Publications by authors named "Nap A"

Study Question: How can we best achieve tissue segmentation and cell counting of multichannel-stained endometriosis sections to understand tissue composition?

Summary Answer: A combination of a machine learning-based tissue analysis software for tissue segmentation and a deep learning-based algorithm for segmentation-independent cell identification shows strong performance on the automated histological analysis of endometriosis sections.

What Is Known Already: Endometriosis is characterized by the complex interplay of various cell types and exhibits great variation between patients and endometriosis subtypes.

Study Design, Size, Duration: Endometriosis tissue samples of eight patients of different subtypes were obtained during surgery.

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There is a growing trend of patients with significant comorbidities among those referred for percutaneous coronary intervention (PCI). Consequently, the number of patients undergoing complex high risk indicated PCI (CHIP) is rising. CHIP patients frequently present with factors predisposing to extensive drug-eluting stent (DES) implantation, such as bifurcation and/or heavily calcified coronary lesions, which exposes them to the risks associated with an increased stent burden.

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Background: Transgender and gender diverse (TGD) people embody social and health inequalities that disproportionately affect this community more than the cisgender population. Endometriosis is a chronic condition of the reproductive tract that affects 5-10% of cisgender women. A recent systematic review with meta-analysis uncovered a pooled prevalence of 25.

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Introduction: Hysterosalpingography (HSG) and hysterosalpingo-foam sonography (HyFoSy) are commonly used tubal patency tests during the fertility work-up. Besides its diagnostic purpose, HSG with oil-based contrast can also be applied for its fertility-enhancing effect, by tubal flushing. HyFoSy is considered as less painful compared with HSG, it lacks exposure to iodinated contrast medium and ionising radiation.

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Background: The applicability of quantitative flow ratio (QFR), a nonhyperemic, invasive coronary angiography-derived computation of fractional flow reserve (FFR), has not been studied in coronary artery bypass grafts. We sought to explore the correlation and diagnostic agreement between QFR and FFR in saphenous vein grafts (SVGs).

Methods And Results: A total of 129 prospectively included patients (mean age 73±8 years, 84% male) with prior coronary artery bypass grafting underwent invasive coronary angiography and pressure-derived functional assessment in 150 nonoccluded SVGs.

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Article Synopsis
  • The systematic review examined the effects of chronic total occlusion (CTO) in non-infarct-related arteries on clinical outcomes in patients with acute coronary syndrome (ACS) and the potential advantages of staged revascularization.
  • Analysis of 30 studies revealed that patients receiving only culprit lesion PCI faced higher rates of all-cause mortality and major adverse cardiac events compared to those undergoing multivessel PCI, particularly in cases of ST elevation myocardial infarction.
  • The findings suggest that while revascularizing non-IRA CTOs may improve outcomes, especially in specific conditions like cardiogenic shock, the best treatment strategies are still unclear and require further investigation.
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Study Question: Does offering the Pleasure&Pregnancy (P&P) programme rather than expectant management improve naturally conceived ongoing pregnancy rates in couples diagnosed with unexplained infertility?

Summary Answer: The P&P programme had no effect on the ongoing pregnancy rates of couples with unexplained infertility.

What Is Known Already: Underpowered studies suggested that face-to-face interventions targeting sexual health may increase pregnancy rates. The impact of an eHealth sexual health programme had yet to be evaluated by a large randomized controlled trial.

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Evaluation of treatment outcomes in patients supported by temporary mechanical circulatory support (tMCS) currently relies mainly on mortality, which may not sufficiently address other patient benefits or harms. Bleeding and thrombosis are major contributors to mortality. Still, current bleeding scores are not designed for critically ill patients undergoing tMCS, only consider selected populations, and do not account for the high heterogeneity among bleeding and thrombotic adverse events.

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Background: Fibrosis is an important pathological feature of endometriotic lesions of all subtypes. Fibrosis is present in and around endometriotic lesions, and a central role in its development is played by myofibroblasts, which are cells derived mainly after epithelial-to-mesenchymal transition (EMT) and fibroblast-to-myofibroblast transdifferentiation (FMT). Transforming growth factor-β (TGF-β) has a key role in this myofibroblastic differentiation.

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Study Question: Is it possible to establish an ex vivo endometriosis model using cryopreserved endometriotic tissue fragments?

Summary Answer: Cryopreserved endometriotic tissue fragments remain viable after thawing and during at least 3 days of culture and can therefore be used to establish an ex vivo endometriosis model to efficiently test potential therapeutic agents.

What Is Known Already: Endometriosis is the most prevalent benign gynecologic disease with an enormous societal burden; however, curative therapies are still lacking. To efficiently test potential new therapies, an ex vivo model based on previously cryopreserved endometriotic tissue that recapitulates the different endometriosis subtypes and their microenvironment is highly desirable.

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Article Synopsis
  • The study explores the feasibility and safety of same-day discharge (SDD) for patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) with large-bore vascular access.
  • Out of 948 patients, 62% were successfully discharged the same day, with lower risks for those without renal issues or previous surgeries, but local access bleeding raised the likelihood of needing hospitalization.
  • At a 30-day follow-up, both SDD and non-SDD patients had low readmission rates (5% vs. 7%), indicating that SDD is a safe option for most patients undergoing this procedure.
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Background: Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear.

Aims: We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation.

