Detection of peripheral vascular stenosis by assessing skeletal muscle flow reserve

ObjectivesWe sought to determine whether the severity of peripheral arterial disease (PAD) can be assessed by measuring blood flow reserve in limb skeletal muscle with contrast-enhanced ultrasound (CEU).BackgroundNoninvasive imaging of distal limb perfusion could improve management of patients with PAD by evaluating the impact of large and small vessel disease, and collateral flow.MethodsIn 12 dogs, blood flow in the quadriceps femoris was measured by CEU at rest and during either electrostimulated contractile exercise or adenosine infusion. Femoral artery blood flow was measured by Doppler ultrasound. Studies were performed in the absence and presence of either moderate or severe stenosis (pressure gradient of 10 to 20 mm Hg and >20 mm Hg, respectively).ResultsResting femoral artery blood flow progressively decreased with stenosis severity, while resting skeletal muscle flow was reduced only with severe stenosis (52 ± 21% of baseline, p < 0.05), indicating the presence of collateral flow. Skeletal muscle flow reserve during contractile exercise or adenosine decreased incrementally with increasing stenosis severity (p < 0.01). The stenotic pressure gradient correlated with skeletal muscle flow reserve for exercise and adenosine (r = 0.70 for both, p < 0.01).ConclusionsContrast-enhanced ultrasound of limb skeletal muscle can be used to assess the severity of PAD by measuring muscle flow reserve during either contractile exercise or pharmacologic vasodilation. Unlike currently used methods, this technique may provide a measure of the physiologic effects of large- and small-vessel PAD, and the influence of collateral perfusion

Morphological and Chemical Investigation of Ovarian Structures in a Bovine Model by Contrast-Enhanced X-ray Imaging and Microscopy

An improved understanding of an ovary’s structures is highly desirable to support advances in folliculogenesis knowledge and reproductive medicine, with particular attention to fertility preservation options for prepubertal girls with malignant tumors. Although currently the golden standard for structural analysis is provided by combining histological sections, staining, and visible 2D microscopic inspection, synchrotron radiation phase-contrast microtomography is becoming a new challenge for three-dimensional studies at micrometric resolution. To this aim, the proper use of contrast agents can improve the visualization of internal structures in ovary tissues, which normally present a low radiopacity. In this study, we report a comparison of four staining protocols, based on iodine or tungsten containing agents, applied to bovine ovarian tissues fixed in Bouin’s solution. The microtomography (microCT) analyses at two synchrotron facilities under different set-ups were performed at different energies in order to maximize the image contrast. While tungsten-based agents allow large structures to be well identified, Iodine ones better highlight smaller features, especially when acquired above the K-edge energy of the specific metal. Further scans performed at lower energy where the setup was optimized for overall quality and sensitivity from phase-contrast still provided highly resolved visualization of follicular and intrafollicular structures at different maturation stages, independent of the staining protocol. The analyses were complemented by X-ray Fluorescence mapping on 2D sections, showing that the tungsten-based agent has a higher penetration in this type of tissues

Psychotic-like experiences in help-seeking adolescents:Dimensional exploration and association with different forms of bullying victimization – A developmental social psychiatry perspective

Background: Psychotic-like experiences (PLEs) are common in the general population and increase the risk of psychotic disorders. Adolescents are a high-risk group of this condition. Stressful events, such as bullying, have a role in the onset of PLEs. This study has several aims: (1) to assess PLEs in adolescents seeking help from a Child and Adolescent Mental Health Service, (2) to assess the association of PLEs with specific bullying victimization and (3) to assess difference in PLEs and victimizations by sex and age. Methods: Participants were help-seeking (HS) adolescents initially screened for PLEs. They completed an assessment including characteristics of PLEs and bullying victimization. We paid particular attention to different kinds of PLEs and victimization. Results: In total, 50 PLE-positive adolescents screened from 324 HS adolescents (15.4%) constituted the sample. Paranoia and verbal bullying were the PLEs and form of victimization most represented, respectively. Verbal bullying was strongly associated with paranoia (odds ratio (OR): 4.40, confidence interval (CI): 2.8â\u88\u925.9, p <.001). Results remained significant after controlling for confounder (socio-demographic, anxiety, depression and for the latter analysis also other forms of victimization). Furthermore, social manipulation showed a strong association of paranoia and physical bullying with grandiosity. Verbal bullying was also associated with psychotic negative symptoms, but controlling for emotional symptoms and other victimization led to a reduction in the effect. Men were more involved in physical victimization and experienced grandiosity; on the contrary, late adolescents were most involved in social victimization and negative psychotic symptoms Conclusion: PLEs are relevant in HS adolescents. Bullying victimization interacts with the onset of these phenomena. In particular, verbal bullying predicted paranoia onset significantly

