Comprehensive Functional Assessment Research Articles

Comprehensive assessment of the respiratory function of nasal packs with airway tubes

We studied packs with air tubes from two manufacturers: Medtronic and Spiggle & Theis. During the experimental part, measurements of the air tubes and their study using acoustic rhinometry were carried out. In the clinical part, there were two groups of patients with different types of tampons and control group of volunteers with normal nasal breathing, the total number of participants was 45 people. All patients of groups 1 and 2 underwent septoplasty, bilateral lower partial conchotomy. In the postoperative period, rhinomanometry, rhinoflowmetry, a study of the duration of nasal breathing, and a subjective assessment of nasal breathing were performed. According to measurements and acoustic rhinometry, the airway tubes of the tampons have a cross-sectional area that is more than 4 times smaller than the narrowest part of the nasal cavity in healthy volunteers. According to the results of a clinical study, the tampons in question are not able to provide a level of nasal breathing comparable to normal, even after clearing the lumen by a doctor. Medtronic packs provide somewhat better airway function due to the larger internal diameter of the tubes, but also do not create conditions for satisfactory nasal breathing. Improving the respiratory function of tampons in the future can be achieved by increasing the internal lumen of the breathing tubes while maintaining comfort of use.

Justification of vacuum prophylaxis as part of the penile rehabilitation in patients after nerve-sparing radical prostatectomy

Introduction. In healthy men, a significant increase in pO2 in the cavernous tissue occurs during episodes of nocturnal erections. This process ensures sufficient oxygenation and high-pressure substances such as prostaglandin-E1 and nitric oxide. These substances suppress the expression of transforming growth factor β1, thereby preventing collagen synthesis and the development of cavernous fibrosis. In patients undergoing nerve-sparing radical prostatectomy, nocturnal erections are absent, hypoxia inhibits the production of PGE-i, and neuropraxia inhibits NO. Thus, cavernous fibrosis develops through the production of pro-apoptotic and profibrotic factors, resulting in persistent erectile dysfunction. The importance of a vacuum in penile rehabilitation for the prevention of penile cavernous hypoxia is not fully understood. This is due to the deficiency of data on the gas composition of cavernous blood when a vacuum-induced erection is achieved.Purpose of the study. To investigate the cavernous blood at the time of vacuum-induced erection, to analyze the obtained results with the International Index of Erectile Function score and with the values of penile hemodynamics.Materials and methods. The study included i5 patients with prostate cancer and preserved sexual function. The average age of all men was 57.87 ±4.36 years. All patients underwent a preoperative comprehensive assessment of erectile function: International Index of Erectile Function questionnaire, dynamic duplex penile ultrasound. Immediately prior to the surgery, penile blood was collected at the time of achieving a vacuum-induced erection. The gas composition and oxygenation were assessed using the values of the partial oxygen pressure, carbon dioxide and saturation in accordance with the approved standards to differentiate arterial and venous blood. Statistical data processing was carried out using the PASW Statistics 22 software (IBM SPSS, IBM Corp., Chicago, IL, USA)Results. All patients were divided into 3 groups depending on the gas composition and oxygen level of the cavernous blood. Group I included 4 (26.6%) patients with a predominance of arterial blood, group II — 4 patients (26.6%) with venous blood and group III — 7 patients (46.6%) with a mixed composition of cavernous blood. The average International Index of Erectile Function score in group I was 23.5 [2i.0; 25.0], in group II — 22.0 [2i.0; 24.0] and in group III — 24.0 [i9.0; 25.0]. Peak systolic velocity (cm/s) in group I was 40.i [35.i; 45.2], in group II — 35.9 [29.5; 50.2], in group III — 32.5 [32.5; 34.4]. End-diastolic velocity (cm/s) in group I was 2.52 [0.55; i0.5], in group II — 8.3 [2.9; i0.8], in group III — 7.5 [7.5; 9.0]. Resistive index in group I was 0.87 [0.77; 0.98], in group II — 0.75 [0.63; 0.94], in group III — 0.75 [0.73; 0.75].Conclusions. Vacuum prophylaxis may be the method of choice for penile rehabilitation in patients after nerve-sparing radical prostateectomy, especially in the early postoperative period during neuropraxia. The use of vacuum devices should be prescribed to patients with preserved veno-occlusive mechanism, which should be confirmed by dynamic duplex penile ultrasound.

