Improving Prenatal Diagnosis of Coarctation of the Aorta

Background

The purpose of the study was to evaluate the association between fetal echocardiographic measurements and the need for intervention (primary coarctation repair, staged coarctation repair, or catheter intervention) in prenatally diagnosed coarctation of the aorta.

Abscess formation after transobturator sling placement: a case report

New techniques of sling placement may be associated with infectious complications. Slings through the obturator foramen and thigh can lead to a significant abscess formation within the thigh adductor muscles. A large thigh abscess associated with a transobturator sling was diagnosed and treated. The authors report the evaluation and treatment of a unique infectious complication of transobturator slings.     

Web Data Mining: Validity of Data from Google Earth for Food Retail Evaluation

To overcome the challenge of obtaining accurate data on community food retail, we developed an innovative tool to automatically capture food retail data from Google Earth (GE). The proposed method is relevant to non-commercial use or scholarly purposes. We aimed to test the validity of web sources data for the assessment of community food retail environment by comparison to ground-truth observations (gold standard). A secondary aim was to test whether validity differs by type of food outlet and socioeconomic status (SES). The study area included a sample of 300 census tracts stratified by SES in two of the largest cities in Brazil, Rio de Janeiro and Belo Horizonte. The GE web service was used to develop a tool for automatic acquisition of food retail data through the generation of a regular grid of points. To test its validity, this data was compared with the ground-truth data. Compared to the 856 outlets identified in 285 census tracts by the ground-truth method, the GE interface identified 731 outlets. In both cities, the GE interface scored moderate to excellent compared to the ground-truth data across all of the validity measures: sensitivity, specificity, positive predictive value, negative predictive value and accuracy (ranging from 66.3 to 100%). The validity did not differ by SES strata. Supermarkets, convenience stores and restaurants yielded better results than other store types. To our knowledge, this research is the first to investigate using GE as a tool to capture community food retail data. Our results suggest that the GE interface could be used to measure the community food environment. Validity was satisfactory for different SES areas and types of outlets.     

Quality of life outcomes after minimally invasive repair of pectus excavatum utilizing a new set of metallic bars and stabilizers

Background/PurposeThe aim of the study was to evaluate the postoperative quality of life (QoL) of patients who underwent minimally invasive repair of pectus excavatum (MIRPE) with a newly designed bar and bar stabilizers.MethodsWe conducted a prospective randomized study in which patients were operated either with standard perpendicular stabilizers (control group) or with the newly designed oblique stabilizers (intervention group). All patients were evaluated 6 months after the operation with the Pectus Excavatum Evaluation Questionnaire (PEEQ).ResultsThere were 16 patients in the control group and 14 in the intervention group. Mean age was 17 (SD: 3.3, range 14–27) years. There were no demographic differences between groups. Two patients in the control group and one in the intervention group were repaired with two bars instead of one. There was one reoperation in each group. There was a significant difference between the pre- and postoperative scores, in both groups, in the patient body image domain (control group: 9.5 to 3; p < 0.01; intervention group 10 to 3; p < 0.01), as well as in the psychosocial domain (control group: 13.5 to 24, p < 0.01; intervention group: 15 to 24, p < 0.01). With regards to the patients' perception of physical difficulties before and after MIRPE, the difference between pre- and postoperative scores was greater in the intervention group (8 to 12, p < 0.01) than in the control group (10 to 11, p = 0.04). The mean length of stay was 4.5 and 5 days in the intervention group and the control group, respectively.ConclusionOur study showed that patients who underwent MIRPE with the newly designed bars and stabilizers had non-inferior outcomes than patients reported in the literature who underwent MIRPE with standard bars and stabilizers. We found slightly better outcomes in patients in the intervention group compared to the control group, but larger studies will be needed to confirm if those differences are statistically significant.Level of evidenceII     

Coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts: case report

This report describes a rare case of coexistence of benign phyllodes tumor, which measured 9 cm in the right breast, and invasive ductal carcinoma of 6 cm in the left breast, synchronous and independent, in a 66-year-old patient. The patient underwent a bilateral mastectomy due to the size of both lesions. Such situations are rare and usually refer to the occurrence of ductal or lobular carcinoma in situ when associated with malignant phyllodes tumors, and more often in ipsilateral breast or intra-lesional.     

Diagnostic neuroradiology: Ready for the neuro-interventional age?

Acute cerebral ischemia or stroke is currently considered an emergency for which therapeutic options are available if the therapeutic window of 4.5 h is respected.Imaging modalities have progressed greatly over the last few decades,rendering ischemia detectable in the first hours after the event.However,in order for treatment to be efficacious it is necessary to speed up all the processes before the start of therapy.Thus,one must decrease the time to arrival at the hospital and to the radiological method that is to be employed(be it computed tomography or magnetic resonance imaging);only then will the medical or interventional techniques available fulfill their potential.     

Heart remodeling produced by aortic stenosis promotes cardiomyocyte apoptosis mediated by collagen V imbalance

Cardiac remodeling (CR) is a structural change of the heart due to chronic hemodynamic overload related to changes in both myocyte and extracellular matrix (ECM). We investigated that the imbalance of collagen V promotes cardiomyocyte apoptosis that contributes to heart failure and cell death. Aortic stenosis was induced surgically and male Wistar rats were randomized to 18 weeks (Sham 18?w, n?=?12; AoS 18?w, n?=?12) and severe of heart failure (Sham HF, n?=?12; AoS HF, n?=?12) groups. Functional and structural echocardiogram, immunohistochemistry for Ki-67, TUNEL assay and Immunofluorescence for collagen were performed. Our main results were: (1) Progressive reduction of cardiac functional capacity due to cardiac remodeling with decreased eject fraction in heart failure; (2) Imbalance of collagen deposition with increased, crowded and irregular collagen I in situ expression; (3) Dysregulation of dynamic control of collagen fibers with exposed epitopes of collagen V; (4) Additional apoptosis that are dependent to cardiac injury. The collagen V expression in cardiac remodeling is for the first time described and may be related to additional apoptosis and autoimmune response. Our findings suggest a critical role of collagen V in cardiac remodeling to modulate and promote heart failure and death.