Portion Of Wall Research Articles

Left ventricular noncompaction\u2014a rare cause of triad: heart failure, ventricular arrhythmias, and systemic embolic events: a\xa0case report\xa0

BackgroundLeft ventricular noncompaction is a rare cardiomyopathy characterized by a thin, compacted epicardial layer and a noncompacted endocardial layer, with trabeculations and recesses that communicate with the left ventricular cavity. In the advanced stage of the disease, the classical triad of heart failure, ventricular arrhythmia, and systemic embolization is common. Segments involved are the apex and mid inferior and lateral walls. The right ventricular apex may be affected as well.Case presentationA 29-year-old Caucasian male was hospitalized with dyspnea and fatigue at minimal exertion during the last months before admission. He also described a history of edema of the legs and abdominal pain in the last weeks. Physical examination revealed dyspnea, pulmonary rales, cardiomegaly, hepatomegaly, and splenomegaly. Electrocardiography showed sinus rhythm with nonspecific repolarization changes. Twenty-four-hour Holter monitoring identified ventricular tachycardia episodes with right bundle branch block morphology. Transthoracic echocardiography at admission revealed dilated left ventricle with trabeculations located predominantly at the apex but also in the apical and mid portion of lateral and inferior wall; end-systolic ratio of noncompacted to compacted layers > 2; moderate mitral regurgitation; and reduced left ventricular ejection fraction. Between apical trabeculations, multiple thrombi were found. The right ventricle had normal morphology and function. Speckle-tracking echocardiography also revealed systolic left ventricle dysfunction and solid body rotation. Abdominal echocardiography showed hepatomegaly and splenomegaly. Abdominal computed tomography was suggestive for hepatic and renal infarctions. Laboratory tests revealed high levels of N-terminal pro-brain natriuretic peptide and liver enzymes. Cardiac magnetic resonance evaluation at 1 month after discharge confirmed the diagnosis. The patient received anticoagulants, antiarrhythmics, and heart failure treatment. After 2 months, before device implantation, he presented clinical improvement, and echocardiographic evaluation did not detect thrombi in the left ventricle. Coronary angiography was within normal range. A cardioverter defibrillator was implanted for prevention of sudden cardiac death.ConclusionsLeft ventricular noncompaction is rare cardiomyopathy, but it should always be considered as a possible diagnosis in a patient hospitalized with heart failure, ventricular arrhythmias, and systemic embolic events. Echocardiography and cardiac magnetic resonance are essential imaging tools for diagnosis and follow-up.

Creation of a High Fidelity, Cost Effective, Real World Surgical Simulation for Surgical Education

