Tract Area Research Articles

Core Laboratory Versus Center-Reported Echocardiographic Assessment of the Native and Bioprosthetic Aortic Valve.

Insights into quantitative differences between core laboratory and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations. Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and blindly reanalyzed by an independent echocardiographic core laboratory (ECL). For the bioprosthetic valve analysis, postoperative data throughout the 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen's kappa coefficients. The analysis on the native aortic valve was performed on 1118 echocardiograms. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11%-7% higher. High ICCs of around 0.90 were observed for the parameters peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. Over 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM. There is high agreement between the ECL and clinical centers on continuous-wave Doppler-related measurements. In contrast, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation. ClinicalTrials.gov identifier: NCT02088554.

Organ-specific sympathetic innervation defines visceral functions.

The autonomic nervous system orchestrates thefunctions of the brain and body through the sympathetic and parasympathetic pathways1. However, our understanding of the autonomic system, especially the sympathetic system, at the cellular and molecular levels is severely limited. Here we show topological representations of individual visceral organs in the major abdominal sympathetic ganglion complex. Using multi-modal transcriptomic analyses, we identified molecularly distinct sympathetic populations in the coeliac-superior mesenteric ganglia (CG-SMG). Of note, individual CG-SMG populations exhibit selective and mutually exclusive axonal projections to visceral organs, targeting either the gastrointestinal tract or secretory areas including the pancreas and bile tract. This combinatorial innervation pattern suggests functional segregation between different CG-SMG populations. Indeed, our neural perturbation experiments demonstrated that one class of neurons regulates gastrointestinal transit, and another class of neurons controls digestion and glucagon secretion independent of gut motility. These results reveal the molecularly diverse sympathetic system and suggest modular regulation of visceral organ functions by sympathetic populations.

Carbimazole-induced eosinophilic gastroenteritis in a young female with abdominal pain and ascites: a case report

BackgroundEosinophilic gastroenteritis is a rare disease characterized by eosinophilic infiltration into one or more layers of the gastrointestinal tract. It commonly affects children more than adults. The clinical features depend on the site of gut involvement, but the most common symptoms include abdominal pain and diarrhea. The most common cause reported in the literature is hypersensitivity, as many patients have a history of seasonal allergies, atopy, asthma, food allergies, and so on. However, drugs can be a rare triggering factor. In the literature review, we found multiple case reports of eosinophilic gastroenteritis; however, only one other case of carbimazole-induced eosinophilic gastritis has been reported.Case presentationWe report herein the case of a 36-year-old female from the Philippines who developed eosinophilic gastroenteritis localized to the esophagus and ileum 12 months following treatment with carbimazole for hyperthyroidism. In our facility, she was extensively investigated for malignancy, autoimmune pathologies and infectious etiologies. As the symptoms coincided with carbimazole exposure and other causes were ruled out, we labeled her as carbimazole-induced eosinophilic gastroenteritis. On subsequent follow-up after discharge, her symptoms and eosinophilia resolved when carbimazole was discontinued, suggesting a causative role. This is the first case of eosinophilic gastroenteritis secondary to carbimazole encountered in our region.ConclusionDiagnosis of eosinophilic gastroenteritis requires three criteria, namely (1) presence of gastrointestinal symptoms, (2) histologic evidence of eosinophilic infiltration in one or more areas of the gastrointestinal tract, and (3) exclusion of other causes of tissue eosinophilia. Our patient fulfilled all the criteria; additionally, she had a positive history of atopic tendencies and drug exposure. The diagnosis of hyperthyroidism was established a year ago and in another facility, so we were not sure of the underlying etiology of hyperthyroidism. Upon subsequent follow-up, her thyroid function remained stable. The case highlights the need for a collaborative multidisciplinary approach toward managing rare conditions.

