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OBJECTIVE: This paper examines the incidence, clinical presentation, and pathophysiology of portal vein thrombosis (PVT) in cirrhosis. Additionally, we have reviewed the literature regarding the current status of medical and interventional radiology management of PVT and have proposed a novel algorithm for the management given different clinical scenarios. Lastly two representative cases displaying endovascular treatment options are provided. BACKGROUND: Portal vein thrombus in the setting of cirrhosis is an increasingly recognized clinical issue with debate on its pathophysiology, natural course, and optimal treatment. Approximately one-third of patients are asymptomatic, and detection of the thrombus is an incidental finding on imaging performed for other reasons. In 30% to 50% of patients, PVT resolves spontaneously. However, there is increased post-transplant mortality in patients with completely occlusive PVT, therefore effective early revascularization strategies are needed for patients with complete PVT who are expected to undergo liver transplant. Additionally, no consensus has been reached regarding PVT treatment in terms of timing and type of interventions as well as type and duration of anticoagulation. METHODS: Computerized literature search as well as discussion with experts in the field. CONCLUSIONS: Management of PVT is complex, as many variables affect which treatments can be used. Anticoagulation appears to be the optimal first-line treatment in patients with acute PVT but without bleeding varices or mesenteric ischemia. Minimally invasive treatments include various methods of mechanical thrombectomy, chemical thrombolysis, and transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization. Definitive recommendations are difficult due to lack of high quality data and continued research is needed to evaluate the efficacy of different anticoagulants as well as the timing and use of various minimally invasive therapies in specific circumstances.

Opium has been used traditionally for lowering blood lipids, diabetes, cancer, and postpone of cardiac diseases. The coronary angiography patients were divided to opium user and control group. SYNT...

Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking.The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted.Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization.Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus.· This review will enable interventionalists to establish a framework for treating portal vein thrombosis by identifying patient risk factors and thrombus characteristics that determine patient management.. · The unique risks and benefits for transhepatic, transsplenic, and transmesenteric approaches for establishing portal venous access will be discussed.. · Advantages and complications of thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt creation for treating portal vein thrombosis will be reviewed in detail based on our extensive institutional experience..· Ju C, Li X, Gadani S et al. Portal Vein Thrombosis: Diagnosis and Endovascular Management. Fortschr Röntgenstr 2022; 194: 169 - 180.Die Pfortaderthrombose (PVT) ist eine seltene, aber schwere Erkrankung, die klinisch signifikante Folgeerscheinungen wie eine Verschlechterung der portalen Hypertonie oder eine mesenteriale Ischämie verursachen kann. Fälle, die auf eine medizinische Behandlung nicht ansprechen, können zur endovaskulären Intervention überwiesen werden. In der Literatur sind verschiedene technische Gesichtspunkte beschrieben worden, aber ein umfassender Vergleich dieser verschiedensten Methoden fehlt.In diesem Artikel werden die Diagnose und die endovaskuläre Behandlung der PVT besprochen, einschließlich der Bereiche, in denen weitere Forschung erforderlich ist.PVT-Fälle lassen sich mit Ultraschall, Computertomografie oder Magnetresonanztomografie leicht diagnostizieren. Die Behandlung beginnt häufig mit einer systemischen Antikoagulation, und in ausgewählten Fällen können endovaskuläre Interventionen eingesetzt werden. Die Bestimmung des optimalen Zugangs zum Pfortadersystem hängt von der Grunderkrankung und der Chronizität des Thrombus sowie vom Grad der Okklusion ab. Sobald der Zugang zum Pfortadersystem hergestellt ist, kann eine Katheter-gesteuerte Therapie durchgeführt werden, um eine Rekanalisierung zu erreichen.Trotz der Heterogenität der Patienten bei Vorstellung können Fälle von PVT mit verschiedenen bildgebenden Verfahren leicht diagnostiziert werden. Bei der Planung von Interventionen müssen die Grunderkrankung und die Chronizität des Thrombus berücksichtigt werden.· Diese Übersicht ermöglicht es den interventionell tätigen Ärzten, Rahmenbedingungen für die Behandlung von Pfortaderthrombosen zu schaffen, indem Risikofaktoren für Patienten und Thrombusmerkmale identifiziert werden, die das Patientenmanagement bestimmen.. · Die besonderen Risiken und Vorteile transhepatischer, transsplenischer und transmesenterialer Ansätze zur Etablierung eines portalvenösen Zugangs werden diskutiert.. · Vorteile und Komplikationen der Thrombolyse, der Thrombektomie und der Anlage eines transjugulären intrahepatischen portosystemischen Shunts zur Behandlung von Pfortaderthrombosen werden basierend auf der umfangreichen Erfahrung in unserem Institut im Detail besprochen..