Background How do surgical residents learn to operate? What is a surgical plane? How does one learn to see and dissect the plane? How do surgical residents learn tissue handling and suturing (sewing)? One method to learn and practice performing surgery is through the use of simulation training. Surgical training models include laparoscopic box trainers (a plastic box with holes for instruments) with synthetic materials inside to simulate tissues, or computer-based virtual reality simulation for laparoscopic, endoscopic, and robotic techniques. These methods, however, do not use real tissues. They lack the haptic and kinesthetic feedback of real tissue. These simulations fail to recreate the fidelity of soft tissues, do not foster the ability to accurately see surgical planes, do not accurately mimic the act of dissecting surgical planes, do not allow for complex surgical procedures, and do not provide accurate experience to learn tissue handling and suturing. Despite their poor performance, these plastic and virtual trainers are extremely costly to purchase, maintain, and keep up to date - with prices starting at $700 for basic plastic training boxes to thousands of dollars for virtual simulation. Also, there are additional costs of maintenance and software curriculum. Despite the cost of software, virtual simulators do not include a simulation for every surgery. Our aim was to create a life-like surgical simulation as close to real world as possible that allows trainees to learn how to see and dissect surgical planes, learn how soft tissues move, and learn the dynamics of soft tissue manipulation. We created a laparoscopic simulator using porcine tissues for gallbladder removal, acid reflux surgery, and surgery to treat swallowing difficulties (cholecystectomy, Nissen fundoplication, and Heller myotomy, respectively). Second year general surgery residents were able to practice these procedures on real tissues, enabling them to learn the steps of each procedure, increase manual dexterity, improve use of laparoscopic equipment, all while maintaining life-like haptic, soft-tissue feedback and enabling them to develop the ability to see real surgical planes. Methods The abdomen was recreated by purchasing intact porcine liver, gallbladder, (Cholecystectomy simulation) and intact esophagus, stomach, and diaphragm (Nissen and Heller simulation) from a packing supplier. Each organ system was placed into a laparoscopic trainer box with the ability to re-create laparoscopic ports. Surgical residents were then able to perform the procedures using real laparoscopic instruments, laparoscopic camera/video imaging, and real-time electrocautery. The simulation included all critical steps of each procedure such as obtaining the critical view of safety and removing the gallbladder from the liver bed (cholecystectomy), wrapping the stomach around the esophagus and laparoscopic suturing (Nissen fundoplication), and dissecting the muscular portion of the esophageal wall (Heller myotomy). Because these porcine tissues were readily available, several stations were set-up to teach multiple residents during each session (10-12 residents / session). Discussion Surgeons develop haptic perception of soft tissues by cutaneous or tactile feedback and kinesthetic feedback (Okamura, 2009). Kinesthetic feedback is the force and pressure transmitted by the soft tissues along the shaft of the laparoscopic instruments (Okamura, 2009). This soft tissue simulation re-creates the ability to experience what soft tissue feedback feels like, outside a normal operative environment. Real tissue learning allows trainees to learn how to see surgical planes, learn how soft tissues feel and move, develop proficiency in surgical dissection, and learn how to suture laparoscopically. This is the only model that recreates the movement of soft tissues and visualization of dissection planes outside the operative environment. Because this model utilizes the laparoscopic instruments used in the operating room, residents also develop familiarity with laparoscopic instruments, thus, flattening another learning curve. A literature review found that this is the only real tissue simulation being performed for foregut procedures used specifically for resident training. By building a realistic, anatomical model with inherent accurate soft tissue surgical planes, surgical trainees can have a more realistic surgical experience and develop skills in a safe, low pressure environment without sacrificing the hepatic learning and surgical visualization that is critical to performing safe laparoscopic surgery. All residents that participated in the stimulation reported positive feedback and felt that is contributed to their surgical education.

Effects of Arabidopsis wall associated kinase mutations on ESMERALDA1 and elicitor induced ROS.

Angiosperm cell adhesion is dependent on interactions between pectin polysaccharides which make up a significant portion of the plant cell wall. Cell adhesion in Arabidopsis may also be regulated through a pectin-related signaling cascade mediated by a putative O-fucosyltransferase ESMERALDA1 (ESMD1), and the Epidermal Growth Factor (EGF) domains of the pectin binding Wall associated Kinases (WAKs) are a primary candidate substrate for ESMD1 activity. Genetic interactions between WAKs and ESMD1 were examined using a dominant hyperactive allele of WAK2, WAK2cTAP, and a mutant of the putative O-fucosyltransferase ESMD1. WAK2cTAP expression results in a dwarf phenotype and activation of the stress response and reactive oxygen species (ROS) production, while esmd1 is a suppressor of a pectin deficiency induced loss of adhesion. Here we find that esmd1 suppresses the WAK2cTAP dwarf and stress response phenotype, including ROS accumulation and gene expression. Additional analysis suggests that mutations of the potential WAK EGF O-fucosylation site also abate the WAK2cTAP phenotype, yet only evidence for an N-linked but not O-linked sugar addition can be found. Moreover, a WAK locus deletion allele has no effect on the ability of esmd1 to suppress an adhesion deficiency, indicating WAKs and their modification are not a required component of the potential ESMD1 signaling mechanism involved in the control of cell adhesion. The WAK locus deletion does however affect the induction of ROS but not the transcriptional response induced by the elicitors Flagellin, Chitin and oligogalacturonides (OGs).

