The diagnosis of acute myocarditis (AM) remains challenging because of its diverse clinical manifestations. Thus, a wide range of diagnostic tests may be warranted. Although cardiac magnetic resonance (CMR) is the preferred imaging technique, it may not be applicable in the acute AM phase. Our case report highlights the usefulness and diagnostic accuracy of echocardiographic examination. In the first 2-dimensional echocardiography, the focal echobright was presented. A reduced value of global longitudinal strain, and regional disturbances of segmental myocardial strain, both longitudinal and circumferential, in the epicardial layer, were detected with a good correlation with CMR results.
Managing endangered species in fragmented landscapes requires estimating dispersal rates between populations over contemporary timescales. Here we develop a new method for quantifying recent dispersal using genetic pedigree data for close and distant kin. Specifically, we describe an approach that infers missing shared ancestors between pairs of kin in habitat patches across a fragmented landscape. We then apply a stepping-stone model to assign unsampled individuals in the pedigree to probable locations based on minimizing the number of movements required to produce the observed locations in sampled kin pairs. Finally, we use all pairs of reconstructed parent-offspring sets to estimate dispersal rates between habitat patches under a Bayesian model. Our approach measures connectivity over the timescale represented by the small number of generations contained within the pedigree and so is appropriate for estimating the impacts of recent habitat changes due to human activity. We used our method to estimate recent movement between newly discovered populations of threatened Eastern Massasauga Rattlesnakes (Sistrurus catenatus) using data from 2996 RAD-based genetic loci. Our pedigree analyses found no evidence for contemporary connectivity between five genetic groups, but, as validation of our approach, showed high dispersal rates between sample sites within a single genetic cluster. We conclude that these five genetic clusters of Eastern Massasauga Rattlesnakes have small numbers of resident snakes and are demographically isolated conservation units. More broadly, our methodology can be widely applied to determine contemporary connectivity rates, independent of bias from shared genetic similarity due to ancestry that impacts other approaches.
Background and objective: The number of children with complex physical and developmental pathologies, including chronic respiratory insufficiency, surviving and growing beyond early childhood continues to rise. No study has examined the clinical pathway of children on invasive LTMV in an Irish setting. Our data over a 10-year period was reviewed to see if our demographics and outcomes are in line with global trends. Methods: Children’s Health Ireland (CHI) at Crumlin, Dublin is Ireland’s largest tertiary paediatric hospital. A retrospective review analysed data from children in our centre commenced on LTMV via a tracheostomy over 10 years (2009 – 2018). This data was subdivided into two epochs for statistical analysis of longitudinal trends. Results: Forty-six children were commenced on LTMV from 2009 to 2018. Many had complex medical diagnoses with associated co-morbidities. Far less children, 30.4% (n=14) commenced on LTMV in the latter half of the 10-year period, they also fared better in all aspects of their treatment course. Focusing solely on children who have needed LTMV over this timeframe has enabled us to isolate trends specific to this cohort. Less patients commenced LTMV on a year on year basis, and for those that require tracheostomy and LTMV, their journey to decannulation tends to be shorter. Conclusion: Over the period reviewed, less patients over time necessitated long-term invasive therapy and those patients are being weaned and decannulated with ever more success. This has implications in terms of predicting numbers transitioning to adult services and allocation of hospital and community care resources.
