Degree Of Dilatation Research Articles

Social motivation predicts gaze following between 6 and 14months.

Infants vary in their ability to follow others' gazes, but it is unclear how these individual differences emerge. We tested whether social motivation levels in early infancy predict later gaze following skills. We longitudinally tracked infants' (N=82) gazes and pupil dilation while they observed videos of a woman looking into the camera simulating eye contact (i.e., mutual gaze) and then gazing toward one of two objects, at 2, 4, 6, 8, and 14months of age. To improve measurement validity, we used confirmatory factor analysis to combine multiple observed measures to index the underlying constructs of social motivation and gaze following. Infants' social motivation-indexed by their speed of social orienting, duration of mutual gaze, and degree of pupil dilation during mutual gaze-was developmentally stable and positively predicted the development of gaze following-indexed by their proportion of time looking to the target object, first object look difference scores, and first face-to-object saccade difference scores-from 6 to 14months of age. These findings suggest that infants' social motivation likely plays a role in the development of gaze following and highlight the use of a multi-measure approach to improve measurement sensitivity and validity in infancy research.

PO-455617-18 SHORT COUPLED PREMATURE ATRIAL COMPLEXES LEAD TO ADVERSE ATRIAL REMODELING AND ATRIAL FIBRILLATION IN A SWINE MODEL

Frequent premature atrial complexes (PACs) are associated with left atrial (LA) myopathy and atrial fibrillation (AF), however, the effect of coupling interval and irregularity on the ensuing atrial myopathy has not been tested. To explore the impact of coupling interval and regularity of atrial ectopics on the development of atrial remodeling and AF in a swine model. Thirty-five swine underwent baseline electrophysiologic study followed by pacemaker implantation and pacing from the lateral LA via the coronary sinus for 16 weeks in 4 groups: 1) controls without PACs (CTRL, n=10); 2) 50% paced PACs at a short coupling interval (CI) of 250ms (Short-PAC, n=10); 3) 50% PACs at a long CI of 400ms (Long-PAC, n=5); and 4) regular pacing at a faster mean atrial rate (130 beats/min) than during PACs (Reg-130, n=10). At the terminal study, a repeat electrophysiologic study was performed followed by sacrifice and histologic analysis. Structural changes: The Short-PAC group had the greater degree of LA dilation (terminal - baseline: Short-PAC 5.9±1.2cm2 vs. Long-PAC 3.9±0.5cm2 vs. Reg-130 3.0±1.0cm2 vs. CTRL 0.9±0.3cm2, p<0.001) and decrease in peak LA strain (terminal - baseline: Short-PAC -17.3±3.2% vs. Long-PAC -12.7±2.9% vs. Reg-130 -8.2±2.9% vs. CTRL -0.7±4.2%, p<0.001). Electrophysiologic changes: The Short-PAC group had slower LA conduction velocity than the Reg-130 and CTRL groups (Short-PAC 1.1±0.2m/s vs. Long-PAC 1.2±0.1m/s vs. Reg-130 1.3±0.1m/s vs. CTRL 1.5±0.2m/s, p<0.001); atrial effective refractory period (ERP) was only decreased in the Reg-130 group (terminal - baseline: Short-PAC -4.0±23.6ms vs. Long-PAC -8.7±17.9ms vs. Reg-130 -23.7±14.3ms vs. CTRL -3.2±23.7ms, p=0.09). Fibrosis: percent LA fibrosis was highest in the Short-PAC group followed by Long-PAC, Reg-130, and then CTRL groups (Figure, Panel A). AF induction: The Short-PAC group had the longest duration of induced AF (Panel B). In a swine model, frequent PACs can cause structural and electrical atrial remodeling with a heightened propensity for AF. PACs led to slow conduction and fibrosis without change in atrial ERP, suggesting a process distinct from tachy-pacing induced atrial remodeling. Moreover, PACs with short CIs resulted in a greater degree of LA remodeling and induced AF duration compared to PACs with long CIs. These findings suggest that frequent, short coupled PACs pose the highest risk for developing atrial remodeling and AF.

