Visceral artery aneurysm

Background: A 36-year-old female patient with no relevant clinical history was referred to the gastroenterology department for chronic epigastric pain. Blood analysis and gastroscopy were normal. Subsequently, abdominal ultrasonography and CT scan of the abdomen were made

The Contributions of Biomass Supply for Bioenergy in the Post-COVID-19 Recovery

This research investigates how biomass supply chains (BSChs) for bioenergy within the broader bioeconomy could contribute to the post-COVID-19 recovery in three dimensions: boosting economic growth, creating jobs, and building more resilient and cleaner energy systems in four future scenarios, in the short term (by 2023) and long term (by 2030). A SWOT analysis on BSChs was used for generating a questionnaire for foresight by a two-round Delphi study. To interpret the results properly, a short survey and literature review is executed to record BSChs behavior during the pandemic. In total, 23 (55% response rate) and 28 (46% response rate) biomass experts from three continents participated in the Delphi and the short survey, respectively. The strongest impact from investment in BSChs would be on economic growth, followed by a contribution to the resilient and cleaner energy systems and job creation. The effects would be more visible in the long- than in the short-term period. Investments with the most impact on recovery are those that improve biomass material efficiency and circularity. Refurbishment of current policies to enhance the supply of biomass as a renewable resource to the future economy is a must

Sonographic evaluation of transjugular intrahepatic porto-systemic shunt

The purpose of this article is to review the role of sonography before, during and after transjugular intrahepatic portosystemic shunt placement. A sonographic assessment of the liver and abdomen is recommended before the procedure. We illustrate several important sonographic findings for the echographist, which may alter the procedure approach or even preclude transjugular intrahepatic portosystemic shunt placement. The most challenging step during the procedure is the puncture of the right portal vein. Sonography can be a helpful tool in reducing the number of needle passes, thereby reducing the risk of hemorrhagic complications. Because of its non-invasive and costbenefit nature, sonography is useful for transjugular intrahepatic portosystemic shunt follow-up. A baseline study at 24 to 48 hours is recommended to discover procedure-related complications. Long-term follow-up is important to detect malfunction of the shunt. Doppler ultrasound is very accurate in detecting shunt thrombosis. However, no consensus exists on the optimal sonographic screening protocol for detecting stenosis. We describe three sonographic parameters to detect transjugular intrahepatic portosystemic shunt stenosis with high sensitivity. Finally, additional sonographic parameters and potential pitfalls are provided in order to improve sensitivity

Agenesis of the infrarenal inferior vena cava

A 71-year-old man presented to the emergency room with complaints of progressive dyspnoe and pain in both lower extremities. His medical history consisted of multiple idiopathic deep vein thrombosis, familial deafness and cholecystolithiasis. Clinical examination revealed large varicose veins in both lower extremities. A following electrocardiogram, echocardiography and radio graphy of the thorax were normal (not shown). D-dimeren had risen for which an angio CT of the thorax was performed. This showed no pulmonary embolism (not shown). A venous duplex of the lower extremities revealed insufficiency of both the superficial and deep venous system (not shown). An abdominal CT with intravenous contrast injection showed absence of the infrarenal inferior vena cava (Fig. A), absence of the common iliac veins, enlarged ascending lumbar veins (Fig. B) and prominent anterior paravertebral collateral veins (Fig. C) which lead to a prominent azygos vein (Fig. C). A complex venous collateral circulation was found infrarenally (Fig. A) as well as in the abdominal wall (Fig. D). The suprarenal IVC was normal (Fig. E), formed by confluence of the renal veins. Multiple calcifications in the enlarged internal and external iliac veins confirm a history of deep vein thrombosis (Fig. F)

Eosinophilic cystitis mimicking bladder tumor

A 48-year-old man presented to the Urology Department with acute dysuria and macroscopic hematuria for 2 days. There was no frequency or nocturnal enuresis. Analysis of midstream urine showed hematuria and pyuria

Trifluoromethylated Proline Surrogates as Part of "Pro-Pro" Turn-Inducing Templates

