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

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

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

European Society of Cardiology quality indicators for the prevention and management of cancer therapy-related cardiovascular toxicity in cancer treatment.

AIMS: To develop quality indicators (QIs) for the evaluation of the prevention and management of cancer therapy-related cardiovascular toxicity. METHODS AND RESULTS: We followed the European Society of Cardiology (ESC) methodology for QI development which comprises (i) identifying the key domains of care for the prevention and management of cancer therapy-related cardiovascular toxicity in patients on cancer treatment, (ii) performing a systematic review of the literature to develop candidate QIs, and (iii) selecting of the final set of QIs using a modified Delphi process. Work was undertaken in parallel with the writing of the 2022 ESC Guidelines on Cardio-Oncology and in collaboration with the European Haematology Association, the European Society for Therapeutic Radiology and Oncology and the International Cardio-Oncology Society. In total, 5 main and 9 secondary QIs were selected across five domains of care: (i) Structural framework, (ii) Baseline cardiovascular risk assessment, (iii) Cancer therapy related cardiovascular toxicity, (iv) Predictors of outcomes, and (v) Monitoring of cardiovascular complications during cancer therapy. CONCLUSION: We present the ESC Cardio-Oncology QIs with their development process and provide an overview of the scientific rationale for their selection. These indicators are aimed at quantifying and improving the adherence to guideline-recommended clinical practice and improving patient outcomes

A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus

Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators. Three classes of parenterally administered inotropes are currently indicated for decompensated heart failure, (i) the beta adrenergic agonists, including dopamine and dobutamine and also the catecholamines epinephrine and norepinephrine, (ii) the phosphodiesterase III inhibitor milrinone and (iii) the calcium sensitizer levosimendan. These three families of drugs share some pharmacologic traits, but differ profoundly in many of their pleiotropic effects. Identifying the patients in need of inotropic support and selecting the proper inotrope in each case remain challenging. The present consensus, derived by a panel meeting of experts from 21 countries, aims at addressing this very issue in the setting of both acute and advanced heart failure. (C) 2019 The Authors. Published by Elsevier B.V.Peer reviewe

Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Levosimendan was first approved for clinical use in 2000, when authorization was granted by Swedish regulatory authorities for the hemodynamic stabilization of patients with acutely decompensated chronic heart failure (HF). In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitization and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced HF, right ventricular failure, pulmonary hypertension, cardiac surgery, critical care, and emergency medicine. Levosimendan is currently in active clinical evaluation in the United States. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and noncardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute HF arena in recent times and charts a possible development trajectory for the next 20 years

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Root Canal Anatomy of Maxillary and Mandibular Teeth

It is a common knowledge that a comprehensive understanding of the complexity of the internal anatomy of teeth is imperative to ensure successful root canal treatment. The significance of canal anatomy has been emphasized by studies demonstrating that variations in canal geometry before cleaning, shaping, and obturation procedures had a greater effect on the outcome than the techniques themselves. In recent years, significant technological advances for imaging teeth, such as CBCT and micro-CT, respectively, have been introduced. Their noninvasive nature allows to perform in vivo anatomical studies using large populations to address the influence of several variables such as ethnicity, aging, gender, and others, on the root canal anatomy, as well as to evaluate, quantitatively and/or qualitatively, specific and fine anatomical features of a tooth group. The purpose of this chapter is to summarize the morphological aspects of the root canal anatomy published in the literature of all groups of teeth and illustrate with three-dimensional images acquired from micro-CT technology.info:eu-repo/semantics/publishedVersio