Seismic Response of Byzantine Land Walls and Restoration Approaches

ABSTRACT A portion of Byzantine land walls from “Mevlanakapi” to “Belgradkapi”, part of Theodosian walls, is surveyed by laser scanners for recording the current condition and for identification of the damage levels towards the establishment of restoration approaches. Based on the failure mechanism of the structure and review of the earlier restorations, a restoration approach with minimum interventions to the historic structure is established. A parametric study is also performed to identify the seismic response of towers based on nonlinear static pushover analysis, and the simplified charts are presented for a simpler implementation of a diaphragm as a restoration strategy for towers.

Occult parotid involvement in early-stage squamous cell carcinoma of the external auditory canal.

The importance of elective parotidectomy in early-stage squamous cell carcinoma (SCC) of the external auditory canal (EAC) is not well established. A retrospective study of 43 patients with early-stage SCC of the EAC who underwent parotidectomy in conjunction with lateral temporal bone resection at three centers. Overall occult parotid involvement (OPI) rate in early-stage SCC of the EAC was 13.9% (6/43). When considering both the anteroposterior position and the bony-cartilaginous position, patients with SCC in both the anterior wall and cartilaginous portion exhibited significantly higher OPI than other locations (37.5% vs. 0%, p=0.001), with an increase in the OPI predictive value. SCC located in either the anterior wall of the EAC or the cartilaginous portion of the EAC or both simultaneously showed a high prevalence of OPI, and elective parotidectomy should be considered in those patients.

Overexpression of a Sugarcane BAHD Acyltransferase Alters Hydroxycinnamate Content in Maize Cell Wall.

The purification of hydroxycinnamic acids [p-coumaric acid (pCA) and ferulic acid (FA)] from grass cell walls requires high-cost processes. Feedstocks with increased levels of one hydroxycinnamate in preference to the other are therefore highly desirable. We identified and conducted expression analysis for nine BAHD acyltransferase ScAts genes from sugarcane. The high conservation of AT10 proteins, together with their similar gene expression patterns, supported a similar role in distinct grasses. Overexpression of ScAT10 in maize resulted in up to 75% increase in total pCA content. Mild hydrolysis and derivatization followed by reductive cleavage (DFRC) analysis showed that pCA increase was restricted to the hemicellulosic portion of the cell wall. Furthermore, total FA content was reduced up to 88%, resulting in a 10-fold increase in the pCA/FA ratio. Thus, we functionally characterized a sugarcane gene involved in pCA content on hemicelluloses and generated a C4 plant that is promising for valorizing pCA production in biorefineries.

Assessing event magnitude and target water depth for marine-target impacts: Ocean resurge deposits in the Chicxulub M0077A drill core compared

The rim wall of water formed from even a modestly-sized marine impact may be kilometers in height. Although modeling has shown that this wave swiftly breaks and relatively rapidly loses energy during outwards travel from the impact site, the portion of the rim wall that collapses inwards may generate a resurge flow with tremendous transport energy. Here we compare the deposits generated by this ocean resurge inside one of the largest marine-target craters on Earth, the 200-km wide Chicxulub crater, Yucatán Peninsula, México, with resurge deposits (breccias) in eight drill cores from five other marine-target craters in Sweden and the United States. Examination of the wide range of cored locations within the craters, and target water depths (H) relative to modeled projectile diameters (d) reveal a high correlation between location, average clast frequency (〈N〉), and d/H from which any of the four variables can be obtained. The relationship shown here may provide an important tool for diagnosing marine impact cratering processes where there is limited understanding of crater size and/or paleobathymetry.

Intramyocardial Mass with an Echo-Free Center as an Echocardiographic Presentation of Hypertrophic Cardiomyopathy.