PO-01-001 SHORT COUPLED PREMATURE ATRIAL COMPLEXES LEAD TO ADVERSE ATRIAL REMODELING AND ATRIAL FIBRILLATION IN A SWINE MODEL

Frequent premature atrial complexes (PACs) are associated with left atrial (LA) myopathy and atrial fibrillation (AF), however, the effect of coupling interval and irregularity on the ensuing atrial myopathy has not been tested. To explore the impact of coupling interval and regularity of atrial ectopics on the development of atrial remodeling and AF in a swine model. Thirty-five swine underwent baseline electrophysiologic study followed by pacemaker implantation and pacing from the lateral LA via the coronary sinus for 16 weeks in 4 groups: 1) controls without PACs (CTRL, n=10); 2) 50% paced PACs at a short coupling interval (CI) of 250ms (Short-PAC, n=10); 3) 50% PACs at a long CI of 400ms (Long-PAC, n=5); and 4) regular pacing at a faster mean atrial rate (130 beats/min) than during PACs (Reg-130, n=10). At the terminal study, a repeat electrophysiologic study was performed followed by sacrifice and histologic analysis. Structural changes: The Short-PAC group had the greater degree of LA dilation (terminal - baseline: Short-PAC 5.9±1.2cm2 vs. Long-PAC 3.9±0.5cm2 vs. Reg-130 3.0±1.0cm2 vs. CTRL 0.9±0.3cm2, p<0.001) and decrease in peak LA strain (terminal - baseline: Short-PAC -17.3±3.2% vs. Long-PAC -12.7±2.9% vs. Reg-130 -8.2±2.9% vs. CTRL -0.7±4.2%, p<0.001). Electrophysiologic changes: The Short-PAC group had slower LA conduction velocity than the Reg-130 and CTRL groups (Short-PAC 1.1±0.2m/s vs. Long-PAC 1.2±0.1m/s vs. Reg-130 1.3±0.1m/s vs. CTRL 1.5±0.2m/s, p<0.001); atrial effective refractory period (ERP) was only decreased in the Reg-130 group (terminal - baseline: Short-PAC -4.0±23.6ms vs. Long-PAC -8.7±17.9ms vs. Reg-130 -23.7±14.3ms vs. CTRL -3.2±23.7ms, p=0.09). Fibrosis: percent LA fibrosis was highest in the Short-PAC group followed by Long-PAC, Reg-130, and then CTRL groups (Figure, Panel A). AF induction: The Short-PAC group had the longest duration of induced AF (Panel B). In a swine model, frequent PACs can cause structural and electrical atrial remodeling with a heightened propensity for AF. PACs led to slow conduction and fibrosis without change in atrial ERP, suggesting a process distinct from tachy-pacing induced atrial remodeling. Moreover, PACs with short CIs resulted in a greater degree of LA remodeling and induced AF duration compared to PACs with long CIs. These findings suggest that frequent, short coupled PACs pose the highest risk for developing atrial remodeling and AF.

Small Caliber Distal Cephalic Veins Undergo Significant Dilation under Anesthesia and Can Successfully Be Used for Arteriovenous Fistula Creation

Successful arteriovenous fistula (AVF) maturation and use for dialysis is highly dependent on preoperative diameter. Small veins (<2mm) exhibit high failure rates and are typically avoided. This study investigates the effects of anesthesia on the distal cephalic vein diameter as compared to preoperative outpatient vein mapping for the purpose of hemodialysis access creation. One hundred eight consecutive procedures for dialysis access placement met inclusion criteria and were reviewed. All patients received preoperative venous mapping and postanesthesia ultrasound mapping (PAUS). All patients received either regional and/or general anesthesia. A multiple regression was conducted to determine predictors of venous dilatation. The independent variables included both demographical and operative-specific variables such as the type of anesthesia. Outcomes of fistula maturation (successful cannulation and dialysis) were analyzed. In this cohort, the mean preoperative vein diameter was 1.85mm and the mean PAUS diameter was 3.45mm, a 2.21× increase, with only 2 patient veins failing to increase in diameter. Smaller veins (<2mm) exhibited significantly more dilation than larger veins after anesthesia (2.73 vs. 1.47×, P<0.001). In the multiple regression analysis, smaller vein diameter was correlated with a significantly greater degree of dilation (P<0.001). The degree of venous dilation was not affected by patient demographic-specific factors or by the type of anesthesia (regional block versus general) in the multiple regression analysis. 6month follow-up data for fistula maturation was available for 75 of 108 patients. Small veins (<2mm) on preoperative ultrasound matured at a similar rate as larger veins (90% vs. 91.4%, P=0.833). Small caliber distal cephalic veins experience a significant degree of dilation under regional and general anesthesia and can successfully be used for AVF creation. Consideration should be made to perform a postanesthesia vein mapping for all patients undergoing access placement despite preoperative venous mapping results.