Prevalence of diseases of digestive organs in children in the Udmurt Republic

Introduction. Conducting targeted epidemiological studies allows objectively characterizing the health status of the population. Purpose of the work is to characterize current trends in the epidemiology of digestive diseases in children in the Udmurt Republic based on a special study. Materials and methods. Survey of 2516 children of age 6–17 years: 6–14 years — 1,482, 15–17 years adolescents — 1,034. The study was continuous, all students of two secondary schools in Izhevsk. Stages: survey of schoolchildren (n = 2,516) and parents; clinical examination (n = 2,516); laboratory and instrumental examination in children suspected of having pathology of the digestive organs based on the results of stages I and II; IV — summing up and forming a group of children with proven pathology of the digestive organs (n = 1,141). Assessment of the reliability of differences in indicators based on Student’s t-test. Results. The prevalence of gastroenterological diseases among all children does not have a gender component (p = 0.1). In the younger age group, girls and boys get sick with the same incidence. In adolescents, the prevalence of gastroenterological pathology in girls is higher than in boys (p < 0.001). The prevalence among boys of different ages does not have a statistical difference, and among girls of different ages, older schoolgirls are more often affected (p < 0.001). In the structure of pathology of the digestive organs in 6-17 years children dominated due to diseases of the stomach and duodenum. The prevalence of diseases of the hepato-pancreatic-biliary system and intestines was the same. The prevalence of digestive diseases is 453.5 ± 9.9 per 1000 subjects. The proportion of functional diseases is 9.9–96.7%, depending on age and the affected area of ​​the gastrointestinal tract. Conclusion. The true prevalence of digestive diseases exceeds official statistics. The structure is dominated by diseases of the gastroduodenal zone. Epidemiological features include an increase in the prevalence of pathology in girls of puberty. In children aged 6–14 years, functional diseases predominate; in children aged 15–17 years, the proportion of organic diseases increases.

Abstract 4140136: Aortic Valve Calcification Density Performs Better Compared to Absolute Aortic Valve Calcification in Aortic Stenosis Risk Stratification

Aortic valve calcification (AVC) scores can be used to stratify aortic stenosis (AS) severity. Current practice guidelines recommend use of absolute AVC scores without considering body surface area or aortic annulus size. We investigated whether size variation in aortic annular area should be considered in identifying optimal AVC cutoffs for patients with severe AS. This was a retrospective analysis of AS patients that underwent AVC assessment during 2018-2023. Outcomes were composite of valve intervention or all-cause mortality. AVC density was defined by dividing AVC by echo-derived left ventricular tract area. Receiver operator curve analysis determined optimal AVC density scores. Absolute AVC cutoffs of >1200AU for females and >2000AU for males were used to identify severe AS. The study included 749 patients (mean age 78 years, 46% female). Median CT-annulus area was larger for males compared with females (532mm 2 [Q1, Q3: 479, 582] vs. 413mm 2 [370, 458], p<0.001). There was a strong association of absolute AVC with CT-annulus area for both males and females (Spearman coefficient: 0.87 and 0.83, p<0.01 each) respectively (Figure 1). The optimal AVC density cutoffs for males and females were 427 and 326, respectively (accuracy 76%, sensitivity 83%, specificity 51%). Composite outcomes were better differentiated with AVC density (males: HR 2.48, 95% CI: 1.82-3.37, p<0.001; females: HR 2.37 (1.71-3.28), p<0.001) compared with absolute AVC scores (males: HR 1.81 (1.43-2.30), p<0.001; females: HR 2.11 (1.62-2.74), p<0.001) (Figure 2). AVC is strongly associated with CT-annulus area and risk stratification is improved with the use of AVC density compared with absolute AVC. This may be especially helpful in patients with extremes of annulus area sizes.

Advances in estimations of number of undiscovered mineral deposits in three-part assessments

A central part of three-part mineral assessments is estimating number of undiscovered mineral deposits. Internal consistency and well-explored deposits in grade–tonnage models reduce chances of biased estimates in three-part quantitative assessments. Estimates are of specific types of deposit permitted by geology in delineated tracts. Regardless of estimation method, each deposit type needs a grade–tonnage model constructed with well-explored deposits and estimated numbers must be consistent with this model. Local well-explored deposits are typed and statistically tested to ensure the global grade and tonnage model is representative of them.Three-part assessments used expert judgements since 1975 that relied on analogy-based guidelines to aid in estimation of number. The advantage of expert judgements is that they can use all available information and adapt to information supplied by other experts during the assessment. A targeting method has seen limited application due to the requirement that location indicators of each possible target need to be present. Another estimation method developed around 2008 is a generalized deposit density model based on multiple deposit types which uses deposit type's median tonnage, permissive tract area, and number of known deposits in well-explored control areas. It is remarkably robust and can be applied to any deposit type in a proper permissive tract.Advanced deposit estimations use the generalized density method to guide expert estimates. Experts can then identify possibly flawed estimates and improve estimates based on local information such as local exploration results or observations by experts thereby further reducing chances of biased estimates.