1. Stable isotopes represent a unique approach to provide insights into the ecology of organisms. δ13C and δ15N have specifically be used to obtain information on the trophic ecology and food web interactions. The trophic discrimination factor (TDF, Δ13C and Δ15N) describes the isotopic fractionation occurring from diet to consumer tissue and this value is critical to obtain precise estimates within any application of δ13C and δ15N. It is widely acknowledged that metabolism influences the TDF, being responsible for different TDFs between tissues of variable metabolic activity (e.g. liver vs. muscle tissue) or species body size (small vs. large). However, the connection between the variation of metabolism occurring within a single species during its ontogeny and TDFs has rarely been considered. 2. Here, we conducted a 9-month feeding experiment to report Δ13C and Δ15N of muscle and liver tissue for several weight classes of Eurasian perch (Perca fluviatilis), a widespread teleost often studied using stable isotopes, but without established TDFs for feeding on a natural diet. In addition, we assessed the relationship between the standard metabolic rate (SMR) and TDFs by measuring their oxygen consumption of the individuals. 3. Our results showed a significant negative relationship of SMR with Δ13C, but not with Δ15N of muscle or TDFs of liver tissue. SMR was significantly higher in perch juveniles, which translated to significantly lower Δ13C of muscle tissue. 4. In summary, our results emphasize the role of metabolism in shaping specific TDFs (i.e. Δ13C of muscle tissue), and especially highlight the substantial differences between individuals of different ontogenetic stages within a species. Our findings thus have direct implications for the use of stable isotope data and the applications of stable isotopes in food web studies.
Objectives: The goal of this study was to describe and evaluate our simulation training program on biological models for the cardiovascular surgery residency program at our institution. Material and Methods: Since 2016, with the purpose to develop better practical performance and evaluate the improvement of resident’s surgical skills, it was implemented a simulation training program, composed of some elemental procedures in cardiovascular surgery. It was established one wet lab session weekly lasting 2 hours, coached by 2 expert cardiovascular surgeons. Bovine and porcine hearts were used as biological models. At the end of the hands on program, an objective assessment consisting of 2 practical modules was applied and performance was rated by way of a 5-point scale. In addition, to provide a subjective assessment, each resident filled out a questionnaire consisting of 3 items reviewing the overall quality of the workshops on a 10-point scale. Results: The objective evaluation applied at the end of the training program consisted by valve replacement and coronary artery bypass grafting (CABG) modules. The mean performance rating scores for valve replacement module ranged from 4.2 to 4.79, and to CABG, from 4.33 to 4.87. Regarding subjective assessment, all items evaluated, such as expert’s didactics, simulation performance and biological simulator fidelity, received high grades (above 9 on a 10-point scale). Conclusions: Simulator training on biological models for cardiac surgery medical residents is a simple and effective learning method of surgical skills.
Background The current trend in management of first-time primary spontaneous pneumothorax (PSP) in children is to obtain a high resolution chest computerized tomography (HRCT) scan to look for bleb/bullae disease or other structural lung disease. We aimed to evaluate the significance of HRCT findings in relation to initial management strategies, and we hypothesized that these findings do not guide management. Methods We evaluated patients with first time PSP in a single-institution, retrospective, longitudinal study. The primary endpoint was the percentage of patients who underwent surgical intervention after HRCT. Results We identified ten children from 10-17 years old from January 2013 to November 2019 who met criteria for the study. Seven out of ten patients (70%) had HRCT after first-time PSP during the same hospital stay. Blebs/bullae were discovered in five out of seven (71%) of those patients. Two of those five patients had subsequent surgical intervention (40%). 28% of those who had a HRCT had surgery at that point. Of those treated conservatively with blebs/bullae identified on HRCT, 66% had recurrence of PSP and all patients subsequently underwent VATS with blebectomy and pleurodesis. Among the patients without initial HRCT, there were no recurrent cases of PSP noted. Conclusions There is value in obtaining HRCT after the first time PSP, as these results can be used to guide management strategies. Further studies in pediatric PSP are needed to validate the sensitivity of HRCT in bleb detection, the predictive value of bleb disease and recurrence, and the benefits and risks of early surgical intervention
Objectives: Multimorbidity and polypharmacy in older adults always increase the prevalence of potentially inappropriate medications (PIMs) and affect the quality of life of the older adults. The purposes of this study were aimed to investigate the prevalence of PIMs prescription and the most frequent PIMs among outpatients according to Beers criteria and to explore related risk factors for PIMs prescription. Methods: The cross-sectional retrospective study was conducted among elderly outpatients in Chengdu (a city in China) from January 2018 to December 2018. The 2015 Beers criteria was used to assess PIMs in elderly outpatients. Univariate analysis and multivariate logistic regression analysis were adopted to determine the factors that may affect the prevalence of PIMs in elderly outpatients. Results: A total of 15523 patient prescriptions were enrolled, of which 4654 (29.98%) were identified with at least one PIM based on Beers criteria, and 6460 PIMs were detected. Of these PIM prescriptions, 76.32% were detected to receive 1 PIM, 16.54% were detected to receive 2 PIMs, and only 7.13% were found to have at least 3 PIMs. Benzodiazepines (2371, 50.95%), diuretics (1197, 25.72%), and selective serotonin reuptake inhibitors (439, 9.43%) were three common types of drugs that were the most frequent PIMs used. Sex, age, number of diseases, number of medications, and diseases or disease states were risk factors for PIMs in outpatients. Conclusion: The results of the study showed that the phenomenon of PIM was common among elderly outpatients in Chengdu. Risk factors for PIM in elderly outpatients include gender, age, number of diseases, number of medications, and sleep disorder.
