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2021 ◽  
Vol 12 (1) ◽  
pp. 275-286
Ayesha Ammar ◽  
Kahkashan Bashir Mir ◽  
Sadaf Batool ◽  
Noreen Marwat ◽  
Maryam Saeed ◽  

Objective: Study was aimed to see the effects of hypothyroidism on GFR as a renal function. Material and methods: Total of Fifty-eight patients were included in the study. Out of those forty-eight patients were female and the rest were male. Out of fifty eight patients, fifty three patients were of thyroid cancer in which hypothyroidism was due to discontinuation of thyroxine before the administration of radioactive iodine for Differentiated thyroid cancer.Moreover, remaining five patients were post radioactive iodine treatment (for hyperthyroidism) hypothyroid. All of the patients were above eighteen years of age with TSH value > 30µIU/ml. Pregnant and lactating females were excluded.Renal function tests (urea/creatinine, creatinine clearance) and serum electrolytes followed by Tc-99m-DTPA renal scan for GFR assessment (GATES’ method) were carried out in all subjects twice during the study, One study during hypothyroid state (TSH > 30 µIU/ml) and other during euthyroid state (TSH between 0.4 to 4µ IU/ml). The results of Student’s t-test showed significant difference in renal functions (Urea, creatinine, creatinine clearance, GFR values) in euthyroid state and hypothyroid state (p-value <0.05). RESULTS: In case of creatinine the paired t test reveal the mean 1.014±0.428, with standard error of 0.669 within 95% confidence interval, for creatinine clearance 80.11±14.12 with standard error of 1.94 within 95% confidence intervals, for urea the mean 28±12.13 with standard error of 1.607 within 95% confidence intervals and for GFR for individual kidney is 38.056±8.56 with standard error of 1.3717 within 95% confidence interval. There was no difference in the outcome of the 2 groups. Conclusion: Hypothyroidism impairs renal function to a significant level and hence needs to be prevented and corrected as early as possible.

2021 ◽  
Vol 8 (1) ◽  
Alexandra M. Blokker ◽  
Ryan Wood ◽  
Jaques C. Milner ◽  
David W. Holdsworth ◽  
Timothy A. Burkhart ◽  

Abstract Purpose A large percentage of anterior cruciate ligament (ACL) surgical reconstructions experience sub-optimal outcomes within 2 years. A potential factor contributing to poor outcomes is an incomplete understanding of micro-level, regional ACL biomechanics. This research aimed to demonstrate a minimally invasive method that uses micro-CT imaging to quantify regional ACL strains under clinically relevant joint loading. Methods A pattern of 0.8 mm diameter zirconium dioxide beads were arthroscopically inserted into four regions of the ACL of four cadaveric knee specimens (mean [SD] age = 59 [9] years). A custom micro-CT compatible joint motion simulator then applied clinically relevant joint loading conditions, while an image was acquired at each condition. From the resulting images, strains within each region were calculated using the centroid coordinates of each tissue-embedded bead. Strain repeatability was assessed using the mean intra-specimen standard deviation across repeated load applications. A one-way repeated measures ANOVA (α = 0.05) was used to determine regional strain variations. Results The mean intra-specimen standard deviation across repeated load application was ±0.003 strain for all specimens. No statistically significant differences were found between tissue regions, although medium and large effect sizes (0.095–0.450) suggest that these differences may be clinically relevant. Conclusions The method presented here demonstrates a minimally invasive measurement of regional ACL strain under clinically relevant joint loads using micro-CT imaging. The strain measurements demonstrated excellent reliability across the five repeated load applications and suggest a non-homogenous distribution of strain through the ACL.

2021 ◽  
Alam Khan

<div>Catheter insertion for gynecological interstitial brachytherapy is a challenging surgical procedure due to the lack of real-time guidance available to Radiation Oncologists. To mitigate the limitations associated with catheter placement, electromagnetic navigation (EMN) was proposed as a solution to the current interstitial brachytherapy workflow. The sequence of events leading up to the completion of this project were as follows, the validation of the system and then the application of the EMN system in a clinical trial. Using a phantom-based validation method, submillimetric accuracy and jitter was characterized for the operational performance of an EMN system in a brachytherapy operating room environment.</div><div>Following validation, the EMN system was used for catheter placement in 5 patients, in an ongoing prospective clinical study. The mean catheter deflection documented was 3.52 +/- 2.53 mm when adopting EMN as a form of real-time guidance compared to 5.48 +/- 3.63 mm when the standard clinical workflow (SCW) was employed. The mean catheter spacing when using EMN was 9.31 +/- 4.81 mm compared to 7.09 +/- 6.06 mm when the SCW was followed. Also, the mean intraoperative time was 50.00 +/- 18.80 minutes for EMN and 38.20 +/- 15.29 minutes for the SCW.</div><div>The results of this project demonstrate that electromagnetic navigated interstitial catheter placement is promising as a real-time guidance option for the interstitial gynecological brachytherapy workflow. <br></div>