Contribution of Imagery in Larynx Cancer: About 61 Cases

Extensional imaging of laryngeal tumors relies on multi-bar helical CT scans. This examination requires compliance with a few simple rules in its preparation and performance. The protocol for performing cervico-mediastinal CT scans will be developed. Imaging must take into account not only the initial tumor pathology, but also the entire upper aero-digestive tract and lymph node areas, i.e. acquisition must extend from the base of the skull to the cervico-mediastinal orifice. Thoracic imaging should be performed as a matter of course for overall patient management. Certain deep extensions, only accessible by imaging, are decisive in the choice of treatment: surgery or radio-chemotherapy. In the case of surgery, imaging is a key factor in the choice of total or partial surgery. A complete lymph node survey is also essential in the management of these lymphophilic tumors.

Core laboratory versus center-reported echocardiographic assessment of the native and bioprosthetic aortic valve

Abstract Background The use of a central echocardiographic core laboratory (ECL) is advised to minimize measurement variation and heterogeneity in clinical trials. Insights into quantitative differences between ECL and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations. Methods Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and reanalyzed by an independent ECL. For the bioprosthetic valve analysis, postoperative data throughout 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Between-center differences were illustrated by plotting standardized mean differences (SMDs) between centers and the ECL for the 10 sites that implanted the most prostheses. Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen’s kappa coefficients. Results The analysis on the native aortic valve was performed on 1118 patients. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11-7% higher (Table 1). High ICCs of around 0.90 were observed for peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. More than 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. In Figure 1, differences in assessment on center level are illustrated. The SMDs for peak velocity were between 0 and 0.5 for all centers, while there was more heterogeneity between centers for other parameters. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM. Conclusions For echocardiographic assessment of the native and bioprosthetic aortic valve, agreement between the ECL and the clinical centers varies by parameter and by center. There is high agreement on continuous-wave Doppler-related measurements. On the contrary, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation.

Ремонт деталей авіаційних двигунів із жароміцних нікелевих сплавів із застосуванням адитивних плазмових технологій