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A young female patient presenting with a non-ST-segment elevation myocardial infarction underwent invasive coronary angiography, revealing a total occlusion of the right coronary artery. During percutaneous coronary intervention with dual catheter access, a retrograde tip injection and peculiar retrograde wiring unmasked a giant coronary aneurysm, which noninvasive imaging confirmed.

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Objectives: We sought to investigate the impact of sex on myocardial perfusion changes following chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) as measured by [O]HO positron-emission tomography (PET) perfusion imaging.

Background: CTO PCI has been associated with an increase in myocardial perfusion, yet females are less likely to undergo revascularization. As such, data on the impact of sex on myocardial perfusion following CTO PCI is scarce.

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Background: Due to a heterogeneity of symptoms, a lack of an adequate diagnostic test, and a lack of awareness, diagnostic delay in endometriosis in primary care on average amounts to 35 months.

Aim: To determine which interventions are most feasible to reduce time to diagnosis in primary care, focusing on GPs' preferences, the intervention's content, design, and implementation.

Design & Setting: We conducted a qualitative study by performing focus groups with GPs and GP trainees between July and October 2021.

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Currently, the optimal treatment to increase the chance of pregnancy and live birth in patients with colorectal endometriosis and subfertility is unknown. Evidence suggests that that both surgery and in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are effective in improving live birth rate (LBR) among these women. However, the available evidence is of low quality, reports highly heterogeneous results, lacks direct comparison between both treatment options and does not assess whether a combination strategy results in a higher LBR compared to IVF/ICSI-only treatment.

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Research Question: What is the feasibility of an anti-inflammatory diet in women diagnosed with endometriosis?

Design: Qualitative study using semi-structured focus groups and individual interviews among patients with endometriosis. Transcripts of the focus groups and interviews were thematically analysed using ATLAS.ti 9.

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In patients evaluated for obstructive coronary artery disease (CAD), guidelines recommend using either fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) to guide coronary revascularization decision-making. The hemodynamic significance of lesions with discordant FFR and iFR measurements is debated. This study compared [O]HO PET-derived absolute myocardial perfusion between vessels with concordant and discordant FFR and iFR measurements.

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Background: Coronary flow capacity (CFC) is a measure that integrates hyperemic myocardial blood flow and coronary flow reserve to quantify the pathophysiological impact of coronary artery disease on vasodilator capacity. This study explores the prognostic value of modified CFC derived from [O]HO positron emission tomography perfusion imaging.

Methods: Quantitative rest/stress perfusion measurements were obtained from 1300 patients with known or suspected coronary artery disease.

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Article Synopsis
  • The study evaluates how well the Japanese Channel (J-Channel) score predicts the success of retrograde percutaneous coronary interventions (PCI) in patients with chronic total coronary occlusions (CTOs) compared to established collateral grading systems (Rentrop and Werner).
  • Among 600 patients studied, the J-Channel score showed comparable predictive value for successful guidewire crossing as the Rentrop classification and was better than the Werner grade.
  • While the J-Channel score may help in choosing the right collateral channels, all three scoring systems were found to have limited effectiveness in predicting overall technical success in CTO PCI procedures.
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The use of coils is fundamental in interventional cardiology and can be lifesaving in selected settings. Coils are classified by their materials into bare metal, fiber coated, and hydrogel coated, or by the deliverability method into, pushable or detachable coils. Coils are delivered through microcatheters and the choice of coil size is important to ensure compatibility with the inner diameter of the delivery catheter, firstly to be able to deliver and secondly to prevent the coil from being stuck and damaged.

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More than half of women in developed countries undergo surgery during their lifetime, putting them at risk of adhesion-related complications. Adhesion-related complications include small bowel obstruction, chronic (pelvic) pain, subfertility, and complications associated with adhesiolysis during reoperation. The aim of this study is to predict the risk for adhesion-related readmission and reoperation after gynecological surgery.

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Article Synopsis
  • This study investigates the use of ticagrelor or prasugrel as a monotherapy right after PCI in patients with NSTE-ACS, offering an alternative to traditional dual antiplatelet therapy.
  • Out of 125 enrolled patients, 75 were eligible and 93.3% received monotherapy, with low rates of major ischemic events and bleeding complications within 6 months.
  • Findings suggest that this monotherapy approach is feasible and generally safe, indicating the need for further randomized trials to compare it with current treatment methods.
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Article Synopsis
  • Recent studies suggest that while transradial access (TRA) is preferred for complex coronary procedures, many patients still require femoral access, especially for chronic total occlusions (CTO), and using ultrasound for puncture may reduce complications.
  • A study involving 542 patients is designed to compare ultrasound-guided puncture and fluoroscopy-guided puncture for accessing the femoral artery during complex PCI, focusing on access site complications and major adverse cardiovascular events.
  • Ethical approval has been obtained from multiple committees, and the outcomes of the trial will be shared in peer-reviewed journals, with details available on ClinicalTrials.gov under identifier NCT03846752.
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Article Synopsis
  • This study aimed to compare two types of mechanical circulatory support (MCS) systems, Impella CP and VA-ECMO, in patients undergoing complex high-risk PCI procedures.
  • Researchers analyzed data from 41 patients who could not undergo surgery, with no significant differences found in hemodynamic stability or major adverse cardiac events between the two groups.
  • The findings suggest that the choice between Impella CP and VA-ECMO does not significantly impact patient outcomes, including mortality rates.
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