Clinical presentation and neurovascular manifestations of cardiac myxomas and papillary fibroelastomas: a retrospective single-institution cohort study.

Background: Primary cardiac tumors are often benign and commonly present as cardiac myxomas (CMs) or papillary fibroelastomas (CPFEs). There is a paucity of prognostic indicators for tumor burden or potential for embolic cerebrovascular events (CVEs). This study was performed to address these gaps. Methods: Medical records at the University of Florida Health Shands Hospital between 1996 and 2021 were screened to identify patients with CMs or CPFEs. Clinical features, echocardiographic reports, and CVE outcomes were quantitatively assessed. Results: A total of 55 patients were included in the study: 28 CM (50.9%) and 27 CPFE (49.1%) patients. Baseline patient characteristics were similar among patients. The neutrophil-lymphocyte ratio was correlated (p < 0.005 in all cases) to three metrics of tumor size in both CM (r = 64-67%) and CPFE (r = 56-59%). CVEs were the presenting symptom in 30 (54.5%) patients. CVE recurrence was high; the 5-year CVE recurrence rate in patients with tumor resection was 24.0% compared to 60.0% without resection. No baseline patient characteristics or tumor features were associated with an initial presentation of CVEs compared to any other indication. Univariate analysis indicated that prolonged duration to surgical resection, left atrial enlargement, male sex, and a neutrophil-lymphocyte ratio >3.0 at the follow-up were significantly associated with 5-year CVE recurrence. Left atrial enlargement and a neutrophil-lymphocyte ratio >3.0 at the follow-up remained significantly associated with 5-year CVE recurrence in multivariate analysis. Conclusion: The neutrophil-lymphocyte ratio may prognosticate tumor size and recurrence of neurologic events. An increased risk of CVE within 5 years of mass resection is almost exclusive to patients initially presenting with CVEs.

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

Syntheses and Characterizations of the Mixed Noble-Gas Compounds, [FKrII FXeII F][AsF6 ]⋠0.5 KrII F2 ⋠2 HF, ([KrII 2 F3 ][AsF6 ])2 ⋠XeIV F4 , and XeIV F4 ⋠KrII F2.

Reaction of [XeF][AsF6 ] with excess KrF2 at -78 °C in anhydrous HF (aHF) solvent has yielded the first mixed KrII /XeII noble-gas compound, [FKrFXeF][AsF6 ] ⋅0.5 KrF2 ⋅2 HF, a salt of the [FKrFXeF]+ cation. The potent oxidative fluorinating properties of KrII fluoride species resulted in oxidation of XeII to XeIV in aHF at -60 °C to form the mixed KrII /XeIV cocrystals, ([Kr2 F3 ][AsF6 ])2 ⋅XeF4 and XeF4 ⋅KrF2 . Further decomposition at 22 °C resulted in oxidation of XeIV to XeVI to give the recently reported KrII /XeVI complexes, [F5 Xe(FKrF)n ][AsF6 ] (n=1, 2), [F5 Xe][AsF6 ], and a new KrII /XeVI complex, [(F5 Xe)2 (µ-FKrF)(AsF6 )2 ], which was characterized by low-temperature (LT) Raman spectroscopy. The [FKrFXeF][AsF6 ]⋅0.5 KrF2 ⋅2 HF, ([Kr2 F3 ][AsF6 ])2 ⋅XeF4 , and XeF4 ⋅KrF2 compounds were characterized by LT Raman spectroscopy and single-crystal X-ray diffraction. Quantum-chemical calculations were used to assess the bonding in [FKrFXeF]+ , [Kr2 F3 ]+ , and [Xe2 F3 ]+ and to aid in their vibrational assignments.

Verification testing to confirm VO2max attainment in persons with spinal cord injury.

Context/Objective: Maximal oxygen uptake (VO2max) is a widely used measure of cardiorespiratory fitness, aerobic function, and overall health risk. Although VO2max has been measured for almost 100 yr, no standardized criteria exist to verify VO2max attainment. Studies document that incidence of 'true' VO2max obtained from incremental exercise (INC) can be confirmed using a subsequent verification test (VER). In this study, we examined efficacy of VER in persons with spinal cord injury (SCI).Design: Repeated measures, within-subjects study.Setting: University laboratory in San Diego, CA.Participants: Ten individuals (age and injury duration = 33.3 ± 10.5 yr and 6.8 ± 6.2 yr) with SCI and 10 able-bodied (AB) individuals (age = 24.1 ± 7.4 yr).Interventions: Peak oxygen uptake (VO2peak) was determined during INC on an arm ergometer followed by VER at 105 percent of peak power output (% PPO).Outcome Measures: Gas exchange data, heart rate (HR), and blood lactate concentration (BLa) were measured during exercise.Results: Across all participants, VO2peak was highly related between protocols (ICC = 0.98) and the mean difference was equal to 0.08 ± 0.11 L/min. Compared to INC, VO2peak from VER was not different in SCI (1.30 ± 0.45 L/min vs. 1.31 ± 0.43 L/min) but higher in AB (1.63 ± 0.40 L/min vs. 1.76 ± 0.40 L/min).Conclusion: Data show similar VO2peak between incremental and verification tests in SCI, suggesting that VER confirms VO2max attainment. However, in AB participants completing arm ergometry, VER is essential to validate appearance of 'true' VO2peak.