In ecological communities, interactions between consumers and resources lead to the emergence of ecological networks and a fundamental problem to solve is to understand which factors shape network structure. Empirical and theoretical studies on ecological networks suggest predator body size is a key factor structuring patterns of interaction. Because larger predators consume a wider resource range, including the prey consumed by smaller predators, we hypothesized that variation in body size favors the rise of nestedness. In contrast, if resource consumption requires specific adaptations, predators are expected to consume distinct sets of resources, thus favouring modularity. We investigate these predictions by characterising the trophic network of a species-rich Amazonian snake community (62 species). Our results revealed an intricate network pattern resulting from larger species feeding on higher diversity of prey, promoting nestedness, and specific lifestyles feeding on distinct resources, promoting modularity. Species removal simulations indicated that the nested structure is favored mainly by the presence of five species of the family Boidae, which because of their body size and generalist lifestyles connect modules in the network. Our study highlights the particular ways traits affect the structure of interactions among consumers and resources at the community level.
Objective: Cardiovascular involvement due to iron overload is the leading cause of morbidity and mortality in patients with beta-thalassaemia major (β-TM). However many patients remain asymptomatic until the late stage. In this study, we investigated the role of real-time three-dimensional echocardiography (RT3DE) findings and endothelial dysfunction parameters in asymptomatic β-TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2 * value. Methods: 51 asymptomatic β-TM patients who were receiving regular blood transfusions were evaluated by two-dimensional echocardiography (2DE) and RT3DE examinations including endothelial dysfunction parameters. The study population was divided into two subgroups based on their cardiac MRI T2* values (MRI T2* ≤20ms and >20ms). The relationships between serum ferritin levels, 2DE and RT3DE measurements, endothelial dysfunction parameters, and cardiac MRI T2* values were investigated. Results: Although all left ventricle ejection fraction (LVEF) values obtained by 2DE were within normal limits (≥50%), they were not associated with MRI T2* values. LVEFRT3D (53.25 +2.33 vs 58.81 +1.02), SDI12 (6.53 +0.56 vs 2.85 +0.48), SDI16 (7.65 +0.75 vs 3.26 +0.49) were significantly different and negatively correlated between two groups respectively . Flow-mediated dilatation (FMD) (6.08% + 0.34 vs 14.46% + 1.12), aortic strain (7.79% + 2.19 vs 12.76% + 4.19), and serum ferritin values were significantly different and negatively correlated between two groups respectively. Conclusion: Decreased LVEF and increased SDI by RT3DE could be parameters of early cardiac deterioration. Decreased FMD and aortic strain may be good predictors of subclinical cardiovascular involvement in asymptomatic patients with β-TM.
Being of embryonal tissue origin, the teratomas are rare in adults, typically occurring either in the gonads or in the sacrococcygeal region in infancy and childhood. We present a case of a teratoma in the lesser sac of an adult female managed by en-bloc resection with the infiltrating stomach segment.
