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Introduction: To compare the impact of an e-learning package with theoretical teaching on the ability of both graduate and undergraduate medical students to learn the management of supraventricular tachycardia.Methods: We conducted a randomised, controlled, study at two Welsh medical schools. Participants were graduate-entry and undergraduate medical students, who were randomised (in a 1:1 ratio) to either 1 hour of training using an e-learning package or an hour of lecture-based teaching. The outcome was a comparison, within each group and between groups, of median scores achieved in assessments of knowledge through completion of preintervention, immediate post intervention and 2 weeks postintervention questionnaires.Results: Of the 97 participants available for randomisation, 47 underwent teaching using the e-learning package and 50 were taught in the lecture group. Median scores were higher in the e-learning package group than the lecture group, though this difference was not statistically significant (4.00 vs 3.00; p=0.08) immediately after intervention. At 2 weeks post intervention, median scores in the e-learning package group were significantly higher than the median scores in the lecture group (4.00 vs 3.00; p=0.002). This was despite a subanalysis of the results demonstrating that subjects in the lecture group reported having seen more cases compared with those in the e-learning group (32 vs 13; p=0.002). Further, there was a significant fall in score over 2 weeks in the group receiving lecture-based teaching, but no such decrease in those using the e-learning package.Conclusion: E-learning seems to be the preferred method of learning and the method that confers longer retention time for both postgraduate and undergraduate medical students. [ABSTRACT FROM AUTHOR]

Introduction: Fractional flow reserve (FFR) improves assessment of the physiological significance of coronary lesions compared with conventional angiography. However, it is an invasive investigation. We tested the performance of a virtual FFR (1D-vFFR) using routine angiographic images and a rapidly performed reduced order computational model. Methods: Quantitative coronary angiography (QCA) was performed in 102 with coronary lesions assessed by invasive FFR. A 1D-vFFR for each lesion was created using reduced order (one-dimensional) computational flow modelling derived from conventional angiographic images and patient specific estimates of coronary flow. The diagnostic accuracy of 1D-vFFR and QCA derived stenosis was compared against the gold standard of invasive FFR using area under the receiver operator characteristic curve (AUC). Results: QCA revealed the mean coronary stenosis diameter was 44% ± 12% and lesion length 13 ± 7 mm. Following angiography calculation of the 1DvFFR took less than one minute. Coronary stenosis (QCA) had a significant but weak correlation with FFR (r = −0.2, p = 0.04) and poor diagnostic performance to identify lesions with FFR <0.80 (AUC 0.39, p = 0.09), (sensitivity – 58% and specificity – 26% at a QCA stenosis of 50%). In contrast, 1D-vFFR had a better correlation with FFR (r = 0.32, p = 0.01) and significantly better diagnostic performance (AUC 0.67, p = 0.007), (sensitivity – 92% and specificity - 29% at a 1D-vFFR of 0.7). Conclusions: 1D-vFFR improves the determination of functionally significant coronary lesions compared with conventional angiography without requiring a pressure-wire or hyperaemia induction. It is fast enough to influence immediate clinical decision-making but requires further clinical evaluation. [ABSTRACT FROM AUTHOR]

Background: Application to cardiology specialty training is competitive with uncertainty among candidates as to what the secret recipe for a successful appointment is. We aimed to investigate objective variables, which were demonstrated by successful appointees to cardiology training schemes in the UK.Methods: Data from successful cardiology applicants for the years 2014 to 2016 were obtained from the Joint Royal Colleges of Physicians Training Board under the Freedom of Information Act. These data included basic demographics as well as objective scores awarded for selection categories such as qualifications, academic, teaching and other achievements.Results: There were a total of 976 applicants during the study period, of whom 423 were successfully appointed, generating a competition ratio of 2.3 applicants for each position. There was an increasing proportion of successful female applicants (22% in 2014, 28% in 2015 and 32% in 2016). Median scores for postgraduate exams (14/14), presentations (6/6) and quality improvement (10/10) scores corresponded to maximum possible scores, whereas median scores for additional undergraduate and postgraduate degrees were 0. Median scores for prizes, publications and teaching experience were 6/10, 4/8 and 9/10, respectively.Conclusion: The secret to a successful cardiology training appointment is associated with completion of all postgraduate clinical exams, completion and presentation of quality improvement projects, national presentations and substantial teaching achievements. At least half of the successful candidates had no additional undergraduate or postgraduate degrees but had evidence of some prizes and publications. The ratio of successful female candidates is rising, but remains less than males in cardiology training. [ABSTRACT FROM AUTHOR]

