Συστροφή όρχι κατά την εμβρυϊκή ζωή και τη νεογνική ηλικία (Περιγεννητική συστροφή όρχι)

The term perinatal testicular torsion (PTT) defines the extravaginal testicular torsion that happens either during the fetal period (prenatal testicular torsion) or the neonatal period (postnatal testicular torsion). It concerns 10-22% of testicular torsions that appear during childhood. The clinical findings of PTT after birth depend on the time of the event. In every newborn male with scrotal swelling and discoloration, while the other testis is hard, PTT should be considered as the diagnosis until proven otherwise. The treatment of PTT is discussed by the authors. Disagreement is present concerning the time and method of treatment, as well as the necessity of preventing orchidopexy of the contralateral testis. In our study, we review recent literature in order to establish an evidence based conclusion over treatment.Με τον όρο περιγεννητική συστροφή όρχι (ΠΣO) αποδίδεται η εξωελυτροειδική –κατά κανόνα- συστροφή όρχι που συμβαίνει είτε κατά την εμβρυική ζωή (prenatal testicular torsion) είτε στη νεογνική ηλικία (postnatal testicular torsion). Αφορά το 10-22% των συστροφών όρχι που συμβαίνουν κατά την παιδική ηλικία. Τα κλινικά ευρήματα της ΠΣO όπως μπορούν να εκτιμηθούν μετά την γέννηση εξαρτώνται ουσιαστικά από τον χρόνο που συνέβη η συστροφή. Σε κάθε άρρεν νεογέννητο με διόγκωση οσχέου το οποίο έχει μελανόχρωμη εμφάνιση ενώ ο σύστοιχος όρχις έχει σκληρή σύσταση θα πρέπει να θεωρείται ως πιθανή η ΠΣO μέχρι απόδειξης του αντιθέτου. Σχετικά με την ενδεδειγμένη αντιμετώπιση της ΠΣO δεν υπάρχει ομοφωνία από τους συγγραφείς. Παραμένουν οι διαφωνίες αναφορικά με τον χρόνο και την μέθοδο αντιμετώπισης καθώς και για την αναγκαιότητα της προληπτικής ορχεοπηξίας του ετερόπλευρου όρχι. Στην παρούσα μελέτη, έπειτα από την διεξοδική αναδίφηση της πρόσφατης και σχετικά περιορισμένης βιβλιογραφίας, γίνεται προσπάθεια για τεκμηριωμένη αποσαφήνιση των ζητουμένων που παραμένουν

Cardiac failure in β-thalassemia: diagnosis, prevention and management

Heart failure always represented and still remains the leading cause of mortality in &beta; (&beta;)-thalassemia, despite the therapeutic advances and the considerable amelioration of prognosis accomplished over the last decades. High cardiac output due to chronic anemia and myocardial iron overload due to repetitive blood transfusions are the two main pathogenetic mechanisms causing heart failure in &beta;-thalassemia. In regularly treated thalassemia major patients, left ventricular dysfunction, resulting mainly from myocardial siderosis, is considered to be the primary cause of heart failure and thus the prevention, early recognition and effective management of iron overload is of key importance. However, the spectrum of cardiovascular complications that may ultimately lead to heart is wide and should be individually investigated in each one of the patients. Echocardiography is the main modality used for the regular follow-up and screening of asymptomatic patients and for the evaluation of patients with cardiac symptoms, while the T2* relaxation time provided by magnetic resonance imaging allows the accurate identification and quantification of myocardial iron burden and thus the proper guidance of iron chelation therapy.&nbsp;近几十年来，尽管治疗方法取得进步和预断方法得到显著改进，但是心脏衰竭仍是引起&beta;地中海贫血症患者死亡的主要原因。 慢性贫血导致的高心输出量和反复输血导致的心脏铁过载，是导致&beta;地中海贫血患者心脏衰竭的两大发病机制。 在常规治疗的重型地中海贫血患者中，心脏铁质沉着病引起的可逆性左心室功能障碍，被认为是心脏衰竭的主要原因。因此，预防、早期确诊和有效控制铁过载至关重要。 然而，最终导致心脏衰竭的心血管并发症的症状繁多，应对每个患者单独进行检查。 超声心动图仪是用于无症状患者定期随访、筛查和诊断有心脏病症状患者的主要仪器，磁共振成象显示的T2*松弛时间可更准确地识别和量化心脏的铁负荷，有助于正确引导铁螯合疗法。</p

Chronic pyelonephritis presenting as a renal sinus tumor with retroperitoneal extension: a case report

<p>Abstract</p> <p>Introduction</p> <p>Chronic pyelonephritis is associated with progressive renal scarring and occurs, most of the time, in patients with major anatomical anomalies, including urinary tract obstruction, calculi, renal dysplasia or vesicoureteric reflux. We report the computed tomography imaging findings of a patient with chronic pyelonephritis appearing as a renal sinus mass. To our knowledge, it is the first time that such a case has been published in the literature.</p> <p>Case presentation</p> <p>We present a case of a 68-year-old woman who underwent a computed tomography scan of the abdomen in the work-up for recently diagnosed hypertension. A non-enhancing left renal sinus mass was detected extending to the para-aortic space. The initial diagnosis was that of a tumor of the collecting system. Nephro-ureterectomy was performed and the pathology results revealed changes of chronic pyelonephritis.</p> <p>Conclusion</p> <p>Chronic pyelonephritis presenting as a renal sinus mass is reported for the first time in the literature. This may lead to the conclusion that diagnostic ureteropyeloscopy and biopsy should be performed prior to radical surgery for possible upper tract urothelial tumors.</p

EACVI/HFA Cardiac Oncology Toxicity Registry in breast cancer patients: rationale, study design, and methodology (EACVI/HFA COT Registry)-EURObservational Research Program of the European Society of Cardiology.

