Search

The primary aim of our study was to evaluate diagnostic accuracy of the tibial tubercle-trochlear groove (TT-TG) distance relative to associated quotients produced from trochlear width (TT-TG distance/TW) and trochlear dysplasia index (TT-TG distance/TDI) for detecting patellofemoral instability. Secondary aims included identifying thresholds for risk and comparing differences between cases and controls.Consecutive sampling of electronic medical records produced 48 (21 males, 27 females) patellofemoral instability cases (19 ± 7 years old) and 79 (61 males, 18 females) controls (23 ± 4 years old) who had a history of isolated meniscal lesion, as evaluated by magnetic resonance imaging. Standardized methods were employed with measurements executed in a blinded and randomized manner. A receiver operating characteristic curve assessed accuracy by area under the curve (AUC). The index of union (IU) was employed to identify a threshold for risk. Two-sample t-tests examined group differences. P.05 denoted statistical significance.The AUC values were .69 (.60, .79) for TT-TG distance, .81 (.73, .88) for TT-TG distance/TW, and .85 (.78, .91) for TT-TG distance/TDI. Thresholds were 14.7 mm for TT-TG distance, .36 for TT-TG distance/TW, and 1.88 for TT-TG distance/TDI. Cases demonstrated statistically significant (P.001) greater values for each measure compared with controls: TT-TG distance (15.8 ± 4.2 mm vs 12.9 ± 3.6 mm, [1.4, 4.3]); TT-TG distance/TW (.51 ± .24 vs .31 ± .09, [.13, .27]); TT-TG distance/TDI (3.07 ± 1.55 vs 1.7 ± .7, [.9, 1.84]).The TT-TG distance, TT-TG distance/TW, and TT-TG distance/TDI measures were 69%, 81%, and 85%, respectively, accurate for determining patellofemoral instability risk. Thresholds for risk were 14.7 mm for TT-TG distance, .36 for TT-TG distance/TW, and 1.88 for TT-TG distance/TDI. The thresholds reported in this study may help in advancing clinical decision-making.Level III, diagnostic retrospective comparative observatory trial.

Background Overgeneralised self-blame and worthlessness are key symptoms of major depressive disorder (MDD) and have previously been associated with self-blame-selective changes in connectivity between right superior anterior temporal lobe (rSATL) and subgenual frontal cortices. Another study showed that remitted MDD patients were able to modulate this neural signature using functional magnetic resonance imaging (fMRI) neurofeedback training, thereby increasing their self-esteem. The feasibility and potential of using this approach in symptomatic MDD were unknown. Method This single-blind pre-registered randomised controlled pilot trial probed a novel self-guided psychological intervention with and without additional rSATL-posterior subgenual cortex (BA25) fMRI neurofeedback, targeting self-blaming emotions in people with insufficiently recovered MDD and early treatment-resistance (n = 43, n = 35 completers). Participants completed three weekly self-guided sessions to rebalance self-blaming biases. Results As predicted, neurofeedback led to a training-induced reduction in rSATL-BA25 connectivity for self-blame v. other-blame. Both interventions were safe and resulted in a 46% reduction on the Beck Depression Inventory-II, our primary outcome, with no group differences. Secondary analyses, however, revealed that patients without DSM-5-defined anxious distress showed a superior response to neurofeedback compared with the psychological intervention, and the opposite pattern in anxious MDD. As predicted, symptom remission was associated with increases in self-esteem and this correlated with the frequency with which participants employed the psychological strategies in daily life. Conclusions These findings suggest that self-blame-rebalance neurofeedback may be superior over a solely psychological intervention in non-anxious MDD, although further confirmatory studies are needed. Simple self-guided strategies tackling self-blame were beneficial, but need to be compared against treatment-as-usual in further trials. https://doi.org/10.1186/ISRCTN10526888

A new non-invasive adhesive bone conduction hearing device (ABCD) has been proposed as an alternative solution for reversible bilateral conductive hearing loss in recurrent or long-lasting forms of otitis media with effusion (OME) in children that cannot undergo surgical treatment. Our aim was to assess the effectiveness of ABCD in children with OME. Twelve normal-hearing Italian-speaking volunteers, in whom a conductive hearing loss was simulated, participated in the study. The free-field average hearing threshold was determined and, to evaluate binaural hearing skills, loudness summation and the squelch effect were assessed. Five conditions were tested: (1) unaided without earplugs, (2) unaided with bilateral earplugs, (3) aided right ear with bilateral earplugs, (4) aided left ear with bilateral earplugs, and (5) bilateral aid with bilateral earplugs. Post-hoc analysis showed a significant statistical difference between plugged, unplugged, and each aided condition. The main results were a better loudness summation and a substantial improvement of the squelch effect in the bilaterally aided. Our results suggest that ABCD is a valid treatment for patients with conductive hearing loss that cannot undergo bone conduction implant surgery. It is also important to consider bilateral aids in order to deal with situations in which binaural hearing is fundamental.

The recent novel coronavirus disease 2019 (COVID-19) outbreak has led health care providers to shift rapidly from on-site consultation towards teleconsultation. However, knowledge about patient satisfaction with teleconsultation, particularly for mental health care, is limited and demands further investigation. This study aimed to evaluate patient satisfaction with teleconsultation in mental health care during the COVID-19 pandemic. The study also aimed to identify the leading contributing factors to patient satisfaction with teleconsultation. A convenience sampling method was employed. An online survey was conducted between June 8 and August 3, 2020. A 14-item questionnaire was used to assess the patient's level of satisfaction in four domains of satisfaction. A total of 106 questionnaires were received. Respondents reported a high level of satisfaction with teleconsultation. The convenience of not having to travel to the health center for consultation was the leading contributing factor to patient satisfaction with teleconsultation. However, patients reported that they were least satisfied with teleconsultation because they could not express their feelings deeply to the provider. The current study provides preliminary evidence that teleconsultation may be a satisfactory mode of communication during the COVID-19 pandemic for mental health care in Malaysia. Most importantly, consultation in mental health care should carry on to be performed remotely to prevent the spread of infectious disease. Future research is warranted to provide a better understanding of other factors contributing to patient satisfaction with teleconsultation and ways to improve them.

Background The fact that kinesio tape may be capable to enhance muscle power would qualify it as practical tool to be considered during passive warm-up (WU) or coupled with active WU processes prior to power-based performance. Therefore, the aim of this study was to investigate the single and combined effect of kinesio tape (KT) and WU on sprint cycling performance. Methods In a repeated measure design, fifteen participants underwent six sessions to assess sprint cycling performance involving a combination of three taping conditions (without KT: NoKT; with KT positioned vertically over the thigh muscles KT; with KT positioned horizontally over the thigh muscles: Sham) with two pre-exercise routines (with WU: WU; without WU: NoWU) in a randomized order. Allometric scaling of peak power (PP) and average power (AP) values were considered for each sprint. Results KT-WU demonstrated the highest PP and AP with respect to the other conditions (p p > 0.05). Moreover, NoKT-NoWU showed the lowest PP and AP with respect to the other conditions (p Conclusions Overall, our findings suggest that kinesio tape might be a possible tool to be combined with an active WU routine, inducing benefit on sprint performance. Moreover, KT may be considered a potential strategy to include within a passive WU, perhaps where an active WU is not feasible. However, as the influence of KT on muscle function is still unclear, our results should not be overinterpreted.

