An Updated Review of Magnetic Resonance Neurography for Plexus Imaging

Magnetic resonance neurography (MRN) is increasingly used to visualize peripheral nerves in vivo. However, the implementation and interpretation of MRN in the brachial and lumbosacral plexi are challenging because of the anatomical complexity and technical limitations. The purpose of this article was to review the clinical context of MRN, describe advanced magnetic resonance (MR) techniques for plexus imaging, and list the general categories of utility of MRN with pertinent imaging examples. The selection and optimization of MR sequences are centered on the homogeneous suppression of fat and blood vessels while enhancing the visibility of the plexus and its branches. Standard 2D fast spin-echo sequences are essential to assess morphology and signal intensity of nerves. Moreover, nerve-selective 3D isotropic images allow improved visualization of nerves and multiplanar reconstruction along their course. Diffusion-weighted and diffusion-tensor images offer microscopic and functional insights into peripheral nerves. The interpretation of MRN in the brachial and lumbosacral plexi should be based on a thorough understanding of their anatomy and pathophysiology. Anatomical landmarks assist in identifying brachial and lumbosacral plexus components of interest. Thus, understanding the varying patterns of nerve abnormalities facilitates the interpretation of aberrant findings.

From Lung to Brain: Respiration Modulates Neural and Mental Activity / 神经科学通报·英文版

Respiration protocols have been developed to manipulate mental states, including their use for therapeutic purposes. In this systematic review, we discuss evidence that respiration may play a fundamental role in coordinating neural activity, behavior, and emotion. The main findings are: (1) respiration affects the neural activity of a wide variety of regions in the brain; (2) respiration modulates different frequency ranges in the brain's dynamics; (3) different respiration protocols (spontaneous, hyperventilation, slow or resonance respiration) yield different neural and mental effects; and (4) the effects of respiration on the brain are related to concurrent modulation of biochemical (oxygen delivery, pH) and physiological (cerebral blood flow, heart rate variability) variables. We conclude that respiration may be an integral rhythm of the brain's neural activity. This provides an intimate connection of respiration with neuro-mental features like emotion. A respiratory-neuro-mental connection holds the promise for a brain-based therapeutic usage of respiration in mental disorders.

Comparison of misoprostol in conjunction with oxytocin and oxytocin alone for the prevention of postpartum hemorrhage during active management of the third stage of labor

Background: When it occurs after a cesarean section or a normal vaginal delivery, postpartum hemorrhage (PPH) is a potentially fatal obstetric emergency. Aims and objectives: The aim of the study was to compare the efficacy and safety of oxytocin against oxytocin plus misoprostol in avoiding PPH during active management of the third stage of labor (AMTSL). Materials and Methods: Using simple randomization, 150 women from the labor ward of the Department of Obstetrics and Gynaecology at the Indore Medical College were recruited and randomly allocated to either test Group A or test Group B. Standard pharmacological treatment, including intramuscular injection of 10 IU of oxytocin and other components of AMTSL criteria, was administered to patients in Group A. In addition to the other components of the AMTSL criteria, Group B patients got the usual pharmacological treatment of 10 IU of oxytocin through the injectable route and 600 g of misoprostol through the oral route. Various characteristics of both groups were compared, including parity, gravida, delivery style, PPH etiology, blood transfusion, and surgical intervention. Results: Mode of delivery was vaginally seen in 85% and 92% and cesarean in 15% and 8%. Etiology was uterine atony in 54% and 64%, retained tissue in 26% and 12%, laceration in 11% and 18%, and coagulopathy in 9% and 6%. Blood transfusion was needed in 27% and 57% and surgical intervention in 82% and 68% in Groups A and B, respectively. A statistically significant difference was observed (P ? 0.05). Conclusion: The results of this study support the use of misoprostol in hospital settings as an adjunct to oxytocin since it reduces the incidence of PPH, eliminates the need for intrusive interventions, and ultimately reduces maternal mortality.

