Application of AI in cardiovascular multimodality imaging.

Technical advances in artificial intelligence (AI) in cardiac imaging are rapidly improving the reproducibility of this approach and the possibility to reduce time necessary to generate a report. In cardiac computed tomography angiography (CCTA) the main application of AI in clinical practice is focused on detection of stenosis, characterization of coronary plaques, and detection of myocardial ischemia. In cardiac magnetic resonance (CMR) the application of AI is focused on post-processing and particularly on the segmentation of cardiac chambers during late gadolinium enhancement. In echocardiography, the application of AI is focused on segmentation of cardiac chambers and is helpful for valvular function and wall motion abnormalities. The common thread represented by all of these techniques aims to shorten the time of interpretation without loss of information compared to the standard approach. In this review we provide an overview of AI applications in multimodality cardiac imaging.

Proximal ventricular shunt malfunctions in children: Factors associated with failure.

Ventricular shunt failures and subsequent revisions are a significant source of patient morbidity. We conducted a review of pediatric patients undergoing placement or revision of ventricular shunts at our institution between January 2007 and December 2008. Patients were followed through to July 2014. Data collected included patient demographics, shunt history and indication for procedure, approach taken for shunt placement, and location of shunt tip in relation to the foramen of Monro. Univariate and multivariate analyses were conducted to identify factors associated with proximal failure. A total of 87 procedures were identified in 40 patients, consisting of 23 initial placements and 64 revisions. Thirty-nine proximal catheter malfunctions were identified. Indications for shunt placement included Chiari II malformation (33%) and intraventricular hemorrhage (33%). Mean follow-up period was 5.5 years. Median time to shunt failure was 1.57 years. In the multivariate model, younger age at placement was associated with decreased time to proximal failure (hazard ratio [HR]=0.80 per increasing year of age, 95% confidence interval [CI] 0.64-0.98). Both anterior approach (HR=0.39, 95% CI 0.23-0.67) and farther distance to foramen of Monro (HR=0.02 per increasing 10mm, 95% CI 0.00-0.22) were associated with increased time to proximal failure when the catheter tip was located within the contralateral lateral ventricle. Optimizing outcomes in patients with shunt-dependent hydrocephalus continues to be a challenge. Despite unsatisfactory outcomes, particularly in the pediatric population, few conclusions can be drawn from studies assessing operative variables.

Anorectal fissures: an under-recognized cause of low back pain? Case report.

INTRODUCTION: Low back pain is one of the most common complaints for which patients seek medical attention. The differential for such a complaint is wide and therefore requires a thoughtful and thorough work-up. Anorectal disorders are an often-overlooked cause of low back pain. CASE PRESENTATION: We discuss the case of a 46-year-old male with history of dull aching back pain in the midline at the lumbosacral junction. The pain extended to the left of midline, into the region of the sacroiliac joint. There was no radiation into the buttock or leg. Physical exam was unremarkable. Upon soliciting further history, the patient reported a long history of anal pruritus and occasional hematochezia. Colonoscopy subsequently revealed anal fissures in various stages of healing. He was treated with Metamucil capsules and oral nifedipine with significant improvement of his symptoms. CONCLUSION: Low back pain is a challenging chief complaint to the primary care diagnostician due to its wide differential. In a careful and thorough work-up of this complaint, disorders of the anus and rectum should not be overlooked as possible culprits.

Short term changes in melatonin and cortisol serum levels after a single administration of estrogen to menopausal women.

OBJECTIVES: It has been well-documented that serum melatonin levels are insensitive to estrous or menstrual ovarian steroid variations in the female rat or the human. However, a negative coupling has been already demonstrated between the nocturnal serum melatonin peak and serum E2 concentration during the late premenopausal period in the woman. The objection of the present study was designed to determine if diurnal serum melatonin values can be also lowered by a single administration of estrogen. METHODS: We performed a detailed analysis of variations of serum estradiol, LH, FSH, melatonin and cortisol after one single I.M. injection of 2 mg of a conjugated estrogen, delestrogen (estradiol valerate) in 0.1 ml of oil. A 15 ml blood collection was done at 8:00 a.m. before the injection, and at 8:30 a.m., 9:00 a.m., 10:00 a.m., 12:00 noon, and 4:00 p.m. 17beta-estradiol, LH and FSH were determined by microparticle enzyme immunoassays kits. Melatonin determination was made using a RIA kit and cortisol was assayed by a RIA method. RESULTS: A significant rise in serum 17beta-estradiol was already seen by one hour after the injection of estradiol valerate. Then, an almost linear increase was observed up to at last eight hours after the injection of estradiol valerate. A significant decrease in serum LH was not seen before four hours after the injection of estradiol valerate. Overall, there was a trend toward a decline in serum melatonin and cortisol concentration. The decreasing trend of cortisol serum level was tested as significant over time (p< 0.001). However, the decrease in serum concentration did not reach a significant level for melatonin. CONCLUSION: Overall, these results show that after menopause an acute administration of estrogen during the early diurnal period of the day leads to a significant rapid decrease in cortisol serum values, but to only a partial non significant decrease in melatonin serum values.

Optimizing use of assisted reproduction.

Infertile couples who have failed to achieve pregnancy now have new options that have become available in the last two decades. The costs are generally large and frequently not covered by insurance. Risks include multiple pregnancy and hyperstimulation syndrome. Evidence concerning results of several treatment options is presented. The large difference in success between age groups is displayed. Results to be expected from donor eggs to overcome the low success in older age groups (>38 years) are presented.