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Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe three cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement (DFR). All the three patients presented early full weight-bearing mobilization (average time to first ambulation was five days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of ten days). According to our experience, primary arthroplasty with DFR could be a good therapeutic option for complex DFF in elderly patients.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spanish Government, Madrid, Spain [FIS_PI16/00435 Background Late gadolinium enhancement MRI (LGE-MRI) is increasingly used to detect native as well as ablation-induced atrial fibrosis in the context of atrial fibrillation (AF). However, cardiac fibrotic tissue including ablation lesions is subject to sustained remodeling, and neither the development of ablation-induced fibrosis over time nor the capability of LGE-MRI to detect it at different stages of scar formation have been defined. We sought to define the long-term development of ablation-induced atrial fibrosis and to validate LGE-MRI for the assessment of ablation lesions at different time points. Methods Patients with first-time AF ablation and an early follow-up LGE-MRI (3 months post ablation) and a late follow-up LGE-MRI (>12 months post ablation) were included. LGE-MRI data were postprocessed for quantification of fibrotic tissue using the ADAS 3D software. In the majority of patients high-density electroanatomical mapping (EAM), performed in a repeat procedure served as a reference. Results 22 consecutive patients fulfilling the inclusion criteria were analysed retrospectively. In the LGE-MRI 3 months post ablation an average of 91.7 ± 7.0% of the ablation lines" circumference displayed late gadolinium enhancement (LGE) reflecting ablation-induced fibrosis, whereas in the late follow-up LGE-MRI, at a median of 28 months post ablation, only 62.8 ± 25.0% of the ablation lines" circumference was covered by LGE (p Conclusions Our results indicate that while ablation-induced atrial fibrosis appears to remain rather constant over time, LGE-MRI loses some of its capability to detect it. Thus, LGE-MRI 3 months post ablation may be more accurate in the detection of durable ablation lesions than LGE-MRI at later time points more than 12 months after ablation. Abstract Figure

Funding Acknowledgements Type of funding sources: None. Introduction Myocardial T1 mapping constitutes a reliable indicator of heart diseases related to changes of myocardial extracellular content (e.g. oedema, fibrosis) as well as fat, iron and amyloid content. T1-mapping techniques rely on fitting a model to a series of MRI measurements. Alignment between these measurements is required for accurate T1 estimation. This is limited by triggering accuracy and patient motion. Image registration is often applied to improve the alignment. In the case of MOLLI series, registration is compromised by contrast variation between the images. We present the validation of a new registration method, designed to account for the contrast properties of MOLLI data. Methods A cohort of 186 patients referred for a CMR was included in this study (115 M / 71 F; weight 75 ± 15 Kg; age 55 ± 16). Scans on a 3.0T MR included a MOLLI sequence with target parameters: 2D bSSFP, 160x148, pFOV 0.8-1.0, 1.4x1.4mm², ST 8mm, TE 1.4ms, TR 3.0ms, FA 35deg, NEX 1, BW 100kHz, 2x ASSET, 5(3)3. Cartesian 2D reconstruction followed by motion correction was applied retrospectively. A new correction algorithm was implemented, based on a similarity criterion that accounted for T1 relaxation: It consisted of an iterative approach alternating polarity estimation, T1 fitting, relaxation simulation and frame registration. The coefficient of determination (R²) was used as a quality measure. A representative subset of the results was reviewed by two experienced cardiologists. Results All reconstructions (totalling 1133 2D MOLLI series) yielded qualitatively correct T1 maps. Results with the new method were compared to conventional motion correction and no correction. The number of pixels with R²>0.95 was 85%±9% with standard motion correction and 90%±7% with the new dedicated method. In terms of improvement w.r.t. uncorrected data, the standard method yielded +3%±8% and the new one +9%±8%. Motion correction caused noticeable performance degradation in 12% of cases with the standard method, compared to 0.2% with the proposed method. The relative performance of the different methods can be appreciated in Figure 3. Discussion Despite T1 mapping techniques constituting a reliable diagnostic tool in cardiac imaging, they remain sensitive to patient motion and triggering inaccuracies, making them vulnerable to arrhythmia episodes. Improving the similarity criterion by accounting for T1 relaxation significantly decreased the incidence of misregistration and subsequent T1 inaccuracies. Using the R² of the voxel-wise T1 fit as a surrogate of alignment allowed to confirm the increased robustness of the new, dedicated motion correction method for MOLLI series. Conclusion We have demonstrated a new reconstruction pipeline with built-in registration, optimized for MOLLI T1-mapping. Using a large database of clinical data, the new method has been shown to improve the robustness to motion of cardiac T1 mapping. Abstract Figure.