Background Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergic patients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergic patients, including those with anaphylaxis histories. Methods We conducted a pre and postintervention quality improvement evaluation of an institution-wide policy change at a tertiary-care hospital, before (October 2017–January 2018), during (February 2018–September 2018), and after (October 2018–October 2019) transition to routine cefazolin prophylaxis for penicillin-allergic patients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergic patients receiving cefazolin perioperatively. Results From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P = .70), surgical site infections (P = 1.00), or adverse events (P = .32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergic patients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillin allergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842). Conclusion Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe.

Background: It is vital to screen all critical congenital heart defects as early as possible. Screening for congenital heart diseases in neonates is essential for saving children's lives and reducing undetected adult congenital heart diseases. Unfortunately, over 50% of neonates with heart malformations are unrecognized at birth. Accurate screening for congenital heart malformations can be accomplished using the certified and internationally patented digital intelligent phonocardiography machine. The objective of this study is 2-fold: assess the actual prevalence of newborn heart defects in our well-baby nursery and evaluate the digital intelligent phonocardiogram screening for critical congenital heart diseases. Methods: In this study, we have accomplished "The Neonates Cardiac Monitoring Research Project" (ethics approval IR-IUMS-FMD. REC.1398.098) at Shahid Akbarabadi Maternity Hospital. Eight hundred forty neonates from our well-baby nursery have undergone both the standard clinical examinations at birth and the digital intelligent phonocardiogram examination in a double-blinded format. The median age of the neonates was 30,85 hours, and the median weight was 3.12 Kg. In addition, the pediatric cardiologist has performed echocardiography diagnosis for each neonate classified as abnormal either by the intelligent machine or by the standard medical examinations of a neonate. Detailed dataset of the eight hundred neonates’ examinations and printouts of the intelligent machine are available online.Results: We have found that the prevalence of heart malformations in our well-baby nursery is 5%. 44% of the heart malformations are unrecognized at birth through the standard medical examination of the hospital, including neonates with CCHD, Whereas the intelligent phonocardiogram has recognized 100% of neonates with heart malformations.Conclusions: We have accomplished screening for congenital heart malformations in all neonates accurately and cost-effectively in our hospital using the digital intelligent phonocardiogram. The intelligent machine has detected CCHD, where we have not detected it through the hospital's standard medical examinations, including pulse oximetry and the heart sound auscultation. In addition, the intelligent machine interprets innocent murmurs as healthy heart sounds.

Purpose To evaluate the value of dual-phase parenchymal blood volume (PBV) C-arm mounted cone-beam-CT (CBCT) to enable assessment of radiopaque, doxorubicin-loaded drug-eluting embolics (rDEE) based on the visual degree of embolization, embolic density and residual tumor perfusion as early predictors for tumor recurrence after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Material and Methods Thirty patients (50 HCCs) were prospectively enrolled, underwent cross-sectional imaging before and after TACE using 100–300 µm rDEE and had regular follow-up examinations. Directly before and after the TACE procedure, PBV-CBCT was acquired. The response was evaluated and compared to visual degree of embolization (DE) and embolic density (ED) of rDEE deposits, as well as the presence of residual tumor perfusion (RTP) derived from PBV-CBCT. Outcome was assessed by mid-term tumor response applying mRECIST and patient survival after 12 months. Results RTP was detected in 16 HCCs and correlated negatively with DE (p = .03*) and ED (p = .0009*). The absence of RTP significantly improved lesion-based mid-term response rates regarding complete response (CR, 30/34 (88%) vs 2/16 (12.5%), p = .0002*), lesion-based complete response rate was 75% (21/28) for DE ≥ 50% vs. 50% (11/22) for DE p = .08) and 82% (27/33) for ED ≥ 2 vs. 29% for ED p = .005*). Thirteen patients were treated with re-TACE within 12 months, 11 of which had shown RTP. 12-month survival rate was 93%. Conclusion Residual tumor perfusions as assessed by PBV-CBCT during rDEE-TACE proved to be the best parameter to predict mid-term response. “Level of Evidence: Level 3”

In recent years, non-communicable diseases (NCDs) have accounted for about 70% of the world's deaths. The most common NCDs are cardiovascular disease, cancer, diabetes mellitus, and chronic respiratory diseases. These diseases have four common risk factors, including inadequate physical activity, unhealthy diet, smoking, and excessive alcohol consumption. Cardiovascular diseases, despite their high prevalence, are the most preventable chronic diseases. The most common risk factor for cardiovascular disease is high blood pressure, which can be prevented if it is diagnosed and controlled carefully. Recent guidelines have changed the methods of blood pressure measurement, definition, and treatments. Recently, more emphasis has been placed on Out-of-Office Blood Pressure Measurement. Therefore, it is necessary to consider the methods of measuring blood pressure at home and 24-hour Holter blood pressure monitoring, as well as understanding its standards. The use of automatic arm sphygmomanometers to measure blood pressure is more acceptable than manual ones (mercury or Aneroid). The most accepted definitions of hypertension are BP≥140/90 mm Hg in the clinic, the average blood pressure at home≥135/85 mm Hg, and the average blood pressure in 24-hour Holter monitoring≥130/80 mm Hg. Proper treatment of hypertension by changing lifestyle and proper medication therapy can control blood pressure and prevent serious complications. Today, the use of combination drugs, especially a single pill in a single dose, has been emphasized. This study aimed to review the most recent hypertension treatment protocols based on the guidelines of the American Heart Association (AHA 2017), the European Society of Cardiology (ESC 2018), the British Heart Association (NICE 2019), and the International Society of Hypertension (ISH 2020). Furthermore, this study attempted to assess the symptoms, complications, methods of diagnosing, definitions, as well as pharmacological and non-pharmacological treatments of hypertension.