Impacto científico y temático de la Rev. Cuerpo Méd. HNAAA: un análisis bibliométrico, 2011-2020

Introducción: El Perú posee un gran número revistas de áreas biomédicas, pero solo algunas han logrado visibilizar e indizar sus publicaciones en diferentes medios de indización de alcance global. Objetivo: Analizar las características de publicación de la Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo (Chiclayo) a partir de indicadores bibliométricos. Material y métodos: Estudio descriptivo que analiza 587 registros bibliográficos de los artículos publicados en la revista durante 2011-2020, a partir de indicadores de impacto científico y análisis de términos. Resultados: La mayor producción de artículos corresponde a originales (60%; X̅=66). Los artículos publicados sobre medicina general obtuvieron más impacto en años anteriores. Los temas más frecuentes fueron estudios sobre pacientes de hospitales de Chiclayo, Lambayeque con casos de covid-19. Conclusiones: La Revista del Cuerpo Médico HNAAA se perfila como una publicación seriada de importancia para visibilizar la producción nacional y local por la cobertura temática en especialidades médicas de relevancia regional que publica.

Background: There are several journals about biomedical areas in Peru, however only a few have managed to make their publications avisible and indexed in different global indexing media. Objective: To analyze the main publication characteristics from Revista del Cuerpo Médico Hospital Nacional Almanzor Aguinaga Asenjo (Chiclayo) based on bibliometric methods. Material and methods: Descriptive study that analyzes 587 articles published by the journal from 2011 to 2020, based on bibliometric methods and indicators: citations, scientific impact and co-word analysis. Results: Original articles were the highest types of document published (60%; X̅=66). Published research articles on general medicine received more impact in previous years than the recents. Most frequent topic analyzed were studies about patients from hospitals in Chiclayo city (Lambayeque) with covid-19 clinical cases. Conclusion: Revista del Cuerpo Médico HNAAA is emerging as an important serial publication to make local, national, and international production visible due to thematic coverage in relevant medical specialties.

Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures

Background@#Muscular forces drive proximal humeral fracture deformity, yet it is unknown if arm position can help mitigate such forces. Our hypothesis was that glenohumeral abduction and humeral internal rotation decrease the pull of the supraspinatus and subscapularis muscles, minimizing varus fracture deformity. @*Methods@#A medial wedge osteotomy was performed in eight cadaveric shoulders to simulate a two-part fracture. The specimens were tested on a custom shoulder testing system. Humeral head varus was measured following physiologic muscle loading at neutral and 20° humeral internal rotation at both 0° and 20° glenohumeral abduction. @*Results@#There was a significant decrease in varus deformity caused by the subscapularis (p<0.05) at 20° abduction. Significantly increasing humeral internal rotation decreased varus deformity caused by the subscapularis (p<0.05) at both abduction angles and that caused by the supraspinatus (p<0.05) and infraspinatus (p<0.05) at 0° abduction only. @*Conclusions@#Postoperative shoulder abduction and internal rotation can be protective against varus failure following proximal humeral fracture fixation as these positions decrease tension on the supraspinatus and subscapularis muscles. Use of a resting sling that places the shoulder in this position should be considered.

The Use of a Pipeline Embolization Device for Treatment of a Ruptured Dissecting Middle Cerebral Artery M3/M4 Aneurysm: Challenges and Technical Considerations / 신경중재치료의학

Prompt, effective treatment is necessary following aneurysmal subarachnoid hemorrhage to prevent recurrent rupture, which is thought to double mortality. Atypical ruptured aneurysms, such as blister or dissecting pseudoaneurysms, or those that are unusually distal in the middle cerebral artery (MCA) are challenging to treat with either open or endovascular options, though the pipeline embolization device (PED) has shown promise in multiple case series. We present a case of a ruptured dissecting pseudoaneurysm in the distal MCA (distal M3/proximal M4) prefrontal division in an healthy young patient (<60 years) successfully treated with a PED. The PED was chosen both as the only vessel sparing option in the young patient as well as for its potential as a vessel sacrifice tool if the pseudoaneurysm was felt to be incompletely treated, which in this case was not necessary—though would have leveraged the thrombogenicity of the device as a therapeutic advantage.