Funding Acknowledgements Type of funding sources: None. Introduction Myocardial delayed enhancement (MDE) MRI plays an important role in the identification of several cardiac conditions, both ischemic and non-ischemic (e.g. myocarditis, IDC, amyloidosis). 3D imaging offers increased resolution, full heart coverage and better depiction of complex pathologies, but its image quality is limited by long acquisition times. Deep learning (DL) models enable advanced reconstruction algorithms that yield regularized images in practical computation times. In this study we evaluate a novel 3D-DL reconstruction to overcome the trade-off between reconstructed quality and acquisition time on MDE data. Methods A group of 14 subjects referred for CMR (5 F / 9 M, 59 ± 11 y.o., 78 ± 13 kg) were scanned with a 3D MDE sequence prototype: SPGR with IR preparation, fat & spatial saturation, respiratory navigator, ARC 2x, FOV 40x40cm, ST 1.4-2.4mm, matrix 280²-320², FA 20deg, BW 62.5 kHz, TE 2.1 ± 0.1ms, TI based on a CINE IR scout. All were retrospectively reconstructed using a 3D DL algorithm, trained on a database of over 700 datasets to reconstruct high-quality images with adjustable noise reduction. The images were compared with standard 3D Cartesian reconstruction by two experienced cardiologists, to identify alterations in morphology or contrast distribution. Noise was estimated using the intensity standard deviation on a blood pool ROI. Feature preservation was estimated using the structural similarity index (SSI). Results The new method improved perceived image quality without loss of structural information or resolution (fig 1). Quantitative analysis (fig 2) confirmed these results: The average coefficient of variation in the blood was 0.08 ± 0.02 in the reference and 0.05 ± 0.02 with the new method; Given a target image noise level, DL reconstruction yielded up to 10% better SSI, compared to anisotropic filtering. The clinical review didn’t reveal diagnostically significant alterations of structure or uptake pattern. A perceived reduction of sharpness was initially reported but individual examination of landmarks (e.g. pulmonary and coronary arteries) confirmed that no relevant features were being lost with the new reconstruction. Discussion The 3D MDE images obtained with DL reconstruction improved the trade-off between image noise -estimated by the blood pool intensity deviation- and feature preservation -estimated by SSI-. Consistent improvement of image quality without morphological alterations of diagnostic relevance indicates that the new method can be considered for clinical practice. The next step in the validation process will require testing the robustness over a large set of cases with heterogeneous acquisition settings. Conclusion We presented the preliminary evaluation of a deep learning reconstruction method with 3D myocardial delayed enhancement data. The results show systematic improvement of overall image quality without loss of relevant diagnostic information. Abstract Figure.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738) and the Clinical Research in Cardiology grant from the Spanish Cardiac Society. Background The aetiology of left ventricular hypertrophy (LVH) is a relevant clinical challenge with consequences for patient management. Phenotypes resulting from hypertensive remodelling and sarcomere mutation often overlap. Synchrotron X-ray phase-contrast imaging (X-PCI) is a technique that can provide 3-dimensional detailed information on myocardial micro-structure non-destructively. The aim is to relate macrostructural/functional, non-invasive, imaging phenotypes of hypertrophic cardiomyopathy (HCM) to the underlying myocardial microstructure assessed with X-PCI. Methods Myocardial tissue samples were obtained from three patients (P1-3) with obstructive myocardial hypertrophy undergoing septal myectomy. Medical history and the 5-year HCM risk scores were evaluated. The patients were imaged with magnetic resonance imaging and echocardiography prior to procedure. Myocardial structure was assessed with wall thickness, late gadolinium enhancement (LGE), whereas function with speckle-tracking deformation (STE) and tissue Doppler imaging (TDI). Myectomy tissue was imaged with X-PCI in the TOMCAT beamline, using a multiscale propagation-based protocol combining a low-resolution (LR) and a high-resolution (HR) setup (5.8 and 0.7 um pixel size, respectively). Results The clinical and imaging data are shown in Fig 1. On initial assessment, wall thickness, LGE distribution, global longitudinal strain and septal TDI demonstrated a similar macrostructural and functional phenotype of P1 and P2, whereas P3 stood out with more severe hypertrophy, scarring and dysfunction. Additional regional deformation analysis with STE revealed reduced deformation in the basal and mid septum in P1, paired with a hypertensive pattern of post-systolic shortening (PSS) (yellow arrows). In comparison, in P2 and P3, deformation was more heterogeneous regionally, with regions of almost complete absence of deformation (orange arrows). Upon further exploration with TDI, areas with abnormal deformation were identified on the transition from basal to mid septum in both P2 and P3, whereas deformation was normal, but reduced in P1, and paired with PSS. LR X-PCI defined regions of interest to scan with HR (yellow frame), where HR revealed extensive interstitial fibrosis (orange arrow) with normal myocyte size and organisation in P1, compatible with severe hypertensive remodelling. However, in P2 and P3, patches of fibrosis (yellow arrow) paired with enlarged myocytes organized in visible disarray, considerably more prominent in P3, were both compatible with sarcomere-mutation HCM. Conclusion The results demonstrate multiscale phenotyping of HCM - relating micro- and macrostructural findings to function, and integrating multimodality data. In-depth regional deformation analysis, validated by synchrotron-based microstructural analysis, showed potential to identify distinct imaging phenotypes in HCM, distinguishing between overlapping presentations in different aetiologies. Abstract Figure 1