Background: Environmental characteristics, as well as the quality of health care services provided to older adults group, are among significant determinants of elderly quality of life. The present study was done to assess the quality of services delivered to elderly residents in nursing homes located in Tabriz, Iran in 2019. Materials & Methods: This cross-sectional study was conducted on the elderly living in nursing homes in Tabriz, Iran, of whom 74 residents met the inclusion criteria and were included. The researchers referred to the nursing homes and recruited the participants with regard to the inclusion and exclusion criteria. Results: Out of the 74 older adults, 35 and 39 cases were respectively male and female. The largest age group (43.2%) was related to those between 60 and 69 years old. Also, 71.6% of the elderly had been residing in nursing homes for 6-20 months. The rate of service quality in terms of the medical, psychological, welfare, and social domains was 66%, 48%, 68%, and 65%, respectively. Besides, no significant relationship was observed between demographic variables and total scores of service quality (P>0.05). Conclusion: Paying attention to psychological services, including providing counseling and social work services, adapting the centers, and creating recreational departments can lead to an increase in psychological quality and ultimately, overall service quality.

Late vena cava/hepatic outflow obstruction after orthotopic liver transplantation (OLT), while rare, is among the most challenging complications. The cause may be an organized thrombus, reactive edema, fibrosis/scarring with calcification, or neointimal hyperplasia. Moreover, the obstruction can involve different anatomical parts of the vena cava. Surgical approaches have classically included anastomotic revision, hepatopexy, thrombectomy, cavoatrial shunt, and retransplantation. We present a case report of an innovative approach to combined inferior vena cava (IVC)/hepatic outflow obstruction in a 62-year-old female who underwent OLT using a piggyback technique for end-stage liver disease secondary to hepatitis C virus and alcohol, approximately 10 months post-transplant. A right atrial approach and hypothermic circulatory (cardiac) arrest were employed. The IVC stricture was easily resolved by performing a side to side cavo-cavostomy using an endovascular stapler (endo-GIA). In conclusion, this innovative approach is safe and effective in resolving severe outflow obstruction after liver transplantation.

Objective The purpose of this study was to investigate the value of cone beam computed tomography (CBCT) scanners versus plain radiography for detection and classification of fractures of the wrist and hand after acute trauma. Methods Images of 56 patients that received both plain radiography and CBCT after presenting to our emergency department with suspected fracture of the wrist or hand between November 2015 and July 2016 were analyzed retrospectively by three blinded observers. Results Using plain radiographs compared to CBCT, 69% of fractures of the carpals and 37% of fractures of metacarpals and phalanges remained undetected. Higher fracture classification reliability in radius fractures was observed when using CBCT. Conclusion CBCT is superior to plain radiography in detecting wrist and hand fractures in an emergency setting and presents an alternative first line imaging tool in the acute trauma patient population.

Summary: Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.

Hesperidin (HD), a bioflavanone glycoside, was isolated from orange peel and converted to hesperetin (HT) using a simple and efficient green procedure. Then dextran-hesperetin conjugate (Dex-HT) was prepared by free radical grafting reaction and the functionalization degree of it was assessed by the Folin–Ciocalteu method. The antioxidant activity of HD, HT and Dex-HT was tested by DPPH⋅ radical method. Presence of dextran as a backbone in the Dex-HT structure, improved antioxidant activities of the hesperetin. In addition, antimicrobial effect of these compounds was evaluated against some food pathogens (Listeria monocytogenes and Salmonella typhimurium). According to the results, L. monocytogenes was more sensitive to these compounds than S. typhimurium. Also, Dex-HT was more bacteriostatic than HD and HT. In addition, cytotoxic effect of Dex-HT against MCF-7(human breast adenocarcinoma), AGS (gastric adenocarcinoma) and normal fibroblast cells was determined in 48 and 72 h using MTT assay. The outcomes indicated that Dex-HT induced a significant dose-dependent cytotoxic effect on both AGS and MCF-7 cells. Moreover, Dex-HT showed a greater cytotoxic effect on MCF-7 cells than on AGS and normal cells. In this study, dextran, a biodegradeble carbohydrate polymer, was employed as a versatile scaffold to develop highly efficient antioxidant, antibacterial and anticancer hybrid material.