V04-07 ROBOTIC ASSISTED SIDE-TO-SIDE REFLUXING NON-DISMEMBERED URETEROCYSTOTOMY FOR MANAGEMENT OF AN OBSTRUCTED MEGAURETER

You have accessJournal of UrologyCME1 Apr 2023V04-07 ROBOTIC ASSISTED SIDE-TO-SIDE REFLUXING NON-DISMEMBERED URETEROCYSTOTOMY FOR MANAGEMENT OF AN OBSTRUCTED MEGAURETER Hailey Silverii, Xinyuan Zhang, and Nicolas Fernandez Hailey SilveriiHailey Silverii More articles by this author , Xinyuan ZhangXinyuan Zhang More articles by this author , and Nicolas FernandezNicolas Fernandez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obstructed megaureters can often be safely observed; however, when there are associated changes in renal function or recurrent infections, surgical intervention is indicated. Surgical management options include: endoscopic intervention, diversion with cutaneous ureterostomy, non-refluxing ureteral reimplantation, or refluxing ureteral reimplantation with an end-to-side or side-to-side approach. Determining factors for management include the circumstance for which intervention is indicated, age and size of the patient, degree of ureteral dilation and obstruction, and bladder size. In this video, we present a robotic assisted side-to-side refluxing non-dismembered ureterocystotomy for an infant with a ureterovesical junction (UVJ) obstruction. METHODS: A 4-month-old, 6.6 kg male with a history of antenatally diagnosed hydroureteronephrosis presents with a 3 month interval renal ultrasound demonstrating worsened degree of right hydroureteronephrosis with debris and increased parenchymal thinning. He has no prior history of urinary tract infections. A MAG3 renal scan demonstrated normal differential function and an obstruction at the level of the right UVJ. Given the patient’s young age and small bladder capacity, a non-refluxing ureteral reimplantation was not felt to be a feasible option. A side-to-side ureterocystotomy was recommended to which the family consented. After further counseling, a robotic approach was agreed upon and completed with the assistance of the Da Vinci XI platform (Intuitive Surgical, Sunnyvale, CA). RESULTS: The case began with a cystoscopy and right retrograde pyelogram which confirmed the level of the obstruction at the UVJ. Three supraumbilical 8 mm ports were placed prior to docking the Da Vinci system. Console time was 60 minutes. The tension free side-to-side anastomosis was completed in an interrupted fashion between the bladder and the dilated distal ureter. Estimated blood loss was less than 5 cc. The patient was discharged on post-operative day one after Foley catheter removal and the patient is doing very well. CONCLUSIONS: In conclusion, a robotic approach to a refluxing non-dismembered ureterocystotomy can safely be employed in small infants with adaptations in port placement, dissection, and anastomosis given small working space and risk to injuring nearby structures. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e340 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hailey Silverii More articles by this author Xinyuan Zhang More articles by this author Nicolas Fernandez More articles by this author Expand All Advertisement PDF downloadLoading ...

ВЫРАЖЕННОСТЬ ЭНДОТЕЛИАЛЬНОЙ ДИСФУНКЦИИ КАК ОБЪЕКТИВНЫЙ КРИТЕРИЙ СТЕПЕНИ ТЯЖЕСТИ ПРЕЭКЛАМПСИИ

Preeclampsia remains one of the most significant obstetric problems due to its high prevalence, high incidence of maternal and perinatal morbidity and mortality, as well as the need for significant economic costs for the management and delivery of pregnant women with this pathology. In recent years, a number of authors have proven the most important role of vascular endothelial dysfunction in initiating disorders of vascular tone and blood coagulation potential, which underlie the formation of multiple organ failure in pregnant women with preeclampsia. The aim of the study was to establish new objective criteria for assessing the severity of preeclampsia based on the study of the functional state of the vascular wall by various methods, both invasive and non-invasive. 118 women with 28-37 weeks of pregnancy were examined. The 1st observation group consisted of 58 pregnant women with moderate preeclampsia, the 2nd observation group included 20 pregnant women with severe preeclampsia. The control group consisted of 40 women with a physiological course of pregnancy. The functional activity of the vascular wall was assessed by the level of endothelin-1, thrombospondin, intercellular adhesion molecules and nitric oxide metabolites in the blood by enzyme immunoassay. In patients with moderate preeclampsia, the content of nitric oxide metabolites significantly decreased, and the content of endothelin-1, thrombospondin, and intercellular adhesion molecules increased relative to patients in the control group. These changes were significantly more pronounced in patients with severe preeclampsia. At the same time, to study the function of the endothelium in pregnant women with preeclampsia, we used a non-invasive method - an ultrasonic cuff test according to the Celermajer D.S. In patients with moderate preeclampsia, the degree of endothelium-dependent arterial expansion during the cuff test decreased by more than 2 times compared with the parameters of pregnant women in the control group. In pregnant women with severe preeclampsia of the group, an even more pronounced decrease in the degree of dilatation of the brachial artery was noted. Thus, the determination of markers of endothelial dysfunction in the blood, as well as the use of an ultrasonic cuff test, made it possible to identify violations of the vasomotor function in pregnant women with preeclampsia, which correlate with the severity of preeclampsia. The use of an ultrasonic cuff test and the determination of endothelial dysfunction markers can be recommended as additional objective diagnostic criteria for the severity of preeclampsia, the transition from moderate preeclampsia to severe preeclampsia.