The Feasibility of Translaminar Screws in the Subaxial Cervical Spine: Computed Tomography and Cadaveric Validation

Background@#The use of translaminar screws may serve as a viable salvage method for complicated cases. To our understanding, the study of the feasibility of translaminar screw insertion in the actual entire subaxial cervical spine has not been carried out yet. The purpose of this study was to report the feasibility of translaminar screw insertion in the entire subaxial cervical spine. @*Methods@#Eighteen cadaveric spines were harvested from C3 to C7 and 1-mm computed tomography (CT) scans and three-dimensional reconstructions were created to exclude any bony anomaly. Thirty anatomically intact segments were collected (C3, 2; C4, 3; C5, 3; C6, 8; and C7, 14), and randomly arranged. Twenty-one segments were physically separated at each vertebral level (group S), while 9 segments were not separated from the vertebral column and left in situ (group N–S). CT measurement of lamina thickness was done for both group S and group N–S, and manual measurement of various length and angle was done for group S only. Using the trajectory proposed by the previous studies, translaminar screws were placed at each level. Screw diameter was the same or 0.5 mm larger than the proposed diameter based on CT measurement. Post-insertion CT was performed. Cortical breakage was checked either visually or by CT. @*Results@#When 1° and 2° screws of the same size were used, medial cortex breakage was found 13% and 33% of the time, respectively. C7 was relatively safer than the other levels. With larger-sized screws, medial cortex breakage was found in 47% and 46% of 1° and 2° screws, respectively. There were no facet injuries due to the screws in group N–S. @*Conclusions@#Translaminar screw insertion in the subaxial cervical spine is feasible only when the lamina is thick enough to avoid any breakage that could lead to further complications. The authors do not recommend inserting translaminar screws in the subaxial cervical spine except in some salvage cases in the presence of a thick lamina.

Do adolescents exposed to peer aggression at school consider themselves to be victims of bullying? The influence of sex and age

Abstract Introduction Exposure to peer aggression (PA) and bullying victimization (BV) are both expressions of peer victimization. Objectives In four age-sex groups, (1) Can exposure to PA and BV be considered distinct experiences? (2) To what extent do adolescents exposed to PA consider themselves bullying victims? and (3) What is the effect on BV of the number of PA events experienced? Methods This cross-sectional study evaluated a probabilistic community-based sample of 669 adolescents (11-15 years, 51.7% girls). A three-stage probabilistic sampling plan involved random selection of census units, eligible households, and one target child per household selected. A 15-item scale investigated exposure to PA events (physical aggression, verbal harassment, social manipulation) occurring more than once in the past six months. BV occurring more than once a week or most days in the past six months was investigated after presenting respondents with a BV definition that required them to feel harmed by their victimization experiences. Results Adolescents exposed to PA and/or BV reported PA only (76.2%), BV only (4.7%), and both (19.1%). Rates of BV among those exposed to PA were as follows: 11-to-12-year-old boys (22.7%), 13-to-15-year-old boys (9.7%), 11-to-12-year-old girls (46.5%), and 13-to-15-year-old girls (13.2%). Multiple logistic regression analysis (outcome = BV) found a significant interaction between PA, age, and sex. PA events had a significant effect on BV for all except older girls. Conclusion Exposure to PA and BV are different constructs; few older boys exposed to PA consider themselves bullying victims; and older girls are less affected by PA when it comes to BV.

Características del melanoma cutáneo en dos instituciones de Bogotá, Colombia: Análisis 2012-2016 / Characteristic features of cutaneousmelanoma in two institutions of Bogotá, Colombia: Analysis, 2012-2016

Resumen Introducción: El Melanoma es una neoplasia que se origina de los melanocitos. Este tumor, a pesar de representar solo el 5% de las neoplasias cutáneas, es el responsable del 70% de las muertes producidas por cáncer de piel. En Colombia se ha registrado una supervivencia del 79% a 5 años y en el caso particular del melanoma lentiginoso acral, de tan solo 54%. No obstante, los datos nacionales no son claros, por lo cual es necesario caracterizar a los pacientes con dicho diagnóstico para contribuir con futuros estudios. Metodología: Estudio de corte transversal en el cual se incluyeron y analizaron registros clínicos, demográficos e histopatológicos de pacientes con diagnóstico de melanoma cutáneo atendidos en dos instituciones dermatológicas de Bogotá, Colombia, durante los años 2012-2016. Resultados: Se incluyeron un total de 255 pacientes, la mayoría mujeres (61.0%). Se observó un aumento de 22 a 64 casos diagnosticados en los años 2012 y 2016 respectivamente. El subtipo histológico más frecuente fue el lentigo maligno (33.7%) seguido del melanoma lentiginoso acral (16.1%). La principal localización fue la cara (43.1%). El tiempo entre la detección y la confirmación del diagnóstico por biopsia fue de 17 meses. El 20% de los casos correspondió con un índice de Breslow <1 y el 42.4% de los casos un Clark de I. Conclusiones: Se observó un aumento en el número de casos nuevos de melanoma cutáneo entre los años 2012 y 2016, siendo los subtipos más frecuentemente diagnosticados el lentigo maligno y el melanoma lentiginoso acral. Los tiempos promedio de diagnóstico fueron prolongados.

Abstract Introduction: Melanoma is a cutaneous neoplasm originating from melanocytes. This tumor, despite representing only 5% of skin neoplasms, is responsible for 70% of deaths caused by skin cancer. In Colombia, a mortality of 0.5/100,000 inhabitants has been reported with a survival rate of 79% at 5 years, but in the case of acral lentiginous melanoma, survival is only 54%. However, national data are not clear, which highlights the need to characterize patients with this diagnosis to contribute to further epidemiological studies. Methodology: Cross-sectional study of the clinical, demographic, and histopathological records of patients with diagnosis of cutaneous melanoma, who were attended in two dermatological centers of Bogotá, Colombia, during 2012-2016. Results: A total of 255 patients were included, most of them women (61.0%). An increase from 22 to 64 diagnosed cases was observed from 2012 to 2016, respectively. The most frequent histological subtype was lentigo maligna (33.7%), followed by lentiginous acral melanoma (16.1%). The main location was face (43.1%). The time between detection and confirmation of diagnosis by biopsy was 17 months. 20% of the cases had a Breslow index <1 and 42.4% of the cases were Clark's level I. Conclusions: There was an increase in the number of new cases of cutaneous melanoma between 2012 and 2016, the most frequently diagnosed subtypes being lentigo maligna and acral lentiginous melanoma. The average time of diagnosis was prolonged.

Uso racional de antimicrobianos en tiempos de COVID-19 en Perú: rol de los programas de optimización del uso de antimicrobianos e intervenciones desde el punto de vista de control de infecciones

La resistencia antimicrobiana (RAM) es una pandemia adicional de lenta evolución que precede a la pandemia de COVID-19 y continuará cuando esta termine. Sin embargo, en países como Perú, donde existe un alto consumo y prescripción inadecuada de antimicrobianos, puede pasar desapercibida y se puede esperar, en el futuro, un escenario más desafiante. Los programas de optimización de uso de antimicrobianos (PROA) son equipos multidisciplinarios de profesionales que tienen como objetivo retardar la aparición de organismos multirresistentes a través de estrategias como la auditoría de prescripciones o la creación de algoritmos de tratamiento antimicrobiano basados en las tasas locales de RAM. La dificultad en el diagnóstico oportuno de coinfecciones o superinfecciones en el curso clínico y progresión de la COVID-19 predisponen al uso inadecuado de antimicrobianos, lo que obliga a los PROA a adaptar sus estrategias en este panorama cambiante. En Latinoamérica, los PROA no solo tienen que fomentar el cambio de comportamiento en los prescriptores de antimicrobianos, sino también luchar contra la epidemia de información falsa (infodemia) y las campañas de desinformación sobre la COVID-19. Además, la pobre cultura local de prevención y control de infecciones obliga a revisar estrategias para mitigar el impacto posterior en la RAM.

Antimicrobial resistance (AMR) is an additional slow-evolving pandemic that precedes the COVID-19 pandemic and will continue when it ends. However, in countries like Peru, where high consumption and inadequate prescription of antimicrobials occur, AMR may go unnoticed and a more challenging future scenario can be expected. Antimicrobial stewardship programs (ASPs) consist of multidisciplinary teams of professionals that aim to slow down the emergence of multidrug-resistant organisms through strategies such as prescription auditing or creation of antimicrobial treatment guidelines based on local AMR rates. The difficulty in the timely diagnosis of co-infections or superinfections in the clinical course and progression of COVID-19 leads to inappropriate use of antimicrobials, forcing ASPs to adapt their strategies in this changing scenario. In Latin America, ASPs not only have to promote behavior change in antimicrobial prescribers but also fight the epidemic of false information (infodemic) and disinformation campaigns on COVID-19. Furthermore, poor-quality infection prevention and control principles require evaluating strategies to mitigate the subsequent impact on AMR.

Hepatitis por citomegalovirus en una lactante de 2 meses: reporte de un caso

La infección por citomegalovirus congénito es una causa de infección neonatal que puede cursar asintomático; sin embargo, es posible sus complicaciones en algunos órganos como el sistema nervioso y el hígado. Reportamos un caso de una lactante mujer de 2 meses, con hepatitis por citomegalovirus caracterizado por distensión abdominal, colestasis, irritabilidad y pobre lactancia. En los exámenes se evidenció compromiso hepático, microcalcificaciones periventriculares e hipoacusia neurosensorial. El diagnóstico se determinó mediante anticuerpos séricos, confirmado con carga viral en sangre, orina y en tejido hepático. Se administró tratamiento con ganciclovir, vitamina K y ácido ursodesoxicólico con adecuada evolución. La hepatitis por citomegalovirus es una complicación que puede estar asociado con el compromiso de otros órganos. El tratamiento antiviral para el compromiso hepático aún es controversial; sin embargo, está recomendado en menores de un mes si está asociado a daño neurológico.

Congenital cytomegalovirus infection is a cause of neonatal infection that can be asymptomatic; however, its complications are possible in some organs such as the nervous system and the liver. We report a case of a 2-month-old female infant with cytomegalovirus hepatitis characterized by abdominal distention, cholestasis, irritability, and poor breastfeeding. In the tests, liver involvement, periventricular microcalcifications, and sensorineural hearing loss were found. The diagnosis was determined by serum antibodies, confirmed with viral load in blood, urine, and liver tissue. Treatment with ganciclovir, vitamin K, and ursodeoxycholic acid was administered with adequate evolution. Cytomegalovirus hepatitis is a complication that may be associated with the involvement of other organs. Antiviral treatment for liver involvement is still controversial; however, it is recommended in children under one month of age if it is associated with neurological damage.

Reconstruction with a Custom made Prosthetic Wrist Arthrodesis after Bone Tumor Resections of the Distal Radius. Single Centre Experience / Reconstrução com implante metálico personalizado de artrodese após ressecções de tumor ósseo do rádio distal. Experiência em um único centro

Abstract Objective The present study aimed at analyzing the clinical, radiological and functional results of the reconstruction of the distal radius after tumor resection with a custom-made metal arthrodesis implant and compare them with other types of distal radius reconstruction, as presented in the literature. To our best knowledge, this is the first article describing this particular type of implant and patient functionality. Methods Functional outcomes of reconstruction of the distal radius were assessed in a series of 4 patients. Three of the patients having had resection of giant cell tumors (GCTs), one patient having had resection of osteosarcoma. Results There were no major implant-related complications like infection, nonunion or loosening. Two patients had to undergo further surgery for protruding metalwork. Overall function was good according to the Musculoskeletal Tumor Society MSTS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Conclusion The present study shows that custom-made metal arthrodesis implant benefits from the fact that it can be used as a salvage option when other treatments have failed, or it can be used as a primary option in cases in which there is limited bone stock after distal radius tumor resection.

Resumo Objetivo O presente estudo teve como objetivo analisar os resultados clínicos, radiológicos e funcionais da reconstrução do rádio distal após a ressecção do tumor com implante metálico personalizado de artrodese e compará-los com outros tipos de reconstrução do rádio distal, conforme apresentado na literatura. Pelo que conhecemos, este é o primeiro artigo descrevendo esse tipo particular de implante e funcionalidade no paciente. Métodos Os desfechos funcionais de reconstrução do rádio distal foram avaliados em uma série de 4 pacientes. Três dos pacientes tiveram ressecção de tumores de células gigantes (TCGs), sendo um paciente com ressecção de osteossarcoma. Resultados Não houve complicações relacionadas ao implante, como infecção, não sindicalidade ou afrouxamento. Dois pacientes tiveram que passar por uma nova cirurgia para a protusão da prótese metálica. A função geral foi boa de acordo com as pontuações da Musculoskeletal Tumor Society (MSTS) e Disabilities of the Arm, Shoulder, and Hand (DASH). Conclusão O estudo mostra que o implante metálico personalizado de artrodese se beneficia do fato de que pode ser usado como opção de salvamento quando outros tratamentos falharam, ou pode ser usado como opção primária nos casos em que há estoque ósseo limitado após a ressecção do tumor do rádio distal.

Consumo de tabaco y condición de empleo en una región del eje cafetero colombiano / Smoking and employment conditions in a department of the coffee-triangle region of Colombia

RESUMEN Objetivos Estimar la prevalencia del consumo de tabaco en una región del eje cafetero y su asociación con la condición de empleo. Métodos Este estudio fue del tipo corte transversal. Los participantes fueron hombres y mujeres mayores de 15 años residentes de los municipios de Risaralda que aceptaron ser encuestados sobre las características del consumo de tabaco en 2017. Resultados Se evaluaron 4 157 registros de personas y se obtuvo una prevalencia de consumo de tabaco en Risaralda del 11,5%. En subempleados hubo una asociación significativa por fumar (p<0,05) (OR=1,51 IC95%: 1,18-1,94) cuando se ajustó el consumo de cigarrillo por edad y sexo, mientras que en desempleados el odds ratio reportado fue mayor (OR=3,10 IC95%: 2,03-4,73). Conclusiones Se encontró que el subempleo es un factor de riesgo para el consumo de tabaco que debe ser considerado en el desarrollo de políticas para el control de consumo de tabaco en la región en población vulnerable. La condición de empleo puede explicar las limitaciones de una política de control de consumo de tabaco en la población.

ABSTRACT Objective To estimate the links between smoking and employment conditions in a department of the coffee-triangle region. Methods This was a cross-sectional study. Participants were men and women older than 15 years residing in the municipalities of Risaralda. They agreed to complete a survey asking about the characteristics of tobacco consumption and socioeconomic status, in 2017. Results A total of 4 157 participants were surveyed. The smoking prevalence in Risaralda was 11,5%. Underemployment had a significant association with smoking (p<0,05 OR:1,51 CI95%: 1,18-1,94). Statistical significance was found when adjusting smoking by age and sex, whereas unemployment had over three times greater odds for smoking (OR:3,10, CI95%: 2,03-4,73). Conclusion This study finds that underemployment is a risk factor for smoking. This statement should be considered to the future assessment of the tobacco control policies in the region, particularly for vulnerable population. The employment conditions could explain the boundaries at the tobacco control policies in the population.

Association between lung compliance phenotypes and mortality in COVID-19 patients with acute respiratory distress syndrome

INTRODUCTION@#Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with a high mortality rate, though outcomes of the different lung compliance phenotypes are unclear. We aimed to measure lung compliance and examine other factors associated with mortality in COVID-19 patients with ARDS.@*METHODS@#Adult patients with COVID-19 ARDS who required invasive mechanical ventilation at 8 hospitals in Singapore were prospectively enrolled. Factors associated with both mortality and differences between high (<40mL/cm H@*RESULTS@#A total of 102 patients with COVID-19 who required invasive mechanical ventilation were analysed; 15 (14.7%) did not survive. Non-survivors were older (median 70 years, interquartile range [IQR] 67-75 versus median 61 years, IQR 52-66; @*CONCLUSION@#COVID-19 ARDS patients with higher compliance on the day of intubation and a longitudinal decrease over time had a higher risk of death.

Use of 3D mapping system for ablating an accessory pathway associated with coronary sinus diverticulum

Background@#This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal acces‑ sory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries.Case Presentation: The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticu‑ lum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroana‑ tomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. @*Conclusion@#We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

Use of 3D mapping system for ablating an accessory pathway associated with coronary sinus diverticulum

Background@#This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal acces‑ sory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries.Case Presentation: The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticu‑ lum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroana‑ tomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. @*Conclusion@#We have demonstrated that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

Radiomic analysis of mri to predict sustained complete response after radiofrequency ablation in patients with hepatocellular carcinoma - a pilot study

OBJECTIVES: To investigate whether quantitative textural features, extracted from pretreatment MRI, can predict sustained complete response to radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC). METHODS: In this IRB-approved study, patients were selected from a maintained six-year database of consecutive patients who underwent both pretreatment MRI imaging with a probable or definitive imaging diagnosis of HCC (LI-RADS 4 or 5) and loco-regional treatment with RFA. An experienced radiologist manually segmented the hepatic nodules in MRI arterial and equilibrium phases to obtain the volume of interest (VOI) for extraction of 107 quantitative textural features, including shape and first- and second-order features. Statistical analysis was performed to evaluate associations between textural features and complete response. RESULTS: The study consisted of 34 patients with 51 treated hepatic nodules. Sustained complete response was achieved by 6 patients (4 with single nodule and 2 with multiple nodules). Of the 107 features from the arterial and equilibrium phases, 20 (18%) and 25 (23%) achieved AUC >0.7, respectively. The three best performing features were found in the equilibrium phase: Dependence Non-Uniformity Normalized and Dependence Variance (both GLDM class, with AUC of 0.78 and 0.76, respectively) and Maximum Probability (GLCM class, AUC of 0.76). CONCLUSIONS: This pilot study demonstrates that a radiomic analysis of pre-treatment MRI might be useful in identifying patients with HCC who are most likely to have a sustained complete response to RFA. Second-order features (GLDM and GLCM) extracted from equilibrium phase obtained highest discriminatory performance.

Seroprevalence and Risk Factors of Brucellosis in Dogs in Enugu and Anambra States, Nigeria / Seroprevalencia y factores de riesgo de la brucelosis en perros de los Estados Enugu y Anambra, Nigeria

Abstract Seroprevalence of the antibodies of Brucella canis and Brucella abortus in dogs was assessed using a cross-sectional survey in Anambra and Enugu States, Nigeria. A total of 123 Companion dogs made up of 65 clinic dogs, 34 slaughter dogs and 24 household dogs were screened. For B. abortus antibody assay, the collected serum was used for Rose Bengal plate test (RBPT), Serum agglutination test (SAT) and Solid Phase Immunoassay technique with Immunocomb® Canine Brucellosis Antibody Test Kit was used. Out of the 123 dogs screened, none was positive for Brucella abortus antibodies while 34 (27.7%) of the dogs screened were positive for B. canis antibodies. There was a significant association (P<0.05) between infection and sex, the infection was significantly higher (P<0.05) in female than male dogs. Prevalence was significantly higher (P<0.05) in Exotic breeds than in mixed and local dog breeds. There was no association (P>0.05) between infection and antibody titre levels in the different categories of dogs. However, there was significant association (P<0.05) between the presence of Brucella canis antibodies and free roaming of dogs. This study provides the first serological evidence of B. canis infection in dogs in Enugu and Anambra States. This shows that B. canis is endemic in both states, underscoring the need for further studies. Female dogs, exotic breeds and freely roaming dogs are at a higher risk of Brucella infection in the study area; therefore, preventive and control measures are strongly recommended.

Resumen Se evaluó la seroprevalencia de los anticuerpos de Brucella canis y Brucella abortus en perros usando un sondeo transversal en los Estados Anambra and Enugu, Nigeria. Se examinó un total de 123 perros de compañía, de los cuales 65 eran perros de clínica, 34 perros de matadero y 24 perros caseros. Para el ensayo de anticuerpos de B. abortus, el suero muestreado se usó para la prueba de Rosa de Bengala (RBPT), prueba de aglutinación del suero (SAT) y se usó la técnica de inmunoensayo en fase sólida con el kit de prueba de anticuerpos para brucelosis canina Immunocomb®. De los 123 perros analizados, ninguno dio positivo para los anticuerpos de Brucella abortus mientras que 34 (27.7%) de los perros analizados dieron positivo para los anticuerpos de B. canis. Hubo una asociación significativa (P<0.05) entre infección y género; la infección fue significativamente más alta (P<0.05) en las hembras que en los machos. La prevalencia fue significativamente más alta (P<0.05) en las razas exóticas que en las razas cruzadas y las razas locales. No hubo ninguna relación (P>0.05) entre la infección y los niveles de titulación de anticuerpos en las diferentes categorías de perros. Sin embargo, hubo una relación significativa (P<0.05) entre la presencia de anticuerpos Brucella canis y los perros que andan libremente por doquier. Este estudio provee la primera evidencia serológica de infección con B. canis en perros de los Estados Enugu y Anambra. Esto muestra que la B. canis es endémica en ambos estados, enfatizando la necesidad de hacer más estudios. Las hembras, las razas exóticas y los animales que deambulan libremente se encuentran en el riesgo más alto de infección con Brucella en el área de estudio; por consiguiente, se recomienda enormemente tomar medidas preventivas y de control.

The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors

Background/Aims@#The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratify PNETs. This study investigates the concordance rate of Ki67 grading between EUS-FNA and surgical pathology specimens in NFPNETs and whether certain NF-PNET characteristics are associated with disease recurrence and disease-related death. @*Methods@#We retrospectively reviewed the clinical history, imaging, endoscopic findings, and pathology records of 37 cases of NFPNETs that underwent pre-operative EUS-FNA and surgical resection at a single academic medical center. @*Results@#There was 73% concordance between Ki67 obtained from EUS-FNA cytology and surgical pathology specimens; concordance was the highest for low- and high-grade NF-PNETs. High-grade Ki67 NF-PNETs based on cytology (p=0.028) and histology (p=0.028) were associated with disease recurrence and disease-related death. Additionally, tumors with high-grade mitotic rate (p=0.005), tumor size >22.5 mm (p=0.104), and lymphovascular invasion (p=0.103) were more likely to have poor prognosis. @*Conclusions@#NF-PNETs with high-grade Ki67 on EUS-FNA have poor prognosis despite surgical resection. NF-PNETs with intermediate-grade Ki67 on EUS-FNA should be strongly considered for surgical resection. NF-PNETs with low-grade Ki67 on EUSFNA can be monitored without surgical intervention, up to tumor size 20 mm.

Prevalence of Hyperuricemia and Its Association with Obesity in Korean Adults: Analysis Based on 2018 Korea National Health and Nutrition Examination Survey

Background@#This study aimed to analyze the association between the prevalence of hyperuricemia and obesity in Korean adults. @*Methods@#The participants included 5,922 adults from the 2018 Korea National Health and Nutrition Examination Survey. We examined the relationship between obesity status and serum uric acid levels using a chi-square test and multiple logistic regression. @*Results@#There was an increase in the prevalence of hyperuricemia with higher body mass index (P<0.001 and P=0.003, respectively). Both male and female in a higher obesity class also had a higher odds ratio for the prevalence of hyperuricemia (P<0.001). This trend remained consistent after adjusting for all confounding factors. The obesity class III group was found to be associated with the highest risk of hyperuricemia. @*Conclusion@#In this study, we found that hyperuricemia was significantly associated with obesity in Korean adults. In a clinical setting, this finding presents objective data for more aggressive management and ultimate prevention of obesity.