Oligodendroglioma is defined by IDH mutation and 1p/19q codeletion. The latter is mutually exclusive to ATRX immunohistochemical loss and has been recently associated with the loss of H3K27me3 immunostaining. We aimed to assess the diagnostic and prognostic value of H3K27me3 immuno-expression in diffuse gliomas with oligodendroglial or mixed oligoastrocytic morphology. H3K27me3 immunostaining was performed in 69 diffuse gliomas with oligodendroglial (n = 62) or oligoastrocytic (n = 7) morphology. The integration with routinely assessed IDH mutations, ATRX immunostaining, and 1p/19q codeletion classified these cases as 60 oligodendroglial and 9 astrocytic. H3K27me3 was lost in 58/60 oligodendrogliomas with retained (n = 47) or non-conclusive (n = 11) ATRX staining, 3/6 IDH-mutant astrocytomas with ATRX loss, and 3/3 IDH-wt astrocytomas. H3K27me3 was retained in 2/60 oligodendrogliomas with retained ATRX, and in 3/6 IDH-mutant astrocytomas, two of which had lost and one retained ATRX. The combination of H3K27me3 and ATRX immunostainings with IDH mutational status correctly classified 55/69 (80%) cases. In IDH-mutant gliomas, ATRX loss indicates astrocytic phenotype, while ATRX retention and H3K27me3 loss identify oligodendroglial phenotype. Only 14 (20%) IDH-mutant cases with retained ATRX and H3K27me3 or inconclusive ATRX immunostaining would have requested 1p/19q codeletion testing to be classified. Furthermore, H3K27me3 retention was associated with significantly shorter relapse-free survival (P < 0.0001), independently from IDH mutation or 1p/19q codeletion (P < 0.005). Our data suggest that adding H3K27me3 immunostaining to the diagnostic workflow of diffuse gliomas with oligodendroglial or mixed morphology is useful for drastically reducing the number of cases requiring 1p/19q codeletion testing and providing relevant prognostic information.

Purpose: To investigate the relationship between the training load (TL = rate of perceived exertion × training time) and wellness index (WI) in soccer. Methods: The WI and TL data were recorded from 28 subelite players (age = 20.9 [2.4] y; height = 181.0 [5.8] cm; body mass = 72.0 [4.4] kg) throughout the 2017/2018 season. Predictive models were constructed using a supervised machine learning method that predicts the WI according to the planned TL. The validity of our predictive model was assessed by comparing the classification’s accuracy with the one computed from a baseline that randomly assigns a class to an example by respecting the distribution of classes (B1). Results: A higher TL was reported after the games and during match day (MD)-5 and MD-4, while a higher WI was recorded on the following days (MD-6, MD-4, and MD-3, respectively). A significant correlation was reported between daily TL (TLMDi) and WI measured the day after (WIMDi+1) (r = .72, P

Hemangioblastoma is a rare benign vascular tumour of the central nervous system that occurs either sporadically or in association with Von Hippel-Lindau syndrome. Hemangioblastoma can be found throughout the central nervous system and usually present with late manifestations due to their slow growth rate. Cauda equina hemangioblastomas are extremely rare, and in the literature, no cases are reported on the surgical management of pregnant patients with this condition. We report the case of a young woman with back pain and sphincter dysfunctions in whom an L1-L2 hemangioblastoma was diagnosed. We describe the perioperative and surgical strategies we adopted to successfully treat the patient and preserve the fetus well-being.

Background: With the advent of IoT, the deployment of batteries with a limited lifetime in remote areas is a major concern. In certain conditions, the network lifetime gets restricted due to limited battery constraints. Subsequently, the collaborative approaches for key facilities to reduce the constraint demands of the current security protocols. Objective: This work covers and combines a wide range of concepts linked by IoT based on security and energy efficiency. Specifically, this study examines the WSN energy efficiency problem among IoT devices and security for the management of threats in IoT through collaborative approaches and finally outlines the future. The concept of energy-efficient key protocols which clearly cover heterogeneous IoT communications among peers with different resources has been developed. Because of the low capacity of sensor nodes, the energy efficiency in WSNs has been an important concern. Methods: In this paper, we present an algorithm for Artificial Bee Colony (ABC) which reviews security and energy consumption to discuss their constraints in the IoT scenarios. Results: The results of a detailed experimental assessment are analyzed in terms of communication cost, energy consumption and security, which prove the relevance of a proposed ABC approach and a key establishment. Conclusion: The validation of DTLS-ABC consists of designing an inter-node cooperation trust model for the creation of a trusted community of elements that are mutually supportive. Initial attempts to design the key methods for management are appropriate individual IoT devices. This gives the system designers, an option that considers the question of scalability.

BACKGROUND In soccer, a better understanding of the bioimpedance parameters with physical performance may be useful to efficiently monitor and interpret players' performance variation throughout a certain period of the season. Therefore, this study aimed to examine the association between phase angle (PhA) and arms and legs lean soft tissue (ALST and LLST) with physical performance in young elite soccer players. METHODS Fifteen young male elite soccer players (age = 14.2±1.2 years, BMI = 20.51±1.38 kg/m2) participated in this investigation. Raw bioimpedance parameters (reactance, resistance, and phase angle) were obtained by a bioelectrical impedance analysis (BIA) device. Then, ALST and LLST were estimated. All players underwent a physical testing battery including countermovement jump (CMJ), 10-m and 20-m sprint, and Yo-Yo Intermittent Recovery Test level 1 (YoYo IRTL1) in the domains of anaerobic and aerobic performance, respectively. RESULTS The results showed that LST (total, arms and legs) positively correlated with CMJ (0.64 < r < 0.69; p < 0.001) and negatively correlated with 10-m (-0.59 < r < -0.63; p < 0.05) and 20-m sprint (-0.67 < r < -0.73; p < 0.001), while PhA positively correlated with CMJ (r = 0.57; p < 0.05) and negatively correlated (r = -0.54; p < 0.05) only with 20-m sprint. No significant association was found between the BIA-related parameters (PhA and LST) and Yo- Yo IRT level 1. CONCLUSIONS The present findings highlight the existing association of PhA and LST with jumping and sprinting performance in young elite soccer players. This result supports the use of BIA-related measures as a simple and practical approach to monitoring anaerobic performance changes, rather than aerobic, over time throughout the season.

Hypophysitis is a rare and potentially life-threatening disease, characterized by an elevated risk of complications, such as occurrence of acute central hypoadrenalism, persistent hypopituitarism, or extension of the inflammatory process to the neighboring neurological structures. In recent years, a large number of patients have been described as being affected by hypophysitis, due to the increased administration of immuno-chemotherapies. At the present time, the heterogeneous nature of hypophysitis diagnostic criteria and of the treatment protocols makes the management of affected patients difficult. We review the current data and evidence on primary and secondary hypophysitis, in order to suggest a diagnostic and therapeutic protocol that should be focused on a multidisciplinary approach, for reaching a prompt diagnosis and an appropriate and safe treatment.

Purpose: We aimed to evaluate the results of Tinnitus Retraining Therapy (TRT) in patients who did not complete the program. Methods: We divided 90 patients who failed to complete the TRT program were into 3 groups: 36 patients who only completed the first phase of the TRT program (Missing group, M), 34 patients who attended counselling for less than 6 months (Noncompliant group, NC) and 20 patients who attended counselling for more than 6 months but did not complete the TRT program (Compliant group, C). The Tinnitus Handicap Inventory (THI), tinnitus Visual Analogue Scales (VAS) and a questionnaire regarding the reasons for dropout were obtained through a telephone survey. Results: Telephonic THI and VAS scores were significantly lower than the initial scores in the M and C groups but not in the NC group. Patients who were unsure about the effectiveness of TRT were prevalent in the NC group, and the poorest long-term THI results were registered in those patients. Conclusions: A fundamental cause of very poor TRT results was when patients were unsure about TRT. On the other hand, a single counselling session could be effective in reducing tinnitus annoyance in patients who accepted the TRT approach and trusted its efficacy.

