterioro de función renal y todos requirieron tratamiento inmunosupresor. Además, algunos presentaron recuperación incompleta de función renal. Esta serie de casos afianza la posibilidad de que la infección por SARS-CoV-2 sea un desencadenante más de esta patología.

MO211FORMALIZATION AND DEVELOPMENT OF A NEPHROLOGY ELECTRONIC CONSULTATION (ECONSULT) IN COVID-19 PANDEMIC

Background and Aims

Due to COVID-19 pandemic we must continue attending in our hospital consultations and, at the same time, avoid transfers and visit that involve risks to our patients. For this reason, we implemented new forms of care. Mainly electronic consultation (eConsult) using institutional email as way of contact between Primary Care Providers (PCPs) and nephrologist, trying to decrease in-person visit.

Objective

To analyze the results of the creation in June 2020 of a Nephrology electronic consultation in our hospital.

Method

Retrospective observational study of eConsults made to our department, which serves a population of 200.000 people, with total of 9 primary care centers. The study period was June 10, 2020 to December 31, 2020. We have studied the number of eConsults, response time, type of consult made, problem resolution and subsequent follow up.

Results

Of 141 workdays, in 61 days (43%) there was eConsult, total 80 eConsults, mean 1.3 and median 1 daily (range 1 to 3). All primary care centers used this communication way, as well as 50 PCPs. Median response time for eConsult was 1 day (range 1-4). 55% patient was male, mean age 70.8 years (SD 13.9) (range 16-95 years). 64% it was his first assessment for Nephrology. The most frequent causes of eConsult: increase of creatinine (41.3%), uncontrolled blood pressure (12.5%), sodium and potassium disturbances (11.3%), treatment adjustment (11.3%) and changes in previous appointment (8.8%). After assessment eConsult, to 55% of patients was treatment adjustment, 22.5% were converted to an in-person visit, 11% they didn´t need any action but only 1 patient was referred to the emergency room. 44% patient is subsequent follow up by PCPs, 39% by nephrologist, 15% joint assessment PCP and nephrologist and 2% by other specialists. Only 2 patients (2.5%) made second eConsult.

Conclusion

The eConsult is an important help to PCPs to solve doubts quickly, avoid unnecessary the travels to hospital the patients, treatment adjustment above all in control of hypertension an ionic disturbance, and guide in handling of chronic kidney disease. The diffusion and empowerment of this type of consultation in a next future may decrease, partly, the usual saturation of face-to-face visit and optimize the patient population being seen by nephrologist.

Acupuncture in diabetic peripheral neuropathy-protocol for the randomized, multicenter ACUDPN trial

BACKGROUND

Acupuncture is used to treat patients with diabetic peripheral neuropathy; however, the evidence is unclear. We present the design and methodology of the ACUDPN (ACUpuncture in Diabetic Peripheral Neuropathy) trial, which investigates the effectiveness of acupuncture for the treatment of diabetic peripheral neuropathy (DPN) symptoms. The aim of this study is to investigate whether acupuncture is effective for the treatment of DPN symptoms.

METHODS

This study is a two-armed, randomized, controlled, parallel group, open-label, confirmatory, multicenter trial (8-week intervention period plus 16 weeks of follow-up). Physicians in outpatient units in Germany who specialize in acupuncture treatment will treat 110 diabetes type II patients with clinical symptoms of peripheral neuropathy in the feet and legs with signs of neuropathy according to nerve conduction testing. The patients will be randomized in a 1:1 ratio to one of the following two groups: (a) semi-standardized acupuncture plus routine care or (b) routine care alone. Acupuncture will consist of 12 treatments per patient over 8 weeks. The primary outcome will be the overall DPN-related complaints in the extremities after 8 weeks as measured by the Visual Analog Scale (VAS). Further outcome measures will include DPN-related pain, the Neuropathic Pain Symptom Inventory (NPSI), Diabetic Peripheral Neuropathic Pain Impact (DPNPI) scores, and nerve conduction parameters of the sural nerve at weeks 8, 16, and 24.

