The Use of Handheld Ultrasound Devices-An EFSUMB Position Paper

Publisher Copyright: © 2018 Georg Thieme Verlag KG Stuttgart New York.The miniaturization of ultrasound equipment in the form of tablet-or smartphone-sized ultrasound equipment is a result of the rapid evolution of technology and handheld ultrasound devices (HHUSD). This position paper of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of HHUSD in abdominal ultrasound, pediatric ultrasound, targeted echocardiography and heart ultrasound, and we will report position comments on the most common clinical applications. Also included is a SWOT (Strength-Weaknesses-Opportunities-Threats) analysis, the use for handheld devices for medical students, educational & training aspects, documentation, storage and safety considerations.Peer reviewe

Nanomaterials for Neural Interfaces

This review focuses on the application of nanomaterials for neural interfacing. The junction between nanotechnology and neural tissues can be particularly worthy of scientific attention for several reasons: (i) Neural cells are electroactive, and the electronic properties of nanostructures can be tailored to match the charge transport requirements of electrical cellular interfacing. (ii) The unique mechanical and chemical properties of nanomaterials are critical for integration with neural tissue as long-term implants. (iii) Solutions to many critical problems in neural biology/medicine are limited by the availability of specialized materials. (iv) Neuronal stimulation is needed for a variety of common and severe health problems. This confluence of need, accumulated expertise, and potential impact on the well-being of people suggests the potential of nanomaterials to revolutionize the field of neural interfacing. In this review, we begin with foundational topics, such as the current status of neural electrode (NE) technology, the key challenges facing the practical utilization of NEs, and the potential advantages of nanostructures as components of chronic implants. After that the detailed account of toxicology and biocompatibility of nanomaterials in respect to neural tissues is given. Next, we cover a variety of specific applications of nanoengineered devices, including drug delivery, imaging, topographic patterning, electrode design, nanoscale transistors for high-resolution neural interfacing, and photoactivated interfaces. We also critically evaluate the specific properties of particular nanomaterials—including nanoparticles, nanowires, and carbon nanotubes—that can be taken advantage of in neuroprosthetic devices. The most promising future areas of research and practical device engineering are discussed as a conclusion to the review.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64336/1/3970_ftp.pd

Hepatocellular carcinoma in HCV - liver cirrhosis before and after successful DAA treatment

Chronic hepatitis C virus (HCV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma (HCC) worldwide. The recent advancement of direct-acting Antiviral Agents (DAAs) in hepatitis C therapy, resulted in sustained virological response rates of over 90% in treated patients in different stages of liver fibrosis. The efficacy of DAAs treatment has also been confirmed in real-life cohorts that include subjects with decompensated cirrhosis and therefore seems a promising step to a significant reduction in the recurrence of HCC in patients who achieved complete destruction of the HCC nodules by local therapy. We present a 72-year old patient with HCV-related liver cirrhosis who successfully responded to DAAs treatment after complete destruction of an early HCC nodule

Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria

ObjectiveHCV infection is a leading cause of chronic liver disease with long-term complications—extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital “Queen Joanna-ISUL” for 3-year period (2012–2014).MethodsIt is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital “Queen Joanna-ISUL” for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy) were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF), hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal–Wallis, and Friedman tests were used for statistical processing.Results76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839) with an average cost per patient 4,577 BGN (€2,340). Statistically significant correlation was observed between the total cost per patient from the different payers’ perspective and the Child-Pugh cirrhosis score.ConclusionHCV-related cirrhosis is resource demanding and sets high direct medical costs as it is related with increased hospitalizations and complications acquiring additional treatment

Efficacy and Safety of PAIR for Cystic Echinococcosis: Experience on a Large Series of Patients from Bulgaria

We report our experience with puncture, aspiration, injection, and reaspiration (PAIR) for the treatment of cystic echinococcosis in Bulgaria. PAIR was performed in 230 patients with 348 echinococcal cysts. At 12-month follow-up, 77.6% of the cysts, all cystic echinococcosis (CE) 1 and CE3a cysts according to the World Health Organization Informal Working Group classification, showed various degrees of obliteration. In 11.5% of cysts, all of which were > 10 cm-type CE1, a significant amount of fluid persisted, and they were punctured again. Of those, 16 (4.6%) contained protoscolices and were treated by a second PAIR. The remaining 24 (6.9%) cysts were treated by simple aspiration or drainage. No significant reduction in size and no changes in the structure were observed in 10.9% of cysts, all of which were classified as CE2 or CE3b. Complications developed in 25.2% of patients, including severe anaphylactic reaction in two (0.9%) patients. Our experience confirms that PAIR is a successful first-choice treatment when a stage-specific approach is taken