Phonomechanocardiography in dilated cardiomyopathy

Twenty seven patients with dilated cardiomyopathy (DCM) were studied by phonocardiography and mechanocardiography. The diagnosis was made in each case by history, laboratory, echocardiogram, hemodynamic study and coronary arteriography. Patients with left complete bundle branch block were excluded. As controls we studied 24 subjects with comparable age an sex. The phonomecanocardiographic records were performed with a Siemens-Elema machine (Mingograph-34) with direct ink recording with electrocardiogram in lead DII, phonocardiogram in mitral focus, and carotid pulse or apexcardiogram (ACG) simultaneously. The following data were assessed: heart rate (HR) electromechanical interval (Q-S2), preejection period of left ventricular contraction (PEP), left ventricular ejection time (LVET), relative ejection period (REP), ratio PEP/LVET (IW), "a" wave of the ACG ("a" wave), rising period of the apex-cardiogram (RPACG), isovolumic relaxation time (IRT), first heart sound intensity (S1I), third and fourth heart sound presence (S3 and S4) respectively. The average values (mean) and their standard deviation for the groups (N) and DCM respectively were: HR (b/m): 67.08 +/- 7.67 and 88.84 +/- 15.31; Q - S2 (msec.): 554.23 +/- 28.37 and 561.35 +/- 30.99; PEP (msec.): 145.13 +/- 17.64 and 194.11 +/- 22.09; LVET (msec): 409.38 +/- 27.68 and 375.54 +/- 28.21; REP (%): 102 +/- 9.27 and 84.78 +/- 8.61; IW: 0.395 +/- 0.078 and 0.72 +/- 0.11; "a" wave (%): 7.37 +/- 2.15 and 19.47 +/- 6.76; RPACG (sec.): 0.093 +/- 0.0015 and 0.143 +/- 0.067; IRT (sec.): 0.094 +/- 0.0012 and 0.105 +/- 0.018.(ABSTRACT TRUNCATED AT 250 WORDS)     

The V-shaped artifact of the gallbladder wall

Among 20,000 patients who had undergone abdominal or gallbladder sonographic examinations, 36 had a short V-shaped artifact originating from an hyperechoic focus in the gallbladder wall. Associated symptoms were varied and nonspecific. The 10 gallbladders excised because of associated cholelithiasis showed a thickened wall, and seven patients had diverticulosis of the wall with impacted stones. In vitro sonographic examination of five gallbladders reproduced the "V" artifact and showed that it originated from a small intramural cholesterol stone. The V artifact should be distinguished from the larger comet-tail and ring-down artifacts, which arise from metal or gas.     

Coconut Oil Supplementation Does Not Affect Blood Pressure Variability and Oxidative Stress: A Placebo-Controlled Clinical Study in Stage-1 Hypertensive Patients

Exploring an alternative to improve the clinical management of hypertension, we tested the hypothesis that food supplementation with coconut oil (EVCO), alone or combined with aerobic exercise training, could exert an antihypertensive effect (primary outcome) in patients with stage 1 hypertension. Forty-five hypertensive volunteers of both genders participated in a placebo-controlled clinical trial. The volunteers were submitted to 24-hour ambulatory blood pressure monitoring, analysis of blood pressure variability (BPV), measurement of serum malondialdehyde (MDA) and nutritional assessment. Results indicate that EVCO consumption had no adverse effects. The supplementation did not increase the caloric intake compared with placebo, and the dietary constituents were similar between groups, except for the saturated fats, especially lauric acid. The analysis of blood pressure indicated absence of antihypertensive effect of EVCO alone or combined with physical training. Furthermore, no effects on blood pressure variability and oxidative stress were observed in the supplemented hypertensive patients. Thus, despite the results observed in pre-clinical studies, the current clinical study did not provide evidence to support the use of coconut oil as an adjuvant in the management of hypertension in humans.     