Background Adverse Left Ventricular (LV) remodeling (ALVR) following ST-segment Elevation Myocardial Infarction (STEMI) is the result of numerous mechanical, neurohormonal, micro and macrovascular factors, and remains a major clinical problem. Cardiac Magnetic Resonance (CMR) is a multimodality technique that provides comprehensive functional and tissue characterization of infarcted and non-infarcted myocardium. Whether changes in the extracellular matrix in the remote myocardium in patients following a STEMI are associated with adverse LV remodeling has been a topic of debate. Aim We explored the additive value of native T1 variation (ΔnT1) and derived-extracellular volume (ECV) fraction in the remote non-infarcted myocardium as predictors of adverse LV remodeling following STEMI. Methods A total of 99 subjects (83% male) with their first mechanically reperfused STEMI underwent CMR within 2 weeks and at 6 months, including T1 mapping prior and 15 to 20 minutes following a bolus of gadolinium (0.2 mmol/kg), with a MOLLI sequence. ECV and nT1 values were computed by averaging co-registered ROIs in three distinct segments in the remote non-infarcted myocardium. Results Baseline nT1 but not ECV correlated with infarct size (r=0.349, P ALVR, defined as Δ>20% inLVEDVi, occurred in 21 cases, despite optimal medical therapy. Subjects with ALVR showed greater ΔnT1 (13.2±44.1 vs −5.2±30.2 ms, P Conclusions The nT1 variation in remote non-infarcted myocardium and the extent of microvascular obstruction are superior to ECV changes and infarct size in predicting ALVR following STEMI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Maratό TV3 2015 30 31 32. Fondos FEDER

Funding Acknowledgements none Background Electroanatomical map (EAM) detects areas of low voltage as a surrogated marker of fibrosis areas, being the reference technique for its detection. Cardiac magnetic resonance with Late Gadolinium enhancement (CMR-LGE) allows non-invasive detection of atrial fibrotic areas. CMR-LGE studies have focused on the left atrium since now. Purpose We need to validate this test to extend its use to the right atrium (RA), since it is involved in the arrhythmogenic substrate of several arrhythmias, and probably also in atrial fibrillation (AF). Methods Prospective observational study. Fifteen patients undergoing a first AF ablation procedure were included. All patients had a pre-procedural LGE-CMR performed. The blood pool-normalized intensity signal (image intensity ratio-IIR) was calculated for the right atrial wall, and values projected in a shell. IIR values validated for the left atrium were used to identify dense and intermediate fibrosis, and healthy tissue (>1.32, 1.2-1.32, Results A total of 8,830 points were obtained, mean per patient 588 (± 509) points. A global weak negative correlation was found between the EA bipolar voltage map (EAM) and IIR (CMR) (r= -0.16, p Conclusion There was an inverse correlation between the bipolar voltage EAM and IIR (CMR) of low grade but with statistical significance. CMR underestimated fibrotic tissue in RA with respect to its identification by EAM. Abstract Figure. Correlation between bipolar voltage-IIR

Background/Introduction Substrate-guided techniques have changed the approach and results of ventricular tachycardia (VT) ablation and electroanatomical voltage mapping (EAVM) constitutes a diagnostic and therapeutic cornerstone in this field. In current practice normal myocardium is typically characterized by bipolar voltage > 1.5 mV, dense scar Purpose The purpose of this study is to adjust voltage cut off in order to establish the threshold that more accurately define the pathological substrate in VT ablation. Additionally, predictors of usefulness of current thresholds are analyzed. Methods EAVM were created with CARTO3 System and Sensor-Force catheter (Navistar Smart-Touch and Pentaray). We delineated the conducting channels by analyzing the late potentials activation. Based on these channels we looked for the best cut-off values to detect these channels. We describe the baseline characteristics, the best cut-off values for border zone and scar core in our series and we analyzed the accuracy of the current established values to detect the arrhythmogenic VT substrate Results We investigated 51 patients (74,5% males; 41,2% ischemic cardiomyopathy, mean LVEF 38,6% +/-13,6) with sustained monomorphic VT submitted to ablation during 2016 and 2017. The range of the voltage adjustment was from 0,01-1 mV for core area and 0,2-6mV as maximum, with an average of 0,31-1,42mV. Using currently accepted bipolar voltage cut-off Conclusions EAVM is very important to detect scar and channels in VT ablation, but several elements can affect it and recently the traditional voltage values have been questioned. Our study suggests how the threshold as currently applied in daily practice could be acceptable to detect the core scar area, but it has to be reconsidered in NICM, especially regarding the border zone. An evident trend (p = 0,07) suggests a better accuracy of current values to define VT substrate in ischemic patients than in NICM. Abstract Figure. Channel Identification

Funding Acknowledgements No funding acknowledgements OnBehalf VT and sudden cardiac death Background The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved. Purpose To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar. Methods All consecutive patients who underwent a LGE-MR prior to ICD implantation in primary prevention were prospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software. Results Since 2008 to 2017, 206 patients were included. Mean age was 67 +/- 28 years, 80% men, mean ejection fraction 26%+/-9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46,33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36,05 grams vs 21,5 grams; HR 1.04; 95% CI (1.03-1-05), p 5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15-19.73), p = 0.03). Conclusions The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention. Abstract Figure. Scar characterization