A 43-year-old man presented to the emergency department with atypical chest pains. Physical examinations yielded no significant findings. Serial electrocardiography and high-sensitivity troponin measurements were normal. Transthoracic echocardiography in the emergency department revealed increased septal wall thickness; therefore, the patient was referred to the echocardiography ward for further evaluation. The echocardiographic findings were normal, except for an intramyocardial mass with an echo-free center in the base-to-mid portion of the inferior and inferoseptal walls (Figures 1. A, B & C). Additionally, the base and mid portions of the anteroseptal wall were hypertrophied. Cardiac magnetic resonance imaging demonstrated myocardial hypertrophy in the base and mid portions of the anteroseptal, inferoseptal, and inferior walls (Figures 2. A, B, C, D & E), as well as a patchy mid-wall appearance of late gadolinium enhancement, at the anterior and posterior junction of the right ventricle to the left ventricle (Figures 2. F, G & H). The findings were typical of hypertrophic cardiomyopathy.What was revealed in the late gadolinium-enhanced images was compatible with the echo-free space in echocardiography. Otherwise speaking, the cardiac magnetic resonance images delineated the background pathology (hypertrophic cardiomyopathy) and revealed fibrosis as the etiology of the echo-free space in echocardiography. Holter monitoring of electrocardiography was unremarkable. To our knowledge, intramyocardial masses with echo-free centers as an echocardiographic presentation of hypertrophic cardiomyopathy have not been reported yet. Accordingly, in the differential diagnosis of the aforementioned echocardiographic findings, hypertrophic cardiomyopathy should be included. Cardiac magnetic resonance imaging in this condition is helpful.

Platelet rich plasma in management of anosmia

Background: Anosmia is a loss of sense of smell that means inability to perceive odors. Functional anosmia is loss of smell due to nasal obstruction while organic anosmia is due to damage of the peripheral olfactory area causing permanent loss of smell as post-traumatic anosmia. Objectives: A diagnostic approach to detect the effect of platelet-rich plasma (PRP) injection in the olfactory area as a treatment for anosmia. Study design and methodology: A prospective study was done in otorhinolaryngology department, Aswan university hospital from June 2018 to August 2019, 80 patients were fulfilling the inclusion criteria presented with anosmia were enrolled from otorhinolaryngology outpatient to share in this study. Approximately an amount of 1mL of PRP was injected in each nasal cavity in the olfactory area (located on superior turbinate and superior portion of lateral and medial walls of nasal cavity) guided by nasal endoscope. The procedure is done with follow-up of patients after 1 month. Results: Results of our study revealed that 46 out of 80 patients (57.5%) said that “their smell came back” while 34 out of 80 patients (42.5%) showed no improvement, thus these results show no statistical significance between proportion in a group showing improvement and proportion in the group showing no improvement. 5 patients with idiopathic anosmia improved with 100% ratio. Conclusion: Although there is no statistical significance difference between the two groups of patients all patients with idiopathic anosmia were improved.

Performance of a Solar Chimney for Cooling Building Façades under Different Heat Source Distributions in the Air Channel

Solar chimneys can be employed in buildings for natural ventilation, cooling, or heating of the building envelope, hence saving energy. In open double-skin facades, the air channel's thermal effects between the two layers of a faí§ade are similar to those in a solar chimney. Most studies about solar chimney in the literature have been focusing on heating one air channel wall. In this study, the performance of a solar chimney under different distributions of the heat source on both walls of the air channel was studied numerically by the Computational Fluid Dynamics method. Induced flow rate, temperature rise, and thermal efficiency of the chimney were investigated. Chimneys with practical dimensions with the height ranging from 0.5 m to 1.5 m and the gap-to-height ratio ranging from 0.025 to 0.15 were examined. The results showed that together with the chimney's dimensions, location, and distribution of the heat source on the channel's walls strongly affect the performance of the chimney. While heating the whole left wall induced more flowrate than heating the whole right wall, heating part of the left and the right walls resulted in peak performance at specific portions of the right wall heated from the bottom or the top of the channel. The peak values of the investigated parameters and the specific portions of the heated wall to achieve those peaks also changed with the channel's gap-to-height ratio.