Reference Ranges of Left Ventricular Hemodynamic Forces in Healthy Adults: A Speckle-Tracking Echocardiographic Study.

Background: The normal limits of left ventricular (LV) hemodynamic forces (HDFs) are not exactly known. The aim of this study was to explore the full spectrum of HDF parameters in healthy subjects and determine their physiologic correlates. Methods: 269 healthy subjects were enrolled (mean age: 43 ± 14 years; 123 (45.7%) men). All participants underwent an echo-Doppler examination. Tri-plane tissue tracking from apical views was used to measure 2D global endocardial longitudinal strain (GLS), circumferential strain (GCS), and LV HDFs. HDFs were normalized with LV volume and divided by specific weight. Results: LV systolic longitudinal HDFs (%) were higher in men (20.8 ± 6.5 vs. 18.9 ± 5.6, p = 0.009; 22.0 ± 6.7 vs. 19.8 ± 5.6, p = 0.004, respectively). There was a significant correlation between GCS (increased) (r = −0.240, p < 0.001) and LV longitudinal HDFs (reduced) (r = −0.155, p = 0.01) with age. In a multivariable analysis age, BSA, pulse pressure, heart rate and GCS were the only independent variables associated with LV HDFs (β coefficient = −0.232, p < 0.001; 0.149, p = 0.003; 0.186, p < 0.001; 0.396, p < 0.001; −0.328, p < 0.001; respectively). Conclusion: We report on the physiologic range of LV HDFs. Knowledge of reference values of HDFs may prompt their implementation into clinical routine and allow a more comprehensive assessment of the LV function.

Maintenance of Physical Function in Adult and Older Adult Mice Using Aerobic Exercise

As we age, physical and neuromuscular function declines gradually. Exercise is a therapy to improve neuromuscular ability. Pre-clinical models are needed to understand molecular mechanisms contributing to age-associated functional decline and how exercise affects that downward trajectory. Our goal was to compare the differences in effects of two validated mouse models of endurance exercise designed to mimic human training studies: high intensity interval training (HIIT) and voluntary wheel running (VWR). We hypothesized that both adult and older adults (10 and 26 months old at end, respectively: 10m and 26m) would respond to both exercise regimens by improving or maintaining exercise/physical capacity, but that adult mice would benefit more. We randomly assigned male C57BL/6 mice into experimental groups: 10m: (VWR, HIIT, sedentary control, CON, n=8 per group), and 26m (VWR, n=8, HIIT, n=10). We measured functional ability (pre- and post-intervention) using CFAB (comprehensive functional assessment battery), our composite scoring system (grip strength, inverted cling, treadmill endurance, activity rate, rotarod), tracked body composition (EchoMRI), and measured muscle wet mass. We found that significant retention of ability (CFAB difference, repeated measures ANOVA, p<0.05) and fat percentage (ANOVA., %change: 10m: CON +125%, HIIT +101%, VWR +52%; 26m: VWR -42%, HIIT +26%, p<0.05) was promoted by both exercise modalities compared to control, and furthermore HIIT may have better efficacy in the adult versus the older mice. In conclusion, both exercises are valid models with derived benefits as expected in similar human studies. We anticipate future work using these models to undertake mechanistic investigations.