INTRODUCTION Isolated pulmonary endocarditis is a rare entity, especially in patients without predisposing factors, being its current incidence less than 1% of the total cases of infectious endocarditis. This is due to the lower right heart pressures and a decrease of intravenous drug-consum, being most of the cases nowadays, related to congenital right-heart diseases or pacemakers and defibrillators implants. CLINICAL CASE A 35 year-old man, tobacco smoker and intravenous cocaine consumer since he was 25, was admitted to our Emergency Department for fever up to 40ºC, cough and dyspnea started three days before admission. In the anamnesis he refereed intravenous consum of cocaine and sharing of syringes the last week. On physical examination he was tachycardic and signs of heart right failure were present such as jugular ingurgitation and peripheral edema. No murmurs were heard. No respiratory failure was detected at any time. Blood test analysis showed high levels of protein C reactive and leukocytosis. Blood cultures were positive for S. aureus (OXA-S) in the first 24h. Chest X-ray (image 1) showed a necrotizing bilateral pneumonia that was confirmed with the presence of cavitated images in the pulmonary CT (image 2). Antibiotic treatment was started with daptomicine + cloxaciline. With the suspicion of right endocarditis a transthoracic echocardiography was performed, showing the presence of a big vegetation (4x1cm) on the pulmonary valve that caused moderate pulmonary insufficiency (images 3, 4). Neither tricuspid nor left side valves were involved. Biventricular function was conserved and hyperdynamic. Endocarditis diagnosis was definitive and due to the presence of multiple right embolisms and the big size of the vegetation, the patient underwent cardiac surgery. Intra-surgical finding demonstrated a big vegetation of almost 5 cm (image 5) depending of the posterior pulmonary valve that was removed; the posterior valve needed to be repaired. Posterior clinical evolution was correct without complications, completing 17 days of i.v. antibiotics (cloxaciline) before discharge. CONCLUSIONS Right endocarditis is a rapidly progressive disease due to the fact that staphylococcus are the most frequent microorganisms involved. Valvular destruction and secondary embolic phenomena are the rule. Tricuspid valve is involved most of the times being the isolated pulmonary valve affection very uncommon. Abstract 474 Figure. CT, Echo and surgical images

Research on the neural bases of bilingual language control has largely overlooked the role of preparatory processes, which are central to cognitive control. Additionally, little is known about how the processes involved in global language selection may differ from those involved in the selection of words and morpho-syntactic rules for manipulating them. These processes were examined separately in an fMRI experiment, with an emphasis on understanding how and when general cognitive control regions become activated. Results of region-of-interest analyses on 23 early Spanish-English bilinguals showed that the anterior cingulate cortex (ACC) was primarily engaged during the language preparation phase of the task, whereas the left prefrontal (DLPFC) and pre-supplementary motor areas showed increasing activation from preparation to execution. Activation in the basal ganglia (BG), left middle temporal lobe, and right precentral cortical regions did not significantly differ throughout the task. These results suggest that three core cognitive control regions, the ACC, DLPFC, and BG, which have been previously implicated in bilingual language control, engage in distinct neurocognitive processes. Specifically, the results are consistent with the view that the BG “keep track” of the target language in use throughout various levels of language selection, that the ACC is particularly important for top-down target language preparation, and that the left prefrontal cortex is increasingly involved in selection processes from preparation through task execution.

Background and aim Post-procedure conduction abnormalities (CA) and paravalvular aortic regurgitation (PAR) continue to strain TAVI outcomes. Computer simulations, based on patient-specific anatomy, valve properties, and implantation position, have been validated for prediction of these complications. The new-generation CoreValve Evolut PRO has been shown to have lower levels of PAR and CA than previous generations. The aim was to compare clinical outcomes after Evolut Pro implantation in real-life with outcomes of virtual deployment of the same size, implantation depth adjusted CoreValve Evolut R. Methods Patients undergoing Evolut Pro implantation at a single centre were included into the study. Postoperative Doppler echocardiography was assessed to define PAR, the pre- and postoperative 12-lead ECGs for CA, and the postoperative angiograms to measure implantation depth based on annular plane distance from the non-coronary and left coronary aortic valve cusps. Preoperative multislice computed tomography was used to generate patient-specific models of the native aortic root. Implantation of the Evolut R valve and corresponding aortic root deformation was simulated using computational mechanics, whereas blood flow and level of PAR were predicted using computational fluid dynamics. Prediction of CA – new onset left bundle branch block or atrioventricular block type II or III -was based on calculations of contact pressure in a patient-specific region of the aortic root containing the AV conduction system (ROI). Outcomes were predicted in three implantation depth positions - high, medium, low – where the position closest to the real-life implantation depth was chosen for outcome comparisons. Results Study diagram is shown in Figure 1. Thirty-three patients (57% female, mean age 82±6 years old) underwent a TAVI intervention with an Evolut PRO valve. Evolut PRO implantation depths were, in general, closest to the lowest modeled Evolut R depth. Comparison demonstrated similar overall incidence of moderate-to-severe PAR. The Evolut R simulation predicted 18 patients without PAR and 2 with PAR. With the Evolute PRO, 1 of the 18 not predicted developed significant PAR, and 1 of the 2 predicted did not develop PAR. CA were notably higher with the Evolut R simulation, where CA were present in 9 out of 12 patients, as compared to the observed 5 out of 12 with the Evolut PRO. Figure 1 Conclusion Single-centre outcomes after Evolut Pro implantation in real-life showed a similar overall incidence of moderate-to-severe PAR and a lower incidence of conduction abnormalities as compared to the same size, implantation depth adjusted, patient-specific Evolut R modeled outcomes. As inferred from the results, computer simulations may have high clinical utility in supporting clinical decisions regarding valve choice in TAVI procedures. Acknowledgement/Funding Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738)