Post-Cholecystectomy Biliary Dilatation

Introduction: Despite the fact that the common bile duct (CBD) is thought to dilate following surgery, post-cholecystectomy CBD dilatation still remains a source of debate. Intravenous cholangiography made it possible to measure the common duct directly. Although most patients did not have a substantial increase in duct diameter following cholecystectomy, there was a trend toward a modest degree of duct dilatation, according to prospective studies employing sonography to assess the common duct. Objective: To determine the frequency of common bile duct dilatation after cholecystectomy for chronic cholecystitis. Study Design: Descriptive study Place and Duration of Study: General Surgery Department, Hayatabad Medical Complex, Peshawar from 1st February 2020 to 31st January 2021. Methodology: Eighty seven patients and age range is 20-60 years booked for cholecystectomy in outpatient department were included and followed up to 6 month to determine the frequency of common bile duct dilatation. Results: The mean age was 38.6±10.3 years with 25 (28.7%) males and 62 (71.2%) females. Mean body mass index of the sample was 25±2.3kg/m2. Sixty (68.9%) underwent laparoscopic cholecystectomy while 17 (19.5%) underwent open cholecystectomy. Mean baseline common bile duct diameter on ultrasound was 1.3±0.1 mm while the mean follow up common bile duct diameter was 1.8±0.2 mm (p&lt;0.001). Common bile duct dilatation was recorded in 20 (22.98%) patients. Conclusion: Common bile duct dilatation after cholecystectomy is controversial, but in asymptomatic patients, a dilation of up to 10mm should be accepted as normal. Keywords: Cholecystectomy, Cholecystitis, Common bile duct dilatation, Body mass index

Importance of shear dilation to two-phase flow in naturally fractured geological media: A numerical study using zero-thickness interface elements

In this paper, a hydro-mechanical coupling model is proposed to investigate the geomechanical effects on two-phase flow in fractured rocks. The discrete fracture model (DFM) and modified Barton-Bandis's model are used to model two-phase fluid flow and mechanical behavior of fractures, respectively. The coupled problem is solved by a mixed finite volume/finite element method, together with the fixed-stress split algorithm. Our model is able to capture the complex coupled behavior induced by the interaction between pore pressure and in-situ stress loadings. Then the proposed model is applied to investigate the two-phase flow behaviors in the fracture networks with different fracture configurations under various in-situ stress conditions. The results illustrate significant influences of shear dilation on the hydraulic properties of fractured rock. With the increase of differential stress, fracture aperture gradually increases due to shear dilation, which accordingly enhances the equivalent permeability of the fractured medium. The degree of shear dilation is highly dependent on the fracture orientation and length distribution. Consequently, channelized flow is formed through the dilated fractures, which results in early water breakthrough and reduces the water sweep efficiency. This study highlights the necessity of considering hydro-mechanical coupling effect for accurate prediction of saturation distributions in fractured rocks.

The Role of Bone Marrow Biopsy Morphology and Clinical Characteristics in Facing the Challenges of Diagnosing Primary Myelofibrosis, Polycythemia Vera, and Essential Thrombocythemia at Cipto Mangunkusumo Hospital