DISCUSSION

The results of this trial will be available in 2021 and will help clarify whether acupuncture can be considered effective for the treatment of DPN with regard to the subdimensions of the neuropathic clinical picture.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03755960 . Registered on 11 August 2018.

Using advanced analysis of multifocal visual-evoked potentials to evaluate the risk of clinical progression in patients with radiologically isolated syndrome

This study aimed to assess the role of multifocal visual-evoked potentials (mfVEPs) as a guiding factor for clinical conversion of radiologically isolated syndrome (RIS). We longitudinally followed a cohort of 15 patients diagnosed with RIS. All subjects underwent thorough ophthalmological, neurological and imaging examinations. The mfVEP signals were analysed to obtain features in the time domain (SNR_min: amplitude, Lat_max: monocular latency) and in the continuous wavelet transform (CWT) domain (b_max: instant in which the CWT function maximum appears, N_max: number of CWT function maximums). The best features were used as inputs to a RUSBoost boosting-based sampling algorithm to improve the mfVEP diagnostic performance. Five of the 15 patients developed an objective clinical symptom consistent with an inflammatory demyelinating central nervous system syndrome during follow-up (mean time: 13.40 months). The (SNR_min) variable decreased significantly in the group that converted (2.74 ± 0.92 vs. 4.07 ± 0.95, p = 0.01). Similarly, the (b_max) feature increased significantly in RIS patients who converted (169.44 ± 24.81 vs. 139.03 ± 11.95 (ms), p = 0.02). The area under the curve analysis produced SNR_min and b_max values of 0.92 and 0.88, respectively. These results provide a set of new mfVEP features that can be potentially useful for predicting prognosis in RIS patients.

Early diagnosis of multiple sclerosis by OCT analysis using Cohen's d method and a neural network as classifier

BACKGROUND

The consequences of inflammation, demyelination, axonal degeneration and neuronal loss in the central nervous system, typical of the development of multiple sclerosis (MS), are manifested in thinning of the retina and optic nerve. The purpose of this work is to diagnose early-stage MS patients based on analysis of retinal layer thickness obtained by swept-source optical coherence tomography (SS-OCT).

METHOD

OCT (Triton® SS-OCT device -Topcon, Tokyo, Japan-) recordings were obtained from 48 control subjects and 48 recently diagnosed MS patients. The following thicknesses were measured on a 45 × 60 grid: retinal nerve fibre layer (RNFL), ganglion cell layer (GCL+), GCL++, retinal thickness and choroid. Using Cohen's d effect size, it was determined the regions and layers with greatest capacity to discriminate between control subjects and patients. Points exceeding the threshold set were used as inputs for an automatic classifier: support vector machine and feed-forward neural network.

RESULTS

In MS at clinical onset the layer with greatest discriminant capacity is GCL++ [AUC = 0.83] which exhibits a horseshoe-like macular topographic distribution. It is followed by retina, GCL+ and RNFL; choroidal thicknesses do not provide discriminatory capacity. Using a neural network as a classifier between controls and MS patients, obtains sensitivity of 0.98 and specificity of 0.98.

CONCLUSIONS

This work suggest that OCT may serve as an important complementary role to other clinical tests, particularly regarding neurodegeneration. It is possible to characterise structural alterations in retina and diagnose early-stage MS with high degree of accuracy using OCT and artificial neural networks.

Genotype/Phenotype correlation and prognosis for undescribed ACTC1 missense variants

Purpose

Establish the genotype/phenotype correlation for missense undescribed variants in ACTC1, and evaluate their prognostic implications.