2021 ◽  
Kiriaki Syrmali ◽  
Georgios Nikitas ◽  
Emmanouil C. Papadakis ◽  
Sotirios P. Patsilinakos

Abstract Purpose: Patients with angina and a positive SPECT for reversible ischemia, with no or non-obstructive CAD on ICA represent a frequent clinical problem and predicting prognosis is challenging. Methods: A retrospective single center study focused on patients that underwent elective-ICA with angina and a positive SECT with no or non-obstructive CAD in the CathLab, during a seven-year period. Assessment of patients’ cardiovascular morbidity, mortality, and MACE during a follow-up period of at least three years after ICA, with the assist of a telephone questionnaire.Results: Data of all patients that underwent ICA for a period of 7 years (from January 1,2011 until December 31, 2017) in our hospital were analyzed. The patients that fulfilled the prespecified criteria were 569. At the telephone survey, 285(50.1%) were successfully contacted and agreed to participate. The mean age was 67.6 (SD8.8) years (35.4%female) and the mean follow-up time was 5.53years (SD1.85). Mortality rate was 1.7% (4 patients/non-cardiac causes) and 1,7% rate of revascularization. 31(10,9%) were hospitalized for cardiac reasons and 10,9% patients reported symptoms of HF (no patients with NYHA-Class above II). 21 had arrhythmic events and only two mild anginal symptoms. Noteworthy finding was, the mortality rate in the not-contacted group (12 out of 284, 4,2%), derived by public security records, did not differ significantly from the contacted-group. Conclusions: Patients with angina, a positive SPECT for reversible ischemia and no or non-obstructive CAD in ICA have very good long-term cardiovascular prognosis for at least 5 years.

2021 ◽  
Abhishekh Kumar Srivastava ◽  
Richard Grotjahn ◽  
Paul Aaron Ullrich ◽  
Colin Zarzycki

AbstractThe present work evaluates historical precipitation and its indices defined by the Expert Team on Climate Change Detection and Indices (ETCCDI) in suites of dynamically and statistically downscaled regional climate models (RCMs) against NOAA’s Global Historical Climatology Network Daily (GHCN-Daily) dataset over Florida. The models examined here are: (1) nested RCMs involved in the North American CORDEX (NA-CORDEX) program, (2) variable resolution Community Earth System Models (VR-CESM), (3) Coupled Model Intercomparison Project phase 5 (CMIP5) models statistically downscaled using localized constructed analogs (LOCA) technique. To quantify observational uncertainty, three in situ-based (PRISM, Livneh, CPC) and three reanalysis (ERA5, MERRA2, NARR) datasets are also evaluated against the station data. The reanalyses and dynamically downscaled RCMs generally underestimate the magnitude of the monthly precipitation and the frequency of the extreme rainfall in summer. The models forced with CanESM2 miss the phase of the seasonality of extreme precipitation. All models and reanalyses severely underestimate both the mean and interannual variability of mean wet-day precipitation (SDII), consecutive dry days (CDD), and overestimate consecutive wet days (CWD). Metric analysis suggests large uncertainty across NA-CORDEX models. Both the LOCA and VR-CESM models perform better than the majority of models. Overall, RegCM4 and WRF models perform poorer than the median model performance. The performance uncertainty across models is comparable to that in the reanalyses. Specifically, NARR performs poorer than the median model performance in simulating the mean indices and MERRA2 performs worse than the majority of models in capturing the interannual variability of the indices.

2021 ◽  
Vol 11 (1) ◽  
Michael Anapolski ◽  
Anja Schellenberger ◽  
Ibrahim Alkatout ◽  
Dimitrios Panayotopoulos ◽  
Alexander Gut ◽  

AbstractElectromechanical morcellation—so called power morcellation—is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11–24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4–14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20–194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13–896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0–39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.