In order to improve the maintainability of aircraft engine parts, the article examined the use of additive technologies in repairs. The article establishes that the use of additive technologies by the method of plasma surfacing in the repair of aircraft engine parts, such as turbine blades, sealing discs, NA parts, is very promising and will significantly increase the percentage of parts and assemblies restored after operation, which have a significant area of damage. Turbine blades are made of nickel heat-resistant alloys with a polycrystalline structure (ЖС6К-ВИ, ЖС6У-ВИ), or from alloys with directional crystallization (ЖС32-ВИ, ЖС26-ВИ). After operating for more than 6 thousand hours, in addition to the operational wear of the ends and side walls of the shroud flanges, thermal fatigue cracks up to 6 mm deep are observed on the blades received for repair. The technology of argon-arc surfacing and the surfacing materials existing for this process do not provide the heat-resistant properties of the restored surface necessary for the operation of the blades. The solution to the problem was achieved through the use of a compressed arc source with precision adjustment of the welding current and mechanization of the supply of filler material (powder), which would make it possible to surfacing with a limited penetration depth and, accordingly, mixing the deposited material with the base metal. The developed technology made it possible to restore damaged sections of blades after operation (shroud flanges, labyrinth scallops, z-shaped profiles and airfoil ends) on heat-resistant alloys using filler material equal to the strength of the base metal. For this process, powders of nickel and cobalt alloys with a fraction of +63...-160 microns are used, obtained by atomization with a jet of inert gas (argon). The main powders used are ЖС32-ВИ, ЖС6К-ВИ, В3К, Stellite 12, Stellite 6, ХТН61. Disc material – ЭП742-ИД. Working medium, air, oil and combustion products. The maximum heating temperature of labyrinth scallops is up to 680 ºC at a maximum medium pressure of up to 1.47 MPa. The maximum peripheral speed of the scallop end is 251 m/s. Material of seal mating parts ЭИ435 (cell δ = 0,1 mm). When developing the technology, the successful experience of restoring labyrinthine scallops of turbine blades was taken into account. The restoration of the labyrinthine ridges of the disk was carried out using a compressed arc source with precision control of the welding current and a robotic installation, which included a robot for moving the plasma torch and a manipulator for rotating the disk. This made it possible to carry out surfacing with a limited penetration depth and obtain a uniformly directed bead over the entire diameter of the disk. Testing of the restored disk in order to verify its performance was carried out as part of a run-in aircraft engine. To do this, after the next assembly of the run-in engine, the disk was installed in the MPT rotor. The test was carried out in 5 cycles, the duration of each cycle was 15 hours. No wear of the labyrinth ridges or cracks was detected. The functionality of the restored disk has been confirmed. NA parts are made of heat-resistant, low-aging, high-chromium nickel-based alloy ЭП648-ВИ. They operate in hot engine conditions at temperatures up to 900'C. As a result of operation, both end surfaces and flat surfaces in the tract area are subject to wear. To restore parts of the NA, the technology of additive growth by the method of microplasma powder surfacing was used. To confirm the operability of restored parts, a set of studies of samples grown using the same repair technology was conducted. At the same time, it was established that the chemical composition of the deposited metal corresponds to the requirements of the technical conditions-» the microstructure of the deposited metal after heat treatment corresponds to the normal heat-treated state of the alloy ЭП648-ВИ (ХН50ВМТЮБ-ВИ), the level of mechanical properties of the grown alloy with subsequent serial heat treatment (aging at 700ºC, exposure -16 hours) is not lower than the forging level used in serial production of the part.

Non-receipt of targeted and immunotherapies in diverse patients with metastatic cancers.

93 Background: The rapid evolution of molecularly targeted kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in the treatment of metastatic cancer, coupled with high drug costs, raises potential for unwarranted variation in patient management. We evaluated correlates of non-receipt of TKIs and ICIs in a diverse, population-based sample of patients with metastatic non-small cell lung cancer (NSCLC), kidney and bladder (GU) cancer, and melanoma. Methods: We identified 2240 patients diagnosed in 2019 with metastatic NSCLC, GU cancer, or melanoma and reported to the Georgia or Los Angeles SEER registries. Using SEER registry data, we linked all patients to a managing oncology physician. We collected data from the managing physician regarding receipt of TKIs and ICIs. We used bivariate analyses and multivariable logistic regression models to assess associations between non-receipt of TKIs and ICIs and patient-level factors. Results: We present results for a preliminary sample (N=894). About half (55%) of the patients had NSCLC, 31% had GU cancer, and 14% had melanoma. The mean age was 62 (SD 12); 59% were male; 65% were White, 16% were Black, 11% were Hispanic, and 7% were Asian; 52% had Medicare, 29% had private insurance, 9% had Medicaid, and 4% had no insurance; 89% resided in urban areas, 11% resided in rural areas. 22% lived in a census tract area with >20% of the population living below the poverty level. The Table shows that in bivariate analyses, non-receipt of TKIs was associated with NSCLC, older age, male sex, non-white race, and non-private or no insurance (all p<0.05). After adjustment, non-receipt of TKIs was associated with NSCLC, older age, male sex, and race. Asian and Hispanic patients had lower rates of non-receipt, and Black patients had higher rates. In bivariate analyses, non-receipt of ICIs was associated with NSCLC and GU cancer (p=0.004); this association remained significant after adjustment. Conclusions: Non-receipt of TKIs was associated with important non-clinical factors including race and sex. Non-receipt of ICIs was associated only with cancer type. These findings suggest that policy-relevant factors such as out-of-pocket costs for oral cancer therapies and differential access to molecular sequencing may contribute to unwarranted variation in receipt of TKIs. Bivariate analyses of non-receipt. Did not Receive TKI Did not Receive ICI % P % P Cancer type NSCLC GU Melanoma 786572 0.002 313015 0.004 Age <50 50-64 65-74 75-84 85+ 5471757986 <0.001 2625302940 0.385 Sex Male Female 7670 0.048 2631 0.085 Race & Ethnicity White Black Hispanic Asian Other 7579655860 0.002 2329312927 0.981 Marital Status Married Unmarried 7373 0.645 2630 0.158 Insurance Medicare Medicaid Private Other government None 7075637080 <0.001 3130215031 0.101 Geography Urban Rural 7375 0.784 2826 0.567 % population below poverty level 0-5% 5-<10% 10-<20% 20-100% 69717774 0.314 29273222 0.138