Clinical profile of an Alzheimer´s disease cohort in the Peruvian population

AbstractBackgroundAmong older Peruvians (over 65‐years) the prevalence of dementia is 7%, with 56% meeting clinical criteria for Alzheimer Disease (AD). Peruvians, are an admixed population with approximately 80% Amerindian ancestral background. We have ascertained a cohort of Alzheimer Disease (AD) cases and cognitively intact controls for genetic studies.MethodAll participants have been recruited since 2019 using community outreach ascertainment strategies and hospital‐based recruitment from Lima, Peru. Cases were assessed by neurologist following NINDS/ADRDA criteria; and completed a comprehensive neurocognitive, neuropsychiatric and functional assessments. Controls were screened using MMSE, Clock drawing test and Pfeffer functional activities questionnaire. IRBs approvals from the participating Peruvian institutions and University of Miami were obtained for this study.ResultA total of 102 AD cases (4 familial cases) and 152 controls were recruited since 2019 to December 2020. For AD cases: age at examination were 76.5±9.09, age at onset were 72.15±8.82, and 63.7% were female, average of 9.9±4.9 year of education. For controls: age at examination were 73.13±6.54, 62.5% were female, average of 11.62±4.41 year of education. Among cases diagnosis was classified as: 62.8% possible AD (two cases screened for Cerebrospinal fluid Abeta42 and tau protein levels) and 37.2% probable AD. Clinical and cognitive assessment profile for cases: MMSE average score was 17.2± 4.9 and Addenbrook’s Cognitive Examination average score was 38.5± 21.7 with memory loss predominance. Based on NPI the most frequent neuropsychiatric symptoms were irritability (51%), delusions (46%) and apathy (45%). Severity of dementia were assessed by CDR (CDR=3 for 33.9%, CDR=2 for 32.3%, CDR=1 for 24.2% and CDR=0.5 for 9.7%). Depressive symptoms were assessed with Geriatric Depression Scale with an average of 4.4±3.5 .ConclusionThe clinical features of the AD cohort in the Peruvian population are consistent with previous reports. There is a tendency of a higher level of education in the control . Among the Peruvian AD cohort, the main neuropsychiatric symptoms are irritability, delusions and apathy consistent with the predominance of moderate to severe dementia. Reference: Marca V. et al. Dissecting the role of Amerindian genetic ancestry and ApoE ε4 allele on Alzheimer disease in an admixed Peruvian population, Neurobiology of Aging, 2020.

The Pivotal Role of Invasive Functional Assessment in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA).

Myocardial infarction with non-obstructive coronary arteries (MINOCA) encompasses several pathophysiological mechanisms not yet fully understood. Among the latter, vasomotion abnormalities and coronary microvascular dysfunction (CMD) play a major role for both epidemiological and prognostic reasons. Despite current guidelines do not recommend routine physiological assessment of both epicardial and microvascular coronary compartments within the context of an acute myocardial infarction, several recent evidence support the critical role of a comprehensive invasive functional assessment in order to identify the underlying pathophysiological mechanism and consequently to select an appropriate therapeutic strategy. Unfortunately, optimal medical therapy for these patients is not currently established due to the lack of dedicated trials evaluating clinical outcomes of commonly used medications for secondary prevention in MINOCA patients. For this reason, additional research is warranted to provide personalized treatments for patients affected by this puzzling clinical entity.

Comprehensive Assessment of Cognitive Function in Patients with Sickle Cell Disease Reveals Deficits in Memory and Processing Speed