Machine learning and national health data to improve evidence: Finding segmentation in individuals without private insurance

ObjectiveIndividuals without private health insurance have less access to healthcare, therefore are more prone to experience poor health when compared to those who have. Segmentation is an approach to find homogenous groups of people with the purpose of tailoring services and products. In public policy, segmentation might be used to identify characteristics and needs of specific groups and deliver targeted programs and spare costs. We aim to identify and describe segments within the uninsured population to aid targeted policy actions and improve health.MethodsWe used secondary data collected from a representative, nationwide health survey (n=18,204). For the purpose of our analysis, we included data from individuals who answered “no” to the question: “Do you have private health insurance?” (n=12,134). Variables pertaining information on socio-demographic, health status, access and care were used. A multiple correspondence analysis was performed to find principal components followed by a hierarchical cluster.ResultsWe found three clusters. The first (54.12% of our sample) composed by a group of young, middle aged and professionally active individuals without health problems. The second (36.70%), a cluster of aging individuals composed especially by elderly women, either retired or fulfilling domestic tasks, with a long-term health problem. The last (9.17%) composed by elder people, with long-term health problem and scoring low in mental health related questions.ConclusionOur study found three clusters (profiles of individuals) among the uninsured. Ultimately, our findings aim to support policy makers to deliver customized actions to improve health and provide cost-effective policies.     

Comparing the Approach to Radical Prostatectomy Using the Multiport da Vinci Xi and da Vinci SP Robots: A Propensity Score Analysis of Perioperative Outcomes

BackgroundUse of the single-port da Vinci SP robotic platform for various urological procedures has been described by several groups. However, the comparative performance of the SP robot in relation to earlier models such as the da Vinci Xi is still unclear.ObjectiveTo compare intraoperative and short-term postoperative outcomes between the da Vinci Xi and SP robots for patients undergoing radical prostatectomy (RP) in a referral center.Design, setting, and participantsData were prospectively collected for patients undergoing RP from June 2019 to April 2020 in a single center. The da Vinci SP was used for 71 patients and the da Vinci Xi for 875 patients. After propensity score (PS) matching, two groups of 71 patients were selected for the comparative study.InterventionRP via a transperitoneal approach using the same technique steps and anatomy access with both robot consoles.Outcome measurements and statistical analysisA PS analysis was performed using the covariates age, body mass index, Charlson comorbidity index, Sexual Health Inventory for Men score, American Urological Association symptom score, prostate size, prostate-specific antigen levels, Gleason score, D’Amico risk group, and degree of nerve-sparing. Intraoperative performance and short-term functional (continence and potency) and oncological outcomes were compared between the groups.Results and limitationsMedian follow-up was 4.4 mo (interquartile range [IQR] 1.6–7.2) for the SP group and 3.2 mo (IQR 1.6–4.8) for the Xi group (p = 0.2). The median total operative time and median console time were both significantly higher in the SP group, with median differences of 14 min (95% confidence interval [CI] 9–19) and 5 min (95% CI 0–5), respectively. The proportion of patients with blood loss of >100 ml was significantly lower in the SP group (difference of 27%, 95% CI 12–42%). No intra- or postoperative complications were reported in either group. There were no significant differences in pain scores at 6, 12, and 18 h or in positive surgical margin rates between the groups. The SP group had a significantly higher percentage of extraprostatic extension than the Xi group (difference of 16%, 95% CI 4.6–27%). None of the patients experienced biochemical recurrence during follow-up. The difference in continence rates at 45 d between the SP and Xi groups was 11% (95% CI ?5.6% to 28%) and the difference in potency rates at 45 d was ?7.3% (95% CI ?21% to 6.2%). The short-term follow-up for comparison of functional and oncological outcomes is a limitation.ConclusionsDespite differences in trocar placement and technology between the two da Vinci consoles, the SP has satisfactory intraoperative performance compared to the Xi. SP surgery can be performed safely and effectively during the initial learning phase. However, longer-term follow-up is needed to provide further evidence on the impact of SP implementation on functional and oncological outcomes.Patient summaryWe compared intraoperative and short-term postoperative outcomes for patients who underwent radical prostatectomy using two different robots, the da Vinci Xi and the single-port da Vinci SP. We found that operative time was longer for the Single Port console. Studies with long-term follow-up are needed to compare the functional and oncological outcomes.     

Surgical management of symptomatic cavum septum pellucidum cysts: systematic review of the literature

Neurosurgical Review - Cavum septum pellucidum (CSP) and cavum vergae (CV) cysts are commonly found incidentally. They are usually asymptomatic but may present with symptoms related to obstructive...     

Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries

Neurosurgical Review - A preferred treatment for residual/recurrent pituitary adenomas has not been established. The existence of higher complication rates for revision surgeries remains under...