Summary: Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolism and deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement. However, IVC filters have been associated with a platitude of complications. Therefore, there exists a need to examine the current indications and identify the patient population at risk. In this paper, we comprehensively reviewed the current indications and techniques of IVC filter placement. Further, we examined the various complications associated with either permanent or retrievable IVC filters. Lastly, we examined the current data on filter retrieval.

Gastrointestinal malignancy encompasses a wide range of disease processes. Its incidence and mortality rate rank among the highest of all cancers. Venous thromboembolic disease is a common complication of gastrointestinal malignancy. Anticoagulation remains the first-line therapy. However, for patients who cannot tolerate or have failed anticoagulation, inferior vena cava (IVC) filter placement may be an option. Furthermore, to improve symptom resolution and reduce the severity of postthrombotic syndrome, catheter-directed thrombolysis (CDT) may be an option. Recent randomized trials including the ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial have shed new light on the efficacy and safety of CDT and related methods. Overall, the decision to proceed with IVC filter placement or CDT must be individualized.

The manuscript discusses the application of CT pulmonary angiography, ventilation–perfusion scan, and magnetic resonance angiography to detect acute pulmonary embolism and to plan endovascular therapy. CT pulmonary angiography offers high accuracy, speed of acquisition, and widespread availability when applied to acute pulmonary embolism detection. This imaging modality also aids the planning of endovascular therapy by visualizing the number and distribution of emboli, determining ideal intra-procedural catheter position for treatment, and signs of right heart strain. Ventilation–perfusion scan and magnetic resonance angiography with and without contrast enhancement can also aid in the detection and pre-procedural planning of endovascular therapy in patients who are not candidates for CT pulmonary angiography.

In this review, we examine the pharmacokinetics and clinically relevant drug interactions of the newer generation direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C, specifically sofosbuvir/velpatasvir (Epclusa®), sofosbuvir/velpatasvir/voxilaprevir (Vosevi®), glecaprevir/pibrentasvir (Maviret®), and elbasvir/grazoprevir (Zepatier®). We searched MEDLINE (1948-January 2020), Embase (1964-January 2020), Google, and GoogleScholar using the terms pharmacokinetics, drug interaction, drug metabolism, sofosbuvir, velpatasvir, Epclusa, voxilaprevir, Vosevi, glecaprevir, pibrentasvir, Maviret, elbasvir, grazoprevir, and Zepatier, from inception to January 13, 2020. The search was limited to randomized controlled trials, in vitro studies, prospective and retrospective human studies, drug monographs, abstracts, and conference proceedings. All relevant published literature on pharmacokinetic and pharmacodynamic interactions involving DAAs were reviewed and the data extracted. Numerous clinically relevant drug-drug interactions (DDIs) were identified with the newer generation DAAs and commonly prescribed drugs. NS3/4A protease inhibitors are more likely to be involved in DDIs, followed by NS5A inhibitors and NS5B polymerase inhibitor. The majority of clinically relevant DDIs are predictable, according to known pharmacokinetic, pharmacodynamics, and physicochemical properties of DAAs; however, in select cases, unpredictable DDIs do occur. As expected, many drug interactions exist between newer generation DAAs and commonly prescribed medications. While the majority of clinically relevant interactions are predictable, many require therapeutic dose adjustment or careful selection of non-interacting drugs. In select cases, severe and unpredictable drug interactions can occur. Clinicians should consult hepatitis C virus pharmacotherapy experts and tertiary drug interaction resources when initiating DAA therapy in patients taking other medications.

Objective: To investigate the effect of the Feldenkrais method versus core stability exercises on pain, disability, quality of life and interoceptive awareness in patients with chronic non-specific low back pain. Design: A single-blinded, randomised, controlled trial. Setting: Outpatient, sports medicine clinic of Mazandaran medical university. Participants: Sixty patients with chronic non-specific low back pain randomised equally into the Feldenkrais method versus core stability exercises groups. Intervention: Intervention group received Feldenkrais method consisting of training theoretical content and supervised exercise therapy two sessions per week for five weeks. Control group received educational programme and home-based core stability exercises for five weeks. Outcome measures: All patients were examined by World Health Organization’s Quality of life Questionnaire, McGill Pain Questionnaire, Oswestry Disability Questionnaire and Multidimensional Assessment of Interoceptive Awareness Questionnaire. All outcomes were measured at baseline and the end of the intervention Results: There were statistically significant differences between groups for quality of life ( P = 0.006, from 45.51 to 60.49), interoceptive awareness ( P > 0.001, from 2.74 to 4.06) and disability ( P = 0.021, from 27.17 to 14.5) in favour of the Feldenkrais method. McGill pain score significantly decreased in both the Feldenkrais (from 15.33 to 3.63) and control groups (from 13.17 to 4.17), but there were no between-groups differences ( P = 0.16). Conclusion: Feldenkrais method intervention gave increased benefits in improving quality of life, improving interoceptive awareness and reducing disability index.