The current experiment investigated bilingual language control within the dual mechanisms framework. In an fMRI investigation of morphosyntactic rule production, the presence or absence of target language cues was manipulated to investigate the neural mechanisms associated with proactive and reactive global language control mechanisms. Patterns of activation across nine regions of interest (ROIs) were investigated in seventeen early Spanish&ndash, English bilingual speakers. A cue by phase interaction in the left dorsolateral prefrontal cortex (DLPFC) and pre-supplementary motor area (Pre-SMA) was observed, suggesting that these regions were more active during cue phases, and less active during execution phases, when target language cues were presented. Individual differences analyses showed that variability in proactive control (informative &gt, non-informative cued trial activation during preparation) in the basal ganglia was correlated with proactive control in the left DLPFC, left inferior frontal gyrus (IFG), and right precentral ROIs. In contrast, reactive control (non-informative &gt, informative cued activation during execution) in the anterior cingulate was correlated with reactive control in the Pre-SMA and left orbital frontal ROIs. The results suggest that, consistent with the dual mechanisms framework, bilinguals differ in the degree to which they use cues to proactively prepare to use a target language.

We present BrainNet which, to our knowledge, is the first multi-person non-invasive direct brain-to-brain interface for collaborative problem solving. The interface combines electroencephalography (EEG) to record brain signals and transcranial magnetic stimulation (TMS) to deliver information noninvasively to the brain. The interface allows three human subjects to collaborate and solve a task using direct brain-to-brain communication. Two of the three subjects are designated as “Senders” whose brain signals are decoded using real-time EEG data analysis. The decoding process extracts each Sender’s decision about whether to rotate a block in a Tetris-like game before it is dropped to fill a line. The Senders’ decisions are transmitted via the Internet to the brain of a third subject, the “Receiver,” who cannot see the game screen. The Senders’ decisions are delivered to the Receiver’s brain via magnetic stimulation of the occipital cortex. The Receiver integrates the information received from the two Senders and uses an EEG interface to make a decision about either turning the block or keeping it in the same orientation. A second round of the game provides an additional chance for the Senders to evaluate the Receiver’s decision and send feedback to the Receiver’s brain, and for the Receiver to rectify a possible incorrect decision made in the first round. We evaluated the performance of BrainNet in terms of (1) Group-level performance during the game, (2) True/False positive rates of subjects’ decisions, and (3) Mutual information between subjects. Five groups, each with three human subjects, successfully used BrainNet to perform the collaborative task, with an average accuracy of 81.25%. Furthermore, by varying the information reliability of the Senders by artificially injecting noise into one Sender’s signal, we investigated how the Receiver learns to integrate noisy signals in order to make a correct decision. We found that like conventional social networks, BrainNet allows Receivers to learn to trust the Sender who is more reliable, in this case, based solely on the information transmitted directly to their brains. Our results point the way to future brain-to-brain interfaces that enable cooperative problem solving by humans using a “social network” of connected brains.

Bilingual language control is characterized by the ability to select from amongst competing representations based on the current language in use. According to the Conditional Routing Model (CRM), this feat is underpinned by basal-ganglia signal-routing mechanisms, and may have implications for cognitive flexibility. The current experiment used dynamic causal modeling of fMRI data to compare network-level brain functioning in monolinguals and bilinguals during a task that required productive (semantic decision) and receptive (language) switches. Consistent with the CRM, results showed that: (1) both switch types drove activation in the basal ganglia, (2) bilinguals and monolinguals differed in the strength of influence of dorsolateral prefrontal cortex (DLPFC) on basal ganglia, and (3) differences in bilingual language experience were marginally related to the strength of influence of the switching drives onto basal ganglia. Additionally, a task-by-group interaction was found, suggesting that when bilinguals engaged in language-switching, their task-switching costs were reduced.

Research on the biological basis of autism spectrum disorder has yielded a list of brain abnormalities that are arguably as diverse as the set of behavioral symptoms that characterize the disorder. Among these are patterns of abnormal cortical connectivity and abnormal basal ganglia development. In attempts to integrate the existing literature, the current paper tests the hypothesis that impairments in the basal ganglia's function to flexibly select and route task-relevant neural signals to the prefrontal cortex underpins patterns of abnormal synchronization between the prefrontal cortex and other cortical processing centers observed in individuals with autism spectrum disorder (ASD). We tested this hypothesis using a Dynamic Causal Modeling analysis of neuroimaging data collected from 16 individuals with ASD (mean age = 25.3 years; 6 female) and 17 age- and IQ-matched neurotypical controls (mean age = 25.6, 6 female), who performed a Go/No-Go test of executive functioning. Consistent with the hypothesis tested, a random-effects Bayesian model selection procedure determined that a model of network connectivity in which basal ganglia activation modulated connectivity between the prefrontal cortex and other key cortical processing centers best fit the data of both neurotypicals and individuals with ASD. Follow-up analyses suggested that the largest group differences were observed for modulation of connectivity between prefrontal cortex and the sensory input region in the occipital lobe [t(31) = 2.03, p = 0.025]. Specifically, basal ganglia activation was associated with a small decrease in synchronization between the occipital region and prefrontal cortical regions in controls; however, in individuals with ASD, basal ganglia activation resulted in increased synchronization between the occipital region and the prefrontal cortex. We propose that this increased synchronization may reflect a failure in basal ganglia signal gating mechanisms, resulting in a non-selective copying of signals to prefrontal cortex. Such a failure to prioritize and filter signals to the prefrontal cortex could result in the pervasive impairments in cognitive flexibility and executive functioning that characterize autism spectrum disorder, and may offer a mechanistic explanation of some of the observed abnormalities in patterns of cortical synchronization in ASD.