TCT-85 Temporal Evaluation of the Neo-Left Ventricular Outflow Tract Area With Computed Tomography in Patients Undergoing Mitral Valve-in-Valve Procedures

TCT-85 Temporal Evaluation of the Neo-Left Ventricular Outflow Tract Area With Computed Tomography in Patients Undergoing Mitral Valve-in-Valve Procedures

Organ-specific Sympathetic Innervation Defines Visceral Functions.

The autonomic nervous system orchestrates the brain and body functions through the sympathetic and parasympathetic pathways. However, our understanding of the autonomic system, especially the sympathetic system, at the cellular and molecular levels is severely limited. Here, we show unique topological representations of individual visceral organs in the major abdominal sympathetic ganglion complex. Using multi-modal transcriptomic analyses, we identified distinct sympathetic populations that are both molecularly and spatially separable in the celiac-superior mesenteric ganglia (CG-SMG). Notably, individual CG-SMG populations exhibit selective and mutually exclusive axonal projections to visceral organs, targeting either the gastrointestinal (GI) tract or secretory areas including the pancreas and bile tract. This combinatorial innervation pattern suggests functional segregation between different CG-SMG populations. Indeed, our neural perturbation experiments demonstrated that one class of neurons selectively regulates GI food transit. Another class of neurons controls digestion and glucagon secretion independent of gut motility. These results reveal the molecularly diverse sympathetic system and suggest modular regulations of visceral organ functions through distinct sympathetic populations.

This is a successful removal of more than 450 pieces of metal objects from a patient’s stomach: a case report

BackgroundIngestion of foreign bodies may be seen unconsciously or intentionally in patients with mental health problems. Most cases pass through the esophagus slowly; however, in some cases, the tumor may be located in narrower areas of the digestive tract that require endoscopic or surgical intervention. This study describes a rare case of successful removal of more than 450 pieces of metal objects from the stomach of a 36-year-old man via ingestion of foreign bodies at Imam Khomeini Hospital in Ahvaz.Case presentationA 36-year-old male patient (Aryan race) presented with complaints of chronic abdominal pain, frequent vomiting, and intolerance to liquids and food. The patient’s companions mentioned a history of gradual ingestion of small metal objects 3 months prior. The patient was conscious and had stable vital signs. In the patient’s X-ray and endoscopy, multiple metal objects inside the patient’s stomach were observed, causing gastric outlet obstruction. The patient underwent gastrostomy surgery, and 452 screws, nuts, keys, stones, and other metal parts weighing 2900 g were removed from the stomach. Five days after the operation, the patient was transferred to the psychiatric service in good general condition and was diagnosed with psychosis, and her condition returned to normal at follow-up.ConclusionSuccessful removal of this foreign body is rare. In chronic abdominal pain, especially in the context of psychiatric disorders, attention should be given to the ingestion of foreign bodies. In swallowing large amounts of sharp and metallic foreign objects, surgical intervention is necessary, especially in cases of obstruction, and saves the patient’s life.

Studying the anti-inflammatory activity of <i>Bifidobacterium bifidum</i> supernatants and chicken embryo cells on a model of opisthochic invasion