Prefabricated Urban Underground Utility Tunnels: A Case Study on Mechanical Behaviour with Strain Monitoring and Numerical Simulation

The prefabricated urban utility tunnels (UUTs) have many advantages such as short construction period, low cost, high quality, and small land occupation. However, there is still a lack of in‐depth analysis of the mechanical performance of the prefabricated urban utility tunnel (UUT) structure with bolted connections under different working conditions. In this paper, the force performance of a prefabricated UUT in Tongzhou District, Beijing, was studied under different working conditions using two methods: field monitoring and numerical simulation. The multichannel strain monitor was used for monitoring, and the internal wall concrete and bolt strain change data under the two conditions of installation and backfill were obtained. Combined with the construction process of the UUTs, a three‐dimensional numerical model was established by COMSOL, where the build‐in bolt assembly was used to simulate the longitudinal connection of the tunnel. The simulation results were compared with the measured data to verify the rationality of the computational model. The simulation results showed that the concrete and bolts on the inner wall of the tunnel work well under the two conditions of installation and backfilling; The deformation of the top plate of the prefabricated tunnel was approximately parabolic, with the largest vertical displacement (0.37 mm) in the middle and the most sensitive to the vertical load in the central part of the roof. The central portion of the side wall had the largest displacement (0.17 mm) in the inner concave. The tensile stress of bolt 3 increased the most (30.75 MPa) but was still much smaller than the yield strength of the bolt. The concrete and bolts of the UUT were found to work well through force analysis under operating conditions. In conclusion, analysis of structural forces and deformation failure modes will help design engineers understand the basic mechanisms and select the appropriate UUT structure.

Arabinogalactan-proteins

Arabinogalactan-proteins (AGPs) are highly glycosylated proteins (glycoproteins) found in the cell walls of plants. AGPs account for only a small portion of the cell wall, usually no more than 1% of dry mass of the primary wall. AGPs are members of the hydroxyproline-rich glycoprotein (HRGP) superfamily that represent a large and diverse group of glycosylated wall proteins. AGPs have attracted considerable attention due to their highly complex structures and potential roles in signalling. In addition, they have industrial and health applications due to their chemical/physical properties (water-holding, adhesion and emulsification). Glycosylation can account for more than 90% of the total mass. AGPs have been reported in a wide range of higher plants in seeds, roots, stems, leaves and inflorescences. They have also been reported in secretions of cell culture medium of root, leaf, endosperm and embryo tissues, and some exudate producing cell types such as stylar canal cells are capable of producing lavish amounts of AGPs.

A novel mouse wound model for scar tissue formation in abdominal muscle wall.

Hypertrophic scars found on the human body rarely develop in experimental animals, possibly due to their looser skin structure. This makes it difficult to understand the genesis of scar lesions. Therefore, appropriate animal models are urgently needed. In this study, we established a novel experimental model of a scar-forming wound by resecting a small portion of the abdominal muscle wall on the lower center of the abdomen in C57BL/6N mice, which are exposed to contractive forces by the surrounding muscle tissue. As a low-tension control, a back skin excision model was used with a splint fixed onto the excised skin edge, and granulation tissue formed on the muscle fascia supported by the back skeleton. One week after the resection, initial healing reactions, such as fibroblast proliferation, occurred in both models. However, after 21 days, lesions with collagen-rich granulation tissues, which were also accompanied by multiple nodular/spherical-like structures, developed only in the abdominal wall model. These lesions were analogous to scar lesions in humans. Therefore, the animal model developed in this study is unique in that fibrous scar tissues form under physiological conditions without using any artificial factors and is valuable for studying the pathogenesis and preclinical treatment of scar lesions.

Standardised computed tomographic assessment of left atrial morphology and tissue thickness in humans.