BackgroundMyeloproliferative neoplasm (MPN) is a neoplasm characterized by the proliferation of one or more myeloid cells and their derivatives. The limitations of molecular examination in Indonesia make the diagnosis of MPN based on clinical and histopathological examination very crucial. The aim evaluate the clinicopathological profile of primary myelofibrosis (PMF), polycythemia vera (PV), and essential thrombocythemia (ET) and identify the typical morphological characteristics of bone marrow biopsy.MethodsA retrospective study of cases diagnosed with MPN was conducted at the Department of Anatomic Pathology FMUI/RSCM in 2015-2019. Clinical data and evaluation of bone marrow morphology consisting of cellularity, erythroid myeloid ratio, cluster and megakaryocyte morphology, blast cells, fibrosis, osteosclerosis, and sinus dilatation were analyzed.ResultsA total of 172 cases were diagnosed as MPN BCR-ABL1-negative (PMF: 74; ET: 56; PV: 42). On routine blood examination, there was an increase in hemoglobin (Hb) and hematocrit (Ht) in PV, a decrease in Hb in PMF and an increase in platelets in ET (p&lt;0.001). Splenomegaly is mostly found in PMF. Myeloid erythroid ratio was decreased in PV, normal in ET and increased in PMF (p&lt;0.001). Megakaryocytes were arranged in loose clusters in 88.1% of PV cases and 96.4% of ET, dense clusters were found in 91.9% of PMF cases. Staghorn-like megakaryocytes were found in all ET cases and bulbous/cloud-like megakaryocytes were found in 97.3% of PMF cases. Most cases of PV (90.5%) and all cases of ET showed pre-fibrotic bone marrow (grade 0-1), while 77% of PMF cases showed fibrosis grade 2-3.ConclusionIn diagnosing PV, ET, and PMF, correlation between clinical data, laboratory, and bone marrow histomorphological evaluations, especially cellularity, myeloid:erythroid ratio, cluster and megakaryocyte morphology, degree of fibrosis, osteosclerosis, and sinus dilatation is required.

Pregnancy outcomes of urgent cervical cerclage according to the degree of cervical dilation

Pregnancy outcomes of urgent cervical cerclage according to the degree of cervical dilation

Atrial fibrillation recurrences despite durable pulmonary vein isolation: Characteristics, management and outcomes, the PARTY-PVI study

Recurrences of atrial fibrillation (AF) after pulmonary vein (PV) isolation (PVI) are mainly due to PV reconnections. However, a growing number of patients have recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We aimed at analyzing the impact of various ablation strategies in such patients in the context of a large multicenter study. Patients scheduled for a redo ablation of AF and presenting durable PVI were included in 39 centers. PV-based, linear-based, electrogram-based and trigger-based ablation strategies were compared. A total of 367 patients underwent a redo AF ablation procedure revealing a durable PVI (43.6% paroxysmal AF, 67.0% men, 63.4 ± 10.2 years, CHA2DS2-VASc of 1.7 ± 1.4) between 2010 and 2020. Regarding strategy combinations, 200 (54.5%) patients underwent a single ablation strategy, while 136 (37.1%) and 24 (6.5%) patients underwent a combination of 2 and 3 strategies, respectively. Following the redo ablation procedure, arrhythmia recurrence was observed in 122 patients (33.2%) at 12 months. The recurrence rate was not significantly different between paroxysmal and persistent AF groups (P = 0.120). In multivariate analysis, none of the ablation strategies employed during the redo procedure improved the 12-month arrhythmia-free survival. The degree of left atrial dilatation (HR: 1.36, 95%CI: 1.13–1.65, P = 0.002) was the only independent factor associated with arrhythmia-free survival at 12 months (Fig. 1). In patients with recurrent AF despite durable PVI, no ablation strategy used during the redo procedure appears to be superior in improving the 12-month atrial arrhythmia free survival. The AF recurrence rate was the same whether the patient presented with a paroxysmal or persistent form of AF. Left atrial size is a major predictive factor of the arrhythmia-free survival in this population.

Value of contrast-enhanced ultrasound in the differential diagnosis of ureteral tuberculosis from ureteral malignant tumour in women.

This study aimed to evaluate the contrast-enhanced ultrasound (CEUS) features of ureteral tuberculosis (UTB) and ureteral malignant tumour and to explore its application value in the differentiation of UTB from ureteral tumour. The ultrasound (US) and CEUS imaging features of 33 and 12 cases of pathologically confirmed UTB and ureteral malignant tumour, respectively, were retrospectively evaluated, and echo of the ureteral wall, abnormal echo of the lumen, degree of ureteral dilation and CEUS patterns of the two diseases were statistically analysed. The results revealed that the lumen echo of UTB was hyperechoic or anechoic, whereas that of ureteral tumour lesions was hypoechoic (χ2 = 28.22, P < 0.001). The wall echo of the obstruction site differed between the two diseases; in UTB, the ureteral wall was thickened but the outer wall remained intact, whereas in ureteral tumour, both the malignant tumour wall and outer wall were irregular (χ2 = 30.25, P < 0.001). CEUS of UTB revealed nonenhancement or heterogeneous enhancement in the lumen, whereas that of ureteral tumours revealed significant homogeneous enhancement (χ2 = 30.25, P < 0.001). Thus, CEUS can reveal lesion microcirculation and be used to evaluate blood supply characteristics in the lesion, indicating that it has high potential for differentiating the two diseases.