Methods

A systematic screening for the ACTC1 gene was performed using NGS in 17,683 individuals with inherited cardiovascular disease, 6,984 of them with hypertrophic cardiomyopathy, 3,507 with dilated cardiomyopathy, and 760 left ventricular non-compaction. These phenotypes were clinically diagnosed by each center prior to the genetic study. Frequency of the variants was compared with gene gnomAD and ClinVar databases. A systematic review of the literature was performed to search for previously reported variants.

We evaluated available follow up data and constructed Kaplan-Meier survival curves free from cardiovascular death (sudden death, Heart transplant, heart failure death, appropriate ICD discharge and stroke related death). Log-rank test was used to compare event-free survival time between males and females.

Results

39 missense variants were identified in 283 carriers (125 index cases; 158 first-degree relatives). Twenty-two have not been previously described or identified in public databases. 17 have been reported in gnomAD or Clinvar. Carriers phenotypes were: 120 HCM; 43 LVNC; 16 DCM; three had cardiac septal defect and two had sudden death. Some of the carriers had overlapped or combined phenotypes: 7 HCM and LVNC, 7 septal defects and LVNC, 3 HCM and septal defects, 4 MCD and LVNC. 24 were healthy carriers, and we have no phenotypic data of the remaining individuals. Family studies were performed in 12 families out of the 22 undescribed variants, showing cosegregation in 8 variants. One case was “de novo”.

Interestingly, a rare variant, previously identified as VUS in ClinVar, showed a clearly cosegregation with HCM. The Leu10Met variant with a frequency of 9/282084 alleles in gnomAD (1/15671 individuals) was identified in 20 index cases, which represents 1/884 of all the genotyped (0.11%), and 1/387 patients with HCM (0.35%). We found it in 2/9289 patients with other phenotypes (p<0.001).

51 patients (18%) presented an event during follow up. In several cases, carriers developed early atrial fibrillation.

The survival curve shows adverse events from the first decade of life, with a 10% cumulative rate of events at age 40, 80% survival at age 60, and a 60% survival at age 70. No significant differences in the incidence of cardiovascular death between men and women were observed.

Conclusion

HCM is the most frequent phenotype in carriers of ACTC1 variants, followed by LVNC, and DCM. Septal defects are not rare, and they are usually described in combination with cardiomyopathies.

Disease course seems to have a good prognosis. Sudden death is an exception at early ages and appears to be associated with severe morphological expression.

Given the presence of cosegregation with disease in rare variants, many of the ACTC1 variants may have an incomplete penetrance, and late disease expression.

ACTC1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Health in Code

Survival analysis in arrhythmogenic/dilated cardiomyopathy caused by pathogenic DSP truncating variants

Background

Desmoplakin (DSP) truncating variants have been associated with arrhythmogenic cardiomyopathy (ACM), which can exclusively affect the left ventricle up to 30% of the cases. Nonetheless, data on prognosis in carriers is still limited.

Purpose

To evaluate survival free of cardiovascular events in carriers of pathogenic DSP truncating variants.

Methods

Clinical and genetic data on families carrying DSP truncating variants (nonsense, frameshift, and splicing-site) in the literature were systematically revised and collected in a dedicated database. Classification of variant pathogenicity was in accordance with ACMG criteria. We evaluated available follow-up data and constructed Kaplan-Meier survival curves free from cardiovascular death (sudden death, appropriate cardiodefibrillator shock, heart failure death, and stroke-related death) or heart transplant based. Long-rank test was used to compare event-free survival time between genders.

Results

707 carriers (336 index cases and 371 relatives; 51.1% were female carriers) were identified carrying 198 variants (90 nonsense, 89 frameshift, 19 splicing-site). 292 had ACM, 136 dilated cardiomyopathy (DCM), eight cases of unexplained sudden death, 120 were unaffected carriers, and no clinical data was reported in 151 carriers. In addition, 73 affected relatives without genetic testing were reported (28 had ACM, 28 DCM, and 17 unexplained sudden deaths).