Proline is often found as a turn inducer in peptide or protein domains. Exploitation of its restricted conformational freedom led to the development of the d-Pro-l-Pro (corresponding to (R)-Pro-(S)-Pro) segment as a "templating" unit, frequently used in the design of beta-hairpin peptidomimetics, in which conformational stability is, however, inherently linked to the cis-trans isomerization of the prolyl amide bonds. In this context, the stereoelectronic properties of the CF3 group can aid in conformational control. Herein, the impact of alpha-trifluoromethylated proline analogues is examined for the design of enhanced beta-turn inducers. A theoretical conformational study permitted the dipeptide (R)-Pro-(R)-TfmOxa (TfmOxa: 2-trifluoromethyloxazolidine-2-carboxylic acid) to be selected as a template with an increased trans-cis rotational energy barrier. NMR spectroscopic analysis of the Ac-(R)-Pro-(R)-TfmOxa-(S)-Val-OtBu beta-turn model, obtained through an original synthetic pathway, validated the prevalence of a major trans-trans conformer and indicated the presence of an internal hydrogen bond. Altogether, it was shown that the (R)-Pro-(R)-TfmOxa template fulfilled all crucial beta-turn-inducer criteria

Ultrasound shear wave elastography and its association with rotator cuff tear characteristics

Background: Approximately 20-60% of rotator cuff repairs fail with higher failure rates in patients with larger or more chronic tears. Although MRI provides an objective estimate of tear size, it can only provide qualitative descriptions of tear chronicity. By contrast, ultrasound shear wave elastography (SWE) may assess tear chronicity by estimating tissue mechanical properties (ie, shear modulus). Furthermore, SWE imaging does not share many of the challenges associated with MRI (eg, high cost, risk of claustrophobia). Therefore, the objective of this study was to determine the extent to which estimated supraspinatus shear modulus is associated with conventional MRI-based measures of rotator cuff tear size and chronicity. Methods: Shear modulus was estimated using ultrasound SWE in two regions of the supraspinatus (intramuscular tendon, muscle belly) under two contractile conditions (passive, active) in 22 participants with full-thickness rotator cuff tears. The extent to which estimated supraspinatus shear modulus is associated with conventional MRI measures of tear size and chronicity was assessed using correlation coefficients and Kruskal-Wallis tests, as appropriate. Results: Estimated shear modulus was not significantly associated with anterior/posterior tear size (P \u3e .09), tear retraction (P \u3e .20), occupation ratio (P \u3e .11), or fatty infiltration (P \u3e .30) under any testing condition. Discussion: Although ultrasound SWE measurements have been shown to be altered in the presence of various tendinopathies, the findings of this study suggest the utility of ultrasound SWE in this population (ie, patients with a small to medium supraspinatus rotator cuff tear) before surgical rotator cuff repair remains unclear

Elbow Torque May be Predictive of Anatomic Adaptations to the Elbow After a Season of Collegiate Pitching: A Dynamic Ultrasound Study

Purpose: To determine whether elbow torque was associated with anatomic adaptations of the medial elbow following a season of competitive pitching. Methods: Pitchers from 3 collegiate baseball teams were recruited during the preseason for participation. Before the season, pitchers were recorded throwing 5 game-speed fastball pitches from a standard distance off a mound while wearing a wearable sensor baseball compression sleeve that calculates elbow torque, arm speed, arm slot, and arm rotation. Participants subsequently underwent dynamic ultrasound imaging of the medial elbow, including measurements of the ulnar collateral ligament (UCL) and ulnohumeral joint space to assess elbow laxity. Following a full season of competitive pitching, all testing was repeated, and statistical analysis comparing preseason to postseason sonographic findings was performed. Results: Twenty-eight collegiate pitchers underwent preseason sonographic and kinematic testing. Nineteen pitchers were available for postseason testing. The average age (standard deviation) and playing experience was 19.9 (1.2) and 14.7 (1.5) years. Compared with preseason, there were significant increases in postseason UCL thickness (1.92 ± 0.09 vs 1.56 ± 0.09 mm, P \u3c .01) and elbow laxity (1.77 ± 0.23 vs 1.15 ± 0.22 mm, P = .028) after a season of pitching. No significant changes in pitching kinematic measurements were observed between preseason and postseason testing. Preseason pitching kinematic measurements were significantly associated with increased UCL thickness (arm slot: beta estimate -0.03 ± 0.01, P = .011) and reduction in elbow laxity (elbow torque: beta estimate -0.03 ± 0.01, P = .04) after a season of pitching. Pitchers with increased body weight and arm length demonstrated reduced medial elbow torque during pitching (P \u3c .05). Conclusions: After a season of competitive pitching, adaptive changes of the medial elbow were demonstrated on dynamic ultrasound. However, the influence of pitching kinematic measurements on these adaptations are of small magnitude and unknown clinical significance. Although wearable sensor technology may have value in trending individual pitcher kinematics, no discrete threshold appears to predict the development of adaptive changes at the elbow. Level of Evidence: Level II, prospective observational study

Partial-Thickness Rotator Cuff Tears

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs