Background: Wave speed is needed to separate net wave intensity into forward and backward traveling components. However, wave speed in diseased coronary arteries cannot be assessed from hemodynamic measurements obtained distal to a stenosis. Wave speed inherently depends on arterial wall properties which should be similar proximal and distal to a stenosis. Our hypothesis is that proximal wave speed can be used to separate net wave intensity obtained distal to a stenosis.Methods: We assessed coronary wave speed using the sum-of-squares single-point technique (SPc) based on simultaneous intracoronary pressure and flow velocity measurements in human coronary arteries. SPc at resting flow was determined in diseased coronary vessels of 12 patients both proximal and distal to the stenosis. In seven of these vessels, distal measurements were additionally obtained after revascularization by stent placement. SPc was also assessed at two axial locations in 14 reference vessels without a stenosis.Results: (p < 0.02), despite the lower distending pressure downstream of the stenosis. The corresponding separated wave energy tended to be underestimated when derived from SPc at the distal compared with the proximal location. (p = 0.48). Accordingly, no significant difference in separated wave energy was observed for forward or backward waves.Results:  No diffeResults:  In diseaocation.  After suConclusion: In diseased coronary vessels, SPc assessed from distal hemodynamic signals is erroneously elevated. Our findings suggest that proximal wave speed can be used to separate wave intensity profiles obtained downstream of a stenosis. This approach may extend the application of wave intensity analysis to diseased coronary vessels. Wave intensity analysis has emerged as a powerful time-domain method to investigate the dynamic interactions between the contracting myocardium and coronary blood flow. Coronary wave intensity distinguishes between concurrently generated upstream and downstream contributions on coronary hemodynamic waveforms and is characterized by forward (aortic) and backward-traveling (microcirculatory) waves –3. ComprWave speed is fundamental to split net wave intensity into separate forward and backward traveling components . Local cIn patients, wave intensity analysis has been applied to study changes in coronary-cardiac interaction through interventions ranging from pacing and exercise to alterations in left ventricular mechanics by Valsalva maneuver, aortic valve replacement, or left ventricular stunning –14. In aAccording to the Moens-Korteweg equation, arterial pulse wave velocity intrinsically depends on the elastic properties of the vessel wall. It can reasonably be expected that the elastic wall properties are similar in angiographically normal vessel sections proximal and distal to a focal stenosis. We therefore hypothesized that proximal wave speed may be suitable to separate the net wave intensity profile obtained distal to a stenosis. To test this hypothesis, we analyzed hemodynamic signals obtained at different axial locations in diseased and unobstructed coronary arteries in patients.The dataset for this study was extracted from existing hemodynamic recordings obtained in patients with stable angina pectoris and a single stenosis in a coronary artery, who were scheduled for elective percutaneous coronary intervention (PCI). Exclusion criteria were age below 18 or over 80 years, left main stenosis, subtotal or serial lesions, severe aortic valve disease or heart failure, hypertrophic cardiomyopathy, prior myocardial infarction <6 weeks before PCI or prior cardiac surgery.Cardiac catheterization was carried out by standard femoral approach. All anti-anginal medication was continued. Intracoronary nitroglycerin (0.1 mg) was administered in order to relax epicardial vessel tone, and coronary angiograms were recorded for quantification of stenosis severity. Aortic pressure (Pa) was measured via the guiding catheter at the coronary ostium. A dual-sensor equipped guide wire  was advanced into the study vessel to simultaneously acquire intracoronary pressure (Pd) and flow velocity (U) signals . HemodynStudyManager software  to derive cycle-averaged values for all relevant variables.Vessel dimensions and stenosis diameter reduction were determined by quantitative angiogram analysis . Pressure and flow velocity signals were extracted from the digital recordings and processed using the in-house developed Wave intensity analysis was carried out using custom software written in Delphi . The single-point estimate of coronary wave speed (SPc) was assessed according to the sum-of-squares method  as repor3 was used for blood density. Summations were taken over an integer number of three to eight consecutive cardiac periods during resting flow .−2 s−2). Four dominant peaks during the cardiac cycle characterize coronary wave intensity waveform: the forward-traveling compression wave (FCW) in early systole and early diastolic backward-traveling expansion wave (BEW), leading to flow acceleration, and the backward compression wave (BCW) and forward expansion wave (FEW), that cause flow deceleration  and backward traveling (negative WI) waves, the area under the respective curve was integrated to yield the corresponding wave energy . Unpaired Student's t-test assuming equal variance was used to compare data in reference vessels with those in diseased vessels after PCI. Agreements were assessed with Bland-Altman analysis. A two-sided probability value of p < 0.05 was considered significant.All values are expressed as mean ± SEM unless otherwise noted. Comparison between results obtained at proximal and distal locations in the same vessel were performed by paired Student's Simultaneous pressure and flow velocity signals of sufficient quality at rest conditions were collected in 12 patients both upstream and downstream of the stenosis. The patient characteristics are shown in p < 0.0002) and the pressure difference to aortic pressure was less than downstream of the stenosis (p < 0.005).Hemodynamic variables (mean ± SEM) are summarized in p < 0.02). Despite the lower distending pressure downstream of the lesion, SPc at that location was on average 10.1 ± 3.4 m/s higher than upstream. The corresponding separated wave energy tended to be underestimated when calculated using SPc derived at the distal compared with the proximal location . As shown in p = 0.48). After PCI, no significant difference in wave energy was observed for either forward or backward separated waves  oscillations during the cardiac cycle . All subjects gave written informed consent conform the Declaration of Helsinki.MS conceived the study. LC and MS designed the methodology. JB and JP conducted the experiments to collect the intracoronary hemodynamic data. LC performed wave intensity analysis. LC and MS carried out the statistical analysis and wrote the first draft of the manuscript. All authors contributed to the article and approved the submitted version.JP serves as a consultant for Philips-Volcano, manufacturer of sensor-equipped guide wires. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


A significant need exists to improve enrollment of people-of-color (POC) in randomized clinical trials as the gold standard for evaluating new therapies so that health disparities can be reduced. Improving representation in clinical trials is expected to improve the applicability of clinical findings more broadly, especially for minority subgroups. This cross-sectional study assessed the perception of organizational climate (OC) among staff in five cancer research groups (CRGs) of a mid-Atlantic NCI-designated comprehensive cancer center. The Organizational Climate Measure (OCM), a measure of four OC models of the Competing Values Framework, was used. Enrollment data were obtained from the 2016 Cancer Research Management System data and 2017 enrollment rates. A statistically significant difference in mean scores was found in the Pressure to Produce Scale . One CRG’s staff reported lower pressure to meet targets than three other CRGs (p < .05) and trending towards significance for the fourth CRG (p < .08). This suggests that organizational priorities considering all patients as potential clinical trial participants increases accrual. A statistically significant negative relationship between the Outward Focus sub-scale and POC enrollment  was also found, suggesting that an external organizational focus, alone, is insufficient to increase POC accrual. Implications for future research include 1) does the organizational priority of decreasing the pressure to produce influence accrual of POC? and 2) does an OC that is flexible and externally focused lead to a more effective means of accruing POC as clinical trial participants?


Individuals exposed to elder mistreatment are affected in dissimilar ways. Most existing studies are cross-sectional and fail to capture the change in mental health of older adults with exposure to elder mistreatment. This study aims to examine depression trajectories of elder mistreatment victims and identify protective factors. Data were drawn from the two-wave Population Study of Chinese Elderly in Chicago (PINE) with 725 participants who reported elder mistreatment at the baseline. Depression was measured by Patient Health Questionnaire-9. Self-mastery was assessed by the Pearlin Mastery Scale. Conscientiousness was evaluated by the NEO Five-Factor Inventory. Multinomial logistic regression was used while controlling demographic factors and recurrence of elder mistreatment. We identified four depression trajectories among elder mistreatment victims: chronic (9.61%), delayed (6.27%), recovery resilience (21.17%), and resistance resilience (62.95%). The chronic group was showing severe depression in both waves. The delayed group experienced a delayed reaction with increasing depression over time. The depression level of the recovery resilience group bounced back from elder mistreatment. The resistance resilience group exhibited low depression over time. Elder mistreatment victims with increasing self-mastery were more likely to be in recovery resilience group than in chronic group . In addition, elder mistreatment victims with increasing conscientiousness were less likely to be in delayed group than in resistance resilience group . Healthcare providers and social service agents could focus on elder mistreatment victims with chronic and delayed depression trajectories. Interventions could promote mental health of elder mistreatment victims through improving self-mastery and conscientiousness.


Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman. In non-union, surgical options are mainly divided into head salvage or sacrificing procedures, depending on the viability of the femoral head. Preservation of the femoral head can be achieved via biological or biomechanical methods. Bone grafts  improve the microenvironment biology. Valgus hip angulation osteotomy improvises the biomechanical load of the hip joint. It will reorient a vertical fracture into a horizontal fracture, thus converting shearing force into compressive force across the fracture site. However, surgeons nowadays tend to favour the easier option of femoral head sacrificing hip arthroplasty. This provides immediate pain relief and early mobilisation, which is the goal of treatment in elderly patients. However, one must remember the goal of treatment in young adults should be focusing on preserving the femoral head due to the mismatch between their high functional demand and prosthetic implants longevity in the long term. Thus, an alternative, less radical approach like valgus hip angulation osteotomy is worth considering in younger people. We report a case of femoral neck non-union in a young adult treated with valgus sliding subtrochanteric osteotomy and the rationale behind it.Femoral neck fracture fixation can be complicated with non-union, especially in Pauwels type-3 fracture owing to high shearing force across the fracture site, with reported average incidence of 12% in literatureA 33-year-old gentleman suffered a left hip neck of femur fracture from a fall. A pelvic radiograph demonstrated a displaced neck of left femur basicervical fracture, Pauwels type-3. He underwent immediate fracture reduction and fixation with two cannulated screws . No immeHowever, six months post-operation, he complained of persistent left groin pain upon moving his left hip, and he was unable to bear weight on the affected limb. Pelvic radiograph  showed n1. Thus, obtaining anatomic reduction and stable fixation remains the key to successful treatment of femoral neck fractures. Failure is often a result of not achieving these principles. Initial operation with two cannulated cancellous screws fixation was a suboptimal management for this patient, who had typical Pauwels type-3 basicervical femoral neck fracture. A primary DHS fixation would have provided a more stable fixation. Cannulated cancellous screw fixation is still possible provided three cannulated screws with triangular configuration are used. Three screws offer better stability and can withstand higher load before failure compared to two vertical screws2.A non-union femoral neck fracture is common because of the absence of periosteal cambium layer and the continuous synovial bathing. These prevent hematoma formation, which in turn leads to decreased healing potential1. Pauwels type-3 fracture describes femoral neck fracture which is more vertically orientated (more than 50°), resulting in high shearing force across the fracture site that predispose to fixation failure and fracture non-union. Pauwels’ valgus intertrochanteric osteotomy realigns the neck shaft angle; reorient vertical fracture into horizontal fracture pattern. Thus, it converts shearing force to compressive force across the fracture site, creating an optimal healing environment as illustrated in the schematic diagram  is used to pack the fracture site to further enhance fracture healing.We do not recommend this technique as a primary fixation in Pauwels III acute femoral neck fracture because of the potential morbidity associated with the creation of an additional osteotomy. It should only be reserved for management of revision of non-unions and implant failures. Acute fracture fixation still adheres to the principle of anatomic reduction with rigid fixation. Muscle pedicle bone grafting using quadratus femoris muscle or gluteus minimus muscle should be employed if the biological cause of non-union like coexistence avascular necrosis or late presenter is suspectedTreatment of femoral neck non-union in young adults can be challenging with many methods of fixation available. The principle of a revision surgery is to first establish the cause of non-union. The biomechanical problem seems to be the primary cause of non-union detected early. Thus, femoral head preserving surgery should be the mainstay of treatment and valgus sliding subtrochanteric osteotomy provides a viable option.


Accumulating evidence suggests that sedentary behavior (SB), or time spent sitting, is regulated by both conscious  and non-conscious  motivational processes. Much of the work investigating these processes has employed summary-based measures of typical motivation and behavior. This study employed ecological momentary assessment (EMA) methods and accelerometry to determine the extent to which conscious and non-conscious processes regulate minority older adults’ momentary decisions to engage in SB. Over the course of the 8-day study, minority older adults  answered 6 EMA questionnaires/day on a mobile phone and wore an ActivPAL activity monitor to measure SB. EMA questionnaires assessed momentary intentions to limit SB over the next two hours. SB habit strength was self-reported at an introductory session. Results from a multilevel linear regression model indicated that on occasions when individuals had stronger intentions than usual to limit SB, they subsequently engaged in less SB . Individuals who had stronger SB habits, tended to engage in more SB . An additional multilevel model revealed that habits did not significantly moderate the association between momentary intentions and subsequent SB . In conclusion, minority older adults’ momentary SB appears to be directly influenced by both conscious and non-conscious motivational processes, though the interactive effects are unclear. Interventions to reduce minority older adults’ SB should include content to increase intentions to limit SB  and disrupt habitual SB .


Orthodromic tachycardia using a left lateral accessory pathway was repeatedly induced.A 49-year-old woman with multiple documented episodes of narrow QRS complex tachycardia underwent electrophysiology study at our hospital. Baseline ventricular pacing demonstrated eccentric retrograde coronary sinus activation consistent with a left lateral accessory pathway 1 was used by collecting the absolute dV/dt bipolar electrogram from the high-density grid to help distinguish the mitral valve anulus, collecting both atrial and ventricular electrograms to delineate functional block located at the valve plane . At the location of the accessory pathway, bipolar fusion and pathway potentials recognized and annotated on the high-density grid were able to showcase the atrial insertion point of the accessory pathway (1C). Additionally, during ventricular pacing and, similarly, during orthodromic supraventricular tachycardia, EnSite Precision™ open-window propagation and, in particular, the SparkleMap™ display feature  and 2B allowed for more precise localization of the atrial insertion of the bypass tract by dynamically displaying wavefront propagation superimposed on top of the local activation timing and voltage maps  and 2.Transseptal puncture allowed access to the left atrium and left ventricle, where high-density mapping was performed across the mitral valve anulus during ventricular pacing using the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ and the EnSite Precision™ electroanatomic mapping system to localize the concealed left lateral accessory pathway. The open-window mapping technique. A thorough waiting period and electrophysiology study showed no evidence of accessory pathway conduction and the patient has remained symptom-free during follow-up.Ablation was performed with the TactiCath™ Contact Force Ablation Catheter, Sensor Enabled™ at a power of 30 W and a minimal contact force of 10 g while the patient was in orthodromic supraventricular tachycardia. The tachycardia was terminated with a single lesion delivered to the mitral valve annulus at the atrial insertion site, subsequently eliminating the accessory pathway


Rosai-Dorfman disease is a histiocytic lesion that affects lung rarely.We present a 52-year-old female diagnosed with right intrabronchial mass invading the bronchial wall and the extrabronchial tissues with lymphadenopathy. Multiple bronchoscopic biopsies were not diagnostic. Pneumonectomy was performed and postoperative histology revealed marked mucin impaction and bronchial dilatation. The pulmonary tissue showed areas of hemorrhage and chronic inflammation. The mass exhibited an excessive number of lymphocytes, plasma cells, and numerous histiocytes engulfing them (lymphocytophagocytosis). These histiocytes were S100 protein and CD68 positive. These features are consistent with Rosai-Dorfman disease.Rosai-Dorfman Disease with pulmonary affection can be misdiagnosed as malignancy. Careful histological examination of the specimen for emperipolesis or lymphocytophagocytosis together with S100 protein and CD68 positivity are the clue for proper diagnosis. Rosai-Dorfman disease (RDD) is a histiocytic lesion that commonly occurs in young males . TypicalA 52-year-old female with a history of hypothyroidism presented with continuous cough and shortness of breath. General examination was normal and local chest examination revealed absent breathing sounds on the right side. Pulmonary function test showed a mixed obstructive and restrictive lung pathology. Chest x-ray revealed complete opacity on the right side and contralateral mediastinal shift. Computed tomography (CT) scan of the chest showed infiltrative right hilar soft tissue lesion measures 4 × 5 cm with an endobronchial extension of the lesion obliterating the right main and upper lobe bronchus Fig. a and b. Rosai-Dorfman disease is an uncommon nonmalignant histiocytic proliferative disorder that was originally described as a discrete pathological disorder in 1969 by Rosai and Dorfman . MoreoveRosai-Dorfman disease involving the tracheobronchial tree is rarely reported in the literature . The disThe prognosis of RDD is generally benign. Many cases of RDD undergo spontaneous complete resolution, especially in cases with nodal involvement only ; while oIn conclusion, Rosai-Dorfman disease with pulmonary affection can be misdiagnosed as malignancy. Careful histological examination of the specimen for emperipolesis or lymphocytophagocytosis together with S100 protein and CD68 positivity are the clue for proper diagnosis.


On December 1, 2020, this report was posted online as an MMWR Early Release.Acinetobacter baumannii (CRAB), an opportunistic pathogen primarily associated with hospital-acquired infections, is an urgent public health threat (Carbapenem-resistant A. baumannii with meropenem minimum inhibitory concentration testing of ≥8 μg/mL) isolates from weekly ICU point prevalence surveys (colonization screening) and from clinical infections. Hospital A retrospectively reviewed microbiology records for CRAB isolated from inpatient specimens since November 2019 and instituted prospective surveillance of laboratory results to identify all CRAB isolates. Inpatients with hospital-acquired CRAB infection were defined as those for whom CRAB was isolated from clinical or colonization screening specimens collected on or after hospital day 3 and who had no earlier CRAB isolated from specimens during the same hospitalization; incident CRAB was a patient‘s first CRAB infection or colonization. Patients’ demographic characteristics, diagnoses, treatments, disposition, and COVID-19 status were collected from medical records. Diagnoses of CRAB infection or colonization were determined by infectious disease specialists. NJDOH began an investigation to assess IPC practices at hospital A and gather additional data. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.*Hospital A is an urban, acute-care hospital in New Jersey with approximately 500 beds. In May 2020, hospital A notified NJDOH of an increase in CRAB  whose incident CRAB infection or colonization occurred during the facility’s surge in COVID-19 cases (March–June 2020) , and 17 A. baumannii with documented resistance to three or more classes of antibiotics) was applied to hospital clinical laboratory antimicrobial susceptibility data for incident cases  or these were different introductions remains unclear.The COVID-19 pandemic has required hospitals to take unprecedented measures to maintain continuity of patient care and protect health care personnel from infection. This outbreak highlights that MDROs can spread rapidly in hospitals experiencing surges in COVID-19 cases and cause serious infections in this setting. To reduce spread of MDROs and the risk of infection for patients, hospitals should remain vigilant to prevent and detect clusters of unusual infections and respond promptly when they are detected. Facilities should prioritize continuity of core IPC practices  to the greatest extent possible during surges in hospitalizations and make every effort to return to normal operating procedures as soon as capacity allows.Acinetobacter baumannii (CRAB) causes health care–associated infections that are challenging to contain and often linked to infection prevention and control (IPC) breaches.Carbapenem-resistant A New Jersey hospital reported a cluster of 34 CRAB cases that peaked during a surge in COVID-19 hospitalizations. Strategies to preserve continuity of care led to deviations in IPC practices; CRAB cases decreased when normal operations resumed.Hospitals managing surges of patients with COVID-19 might be vulnerable to outbreaks of multidrug-resistant organism (MDRO) infections. Maintaining IPC best practices  to the extent possible could mitigate spread.