The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations.

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations.

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations.

Deviations of attention from the task at hand are often associated with worse reading performance (Schooler, Reichle, & Halpern, 2004). Ironically, current methods for detecting these shifts of attention typically generate task interruptions and further disrupt performance. In the current study, we developed a method to (1) track shifts of attention away from the reading task by examining the similarity between 5 min of eyes-closed-resting-state EEG and 5 min reading EEG; and (2) investigate, during reading, how the ratio between attention shifts and focused reading relates to readers’ comprehension. We performed a Spectral Similarity Analysis (SSA) that examined the spectral similarity between EEG recorded during reading and at rest on a moment-by-moment basis. We then recursively applied the algorithm to the resting-state data itself to obtain an individual baseline of the stability of brain activation recorded during rest. We defined any moment in which SSA during reading was greater than the mean correlation between resting-state EEG and itself as an “attentional shift.” The results showed that the proportion of such attentional shifts recorded over the left visual region (O1) significantly predicted reading comprehension, with higher ratios (indicative of more frequent attentional shifts) relating to worse comprehension scores on the reading test. As a proof of its validity, the same measure collected during the reading comprehension test also predicted participants’ Simon effect (incongruent - congruent response times) which is a common index of selective attention. This novel method allows researchers to detect attention shifts moments during reading without interrupting natural reading process.

The current study used quantitative electroencephalography (qEEG) to characterize individual differences in neural rhythms at rest and to relate them to fluid reasoning ability, to first language proficiency, and to subsequent second language (L2) learning ability, with the goal of obtaining a better understanding of the neurocognitive bases of L2 aptitude. Mean spectral power, laterality, and coherence metrics were extracted across theta, alpha, beta, and gamma frequency bands obtained from eyes-closed resting-state qEEG data from 41 adults aged 18–34 years. Participants then completed 8 weeks of French training using a virtual language and cultural immersion software. Results replicate and extend previous studies showing that faster learners have higher beta power recorded over right hemisphere (RH) electrode sites, greater laterality (RH − LH/RH + LH) of alpha and beta bands, and greater coherence between RH frontotemporal sites across all frequencies, although only coherence measures survived multiple comparisons. Increased coherence within and between RH networks was also associated with greater posttest declarative memory scores and with more accurate speech during learning. Total speech attempts, in contrast, correlated with bilaterally distributed small-world network configurations, as indexed by lower power and coherence over high-frequency (beta and gamma) bands recorded over frontotemporal networks in both hemispheres. Results from partial correlations and regression analyses suggest that the neural predictors of L2 learning rate, posttest proficiency, and total speech attempts varied in their degree of overlap with qEEG correlates of first language proficiency and fluid reasoning abilities, but that neural predictors alone explained 26–60% of the variance in L2 outcomes.

Aim The treatment of intertrochanteric fractures using a minimally invasive dynamic hip screw (MIDHS) technique has been reported to provide better results than the conventional technique (CDHS). The present study aims to determine whether there are any differences in terms of transfusion needs, morbidity, length of hospital stay, and economical costs, based on a study of two retrospective cohorts. Materials and methods Cohorts study of 80 patients with intertrochanteric femoral fractures (31-A1 and 31-A2.1) who underwent DHS procedure from July 2005 to September 2007; 40 of them were treated using the traditional technique (CDHS), and the other 40 using the minimally invasive technique (MIDHS). Results No differences were found in terms of blood loss, transfusion requirements or morbidity. Mean hospital stay for MIDHS group was 1.3 days lower, reducing the costs regarding the CDHS group by €306.3, but this difference was not statistically significant ( P = .3). The time required to perform the surgery was shorter for the MIDHS group: 49.3 versus 78.8 minutes ( p = 0.0001). Discussion Contrary to previous studies published, the present study did not show any advantage for the MIDHS technique, except for a shorter surgical time to perform the procedure. We consider that the MIDHS could help in improving operating room productivity and efficiency.

Premature ventricular complex are common findings in the exam of many athletes. There is no extensive scientific evidence in the management of this situation particularly when associated with borderline contractile function of the left ventricle. In this case report, we present a 35-year-old asymptomatic healthy athlete with high incidence (over 10 000 beats in 24 h) of premature ventricular complex and left ventricular dilatation with dysfunction, which persisted after a resting period of 6 months without training. We performed radiofrequency ablation of the premature ventricular complex focus. After 1-year follow-up, he was asymptomatic without arrhythmia and the left ventricle normalized its size and function as shown by echocardiogram and cardiac magnetic resonance.

Aim Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic. Material and methods A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011. Results Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones. Discussion It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures. Conclusions Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years.