Malaria is a life-threatening epidemic disease with half of the world's population at risk. Although its incidence rate has fallen since 2010, this ratio dramatically stalled between 2014 and 2018. New fast and optimized tools in vaccine analysis and seroconversion testing are critically needed. We developed a clinical diagnostic device based on piezo-actuated nanoresonators that perform as quantitative in situ calibrated nano-bio sensors for specific detection of multiple target molecules in serum samples. The immunoassay successfully diagnoses humoral immune responses induced by malaria vaccine candidates and reveals the timeline and stage of the infection. We applied the newly developed strategy to a variety of different samples, from pure antibody/vaccine solutions, to blood samples from clinical trials on both naïve and pre-exposed malaria volunteers from sub-Saharan countries. Our nanomechanical assay provides a direct one-step label-free quantitative immunoassay that is on par with the gold-standard, multi-step enzyme-linked immunosorbent assay (ELISA). We achieve a limit of detection of few pg ml-1, or sub-pM concentrations. The 6 μl sample volume allows more than 50 experiments from one finger prick. Furthermore, we simultaneously detected multiple analytes by differential functionalization of multiple sensors in parallel. The inherent differential read-out with in situ controls reduces false positive results. Due to the faster turnaround time, the minimal volume required and the automatized handling system, this technique has great potential for miniaturization and routine diagnostics in pandemic emergencies.

Metastatic lymph nodes of the head and neck are often associated with locoregional spread of mucosal squamous carcinoma, but in rare instances visceral malignancies may bypass Virchow's node. The possibility of distant metastasis should be considered.

Introduction: This study evaluated the effect of the vibratory platform on the lumbar spine morphology of Wistar rats submitted to hormonal deprivation by oophorectomy. Material and method: Twenty rats were divided into four groups: Pseudo-oophorectomy (GP), Pseudo-oophorectomy Treated (GPT), Oophorectomy (GO), Oophorectomy Treated (GOT). After 60 days of postoperative, the treated groups started exercises on a vibratory platform in the frequency parameters of 60 Hz, alternating vibration with amplitude of 2 mm, acceleration of 57.6 m/s² and time of 10 minutes, three times in the during the four week period. Following the euthanasia of the animals, the lumbar spine was dissected and processed for analysis of the anterior and posterior longitudinal ligaments, intervertebral disc height (IVD), nucleus pulposus (NP) height, radiographic density of the lumbar vertebrae and IVD morphology. Results: The results showed a decrease in the height of the NP associated to the GO and morphological alterations such as lamellar disorganization and presence of rifts in the fibrous ring, alterations of the structural limits and decrease of the NP cavity; while the other groups presented organized lamellae, peripheral and nuclear region well delimited and wide cavity of the nucleus. Conclusion: In this way, it can be concluded that the oophorectomy protocol promoted a decrease in the height of the NP of the IVD and that the exercise in the vibratory platform did not generate lesions in the analyzed tissues, as well as preserved the structural organization of the IVD and the height of the NP of oophorectomized rats.

BACKGROUND/OBJECTIVES: Several scoring systems have been specifically developed for risk stratification in COVID-19 patients. DESIGN: We compared, in a cohort of confirmed COVID-19 older patients, three specifically developed scores with a previously established early warning score. Main endpoint was all causes in-hospital death. SETTING: This is a single-center, retrospective observational study, conducted in the Emergency Department (ED) of an urban teaching hospital, referral center for COVID-19. PARTICIPANTS: We reviewed the clinical records of the confirmed COVID-19 patients aged 60 years or more consecutively admitted to our ED over a 6-week period (March 1st to April 15th, 2020). A total of 210 patients, aged between 60 and 98 years were included in the study cohort. MEASUREMENTS: International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol-Coronavirus Clinical Characterization Consortium (ISARIC-4C) score, COVID-GRAM Critical Illness Risk Score (COVID-GRAM), quick COVID-19 Severity Index (qCSI), National Early Warning Score (NEWS). RESULTS: Median age was 74 (67-82) and 133 (63.3%) were males. Globally, 42 patients (20.0%) deceased. All the score evaluated showed a fairly good predictive value with respect to in-hospital death. The ISARIC-4C score had the highest area under ROC curve (AUROC) 0.799 (0.738-0.851), followed by the COVID-GRAM 0.785 (0.723-0.838), NEWS 0.764 (0.700-0.819), and qCSI 0.749 (0.685-0.806). However, these differences were not statistical significant. CONCLUSION: Among the evaluated scores, the ISARIC-4C and the COVID-GRAM, calculated at ED admission, had the best performance, although the qCSI had similar efficacy by evaluating only three items. However, the NEWS, already widely validated in clinical practice, had a similar performance and could be appropriate for older patients with COVID-19.

Minifascicular neuropathy (MN) is a rare, autosomal recessive disease with prominent structural changes of peripheral nerves. So far, it has been observed in females with a 46,XY karyotype and mutations of the Desert Hedgehog (DHH) gene, thus linking MN to gonadal dysgenesis (GD) and disorders of sex development (DSD). However, a 46,XX proband with normal female sex and gender development underwent clinical evaluations, nerve conduction studies and genetic screening for a severe motor-sensory neuropathy with a pathological phenotype that hinted at MN. Indeed, sural nerve biopsy revealed a profound disturbance of perineurium development with a thin and loose structure. High-resolution ultrasound (HRUS) also disclosed diffuse changes of nerve echotexture that visibly correlated with the pathological features. After extensive genetic testing, a novel homozygous DHH null mutation (p.Ser185*) was identified in the proband and in her sister, who was affected by a similar motor-sensory neuropathy, but was eventually found to be a 46,XY patient according to a late diagnosis of DSD with complete GD. DHH should therefore be considered as a possible cause of rare non-syndromic hereditary motor-sensory neuropathies, regardless of DSD. Furthermore, HRUS could effectively smooth the complex diagnostic workup as it demonstrated a high predictive power to detect MN, providing the same detailed correlations to the pathologic features of the nerve biopsy and Dhh-/- mice in both sisters. Hence, HRUS may assume a pivotal role in guiding molecular analysis in individuals with or without DSD.

Charcot-Marie-Tooth disease type 1 (CMT1) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have distinct clinical and neurophysiological features that result from dysmyelination in CMT1 and macrophage-mediated segmental demyelination in CIDP. CMT1 may occur in genetically isolated cases with atypical presentations that converge phenotypically with CIDP; in rare cases, however, CMT1 may be complicated by superimposed CIDP. We report the case of a patient harboring a de novo heterozygous null mutation of the myelin protein zero (MPZ) gene and affected by subclinical CMT1B who became symptomatic due to superimposed CIDP. Peripheral nerve high-resolution ultrasound (HRUS) aided in establishing the coexistence of CMT1B and CIDP; the diagnosis was further supported by favorable clinical, neurophysiological, and ultrasound responses to immunoglobulin therapy.

Background: Photocatalytic oxidation is a promising tool for waste water treatment and decomposition of biologically non digestible substances. Immersed nanoscale catalyst particles from semiconductor materials such as TiO2 and ZnO can be excited by absorbed UV radiation, leading to hydroxyl-ion formation at the surface of the semiconductor and oxidative degradation of pollutants. Objective: This contribution deals with reactors equipped with catalyst coated light guides to combine the advantages of immobilized catalysts with nearly homogeneous irradiation. With experimental and theoretical methods the coupling and decoupling of radiation were investigated and the performance of catalyst coated light guides was tested by means of methylene-blue degradation. Methods: Radiation models, known from the recent literature, use single ray, parallel ray or multi ray models to approximate the light transmission. These models neglect Fresnel reflection and consider only coupling into the light guide. In this study, the LED was simulated as a Lambertian radiator using 10 4 rays with angle dependent intensities. This well-known model was extended with Fresnelreflection, which predicted the measured coupling efficiencies accurately. The simulations predict the decoupling and catalyst activation at the lateral surface of the light guide for two boundary cases, ideal matt and ideal reflective surfaces. To generate matt surfaces, the light guides were either scratched or coated with TiO2 p25 nanopowder. Sol-gel coating methods were used, to create reflective surfaces. Results: When using matt surfaces, the decoupling rate is very high: 80% of the radiant flux exits the light guide in less than 10 cm. If light guides with reflective surfaces are used, the radiant flux leaving the light guide is low: less than 10% of the radiation exited the light conductor in the first 10 cm. Methyleneblue degradation, seen as a model reaction, was used to determine the reactor performance by comparing the pseudo first order reaction coefficients. Due to the uniform light distribution along the length of the light guides and the resulting even formation of reactive radicals, the quantum yield was increased by a factor of 3, using sol-gel coated light guides, rather than powder coated light guides. Conclusion: The effectiveness of LED driven optical fiber reactors was intensified, if reflective surfaces are used instead of matt surfaces. These surfaces are achieved by sol gel chemistry. However, to use the complete amount of photons, which entered the optical fiber, very long light guides are needed.

