The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation

Background: A large majority of thrombi causing ischemic complications under atrial fibrillation (AF) originate in the left atrial appendage (LAA), an anatomical structure departing from the left atrium, characterized by a large morphological variability between individuals. This work analyses the hemodynamics simulated for different patient-specific models of LAA by means of computational fluid–structure interaction studies, modeling the effect of the changes in contractility and shape resulting from AF. Methods: Three operating conditions were analyzed: sinus rhythm, acute atrial fibrillation, and chronic atrial fibrillation. These were simulated on four patient-specific LAA morphologies, each associated with one of the main morphological variants identified from the common classification: chicken wing, cactus, windsock, and cauliflower. Active contractility of the wall muscle was calibrated on the basis of clinical evaluations of the filling and emptying volumes, and boundary conditions were imposed on the fluid to replicate physiological and pathological atrial pressures, typical of the various operating conditions. Results: The LAA volume and shear strain rates were analyzed over time and space for the different models. Globally, under AF conditions, all models were well aligned in terms of shear strain rate values and predicted levels of risk. Regions of low shear rate, typically associated with a higher risk of a clot, appeared to be promoted by sudden bends and focused at the trabecule and the lobes. These become substantially more pronounced and extended with AF, especially under acute conditions. Conclusion: This work clarifies the role of active and passive contraction on the healthy hemodynamics in the LAA, analyzing the hemodynamic effect of AF that promotes clot formation. The study indicates that local LAA topological features are more directly associated with a thromboembolic risk than the global shape of the appendage, suggesting that more effective classification criteria should be identified

Characterizing archaeological bronze corrosion products intersecting electrochemical impedance measurements with voltammetry of immobilized particles

[EN] Application of electrochemical impedance measurements to microparticulate deposits of copper corrosion products attached to graphite electrodes in contact with 0.10 M aqueous HClO4 electrolyte is described. The impedance measurements were sensitive to the applied potential and the amount of solid sample and were modeled taking into account the contribution of the uncovered base electrode. Several pairs of circuit elements provide monotonic variations which are able to characterize different corrosion compounds regardless the amount of microparticulate solid on the electrode. Application to a set of archaeological samples from the archaeological Roman site of Gadara (Jordan, 4th century AD) permitted to establish a grouping of such samples suggesting different provenances/manufacturing techniques.Financial support from the MINECO ProjectsCTQ2014-53736-C3-1-P and CTQ2014-53736-C3-2-P which are also supported with ERDF funds and Grants ES-2012-052716 and EEBB-I-16-11558 is gratefully acknowledgedRedondo-Marugan, J.; Piquero-Cilla, J.; Domenech Carbo, MT.; Ramírez-Barat, B.; Al Sekhaneh, W.; Capelo, S.; Doménech Carbó, A. (2017). Characterizing archaeological bronze corrosion products intersecting electrochemical impedance measurements with voltammetry of immobilized particles. Electrochimica Acta. 246:269-279. https://doi.org/10.1016/j.electacta.2017.05.190S26927924

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Follicular B-Cell Lymphoma Embedded in a Pulmonary Chondroid Hamartoma: A Case Report

Background: Here we report a rare case of concomitant pulmonary chondroid hamartoma and follicular non Hodgkin lymphoma in a 65-year-old woman with a history of 4-month nonspecific symptoms like fever, sweating and weight loss.Methods: Chest CT scan revealed a 12-mm nodule with relatively regular margins in the right middle lung field, adhering to the chest wall, with no involvement of hilar or mediastinal lymph nodes. The patient underwent thoracoscopy and resection of the lesion. Following histological exam and immunohistochemical staining, the patient was diagnosed as having follicular b-cell lymphoma embedded in a pulmonary chondroid hamartoma. FISH analysis was performed and showed the presence of typical follicular lymphoma chromosomal translocation t (14;18) (q32;q21).Conclusions: Following the final diagnosis, we decided not to refer the patient to chemotherapy and she enter watch and wait regimen with imaging control every 6 months. After 18 months, the chest X-ray and abdominal ultrasound are still negative with no evidence of recurrence.</p