Granulosa Cell Tumor of Scrotal Tunics: A Case Report

We report a case of adult granulosa cell tumor arising in the scrotal tunics. The patient was a 34-year-old man who presented with right scrotal swelling, first noticed four months previously. Under the initial clinical impression of epididymoorchitis, antibiotic treatment was instituted but there was no response. The paratesticular nodules revealed by ultrasound and magnetic resonance imaging mimicked intratesticular lesion, and radical orchiectomy was performed. Although several cases of adult testicular granulosa cell tumor, have been reported, the occurrence of this entity in the paratesticular area has not, as far as we are aware, been previously described

Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study

Background: Elective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown.Methods: We investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV.Results: Median number of cardioversions was one per patient with a range of 1-10. Altogether 303/1998 (15.2%) ECVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15-1.80, p 60/min (OR 1.92, CI95% 1.08-3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14-1.93, p < 0.01) and low (<60/ml/min) estimated glomerular filtration rate (OR 1.59, CI95% 1.08-2.33, p = 0.02) were predictors of ineffective ECV.Conclusions: Female gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified

Perception of basic emotion blends from facial expressions of virtual characters:pure, mixed, or complex?

As animated virtual characters in games, movies and other applications become more humanlike, it becomes more and more important to be able to imitate the complicated facial behaviour of a real human. So far, facial expression animation and research have been dominated by the basic emotions view, limited to the six universal expressions: anger, disgust, fear, joy, sadness and surprise. More complex facial expressions can be created by blending these basic emotions, but it is not clear how these blends are perceived. Are they still perceived as basic emotions or combinations of basic emotions, or are they perceived as expressions of more complex emotions? We used a series of online questionnaires to study the perception of all pairwise blends of basic emotions. The blends were produced as a sum of facial muscle activations in the two basic emotions, using a physically-based, animated face model. Our main finding is that several basic emotion blends with an opposite valence are perceived as complex emotions that are neither pure emotions nor their blends. Blends of basic emotions with a similar valence are typically perceived as pure basic emotions (e.g., a blend of anger and disgust is perceived as pure anger). Only one of the blends (joy+surprise) was perceived as a blend of two different basic emotions

Open versus robotic-assisted laparoscopic posterior component separation in complex abdominal wall repair

In this retrospective European multicentre study evaluating surgical treatment of 169 patients with a complex ventral incisional hernia, robotic-assisted laparoscopic transversus abdominis release results in a significant decrease in duration of postoperative hospital stay, and short-term postoperative complications when compared with open transversus abdominis release.Background Transversus abdominis release (TAR) is a surgical technique used in the treatment of complex ventral hernias. The aim of this study was to compare outcomes of open (oTAR) versus robotic-assisted (rTAR) posterior component separation by TAR. Methods Consecutive patients at two European hernia centres who underwent bilateral TAR were included. The primary endpoint was the duration of postoperative hospital stay. Results Data from 90 rTAR and 79 oTAR operations were evaluated. Patient demographics were similar between groups in terms of age, sex, BMI, and co-morbidities. There were more smokers, and hernias were larger in the oTAR group (width 8.7 cm versus 10.0 cm; P = 0.031, length 11.6 cm versus 14.1 cm; P = 0.005). Duration of postoperative hospital stay was significantly shorter in the rTAR group (3.4 days versus 6.9 days; P 0.009) were similar. Conclusion Patients with ventral incisional hernias who undergo bilateral rTAR had significantly shorter postoperative hospital stays and fewer short-term complications compared with patients undergoing bilateral oTAR

Can the reproducibility of fetal heart rate baseline estimation be improved?

Objective: To evaluate the reproducibility of fetal heart rate (FHR) baseline estimation according to an objective and detailed definition presented in this article, by comparison with the FIGO guidelines' definition. Study design: Three hundred consecutively acquired FHR tracings, 150 from antepartum high-risk pregnancies and 150 from unselected intrapartum cases, were presented to nine experienced clinicians included in three different groups, for an estimation of the FHR baseline. The first group consisted of clinicians using the proposed definition, without previous training in its use. The second group consisted of clinicians using the proposed definition, where a previous training session was promoted. The third group consisted of clinicians using the FIGO guidelines' definition. Agreement in baseline estimation was evaluated using the kappa statistic, the proportions of agreement and the intra-class correlation coefficient. Results: Using the baseline definition proposed in this article, agreement was significantly higher in the group with prior training in its use. This group also showed a trend towards a higher agreement than the one using the FIGO guidelines. Conclusion: The FHR baseline definition proposed in this article provides an extremely reproducible estimation when associated with prior training in its use

Open versus robotic-assisted laparoscopic posterior component separation in complex abdominal wall repair

In this retrospective European multicentre study evaluating surgical treatment of 169 patients with a complex ventral incisional hernia, robotic-assisted laparoscopic transversus abdominis release results in a significant decrease in duration of postoperative hospital stay, and short-term postoperative complications when compared with open transversus abdominis release.Background Transversus abdominis release (TAR) is a surgical technique used in the treatment of complex ventral hernias. The aim of this study was to compare outcomes of open (oTAR) versus robotic-assisted (rTAR) posterior component separation by TAR. Methods Consecutive patients at two European hernia centres who underwent bilateral TAR were included. The primary endpoint was the duration of postoperative hospital stay. Results Data from 90 rTAR and 79 oTAR operations were evaluated. Patient demographics were similar between groups in terms of age, sex, BMI, and co-morbidities. There were more smokers, and hernias were larger in the oTAR group (width 8.7 cm versus 10.0 cm; P = 0.031, length 11.6 cm versus 14.1 cm; P = 0.005). Duration of postoperative hospital stay was significantly shorter in the rTAR group (3.4 days versus 6.9 days; P 0.009) were similar. Conclusion Patients with ventral incisional hernias who undergo bilateral rTAR had significantly shorter postoperative hospital stays and fewer short-term complications compared with patients undergoing bilateral oTAR