Made available in DSpace on 2020-12-12T02:13:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-10-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Difference in blood and peritoneal glucose (DBPG) is used in clinical practice to support a diagnosis of septic peritonitis in horses. It is inexpensive, easy and rapid to perform. The aim of this study was to evaluate the accuracy of the DBPG to differentiate between septic and non-septic peritonitis in horses. Blood and peritoneal fluids were harvested from suspected animals. Plasma and peritoneal glucose levels, total nucleated cell count, direct microscopic and microbiological examinations of the peritoneal fluid were evaluated. Using DBPG levels, the animals were classified into two groups: difference ≥ 50 mg/dL (positive test) and difference < 50 mg/dL (negative test). Positive microbiological examination and/or presence of bacteria in direct microscopic examination was used as a gold standard to detect septic peritonitis. The accuracy parameters analysed were: sensitivity, specificity, and positive/negative predictive values, for which the results were respectively: 0.23, 0.91, 0.60 and 0.67. Due to poor accuracy, other cut-off margins and peritoneal glucose concentrations were evaluated. The test was considered most accurate when the DBPG was zero with sensitivity, specificity, and positive/negative predictive values of 0.85, 0.82, 0.73, 0.90 respectively. Peritoneal glucose concentrations alone were not a reliable feature to detect peritonitis. DBPG ≥50 mg/dL, widely used for the diagnosis of septic peritonitis, does not have a good accuracy and the DBPG = 0 has a better accuracy for detecting the disease. Department of Veterinary Surgery and Animal Reproduction School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Animal Production and Preventive Veterinary Medicine School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Internal Medicine Botucatu Medical School Univ. Estadual Paulista (Unesp) Department of Veterinary Clinics School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Veterinary Surgery and Animal Reproduction School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Animal Production and Preventive Veterinary Medicine School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) Department of Internal Medicine Botucatu Medical School Univ. Estadual Paulista (Unesp) Department of Veterinary Clinics School of Veterinary Medicine and Animal Science Univ. Estadual Paulista (Unesp) FAPESP: 2016/08712-8 e 2018/ 16013-8

Objectives: In Sierra Leone, very little data are available on hepatitis B virus (HBV) and hepatitis C virus (HCV) prevalence. Blood donor screening permits estimation of the prevalence of transfusion transmissible infections in a general open population. We analyzed blood donor data in Sierra Leone to estimate national viral hepatitis prevalence and identify risk factors for hepatitis infection among the donor population. Methods: We conducted a retrospective data analysis in five government hospitals. We collected HBV and HCV screening results, donor demographics, and donation type (family replacement or voluntary donor; first-time or repeat). Univariate and multivariate analyses were performed to determine associations between infections and socio-demographic factors. Results: The number of donors screened was 29,713. The overall prevalence was: 10.8% (3200) for HBV and 1.2% (357) for HCV. HBV infection was most strongly associated with male sex (p

ObjectiveTo analyse autoantibody status in a well-defined European multicentre cohort of patients with epilepsy of unknown aetiology and to validate the recently proposed Antibody Prevalence in Epilepsy (APE2) and Response to ImmunoTherapy in Epilepsy (RITE2) scores.MethodsWe retrospectively collected clinical and paraclinical data of 92 patients referred to the Neurology Units of Verona and Salzburg between January 2014 and July 2019 with new-onset epilepsy, status epilepticus or chronic epilepsy of unknown aetiology. Fixed and live cell-based assays, tissue-based assays, immunoblot, and live rat hippocampal cell cultures were performed in paired serum/cerebrospinal fluid (CSF) to detect antineuronal and antiglial antibodies. The APE2 and RITE2 scores were then calculated and compared with clinical and laboratory data.ResultsAutoantibodies were detected in 29/92 patients (31.5%), with multiple positivity observed in 6/29 cases. The APE2 score (median 5, range 1–15) significantly correlated with antibody positivity (p=0.014), especially for the presence of neuropsychiatric symptoms (pConclusionsThis is the first study that independently validates the APE2 and RITE2 scores and includes the largest cohort of patients whose paired serum and CSF samples have been tested for autoantibodies possibly associated with autoimmune epilepsy.

Background: Recent evidence has suggested that chronic physical activities including balance exercises have positive effects on cognition, but their acute effects are still unknown. In the present study, the authors tested the hypothesis that an acute bout of balance exercise would enhance cognitive performance compared with aerobic activity. Methods: A total of 20 healthy middle-aged adults completed 2 acute 30-minute balance and moderate-intensity aerobic exercise sessions on 2 counterbalanced separate occasions. To assess cognitive functions, performance tasks in executive control, perceptual speed, and simple reaction time were tested before and immediately after each exercise session. Results: Although there were no significant interactions (time × exercise condition, P > .05), the main effects of time were significant in executive control (P P P Conclusions: These findings highlight that both types of exercise (aerobic, more metabolic and less cognitively demanding; balance, more cognitively and less metabolically demanding) were able to positively affect simple reaction time performance, perceptual speed, and executive control independently of physiological adjustments occurring during aerobic or balance exercise.

Background Pituitary melanoma metastases (PMMs) are extremely rare and only a few cases are reported in the literature. PMMs can grow rapidly and present local invasiveness, leading to acute onset of neurological symptoms such as headache, visual and oculomotion disorders or endocrinological signs such as diabetes insipidus and hypopituitarism, and can be life-threatening. For this reason, PMMs must be recognized and treated promptly. Case Description The authors present 2 cases of PMMs managed at their institution, performing a review of the dedicated literature and analyzing current therapeutic strategies.

Cannabis contains over a hundred of different cannabinoids, of which Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most well studied. The use of high-potency cannabis, containing high concentrations of THC and low concentrations of CBD, has been linked to adverse health outcomes, particularly for adolescents and young adults. Recently, an increase in cannabis potency has been observed in jurisdictions that legalized the sale of cannabis for non-medical purposes. Moreover, an increase of cannabis use and cannabis-related emergency treatment have also been observed in these jurisdictions. At the same time, risk perception regarding cannabis use has decreased in these populations. Trivializing language and an increased appearance of commercial cannabis in the public space may lead to a generalized underestimation of the risks of cannabis use. New regulation models principally focus on the creation of a legal cannabis market economy, the diversion of profits from illegal markets, and the reduction of costs associated with prohibition. However, an approach that specifically focuses on the rights to the health and safety of the individual should be considered in order to reduce the risks associated with cannabis legalization. Such an approach should promote and protect individual and social health and safety, establish a strict quality control of legal cannabis products regulated according to THC and CBD content, and eliminate all sorts of incentives to use, thus providing a more consistent, sustainable, and ethical framework for the legalization of non-medical cannabis use.

Summary Atypical fibroxanthoma (AFX) has been considered as the non-infiltrating precursor lesion of pleomorphic dermal sarcoma (PDS), which shows an aggressive clinical behavior, because of its extensive invasion of the deeper skin layers. Although these two tumors may represent two stages of the same disease, it can be difficult to differentiate between them, because of their similar clinical and histological features 1. Furthermore, they must be distinguished from a spindled variant of squamous carcinoma, melanoma and leiomyosarcoma 2. AFX/PDS still remains a diagnosis of exclusion, that needs to combine immunohistochemical markers for a definitive diagnosis. Usually AFX/PDS shows positivity for CD10, CD99, CD68, vimentin and lysozyme, while S100, HMB45, MART-1, cytokeratins, CD34, CD31, desmin and h-caldesmon are absent. We report a case of 89-year-old male, with a history of squamous cell carcinoma removed from the right ear, presented to our department with a recently growing, ulcerated and bleeding 2 cm nodule on the scalp. After surgery the tumor recurred with infiltration to the cranial theca. The final histological diagnosis was “pleomorphic dermal sarcoma” (PDS), which showed an unexpected positivity for HMB45. We present, to the best of our knowledge, the first case of AFX/PDS with an aberrant diffuse expression of HMB45 and an aggressive biological behavior, that leads us to a difficult exclusion diagnosis.