Cerebral hyperperfusion syndrome (CHS) and reversible cerebral vasoconstriction syndrome (RCVS) are two syndromes characterized by disordered vascular autoregulatory mechanisms of brain. These may be seen after carotid endarterectomy (CEA). We present a patient who developed both syndromes after CEA which is a rare occurrence. Cerebral hyperperfusion syndrome (CHS) is a rare but well-known complication after major cerebral revascularization procedures including carotid endarterectomy (CEA) and carotid artery angioplasty/stenting (CAS) -2. CliniOn the other hand, the reversible cerebral vasoconstriction syndrome (RCVS) is another known complication after CEA or CAS among many other causes recognized for RCVS . This syA 59-year-old female with a history of hypertension presented to an outside hospital with symptoms concerning for transient ischemic attacks affecting the right middle cerebral artery (MCA) territory causing brief (<15 min) episodes of left hemiparesis. Imaging showed previous infarcts in the right frontal cortex Figure , as wellThe patient improved clinically on post-craniectomy day 1 having purposeful extremity movements and following commands occasionally. However, she started to have seizure-like activity  lasting for hours, although her electroencephalogram (EEG) was negative. Levetiracetam and lacosamide were started. Due to the occurrence of post-CEA ICH and questionable head CT angiography concerning for vasculitis, cerebral catheter angiography was performed on post-craniectomy day 7. The angiogram demonstrated a patent right ICA Figure  and diffWe report a patient with post-CEA CHS presenting with ICH whose clinical course was complicated with RCVS. Fitas et al. reported a 55-year-old-female with post-CEA imaging signs such as cortical edema and focal cortical SAH (compatible with early post-operative CHS) which was later complicated by increasing Lindegaard ratios in serial transcranial Doppler studies (over the course of 10 days) compatible with RCVS . Also, ACHS after CEACerebral hyperperfusion syndrome is a well-known complication after carotid artery revascularization procedures including CEA and CAS , 9. ThisAngiographic findings reported for CHS include: (1) extravasating contrast material in distal vascular bed of the brain, and (2) arteriovenous shunting signs with early draining vein(s) and capillary blush during the CHS phase which fade after resolution of CHS .Management of CHS is generally towards aggressive control of blood pressure keeping it within normal limits if not lower, in addition to symptomatic treatment for seizures and brain edema . Beta-blRCVS after CEAReversible cerebral vasoconstriction syndrome is a relatively newly described entity after CEA. Although episodic vasoconstriction has been reported before, Call and Fleming were the first to systematically describe this syndrome in 1988 . It is cAngiographically, the cerebral vessels show segmental spasm which is diffuse and bilateral and affects both anterior and posterior circulations . TypicalReversible cerebral vasoconstriction syndrome may be associated with ischemic or hemorrhagic stroke. Hemorrhagic sequelae include different forms of ICH, namely, SDH, SAH, and intraparenchymal hemorrhage . The mosTreatment of RCVS is usually supportive. If present, any existing vasoactive medications should be discontinued. Calcium channel blockers have been suggested to relieve the vasoconstriction, although they may not necessarily prevent cerebral vasoconstriction or ICH . Intra-aThe Management Dilemma of Co-existing CHS and RCVSReversible cerebral vasoconstriction syndrome and CHS represent two opposite ends of the pathophysiological spectrum of post-CEA/CAS cerebral dysautoregulation. On one end of the spectrum, the paralyzed arterioles of the brain cannot resist the suddenly increased CBF via proper reciprocal vasoconstriction (CHS). On the other end, diseased autoregulation of the brain leads to exaggerated vasoconstriction after CEA or CAS that may result in RCVS. These phenomena were both seen in the presented case. This constellation of pathophysiological phenomena creates a management challenge. Treatment of CHS requires lowering blood pressure control and avoiding vasodilator medications, whereas treatment of RCVS requires vasodilator therapy, and possibly controlled hypertensive therapy to treat strokes (if present). There is no standard therapy for co-existing CHS and RCVS. We suggest meticulous work up of candidates for CEA/CAS to identify patients at increased risk for disordered cerebral autoregulation . These patients should be carefully followed after revascularization and be treated in a timely fashion to prevent the devastating complications of stroke and/or ICH. When evidence exists to support the coexistence of both syndromes, we suggest cautiously treating the prevailing syndrome (CHS versus RCVS) which is creating the symptoms while avoiding overtreatment (that may cause the other syndrome to become symptomatic) and staying vigilant for the symptoms of the other syndrome. These patients may be followed with daily transcranial Doppler or other studies to detect signs of dysfunctional autoregulation .Reversible cerebral vasoconstriction syndrome and CHS represent the two ends of the dysautoregulation spectrum in post-CEA patients. We report a rare case of concomitant CHS and RCVS after CAE. Proper identification of high-risk patient may warrant more diagnostic tests to detect the signs of dysautoregulation in post-CEA patients to prevent poor outcomes from these syndromes.


Preoperative localization of non-palpable lung nodules plays an important role in video assisted thoracic surgery (VATS). Although percutaneous computed tomography (CT)-guided hook wire marking has become widely accepted, it is accompanied by rare but fatal complications such as air embolisms. We herein report a case of a submillimeter pulmonary nodule successfully localized by a mobile CT scan with a navigation system.A 40-year-old-man presented with the two right pulmonary nodules 4 years after a radical left nephrectomy for a renal clear cell carcinoma. One of the nodules was too small to palpate and preoperative marking was applied using a mobile CT scan with a navigation system. We successfully performed VATS wedge resection for both nodules and confirmed a pathological diagnosis of a metastasis from the renal cell carcinoma. The maximum pathological size of the smaller nodule was 500 μm.Preoperative marking of the lower lobe lesion in the present case was essential for VATS. Our novel technique was helpful for the precise marking without any morbidity.Preoperative marking using a mobile CT scan with a navigation system is safe and easily applicable. It might be a useful option for VATS of non-palpable lung nodules. Although percutaneous CT-guided hook wire marking has become widely accepted , it requ2A 40-year-old-man presented with right pulmonary nodules 4 years after a radical left nephrectomy for a renal clear cell carcinoma  without any drug use nor allergic history. He had no significant familial history. Chest CT revealed two circumscribed nodules in the right upper and lower lobes respectively, suggesting metastatic lung tumors . WithoutThe details of the procedure have been described elsewhere . BrieflyThe nodule in the upper lobe was resected in the usual manner. The operative time was 118 min without any procedure-related morbidity.The histopathological examination of both specimens revealed that the cytoplasm was filled with glycogen and phospholipids, consistent with a metastasis from the renal clear cell carcinoma . The max3The lungs are one of the most frequent metastatic sites from a renal cell carcinoma and a pulmonary metastasectomy is a feasible option in selected patients . Two favVarious methods have been proposed for the localization of non-palpable small pulmonary nodules. A CT-guided hook wire marking is one of the most common procedures and is often accompanied by procedure-related complications such as a pneumothorax and pulmonary hemorrhage . Air embThe O-arm™ is a mobile preoperative CT imaging system. The obtained images are transferred to the Stealth Station™S7 navigation system and allow virtual fluoroscopy to identify the preferred skin marking site . The sec4We herein report a case of a submillimeter metastatic lung tumor successfully resected using a mobile CT with a navigation system for the preoperative marking. This method is safe and easily applicable and might be a useful option for VATS of non-palpable lung nodules even in submillimeter cases.　The authors declare that they have no competing interests.Not applicable.Not applicable.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Asuka Uebayashi wrote this paper. All authors read and approved the final manuscript.Not applicable.Toru Nakamura.Not commissioned, externally peer-reviewed.


A 93-year-old woman presented with confluent yellow plaques with an intense golden glow symmetrically on the neck and lateral face  mimickinThe location of plane xanthomas can serve as a clue to a particular underlying disease. Plane xanthomas in a normolipemic patient with favored distribution on the neck, upper trunk, and flexural folds should prompt a search of underlying hematological disorders such as monoclonal gammopathy or lymphoproliferative disease ,2. Plane


We describe a 38-year-old male who underwent percutaneous coronary intervention (PCI) using a third-generation drug-eluting stent (DES) with a thin stent for an anomalous left main coronary artery (LMCA) originating from the right coronary sinus with a retro-aortic course. Six months later, in-stent restenosis (ISR) occurred due to stent implantation in angled lesions with significant hinge motion. An intravascular ultrasound (IVUS) revealed significant neointimal hyperplasia. The vessel wall of an angled coronary artery lesion is exposed to mechanical stress from the deployed stent. It has been reported before in the major coronary arteries but not in an anomalous LMCA. An angled coronary lesion, which is often accompanied by hinge motion, is reportedly a risk factor for in-stent restenosis (ISR) with all generations of coronary stents . SeveralA 38-year-old male patient with a 15-pack per year smoking history presented to another hospital with acute anterolateral ST-elevation myocardial infarction. He was thrombolyzed with t-PA with the complete resolution of his electrocardiography (ECG) changes. Echocardiogram revealed mild left ventricular (LV) dysfunction with a left ventricular ejection fraction (LVEF) of 40%-45% and anterior/lateral wall hypokinesis. He was then transferred to our center where he was taken to the catheterization laboratory and a diagnostic coronary angiogram was done after obtaining informed consent. The angiogram revealed a normal right coronary artery and an anomalous origin of the left main coronary artery from the right coronary cusp Figure . Normal Six months later, he was admitted again due to the recurrence of chest pain with a normal ECG and mild troponin rise. The echocardiogram revealed an LVEF of 50%. Of note, the patient quit smoking since discharge. The coronary angiogram revealed significant proliferative type three ISR (10 mm extending beyond the stent margins) Figure . The finThe clinical incidence of ISR after BMS implantation is approximately 20%-35%. The use of DES has led to a further decrease in the occurrence of ISR to 5%-10% . These iThe clinical significance of the high incidence of vessel wall injuries and ISA in angled lesions is still unclear. A recent clinical study of second-generation DES reported that lesion angle had no impact on one-year clinical outcomes, inconsistent with a past report in the bare metal stent era . This miISR is not uncommon and several risk factors have been reported as predisposing factors for such unwanted outcomes. Stenting of an angled lesion is associated with a higher incidence of ISR as compared to a non-angled lesion. It has been reported previously in the major coronary arteries. To our knowledge, our case is the first to report such an effect on an anomalous left main coronary artery.