Morphological changes in the liver during infection with Opisthorchis felineus are characterized by significant structural changes. It has been proven that O. felineus modifies immune reactivity by increasing the synthesis of IL-10 and TGF-β and decreasing the levels of IL-4 and IL-5. The experiment was carried out on 15 Mesocricetus auratus aged from 4 to 6 weeks. The animals were divided into 3 equal groups. The duration of observation was 24 days. Live metacercariae of O. felineus were isolated from infected cyprinid fish. Infection was carried out by oral administration of 50 metacercariae. Animals in the experimental groups were injected intraperitoneally with 1 ml of the test supernatants. Histological preparations were examined by video microscopy with morphometry. It has been established that in the acute phase of opisthorchiasis, general infiltration of the portal tract area predominates. The cellular composition of infiltrates is characterized by the presence of lymphocytes, macrophages, fibroblasts, epithelioid cells and foreign body cells. The described cell changes are associated with a local decrease in oxygen access to hepatocytes in the peripheral zone of the lobule due to their compression by fibrous tissue. In the liver of the experimental groups, only tissue-specific changes were noted, and the damage to hepatocytes was the least pronounced in the group with the introduction of B. bifidum supernatant. The cytokine profile in the control group corresponded to the Th1 variant. In experimental group 1, when using the supernatant of B. bifidum, in comparison with the control, the ability of lymphocytes to produce the main pro-inflammatory cytokine, TNFα, decreased 4 times; a suppressive effect was also observed in relation to IL-1β, IL-2, IL-6, IL-8, and IFNγ. Inhibition of IL-10 production was observed, while the level of IL-4 and IL-5 increased in comparison with the control. When using the supernatant of chicken embryo cells, we observed similar results to group 1: a suppressive effect on pro-inflammatory and activation of the production of anti-inflammatory cytokines. IL-17 levels decreased in both experimental groups. Activation of the production of anti-inflammatory cytokines in experimental groups modulates the immune response towards Th2, which helps block inflammatory effects.

ETIOPATHOGENETIC ASPECTS OF SYNTROPY AND MUTUAL BURDEN IN THE PATHOLOGY OF THE GASTROINTESTINAL TRACT AND THE DISEASES OF THE ORAL CAVITY

The purpose of the work is to study the main etiopathogenetic mechanisms of development and peculiarities of the clinical course in the comorbidity of diseases of the oral cavity and pathology of the gastrointestinal tract by analyzing the results of scientific research published in modern scientific publications.Material and methods. Search, systematization, elaboration and analysis of scientific works of domestic and foreign authors, which present the modern results of research on etiopathogenesis and peculiarities of the clinical course in comorbidity of diseases of the oral cavity and gastrointestinal tract, with the involvement of search engines Google Scholar, PubMed and other electronic resources. The bibliosematic and analytical methods are used in the research.Results. The problem of syntropies, the basis of which is the association of etiological and pathogenetic factors of certain diseases, is an actual problem in modern medicine. The analysis of data from modern scientific literary sources proves that the development and progression of periodontal and oral mucosa diseases depends not only on the influence of local factors but also is a reaction to the influence of pathogenic factors that arise as a result of diseases of the gastrointestinal tract.Steady persistence of microflora in certain areas of the digestive tract can complicate the course of dental and gastrointestinal diseases. A gradual change in the properties of representatives of the conditionally pathogenic group of microorganisms, their association with specific diseases of the oral cavity and gastrointestinal tract indicates their role in the pathogenesis of many diseases. Mechanisms of free radical damage to cellular structures and changes in humoral and cellular immunity are important common links in the pathogenesis of periodontal and gastrointestinal tract diseases. The development of an imbalance of the endocrine system and psycho-emotional stress has a significant impact on the process of mutual burden of diseases of the gastrointestinal tract and oral cavity.Conclusion. Тoday considerable factual material has been accumulated regarding the understanding of common mechanisms of etiopathogenesis and syntropy of diseases of the oral cavity and pathology of the gastrointestinal tract. This knowledge makes it possible to develop effective comprehensive measures for the diagnosis, prevention and treatment of both diseases of the oral cavity and diseases of the gastrointestinal tract, taking into account the mutual burden of these pathologies.

Capsule endoscopy for small bowel bleed: Current update.