Context: The Dynamic Leap Balance Test (DLBT) is a new dynamic balance task that requires serial changes in base of support with alternating limb support and recovery of dynamic stability, as compared with the Y modification of the Star Excursion Balance Test (Y-SEBT), which assesses dynamic stability over an unchanging base of support. Objectives: To assess the dynamic balance performance in 2 different types of dynamic balance tasks, the DLBT and the SEBT, in subjects with unilateral chronic ankle instability (CAI) when compared with matched controls. The authors hypothesized that the DLBT score would significantly differ between the CAI involved and uninvolved limbs (contralateral and healthy matched) and demonstrate a modest (r = .50) association with the SEBT scores. Design: Case-control. Setting: Controlled laboratory. Participants: A total of 36 physically active adults, 18 with history of unilateral CAI and 18 without history of ankle injury, were enrolled in the study. CAI subjects were identified using the Identification of Functional Ankle Instability questionnaire. Interventions: The DLBT and the SEBT were performed in a randomized order on a randomly selected limb in CAI and healthy subjects. Main Outcome Measures: Time taken to complete the DLBT and the reach distances performed on the SEBT were compared between the CAI and the healthy subjects. Results: There were no statistically significant differences (P P .01) for unstable ankles compared with the stable ankle. The authors found no correlation (P > .05) between DLBT time and any of the SEBT reach distances suggesting that the DLBT provides unique information in the assessment of patients with CAI. Conclusion: The DLBT challenges the ability to maintain postural control in CAI subjects differently than the SEBT. There is a need of more dynamic balance assessment tools that are functional and clinically relevant.

Background The origin of fractures of the fifth metatarsus and Jones fracture is not clear. The goal of this study was to investigate the evidence of anatomical deformities such as metatarsus adductus, hindfoot varus, or pes cavus as risk factors for this pathology. Methods A literature search of records related to the review question was performed screening PubMed/Medline, Embase and Cochrane library databases (last update: May 2020) according to PRISMA guidelines. A meta-analysis was performed using the mean difference of the assessed angles (in patients with the fractures vs controls) as outcome measure to summarize literature findings about metatarsus adductus angle (MAA) indicating forefoot adduction, calcaneal pitch angle (CP) indicating hindfoot cavus and varus deformity and Talo-1st metatarsus angle/Meary's angle (T1stMA) for varus alignment. Results Eight studies were included in the qualitative analysis (296 patients), 5 in the quantitative synthesis (132 patients). The pooled mean difference of MAA between fracture vs control group on a per patient-based analysis was 4.62 (95% CI 1.31-7.92). Statistical heterogeneity among studies was detected (I-Square: 76.1%), likely due to different patient groups and low number of studies. The pooled mean differences of CP and T1stMA among fracture group vs controls did not show statistical significance. Conclusion Despite limited literature data, metatarsus adductus deformity seems to be correlated with higher risk of proximal metatarsal fractures and Jones fracture. A significant relationship between hindfoot varus or pes cavus and these fractures was not demonstrated. Further studies and trials are warranted to shed more lights on this topic.

The aim of this study was to examine the impact of two different post-match training interventions on the subsequent recovery of perceptual and biochemical parameters after the game. In a crossover design, eight sub-elite players underwent a soccer-specific training (SST) and an active recovery (AR) regimen on the second day after a match (+48 h). Muscle soreness as well as muscle damage (creatine kinase, CK), inflammatory (C-reactive protein and interleukin 6), immunological (e.g., lymphocytes, neutrophils, and monocytes), and endocrine (cortisol) markers were obtained at baseline (−72 h), immediately after (0 h), and 72 h post-match (+72 h). AR promoted a higher restoration of muscle soreness values (P = 0.004, η2p = 0.49) together with a better restoration of CK within 72 h post-match compared with SST (P = 0.04, η2p = 0.36). Conversely, no significant (P > 0.05, η2p < 0.91) differences were observed in the recovery timeframe of inflammatory, immunological, and endocrine responses between SST and AR. Overall, AR elicited a quicker muscle soreness and CK restoration compared to SST intervention at 72 h post-match. Such information provides novel evidence-based findings on the appropriateness of different recovery strategies and may aid to improve the practitioners’ decision-making process when two consecutive games are played within 3 days.

A man with previous asbestos exposure in the workplace presented with exertional dyspnea. Chest radiography revealed right basilar opacity, with blunting of the costophrenic angle suggestive of pleural effusion. The patient was treated empirically with antibiotics. Radiological findings remained unchanged after 1 month. Chest ultrasonography and computed tomography (CT) confirmed right pleural effusion and revealed bilateral pleural plaques. The patient’s health care providers discussed possible diagnostic options, including nuclear imaging and invasive procedures. Medical thoracoscopy was performed and showed diffuse pleural plaques and nodules. Biopsy of the parietal pleura demonstrated stromal invasion by epithelioid malignant pleural mesothelioma. At a multidisciplinary team meeting, thoracic surgeons recommended surgical resection. The patient, made aware of the uncertain benefit of surgery on survival and its potential impact on the quality of life, opted for medical management, and first-line chemotherapy with pemetrexed plus cisplatin was initiated. This chapter discusses several aspects of malignant pleural mesothelioma, including the histological and molecular diagnosis, diagnostic imaging techniques, and therapeutic options.

A 50-year-old man, a current smoker with a history of alcohol abuse, presented to the emergency room with fever, breathlessness, palpitations, and occasional cough with hemoptysis. He was found with respiratory failure; atrial fibrillation, with a high mean ventricular response, elevated white blood cell count, and high inflammatory indices. Chest radiography revealed abundant right hydropneumothorax, and ultrasonography was suggestive of pyopneumothorax. Therapy with oxygen supplement, beta-blocker, calcium channel blocker, anticoagulant, antibiotic, and antipyretic was needed. After the initial medical treatment, a large-bore (24-French [Fr]) chest tube was placed. Abundant creamy and foul-smelling pus flowed out from the pleural space, together with many air bubbles. Colonies of methicillin-resistant Staphylococcus aureus (MRSA) grew in the pleural fluid cultures. Despite clinical improvement, chest computed tomography (CT) showed incomplete expansion of the right lung, with persistence of pneumothorax and a small amount of pleural effusion. It also documented irregular excavated lung hyperdensity resulting from necrotizing pneumonia, with peripheral bronchopleural fistula (BPF). Medical thoracoscopy revealed pleural thickening and tenacious adhesions between the lung and the pleura, which could not be removed. The histology of parietal pleural biopsies showed negative results for malignancy. The patient finally underwent thoracotomy with lysis of adhesions, suture of BPF, and decortication for lung re-expansion. This chapter deals with the diagnosis and management of BPF caused by necrotizing pneumonia. It also discusses the ultrasound appearance of empyema and choosing the ideal chest drain insertion site.