Manejo clínico e tratamento cirúrgico do carcinoma hepatocelular: revisão integrativa / Clinical management and surgical treatment of hepatocellular carcinoma: an integrative review

Introdução: Dado a incidência e importância do carcinoma hepatocelular a nível global, o objetivo deste artigo é realizar uma revisão integrativa sobre a abordagem desse tipo de neoplasia. Metodologia: Foram utilizados descritores inseridos no MeSH: “carcinoma hepatocelular”; “tratamento de doenças” e “procedimentos cirúrgicos operatórios''. Foi utilizado o operador boleano “AND” entre as combinações. Encontrou-se 46 artigos, com filtros: Free full text, Randomized Controlled Trial, nos últimos 10 anos, em humanos, com a linguagem em inglês, que foram publicados no MEDLINE e em pacientes com faixa etária entre 19 e 64 anos. Resultados: A radiofrequência foi relacionada a uma sobrevida geral e melhor tolerabilidade, e é recomendada para pacientes com reserva funcional hepática limitada. Foi visto que 61,6% dos pacientes tiveram cirrose hepática confirmada por histopatologia pós-operatória alguma complicação grave ou moderada com taxa de complicação esperada moderada de 27% para ressecções abertas e 13% para ressecções laparoscópicas. Discussão: A hepatectomia é a opção de primeira escolha para indivíduos com carcinoma hepatocelular, mas o prognóstico varia de cada paciente. Conclusão: A ressecção cirúrgica é a primeira linha de tratamento do CHC. Por sua vez, a radiofrequência é prevalecente para pacientes em que a ressecção cirúrgica é contraindicada.

Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy

BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer

Uma análise crítica das vacinas disponíveis para Sars-cov-2 / A critical analysis of the vaccines available for Sars-cov-2

INTRODUÇÃO: O desenvolvimento e a utilização de vacinas configuram-se de extrema importância para o enfrentamento e para a gestão da crise de saúde mundial devido à causa causada pelo novo Coronavírus. A pandemia impõe aos números desafios de ordem econômica, epidemiológica e, sobretudo, biomédica pela alta transmissibilidade do SARS-CoV-2 e pela gravidade da evolução clínica da doença para sua forma severa. A crise pandêmica tem levado os profissionais à exaustão e os sistemas de saúde em estados quase colapsados em todo o mundo.Além disso, no contexto brasileiro, os impactos da pandemia são ainda mais perceptíveis, pois existe, entre outros fatores, uma dificuldade de disponibilidade de testes diagnóstico para toda a população, o que impede a detecção de casos suspeitos, e o posterior emprego de medidas de propagação da doença. Nesse sentido, uma vacinação - modo de proporcionar uma memória imunológica de longa duração - demonstração-se uma saída eficiente de controle e contenção da disseminação do SARS-CoV-2. Assim, neste artigo buscou-se analisar como vacinas Sinovac, Astrazeneca, Janssen, Pfizer, importantes pelo seu uso ou potencial uso no Brasil, com um formulário de comparador de suas plataformas tecnológicas, segurança, efetivos, entre outros parâmetros.METODOLOGIA: Utilizando-se a base Pubmed e o site clinictrials.gov, foram selecionados 22 artigos a respeito de 13 vacinas desenvolvidas contra Sars-Cov-2. RESULTADOS / DISCUSSÃO: Os estudos têm como objetivo avaliar a produção de resposta imune e a ocorrência de efeitos adversos de componentes vacinais dos tipos: vírus inativado, RNA mensageiro, vetor recombinante e partícula recombinante. Tratam-se de ensaios clínicos randomizados, controlados de fase III, com cegamento, número e idade de participantes variados, que ainda conhecido-se em andamento. CONCLUSÃO: Os estudos sobre vacinas contra coronavírus que verdadeiro sendo realizados alcançados resultados promissores quanto à eficácia e segurança dos agentes imunológicos. No entanto, pesquisas que demandam mais tempo de seguimento e maiores populacionais são exigidos para melhores arquivos.