AimsLeft atrial (LA) remodelling is a common feature of many cardiovascular pathologies and is a sensitive marker of adverse cardiovascular outcomes. The aim of this study was to establish normal ranges for LA parameters derived from coronary computed tomographic angiography (CCTA) imaging using a standardised image processing pipeline to establish normal ranges in a previously described cohort.MethodsCCTA imaging from 193 subjects recruited to the Budapest GLOBAL twin study was analysed. Indexed LA cavity volume (LACVi), LA surface area (LASAi), wall thickness and LA tissue volume (LATVi) were calculated. Wall thickness maps were combined into an atlas. Indexed LA parameters were compared with clinical variables to identify early markers of pathological remodelling.ResultsLACVi is similar between sexes (31 ml/m2 v 30 ml/m2) and increased in hypertension (33 ml/m2 v 29 ml/m2, p = 0.009). LASAi is greater in females than males (47.8 ml/m2 v 45.8 ml/m2 male, p = 0.031). Median LAWT was 1.45 mm. LAWT was lowest at the inferior portion of the posterior LA wall (1.14 mm) and greatest in the septum (median = 2.0 mm) (p < 0.001). Conditions known to predispose to the development of AF were not associated with differences in tissue thickness.ConclusionsThe reported LACVi, LASAi, LATVi and tissue thickness derived from CCTA may serve as reference values for this age group and clinical characteristics for future studies. Increased LASAi in females in the absence of differences in LACVi or LATVi may indicate differential LA shape changes between the sexes. AF predisposing conditions, other than sex, were not associated with detectable changes in LAWT.Clinical trial registration:http://www.ClinicalTrials.gov/NCT01738828.

Analysis of the Formation of an Aneurysm in Arteries Through Finite Element Modeling Using Hyper-Elastic Model

This paper presents the stress patterns and deformation in an artery with an aneurysm under a variation of pressure. An aneurysm occurs when a weak portion of artery wall bulges out under pressure. To make a proper treatment decision, one must understand the formation and growth of the condition. In this article, finite element analysis of the formation of fusiform aneurysms in arteries is presented using the hyperelastic material model by employing ANSYS. We present the effect of different blood pressures in the deformation of the weakened arterial wall and also compare it with a normal artery. This work can be used as a reference for research in this area.

S2332 Complete Occlusion of the Common Bile Duct Due to Erosion of a Gastroduodenal Artery Coil

INTRODUCTION: Endoscopic intervention remains the first-line method for treating upper gastrointestinal bleeding. In the case of bleeding duodenal ulcers and failed endoscopic hemostasis, visceral artery embolization has become standard of care at many centers because of its high efficacy and minimal side-effect profile. We present a patient who presented with ascending cholangitis due to complete occlusion of the CBD after migration of a gastroduodenal (GDA) coil. CASE DESCRIPTION/METHODS: 53-year-old male with history of duodenal ulceration and massive hemorrhage status post graham patch repair and suture ligation of the GDA followed by elective embolization of the GDA, complicated by disruption of the common bile duct (CBD) and hepatic artery hemorrhage status post stenting, presented 30 months after GDA embolization with transaminitis and recent hospitalization with Klebsiella bacteremia of unclear etiology. Subsequent outpatient ERCP revealed complete obstruction of the CBD at the level of the GDA coils. Manipulation of wires allowed for passage through a fistula that ended on the bulb side of the pylorus. Cholangioscopy revealed erosion of nearly the entire GDA coil into the bile duct entrapping multiple portions of the biliary wall. Various sites were probed with wire but without ability to pass. Patient was referred for percutaneous biliary tube placement and initial plan was to repeat ERCP after PTC to try to pull coils out of the duct with forceps. However, subsequent cholangiogram and intervention resulted in successful recanalization of distal CBD obstruction and placement of internal/external biliary drain. Intraluminal portion of the coil pack had migrated into the duodenum and was removed. A 10 mm × 60 mm covered stent was positioned under fluoroscopic guidance to reconnect the ducts. DISCUSSION: Percutaneous endovascular embolization is generally safe and capable of achieving hemostasis in 93% of emergent cases of GI bleeding nonamenable to endoscopic therapy. Coil migration causing biliary obstruction, although rare, has been previously reported including a few case reports involving the embolization of the hepatic arteries and one case in the English literature involving the GDA. ERCP with removal of the coils is the best management. When ERCP fails, as in our case, decompression of the biliary system by PTC or surgery should be considered.Figure 1.: ERCP showing GDA coils in the CBD.Figure 2.: ERCP cholangiogram showing complete obstruction of the CBD.Figure 3.: IR Cholangiogram showing recanalization of CBD.