Abstract Background The paced morphology of right bundle branch block (RBBB) pattern is one of the parameters which can be used to confirm the left bundle branch capture during left bundle branch pacing (LBBP) implantation. However, changes of paced morphology after LBBP performed in patients with RBBB have not been well discussed. Objective To compare the paced morphology in patients with RBBB before and after LBBP and to discuss the possible mechanisms behind such changes. Methods Patients with RBBB who underwent LBBP implantation were selected. The QRS duration was measured before and after the implantation of LBBP for each patient and compared Student t test. Results We included 34 consecutive patients (median age 72.76 years, 73.53% male), of whom 3 had sick sinus syndrome (SSS) and 31 had high-grade atrioventricular conduction block (AVB). The average QRS duration was 144.87±5.22ms before LBBP implantation and 116.18±6.15ms after LBBP implantation, with a mean decrease in QRS duration of 28.70±3.30ms (95% CI: 27.55-29.85 ms, P < 0.01). Conclusion In patients with RBBB, the QRS duration after LBBP is narrower than that before LBBP. The specific mechanism is still unclear.
A clear understanding by the patient and family of airway pathology caused by vascular rings can be difficult to achieve. The pathology is three-dimensional in nature, and is a compilation of differing anatomic structures. Patient confusion can lead to misunderstandings regarding the nature of the operation, attendant risks, and the expected post-operative course. In this review we describe our use of 3D printing in the setting of circumflex aorta and double aortic arch to help guide a child and their family through the decision for treatment of what can be a difficult problem in both diagnosis and management. Our patient underwent two operations. First, a thoracoscopic division of a left ligamentum and atretic distal left aortic arch. While symptoms improved somewhat post-operatively, moderate dysphagia and dyspnea persisted. Based on further evaluation we concluded that the circumflex aorta was the etiology of the ongoing symptoms, so an aortic uncrossing procedure under circulatory arrest was recommended and performed. We used a 3D model in the education of the patient and family prior to the second surgery and greatly enhanced their understanding of why a repeat operation was required to address an additional component of this complex vascular ring. The use of 3D printing in preoperative discussions facilitated better understanding of complex three dimensional anatomy for the patient and patient's family. In addition, this communication strategy helped frame expectations regarding the post-operative course and convalescence.
Objective: To determine whether viral coinfection is a risk for severe lower respiratory tract infection (LRTI). Working Hypothesis: Children with viral coinfection had a higher risk for admission to the intensive care unit (ICU) than those with a single virus infection. Study Design: Retrospective, observational study for ten years. Patient-Subject Selection: Children between 1-60 months of age hospitalized with LRTI. Methodology: We defined severe LRTI as admission to the ICU for high-flow nasal cannula oxygen/bilevel positive airway pressure/invasive ventilation and assessed demographic and laboratory data with potential risk factors from the patients’ medical records. Results: Of 2115 children hospitalized with LRTI, 562 had severe, and 1553 had mild disease. Viral coinfection was present in 28.3% of all patients, and those with viral coinfection were at a higher risk of severe LRTI than those with a single virus infection (43.8% vs. 22.7%; aOR, 3.44; 95% CI, 2.74-4.53). Respiratory syncytial virus (RSV) and rhinovirus (except for between 25-60 months) coinfections were associated with severe LRTI in all ages, whereas parainfluenza virus-3 (PIV3; 7-24 months) and bocavirus (7-12 months) coinfections led to severe LRTI in early childhood. Moreover, influenza-A coinfection caused severe LRTI in children between 7-12 and 25-60 months. Other risk factors included young age, prematurity, history of atopy, exposure to tobacco smoke, underlying condition, neutrophilia, lymphopenia, and high CRP value. Conclusion: Children with viral coinfection, particularly with rhinovirus, RSV, influenza-A, PIV3, and bocavirus, may be followed closely regarding the clinical changes.