Aims Typically, myocardial perfusion imaging with two-dimensional (2D) cardiovascular magnetic resonance (CMR) acquires data in three to four myocardial slices at a spatial resolution of 2-3 mm. However, accelerated data acquisition can facilitate higher spatial resolution (<2 mm) or three-dimensional (3D) whole-heart coverage (up to 16 slices). This study aims to compare image quality, diagnostic confidence, and quantitation of myocardial ischaemic burden (MIB) between 2D high-resolution and 3D whole-heart perfusion-CMR. Methods Twenty-seven patients with stable angina underwent both high-resolution 2D and whole-heart 3D perfusion-CMR. and results Total perfusion defect (TPD) and total scar burden (TSB) areas were contoured and expressed as percentage myocardium. MIB was calculated by subtracting TSB from TPD. Image quality, artefact, and diagnostic confidence scores were similar for both techniques (P > 0.05). The mean MIB from high-resolution and 3D acquisition was similar (4.3 ± 5.2% vs. 4.1 ± 4.9%; P = 0.81), with a strong correlation between techniques (r = 0.72; P < 0.001). There was no systematic bias for estimates of MIB between techniques [mean bias = 20.17%, 95% confidence interval (CI): 21.7 to -1.3%] and the 95% limits of agreement were 27.5 to 7.2%. When used to categorize MIB as >10% or <10%, there was only fair agreement between the two techniques (κ = 0.29, 95% CI: 20.12 to 0.70). Conclusion There is strong correlation and broad agreement between estimates of MIB from both techniques. However, the 95% limits of agreement are relatively wide and therefore a larger comparative study is needed before they can be considered interchangeable--particularly around the clinically relevant 10% threshold. [ABSTRACT FROM AUTHOR]

Introduction. Anorexia nervosa (AN) is a life-threatening condition, with significant risk of death due to cardiac abnormalities. Aim. The aim of this study was to investigate for QTc interval or heart rate (HR) abnormalities in AN patients and any correlation between BMI, HR and QTc interval at baseline and at completion of treatment. Material and methods. 30 patients (29 females, 1 male) aged 16 to 45 years with a diagnosis of AN were retrospectively analyzed from January 2012 to September 2014. An ECG, biochemical tests, BMI and clinical assessment were performed on admission. ECG and BMI were also repeated at discharge. Results. A paired t-test was used to compare two sets of scores that come from the same participants on both admission and discharge. The mean baseline BMI was 14.8 +/− 4 kg/m2, baseline HR was 53.4 +/− 16 bpm and QTc interval 416 +/− 40 ms. At discharge, mean BMI was 18.7 +/− 2 kg/m2, HR was 73 +/− 11 bpm and QTc interval 402 +/− 34. The mean QTc interval was decreased by 14 ms and the HR increased by 19 beats/min. A Wilcoxon test showed that the treatment course did not elicit a statistically significant change in HR score in individuals with AN (Z=−4, p=0.000). Pearson correlations showed that patients with a higher magnesium had lower heart rate on admission (r=−0.61; p=0.002). Conclusion. Further exploration is needed in a larger population to investigate for etiology and medical management of cardiac abnormalities in AN. [ABSTRACT FROM AUTHOR]

The article discusses case study of a 50-year-old West African man who was suffering from raised cerebrospinal fluid (CSF) disease. Medical examination of the patient showed relapsing/remitting chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). It is reported that CIDP occurs due to a multifocal inflammatory process which involves the spinal roots, plexuses and nerve trunks.

Introduction: Anorexia nervosa is an eating disorder that continues to have a devastating impact on the lives of both adolescents and adults worldwide. We present a case of persistent chronic hypokalaemia in a patient with anorexia nervosa.Case Presentation: A 26-year-old Caucasian woman was admitted to our eating disorders unit under Section 2 of Mental Health Act (1983) with a body mass index of 13.5 kg/m2. On admission, biochemical tests highlighted moderate hypokalaemia (3.0 mmol/L). She was immediately put on two tablets of Sando-K® (potassium supplement; potassium bicarbonate and potassium chloride twice daily. An electrocardiogram showed signs of bradycardia with T-wave inversion in at least two chest leads. Throughout her admission, she exhibited a fluctuating potassium level (2.5 to 5.0 mmol/L). Once on the unit, she was put on Sando-K® (potassium supplement; potassium bicarbonate and potassium chloride) but her potassium still tended to drop. On one occasion when she became normokalaemic, supplementation was stopped and she was put on observations. After 24 hours of 1 to 1 observation by ward staff including fluid input and output monitoring as well as search of her bedroom, she was again found to be hypokalaemic in spite of no evidence to suggest laxative or diuretic abuse.Conclusions: She kept reiterating to clinicians that her potassium depletion is hereditary, not associated with any purging behaviour and for that reason long-term administration of Sando-K® (potassium supplement; potassium bicarbonate and potassium chloride) tablet remained essential. Self-denial was continued until her planned discharge; however, positive behavioural change was recorded whilst her blood showed normokalaemia for a whole week until her discharge. [ABSTRACT FROM AUTHOR]