Limited mitochondria outer membrane permeability (MOMP) is a novel biological process where mammalian cells initiate the intrinsic apoptosis pathway with increased mitochondrial permeability but survive. One of the major consequences of limited MOMP is apoptotic endonuclease-induced DNA double strand breaks. Recent studies indicate that these DNA double stand breaks and ensuing activation of DNA damage response factors such as ATM play important but previously underappreciated roles in carcinogenesis and tumor growth. Furthermore, novel non-canonical roles of DNA repair factors such as ATM in tumor growth and treatment are also emerging. In this review, we try to summarize recent findings on this newly revealed link between DNA double strand break repair and cell death pathways. Mitochondria outer membrane permeability (MOMP) is a biological process initially described for cells undergoing programmed cell death or apoptosis. MOMP has been considered an essential process in the intrinsic pathway of apoptosis , 2. In tIn a separate study, we showed that myc-induced transformation of mammary epithelial cells depended on limited MOMP, i.e., sublethal Caspase 3 and endoG activation . In factATM) quinoline-2-one core. It showed excellent pharmacokinetics, a low predicted clinical dose, and a high maximum absorbable dose when orally administered at the preclinical level . AZD0156 animals . AZD0156 animals . It was  animals . When co animals . A cliniIn summary, because of availability of clinical trial-ready small molecule compounds, it is very feasible to combine cytotoxic cancer therapy such as radiotherapy with ICB therapy and ATM inhibition. Such a “triple” threat approach may hold great promise in treating some forms of malignancies that are currently not responsive to ICB treatment alone.MOMP/apoptosis and DNA damage response are two fundamental biological processes previously thought to be well understood. However, it is evident from the literature that we covered in this review that each has numerous non-canonical and often times counter-intuitive functions. Recent studies on those non-canonical functions provided important new insights into the roles of those two processes in carcinogenesis and tumor response to treatment. Some of the insights may lead to the development of effective treatment/prevention strategies for cancer.


Mesenchymal stem cells (MSCs) from several tissue sources have been investigated in clinical trials for multiple disorders, and mixed results from these trials have been documented , indicat2 strain) heart failure model to study cardiac repair mechanisms mediated by MSCs [2 hamster heart is known to exhibit an early aging phenotype due to progressive loss of cardiomyocytes and functional decline, it is important to determine whether the aging heart of older TO2 hamster may be able to achieve functional improvement in response to MSC therapy. Echocardiography performed 1 month after MSC injection shows that both the saline (HBSS) - and MSC-treated old TO2 hamsters exhibited a similar decline in function as indicated by indistinguishable fractional shortening (FS) and left ventricular end-diastolic dimension (LVDd) between the two groups (This host tissue deficit remains a major challenge in regenerative medicine because the aging population usually require the therapy. We previously used a hamster (TO by MSCs . However2 hamsters, it is ineffective in treating the older cardiomyopathic hamsters. Advanced age typically exhibits more prevalent adverse events in humans. Although the human heart has been known to harbor a significant number of resident stem cells possessing limited regeneration capacity, age-related ECM remodeling and stem cell senescence can lead to declining cardiomyocyte populations and myocardial dysfunction [2 heart may profoundly interfere with the growth factor signaling cascade mediated by the administered MSCs. The finding highlights the progressive nature of the fibrogenic process in the cardiomyopathic heart, which can interfere with the regenerative therapy. Thus, host tissue aging/fibrosis represents a major consideration in the design of MSC therapy.Thus, although MSC therapy is effective in treating younger TOfunction ,8. Similfunction ,10. Sinc


Strain and crack are critical indicators of structural safety. As a novel sensing device, a patch antenna sensor can be utilized to wirelessly estimate structural strain and surface crack growth through resonance frequency shift. The main challenges for the sensor are other effects such as temperature fluctuation that can generate unwanted resonance frequency shift and result in large noise in the measurement. Another challenge for existing designs of patch antenna sensor is the limited interrogation distance. In this research, thermally stable patch antenna sensors are investigated for more reliable measurement. Fabricated on a substrate material with a steady dielectric constant, a new passive (battery-free) patch antenna sensor is designed to improve reliability under temperature fluctuations. In addition, another newly designed dual-mode patch antenna sensor is proposed to achieve a longer interrogation distance. Extensive experiments are conducted to characterize the patch antenna sensor performance, including thermal stability, tensile strain sensing, and emulated crack sensing. The two new patch antenna sensors are demonstrated to be effective in wireless strain and crack measurements and have potential applications in structural health monitoring (SHM). Civil structures, such as buildings and bridges, can suffer from damage caused by various types of loads during the life span. Without proper maintenance, the damage can adversely affect the performance of a structure and may even result in structural failure . StructuThe development of wireless communication technology has facilitated a more convenient application of SHM systems on large structures. A typical wireless sensing system consists of a server and multiple sensor nodes. The server coordinates the wireless sensing network and receives measurement data from all the sensor nodes. Each sensor node usually has at least an embedded processor and a wireless transceiver. The advantageous features of onboard computing and wireless communication enable the dense and rapid deployment of sensor nodes. During past decades, various wireless sensing systems have been developed for SHM. For example, a low-cost wireless modular monitoring system was first proposed by Straser and Kiremidjian . Among oTo address the challenge of power source, passive (battery-free) wireless sensors have been proposed and studied. With the integration of technologies such as near field communication (NFC) and radiofrequency identification (RFID), passive wireless sensors harvest energy from the interrogation signal and do not require an onboard power supply. Among various passive wireless sensors for strain measurement, antenna sensors stand out for its simple configuration and low cost . The senAlthough extensive simulations and experiments have validated the strain and crack sensing performance of passive antenna sensors, thermal stability and limited interrogation range remain as major challenges for reliable measurement. Besides structural strain, other environmental disturbances, such as temperature fluctuation, can also result in the resonance frequency shift of the antenna by changing the dielectric constant of antenna substrate. A large frequency shift due to temperature fluctuation brings difficulty in distinguishing strain and crack effects from the temperature effect. To improve the strain and crack sensing performance during temperature fluctuation, this research proposes RFID antenna sensors with a thermally stable substrate material. Another limitation of the passive antenna sensor is the relatively short interrogation distance, due to lack of onboard power source. Some researchers have investigated techniques to increase the interrogation distance of RFID-based strain sensors ,24. NeveThe rest of the paper is organized as follows. ® 5880  substrate [® 5880 substrate undergoes large resonance frequency change, due to its large dielectric constant variation (approximately 125 ppm/°C) [® 6202  is chosen as the new antenna substrate material. As the substrate provides more stable dielectric constant under temperature fluctuation, the patch antenna sensor is expected to have more consistent resonance frequency when temperature fluctuates. In addition, integrated with energy harvesting technology, a dual-mode patch antenna sensor is designed to achieve longer interrogation distance. Among several types of antennas that can be used as strain and crack sensor, patch antenna and its variations are simple and low-profile. Previous research work has proposed the patch antenna sensor with RT/duroidubstrate . Althoug® 6202 as substrate material which has a more stable dielectric constant under temperature fluctuation. The material RT/duroid® 6202 is a poly-tetra-fluoro-ethylene (PTFE) composite with limited woven glass reinforcement. The low dielectric constant (This section describes the passive patch antenna sensor design. The sensor adopts RT/duroid2) of the RFID chip further reduces the total size of the antenna sensor. The broad operation frequency range (from 840 MHz to 960 MHz) of the RFID chip facilitates international usage. The chip’s high sensitivity and low power design provide a long interrogation range of the passive patch antenna sensor. In addition, the compatibility with external power enables the design of a dual-mode patch antenna sensor, which achieves a longer interrogation range and is described in The SL3S1013 RFID chip  is chosen for wireless communication. The RFID chip contains a 96-bit tag identifier including a 48-bit factory locked unique serial number. Equipped with an advanced anti-collision mechanism, the RFID chip enables the reader to simultaneously access multiple antenna sensors nearby. The small footprint (0.0394 × 0.0571 inches2. The sensor adopts a quarter-wave rectangular patch (folded-patch) antenna topology [j199.7 topology . The topive mode ) and the2. Both the drawing and picture show that a patch antenna sensor and a power management circuitry are fabricated on the same piece of substrate. Equipped with the power management circuitry, this sensor can harvest solar energy, storing energy in a rechargeable coin battery, and operating in active mode. When the battery runs out, this dual-mode RFID patch antenna sensor can automatically fall back to passive mode.This section describes the dual-mode patch antenna sensor design. Despite the advantages of operating without an onboard power supply, the passive patch antenna sensor can only support limited interrogation range. To increase the interrogation distance, a dual-mode RFID antenna sensor is designed. j205.5 The patch antenna sensor is designed similarly as described in j205.5 Ω . The desThe power management circuitry derives energy from solar radiation and supplies regulated voltage to the RFID chip. The energy harvesting IC (integrated circuit) chip MAX17710  is adopted for this application. This IC chip both charges a cell battery with over-charge protection and powers the RFID chip with over-discharge protection. The harvested solar energy is stored in a high-capacity Lithium-Ion rechargeable coin cell battery RJD2032C1T1 , which improves the reliability of the patch antenna sensor.The strain/crack induced resonance frequency shift of the antenna sensor can be wireless detected and utilized to estimate the structural strain and surface crack propagation. This section describes the sensing mechanism of patch antenna sensors. A patch antenna sensor can wirelessly measure strain and/or crack on a structural surface through the shift of its electromagnetic resonance frequency. According to electromagnetic theory, the resonance frequency −5 (10 micro-strains) to 10−3 (1000 micro-strains). If the effective dielectric constant of the substrate remains as constant, the change of resonance frequency When strain Here This section describes the wireless measurement mechanism of the RFID based patch antenna sensor. To wirelessly obtain the resonance frequency, an RFID reader Tagformance Lite  is used to interrogate the patch antenna sensor. Thermal stability of the patch antenna sensor is investigated through an outdoor temperature test  and a te® 5880 substrate and the other with RT/duroid® 6202 substrate, are installed on the web surface of a steel I-section column. Metal foil strain gages are installed to measure the temperature-induced strain on the steel column surface. To keep track of temperature fluctuations in the field, two thermocouples are installed near the sensors. A reader antenna is placed 12 inches away from patch antenna sensors for wireless interrogation.An outdoor temperature test is conducted to study the influence of the temperature fluctuation on the resonance frequency of the patch antenna sensors. ® 5880 substrate during the test. Meanwhile, the patch antenna senor with RT/duroid® 6202 substrate shows a total of ~0.1 MHz resonance frequency change, which is much less than that of the previous design with RT/duroid® 5880 substrate.The outdoor test starts at noon with ambient temperature at around 76 °F. The temperature is measured every 20 min. until 17:00. The temperature fluctuation is plotted in ® 6202. A temperature chamber test is conducted to further investigate the thermal effects on the resonance frequency change of the patch antenna sensor with substrate material RT/duroid® 6202. For comparison, the resonance frequencies of a patch antenna sensor with substrate material RT/duroid® 5880 during temperature fluctuation are plotted in the same figure [® 6202 substrate when the chamber temperature reduces from 101 °F down to 37 °F. On the other hand, the patch antenna senor with RT/duroid® 5880 substrate experiences ~5 MHz resonance frequency change when the temperature changed from 103 °F to 33 °F. The comparison between two different types of substrate materials indicates that the antenna sensor with RT/duroid® 6202 substrate provides much better thermal stability.The chamber is heated to 101 °F at the beginning of the test and gradually cooled down to 37 °F. A total of 9 temperature levels are tested. After the temperature becomes stable at each level, five frequency sweeps are conducted to measure the interrogation power threshold of the patch antenna sensor. The resonance frequency of the antenna sensor at each temperature level is extracted from the averaged interrogation power threshold curve. e figure . A totalLaboratory tensile tests are conducted to evaluate the strain sensing performance of the dual-mode patch antenna sensor. This section describes the tensile strain sensing performance of the dual-mode patch antenna sensor working in passive mode. The load applied by the tensile machine is configured so that approximately each loading step generates a 50 The resonance frequency of the patch antenna sensor at each strain level is determined by peak picking of each average interrogation power threshold curve. As expected, the resonance frequency decreases as the tensile strain increases. This section describes the tensile strain sensing performance of the dual-mode patch antenna sensor working in active mode. The interrogation distance is increased to 60 inches, about 1.67 times longer than that of the passive mode test. All the other experimental setup and data analysis methods are the same as before. The average interrogation power threshold curves at different loading steps/strain levels are plotted in The resonance frequency of the patch antenna sensor at each strain level is determined by peak picking of each average interrogation power threshold curve. As expected, the resonance frequency decreases as the tensile strain increases. To investigate the crack sensing performance of the patch antenna sensor, an emulated crack test is carried out. For crack sensing, the antenna sensor is bonded on the rotating and fixed plates, above the gap and at the center of the crack opening line, as shown in In total, eleven gap opening sizes are wirelessly measured during the experiment. The resonance frequencies extracted from interrogation power curves are plotted in In this paper, thermally stable patch antenna sensors have been designed and validated for monitoring strain and crack growth of civil structures. Extensive experiments lead to the following conclusions. The temperature-induced dielectric constant change can result in unwanted resonance frequency change in patch antenna sensors. The thermally stable substrate material can improve the strain and crack sensing performance of patch antenna sensors by preserving the dielectric constant at different temperature levels. The tensile test results demonstrate that the developed patch antenna sensors can measure small structural strain by wireless identifying the resonance frequency shift. In addition, working in active mode, the dual-mode patch antenna sensor can achieve longer interrogation distance with the assistance of solar-charged battery power. The emulated crack sensing test results show that the designed patch antenna sensor is capable of tracking surface crack propagation. As the crack grows, the resonance frequency of the patch antenna sensor decreases as expected.Future research can investigate calibration according to temperature effects to further eliminate the unwanted uncertainties in the strain and crack measurements. Sensor performance may also be fine-tuned through more detailed multiphysics modeling and simulation.


Toxicity of misfolded proteins and mitochondrial dysfunction are pivotal factors that promote age-associated functional neuronal decline and neurodegenerative disease across species. Although these neurotoxic challenges have long been considered to be cell-intrinsic, considerable evidence now supports that misfolded human disease proteins originating in one neuron can appear in neighboring cells, a phenomenon proposed to promote pathology spread in human neurodegenerative disease. We have found that C. elegans adult neurons that express aggregating proteins can extrude large (~5µM) membrane-surrounded vesicles that can include the aggregated proteins and damaged mitochondria. We speculate that throwing out the trash may correspond to a conserved mechanism that constitutes a fundamental, but formerly unrecognized, branch of neuronal proteostasis and mitochondrial quality control. I will discuss our current understanding of the mechanisms of neuronal trash elimination.


Inflammatory pseudotumors (IPTs) are benign masses arising from nonspecific inflammatory conditions including surgical invasion. We herein report the rare case of an IPT mimicking port-site metastasis in a 69-year-old patient who underwent retroperitoneal robotic partial nephrectomy for stage T1a renal cell carcinoma. Radiological examination performed six months after the surgery revealed the presence of a mass underneath the abdominal wall which coincided with a port site. The tumor was resected by laparoscopic transperitoneal approach, and histological examination led to the diagnosis of an IPT that consists of xanthogranulomatous inflammation. We also discuss the etiology of IPT formation and features distinguishing IPTs from port-site metastasis. Inflammatory pseudotumors (IPTs) which are caused by nonspecific inflammatory conditions can develop at nearly every body site . Albeit A 69-year-old Japanese male with diabetes mellitus underwent right-sided retroperitoneal RPN for an incidental renal tumor . Five po18F]fluorodeoxyglucose- (FDG-) positron emission tomography- (PET-) CT, the mass had a mild FDG uptake with a maximum standardized uptake value of 3.2 (Follow-up computed tomography (CT) scan performed six months after the surgery revealed an emerging small mass below the right side of the abdominal wall coinciding with a 12 mm AirSeal™ assistant port site . By [18Fe of 3.2 . FurtherTumor resection was subsequently performed by laparoscopic transperitoneal approach . AlthougIPTs are benign tumors which mimic malignant neoplasms and comprise cells associated with both acute and chronic inflammation. The pathogenesis and etiology of IPTs are unspecific; therefore, IPTs have been described under various names such as xanthogranuloma, inflammatory myofibroblastic tumor , and lipSchloffer's tumor might be considered the diagnosis in the present case based on the potential etiology because it is possible that Vicryl™ suture or Surgicel™ used in RPN might have provoked a foreign body reaction. Asano et al.  reportedIn the present case, the Surgicel™ bolster placed on the renal parenchymal defects was nearly invisible at the IPT site. This image finding shows that the Surgicel™ bolster was normally diminished with time after surgery . It is uWhile the exact cause of IPT in the present case remains unknown, we speculate that the following two processes were more likely etiologies. The first one is chronic inflammation by microabscess formation underneath the abdominal wall, which might be partially due to diabetes mellitus. The second is the involvement of FN. Fat fragments produced in RPN might migrate to a port site and subsequently develop FN provoking chronic inflammation. Amblee and Ganesh  reportedThe preoperative differentiation between IPT and PSM of RCC is difficult because of the rarity of both conditions, which were reported in very few case reports –4, 9–11.Song et al. , who rep


Hypoplastic right heart syndrome with pulmonary atresia is a rare cyanotic heart disease with poor prognosis requiring urgent intervention to establish the pulmonary blood flow. Pulmonary blood flow is achieved by BT shunt or percutaneous techniques like PDA stenting or pulmonary valve perforation. Various series have shown that early surgical intervention causes high mortality in these patients. Pulmonary valve perforation is a suitable, physiological alternative to surgical techniques in selected patients.We report a case of hypoplastic right heart syndrome with pulmonary atresia and restrictive VSD presenting with cyanosis from birth and underwent pulmonary valve perforation successfully.Duct-dependent pulmonary circulation is a pediatric emergency, palliative procedure for establishing adequate pulmonary blood flow is essential early in the life. In the management of duct-dependent pulmonary circulation, RVOT perforation is an effective and safe option in suitable high-risk subgroups. The induced pulmonary regurgitation along with established physiological antegrade flow would be beneficial in the remodeling of tripartite/hypertrophied small RV. Hypoplastic right heart syndrome with pulmonary atresia is a rare form of cyanotic congenital heart disease with poor prognosis, high morbidity, and mortality. Early palliation for establishing adequate pulmonary flow is necessary for the relief of cyanosis and duct dependence. These patients are usually treated by aorto pulmonary shunt (BT shunt) followed by univentricular or 1.5 ventricular repair or biventricular repair at a later stage depending on the right ventricular growth if at all it grows. With the advent of use of radio frequency or laser-assisted perforation of pulmonary valve and balloon dilatation percutaneous techniques has garnered importance in achieving pulmonary flow. A series percutaneous techniques offered better outcome compared to surgical repair [z score of annulus − 1.94. There was a severe TR, with measured RVSP of 110 mmHg (+mean RAP). There was a restrictive muscular ventricular septal defect, hypertrophied, hypoplastic tripartite RV, and valvular pulmonary atresia. The branch pulmonary arteries were confluent measuring 2.7/2.5 mm each. The duct arising from the under surface of the left aortic arch, supplying pulmonary circulation  wire was used to perforate the atretic pulmonary valve with serial dilatation using coronary balloons  to obtain the desired diameter (as assessed preoperatively by echocardiogram). The final injection showed unobstructed contrast filling both branch pulmonary arteries with good bilateral arborization  and arterial lines (5 Fr) were established by digital palpation. A JR guiding catheter was crossed across the tricuspid valve and placed at the dimple of atretic pulmonary valve. The position was confirmed in orthogonal views with a hand injection in a diagnostic JR catheter placed in aortic arch. The course of the PDA showed the retrograde filling of MPA up to the atretic part reassuring the position of the guide. A GAIA (ASAHIHypoplastic right heart syndrome (HRHS) is a rare cyanotic heart disease due to the underdevelopment of right heart structures . The spectrum of disorders varies from simple hypoplastic RV with or without pulmonary stenosis to grossly underdeveloped RV with pulmonary and/or tricuspid atresia , 2. VentDuct-dependent pulmonary circulation is a pediatric emergency, palliative procedure for establishing adequate pulmonary blood flow is essential early in the life. In the management of duct-dependent pulmonary circulation, RVOT perforation is an effective and safe option in suitable high-risk subgroups. The induced pulmonary regurgitation along with established physiological antegrade flow would be beneficial in the remodelling of tripartite/hypertrophied small RV.Additional file 1:.Additional file 2:.Additional file 3:.Additional file 4:.Additional file 5:.Additional file 6:.Additional file 7:.