Cognitive impairment (CI) is a serious complication of sickle cell disease (SCD) and can cause significant functional and social limitations. To date, there are only a few studies characterizing CI in adults with SCD. In this study, we comprehensively assessed cognitive function in a cross-sectional sample of patients with SCD compared to healthy controls across ten memory and processing speed domains.Patients with SCD (HbSS, HbSC and HbS/beta thalassemia) ages 18 years and older were recruited from the University of Pittsburgh Medical Center Adult Sickle Cell Program, and sex- and age-matched controls were recruited from the community and by SCD patient referral. Unlike previous studies, we did not restrict participation to patients with HbSS only and we included all SCD comorbidities. All participants underwent neurocognitive assessments using measures that are validated and accurate in discriminating CI from dementia and normal cognition. We conducted linear regression analyses to estimate the difference in each cognitive domain score between patients and controls. We also contrasted pairwise comparisons between controls and patients with and without stroke, with and without chronic blood transfusions, and classified by disease severity based on genotype.Among 86 SCD patients and 66 controls, 43% were male and the average age was 36.2 years. SCD patients had fewer years of education on average (13.3 vs. 14.2) and a higher percent had a history of smoking (46% vs. 29%). Additionally, 45% of patients had milder disease (HbSC or HbSb +-thalassemia) with the rest having severe disease (HbSS or HbSb 0-thalassemia)), 14% had a history of stroke, and 20% were receiving chronic exchange transfusions.Patients with SCD had significantly lower scores on five out of ten cognitive domains: language (b=-5.88, P=0.014), attention/processing (b=-14.47, P<0.001), RBANS total score (b=-7.55, P<0.001), executive function (b=-1.60, P<0.001), and DSST scaled score (b=-2.08, P<0.001). Adjusting for pre-morbid verbal IQ (VIQ), hemoglobin level, and smoking history, attention/processing (b=-10.70, P=0.001), RBANS total (b=-7.27, P=0.003), and DSST scaled scores (b=-1.54, P=0.019) were significantly lower among patients compared to controls.In adjusted models, there were no significant differences in cognitive domain scores between patients with mild disease compared to patients with severe disease; both mild and severe disease subgroups had lower attention/processing scores compared to controls (both P<0.05). Patients with SCD and a history of stroke had significantly lower attention/processing, executive function, RBANS total, and DSST scaled scores (all P<0.01) compared to controls, and SCD patients who did not have a history of stroke had lower attention/processing and RBANS total scores than controls (both P<0.05). Patients with a history of stroke had significantly lower executive function (b=-1.65, P=0.012), RBANS total (b=-8.64, P=0.020), and DSST scaled scores (b=-2.43, P=0.015) than patients without a history of stroke. There were no significant differences in cognitive domain scores between patients receiving chronic transfusions and those not receiving transfusions.To our knowledge, this is the most inclusive real-life study of adult patients with SCD to investigate cognition to date, further characterizing CI among this patient population. Many of the disparities in cognitive function between patients and controls are not explained by pre-morbid VIQ, hemoglobin levels or smoking, indicating further research is needed to understand the pathogenesis of CI in SCD. [Display omitted] DisclosuresNovelli: Novartis Pharmaceuticals: Consultancy.

Cultural Adaptation of the Iranian Version of the "Sniffin' Sticks" Olfactory Test.

Background :Psychophysical tests are typically used for clinical assessment of human smelling function. Given that olfactory identification is linked to the regional culture, the main aim of this study was to provide the comprehensive “sniffin’ sticks” olfactory test, culturally adapted on the Iranian population as well as to examine the discriminatory power of this test between normal people and patients with olfactory disorder. Methods : This cross-sectional study consisted of 3 steps. A total of 200 healthy people were recruited to determine odor familiarity (using Likert- scale) for the first step. In the second step, based on the original sniffin’ sticks test and odor familiarity, 16 odor items were selected. Odor modification was performed and the identification part of the sniffin’ sticks test was created. Then, 99 patients with olfactory disorders and 214 healthy participants were tested using the Iranian sniffin’ sticks test (Ir-SST). After 2 to 4 weeks, participants were reexamined and test reliability was evaluated by using a Pearson correlation coefficient test. Results : The Ir-SST showed that scores of patients with smell loss were significantly lower than normosmic participants (13.6 ± 5.24 vs 34.3 ± 3.41, P < 0.001). The sensitivity (95.2%) and specificity (93.5%) of the test were also found to be high. Test-retest reliability was as follows: composite score: r = 0.8; odor identification: r = 0.83; odor threshold: r = 0.77; and odor discrimination test: r = 0.56; P < 0.001. Conclusion : The results suggest that the Ir-SST can be effectively adapted to the Iranian population. The current study validates that the sniffin' sticks olfactory test is applicable as a useful screening tool for comprehensive assessment of olfactory function in an Iranian population.