Resección endoscópica transmural del colon. Reporte de tres casos

Introduction. Endoscopic Full-thickness Resection (EFTR) consists of the full-thickness resection of a limited portion of the digestive wall immediately followed by defect closure. This technique has been proposed for the resection of selected lesions not amenable to conventional endoscopic resection. Objective. The aim of this work is to describe the first three cases of colonic EFTR performed in Argentina. Material and methods. Three patients are described, one with a laterally spreading tumor of approximately 35-40 mm (n = 1) and two with an incomplete adenoma resection with a scar and a non-lifting sing (n = 2). After tumor delineation using a marking probe, EFTR was performed using the full thickness resection device (FTRD, Ovesco, Germany). Antibiotic prophylaxis was prescribed, abdominal plain film was performed 5 hours after the procedure and hospital discharge was granted after twenty four hours. Results. The resection of the lesions was macroscopically complete and no signs of perforation or significant bleeding were detected. Histopathological examination confirmed the complete resection of a tubulovillous (n = 2) and a tubular (n = 1) adenoma, all with high-grade dysplasia. No complications were detected during the follow up. Conclusion. It was concluded that the EFTR is an innovative technique that was effective and safe used in this small series of patients as an alternative to surgery.

A pseudoaneurysm of the left atrium as a rare source of coronary artery embolization.

A 67years old woman with history of surgical Mitral valve replacement underwent transoesophageal echocardiography for evaluation of mild dyspnoea. It revealed a large narrow-necked outpouching from medial portion of the inferior wall of the left atrium (LA) that was extended to the interatrial septum. A diagnosis of the LA pseudoaneurysm was made. It contained a fresh clot. Five days later, the patient presented with an acute inferior ST-elevation myocardial infarction. Coronary angiography revealed an occluded right coronary artery at its distal part by a large thrombus. Thromboaspiration was done and resulted in restoration of a Thrombolysis in Myocardial Infarction Score (TIMI) flow 3 without underlying stenosis.

Inferior Right Ventricular Wall Thickness by Echocardiogram: A Novel Method of Assessing Hypertrophy in Neonates and Infants.

An established echocardiographic (echo) standard for assessing the newborn right ventricle (RV) for hypertrophy has not been thoroughly developed. This is partially due to the RV's complex architecture, which makes quantification of RV mass by echo difficult. Here, we retrospectively evaluate the thickness of the inferior RV wall (iRVWT) by echo in neonates and infants with normal cardiopulmonary physiology. Inferior RVWT was defined at the medial portion of the inferior wall of the RV at the mid-ventricular level, collected from a subxiphoid, short axis view. iRVWT was indexed to body surface area (BSA) to the 0.5 power and normalized to iLVWT to explore the best normalization method. Ninety-eight neonates and 32 infants were included in the final analysis. Mean age for neonates and infants was 2days and 59days, respectively. Mean ± SD for neonate and infant end-diastole iRVWT was 2.17 ± 0.35mm and 1.79 ± 0.28mm, respectively. There was no residual relationship between the index iRVWT and BSA (r = 0.03, p = NS). In the infant cohort, the iRVWT was significantly lower and iLVWT was significantly higher compared to neonate, consistent with known physiologic changes of RV and LV mass. Thus, iRVWT may serve as a reliable and accurate proxy for RV mass and the parameter warrants further evaluation.

Assessment Hormonal Disorders of Women in Oral and Vaginal Changes

Hormonal deficiencies may contribute to the development of abnormalities of oral and vaginal tissues, such&#x0D; as pain, desquamation, recurrent oral, vaginal ulceration and delayed post-surgical healing .This study was&#x0D; done to determine the differences of cell activity in oral and vaginal mucosa .&#x0D; A total of 200 females of different age groups were used in this study Oral smears were obtained from the&#x0D; buccal mucosa by scraping the area gently using a wooden tongue depressor while vaginal smears were&#x0D; obtained from the proximal portion of the lateral wall of the vagina using Ayre’s spatula by scraping the area&#x0D; gently . In order to find to change in mucosa during different phases of menstrual cycle .&#x0D; In two groups the present results revealed that vaginal cytological patterns of each group is similar to the&#x0D; oral cytological pattern with some differences .&#x0D; In conclusion significant correlation between the hormonal fluctuations in woman and the degree of&#x0D; maturation of their oral epithelium was revealed in this study .