Survival data was reported for 449 individuals (221 males; 228 females). Eight-one had suffered events: 57 sudden cardiac death (32 males), 10 heart failure deaths (7 males), 7 transplants (5 males), 6 cardiodefibrillator shock (4 females), and one stroke-related death (1 female).

Incidence of cardiovascular death or transplant was higher in males than females (p=0.012), with annual incidence between ages 30–70 of 0.84%/year in males and 0.72%/year in females. Mortality at the age of 50 years was 31% for males and 16% for females.

Conclusion

DSP truncating variants are associated with a relevant risk of cardiovascular death, which is higher in males, especially after age 30. More than 70% of the events were sudden deaths.

DSP truncating variants survival curves

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Health in Code SA

Charge-carrier transmission across twins in graphene

Twinning is a known accommodation mechanism of graphene that results in low-energy microstructures or twins. In view of their mechanical stability, twins suggest themselves as a possible means of introducing extended defects in graphene leading to the opening of transmission band gaps. We investigate charge-carrier transmission across the twin structures in graphene using the Landauer-Büttiker (LB) formalism in combination with a tight-binding model. We verify the approach by means of selected comparisons with density functional theory (DFT) and non-equilibrium Green's function (NEGF) calculations using the code SIESTA and TRANSIESTA. The calculations reveal that graphene twins open transport gaps depending on the twin geometry up to maximum of 1.15 eV. As previously reported for grain boundaries, we find that localized states arise at dislocation cores in the twin boundaries that introduce peaks near the Fermi level.

A dynamical model of oncotripsy by mechanical cell fatigue: selective cancer cell ablation by low-intensity pulsed ultrasound

The method of oncotripsy, first proposed in Heyden & Ortiz (Heyden & Ortiz 2016 J. Mech. Phys. Solids 92, 164-175 (doi:10.1016/j.jmps.2016.04.016)), exploits aberrations in the material properties and morphology of cancerous cells in order to ablate them selectively by means of tuned low-intensity pulsed ultrasound. We propose the dynamical model of oncotripsy that follows as an application of cell dynamics, statistical mechanical theory of network elasticity and 'birth-death' kinetics to describe the processes of damage and repair of the cytoskeleton. We also develop a reduced dynamical model that approximates the three-dimensional dynamics of the cell and facilitates parametric studies, including sensitivity analysis and process optimization. We show that the dynamical model predicts-and provides a conceptual basis for understanding-the oncotripsy effect and other trends in the data of Mittelstein et al. (Mittelstein et al. 2019 Appl. Phys. Lett. 116, 013701 (doi:10.1063/1.5128627)), for cells in suspension, including the dependence of cell-death curves on cell and process parameters.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

A dynamical model of oncotripsy by mechanical cell fatigue: selective cancer cell ablation by low-intensity pulsed ultrasound

The method of oncotripsy, first proposed in Heyden & Ortiz (Heyden & Ortiz 2016 J. Mech. Phys. Solids 92, 164-175 (doi:10.1016/j.jmps.2016.04.016)), exploits aberrations in the material properties and morphology of cancerous cells in order to ablate them selectively by means of tuned low-intensity pulsed ultrasound. We propose the dynamical model of oncotripsy that follows as an application of cell dynamics, statistical mechanical theory of network elasticity and 'birth-death' kinetics to describe the processes of damage and repair of the cytoskeleton. We also develop a reduced dynamical model that approximates the three-dimensional dynamics of the cell and facilitates parametric studies, including sensitivity analysis and process optimization. We show that the dynamical model predicts-and provides a conceptual basis for understanding-the oncotripsy effect and other trends in the data of Mittelstein et al. (Mittelstein et al. 2019 Appl. Phys. Lett. 116, 013701 (doi:10.1063/1.5128627)), for cells in suspension, including the dependence of cell-death curves on cell and process parameters.