Understanding Peat Soil Deformation and Mechanisms of Peat Collapse Across a Salinity Gradient in the Southwestern Everglades

AbstractSaltwater intrusion is a significant threat to the structure and ecology of inland and coastal freshwater wetlands, altering biogeochemical cycling and disrupting important ecosystem services. As sea level rises along the Florida coast, the saltwater interface progressively moves further inland reaching freshwater soils previously unexposed to saltwater. One result of this soil salinization is a phenomenon called peat collapse which is currently observable along the South Florida coastline. While previous studies have proposed conceptual models to explain peat collapse many uncertainties still exist regarding the physical mechanisms that trigger this phenomenon. In this study we use a unique combination of laboratory and field‐based measurements using geophysical methods, deformation rods, gas traps, time‐lapse photography, and hydraulic conductivity measurements to investigate the effects of salinization on the physical properties of peat soils across a salinity gradient in the southwestern Everglades. Our results show that freshwater peat soils have about three times greater degree of pore dilation when compared to peat soils previously exposed to saltwater conditions. Differences in soil surface deformation were also observed and related to differences in the soil matrix physical integrity across the salinity gradient. This work also uses electrical resistivity imaging surveys to image areas of peat collapse and demonstrates: (a) the role of salinity in the development of collapse features; and (b) the apparent lack of evidence to suggest subsurface lithological controls on the development of collapse features. A simplified conceptual framework for better understanding peat collapse and pock formation is presented.

Predictors of right atrial dilatation and long-term function after right ventricular outflow tract surgical repair: Quantification of restrictive physiology matters

Right ventricular (RV) diastolic dysfunction in patients with a surgically-repaired RV outflow tract (RVOT) obstruction merits further studies. Right atrial (RA) dilation and function may be related to (RV) diastolic dysfunction in this setting. The end-diastolic forward flow (EDFF) in the pulmonary artery (PA) has been suggested as a non-invasive marker of poor RV compliance, however, there is controversy regarding its true significance; EDFF quantification may help elucidate this controversy. Objectiveto study predictors of RA enlargement and dysfunction in patients with a surgically-repaired RVOT obstruction and its relationship with quantitative EDFF. MethodsIn 81 consecutive patients (mean age: 37.5 (±7) years), transthoracic echocardiography (Echo) and cardiac magnetic resonance (CMR) were performed. Echo parameters: RA size (indexed RA area (iRAA)), RA function (RA global strain (RAGS)) and maximum EDFF velocity-time integral (VTI-EDFF) obtained during a whole respiratory cycle. CMR-indexed RA area (imRAA) was also obtained. Patients were divided into three groups according to iRAA, imRAA and RAGS; bivariate analysis was performed. A multivariate model was then applied using variables that were found to be statistically significant in the bivariate analysis. ResultsUpon multivariate analysis, higher VTI-EDFF values and the presence of significant tricuspid regurgitation proved to be independent factors associated with increased iRAA and imRAA and lower RAGS, whereas RV volumes, function and pulmonary regurgitant fraction were not. ConclusionVTI-EDFF linearly correlated with the degree of RA dilation and deformation; EDFF quantification as against qualitative assessment may be considered a non-invasive tool for diastolic RV dysfunction.

Dilated Optic Nerve Sheath in Mucopolysaccharidosis I: Common and Not Necessarily High Intracranial Pressure.

Hydrocephalus is one of the earliest manifestations of mucopolysaccharidosis I-Hurler syndrome, and delayed treatment of hydrocephalus can lead to neurocognitive delay or even death. Optic nerve sheath diameter has been established as a noninvasive measurement to detect elevated intracranial pressure. This study aimed to establish correlations between optic nerve sheath diameter and opening pressure. Forty-nine MR images and opening pressures in patients with mucopolysaccharidosis I-Hurler syndrome were retrospectively reviewed from 2008 to 2020. The optic nerve sheath diameter was measured 3 mm posterior to the posterior margin of the globe (retrobulbar) and 10 mm anterior to the optic foramen (midpoint segment), and the average was taken between the 2 eyes. Opening pressure was measured with the patient in the lateral decubitus position with controlled end-tidal CO2 on the same day as the MR imaging. The average retrobulbar optic nerve sheath diameter was 5.33 mm, higher than the previously reported measurement in healthy controls, in patients with idiopathic intracranial hypertension, and there was a positive correlation between age and the optic nerve sheath diameter measured at the retrobulbar or midpoint segment (retrobulbar segment, R 2 = 0.27, P < .01; midpoint segment, R 2 = 0.20, P < .01). However, there was no correlation between retrobulbar or midpoint segment optic nerve sheath diameter and opening pressure (retrobulbar segment, R 2 = 0.02, P = .17; midpoint segment, R 2 = 0.03, P < .12). This study shows a higher average optic nerve sheath diameter in patients with mucopolysaccharidosis I-Hurler syndrome than in healthy controls regardless of the location of the measurement. However, the degree of optic nerve sheath dilation does not correlate with opening pressure, suggesting that increased optic nerve sheath diameter is an ocular manifestation of mucopolysaccharidosis I-Hurler syndrome itself rather than a marker of elevated intracranial pressure.