Assessment of Lumbar Extensor Muscles in the Context of Trunk Function, a Pilot Study in Healthy Individuals

A comprehensive assessment of trunk function, including the lumbar extensor muscles, appears to be important in various conditions affecting axial musculature. This pilot cross-sectional observational study aimed to define a battery of tests that comprehensively assess trunk muscle function (strength and muscular endurance). Sixty subjects without low back pain (LBP) underwent measurement of isometric lower back extensor strength using a hand-held dynamometer (HHD) in three positions; measurement of respiratory muscle strength; and Biering-Sørensen, prone-plank, and side-bridge tests. The repeatability, short-term and long-term reliability using the HHD device in different postural positions was confirmed. The greatest isometric lower back extensor strength was generated in the sitting position by male subjects. Time of effort in the Biering-Sørensen test was longer in women and older subgroups than in men and younger individuals, although this was not the case for the other two muscular endurance tests. This pilot monitoring of trunk muscle strength and endurance in healthy volunteers may lead to a better understanding of trunk muscle function. Based on this methodological background, the authors aim to use the defined battery of tests in their further studies in a group of patients with LBP and certain neuromuscular diseases to verify its usefulness in clinical practice.

Three-dimensional echocardiography in transcatheter edge-to-edge tricuspid valve repair

Abstract Background Transcatheter tricuspid valve repair (TTVR) is a new treatment option for severe tricuspid regurgitation (TR). First reports have reported conflicting results on development of right ventricular (RV) function after TTVR and questioned the role of conventional echocardiographic parameters to predict outcome. Purpose The aim of this study was to evaluate 3D echocardiography for the comprehensive assessment of RV function and its prognostic value for TTVR-treated patients. Methods We included patients undergoing TTVR from February 2017 to July 2019 who had preprocedural 3D assessment of RV volumes and ejection fraction. At follow-up (FU), 3D echo was performed to evaluate right ventricular reverse remodeling. All-cause mortality was assessed as clinical endpoint. Results 75 patients treated with TTVR for isolated, severe TR had 3D echo assessment. TTVR reduced TR from grade ≥3+ to ≤2+ in 83.1% of patients at discharge. 3D-RV end-diastolic volume (−46.3 ml, p&amp;lt;0.001), end-systolic volume (−22.0 ml, p=0.027) and 3D-RV ejection fraction (−4.7%, p&amp;lt;0.001) decreased at short-term FU at 1-month and remained stable at 6-month FU. An impaired preprocedural 3D-RVEF &amp;lt;44% conferred higher mortality risk (Figure), and was an independent predictor for 1-year mortality (hazard ratio 5.32, p=0.033) in multivariable analysis. Tricuspid annular systolic excursion (TAPSE) and RV fractional area change were not predictive for this endpoint. Importantly, the observed decrease of 3D-RVEF function after TTVR was not associated with outcome (p=0.22 for decrease of 3D-RVEF vs. no decrease of 3D-RVEF in Kaplan-Meier analysis). Instead, left ventricular stroke volume index increased by 9.2% from 26.0 to 28.4 ml/m2 (p&amp;lt;0.01) Conclusion TTVR leads to right ventricular reverse remodeling and decrease of RV systolic function after TTVR. Impaired preprocedural RV systolic function is associated with worse clinical outcome. In contrast, the observed decrease of RV systolic function after TTVR was not associated with outcome. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Klinikum der Universtität München Figure 1

Impact of left ventricular fibrosis and longitudinal systolic strain on outcomes in low gradient aortic stenosis

Abstract Background The clinical utility of comprehensive cardiac magnetic resonance (CMR) for the assessment of myocardial structure and function remains unknown in patients with low gradient (LG) aortic stenosis (AS). Purpose This study sought to compare CMR characteristics of myocardial structure and function according to different flow / gradient patterns of AS: classical low flow LG (LFLG); paradoxical LFLG; normal flow LG; and high gradient, and to evaluate their impact on the outcomes of these patients. Methods International multicentric prospective study included 147 patients with LG moderate to severe AS and 18 patients with high gradient severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). Results Patients with classical LFLG (n=90) had more LV adverse remodeling and impaired longitudinal function including higher ECV, and higher LGE and volume, and worst LVGLS, compared to other patterns of AS. Over a median follow-up of 2-years, 43 deaths and 48 composite outcomes of death or heart failure hospitalization occurred in LG AS patients. As LVGLS or ECV worsened, risks of adverse events also increased (per tertile of LVGLS: HR [95% CI] for mortality, 1.50 [1.02–2.20]; p=0.04; HR [95% CI] for composite outcome, 1.45 [1.01–2.09]; p&amp;lt;0.05) (per tertile of ECV: HR [95% CI] for mortality, 1.63 [1.07–2.49]; p=0.02; HR [95% CI] for composite outcome, 1.54 [1.02–2.33]; p=0.04). LGE presence was also associated with higher mortality (HR [95% CI], 2.27 [1.01–5.11]; p&amp;lt;0.05) and risk of the composite outcome (HR [95% CI], 3.00 [1.16–7.73]; p=0.02). The risk of all-cause death and of the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV and LGE) (Figure) with and without adjustment for age, true severe AS, classical LFLG, and aortic valve replacement as a time-varying covariate. Conclusions In this international multicentric study of LG AS, comprehensive CMR assessment of myocardial structure and function provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics. Funding Acknowledgement Type of funding sources: None.