Introduction: COVID-19 emerged in China leading to worldwide morbidity and mortality, including depression and anxiety. As the pandemic spread throughout Italy and Europe, mental health concerns emerged for people with cystic fibrosis (pwCF), who are at increased risk. This led to development of a Telehealth Psychological Support Intervention to help adolescents/young adults with CF and caregivers cope with the stress and emotional challenges of the lockdown which began in Italy in March 2020. Methods: This intervention utilized cognitive behavioral skills (e.g., relaxation training, cognitive reframing). Participants included 16 adolescents/adults and 14 parents, who completed 4 individual video sessions with a psychologist. Stress ratings, PHQ-8 and GAD-7 were completed electronically. Feasibility and Satisfaction were rated. Results: Ratings of stress significantly decreased from pre to post-testing for both pwCF (paired t=-4.06 (14), p<.01) and parents (paired t=-5.2, p< 001). Most participants reported clinically elevated depression and anxiety at the pre-test, with statistically significant reductions in depression for pwCF (pre: M=8.0 to post M=4.7; paired t (14)=2.8, p <.05) but not anxiety (pre: M=6.9 to post: M=5.6, t (14)=1.2, p=NS). Reductions in depression were found for parents (pre: M=6.4 to post: M 5.1, (14) t=-2.5, p<.05) but not anxiety (pre: M=8.1 to post: M=7.9, t (14)=-0.2, p=ns). Positive ratings of Feasibility and Satisfaction were documented. Conclusion: This brief telehealth intervention yielded significant reductions in stress and depression for participants. Anxiety was not reduced, possibly because COVID was ongoing. This intervention was effective for improving mental health and was highly feasible and satisfactory.
Purpose: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LV global longitudinal strain (GLS) to estimate the elevated LV filling pressure. Methods and Results: 73 prospectively selected patients undergoing left ventricular catheterization (mean age 63.19±9.64, 68.5% male) participated in this study. Using the algorithm, the LV filling pressure was estimated with the echo parameters obtained within 24hrs before the catheterization. The LV GLS was measured using the automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated. The invasive LV filling pressure was elevated in 43 (58.9%) and normal in 30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity, 84% sensitivity) with higher sensitivity compared with the algorithm (AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We confirmed that the LV GLS is feasible and reproducible in estimating LV filling pressure. In addition, LV GLS highly predicts elevated LAP as E/e’ and TR jet velocity and may be used as major criteria for the diagnosis of HFpEF
Atrial tachycardia (AT) in the right atrium often occurs following open-heart surgery. Catheter ablation for these AT is challenging and can lead to unintended conduction block. We performed late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) prior to catheter ablation and predicted wavefront propagation during SR as well as the slow conduction zone during tachycardia. LGE-MRI may assist predicting the conduction disturbance and reducing the risk of unexpected sinus exit block.
Aims of the Study: A radiographic examination is a significant part of the clinical routine for the diagnosis, management, and follow-up of the disease. Artificial intelligence in dentistry shows that the deep learning technique high enough quality and effective to diagnose and interpret the images in the dental practice. For this purpose, it is aimed to evaluate diagnostic charting on panoramic radiography using a deep-learning AI system in this study. Methods: 1084 anonymized dental panoramic radiographs were labeled for 10 different dental situations including crown, pontic, root-canal treated tooth, implant, implant-supported crown, impacted tooth, residual root, filling, caries, and dental calculus. AI Model (Craniocatch, Eskişehir, Turkey) based on a deep CNN method was proposed. A Faster R-CNN Inception v2 (COCO) model implemented with Tensorflow library was used for model development. The training and validation data sets were used to predict and generate optimal CNN algorithm weight factors. Results: The proposed artificial intelligence model has promising results for detecting dental conditions in panoramic radiographs except for caries and dental calculus. The most successful F1 Scores were obtained from the implant, crown, and implant-supported crown as 0,9433, 0,9122, 0,8947, respectively. Conclusion: Thanks to the improvement of the success rate of AI models in all areas of dentistry radiology, it is predicted that they will help physicians especially in panoramic diagnosis and treatment planning, as well as digital-based student education, especially in this pandemic period when online training is on our agenda.