Magnetic resonance imaging and histology correlation in Cushing's disease

Introduction We continuously look for new techniques to improve the radicality of resection and to eliminate the negative effects of surgery. One of the methods that has been implemented in the perioperative management of Cushing's disease was the combination of three magnetic resonance imaging (MRI) sequences: SE, SPGR and fSPGR. Material and methods We enrolled 41 patients (11 males, 30 females) diagnosed with Cushing's disease. A 3D tumour model with a navigation console was developed using each SPGR, fSPGR and SE sequence. The largest model was then used. In all cases, a standard four-handed, bi-nostril endoscopic endonasal technique was used. Endocrinological follow-up evaluation using morning cortisol sampling was performed for 6–34 months in our study. Results In total, 36 patients (88%) were disease-free following surgery. Our results indicate we achieved 100% sensitivity of MR. Overall, the conformity of at least one donor site, as compared with the places designated on MR, was in 78% of patients. We searched the place of compliance in individual locations. There is a consensus in individual locations in 63 of the 123 cases (or 56%). The correlation gamma function at a 5% significance level was then 0.27. Discussion The combination of MR sequences (SE, SPGR, fSPGR), neuronavigation system and iMRI led to increased sensitivity of up to 100%. Specificity reached 56% in our study. Conclusion We found a high success rate in surgical procedure in terms of the correlation between MR findings and histology, which leads to remission of Cushing's disease

همبستگی عزت نفس با پیشرفت تحصیلی در دانشجویان دانشکده‌ی پرستاری و مامایی زنجان 1388

زمینه و هدف: یکی از بزرگترین معضلات آموزشی، افت تحصیلی دانشجویان است. بنابراین توجه به بهداشت روانی و پیشرفت تحصیلی این گروه اهمیت به‌سزایی دارد. پاره‌ای از مطالعات بیانگر ارتباط مستقیم بین عزت نفس و پیشرفت تحصیلی است، لیکن بعضی از صاحب نظران رابطه‌ی مستقیم این دو را مورد تردید قرار داده‌اند. این پژوهش با هدف تعیین همبستگی عزت نفس با پیشرفت تحصیلی دانشجویان دانشکده‌ی پرستاری و مامایی زنجان انجام شده است. روش بررسی: این پژوهش یک مطالعه‌ی همبستگی بود، کلیه‌ی دانشجویان دانشکده‌ی پرستاری و مامایی زنجان که حداقل دو نیم‌سال سابقه‌ی تحصیلی داشتند، (182 نفر) در مطالعه شرکت کردند. ابزار جمع‌آوری اطلاعات پرسش‌نامه بود. پرسش‌نامه از دو بخش شامل: ویژگی‌های فردی و تحصیلی واحدهای پژوهش و آزمون 58 سوالی عزت نفس کوپراسمیت تشکیل شده بود. یافته‌ها: ضریب همبستگی پیرسون رابطه‌ی معنی‌داری بین عزت نفس و پیشرفت تحصیلی دانشجویان نشان داد (31/0= r ). ولی عزت نفس با سن و جنسیت ارتباط آماری معنی‌داری نداشت (05/0 P ). نتیجه‌گیری: با توجه به وجود همبستگی مثبت بین عزت نفس و پیشرفت تحصیلی دانشجویان، به نظر می‌رسد استفاده از روش‌های تقویت عزت نفس می‌تواند در جلوگیری از افت تحصیلی دانشجویان نقش داشته باشد

Outcomes of patients after successful left ventricular assist device explantation: a EUROMACS study