A 71-year-old woman, who was a never-smoker, presented with low-grade fever, weakness, loss of appetite, chest pain, exertional dyspnea, and dry cough. Chest radiography showed lung opacity in the right upper pulmonary field. Symptoms persisted despite antibiotic therapy. Subsequent chest/abdominal computed tomography (CT) revealed a solid, round lesion in the right upper lobe and bilateral pleural effusion, with the majority on the right side. After discussing the possible diagnostic approach (including thoracentesis, bronchoscopy, transthoracic needle biopsy, thoracoscopy), doctors choose to start with the less invasive procedures. Thoracentesis was performed, and the result of cytology of the pleural fluid was positive for cancer cells, showing an immune-phenotypic pattern compatible with lung adenocarcinoma. The clinical course was soon complicated by severe hypoxemic respiratory failure caused by concomitant lower respiratory tract infection and bilateral pulmonary embolism (PE). The low amount of cancer cells in the pleural effusion did not allow for performance of further tests aimed at predicting patient response to targeted therapy or immunotherapy. Thus ultrasound-guided needle biopsy of a positron emission tomography (PET)–positive left supraclavicular lymph node was performed. However, neither mutation of the epidermal growth factor receptor (EGFR) gene nor rearrangements of anaplastic lymphoma kinase (ALK) and reactive oxygen species 1 (ROS1) was detected. Further staging tests revealed multimetastatic disease, with brain and bone involvement. The patient received the best supportive care possible. This chapter deals with molecular testing of advanced non-small cell lung cancer, venous thromboembolism in malignancy, and management of anticoagulant and antiplatelet agents in adults undergoing percutaneous interventions. A schematic for the optimal timing of drug withdrawal before procedures is provided.

A massive pleural effusion occurred in a 60-year-old man, former smoker with previous asbestos exposure. Chest ultrasound showed floating particles insides the fluid and a poorly moving collapsed lung. Doctors discussed possible diagnostic procedures and proposed to perform a medical thoracoscopy. A desquamating yellow tissue was found over visceral and parietal pleura at the level of diaphragm, pulmonary apex, pericardium, and subclavian vessels. Histological examination revealed a biphasic malignant pleural mesothelioma. No extension of the disease outside the chest was found. After pleural biopsies of the parietal pleura, an attempt of talc poudrage was made. However, a right hydro-pneumothorax with thickened pleural and unexpanded right lung was evident after the procedure. Afterwards the patient received chemotherapy until disease progression, then he refused further treatments. Two palliative thoracentesis were later needed to relief breathlessness. The chapter provide insights on medical thoracoscopy in comparison to VATS and on pleurodesis to prevent recurrent pleural effusion or pneumothorax. It also deals with the role of performance status as an indicator of the patients ability to tolerate treatments such as chemotherapy.

Purpose Compare awake evaluation (modified Mallampati score-MMs, Muller maneuver-MM) to drug-induced sleep endoscopy (DISE) findings according to NOHL (nose-oropharynx-hypopharynx-larynx) classification in moderate-to-severe OSAHS patients. Methods 43 moderate-to-severe OSAHS patients referred to our ENT department were enrolled over a 2-year period. In this observational prospective study, each patient was evaluated by the same ENT team both in wakefulness and during pharmacologically induced sleep. Level and severity of the obstruction were described. Results The comparison of degree of collapsibility was statistically significative only at hypopharyngeal level: 41.8% of the patients showed a hypopharyngeal obstruction in wakefulness whereas 88.3% in DISE (p = 0.000). Laryngeal level was found in 18.6% patients during awake examination, conversely DISE demonstrated laryngeal obstruction in 4.6%. DISE identified significantly higher incidence of multilevel collapses (p = 0.001). However, the incidence of oropharyngeal obstruction in patients classified as MMs I and II was significantly higher in DISE compared to MM (p = 0.021). Conclusion DISE is the best predictor of hypopharyngeal obstruction, whereas MM underestimates the severity of the collapse at this level. DISE is more reliable than MM to identify the obstruction in patients with MMs score I and II.

A 35-year-old woman presented to the emergency department complaining of right chest pain, tachycardia, and low-grade fever. Arterial blood gas analyses revealed hypoxemia and hypocapnia, and blood tests showed only a mild elevation of C-reactive protein (CRP). Chest ultrasonography revealed small right pleural effusion. Computed tomography pulmonary angiography (CTPA) confirmed the right pleural effusion and no significant lung parenchymal involvement. Thromboembolism was ruled out. The patient received oxygen support and empirical therapy, including broad-spectrum antibiotics and systemic glucocorticoids. Blood tests showed positivity for anti-Mycoplasma pneumoniae immunoglobulin M (IgM). The patient experienced remarkable clinical improvement and was discharged with the diagnosis of parapneumonic pleural effusion. One month later, the patient had fever recurrence, accompanied by shivering and chest pain. Chest radiography and ultrasonography showed recurring small pleural effusion on the right side. Blood tests showed a high leukocyte count and elevation of inflammatory indexes. The QuantiFERON tuberculosis (TB) test was positive. The patient was admitted to the infectious disease unit, where gastric aspirate and bronchoscopy with bronchoalveolar lavage were performed. However, Mycobacterium tuberculosis was not found. Ultrasound-guided thoracentesis allowed for obtaining a very small amount (45 mL) of exudative pleural fluid. Polymerase chain reaction (PCR) for detection of the ribosomal ribonucleic acid (rRNA) of Mycobacterium tuberculosis complex was positive. Pleural tuberculosis was then diagnosed, and antituberculosis treatment was started. This chapter addresses tuberculous pleural involvement, indications for diagnostic thoracentesis, and the role of chest ultrasonography in the context of pleural diseases and transthoracic procedures.

A heavy smoker gradually developed shortness of breath and right chest pain. Chest radiography revealed right-sided pleural effusion; thus the patient underwent thoracentesis. After the procedure, hydropneumothorax was found, which did not resolve despite placement of a chest tube. Positron emission tomography/computed tomography (PET/CT) supported the hypothesis of cancer in the lower lobe of the right lung, with ipsilateral hilar lymph node metastasis. Cytology of pleural effusion suggested adenocarcinoma of pulmonary origin. To obtain adequate neoplastic typing and molecular profiling, further diagnostic procedures for histological sampling were discussed. Video-assisted thoracoscopic surgery (VATS) on the right lung, with multiple parietal pleural biopsies, was performed. The visceral pleura was thickened, and pleurodesis was therefore not considered because of the inability of the lung to expand to the chest wall. An indwelling pleural catheter (IPC) was placed. The chapter deals with the strategies to manage malignant pleural effusion, the causes of post-thoracentesis pneumothorax, and treatment options for nonexpandable lung.

An 83-year-old man was taken to the emergency room (ER) because of fever, shortness of breath, swelling of the legs, weakness, confusion, and nausea. He had several comorbidities, including chronic kidney disease and a left fibrothorax with internal fluid collection caused by previous tuberculous pleurisy. The patient was found with acute respiratory failure, and auscultation revealed reduction of breath sounds in the left lower field, crackles in the right middle and basal fields, and widespread rales. Chest radiography showed large opacity in the left middle and lower areas and opacity in the right middle zone. Blood tests showed leukocytosis, marked increase in inflammation indices and volume overload, renal failure, hyperglycemia, and electrolyte imbalance. The patient received oxygen supplement, a loop diuretic, and broad-spectrum antibiotics, with dose adjustment for renal impairment. Urine output was 100 mL/24 hr, but the patient refused hemodialysis, thus peritoneal dialysis was initiated. The patient showed clinical improvement, the fever disappeared, oxygen saturation became sufficient without administration of oxygen, and the white blood cell count and inflammatory indices normalized. The diagnostic workup for active tuberculosis was negative. No invasive pleural procedures were needed. Chest imaging showed that the pulmonary opacities in the middle right and lower left areas had disappeared. Pulmonary opacity caused by the known left calcific fibrothorax was still clearly evident. This chapter deals with the causes, mechanisms, and imaging of fibrothorax. Strategies to prevent it and surgical treatment options are also addressed.