A single-center study of two types of upper kidney preservation surgery for complete duplicated kidney in children.

The objectives of this study were to compare the efficacy, advantages, and disadvantages of insertable ureteral reimplantation (UC group) and ureteral end-to-side anastomosis (UU group) in the treatment of duplicated kidney and summarize the clinical experience in its diagnosis and treatment. The current retrospective study enrolled 20 cases with duplicated kidney in Anhui Provincial Children's Hospital from April 2016 to June 2021, including 11 in the UC group and 9 in the UU group. There were 8 boys and 12 girls, with 12 on the left side and 8 on the right side. Meanwhile, there were three cases with urinary tract infection and nine with urinary incontinence. The rest of them were found by B ultrasound during physical examination. The median age of these patients was 33.5 months. Later, preoperative and postoperative renal pelvis separation, ureteral dilation, operation time, and drainage tube indwelling time were compared between the two groups. There were statistically significant differences in operation time (282 ± 50.55 vs. 176 ± 61.92, P = 0.03), drainage time (9.36 ± 5.00 vs. 5.33 ± 1.22, P = 0.02), and hospital stay (22.18 ± 5.40 vs. 14.78 ± 5.33, P = 0.007) between the two groups. In addition, the degree of hydronephrosis (UC: 1.86 ± 0.93 vs. 1.08 ± 0.77, P = 0.00; UU: 1.8 ± 0.95 vs. 0.89 ± 0.60, P = 0.02) and ureteral dilatation (UC: 1.57 ± 0.30 vs. 0.72 ± 0.22, P = 0.00; UU: 1.47 ± 0.50 vs. 0.88 ± 0.22, P = 0.001) were statistically different between the two groups before and after surgery. Compared with the UC method, the UU method has the advantages of less trauma, faster recovery, and fewer complications. Double J tube or ureter stent placement is beneficial for finding and protecting the lower ureter intraoperatively, without increasing the difficulty in operation, which can also prevent anastomosis or ureteral orifice stenosis.

Influence of pneumoperitoneum and head-down maneuver on the cerebral microvasculature in rabbits

BackgroundWith recent advances in robot-assisted techniques, an increasing number of surgeries are being performed with pneumoperitoneum and head-down maneuver (HDM) that may affect the cerebral microcirculation. For the first time, this study investigated the direct influence of pneumoperitoneum and HDM on the cerebral microvasculature in rabbits.MethodsAdult male rabbits were randomly allocated to the following groups (n = 7 each): control, pneumoperitoneum alone (P), and pneumoperitoneum with HDM (P + HDM) for 120 min. A closed cranial window was installed above the parietal bone to visualize the pial microvasculature. Pial arteriolar diameter and hemodynamic and blood gas parameters were measured during the 140-min observation period. Brain edema was assessed by evaluation of the brain water content at the end of the experiment.ResultsRabbits in the P and P + HDM groups exhibited a similar degree of immediate pial arteriolar dilation following the initiation of both P and P + HDM (P: 1.11 ± 0.03, p = 0.0044 and P + HDM: 1.07 ± 0.02, p = 0.0004, relative changes from the baseline value by defining the baseline as one). In the P + HDM group, pial arteriole diameter returned to the baseline level following the discontinuation of pneumoperitoneum and HDM (1.05 ± 0.03, p = 0.0906, vs. baseline). In contrast, the pial arterioles remained dilated as compared to the baseline level in the P group after discontinuation of pneumoperitoneum. There were no changes in pial arteriole diameter in the animals in the control group. Heart rate, blood gas parameters, and brain water content were not significantly different between the groups.ConclusionThe pial arterioles dilated immediately after pneumoperitoneum with or without HDM. The pial arterioles remained dilated 20 min after discontinuation of pneumoperitoneum alone but constricted upon discontinuation of pneumoperitoneum plus HDM. Pneumoperitoneum and HDM for 2 h did not cause brain edema.