Aims: Sufficient myocardial recovery with the subsequent explantation of a left ventricular assist device (LVAD) occurs in approximately 1–2% of the cases. However, follow-up data about this condition are scarcely available in the literature. This study aimed to report the long-term outcomes and clinical management following LVAD explantation. Methods and results: An analysis of the European Registry for Patients with Mechanical Circulatory Support was performed to identify all adult patients with myocardial recovery and successful explantation. Pre-implant characteristics were retrieved and compared with the non-recovery patients. The follow-up data after explantation were collected via a questionnaire. A Kaplan–Meier analysis for freedom of the composite endpoint of death, heart transplantation, LVAD reimplantion, or heart failure (HF) relapse was conducted. A total of 45 (1.4%) cases with myocardial recovery resulting in successful LVAD explantation were identified. Compared with those who did not experience myocardial recovery, the explanted patients were younger (44 vs. 56 years, P < 0.001), had a shorter duration of cardiac disease (P < 0.001), and were less likely to have ischaemic cardiomyopathy (9% vs. 41.8%, P < 0.001). Follow-up after explantation could be acquired in 28 (62%) cases. The median age at LVAD implantation was 43 years (inter-quartile range: 29–52),

The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery:third report

OBJECTIVES: In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS: Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with 3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (3 months). RESULTS: In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P 3 months: 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS: In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent

Mixed finite element solutions to contact problems of nonlinear Gao beam on elastic foundation

This paper analyzes nonlinear contact problems of a large deformed beam on an elastic foundation. The beam model is governed by a nonlinear fourth-order differential equation developed by Gao (1996); while the elastic foundation model is assumed as Winkler’s type. Based on a decomposition method, the nonlinear variational inequality problem is able to be reformed as a min–max problem of a saddle Lagrangian. Therefore, by using mixed finite element method with independent discretization–interpolations for foundation and beam elements, the nonlinear contact problem in continuous space is eventually converted as a nonlinear mixed complementarity problem, which can be solved by combination of interior-point and Newton methods. Applications are illustrated by different boundary conditions. Results show that the nonlinear Gao beam is more stiffer than the Euler–Bernoulli beam

Examining the Impact of Inlet Shape on Nasal Cavity Flow Field: A Computational Investigation

In numerical calculations, entrance lengths and volumes upstream of the control volume are commonly used to steady the flow and obtain more accurate results. This paper discusses the effect of the geometrical shape of the inlet on the results of the flow field. The study presents the results of a Computational Fluid Dynamics (CFD) simulation of a real model of nasal cavity created from CT images of one patient. Furthermore, the spherical and cubic volume in front of the nostril entrance is modeled. Within the results, the flow fields are observed in planes across the entire sinus from the nostrils up to the nasopharynx. The resulting flow fields from all the three models are compared with each other. The effect of the geometric shape before the entrance to the nostrils is discussed considering the model without the modeled volume. The model created from the CT data of one patient was modified in CAD software to create differently shaped volumes in front of the nostrils. The CFD calculations were performed using Ansys Fluent 2021 R1 software

Preparation of a Real Model of Nasal Cavities from Computed Tomography for Numerical Simulation

With improves in computing hardware and CFD methods, it is possible to work with more complex geometries. The aim of this study is to describe the preparation and creation of a model from CT scans for a numerical study of air flow into the nasal cavities. Research background: The influence of pituitary tumor surgery on the change of geometric proportions of the nasal cavity is investigated in cooperation with the Neurosurgical Department. Purpose of the article: In pituitary tumor surgery, the nasal cavity is used as an access route to the Sella turcica where the pituitary gland is located. Geometric changes occur during surgery. These changes in the geometry of the nasal cavities affect the air flow into the nasal cavities and the sense of the smell of the operated patients. Methods: Based on CT scans of one patient, a procedure was created for creation of models of nasal cavities before and after surgery of pituitary tumor. The open-source software 3D Slicer was used for processing CT scans. Furthermore, the model before and after surgery was modified in CAD program Autodesk Inventor and program Ansys Space Claim. Meshing and subsequent solution of the finite volume method was solved in program Ansys Fluent 2021 R1. Findings & Value added: The models were created considering the anatomical structure of the cavities and were aligned into corresponding coordinate systems. Despite of the efforts to align the planes, inaccuracies occur between the planes. However, the results are comparable