Comprehensive non-invasive and invasive functional assessment of anomalous coronary arteries with anatomical high-risk features

Abstract Background Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital disease associated with an increased risk of myocardial ischemia. In AAOCA, the occurrence of ischemia is based on the extent of a fixed and a dynamic component, each attributed to different anatomical high-risk features (i.e., acute take-off angle, slit-like ostium, proximal narrowing, elliptic vessel shape and intramural course). Coronary computed tomography angiography (CCTA) is the primary non-invasive imaging method to depict the presence and quantitatively assess anatomical high-risk features while invasive physiologic evaluation under maximal dobutamine-volume challenge is the gold standard to unravel the hemodynamic relevance of AAOCA. Methods We included all consecutive AAOCA patients with anatomical high-risk features from our prospective, open-label registry. The objective is to quantify anatomical high-risk features in the CCTA and to measure hemodynamic relevance using invasive fractional flow reserve with maximal dobutamine-volume challenge (gradually increasing dose of dobutamine max. 40 μg/kg per body weight/min, max. 3000 mL ringer lactate and max. 1mg atropine). Pathological invasive FFR was defined as FFR Dobutamine&amp;lt;0.80. Additionally, CCTA-data were processed to assess computational fluid dynamics (CT FFR) and intravascular ultrasound (IVUS) was used to determine minimal lumen area (MLA) during baseline and maximal stress conditions. Results A total of 11 patients were included between 05/19 and 11/2020. Mean age was 59±13 years (range: 40–79), 10 patients showed a right-AAOCA and one patient showed a single right coronary artery. All patients had either one (i.e., in 1 patient) or more than one anatomical-high risk features (i.e., in 10 patients). Mean invasive FFR Dobutamine was 0.88±0.07 with n=2 (18%) being pathological. Mean non-invasive CT FFR was 0.89±0.04 (FFR&amp;lt;0.80; n=0), mean invasive FFR Adenosine was 0.92±0.06 (FFR&amp;lt;0.80; n=1; 9%). There was a significant decrease in IVUS MLA between rest (7.93±2.79mm2) and under dobutamine-volume challenge (6.57±3.20mm2, p=0.008). Mean percentage of MLA reduction was 19±18%. Conclusion Our preliminary results provide evidence that relevant myocardial ischemia seems to be often absent in a middle-aged population with AAOCA and anatomical high-risk features. However, in a minority of cases hemodynamic relevance could be depicted, especially when stressing with dobutamine-volume challenge. The presence of a dynamic component in AAOCA is represented by the reduced minimal lumen area under stress conditions. Comprehensive diagnostic evaluation should be performed to prevent unnecessary guideline recommended open-heart surgery in a middle-aged population with AAOCA. Funding Acknowledgement Type of funding sources: None.

Premorbid personality and cognitive function impact on schizophrenia

Individuals with schizophrenia can experience family and social adjustment difficulties as well as significant barriers to independent living, with cognitive difficulties being one of the pivotal features of this mental health disorder. This article examines a decade of data for a sample of individuals living with schizophrenia and argues that comprehensive assessment of personality and cognitive function in the initial stage of disease should inform management and treatment to enable improved patient life outcomes.