Case Presentation. Three patients with recurrent retinal detachment were treated between January and March 2018. In all cases, the intraoperative internal search did not demonstrate any obvious break or hole. MembraneBlue-Dual (Trypan Blue 0.15% + Brilliant Blue G 0.025% + 4% PEG) was then injected into the subretinal space using a 41-gauge cannula. The eye was rotated such that the dye was pushed through a tiny break which was causing the retinal detachment. 180-degree laser retinopexy was performed on a single eye. After silicon oil removal and absorption of the gas tamponade, retinas remained attached at three-months follow-up.  The purpose of this case series is to demonstrate that subretinal blue dye injection, with and without 180-degree endolaser retinopexy, can be considered a useful tool in finding occult rhegmatogenous retinal breaks in eyes with recurrent retinal detachment.  Chromophore-assisted occult retinal break detection can be considered a useful but not risk-free surgical technique in managing some unexpected and challenging intraoperative situations. Finding retinal holes or breaks is a key point for a successful retinal detachment repair. In redo surgery, this goal is sometimes difficult to achieve because of the modifications of the retina and vitreous and sclera consequences of the previous surgery. Trypan Blue dye-assisted occult retinal break detection represents a relatively novel technique which can simplify identification of previously unseen retinal breaks  helping Three patients with recurrent retinal detachment were treated at the Casa Sollievo della Sofferenza Hospital between January and March 2018. All of them underwent a standard three-port pars plana vitrectomy as well as intraoperative indentation using a binocular indirect RESIGHT (Zeiss) fundus viewing system. The first patient attended vitrectomy having had previously a failed pneumoretinopexy retinal detachment repair; no holes or breaks were detected by intraoperative careful search so MembraneBlue-Dual was injected into the subretinal space using a 41-gauge cannula designed for macular translocation. Perfluorocarbon heavy liquid was then injected into the vitreous cavity displacing the subretinal fluid toward the retina periphery. The eye was rotated such that the dye was vented out of a very tiny break located just anteriorly to the preexisting corioretinal scar. A second patient with a clinical history of multiple surgeries for retinal detachment  presented with a new onset macula off retinal detachment eight months after a successful silicon oil removal. On the superior temporal quadrant was still visible an apparently well buckled and partially treated tear with no other obvious hole or break. Again, MembraneBlue-Dual was injected into the subretinal space and perfluorocarbon heavy liquid injected into the vitreous cavity displacing the subretinal fluid. The dye started leaking out of the superior temporal already buckled tear which was initially considered safe (Video Missing retinal breaks during retinal detachment surgery is a well-recognized cause of failure in primary repairs . In some


A 33-year-old gravid female was brought to the emergency department after she collapsed in the street. Point-of-care ultrasound showed free fluid in the abdomen and confirmed an intrauterine pregnancy. Surgical teams were consulted, and cross-sectional imaging revealed a spontaneously ruptured splenic artery aneurysm (SAA). The patient was taken expeditiously to the operating room for splenic artery ligation and subsequent splenectomy.Ruptured SAA in pregnant patients is associated with significant mortality for both mother and fetus. Maintaining a high index of suspicion in the correct population is crucial to avoid diagnostic errors and provide definitive care with operative repair. A 33-year-old gravida 1 para 0 at 18 weeks gestational age presented to the emergency department for syncope. The patient had passed out while crossing the street and emergency medical services were activated. She reported severe abdominal pain after arrival and vitals showed a heart rate of 120 beats per minute and a blood pressure of 88/52 millimeters of mercury. Point-of-care ultrasound showed free fluid in the left upper quadrant and confirmed an intrauterine pregnancy with good cardiac activity. Obstetrics and general surgery teams were consulted. Following improvement of the patient’s vital signs with a crystalloid bolus, a computed tomography was performed, which revealed a spontaneously ruptured and previously undiagnosed 2.6-centimeter splenic artery aneurysm (SAA)  and 2.The patient was taken emergently to the operating room where surgeons evacuated six liters of blood that originated from her splenic artery rupture. Splenectomy was successful in stabilization; however, post-operatively no fetal heart rate was found and a dilation and evacuation was subsequently performed. The patient was discharged home on day 14.The true incidence of SAA is unknown; however, estimates range from 0.02–10.4%.5What do we already know about this clinical entity?Splenic artery aneurysms are usually asymptomatic until ruptured at which point they are associated with high mortality. Pregnant women are at increased risk.What is the major impact of the image(s)?Images show ruptured aneurysm in conjunction with the developing fetus. These images are uncommon as such patients are often too unstable for advanced imaging.How might this improve emergency medicine practice?Understanding this deadly disease can improve emergency physicians’ ability to quickly make the diagnosis and initiate effective treatment.


Teaching point: CT may help distinguishing benign from life-threatening pneumatosis intestinalis. A 78-year old woman presented with epigastric pain and non-bloody diarrhea 6 days after a second cure of adjuvant chemotherapy for gastric adenocarcinoma  and Irinotecan).Massive Pneumatosis Intestinalis (PI) could be seen Figure  to E on Pneumatosis intestinalis which is defined as the presence of gas within the digestive tract wall is a radiographic finding resulting of a large spectrum of underlying diseases. The nature and severity of the disease determines the clinical significance of PI, not the amount of air. Initially considered indicative of advanced intestinal infarction, PI may be found in benign conditions such as immunosuppressive states.Pathogenesis of PI is multifactorial but two main theories emerge. The ‘bacterial theory’ hypothesizes the action of gas-forming bacilli entering the submucosa through mucosal breaks or increased mucosal permeability. The ‘mechanical theory’ hypothesizes that increasing of intraluminal bowel pressure with loss of intestinal mucosal integrity allows normal bowel gas to dissect the bowel wall.Regarding this, patients with cancer have a greater propensity to develop PI - often benign - because they cumulate multiple risk factors . Thrombogenic and vasospastic effects of 5-FU on the intestinal epithelium may have played a role in our patient.Independently from the clinical status, CT may help differentiate benign from worrisome PI and guide proper clinical treatment . Alarm s