Tricuspid surgery at the time of LVAD implant: A critique.

Tricuspid regurgitation (TR) is a common finding in patients with end stage heart failure referred for implantation of left ventricular assist devices. While functional TR frequently resolves after left ventricular unloading, patients with residual and progressive TR demonstrate increased rates of RV dysfunction and poor survival. Criteria for intervention on the tricuspid valve have focused on the degree of tricuspid annular dilatation and the severity of tricuspid regurgitant volume. The surgical decision making regarding intervention on the tricuspid valve remains obscure and historical cohort data cannot distinguish cause from effect.

Quantitative assessment of transmural fibrosis profile in the human atrium: evidence for a three-dimensional arrhythmic substrate by slice-to-slice histology.

Intramural fibrosis represents a crucial factor in the formation of a three-dimensional (3D) substrate for atrial fibrillation (AF). However, the transmural distribution of fibrosis and its relationship with atrial overload remain largely unknown. The aim of this study is to quantify the transmural profile of atrial fibrosis in patients with different degrees of atrial dilatation and arrhythmic profiles by a high-resolution 3D histology method. Serial microtome-cut tissue slices, sampling the entire atrial wall thickness at 5 µm spatial resolution, were obtained from right atrial appendage specimens in 23 cardiac surgery patients. Atrial slices were picrosirius red stained, imaged by polarized light microscopy, and analysed by a custom-made segmentation algorithm. In all patients, the intramural fibrosis content displayed a progressive decrease alongside tissue depth, passing from 68.6 ± 11.6% in the subepicardium to 10-13% in the subendocardium. Distinct transmural fibrotic profiles were observed in patients with atrial dilatation with respect to control patients, where the first showed a slower decrease of fibrosis along tissue depth (exponential decay constant: 171.2 ± 54.5 vs. 80.9 ± 24.4 µm, P < 0.005). Similar slow fibrotic profiles were observed in patients with AF (142.8 ± 41.7 µm). Subepicardial and midwall levels of fibrosis correlated with the degree of atrial dilatation (ρ = 0.72, P < 0.001), while no correlation was found in subendocardial layers. Quantification of fibrosis transmural profile at high resolution is feasible by slice-to-slice histology. Deeper penetration of fibrosis in subepicardial and midwall layers in dilated atria may concur to the formation of a 3D arrhythmic substrate.

Effectiveness of ultrasound-guided percutaneous transhepatic biliary drainage to reduce radiation exposure: A single-center experience.

Percutaneous transhepatic biliary drainage (PTBD) has been an effective treatment to access the biliary tree, especially in case of endoscopically inaccessible biliary tree. In general, PTBD techniques are divided into two methods: fluoroscopy-guided PTBD and ultrasound (US)-guided PTBD. This study aimed to evaluate the effectiveness of US-guided PTBD, focusing on radiation exposure according to intrahepatic duct (IHD) dilatation degree, differences between right- and left-sided approaches and differences between benign and malignant biliary stenosis/obstruction. We evaluated technical success, clinical success, procedural data (the number of liver capsule punctures, procedural time, fluoroscopy time and radiation dose), and procedure-related complications. During the study period, a total of 123 patients with biliary stenosis/obstruction or bile leakage were initially eligible. We excluded 76 patients treated with only ERCP or initially treated with ERCP followed underwent PTBD insertion. Finally, a total of 50 procedures were performed in 47 patients. Of the 47 patients, 8 patients had anatomical alteration due to previous surgery, 6 patients refused ERCP, and 3 patients failed ERCP. For the remaining 30 patients, PTBD was performed on weekend or at night, 11 of whom had poor general condition, 10 patients underwent ERCP 3 to 4 days later after PTBD insertion, 6 patients improved after PTBD insertion without ERCP, 1 patient died, and 1 patient was referred to other hospital. Remaining 1 patient underwent surgery due to Mirizzi syndrome. All procedures were performed by two interventional radiologists. Technical success rate was 100%, clinical success was 94%, and the complication rate was 10%. Fluoroscopy time and the reported radiation dose were significantly lower in patients with dilated bile ducts than in those with non-dilated bile ducts, when biliary puncture under US guidance was performed initially. However, even in patients with non-dilated bile ducts undergoing initial trials of biliary puncture under US guidance, the fluoroscopy time and the reported radiation dose were low, based on current studies. No statistical significant differences were observed in terms of technical and dosimetry results according to right-sided and left-sided procedures and benign and malignant biliary stenosis/obstruction. Thus, US-guided PTBD was found to be a safe and effective technique that significantly reduced fluoroscopy time and radiation doses.