Effects of an Exoskeleton-Assisted Gait Motor Imagery Training in Functional Brain Connectivity

Lower-limb exoskeletons have been used in gait rehabilitation to facilitate the restoration of motor skills. These robotics systems could be complemented by Brain-Computer Interfaces (BCIs) to assist or rehabilitate people with walking disabilities. In this preliminary study, electroencephalography-based brain functional connectivity is analyzed during exoskeleton-assisted gait motor imagery (MI) training. Partial Directed Coherence (PDC) analysis was employed to assess the exchange of information flow between EEG signals during gait MI in four healthy subjects, two using an exoskeleton and two without using it. Besides, in order to explore the functional connectivity, an outflow index based on the number of significant directed connectivities revealed by the PDC analysis is proposed. We found that the outflow index increases in the central zone (C2, C3, C4) while decreases in the central-parietal (CP1, CP2) and fronto-central (FC1) zones when the training was assisted by an exoskeleton. The results obtained can be useful to obtain informative features for BCI applications as well as in motor rehabilitation.

Functional optimality of the sulcus pattern of the human brain

We develop a mathematical model of information transmission across the biological neural network of the human brain. The overall function of the brain consists of the emergent processes resulting from the spread of information through the neural network. The capacity of the brain is therefore related to the rate at which it can transmit information through the neural network. The particular transmission model under consideration allows for information to be transmitted along multiple paths between points of the cortex. The resulting transmission rates are governed by potential theory. According to this theory, the brain has preferred and quantized transmission modes that correspond to eigenfunctions of the classical Steklov eigenvalue problem, with the reciprocal eigenvalues quantifying the corresponding transmission rates. We take the model as a basis for testing the hypothesis that the sulcus pattern of the human brain has evolved to maximize the rate of transmission of information between points in the cerebral cortex. We show that the introduction of sulci, or cuts, in an otherwise smooth domain indeed increases the overall transmission rate. We demonstrate this result by means of numerical experiments concerned with a spherical domain with a varying number of slits on its surface.

Branding: A competitive strategy in the wine industry

Over the years the wine has had a considerable development in terms of competitiveness given that more and more companies are joining this agro-industrial market and it is crucial to develop strategies such as branding aimed at the country variant so that this In this way, greater international support and recognition of a good land that harvests quality wine is generated. For this reason, in the following work we can observe a theoretical framework directed towards the explanation of competitiveness in a general way together with the development of the concept of branding together with the country variant, mentioned above, so that in this way there is a contribution towards the wine industry, a concept that is also explained in a concise way to give the reader an overview of the importance of the relationship between branding and competitiveness. This work is a qualitative analysis based on a descriptive-documentary study.

Optimizing information transmission rates drives brain gyrification

We investigate the functional optimality of the cerebral cortex of an adult human brain geometry. Unlike most competing models, we postulate that the cerebral cortex formation is driven by the objective of maximizing the total information transmission rate. Starting from a random path model, we show that this optimization problem is related to the Steklov eigenvalue problem. Combining realistic brain geometries with the finite-element method, we calculate the underlying Steklov eigenvalues and eigenfunctions. By comparison to a convex hull approximation, we show that the adult human brain geometry indeed reduces the Steklov eigenvalue spectrum and thus increases the rate at which information is exchanged between points on the cerebral cortex. With a view to possible clinical applications, the leading Steklov eigenfunctions and the resulting induced magnetic fields are computed and reported.

Reduction of high-fat diet-induced liver proinflammatory state by eicosapentaenoic acid plus hydroxytyrosol supplementation: involvement of resolvins RvE1/2 and RvD1/2