To study variation in, and clinical impact of high Therapy Intensity Level (TIL) treatments for elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across European Intensive Care Units (ICUs).2 < 4 kPa), and secondary decompressive craniectomy) in patients receiving ICP monitoring in the ICU stratum of the CENTER-TBI study. A random effect logistic regression model was used to determine between-centre variation in their use. A propensity score-matched model was used to study the impact on outcome (6-months Glasgow Outcome Score-extended (GOSE)), whilst adjusting for case-mix severity, signs of brain herniation on imaging, and ICP.We studied high TIL treatments , intensive hyperventilation (PaCO313 of 758 patients from 52 European centres (41%) received at least one high TIL treatment with significant variation between centres (median odds ratio = 2.26). Patients often transiently received high TIL therapies without escalation from lower tier treatments. 38% of patients with high TIL treatment had favourable outcomes (GOSE ≥ 5). The use of high TIL treatment was not significantly associated with worse outcome . However, a sensitivity analysis excluding high TIL treatments at day 1 or use of metabolic suppression at any day did reveal a statistically significant association with worse outcome.Substantial between-centre variation in use of high TIL treatments for TBI was found and treatment escalation to higher TIL treatments were often not preceded by more conventional lower TIL treatments. The significant association between high TIL treatments after day 1 and worse outcomes may reflect aggressive use or unmeasured confounders or inappropriate escalation strategies.Substantial variation was found in the use of highly intensive ICP-lowering treatments across European ICUs and a stepwise escalation strategy from lower to higher intensity level therapy is often lacking. Further research is necessary to study the impact of high therapy intensity treatments.https://clinicaltrials.gov/ct2/show/NCT02210221?id=NCT02210221&draw=1&rank=1 and with Resource Identification Portal (RRID: SCR_015582).The core study was registered with ClinicalTrials.gov, number NCT02210221, registered 08/06/2014,  Limiting the impact of secondary insults by controlling harmful levels of intracranial pressure (ICP) is an essential part of Traumatic Brain Injury (TBI) care in the intensive care unit (ICU). Interventions used to reduce ICP are typically titrated to balance their clinical effect against their side effects, which may be significant or even life-threatening. The intensity of such interventions can be quantified by the therapy intensity level (TIL) score. The TIL score was first introduced in 1987  which waDespite this proposed framework for rational use of ICP therapies, past studies have found wide variations between centres in their deployment , 5. SomeTherefore, the aim of this study is to investigate the variation in the use of high TIL therapies in clinical practice and explore the impact on clinical outcome in patients with TBI in European ICUs.Data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were used for this analysis . CENTER-TBI recruited patients with TBI, presenting between December 19, 2014 and December 17, 2017  p = 0.004).  patients were well matched in terms of their baseline characteristics .An important finding is that a large proportion of patients receiving high TIL treatments nevertheless recovered to good functional outcome (moderate disability to good recovery) at 6 months. High TIL treatment might be an appropriate final resource for patients with refractory high ICP values and may be beneficial in this group. Nevertheless, since there could be risks of such treatments, this emphasises the need for their rational use. More work is required to understand if outcome benefits could result from a more consistently gradated and progressive application of treatment intensity and/or a shift from institutional policies towards individualized medicine.. explored various definitions for aggressive treatment, such as the definitions ‘use of ICP monitoring in more than 50% in patients meeting the BTF guidelines criteria’ and ‘aggressiveness based on a TIL score ’ . High TIL therapies are shown in bold.Additional file 2. Missing data. Description: This figure shows the proportion of missing data in the original data (before imputation). In the left panel the proportion of missingness per variable is shown. In the combination plot (grid) all patterns of missing (red) and observed data (blue) are shown. For example, the bottom row shows all patients with complete data, above that the patients with the combination missing data for Hb and gluc, ect. The bars on the right of the combination plot show the frequency of occurrence of the combinations.Additional file 3. Treatments on the TIL scale .Description: This table shows the number and percentages of ICP-monitored patients receiving ICP-lowering treatments on the TIL scale. Each row shows the number of patients (frequency) that receive that treatment (a patient could receive multiple treatments per topic).Additional file 4. Daily TIL scores. Description: This figure shows the daily high TIL scores (cumulative score of the high TIL treatments) plotted against the daily low TIL scores (cumulative score for low TIL treatments). It shows that at the same high TIL scores a variety of low TIL treatment (scores) is applied (in some cases even no low TIL treatment). Also, the figure shows mainly at day 3 (dark green) higher TIL treatments are applied including higher low TIL scores.Additional file 5. Treatments on the TIL scale (high TIL patients). Description: This table shows the number and percentages of high TIL patients receiving ICP-lowering treatments on the TIL scale. Each row shows the number of patients (frequency) that receive that treatment (a patient could receive multiple treatments per topic) Bolt treatment are regarded as high TIL treatment.Additional file 6. Higher tier ICP-lowering treatments in patients receiving high TIL treatment. Description: This figure shows the proportion of patients that receive first and second tier treatments of the high TIL patients across 7 days at the Intensive Care Unit.Additional file 7. Variation in high TIL treatment percentages across centres (centre-level). Description: This table describes the between-centre variation for high TIL treatments across the days. The number of centres are the centres that actually apply the individual treatments. The mean percentage represents the mean percentage of patients across centres that receive the therapy, while the IQR and min-max represents the variation in treatment use between centres.Additional file 8. Baseline characteristics matched dataset. Description: This table describes the baseline characteristics of the matched cases with complete data . Significant group differences were determined by using the chi-square or Fisher’s exact test  for categorical variables and an ANOVA or Kruskal Wallis test  for continuous variables.Additional file 9. Maximum ICP values prior to start high TIL use per treatment group. Description: This figure shows the differences in maximum ICP values prior to high TIL treatment between patients with a high TIL (1) versus a low TIL treatment (0). The median ICP for low TIL is 22 [16-28] and for high TIL 22 [16-27]. This difference is not statistically significant.


Teaching Point: Retropharyngeal hematoma appearing under rivaroxaban is uncommon but should be suspected in cases of dysphagia, dysphonia or breathing difficulties. A 74-year-old man was admitted to the emergency department for progressive dysphagia and mild dysphonia in the context of minor bicycle trauma that had occurred four days earlier. He had no significant swelling nor any cervical spine pain and no limitation of neck movement. He had no signs of airways being compromised. Previous medical history included anticoagulation with rivaroxaban for atrial fibrillation and aortic valve replacement four months before the bicycle trauma. Examination of the oropharynx was unremarkable. He was afebrile, with normal blood pressure.Figure 1, double arrow). Contrast-enhanced computed tomography (CECT) with oral gastrografin administration revealed hematoma extending from the retropharyngeal to the superior mediastinal space without active bleeding or vertebral fracture . Axial US image showed a slightly echoic and heterogeneous liquid collection pushing forward trachea and thyroid .Lateral cervical X-ray showed increased soft tissue thickness of 30 mm in front of C5  and axial sequence with fat saturation  confirmed methemoglobin hyperintensity. A control MRI carried out three months later showed the disappearance of the hematoma.The hematoma was not drained due to its good tolerance. The patient was monitored closely. On magnetic resonance imaging (MRI) performed seven days later, T1-weighted sagittal  can be done at the patient’s bedside. MRI offers the advantage of anatomical precision and is recommended for follow-up.Non-compressive hematoma can be treated conservatively by cervical spine immobilization and close clinical monitoring. For a retropharyngeal hematoma producing significant airway obstruction, a tracheostomy may be necessary. Surgical evacuation is generally reserved for hematomas that develop quickly, obstruct mechanical ventilation, or do not resolve themselves traditionally.


Polycarpa aurata were identified with activity against Mycobacterium tuberculosis H37Rv. Native magnetic resonance mass spectrometry (MRMS) against a panel of 37 proteins from Mycobacterium proteomes showed that a fraction from a 95% ethanol re-extraction specifically formed a protein-ligand complex with Rv1466, a putative uncharacterized Mycobacterium tuberculosis protein. The natural product responsible was isolated and characterized to be polycarpine. The molecular weight of the ligand bound to Rv1466, 233 Da, was half the molecular weight of polycarpine less one proton, indicating that polycarpine formed a covalent bond with Rv1466.In recent years, there has been a revival of interest in phenotypic-based drug discovery (PDD) due to target-based drug discovery (TDD) falling below expectations. Both PDD and TDD have their unique advantages and should be used as complementary methods in drug discovery. The PhenoTarget approach combines the strengths of the PDD and TDD approaches. Phenotypic screening is conducted initially to detect cellular active components and the hits are then screened against a panel of putative targets. This PhenoTarget protocol can be equally applied to pure compound libraries as well as natural product fractions. Here we described the use of the PhenoTarget approach to identify an anti-tuberculosis lead compound. Fractions from  Drug discovery research and development has experienced two periods with different centric strategies, namely phenotypic-based drug discovery (PDD) and target-based drug discovery (TDD) . CommonlPenicillium species in 1928  KD of polycarpine with Rv1466 was determined using the following equations [The relative abundances of protein-ligand complex to total protein in the mass spectra correlated to the relative equilibrium concentrations of ligand to total protein in solution. The pseudo quations :(1)Σ I(PKD could be obtained as a parameter of a nonlinear least-squares curve fitting.Experimental relative ratios of protein-ligand complex and total protein ion abundances were plotted against the total concentration of ligand. The pseudo


During visual fixation, the eyes make small and fast movements known as microsaccades (MSs). The effects of MSs on neural activity in the visual cortex are not well understood. Utilizing voltage-sensitive dye imaging, we imaged the spatiotemporal patterns of neuronal responses induced by MSs in early visual cortices of behaving monkeys.Our results reveal a continuous “visual instability” during fixation: while the visual stimulus moves over the retina with each MS, the neuronal activity in V1 ‘hops’ within the retinotopic map, as dictated by the MS parameters. Neuronal modulations induced by MSs are characterized by neural suppression followed by neural enhancement and increased synchronization. The suppressed activity may underlie the suppressed perception during MSs whereas the late enhancement may facilitate the processing of new incoming image information. Moreover, the instability induced by MSs applies also to neural correlates of visual perception processes such as figure-ground (FG) segregation, which appear to develop faster after fixational saccades.Video stream:https://vimeo.com/362367119


Scientific Reports 10.1038/s41598-020-58917-4, published online 06 February 2020Correction to: The Article does not include a reference to a recent relevant paper, which is now cited as Reference 1 below, and should be included in the text as follows.In the Discussion,“Large nerve specimens with large axonal loads often have fixation artefacts, hence absolute axonal loads may not be able to be determined as accurately.Other recent studies on the microanatomy of the facial nerve with large research collectives have used semi-automated or automated methods for axon quantification.”should read:“Large nerve specimens with large axonal loads often have fixation artefacts, hence absolute axonal loads may not be able to be determined as accurately.The ultimate goal of microanatomic nerve research is optimizing intraoperative decision making. Other studies have attempted intraoperative axon quantification successfully in animal nerve cross sections using a rapid automated quantification method, however being dependent on commercial software .Other recent studies on the microanatomy of the facial nerve with large research collectives have used semi-automated or automated methods for axon quantification.”


We examined daily affective vulnerability to short sleep  as a risk factor for developing chronic conditions 10 years later. Participants  from the National Study of Daily Experiences reported sleep duration and affect in daily diary telephone interviews. Chronic conditions were assessed with a 39-item checklist . Multilevel structural equation models revealed that individuals with heightened negative affect following short sleep had an increased number of chronic conditions after 10 years . Positive affective vulnerability  was marginally associated with 10-year chronic conditions . Adding to the well-established connections between sleep duration and well-being across adulthood, these findings suggest that affective vulnerability to short sleep represents a unique risk factor for long-term health as people age.


Neuroendocrine differentiation (NED) of prostate cancer represents an acknowledged predictor of resistant and more aggressive disease. NED can be functionally exploited in vivo using PET/CT imaging with somatostatin analogs radiolabeled with 68Ga. Many previous reports have shown that 18F-FDG PET/CT should also be used in cases such as guiding management, as NED is systematically associated with increased glycolysis. We hereby discuss the case of a metastatic prostate cancer patient in which 68Ga-Dotatoc PET/CT revealed the occurrence of NED with low FDG-avidity.