Investigations of Anorectal Function

Investigations of Anorectal Function Abstract. Investigations of anorectal function allows measurement of anal sphincter pressure, evaluation of rectal sensitivity and verification of rectoanal reflexes, which are essential elements in the assessment of bowel emptying. It is combined with a balloon expulsion test to ensure that the manometric findings are consistent with anorectal function. These tests are used in the diagnostic work-up of chronic defecation disorders, constipation and faecal incontinence, but can also provide clarification in the pre- and post-operative setting, for functional anorectal pain and other disorders of pelvic floor function. Most patients referred for investigation of these symptoms require a comprehensive assessment of anorectal structure and function. Because of the high variability of normal values and complexity of anorectal function, no single examination provides all the information needed to make a symptom-explaining, conclusive diagnosis and influence treatment decisions. Anorectal manometry is useful to assess the extent of impairment of anorectal function and to differentiate between organic and functional disorders (including pelvic floor dyssynergia). A preceding detailed anamnesis as well as endoscopic (procto / rectoscopy) and imaging procedures (anorectal endosonography, dynamic MR defecography) complete the diagnostic investigation instead.

The complementary nature of multimodal imaging in the management of an anomalous aortic origin of the right coronary artery from the left coronary cusp

Anomalous aortic origins of coronary arteries (AAOCA) are congenital abnormalities involving the origin and course of coronary arteries and present with diverse clinical manifestations in patients ranging from asymptomatic incidental findings to sudden cardiac death. The current case describes a patient with an anomalous right coronary artery with an anterior interarterial course originating from a separate ostium at the left coronary cusp. By utilizing complementary multimodality imaging techniques including fractional flow reserve (FFRCT), we obtained a comprehensive functional and anatomic assessment resulting in appropriate surgical therapy and a good clinical outcome.

View the meniscus: MicroCT strategies for enhancing microstructure visualization

The optimization of imaging protocols for soft tissue visualization is mandatory in the musculoskeletal field. Combining these techniques with histology and mechanics can provide a comprehensive structural and functional assessment of the tissue.

Periphery kinetic perimetry: clinically feasible to complement central static perimetry

BackgroundExisting evidence suggests that visual field defect in eyes with glaucoma significantly varies between individuals. The following study compared the central visual field defects with the peripheral visual field defects in patients with suspect glaucoma and primary open-angle glaucoma (POAG) and investigated whether using the central visual field test alone could result in loss of clinically valuable information.MethodsIn this prospective observational study, 167 eyes from 89 patients with suspect glaucoma or POAG were first examined with static automated perimetry (SAP), followed by a peripheral visual field test on Octopus 900 perimeter (Haag-Streit, Koeniz, Switzerland). The peripheral visual field test was performed by “Auto Kinetic Perimetry” program, in which Goldmann III4e stimuli randomly moved along 16 vectors at a constant angular velocity of 5 deg/s.ResultsGlaucomatous peripheral visual field defects were seen in 18% of the eyes with a normal central visual field. In addition, 86% of glaucoma patients with moderate-to-severe central visual field defects had corresponding peripheral visual field defects in the form of localized or diffuse depression of the isopters. Furthermore, a moderate correlation was found between the central and peripheral visual fields. The median test duration was 71 s for the peripheral test and 803 s for the central test (p < 0.001).ConclusionsOur study demonstrated the diversity of glaucomatous visual field defects, as well as the possibility of losing the clinically valuable information due to focusing on the central visual field test alone. The peripheral kinetic perimetry is clinically feasible to complement the central static perimetry for a comprehensive assessment of visual function in glaucoma patients.

Saltwater and nutrient legacies reduce net ecosystem carbon storage despite freshwater restoration: insights from experimental wetlands