Purpose This study examined right hemisphere (RH) neuroanatomical correlates of lexical–semantic deficits that predict narrative comprehension in adults with RH brain damage. Coarse semantic coding and suppression deficits were related to lesions by voxel-based lesion symptom mapping. Method Participants were 20 adults with RH cerebrovascular accidents. Measures of coarse coding and suppression deficits were computed from lexical decision reaction times at short (175 ms) and long (1000 ms) prime-target intervals. Lesions were drawn on magnetic resonance imaging images and through normalization were registered on an age-matched brain template. Voxel-based lesion symptom mapping analysis was applied to build a general linear model at each voxel. Z score maps were generated for each deficit, and results were interpreted using automated anatomical labeling procedures. Results A deficit in coarse semantic activation was associated with lesions to the RH posterior middle temporal gyrus, dorsolateral prefrontal cortex, and lenticular nuclei. A maintenance deficit for coarsely coded representations involved the RH temporal pole and dorsolateral prefrontal cortex more medially. Ineffective suppression implicated lesions to the RH inferior frontal gyrus and subcortical regions, as hypothesized, along with the rostral temporal pole. Conclusion Beyond their scientific implications, these lesion–deficit correspondences may help inform the clinical diagnosis and enhance decisions about candidacy for deficit-focused treatment to improve narrative comprehension in individuals with RH damage.

Understanding the neurobiological basis of individual differences in second language acquisition (SLA) is important for research on bilingualism, learning, and neural plasticity. The current study used quantitative electroencephalography (qEEG) to predict SLA in college-aged individuals. Baseline, eyes-closed resting-state qEEG was used to predict language learning rate during eight weeks of French exposure using an immersive, virtual scenario software. Individual qEEG indices predicted up to 60% of the variability in SLA, whereas behavioral indices of fluid intelligence, executive functioning, and working-memory capacity were not correlated with learning rate. Specifically, power in beta and low-gamma frequency ranges over right temporoparietal regions were strongly positively correlated with SLA. These results highlight the utility of resting-state EEG for studying the neurobiological basis of SLA in a relatively construct-free, paradigm-independent manner.

Mounting evidence suggests that bilingual development may change the brain in a way that gives rise to differences in non-linguistic cognitive functioning; however, only a limited number of studies have investigated the mechanism by which bilingualism shapes the brain. The current study used a network-level analysis to investigate differences in the mechanisms by which bilinguals and monolinguals flexibly adapt their neural networks in the face of novel task demands. Three competing hypotheses concerning differences in network-level adaptation were examined using Dynamic Causal Modeling of data from 15 bilinguals and 14 monolinguals who performed a Rapid Instructed Task Learning paradigm. The results demonstrated that the best-fitting model for the data from both groups specified that novel task execution is accomplished through a modulation of the influence of the anterior cingulate cortex (ACC) on the dorsolateral prefrontal cortex (DLPFC) and on the striatum. Further examination of the best-fitting model revealed that ACC activity increased DLPFC and striatal activity in bilinguals but decreased activity in these regions in monolinguals. Interestingly, an increased positive connection between the ACC and striatum was associated with decreased accuracy across groups. Taken together, the results suggest that regardless of language experience, the ACC plays a critical role in cognitive flexibility, but the exact influence of the ACC on other primary control regions seems to be dependent on language experience. When paired with the behavioral results, these results suggest that bilinguals and monolinguals may employ different neurocognitive mechanisms for conflict monitoring to flexibly adapt to novel situations.

We present, to our knowledge, the first demonstration that a non-invasive brain-to-brain interface (BBI) can be used to allow one human to guess what is on the mind of another human through an interactive question-and-answering paradigm similar to the “20 Questions” game. As in previous non-invasive BBI studies in humans, our interface uses electroencephalography (EEG) to detect specific patterns of brain activity from one participant (the “respondent”), and transcranial magnetic stimulation (TMS) to deliver functionally-relevant information to the brain of a second participant (the “inquirer”). Our results extend previous BBI research by (1) using stimulation of the visual cortex to convey visual stimuli that are privately experienced and consciously perceived by the inquirer; (2) exploiting real-time rather than off-line communication of information from one brain to another; and (3) employing an interactive task, in which the inquirer and respondent must exchange information bi-directionally to collaboratively solve the task. The results demonstrate that using the BBI, ten participants (five inquirer-respondent pairs) can successfully identify a “mystery item” using a true/false question-answering protocol similar to the “20 Questions” game, with high levels of accuracy that are significantly greater than a control condition in which participants were connected through a sham BBI.

We investigated the claim that individual differences in working-memory capacity reflect limitations on the ability to inhibit task-irrelevant information and/or to maintain activation in the face of distracting or interfering events. Specifically, we investigated whether high- and low-capacity individuals differed in their susceptibility to interference on the Stroop task and whether high-capacity individuals employed a strategy for minimizing Stroop interference. In Experiment 1, we found that high-capacity participants showed substantial interference when conflict trials were infrequent, but almost no interference when conflict trials were frequent. In contrast, low-capacity participants showed substantial interference irrespective of the proportion of conflict trials. In Experiment 2, we found that high-capacity participants experienced substantial negative priming, slow responses when the to-be-named color was the irrelevant word on the previous trial. We discuss these results and their implications for high-capacity individuals' ability to reduce Stroop interference in light of both inhibitory and noninhibitory accounts of negative priming.

This study examined how the brain system adapts and reconfigures its information processing capabilities to maintain cognitive performance after a key cortical center [left posterior superior temporal gyrus (LSTGp)] is temporarily impaired during the performance of a language comprehension task. By applying repetitive transcranial magnetic stimulation (rTMS) to LSTGp and concurrently assessing the brain response with functional magnetic resonance imaging, we found that adaptation consisted of 1) increased synchronization between compensating regions coupled with a decrease in synchronization within the primary language network and 2) a decrease in activation at the rTMS site as well as in distal regions, followed by their recovery. The compensatory synchronization included 3 centers: The contralateral homolog (RSTGp) of the area receiving rTMS, areas adjacent to the rTMS site, and a region involved in discourse monitoring (medial frontal gyrus). This approach reveals some principles of network-level adaptation to trauma with potential application to traumatic brain injury, stroke, and seizure.

