Splenosis. A diagnosis to be considered

The term splenosis applies to the autotransplanted splenic tissue resulting from seeding in the context of past splenic trauma or surgery. We report a 42-year-old man with a history of splenectomy observed for an incidentally found retrovesical mass thought to be an ectopic testicle. The abdominal laparotomy revealed multiple focuses of pelvic splenosis. As splenosis can be diagnosed through specific imaging studies one should always consider it in differential diagnosis of a mass discovered years after splenic surgery or trauma

Confidence in risky value-based choice

Risk engenders a phenomenologically distinct experience from certainty, often driving people to behave in ostensibly irrational ways, and with potential consequences for our subjective sense of confidence in having made the best choice. While previous work on decision confidence has largely focused on ambiguous perceptual decisions or value-based choices under certainty, it is unclear how subjective confidence reports are formed during risky value-based choice (i.e. those with uncertain outcomes). Accordingly, we sought to examine the effect of risky (versus certain) choice upon confidence ratings in a calibrated economic choice task and explore the well-documented interrelationships between confidence and subjective value (SV) as well as choice response time (RT) in the context of value-based choice. By jointly analyzing choices (risky versus certain), SV of the chosen option, confidence, and RT, we found a systematic effect of risk on subjective confidence: subjective confidence reports were significantly higher when selecting a certain prospect compared with a risky one. Interestingly, risk attenuated the strength of the relationships between confidence and both RTs and difference in subjective value (ΔSV), as well as the relationship between RT and ΔSV. Taken together, these results corroborate how choice, RT, confidence and SV relate in value-based choice under risk, informing both theories of confidence and risk preferences

Anti-MuSK-positive myasthenia gravis diagnosed during pregnancy: New challenges for an old disease

Myasthenia gravis is an autoimmune disorder affecting predominantly women in their reproductive age. The course of the disease during pregnancy is unpredictable, although it is more difficult to manage earlier in the gestation. Myasthenia gravis with antibodies against the muscle-specific receptor tyrosine kinase (anti-MuSK) has been described as a subtype of disease with more localised clinical features and a poorer response to treatment than acetylcholine receptor antibody (anti-AChR)-positive patients. Few cases have been reported in pregnant women, with deliveries being performed mainly by caesarean section. We report a successful case of vaginal delivery and describe our experience providing the first review of the management of this subtype of disease during pregnancy

Optical Coherence Tomography-Guided Full Plastic Jacket in Spontaneous Coronary Artery Dissection

info:eu-repo/semantics/publishedVersio

A study protocol for a randomized controlled trial of an anti-inflammatory nutritional intervention in patients with fibromyalgia

BackgroundThis study aims to analyze the effects of a potentially anti-inflammatory nutritional intervention in disease assessment parameters, inflammatory markers, and quality of life of fibromyalgia (FM) patients.MethodsA sample of 100 female patients diagnosed with FM, followed up at Portuguese Institute of Rheumatology (IPR) in Lisbon, is being randomly allocated in two groups. Patients in the intervention group are adopting an anti-inflammatory diet, characterized by the exemption of the intake of foods containing gluten, dairy, sugar, and ultra-processed foods, during 3months. During the first month, a low fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) diet is implemented, along with the anti-inflammatory diet, followed by the reintroduction of all fruits and vegetables over a consecutive period of 2months. Patients in the control group are adopting a diet based on general recommendations for healthy eating. The outcomes are pain, fatigue, quality of sleep, quality of life, gastrointestinal symptoms, and inflammation. Before and after the 3months intervention, and also 1month after beginning the intervention, the following questionnaires are applied: Revised Fibromyalgia Impact Questionnaire, visual analog pain scale, Brief Pain Inventory,visual analog scale from a list of common gastrointestinal and extraintestinal symptoms in FM, Short Form 36, Fatigue Severity Survey, and Pittsburg Sleep Quality Index. Ultra-sensitive serum C-reactive protein, eritrocyte sedimentation rate, and interleukin-8 are determined. Age, physical activity, anthropometric parameters, and body composition are being collected. Student's t test will assess the association between the disease evaluation parameters, the inflammatory markers, and the dietary interventions.DiscussionThe results of this study are expected to determine whether a change in patient nutrition helps to alleviate symptoms, which would optimize medical intervention.Trial registrationwww.ClinicalTrials.gov NCT04007705. Registered on July 5, 2019

An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial

Background: Fibromyalgia (FM) has been associated with dysbiosis and low-grade inflammation. Studies have reported that diet influences clinical features in FM. Objective: To evaluate the effect of an anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols (FODMAP) diet on clinical outcomes of patients with FM. Methods: This two arms Randomized Controlled Trial (NCT04007705) included 46 female patients with FM. The intervention group (n = 22) adopted an anti-inflammatory diet for 3 months, excluding gluten, dairy, added sugar, and ultra-processed foods, along with a low FODMAPs diet in the first month. The control group (n = 24) followed general healthy eating recommendations. Both diets were applied by a certified dietitian. Before and after the intervention, participants were assessed regarding pain, fatigue, gastrointestinal symptoms, quality of sleep, and quality of life, through the Revised Fibromyalgia Impact Questionnaire (FIQR), Visual Analogue Pain Scale (VAS), Visual Analog Scale from gastrointestinal symptoms (VAS GI), Brief Pain Inventory (BPI), Pittsburg Sleep Quality Index (PSQI), Fatigue Severity Survey (FSS), and The Short Form Health Survey (SF-36). A blood sample was collected and high-sensitive C-Reactive Protein and Erythrocyte Sedimentation Rate were quantified. Paired Samples t-test/Wilcoxon and independent samples t-test/Mann-Whitney were used to compare variables between groups. Results: After intervention, there was an improvement in intervention group scores of FIQR (p = 0.001), VAS (p = 0.002), BPI (p = 0.011), FSS (p = 0.042), VAS_GI (p = 0.002), PSQI (p = 0.048), and SF36 (p = 0.045) compared to control group. Inflammatory biomarkers (hs-CRP, ESR) did not change in both groups. The intervention was beneficial in the intervention group, regardless of age, disease duration, body mass index variation, and body fat change between baseline and post-intervention. Conclusion: An anti-inflammatory and low-FODMAP diet improved clinical features in patients with FM and may be useful as a complement to pharmacological therapy

Assessment of RC hollow-piers for seismic limit state of damage - Direct repair costs

Due to the vulnerability of reinforced concrete hollow piers subjected to seismic actions, it becomes urgent to assess the expected shear damage and its evolution with the increase of the intensity level. Additionally, the focus of the scientific research dedicated to seismic behaviour of these elements is still reduced, in particular with regard to the limit states of damage and to the economic consequences of repairing and retrofitting the physical damages existing in RC hollow piers subjected to the seismic action. This information is deemed crucial when cost-benefit analysis is concerned for the definition of measures for repair and retrofit of seismic damage. This paper focus on the issue of damage to hollow piers due to the seismic action, proposing a methodology to characterize the limit states of damage under the perspective of the physical behaviour. It also intends to discuss adequate strengthening strategies and their direct costs, associated with each seismic physical limit state of damage. An extensive review of numerous cyclic experimental works on RC hollow piers will be performed, and in liaise with specialized construction companies, the direct repair costs will be estimated.6612-034D-AE05 | PEDRO DA SILVA DELGADON/