Net ecosystem carbon balance is a comprehensive assessment of ecosystem function that can test restoration effectiveness. Coastal peatlands are globally important carbon sinks that are vulnerable to carbon loss with saltwater intrusion. It is uncertain how wetland carbon stocks and fluxes change during freshwater restoration following exposure to saltwater and elevated nutrients. We restored freshwater to sawgrass (Cladium jamaicense) peat monoliths from freshwater marshes of the Everglades (Florida, U.S.A.) that had previously been exposed to elevated salinity (approximately9 ppt) and phosphorus (P) loading (1 g P m−2 year−1) in wetland mesocosms. We quantified changes in water and soil physicochemistry, plant and soil carbon and nutrient standing stocks, and net ecosystem productivity during restoration. Added freshwater immediately reduced porewater salinity from &gt;8 to approximately 2 ppt, but elevated porewater dissolved organic carbon persisted. Above‐ and belowground biomass, leaf P concentrations, and instantaneous rates of gross ecosystem productivity (GEP) and ecosystem respiration (ER) remained elevated from prior added P. Modeled monthly GEP and ER were higher in marshes with saltwater and P legacies, resulting in negative net ecosystem productivities that were up to 12× lower than controls. Leaf litter breakdown rates and litter P concentrations were 2× higher in marshes with legacies of added saltwater and P. Legacies of saltwater and P on carbon loss persisted despite freshwater restoration, but recovery was greatest for freshwater marshes exposed to saltwater alone. Our results suggest that restoration in nutrient‐limited freshwater wetlands exposed to saltwater intrusion and nutrient enrichment is a slow process.

Multiparameter phenotyping of platelet reactivity for stratification of human cohorts

Accurate and comprehensive assessment of platelet function across cohorts of donors may be key to understanding the risk of thrombotic events associated with cardiovascular disease, and, hence, to help personalize the application of antiplatelet drugs. However, platelet function tests can be difficult to perform and analyze; they also can be unreliable or uninformative and poorly standardized across studies. The Platelet Phenomic Analysis (PPAnalysis) assay and associated open-source software platform were developed in response to these challenges. PPAnalysis utilizes preprepared freeze-dried microtiter plates to provide a detailed characterization of platelet function. The automated analysis of the high-dimensional data enables the identification of subpopulations of donors with distinct platelet function phenotypes. Using this approach, we identified that the sensitivity of a donor's platelets to an agonist and their capacity to generate a functional response are distinct independent metrics of platelet reactivity. Hierarchical clustering of these metrics identified 6 subgroups with distinct platelet phenotypes within healthy cohorts, indicating that platelet reactivity does not fit into the traditional simple categories of “high” and “low” responders. These platelet phenotypes were found to exist in 2 independent cohorts of healthy donors and were stable on recall. PPAnalysis is a powerful tool for stratification of cohorts on the basis of platelet reactivity that will enable investigation of the causes and consequences of differences in platelet function and drive progress toward precision medicine.

Assessment of Upper Extremity Motor Function and Its Relation with Fatigue and Cognitive Impairment Among Patients with Multiple Sclerosis

Background: Multiple Sclerosis (MS) is an unpredictable autoimmune disease that causes damage to the central nervous system including brain, spinal cord and optic nerve. This damage occurs as the body’s immune system attack the protective coating called myelin around nerve fibers in the central nervous system. It can affect different aspects of a person’s physical and cognitive functioning. Multiple Sclerosis is a complex, chronic disease that necessitates the support of a knowledgeable and concerned team of healthcare providers. This study aimed to assess the relation between upper extremity motor function among patients with MS with fatigue and cognitive impairment. Descriptive correlational research design was conducted on sixty adult patients with the diagnosis of MS who were admitted the MS Outpatient Clinic of El-Hadara Hospital in Alexandria. Four tools were used for collecting data: Tool I: Demographic and clinical data tool, tool II: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, tool III: Multiple sclerosis Neuropsychological screening questionnaire, and Tool IV: Fatigue assessment tool. Results of the present study revealed that moderate disability of the upper extremity was the most disability level encountered representing more than one third among the study sample (36.7%) , furthermore; more than two third (73.3%) the study sample often having cognitive problems, suffering from severe fatigue (36.7%) and fatigue partially interfered with their quality of life(46.7%). Additionally, there was no significant relation between studied patients' motor function of upper extremity and their cognitive function p=0.54. On the other hand, there was a significant relation between studied patients' motor function of upper extremity and fatigue severity level, and effect of fatigue on their quality of life. Accordingly, conducting a comprehensive assessment of patients' upper extremity motor function, cognitive function, and fatigue level among patients with MS is necessary to determine the degree of suffering; this will help the nurses to predict their functional status and the effect of MS on their quality of life.