A 62-year-old woman with a history of indolent follicular lymphoma and multiple thoracic and abdominal lesions presented with massive right pleural effusion. A chest tube was placed, and about 1900 mL of cloudy, nonmalodorous pleural fluid was evacuated. The analysis of pleural fluid revealed high triglyceride levels, indicative of chylothorax. Conservative treatment, consisting of total parenteral nutrition and subcutaneous octreotide, was started. Chest computed tomography (CT) showed small residual right-sided pleural effusion but no lung parenchymal lesions. In the subsequent days, the amount of drained fluid decreased but still persisted. Therefore thoracoscopy was performed to identify and interrupt the chyle leak into the chest cavity. Oral cream administration allowed for observation of a diffuse leak of chyle during surgery in the posterior mediastinal pleura. The thoracic surgeon sprayed a fibrin sealant at the point of the greatest spill, followed by talc poudrage to achieve pleurodesis and reduce the risk of recurrence of chylothorax. Total parenteral nutrition and octreotide therapy was continued postoperatively for 4 days. No pleural effusion was evident 4 weeks after surgery. Chemotherapy was resumed, and complete remission of the lymphoma was achieved in 3 months. This chapter describes a challenging case and discusses the macroscopic appearance and etiology of chylothorax and the criticisms and pitfalls regarding its diagnosis and management. Differences in the types and sizes of chest drains are addressed as well.

A 60-year-old male Caucasian, who was a smoker, was referred to the pulmonology clinic because of dyspnea. He also had bilateral arthralgia of the hands and wrists. The patient had a history of rheumatoid arthritis, which was being treated with immunosuppressive drugs. Chest radiography revealed right-sided pleural effusion; thus ultrasound-guided right thoracentesis was performed, resulting in extraction of 1300 mL of cloudy nonmalodorous pleural fluid. Microbiological and cytological analyses were unremarkable, whereas the chemical–physical examination revealed pseudochylothorax. The triglyceride concentration was low, no chylomicrons were detected, and the cholesterol concentration was high. Subsequent chest computed tomography (CT) demonstrated thickened parietal pleura on the right side with a small area of residual pleural effusion, together with right lower lobe segmental atelectasis. The patient underwent medical thoracoscopy, which showed soft yellow peel over the basal parietal pleura. Multiple biopsy specimens were obtained. Microbiology results for the pleural fluid and parietal pleura were negative. Histological examination of biopsy specimens revealed infiltration by inflammatory cells, multinucleated giant cells, and very few mesothelial cells, in a background of amorphous material. No malignant cells or granulomas were detected. The findings were consistent with rheumatoid pleurisy. The patient was started on a new treatment with a selective Janus kinase inhibitor, which led to progressive reduction of rheumatoid arthritis symptoms. At the follow-up, chest ultrasonography and CT showed significant reduction in pleural effusion and lung atelectasis. This chapter provides a comprehensive description of pseudochylothorax and addresses related topics, such as pleural fluid pH measurement and moderate sedation during medical thoracoscopy.

An 82-year-old man had worsening breathlessness, chronic cough, low-grade fever, and weight loss. Chest computed tomography (CT) revealed a round mass in the right lower lobe containing nonhomogeneous fluid, contiguous with extensive calcified fibrothorax. When the patient was 25 years old, he had had pulmonary tuberculosis and undergone artificial right pneumothorax. Chronic tuberculous empyema and lung cancer were considered in the differential diagnosis. Although made difficult by the thickened and calcified pleura, ultrasound-guided puncture allowed for extraction of a small amount of liquid. No evidence of mycobacteria or their genetic material was found. Positron emission tomography (PET) showed intense glucose uptake in the peripheral part of the lesion in the right lower lobe. Subsequent CT-guided percutaneous biopsy and histological examination revealed squamous cell carcinoma. No abnormal 18-fluorodeoxyglucose (FDG) accumulation was found in other parts of the body. After evaluation of the performance status and performance of pulmonary function tests, the thoracic surgeon explained the risks of surgery to the patient, who chose stereotactic body radiation therapy (SBRT). This chapter deals with the possible late sequelae and complications of tuberculosis occurring even after successful treatment. These include abnormalities of the lung parenchyma, pleura, airways, mediastinum, and chest wall. The chapter provides details of malignancies associated with chronic empyema and fibrothorax and radiological findings that help distinguish pleural lesions from peripheral pulmonary lesions.

A 35-year-old man presented to the emergency room with sudden worsening of breathlessness, right chest pain, and dry cough. Chest radiography revealed right pneumothorax extending from the apex to the base, without a significant mediastinal shift. The pulmonologist placed an 18-French (Fr) chest tube in the second right intercostal space, along the hemiclavicular line. The patient got relief from breathlessness. However, subsequently, there was continuous air leakage through the thoracic drainage. Chest computed tomography (CT) showed only partial resolution of the right pneumothorax and the presence of peripheral lung bullae. Thus bullectomy through uniportal video-assisted thoracic surgery (U-VATS) and subsequent pleurodesis were performed. The patient was discharged 4 days after the procedure, and was re-evaluated on an outpatient basis after 10 and 20 days after VATS. Chest radiography showed maintenance of good lung expansion. There was no recurrence of pneumothorax over the subsequent 8 months of follow-up. This chapter deals with the management of primary and secondary spontaneous pneumothoraces. It also discusses and compares uniportal and multiportal VATS for anatomical lung resections.

It is not known whether the current territorial organization for acute revascularization treatments in ischemic stroke patients guarantees similar time to treatment and functional outcomes among different levels of institutional stroke care. We aimed to assess the impact of time to treatment on functional outcomes in ischemic stroke patients who received intravenous thrombolysis (IVT) alone, bridging (IVT plus thrombectomy), or primary thrombectomy in level 1 and level 2 Stroke Units (SUs) in Triveneto, a geographical macroarea in Northeast of Italy. We conducted an analysis of data prospectively collected from 512 consecutive ischemic stroke patients who received IVT and/or mechanical thrombectomy in 25 SUs from September 17th to December 9th 2018. The favorable outcome measures were mRS score 0–1 and 0–2 at 3months. The unfavorable outcome measures were mRS score 3–5 and death at 3months. We estimated separately the possible association of each variable for time to treatment (onset-to-door, door-to-needle, onset-to-needle, door-to-groin puncture, needle-to-groin puncture, and onset-to-groin puncture) with 3-month outcome measures by calculating the odds ratios (ORs) with two-sided 95% confidence intervals (CI) after adjustment for pre-defined variables and variables with a probability value ≤ 0.10 in the univariate analysis for each outcome measure. Distribution of acute revascularization treatments was different between level 1 and level 2 SUs (p < 0.001). Among 182 patients admitted to level 1 SUs (n = 16), treatments were IVT alone in 164 (90.1%), bridging in 12 (6.6%), and primary thrombectomy in 6 (3.3%) patients. Among 330 patients admitted to level 2 SUs (n = 9), treatments were IVT alone in 219 (66.4%), bridging in 74 (22.4%), and primary thrombectomy in 37 (11.2%) patients. Rates of excellent outcome (51.4% vs 45.9%), favorable outcome (60.1% vs 58.7%), unfavorable outcome (33.3% vs 33.8%), and death (9.8% vs 11.3%) at 3months were similar between level 1 and 2 SUs. No significant association was found between time to IVT alone (onset-to-door, door-to-needle, and onset-to-needle) and functional outcomes. After adjustment, door-to-needle time ≤ 60min (OR 4.005, 95% CI 1.232–13.016), shorter door-to-groin time (OR 0.991, 95% CI 0.983–0.999), shorter needle-to-groin time (OR 0.986, 95% CI 0.975–0.997), and shorter onset-to-groin time (OR 0.994, 95% CI 0.988–1.000) were associated with mRS 0–1. Shorter door-to-groin time (OR 0.991, 95% CI 0.984–0.998), door-to-groin time ≤ 90min (OR 12.146, 95% CI 2.193–67.280), shorter needle-to-groin time (OR 0.983, 95% CI 0.972–0.995), and shorter onset-to-groin time (OR 0.993, 95% CI 0.987–0.999) were associated with mRS 0–2. Longer door-to-groin time (OR 1.007, 95% CI 1.001–1.014) and longer needle-to-groin time (OR 1.019, 95% CI 1.005–1.034) were associated with mRS 3–5, while door-to-groin time ≤ 90min (OR 0.229, 95% CI 0.065–0.808) was inversely associated with mRS 3–5. Longer onset-to-needle time (OR 1.025, 95% CI 1.002–1.048) was associated with death. Times to treatment influenced the 3-month outcomes in patients treated with thrombectomy (bridging or primary). A revision of the current territorial organization for acute stroke treatments in Triveneto is needed to reduce transfer time and to increase the proportion of patients transferred from a level 1 SU to a level 2 SU to perform thrombectomy.