The goal of the present review is to discuss recent cognitive neuroscientific findings concerning bilingualism. Three interrelated questions about the bilingual brain are addressed: How are multiple languages represented in the brain? how are languages controlled in the brain? and what are the real-world implications of experience with multiple languages? The review is based on neuroimaging research findings about the nature of bilingual processing, namely, how the brain adapts to accommodate multiple languages in the bilingual brain and to control which language should be used, and when. We also address how this adaptation results in differences observed in the general cognition of bilingual individuals. General implications for models of human learning, plasticity, and cognitive control are discussed.

From 1977 to 1986, Chile experienced an important typhoid fever epidemic, despite statistics that indicated apparently improving levels of sanitation of drinking water and sewage disposal. The lack of antibiotic resistance among the Salmonella typhi strains isolated during this period, the mild clinical presentation of the disease, and the initially low level of efficacy of the S. typhi Ty21a vaccine in the population exposed to the epidemic suggested that this epidemic might have resulted from the dissemination of S. typhi strains with unique characteristics. To investigate this hypothesis, we used conventional methods (bacteriophage typing and biotyping) and molecular methods (restriction fragment length polymorphism analysis, ribotyping, IS200 typing, and PCR amplification of the fliC-d gene) to study a population of 149 S. typhi isolates during 1977, 1981, and 1990, the years that included periods with low (when the disease was endemic) and high (when the disease was epidemic) morbidities. Our results indicate that these S. typhi isolates in Chile represent a number of highly diverse variants of the clone of S. typhi with a worldwide distribution described by Selander et al. (R. K. Selander, P. Beltran, N.H. Smith, R. Helmuth, F.A. Rubin, D.J. Kopecko, K. Ferris, B.D. Tall, A. Cravioto, and J.M. Musser, Infect. Immun. 58:2262-2275, 1990). For example, we detected 26 PstI and 10 ClaI ribotypes among 47 and 16 S. typhi strains belonging to this clone, respectively. These results suggest that the Chilean epidemic was probably produced by multiple sources of infection because of deficient sanitary conditions. These findings illustrate the usefulness of molecular methods for characterizing the potential causes of the typhoid epidemics and the possible routes of transmission of S. typhi strains in typhoid epidemics.

Background The presence of microvascular obstruction (MO) on delayed enhanced cardiac magnetic resonance (DECMR) imaging is associated with adverse remodeling and poor prognosis after STEMI. Identifying which patients that may develop MO prior to undergoing acute mechanical reperfusion maybe important in managing patients for more direct interventions. We sought to evaluate clinical predictors of MO as depicted by DECMR. Methods We included 255 patients with their first STEMI reperfused with primary percutaneous intervention. A standard DE-CMR was performed acutely at a mean of 3.9±2.0 days after admission. Clinical risk factors, time to reperfusion as well as angiographic variables were prospectively collected. The angiographic area at risk and the infarct size as a % of the left ventricle (LV) were computed. The number of segments with MO, defined as an area of hypoenhancement surrounded by delayed enhancement on DE-CMR, were summed to calculate MO extent.

Methods A standard Contrast-enhanced Cardiac Magnetic Resonance (ce-CMR) was performed pre-implantation of CRT device in 78 cardiac heart failure patients (64±11 years) with ischemic and non-ischemic dilated cardiomyopathy. Systolic function was assessed by cine imaging. Myocardial scar was characterized by a standard 2D segmented gradient echo inversion-recovery sequence applied in sequential short axis slices. Total scar was expressed as percentage of LV mass and the core and border zone as percentage of total scar). Patients were followed every 6 months to look for appropriate ICD therapy episodes. Results During a mean follow up of 25 months (percentile 25 th 75 th =15-34 months), appropriate therapy of ICD devices occurred in 11.5% of patients. The analysis showed that the percentage of total scar was a strong predictor of VA (ventricular fibrillation or ventricular tachycardia) needing ICD therapy (HR 1.096 [1.053 to 1.143], p

This study used functional magnetic resonance imaging to investigate individual differences in the neural underpinnings of sentence comprehension, with a focus on neural adaptability (dynamic configuration of neural networks with changing task demands). Twenty-seven undergraduates, with varying working memory capacities and vocabularies, read sentences that were either syntactically simple or complex under conditions of varying extrinsic working memory demands (sentences alone or preceded by to-be-remembered words or nonwords). All readers showed greater neural adaptability when extrinsic working memory demands were low, suggesting that adaptability is related to resource availability. Higher capacity readers showed greater neural adaptability (greater increase in activation with increasing syntactic complexity) across conditions than did lower capacity readers. Higher capacity readers also showed better maintenance of or increase in synchronization of activation between brain regions as tasks became more demanding. Larger vocabulary was associated with more efficient use of cortical resources (reduced activation in frontal regions) in all conditions but was not associated with greater neural adaptability or synchronization. The distinct characterizations of verbal working memory capacity and vocabulary suggest that dynamic facets of brain function such as adaptability and synchronization may underlie individual differences in more general information processing abilities, whereas neural efficiency may more specifically reflect individual differences in language experience.