Objective The manuscript discusses landmark studies using abbreviated MRI for breast cancer screening. This includes abbreviated dynamic contrast enhanced MRI and diffusion weighted imaging. Our institutional experience with abbreviated MR protocol for breast cancer screening is also described. Conclusion Abbreviated MRI protocols were found to demonstrate value for screening of breast cancer. It has been shown that abbreviated protocol MRI provides similar diagnostic sensitivities to full protocol MRI for breast cancer in women with increased lifetime risk. Our institutional abbreviated MRI protocol for breast cancer offers improved time and workflow efficiencies and has the potential to increase the number of breast cancers detected and the detection of pathologically relevant invasive breast cancer at earlier stages.

ObjectiveTo improve the quality and participation in pediatric rheumatology research, patient-prioritized studies should be emphasized. We collaborated with United States–based pediatric rheumatology advocacy organizations to survey patients and caregivers of children with rheumatic diseases to identify what research topics were most important to them.MethodsWe conducted Web-based surveys and focus groups (FG) of patients and caregivers of children with juvenile myositis (JM), juvenile arthritis (JA), and childhood-onset systemic lupus erythematosus (cSLE). Surveys were emailed to listservs and posted to social media sites of JM, JA, and cSLE patient advocacy organizations. An initial survey asked open-ended questions about patient/caregiver research preferences. Responses were further characterized through FG. A final ranking survey asked respondents to rank from a list of research themes the 7 most important to them.ResultsThere were 365 JM respondents, 44 JA respondents, and 32 cSLE respondents to the final ranking survey. The top research priority for JM was finding new treatments, and for JA and cSLE, the priority was understanding genetic/environmental etiology. The 3 prioritized research themes common across all disease groups were medication side effects, disease flare, and disease etiology.ConclusionPatient-centered research prioritization is recognized as valuable in conducting high-quality research, yet there is a paucity of data describing patient/family preferences, especially in pediatrics. We used multimodal methodologies to assess current patient/caregiver research priorities to help frame the agenda for the pediatric rheumatology research community. Patients and caregivers from all surveyed disease groups prioritized the study of medication side effects, disease flares, and disease etiology.

Introduction: Tissue engineering is the repair and replacement of damaged tissues and requires a combination of cells, growth factor and porous scaffolds. Scaffolds, as one of the main components in tissue engineering, are used as a template for tissue regeneration and induction and guidance of growth of the new and biologically active tissues. An ideal scaffold in tissue engineering, imitating an extracellular matrix, provides a suitable environment for adhesion, growth and cell proliferation. Scaffolds have also been used as the carriers for the controlled delivery of drugs and proteins. Variety of porous scaffolds, fabricated from biological and synthetic materials and using different manufacturing methods, have been introduced. Among them nanofibrous scaffolds have attracted great attention due to remarkable advantages including the highly porous three-dimensional structure with interconnected cavities which enable the transportation of food and waste materials, as well as high surface to volume ratio. So far, different methods and techniques have been introduced for production of scaffolds with structures similar to the extracellular matrix. Amongst them electrospinning, due to easiness and more control over effective parameters, are preferred. The present study make a review about the used materials and various methods of nanofibrous scaffold fabrication using electrospinning technology, with emphasis on the use of tissue engineering application. It also discussed about the progress and challenges ahead and the goals and perspective presented for this approach.

Background: The visit length is considered one of the indicators for assessing patients’ satisfaction. Factors such as waiting time for getting a visit affects the desirability of the visit. Objectives: This study aimed to investigate the visit length and waiting time of patients in public and private clinics in Tabriz. Methods: This is a descriptive-analytic study conducted in five clinics in 2018. A questionnaire-based survey was used to collect data from 386 participants recruited through simple random sampling. Mann-Whitney U and Kruskal-Wallis tests were applied to analyze the data using SPSS version 22.0. Results: Overall, the mean visit length was 25.5 and 25.4 min in public and private centers, respectively, while the mean waiting time was 141.2 and 156.4 min in public and private centers, respectively. There was no significant difference between public and private centers regarding the visit length (P > 0.05); however, there was a significant difference between public and private centers in terms of waiting time (P < 0.05). Conclusions: The waiting time was too much, especially in private clinics, which can negatively affect patient satisfaction. Therefore, suggested interventions may consist of using internet and telephone admission, scheduling a waiting list, and requiring physicians to be present on time.

Objective: This study aimed to reflect on the participation status of charities at different levels (i.e., prevention, treatment, and rehabilitation) of Iran’s health care system. Methods: This descriptive cross-sectional study was fulfilled in 2019 based on 40 charitable organizations involved in health care services delivery, which were randomly selected from the Iranian Charities Portal (ICP). Data were collected via a valid and reliable researcher-made questionnaire. SPSS software version 16.0 was used to analyze data. Results: Direct and indirect methods of service delivery were used in 63% of organizations. The most important sources of funding were associated with public donations. Furthermore, 94% of charities were evaluating the health care services with internal and external evaluation and customer satisfaction surveys. Conclusions: The charities could be a precious contribution to the health care system. To use this potential as a synergistic factor of the health system, adopting such strategies as creating sustainable funding sources and establishing more coordination between organizations are essential.