The most recent scientific evidence supports the consumption of cow's milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow's milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor-patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products' nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardiovascular disease No clear data are available about the association between milk intake and cancer. Current scientific literature suggests that an appropriate consumption of milk and its derivatives may be beneficial at all ages, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy.

In this work the problem of thermally insulating a PhotoVoltaic Thermal (PVT) hybrid solar panel is investigated. In particular, a PVT panel designed to be laid on the ground like a tile is considered. Such a hybrid solar tile, previously presented, is resistant, walkable and can be used to cover places, terraces and roof. It consists in a core composed of a photovoltaic cell layer placed in contact with an aluminum heat sink which transfers heat from the cells to a water flow. This core is coated on the upper side with a transparent epoxy resin and on the lower and lateral sides with an opaque epoxy resin. To thermally insulate such a panel, the insertion of microspheres in the opaque resin is then considered. In particular, the maximum concentration of the microspheres acceptable with respect to the production process is evaluated. Moreover, the effect on the heat dispersed by the panel, which is produced by inserting microspheres in the opaque resin, is experimentally investigated. Some preliminary results are presented showing reductions in the dispersed heat.

The term weaning describes the time period in which a progressive reduction of breastfeeding or the feeding of infant-formula takes place while the infant is gradually introduced to solid foods. It is a crucial time in an infant’s life as not only does it involve with a great deal of rapid change for the child, but it is also associated with the development of food preferences, eating behaviours and body weight in childhood and also in adolescence and adulthood. Therefore, how a child is weaned may have an influence later, on the individual’s entire life. Babies are traditionally first introduced to solid foods using spoon-feeding, in most countries. Beside to traditional approach, an alternative method, promoting infant self-feeding from six months of age, called baby-led weaning or “auto-weaning”, has grown in popularity. This approach causes concern to healthy professionals and parents themselves as data from observational studies pointed out to a potential risk of iron and energy inadequacy as well as choking risk. Aim of this systematic review was to critically examine the current evidence about baby-led weaning approach and to explore the need for future research. A systematic search was conducted in Cochrane library databases and DARE (Database of Abstract of Reviews of Effects), EMBASE and MEDLINE in the period 2000–2018 (up to March 1st) to address some key questions on baby-led weaning. Prisma guidelines for systematic reviews has been followed. After the inclusion/exclusion process, we included for analysis of evidence 12 articles, 10 observational cross-sectional studies and 2 randomized controlled trials. Pooling of results from very different outcomes in the studies included was not possible. Both randomized trials have potential bias; therefore, the quality of the evidence is low. There are still major unresolved issues about baby-led weaning that require answers from research and that should be considered when advices are requested from health professionals by parents willing to approach this method.

International audience; Verifiability is a key requirement for electronic voting. However, the use of cryptographic techniques to achieve it usually requires specialist knowledge to understand; hence voters cannot easily assess the validity of such arguments themselves. To address this, solutions have been proposed using simple tables and checks, which require only simple verification steps with almost no cryptography. This simplicity comes at a cost: numerous verification checks must be made on the tables to ensure their correctness, raising the question whether the success of all the small verification steps entails the overall goal of end-to-end verifiability while preserving vote secrecy. Do the final results reflect the voters' will? Moreover, do the verification steps leak information about the voters' choices? In this paper, we provide mathematical foundations and an associated methodology for defining and proving verifiability and voter privacy for table-based election protocols. We apply them to three case studies: the Eperio protocol, Scantegrity, and Chaum's Random-Sample Election protocol. Our methodology helps us, in all three cases, identify previously unknown problems that allow an election authority to cheat and modify the election outcome. Furthermore, it helps us formulate and verify the corrected versions.

Study Objective To compare the costs of hysteroscopic polypectomy using mechanical and electrosurgical systems in the hospital operating room and an office-based setting. Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Tertiary referral hospital and center for gynecologic care. Patients Seven hundred and fifty-four women who underwent endometrial polypectomy between January 20, 2015, and April 27, 2016. Interventions Hysteroscopic endometrial polypectomy performed in the same-day hospital setting or office setting using one of the following: bipolar electrode, loop electrode, mechanical device, or hysteroscopic tissue removal system. Measurements and Main Results The various costs associated with the 2 clinical settings at Palagi Hospital, Florence, Italy were compiled, and a direct cost comparison was made using an activity-based cost-management system. The costs for using reusable loop electrode resection-16 or loop electrode resection-26 were significantly less expensive than using disposable loop electrode resection-27, the tissue removal system, or bipolar electrode resection (p = .0002). Total hospital costs for polypectomy with all systems were significantly less expensive in an office setting compared with same-day surgery in the hospital setting (p = .0001). Office-based hysteroscopic tissue removal was associated with shorter operative time compared with the other procedures (p = .0002) Conclusion The total cost of hysteroscopic polypectomy is markedly higher when using disposable equipment compared with reusable equipment, both in the hospital operating room and the office setting. Same-day hospital or office-based surgery with reusable loop electrode resection is the most cost-effective approach in each settings, but requires experienced surgeons. Finally, the shorter surgical time should be taken into consideration for patients undergoing vaginal polypectomy in the office setting, owing more to patient comfort than to cost savings.

Context: Psychological readiness is a significant factor in determining successful return to sport (RTS) and physical activities after anterior cruciate ligament (ACL) reconstruction. Knowing the influence of kinesiophobia on physical tests that are used to guide RTS, such as the single-leg hop for distance (SLHD), would contribute to advancing clinical practice. Objective: To investigate the association between kinesiophobia and SLHD performance in patients after ACL reconstruction. Data Sources: A comprehensive search strategy entailed surveying 6 databases for relevant articles published from January 2009 to March 2021. Study Selection: Articles published in English that were a minimum of level 3 evidence describing kinesiophobia, as measured by the Tampa Scale for Kinesiophobia, and related to SLHD performance in patients after ACL reconstruction. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Study characteristics, sample population demographics, instrument(s), or approach(s) used to assess kinesiophobia and SLHD performance, and corresponding results. Results: A total of 152 potential studies were identified, 106 studies underwent screening, 40 were reviewed in full, and 7 studies were included. Meta-analysis could not be performed because of differences in experimental design among studies and instances of missing outcome data. Currently, moderate evidence indicates patients with ACL reconstruction that exhibit less kinesiophobia perform better on the SLHD test. Conclusion: The outcomes of this review propose that sports health practitioners consider the influence of kinesiophobia on SLHD performance as a criterion for RTS and physical activities in patients after ACL reconstruction. Higher quality studies are necessary to establish the extent of association between these variables.

Purpose To describe the clinical characteristics, severity, and ophthalmological changes in SARS-CoV-2 patients through ophthalmological examinations performed at the reference center of the National Institute of Infectious Diseases, Brazil. Methods This cross-sectional study assessed the examination results of SARS-CoV-2 patients from July 2020 to November 2020. In total, 150 patients were included and allocated into three groups of 50 patients depending on the disease severity. Group 1 patients were in the intensive care unit (ICU), group 2 patients were in the semi-ICU, and group 3 patients were outpatients. Results Ten (6.7%) patients exhibited ophthalmological changes; five (10%), four (8%), and one (2%) patients in groups 1, 2, and 3, respectively. Ophthalmological findings included candle flame hemorrhage and cotton wool exudates. We analyzed the general characteristics of the 10 patients with ophthalmological changes. Nine were hospitalized and one was seen on an outpatient basis. Conclusion We observed ophthalmic changes in patients with SARS-CoV-2 infection, despite the absence of any clinical or laboratory risk factors indicative of such changes.