FACIAL PATTERNS AND PRIMARY NOCTURNAL ENURESIS IN CHILDREN

PURPOSE: Aims of our study are evaluating: (1) the prevalence of dolicofacial pattern among enuretic and control-group children, (2) the prevalence of an abnormal head posture in bedwetters, and (3) the correlation with sleep-related breathing disorders (SRBD) identified by polysomnography (PSG) recording. Nocturnal enuresis is a multifactorial disease, but has been related also to obstructive sleep-disordered breathing in both adults and children. Anatomical factors recognized to predispose to SRBD include adenotonsillar hypertrophy, neuromuscular disorders, craniofacial abnormalities associated with macroglossia, retrognathia or maxillary hypoplasia, and obesity. METHODS: Two hundred seventy enuretic children aged 7-12 years (mean 9.62 ± 2.31) were compared with a control-matched group of 274 children. To screen nocturnal sleep habits, all subjects' mothers filled out the Sleep Disturbance Scale for Children. Among these scales, only SBD scale was taken into account. Sleep breathing disorders (SBD) scale is composed of three items: sleep breathing difficulties, sleep apnea, and snoring. Cephalic index was calculated for each patient in order to identify facial patterns. An overnight PSG was performed in 28 (15 males, 13 females), randomly chosen, enuretic children and in 38 healthy volunteer controls (18 males, 20 females) matched for age (8.73 ± 0.79 vs. 9.12 ± 1.23; p = 0.147) and sex distribution (chi-square = 0.062; p = 0.803). RESULTS: Bedwetters show different sleep habits, higher prevalence of dolicofacial pattern, and abnormal head posture more than controls. CONCLUSIONS: Our preliminary study support further investigation of usage of the cephalic index as a predictor of SRBD

COMORBIDITY OF MIGRAINE AND EPILEPSY

In clinical practice, the finding of headache and epilepsy in the same patient and, moreover, in the presence of ictal and interictal epileptiform EEG patterns in patients with headache, is well known. These associations have stimulated research in the clinical and pathogenic relationships between headache and epilepsy Studies of the incidence of this association in epileptics and headache sufferers and an analysis of the link between the two different types of attacks have led several authors to support a non-casual clinical association between epilepsy and headache. So far, the pathophysiology of this condition remains unknown [1]. In adult patients, several studies demonstrated, according to IHS criteria, that the most common types of headache associated with epilepsy were migraine and tension-type. However, the rate of unclassified headaches has been remarkably high [2]. Probably, the most common relationship between seizures and migraine is when migraine-like headaches occur after seizures. Postictal headaches are often indistinguishable from migraine and are equally common in patients with or without a family history of migraine. Epileptiform abnormalities have been revealed in 9–13% of patients with migraine; this rate is significantly higher than expected from the normal population. Simple and complex partial seizures, primary and secondary generalized seizures, and tonic-clonic seizures have been reported associated with headache. It can be difficult to differentiate seizure disorders from migraine phenomena (and vice versa) in some patients. It is particularly a problem in children with atypical clinical presentations with or without abnormal EEGs [3]. In the absence of EEG recorded seizures, it is not uncommon to introduce an anticonvulsant if the history suggests a severe problem compatible with a diagnosis of epilepsy. Remission of the suspected events under anticonvulsant medication may indicate that the initial diagnosis of epilepsy was correct. However, there is evidence that in some patients, migraine phenomena also respond to these drugs. Valproate, gabapentin, topiramate, and tiagabine have been demonstrated to be efficacious. Furthermore, epileptic patients with a history suggesting migraine require a combination of both antiepileptic and antimigraine drugs in order to achieve full control of epilepsy

Sumatriptan nasal spray safety and effectiveness in migraine with aura adolescents

Background and aims Migraine is a common cause of headache among late childhood and adolescence and is the most common cause of severe, recurrent headaches up in 15–19 ys, with a great impairment on quality of life, sociality and school performances. In 2004, Italian Health Ministry rules triptans use in adolescent age. Aims study is assessing safety and effectiveness of Sumatriptan nasal spray in Migraine with Aura adolescent. Methods According to IHS 2004 criteria, 24 migraine with Aura (MA) patients (M/F 13/11) aged 12–17 ys (mean 13.4 SD±1.48), were selected in Headache Centre of Child and Adolescents Neuropsychiatry Department in Naples, between February 2003 and September 2004. Monthly frequency migraine attacks were 3 to 7. All patients were non responders at analgesics and NSAIDs. Standard neurological and clinical laboratory tests, EEG wake and sleep recordings, electrocardiograms, and nasal examinations were performed at first clinic visit. Patients presented visual aura in 42.85%, limbs parestesia 28.57%, and arms hyposthenia 28.57%. Before and after treatment of each migraine, patients scored pain on a four-point scale (0=none; 1=mild; 2=moderate; 3=severe). Results The success of individual Sumatriptan clinical administration appears related to time to treatment, with resolution pain time in 10 minutes for 64.58% and in 30 minutes for 35.42%. Overall, triptan tolerability in adolescents is similar to that reported in adults. The most common specific drug-related adverse event was unpleasant taste, which was reported in 37.58% of patients and epistaxis in 12.52%. Mean scored value pain after treatment with Sumatriptan was 0.75 (SD±0.8) vs 2.89 (SD±1.24) (p=0.000). Conclusions Triptans (selective 5-hydroxytryptamine1B/1D serotonin agonists) are a new class of agents used in the treatment of migraine. Study results suggest that Sumatripatn nasal spray may effectively alleviate migraine in adolescents MA patients