Objectives To demonstrate proof of concept/feasibility of a novel digital platform using real-time capture of patient-reported outcomes for real-world research involving patients with epilepsy. Methods The phone app collects multi-faceted patient-reported outcomes including seizure frequency, medication side effects, mood, anxiety, quality of life and cognition along with voice and digital images. Patients are invited through a national consortium of 18 adult epilepsy centres in Australia. The patient-reported information potentially allows feedback to their treating specialists and tertiary centre in near real-time, along with deidentified aggregation across all participating centres for comparison. Currently, more than 40 patients are enrolled. We present the outcomes of one patient, with the longest-running data points. The new platform was developed by KeyLead Health TM, Melbourne Australia. Results The results report a single patient’s composite scores for mood, sleep, cognition seizures and medication side-effects from the first 1.5 months. Conclusions Our digital phone platform has the potential to facilitate the more effective and efficient capture of longitudinal data enhancing real-world research data integrity along with patient and specialist engagement. Table: Patient reported outcomes for single patient captured using digital phone app date 4/1 7/1 10/1 15/1 20/1 1/2 15/2 18/2 Side effects 4.5 3.8 3.4 3.4 3.4 3.4 3.3 3.8 Memory 9 1 7 5 5 6 7 6 Seizures 3 0 0 1 1 1 2 0 Reaction time 7.7 7.1 12.4 7.0 7.7 7.7 7.9 6.7 Mood 17 16 15 15 12 15 18 16 Sleep 12 6 8 4 3 10 8 5

Small bowel transplant (SBT) is a surgical procedure that may be used in patients with pathology resulting in severe intestinal failure resistant to conventional forms of surgical and nonsurgical treatment. Intestinal failure is defined as the failure of enterocytes to absorb sufficient macronutrients, water, and/or electrolytes to sustain homeostasis and/or promote growth. With the advancement of surgical techniques and advancements in perioperative transplant management, SBT has become an increasingly common treatment for intestinal failure, with survival rates for SBT comparable to those for other solid organ transplants. This review provides background on SBT, its variations, and the associated preoperative and postoperative imaging studies with regard to surgical planning and anticipated complications. With the increasing use of SBT, radiologists will be expected to be familiar with the diagnostic studies and available endovascular interventions associated with this procedure.

Gastrostomy tube is an effective and safe long-term feeding access that is well-tolerated by patients. The typical placement routes include surgical, endoscopic and interventional radiologic placement. In particular, percutaneous interventional radiologic gastrostomy (PIRG) has increasingly become the preferred method of choice in many practices. Although many PIRG techniques have been developed since the 1980s, there is still a paucity of evidence supporting the choice of a most-optimal PIRG technique. Hence, there is a large variation in institutional approach to PIRG. We are a large, quaternary academic institution with an extensive experience in PIRG. Therefore, we aim to present the “push” PIRG technique utilized in our institution, to review the current literature, to discuss the optimal choice of PIRG technique and to generate further interests in comparison studies.

In order to use lactic acid bacteria as starter and non-starter cultures in fermentative products, their safety qualities should be evaluated. The objective of the present study was to evaluate safety characteristics including antibiotic sensitivity pattern, antimicrobial effect, H2O2 production, and biogenic amine production by Lactobacillus plantarum strains isolated from Siahmazgi cheese. Lactobacillus plantarum strains were unable to produce tyramine except for SD6 strain. All strains in the current study were able to produce histamine but unable to decarboxylate neither lysine nor ornithine. Lactobacillus plantarum strains showed considerable antimicrobial activity against Salmonella typhimurium and Listeria monocytogenes. All L. plantarum strains showed stronger antimicrobial activity against S. typhimurium (3.5-42.55 mm) than L. monocytogenes (1.5-30.49 mm). The SC9 strain had the strongest inhibitory effect against both pathogens. After titering pH of the medium to approximately 6.5, no antimicrobial activity was noticed indicating that the antimicrobial activity of L. plantarum strains was contributed to their acid production and not to bacteriocin. All L. plantarum strains were capable of producing H2O2. SA32 and SD13 strains with 2.37 and 0.77 mmol/L were the strongest and the weakest strains regarding H2O2 production, respectively (P˂ 0.05). All L. plantarum strains were sensitive to chloramphenicol, erythromycin, rifampicin, and tetracycline, yet resistant against vancomycin, and norfloxacin. Four patterns of antibiotic resistance were observed among L. plantarum strains. Only two strains of SC9 and SE4 were resistant against four antibiotics. L. plantarum strains naturally found in Siahmazgi cheese do not generally possess dangerous characteristics to be used in fermentative dairy products.