Salpingitis isthmica nodosa (SIN) is a nodular swelling of the isthmic segment of the fallopian tube. It is of unknown aetiology and is usually an acquired pathologic condition resulting from direct invasion of the muscularis layer by the endosalpinx in the isthmic portion of the fallopian tube between the lumen and the serosa. The clinical significance of SIN rests on its strong association with tubal ectopic pregnancy and subfertility. Assisted reproductive technology (ART) has improved the reproductive capability of SIN patients. Unlike ART, which bypasses pelvic pathologies, tubal surgical approaches improve fertility by correcting the pathology and can improve a patient's related symptoms of pelvic pain and abnormal menstruation, and provide a permanent cure. This paper gives an update on the epidemiology, aetiology, diagnosis and management of SIN and concludes that despite the reported successes with tubal surgery, the mainstay of treatment remains ART in (in the UK) centres recognised by the Human Fertilization and Embryology Authority (HFEA). The success of surgical infertility therapy depends on careful selection of cases using appropriate investigative techniques, with the procedures carried out in centres with sufficient expertise. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that xanthine oxidase inhibitors (XOI) might improve outcome for patients with cardiovascular disease. However, more evidence is required., Methods and Results: We published a meta-analysis of trials conducted before 2014 examining the effects of XOI on mortality in patients with cardiovascular disease. At least two further trials ( N  = 323 patients) have since been published. Accordingly, we repeated our analysis after a further search for randomized controlled trials of XOI in PubMed/MEDLINE, EMBASE, and Cochrane Databases. We identified eight relevant trials with 1031 patients. The average age of the patients was 61 years and 68% were men (one study did not report gender). There were 57 deaths in these eight trials, 26 in those assigned to XOI, and 31 in those assigned to the control. The updated meta-analysis could not confirm a reduction in mortality for patients assigned to XOI compared with placebo (odds ratio 0.84) but 95% confidence intervals were wide (0.48-1.47)., Conclusions: This updated meta-analysis does not suggest that XOI exert a large reduction in mortality but also cannot exclude the possibility of substantial harm or benefit.

Aims: Typically, myocardial perfusion imaging with two-dimensional (2D) cardiovascular magnetic resonance (CMR) acquires data in three to four myocardial slices at a spatial resolution of 2-3 mm. However, accelerated data acquisition can facilitate higher spatial resolution (<2 mm) or three-dimensional (3D) whole-heart coverage (up to 16 slices). This study aims to compare image quality, diagnostic confidence, and quantitation of myocardial ischaemic burden (MIB) between 2D high-resolution and 3D whole-heart perfusion-CMR., Methods and Results: Twenty-seven patients with stable angina underwent both high-resolution 2D and whole-heart 3D perfusion-CMR. Total perfusion defect (TPD) and total scar burden (TSB) areas were contoured and expressed as percentage myocardium. MIB was calculated by subtracting TSB from TPD. Image quality, artefact, and diagnostic confidence scores were similar for both techniques (P>0.05). The mean MIB from high-resolution and 3D acquisition was similar (4.3±5.2% vs. 4.1±4.9%; P=0.81), with a strong correlation between techniques (r=0.72; P<0.001). There was no systematic bias for estimates of MIB between techniques [mean bias=-0.17%, 95% confidence interval (CI): -1.7 to -1.3%] and the 95% limits of agreement were -7.5 to 7.2%. When used to categorize MIB as >10% or <10%, there was only fair agreement between the two techniques (κ=0.29, 95% CI: -0.12 to 0.70)., Conclusion: There is strong correlation and broad agreement between estimates of MIB from both techniques. However, the 95% limits of agreement are relatively wide and therefore a larger comparative study is needed before they can be considered interchangeable-particularly around the clinically relevant 10% threshold., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Reaction-diffusion computational models of cardiac electrophysiology require both dynamic excitation models that reconstruct the action potentials of myocytes as well as datasets of cardiac geometry and architecture that provide the electrical diffusion tensor D, which determines how excitation spreads through the tissue. We illustrate an experimental pipeline we have developed in our laboratories for constructing and validating such datasets. The tensor D changes with location in the myocardium, and is determined by tissue architecture. Diffusion tensor magnetic resonance imaging (DT-MRI) provides three eigenvectors e(i) and eigenvalues λ(i) at each voxel throughout the tissue that can be used to reconstruct this architecture. The primary eigenvector e(1) is a histologically validated measure of myocyte orientation (responsible for anisotropic propagation). The secondary and tertiary eigenvectors (e(2) and e(3)) specify the directions of any orthotropic structure if λ(2) is significantly greater than λ(3)-this orthotropy has been identified with sheets or cleavage planes. For simulations, the components of D are scaled in the fibre and cross-fibre directions for anisotropic simulations (or fibre, sheet and sheet normal directions for orthotropic tissues) so that simulated conduction velocities match values from optical imaging or plunge electrode experiments. The simulated pattern of propagation of action potentials in the models is partially validated by optical recordings of spatio-temporal activity on the surfaces of hearts. We also describe several techniques that enhance components of the pipeline, or that allow the pipeline to be applied to different areas of research: Q ball imaging provides evidence for multi-modal orientation distributions within a fraction of voxels, infarcts can be identified by changes in the anisotropic structure-irregularity in myocyte orientation and a decrease in fractional anisotropy, clinical imaging provides human ventricular geometry and can identify ischaemic and infarcted regions, and simulations in human geometries examine the roles of anisotropic and orthotropic architecture in the initiation of arrhythmias.