2021 ◽  
Vol 15 ◽  
Tianyi Chen ◽  
Fabin Lin ◽  
Guoen Cai

Background: Although a variety of targets for deep brain stimulation (DBS) have been found to be effective in Parkinson's disease (PD), it remains unclear which target for DBS leads to the best improvement in gait disorders in patients with PD. The purpose of this network meta-analysis (NMA) is to compare the efficacy of subthalamic nucleus (STN)-DBS, internal globus pallidus (GPi)-DBS, and pedunculopontine nucleus (PPN)-DBS, in improving gait disorders in patients with PD.Methods: We searched the PubMed database for articles published from January 1990 to December 2020. We used various languages to search for relevant documents to reduce language bias. A Bayesian NMA and systematic review of randomized and non-randomized controlled trials were conducted to explore the effects of different targets for DBS on gait damage.Result: In the 34 included studies, 538 patients with PD met the inclusion criteria. The NMA results of the effect of the DBS “on and off” on the mean change of the gait of the patients in medication-off show that GPi-DBS, STN-DBS, and PPN-DBS are significantly better than the baseline [GPi-DBS: –0.79(–1.2, –0.41), STN-DBS: –0.97(–1.1, –0.81), and PPN-DBS: –0.56(–1.1, –0.021)]. According to the surface under the cumulative ranking (SUCRA) score, the STN-DBS (SUCRA = 74.15%) ranked first, followed by the GPi-DBS (SUCRA = 48.30%), and the PPN-DBS (SUCRA = 27.20%) ranked last. The NMA results of the effect of the DBS “on and off” on the mean change of the gait of the patients in medication-on show that, compared with baseline, GPi-DBS and STN-DBS proved to be significantly effective [GPi-DBS: –0.53 (–1.0, –0.088) and STN-DBS: –0.47(–0.66, –0.29)]. The GPi-DBS ranked first (SUCRA = 59.00%), followed by STN-DBS(SUCRA = 51.70%), and PPN-DBS(SUCRA = 35.93%) ranked last.Conclusion: The meta-analysis results show that both the STN-DBS and GPi-DBS can affect certain aspects of PD gait disorder.

2021 ◽  
Zijun Chen ◽  
Jieshu Zhou ◽  
Li Wan ◽  
Han Huang

Abstract BackgroundCompared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and resultant a decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins.MethodsInformed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors.Results: There was no significant difference was observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI -0.1 to 9.0; P =.0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP is 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors.Conclusion: Infusion of norepinephrine was not associated with less decrease in heart rate during cesarean section for twins, compared with phenylephrine. Clinical trial number: Chinese Clinical Trial Registry (ChiCTR1900021281) Clinical trial registry URL:

2021 ◽  
Vol 10 (21) ◽  
pp. 4853
Iulian Filipov ◽  
Federico Bolognesi ◽  
Lucian Chirila ◽  
Corina Marilena Cristache ◽  
Giuseppe Corinaldesi ◽  

(1) Background: In the lateral area of the maxilla, the alveolar bone can lose significant volume due to maxillary sinus pneumatization following teeth extractions. This preliminary study evaluated the effectiveness of a novel technique for one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm residual alveolar bone. The subsequent survival rate at 1-year post-occlusal loading was assessed. (2) Methods: 15 patients were selected, the main inclusion criteria were the partially edentulous area in the posterior maxilla with alveolar bone height of less than 1.5 mm below the sinus. All of the patients underwent one-stage sinus lifting, along with simultaneous implant placement using a “butterfly” anchorage device to optimize the primary stability and xenograft bone as graft material. At 6 to 9 months after surgery, the anchorage device was removed and implants were loaded. Panoramic x-ray images were used to assess the new bone formation, while the biological stability was measured using resonance frequency analysis. (3) Results: 15 implants were inserted. The mean implant stability quotient (ISQ) value was 71.3 (SD = ±2.51) and the mean healing period was 7.3 (SD = ±1.23) months. The mean bone height after the healing period was 14.4 (SD = ±2.05). A statistically significant correlation was found between the healing period and the ISQ value (Spearman rho = 0.684, sig. = 0.005). No statistically significant correlation was found between the ISQ value and the new regenerated bone height (Person r = 0.389, sig. = 0.152). Smoking was identified as a risk factor involved in postoperative complications. (4) Conclusions: The results of the present preliminary study demonstrated that the proposed “butterfly” technique was effective when performing one-stage sinus lifting and simultaneous implant placement in cases with less than 1.5 mm of residual alveolar bone. The survival rate was 100% at 1-year post occlusal loading.

Madiou Thierno Bah ◽  
Vladimir Grobois ◽  
Frédéric Stachurski ◽  
facundo munoz ◽  
Maxime Duhayon ◽  

For the first time we built a correlative model for predicting the distribution of H. marginatum, one of the main vector of Crimean-Congo Haemorrhagic fever virus (CCHFV), at high resolution in a recently colonized area, namely south of France. Field tick collections were conducted on horses from 2016 to 2021 in 14 French southern departments, which resulted in a first map of H. marginatum on the national territory. Such updated presence/absence data, as well as the mean number of H. marginatum per examined animal (mean parasitic load) as a proxy of the tick abundance, were correlated to multiple parameters that described the climate and habitats characterizing each collection site, as well as movements of horses as a possible source of tick diffusion and new establishment. Our model highlighted the importance of warm temperatures all along the year, as well as dry conditions during summer and moderate annual humidity for the establishment of H. marginatum. A predominance of open natural habitats in the environment was also identified as a supporting factor, in opposition to artificial and humid habitats that were determined as unsuitable. Based on this model, we predicted the current suitable areas for the establishment of the tick H. marginatum in South of France, with a relatively good accuracy using internal and external validation methods. Concerning tick abundance, some correlative relationships were similar than in the occurrence model but the type of horse movements were also pointed out as an important factor explaining the mean parasitic load, leading to differential exposure to ticks. The limitations of estimating and modelling H. marginatum abundance in a correlative model are discussed.

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