In recent years, the prequalified rigid connections of radius-cut reduced beam section (RBS) have been widely used in the design and construction of steel moment frames. Despite extensive investigations performed on the seismic performance of RBS connections, there is little research into the impact of these connections upon the elastic story drift in steel moment frames. In the current study, a precise formulation (partially based on a previous research) has been developed so as to evaluate the amount of stiffness variation or amplified elastic drift introduced by radius-cut RBS connections in a story of steel moment frames. Herein, by defining a novel and accurate method along with the method of virtual work, the amplified elastic drift of a 2-dimensional one-story single-span moment frame due to utilizing radius-cut RBS connections is calculated. The reliability and accuracy of the presented approach are validated using finite element modeling of the moment frame. Sensitivity analyses are also conducted upon the RBS connection parameters to derive the most effective parameters on the amount of elastic drift in steel moment frames. Then, by employing a statistical approach called response surface method (RSM) and combining findings of this study with some premises considered in a previous research, rigorous amplification factor of elastic drift formulas based on utilizing each of IPE and HEA beams in a story (from the first to the last one) with RBS connections are developed. Ultimately, two simple, linear, and functional amplification factor of elastic story drift formulas for each set of IPE and HEA story beams with RBS connections are proposed for designers. The scope of these formulas will be expanded to plate girders as well.

Background: One of the most important foodborne pathogen which causes enteritis is Salmonella enteritidis (SE). Human cases are mostly associated with the consumption of eggs and poultry meat. Objective: An experiment has been carried out to evaluate the impacts of a yeast product as liquid prebiotic on bacterial shedding, performance indices, and some breast meat characteristics of broiler chickens challenged with SE. Materials and Methods: A total of 90 one-day-old male broiler chicks (Ross 308) were randomly assigned to three different groups with three replicates for each treatment. The treatments were as follows: (1) CONT: birds were not challenged, (2) SE: birds were challenged with SE and fed with a control diet without prebiotic, and (3) SE+PREB: birds were challenged with SE and fed with liquid prebiotic. The challenge with SE was performed on birds in groups 2 and 3 at 28 days of age. Performance parameters and Salmonella shedding were determined on days 7 and 14 post infection. Twelve birds per treatment were sampled at the end of the trial for evaluating characteristics of breast meat. Results: The challenged birds which received prebiotic showed significantly higher body weight gain, lower feed intake, and lower SE shedding than SE group (P

Acute thrombotic pulmonary embolism (PE) is a common and potentially fatal event with imaging playing a pivotal role in the diagnosis and management of these patients. This review discusses imaging techniques, diagnostic algorithms, imaging findings and endovascular treatment of acute thrombotic PE, and illustrates important differential diagnoses relating to the spectrum of acute non-thrombotic PE and non-embolic pulmonary artery disease. The review emphasizes information relevant for everyday radiological practice and highlights recent advances that can be readily applied in the clinical routine. Computed tomography pulmonary angiography (CTPA) is the current reference standard for the diagnosis of acute PE. Ventilation and perfusion (VQ) scanning or - in centers with adequate expertise - magnetic resonance imaging (MRI) is indicated in pregnant or young patients and patients with contraindications to iodinated contrast. Invasive angiography is reserved for patients with intended endovascular treatment. Artifacts, acute non-thrombotic PE, chronic PE and non-embolic pulmonary artery diseases should always be considered as differential diagnoses. · CTPA is the reference standard for the diagnosis of acute PE.. · MRI for acute PE should only be performed in centers with adequate expertise.. · Invasive angiography is reserved for patients with intended endovascular treatment.. · Artifacts and non-embolic pulmonary artery diseases can mimic acute pulmonary thromboembolism.. · Non-thrombotic and chronic PE are also differential diagnoses of acute pulmonary thromboembolism..· Palm V, Rengier F, Rajiah P et al. Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses. Fortschr Röntgenstr 2020; 192: 38 - 49. Die akute thrombotische Lungenarterienembolie (LAE) ist ein häufiges und potenziell tödliches Ereignis. Die Bildgebung spielt bei diesen Patienten für Diagnose und Management eine herausragende Rolle. Dieser Übersichtsartikel diskutiert Bildgebung, diagnostische Vorgehensweisen, Bildbefunde und endovaskuläre Behandlungsmöglichkeiten der akuten thrombotischen LAE und illustriert wichtige Differenzialdiagnosen bezüglich des Spektrums akuter nicht thrombotischer LAE und nicht embolischer Lungenarterienpathologien. Der Artikel hebt Informationen mit Relevanz für den radiologischen Alltag besonders hervor und geht auch auf aktuelle Fortschritte ein, die heute in der klinischen Routine angewandt werden können. Die computertomografische pulmonale Angiografie (CTPA) ist der aktuelle Referenzstandard für die Diagnose der akuten LAE. Die Ventilations-Perfusions- (VQ-) Bildgebung oder – in Zentren mit adäquater Expertise – die Magnetresonanztomografie (MRT) sind bei schwangeren oder jungen Patienten sowie Patienten mit Kontraindikationen für jodhaltige Kontrastmittel indiziert. Die invasive Angiografie bleibt Patienten mit der Intention einer endovaskulären Behandlung vorbehalten. Artefakte, akute nicht thrombotische LAE, chronische LAE und nicht embolische Lungenarterienpathologien sollten immer als Differenzialdiagnosen in Betracht gezogen werden. · CTPA ist Referenzstandard für die Diagnose der akuten LAE.. · MRT der akuten LAE sollte nur in Zentren mit adäquater Expertise durchgeführt werden.. · Invasive Angiografie bleibt Patienten mit endovaskulärer Behandlung vorbehalten.. · Artefakte und nicht embolische Lungenarterienpathologien können die akute LAE imitieren.. · Nicht thrombotische und chronische LAE sind weitere Differenzialdiagnosen der akuten thromboembolischen LAE..

Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.

To assess the diagnostic accuracy of automated 3D volumetry of central pulmonary arteries using computed tomography pulmonary angiography (CTPA) for suspected pulmonary hypertension alone and in combination with echocardiography.This retrospective diagnostic accuracy study included 70 patients (mean age 66.7, 48 female) assessed for pulmonary hypertension by CTPA and transthoracic echocardiography with estimation of the pulmonary arterial systolic pressure (PASP). Gold standard right heart catheterisation with measurement of the invasive mean pulmonary arterial pressure (invasive mPAP) served as the reference. Volumes of the main, right and left pulmonary arteries (MPA, RPA and LPA) were computed using automated 3D segmentation. For comparison, axial dimensions were manually measured. A linear regression model was established for prediction of mPAP (predicted mPAP).MPA, RPA and LPA volumes were significantly increased in patients with vs. without pulmonary hypertension (all p 0.001). Of all measures, MPA volume demonstrated the strongest correlation with invasive mPAP (r = 0.76, p 0.001). Predicted mPAP using MPA volume and echocardiographic PASP as covariates showed excellent correlation with invasive mPAP (r = 0.89, p 0.001). Area under the curves for predicting pulmonary hypertension were 0.94 for predicted mPAP, compared to 0.90 for MPA volume and 0.92 for echocardiographic PASP alone. A predicted mPAP 25.8 mmHg identified pulmonary hypertension with sensitivity, specificity, positive and negative predictive values of 86%, 93%, 95% and 81%, respectively.Automated 3D volumetry of central pulmonary arteries based on CTPA may be used in conjunction with echocardiographic pressure estimates to noninvasively predict mPAP and pulmonary hypertension as confirmed by gold standard right heart catheterisation with higher diagnostic accuracy than either test alone.• This diagnostic accuracy study derived a regression model for noninvasive prediction of invasively measured mean pulmonary arterial pressure as assessed by gold standard right heart catheterisation. • This regression model using automated 3D volumetry of the central pulmonary arteries based on CT pulmonary angiography in conjunction with the echocardiographic pressure estimate predicted pulmonary arterial pressure and the presence of pulmonary hypertension with good diagnostic accuracy. • The combination of automated 3D volumetry and echocardiographic pressure estimate in the regression model provided superior diagnostic accuracy compared to each parameter alone.

Heart failure is a clinical condition that is associated with significant morbidity and mortality. With the advent of left ventricular assist device (LVAD), an increasing number of patients have received an artificial heart both as a bridge-to-therapy and as a destination therapy. Clinical trials have shown clear survival benefits of LVAD implantation. However, the increased survival benefits and improved quality of life come at the expense of an increased complication rate. Common complications include perioperative bleeding, infection, device thrombosis, gastrointestinal bleeding, right heart failure, and aortic hemodynamic changes. The LVAD-associated complications have unique pathophysiology. Multiple imaging modalities can be employed to investigate the complications, including computed tomography (CT), positron emission tomography-computed tomography (PET-CT), catheter angiography and echocardiography. Imaging studies not only help ascertain diagnosis and evaluate the severity of disease, but also help direct relevant clinical management and predict prognosis. In this article, we aim to review the common LVAD complications, present the associated imaging features and discuss the role of imaging in their management.

Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.

Chest pain is a clinical symptom for immediate consultation, and electrocardiogram (ECG) is a valuable diagnostic tool for use in the emergency room. Although the ST- elevation myocardial infarction (STEMI) requires urgent management, there are other ECG high-risk findings which are associated with adverse outcomes or imminent acute myocardial infarction (AMI). This is a case of STEMI equivalent pattern such as de Winter. As this ECG pattern is uncommon, it may be misinterpreted in the emergency department. We report a misinterpretation of de Winter´s pattern (dWp) in a young woman referred to the emergency department for chest pain, feeling of suffocation and hemodynamic instability who undergone reteplase treatment with the suspicion of acute massive pulmonary embolism but developed cardiogenic shock as a result of extensive myocardial infarction due to spontaneous dissection of the left anterior descending coronary artery. A prompt diagnosis of de Winter´s pattern and early angiography to detect the underlying cause of clinical manifestation can be lifesaving.