High-fat diet (HFD)-fed mice show obesity with development of liver steatosis and a proinflammatory state without establishing an inflammatory reaction. The aim of this work was to assess the hypothesis that eicosapentaenoic acid (EPA) plus hydroxytyrosol (HT) supplementation prevents the inflammatory reaction through enhancement in the hepatic resolvin content in HFD-fed mice. Male C57BL/6J mice were fed an HFD or a control diet and supplemented with EPA (50 mg/kg/day) and HT (5 mg/kg/day) or their respective vehicles for 12 weeks. Measurements include liver levels of EPA, DHA and palmitate (gas chromatography), liver resolvins and triglyceride (TG) and serum aspartate transaminase (AST) (specific kits) and hepatic and serum inflammatory markers (quantitative polymerase chain reaction and enzyme-linked immunosorbent assay). Compared to CD, HFD induced body weight gain, liver steatosis and TG accumulation, with up-regulation of proinflammatory markers in the absence of histological inflammation or serum AST changes; these results were accompanied by higher hepatic levels of resolvins RvE1, RvE2, RvD1 and RvD2, with decreases in EPA and DHA contents. EPA+HT supplementation in HFD feeding synergistically reduced the steatosis score over individual treatments and increased the hepatic levels of EPA, DHA and resolvins, with attenuation of proinflammatory markers. Lack of progression of HFD-induced proinflammatory state into overt inflammation is associated with resolvin up-regulation, which is further increased by EPA+HT supplementation eliciting steatosis attenuation. These findings point to the importance of combined protocols in hepatoprotection due to the involvement of cross-talk mechanisms, which increase effectiveness and diminish dosages, avoiding undesirable effects.

Comparison of different EEG signal analysis techniques for an offline lower limb motor imagery brain-computer interface

The use of motion assistance devices improves the rehabilitation process of patients that have motor disabilities. In the case these devices are controlled by brain-machine interfaces, the rehabilitation process can be improved due to neuroplasticity. However, in the case of lower limb rehabilitation, the limited accuracy of the control algorithms is a serious difficulty to overcome. In this research, different EEG signal's processing techniques, based on motor imagery, are tested for a brain-computer interface in an offline scenario, in order to detect the limitations of the models previous to its realtime implementation. The results reveal that motor imagery is very dependent on the subject and that Stockwell Transform provides the best accuracy among the models tested.

Novel tDCS montage favors lower limb motor imagery detection

This work studies a novel transcranial direct current stimulation (tDCS) montage to improve a brain-machine interface (BMI) lower limb motor imagery detection. The tDCS montage is composed by two anodes and one cathode. One anode is located over the motor cortex and the other one over the cerebellum. Ten healthy subjects participated in this experiment. They were randomly separated into two groups: sham, which received a fake stimulation, and active tDCS, which received a real stimulation. Each subject was experimented on five consecutive days. Results pointed out that there was a significant difference $(p < 0 .05)$ in the classification accuracy between the sham and the active tDCS group. On each of the five days of the experiment the active tDCS group achieved better accuracy results than the sham group: 4%, 10%, 10%, 9% and 7% higher respectively.

[Design of a thromboprophylaxis care process in patients with atrial fibrillation]

OBJECTIVE

To describe the milestones in the anticoagulant care process of atrial fibrillation patients (AF), as well as quality and safety indicators, in order to establish an integrated care process of these patients in the Community of Madrid.

METHODS

A consensus conference technique was applied, with the participation of 21 professionals (seven in the Steering Group and 14 known experts), from the specialties of Emergency, Internal Medicine, Cardiology, Neurology, Haematology, Family Medicine, Nursing, and Quality. Hospitals and Primary Care were represented. Milestones, elements and barriers/limitations were agreed upon in the care process of anticoagulated AF patients. A minimum set of indicators were also defined to assess the quality of care.

RESULTS

Four milestones (stratification of thromboembolism and bleeding risk, evaluation for anticoagulant treatment, follow-up of direct-acting oral anticoagulants, and follow-up of treatment with vitamin K antagonists) were identified. A total of 14 barriers/limitations were also prioritised. In total, six indicators were defined (two structural-related, two processes-related, and two outcomes-related).

CONCLUSIONS

Milestones and critical activities, together with a set of indicators, have been agreed for the development of guidelines with which to achieve a better therapeutic approach for anticoagulated AF patients.