Small intestine, hitherto an obscure area for endoscopists before 2000, is now easily evaluated non-invasively using capsule endoscopy and invasively by device-assisted enteroscopies. Major advances in understanding the causes and management of small bowel diseases have been in obscure gastrointestinal (GI) bleed, currently re-named as small bowel bleed, after the discovery of capsule endoscopy. The current article is a narrative review of the technology of capsule endoscopy, its advantages and limitations, future perspective and Indian studies on its utility in patients with small bowel bleed. Till date, eight large series reporting 2319 patients with obscure GI bleed (1554 overt and 765 occult) undergoing capsule endoscopy have been reported from India. Overall yield of capsule endoscopy to detect lesions in these studies varied from 43.5% to 90%. The major causes detected in various studies for small bowel bleed include vascular malformation, portal hypertensive enteropathy, ulcer, stricture, tumor, polyps, etc. Hookworm can cause both occult as well as overt small bowel bleed as shown mainly from India. Capsule endoscopy has also been quite safe in patients with small bowel bleed as despite 0.6% to15% retention of imaging capsule in Indian studies, development of clinically evident small bowel obstruction has rarely been reported. The major limitations of capsule endoscopy include lack of maneuvrability and therapeutic capability. Research is in progress to overcome some of the limitations of the current capsule endoscopy system. It is concluded that discovery of capsule endoscopy has brought a new paradigm in GI endoscopy and explored a hitherto unexplored area of GI tract, i.e. small bowel that continued to be a black box for the endoscopists.

Indexed aortic valve area using multimodality imaging for assessing the severity of bicuspid aortic stenosis

BackgroundThe impact of various imaging modalities on discordance/concordance between indexed aortic valve area (iAVA) and catheterization-derived mean transaortic pressure gradient (mPGcath) is unclear in patients with bicuspid aortic valve (BAV). This study aimed to compare iAVA measurements obtained using four different methodologies in BAV and tricuspid aortic valve (TAV) patients, using mPGcath as a reference standard. MethodsWe retrospectively reviewed patients who underwent comprehensive assessment of AS, including two-dimensional (2D) transthoracic echocardiography (TTE), three-dimensional (3D) transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and catheterization, at our institution between 2019 and 2022. iAVA was measured using the continuity eq. (CE) with left ventricular outflow tract area obtained by 2D TTE, 3D TEE, and MDCT, as well as planimetric 3D TEE. Results and ConclusionsAmong 564 patients (64 with BAV and 500 with TAV), 64 propensity-matched pairs of patients with BAV and TAV were analyzed. iAVACE(2DTTE) led to overestimation of AS severity (BAV, 23.4%; TAV, 28.1%) and iAVACE(MDCT) led to underestimation of AS severity (BAV, 29.3%; TAV, 16.7%), whereas iAVACE(3DTEE) and iAVAPlani(3DTEE) resulted in a reduction in the discordance of AS grading. A moderate correlation was observed between mPGcath and iAVACE(3DTEE) (BAV, r = −0.63; TAV, r = −0.68), with iAVACE(3DTEE) corresponding to the current guidelines' cutoff value (BAV, 0.58 cm2/m2; TAV, 0.60 cm2/m2). Discordance/concordance between iAVA and mPGcath in evaluating AS severity varies depending on the methodology and imaging modality used. The use of iAVACE(3DTEE) is valuable for reconciling the discordant AS grading in BAV patients as well as TAV.

Characterizing white matter connectome abnormalities in patients with temporal lobe epilepsy using threshold-free network-based statistics.

Emerging evidence illustrates that temporal lobe epilepsy (TLE) involves network disruptions represented by hyperexcitability and other seizure-related neural plasticity. However, these associations are not well-characterized. Our study characterizes the whole brain white matter connectome abnormalities in TLE patients compared to healthy controls (HCs) from the prospective Epilepsy Connectome Project study. Furthermore, we assessed whether aberrant white matter connections are differentially related to cognitive impairment and a history of focal-to-bilateral tonic-clonic (FBTC) seizures. Multi-shell connectome MRI data were preprocessed using the DESIGNER guidelines. The IIT Destrieux gray matter atlas was used to derive the 162×162 structural connectivity matrices (SCMs) using MRTrix3. ComBat data harmonization was applied to harmonize the SCMs from pre- and post-scanner upgrade acquisitions. Threshold-free network-based statistics were used for statistical analysis of the harmonized SCMs. Cognitive impairment status and FBTC seizure status were then correlated with these findings. We employed connectome measurements from 142 subjects, including 92 patients with TLE (36 males, mean age=40.1±11.7 years) and 50 HCs (25 males, mean age=32.6±10.2 years). Our analysis revealed overall significant decreases in cross-sectional area (CSA) of the white matter tract in TLE group compared to controls, indicating decreased white matter tract integrity and connectivity abnormalities in addition to apparent differences in graph theoretic measures of connectivity and network-based statistics. Focal and generalized cognitive impaired TLE patients showcased higher trend-level abnormalities in the white matter connectome via decreased CSA than those with no cognitive impairment. Patients with a positive FBTC seizure history also showed trend-level findings of association via decreased CSA. Widespread global aberrant white matter connectome changes were observed in TLE patients and characterized by seizure history and cognitive impairment, laying a foundation for future studies to expand on and validate the novel biomarkers and further elucidate TLE's impact on brain plasticity.