In this case we discuss the management of a pediculated floating thrombus in the aortic arch which led to peripheral embolization and acute ischemia oft he left leg.A healthy 46 year old female patient presented with pain in her left leg and progressive numbness. Computed Tomography Angiography (CTA) showed an acute ischemia of the left leg (Rutherford 2 B) with a 2 cm thrombus distal of the aortic bifurcation. Emergency operation with embolectomy, selective thrombembolectomy and patch plasty on the tibioperoneal trunk and local lysis was performed. As part of a further diagnostic examination a thoracic CT scan has been performed revealing a pediculated-floating 2 cm thrombus in the aortic arch. Four days after the initial operation thrombus excision via a minimally invasive access way has been performed. After initiation of the extracorporeal circulation, selective unilateral antegrade cerebral perfusion has been established in mild (30–32 °C) systemic hypothermia. Patients postoperative course was uneventful. Histological evaluation of the mass demonstrated thrombotic material without evidence of infection or malignacy.A pediculated spontaneous thrombus may develop in aortic arch in patients without traditional risk factors or family history of embolic events. Two stage operation was feasible and safe. Peripheral embolization of a thrombus fragment located in the aortic arch is a rare finding in clinical practice. In non-aneurysmal vessels but especially in young patients with no history of atherosclerosis this condition becomes rare. In the current manuscript we aimed to report and discuss the surgical management of a pediculated-floating 2 cm thrombus in the aortic arch which already lead to an acute ischemia of the left leg (Rutherford 2 B). Procedural steps were initiated after interdisciplinary decision making in the Cardio-Vascular-Surgery Team.A 46 year old female patient presented with pain in her left leg and progressive numbness. She has no history of valvular heart disease, atrial fibrillation, hypercoagulable disorder, peripheral vascular disease or claudication. Due to absent pedal pulse an emergency Computed Tomography Angiography (CTA) was initiated with diagnosis of an acute ischemia of the left leg (Rutherford 2 B) with a 2 cm thrombus distal of the aortic bifurcation Fig. . EmergenFour days after the initial operation thrombus excision via a minimally invasive access way  was performed. Basic operative steps were as follows: Limited skin incision (8 cm) followed by left sided L-shaped partial upper sternotomy beginning from jugulum diverted to 4th intercostal space. Direct arterial cannulation via right axillary artery and venous cannulation through the right atrium. After initiation of the extracorporeal circulation, selective unilateral antegrade cerebral perfusion was established in mild 30–32 °C) systemic hypothermia under control of brain tissue oxygen saturation with near-infrared spectroscopy (INVOS). Longitudinal incision of the distal ascending aorta, direct visualization and excision of the 2 cm thrombus  scan was negative. Long-term electrocardiogram (ECG) monitoring showed no atrial fibrillation or any other pathologic finding. The patient was referred for hematology consultation with negative results for congenital or acquired thrombophilia. Paraproteins were excluded, there were no Janus-Kinase-2 (JAK-2) mutations. Antithrombin and functional Protein C were normal. During therapy with phenprocoumon, Protein S was lower so that hereditary Protein S deficiency cannot be fully excluded. Oral anticoagulants are continued while Aspirin was stopped due to a resistance. In the clinical follow up the patient presented in a good clinical condition. CT scan 1 year postoperative showed no further embolic events or remaining embolic material in the aorta.Spontaneous Aortic Arch thrombus is a rare but previously in literature described origin for peripheral embolization . Common Thrombus in the ascending aortic or aortic arch can be associated with embolic events with a subsequent cerebral, visceral and peripheral ischemia. The latter is decisive for the clinical appearance of the patient, which can vary. Once peripheral emboli is retrieved and the peripheral circulation is restored patients without an obvious etiology for the embolic event warrant urgent hypercoagulable screening and diagnostic imaging, including CT-Scan of the thoracic and abdominal aorta as well as echocardiography, to rule out pathology of the thoracic aorta as well as intracardiac thrombus.Medical treatment including heparinization, endovascular stenting, or surgery have been proposed according to the International Guidelines for the treatment of mobile aortic thrombosis  but no cGiven the concern for potential cerebral and recurrent peripheral embolization, we decided against conservative management with anticoagulant agents alone and pursued urgent surgical exploration via a minimally invasive access way. Since the thrombus was pediculated catheterbased thrombectomy was not discussed in this case.Our standard surgical approach for aortic arch surgery has been described previously in detail . Main stAligned with actuarial literature initiation of systemic anticoagulation with phenprocoumon or antiplatelet therapy with aspirin should be considered as secondary prophylaxis for recurrent emboli . AspirinA pediculated spontaneous thrombus may develop in aortic arch in patients without traditional risk factors or family history of embolic events.Two-step surgical treatment of the peripheral acute ischemia followed by minimally invasive thrombectomy in the aortic arch performing through a partial upper sternotomy can be performed safely in a setting of mild systemic hypothermia during selective unilateral antegrade cerebral perfusion.


Antimicrobial surface coatings function as a contact biocide and are extensively used to prevent the growth and transmission of pathogens on environmental surfaces. Currently, scientists and researchers are intensively working to develop antimicrobial, antiviral coating solutions that would efficiently impede/stop the contagion of COVID-19 via surface contamination. Herein we present a flavonoid-based antimicrobial surface coating fabricated by laser processing that has the potential to eradicate COVID-19 contact transmission. Quercetin-containing coatings showed better resistance to microbial colonization than antibiotic–containing ones.


Corneal refractive surgeries cause epithelial damage and induce wound healing processes. To promote wound healing after photorefractive keratectomy, the effectiveness of an autologous platelet tissue graft was assessed.A 45-year-old Asian male with low myopia and/or myopic astigmatism received photorefractive keratectomy in both eyes. The right eye was postoperatively treated with an autologous platelet tissue graft using the GPS III Platelet Concentration System to prepare platelet-rich plasma, while the left eye was not treated. Both eyes achieved the expected uncorrected distance visual acuity, but the platelet-rich-plasma-treated right eye obtained improved visual acuity more than 1 week before the untreated left eye. Perceived pain after photorefractive keratectomy was much lower and of shorter duration in the treated right eye than it was for the left eye. Pericorneal injection on the bulbar conjunctiva with superficial keratitis resolved earlier in the right eye than the left eye.Autologous platelet tissue grafting using a GPS III to obtain platelet-rich plasma was effective in promoting corneal wound healing after photorefractive keratectomy. Thus, platelet-rich plasma may be beneficial for patients undergoing corneal refractive surgeries. Laser litation –3. LASIKlitation , which cPhotorefractive keratectomy (PRK) emerged before LASIK, and this refractive surgery has been equally beneficial compared with LASIK for patients with low myopia and/or myopic astigmatism. PRK entails removing the cornea from the epithelial layers to the Bowman’s layer or the anterior stroma to the degree required for myopia correction –3. The mThe present study was thus conducted to determine if an autologous platelet tissue graft could promote wound healing after PRK, since autologous platelet tissue grafts have shown promise in the promotion of wound healing in many other surgical settings –9.A 45-year-old male received PRK using a MEL 90 excimer laser  under the control of the triple-A algorithm[To determine if an autologous platelet tissue graft may be beneficial for the promotion of wound healing after PRK, we used Gravitational Platelet Separation System with disposable separation tubes (GPSIII: BioMet Biologics) for preparation of PRP . The PRPSodium fluorescein was used to evaluate corneal abrasion  in both Myopic correction occurred as expected. Uncorrected distance visual acuity (UDVA) was postoperatively monitored starting at day 3 for 25 days Fig. After 2PRK and LASIK are widely accepted and performed as corneal refractive surgeries to improve vision. Owing to the differences in surgical procedures, both approaches have merits and demerits –5. PRK dHere, we used the GPS III system  to obtaiThe corneal epithelium is a self-renewing tissue containing ample stem cells residing in the corneoscleral junction and limbus , 3. FollWhile there is little information on the effects of PRP for epithelial regeneration after corneal refractive surgery, it can be hypothesized that PRP is beneficial, as it contains significant amounts of PDGF, TGF-β, and EGF . In thisThis study has a few limitations that should be noted. Since we presented results from only one patient, a greater number of patients should be treated to fully evaluate the effects of PRP on the wound healing process. Moreover, it is possible that other preoperative heath conditions might affect the outcomes of PRP treatment.PRP treatment was effective for promoting corneal wound healing after PRK, and PRP may be beneficial for patients undergoing corneal refractive surgeries.


Suppressing fat in late gadolinium enhancement (LGE) images is a challenging task in a variety of clinical settings. Both fat and LGE appear bright in these images making it difficult to quantify the exact extent of LGE or even in some cases e.g. in myocarditis to establish the presence of late enhancement, which because of its subepicardial location may be easily confused with pericardial fat. We tested the clinical utility of a novel in/opposed phase LGE sequence in this setting.We implemented a cardiac gated two-dimensional inversion recovery prepared pulse sequence to acquire gradient echo images (in and opp.-LGE) with two echo times (2.4 and 5.0 ms) 10 minutes after the IV injection of gadolinium DTPA (0.2 mmol/Kg BW) in a single breath hold. This was achieved at the cost of an increase in bandwidth (140 vs. 400 Hz/Px) in comparison to the standard LGE sequence. All other sequence parameters including the inversion time were kept constant  Images were acquired twice once using the conventional non-fat sat LGE (con-LGE) sequence and then using the proposed in/opposed phase approach in 28 patients with positive LGE secondary to ischemic and non-ischemic conditions. Images were evaluated both quantitatively and qualitatively. Contrast to noise (CNR) ratios between fat, normal and enhanced myocardium were measured. One independent observer visually evaluated the diagnostic quality of all images.Fat was homogenously suppressed over the entire FOV in all cases. The CNR between fat and normal myocardium decreased significantly in opp-LGE compared to con-LGE  indicating effective fat suppression. Furthermore, the CNR between LGE areas and the pericardial fat increased significantly in opp-LGE compared to con-LGE  implying better LGE-fat differentiation. The qualitative assessment proved the sequence robustness over a wide range of indications and that this approach could provide additional diagnostic information over that obtained from con-LGE in 2/28 patients. Figure We provide a first clinical utilization of a novel fat suppression late enhancement imaging combining in/opposed phase imaging with conventional inversion recovery gradient echo sequences. This approach enables effective differentiation between fat and enhanced myocardium, which should result in accurate LGE quantification.