The goal of adjuvant anti-cancer therapies is cure with limited or no side effects, in particular long-term side effects with negative impact on quality of life. In the palliative setting disease control, quality of life and overall survival are important end points. Partly due to improvements in treatment, the population of cancer survivors is large and growing. However, anti-cancer drug-related cardiotoxicity (ADRC) is the leading cause of treatment-associated mortality in cancer survivors. It is one of the most common post-treatment problems among 5- to 10-year survivors of adult cancer. This is particularly true for breast cancer, the most common cancer in women. The EACVI/HFA COT registry is designed for comprehensive data collection and evaluation of the current European practice in terms of diagnosis and management of ADRC in breast cancer patients. The COT registry will be carried out in two continuing phases, the pilot study phase involving 13 countries followed by the long-term registry in which all the 56 ESC countries will be invited to participate. With the COT registry, several critical information will be obtained: on predisposing factors for the development of ADRC, the rate of subclinical LV dysfunction and its transition to overt heart failure, the clinical impact and outcome of ADRC

A paleoepidemiological approach to the osteological paradox : Investigating stress, frailty and resilience through cribra orbitalia

Open Access via the Jisc Wiley Agreement Funder: British Academy (GrantNumber(s): GP2\190224)Peer reviewedPublisher PD

High Specific Energy Lithium Cells for Space Exploration

The paper discusses development under an ESA TRP activity (Contract No. 4000109879/13/NL/LvH) with a target of high specific energy Lithium-ion cells, capable of operating under low temperature conditions, i.e. −40 °C. Such cells may be encountered in future exploration missions, which do not consider the use of Radioisotope Heater Units. During the activity, ≥1 Ah silicon-based high energy density prototype cells, following components characterization and optimization, were designed, developed, manufactured and tested under room and subzero temperature conditions down to −40 °C. The developed and tested prototype cells exhibited energy density of around 208 Wh/Kg at room temperature under C/10 charge-discharge rate within voltage range of 2.8 V and 4.1 V. Moreover, the prototype cells could retain and deliver more than 75% of their capacity at room temperature upon cycling at −40 °C, demonstrating an energy density of 140 Wh/kg

Permanent water swelling effect in low temperature thermally reduced graphene oxide

We demonstrate permanent water trapping in reduced graphene oxide after high relative humidity exposure. For this purpose, we grew graphene oxide films via spin-coating on glass substrates followed by thermal reduction. The electrical resistance of the planar device was then measured. We observed that resistance is significantly increased after water vapor exposure and remains stable even after 250 days in ambient conditions. Various techniques were applied to desorb the water and decrease (recover) the material's resistance, but it was achieved only with low temperature thermal annealing (180 °C) under forming gas (H2/N2 mixture). The permanent effect of water absorption was also detected by x-ray photoelectron spectroscopy.</p

Association Between Hemoglobin Levels and Efficacy of Intravenous Ferric Carboxymaltose in Patients With Acute Heart Failure and Iron Deficiency: An AFFIRM-AHF Subgroup Analysis

BACKGROUND: Iron deficiency, with or without anemia, is an adverse prognostic factor in heart failure (HF). In AFFIRM-AHF (a randomized, double-blind placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalizations and mortality in iron-deficient subjects admitted for acute heart failure), intravenous ferric carboxymaltose (FCM), although having no significant effect on the primary end point, reduced the risk of HF hospitalization (hHF) and improved quality of life versus placebo in iron-deficient patients stabilized after an acute HF (AHF) episode. These prespecified AFFIRM-AHF subanalyses explored the association between hemoglobin levels and FCM treatment effects. METHODS: AFFIRM-AHF was a multicenter, double-blind, randomized, placebo-controlled trial of FCM in hospitalized AHF patients with iron deficiency. Patients were stratified by baseline hemoglobin level (<12 versus ≥12 g/dL). In each subgroup, the primary composite (total hHF and cardiovascular death) and secondary (total hHF; total cardiovascular hospitalizations and cardiovascular death; time to cardiovascular death, and time to first/days lost due to hHF or cardiovascular death) outcomes were assessed with FCM versus placebo at week 52. Sensitivity analyses using the World Health Organization anemia definition (hemoglobin level <12 g/dL [women] or <13 g/dL [men]) were performed, among others. RESULTS: Of 1108 AFFIRM-AHF patients, 1107 were included in these subanalyses: 464 (FCM group, 228; placebo group, 236) had a hemoglobin level <12 g/dL, and 643 (FCM, 329; placebo, 314) had a hemoglobin level ≥12 g/dL. Patients with a hemoglobin level <12 g/dL were older (mean, 73.7 versus 69.1 years), with more frequent previous HF (75.0% versus 68.7%), serum ferritin <100 μg/L (75.4% versus 68.1%), and transferrin saturation <20% (87.9% versus 81.4%). For the primary outcome, annualized event rates per 100 patient-years with FCM versus placebo were 71.1 and 73.6 (rate ratio, 0.97 [95% CI, 0.66-1.41]), respectively, and 48.5 versus 72.9 (RR, 0.67 [95% CI, 0.48-0.93]) in the hemoglobin levels <12 and ≥12 g/dL subgroups, respectively. No significant interactions between hemoglobin subgroup and treatment effect were observed for primary (P$_{interaction}$=0.15) or secondary outcomes. Changes from baseline in hemoglobin, serum ferritin and transferrin saturation were significantly greater with FCM versus placebo in both subgroups between weeks 6 and 52. Findings were similar using the World Health Organization definition for anemia. CONCLUSIONS: The effects of intravenous FCM on outcomes in iron-deficient patients stabilized after an AHF episode, including improvements in iron parameters over time, did not differ between patients with hemoglobin levels <12 and ≥12 g/dL