Addressing Urban Management Challenges for Sustainable Development: Analyzing the Impact of Neighborhood Deprivation on Crime Distribution in Chicago

Urban crime prevention remains a critical challenge intertwined with socioeconomic disparities. This study investigates the spatial nexus between urban deprivation and crime decline in Chicago from 2015 to 2022, addressing the question: How do changes in neighborhood deprivation relate to crime reduction patterns? Using comprehensive crime incident and census tract Area Deprivation Index (ADI) data, this study conducted exploratory spatial analysis, regression modeling, and local bivariate relationship analysis. The findings reveal persistent hotspots of concentrated deprivation on Chicago’s south and west sides, alongside a general citywide crime decline. However, the current research uncovered significant spatial heterogeneity in both deprivation patterns and crime reduction, challenging the achievement of equitable public safety outcomes. Surprisingly, while crime incidents in 2015 and 2022 significantly predicted crime change, ADI scores were not statistically significant predictors in our regression model. Local bivariate analysis exposed diverse relationships between ADI changes and crime rate changes across neighborhoods, with 72.2% of census tracts showing no statistically significant relationship. This underscores the complexity of urban crime dynamics and the importance of local context in understanding these patterns. Our research contributes a nuanced understanding of the intricate relationship between urban deprivation and crime patterns, providing valuable insights for policymakers, law enforcement agencies, and urban planners. These findings highlight the need for integrated, long-term strategies that address both crime prevention and socioeconomic disparities, ultimately fostering safer, more equitable urban environments and informing evidence-based interventions tailored to specific neighborhood contexts.

3-Dimensional Echocardiographic Prediction of Left Ventricular Outflow Tract Area Prior to Transcatheter Mitral Valve Replacement

BackgroundNew postprocessing software facilitates 3-dimensional (3D) echocardiographic determination of mitral annular (MA) and neo–left ventricular outflow tract (neo-LVOT) dimensions in patients undergoing transcatheter mitral valve replacement (TMVR). ObjectivesThis study aims to test the accuracy of 3D echocardiographic analysis as compared to baseline computed tomography (CT). MethodsA total of 105 consecutive patients who underwent TMVR at 2 tertiary care centers between October 2017 and May 2023 were retrospectively included. A virtual valve was projected in both baseline CT and 3D transesophageal echocardiography (TEE) using dedicated software. MA dimensions were measured in baseline images and neo-LVOT dimensions were measured in baseline and postprocedural images. All measurements were compared to baseline CT as a reference. The predicted neo-LVOT area was correlated with postprocedural peak LVOT gradients. ResultsThere was no significant bias in baseline neo-LVOT prediction between both imaging modalities. TEE significantly underestimated MA area, perimeter, and medial-lateral dimension compared to CT. Both modalities significantly underestimated the actual neo-LVOT area (mean bias pre/post TEE: 25.6 mm2, limit of agreement: −92.2 mm2 to 143.3 mm2; P < 0.001; mean bias pre/post CT: 28.3 mm2, limit of agreement: −65.8 mm2 to 122.4 mm2; P = 0.046), driven by neo-LVOT underestimation in the group treated with dedicated mitral valve bioprosthesis. Both CT- and TEE-predicted-neo-LVOT areas exhibited an inverse correlation with postprocedural LVOT gradients (r2 = 0.481; P < 0.001 for TEE and r2 = 0.401; P < 0.001 for CT). ConclusionsTEE-derived analysis provides comparable results with CT-derived metrics in predicting the neo-LVOT area and peak gradient after TMVR.