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We investigated the endogenous production of ghrelin as well as cardiac and pulmonary vascular effects of its administration in a rat model of monocrotaline (MCT)-induced pulmonary hypertension (PH). Adult Wistar rats randomly received a subcutaneous injection of MCT (60 mg/kg) or an equal volume of vehicle. One week later, animals were randomly assigned to receive a subcutaneous injection of ghrelin (100 [micro]g/kg bid for 2 wk) or saline. Four groups were analyzed: normal rats treated with ghrelin (n = 7), normal rats injected with saline (n = 7), MCT rats treated with ghrelin (n = 9), and MCT rats injected with saline (n = 9). At 22-25 days, right (RV) and left ventricular (LV) pressures were measured, heart and lungs were weighted, and samples were collected for histological and molecular analysis. Endogenous production of ghrelin was almost abolished in normal rats treated with ghrelin. In MCT-treated animals, pulmonary expression of ghrelin was preserved, and RV myocardial expression was increased more than 20 times. In these animals, exogenous administration of ghrelin attenuated PH, RV hypertrophy, wall thickening of peripheral pulmonary arteries, and RV diastolic disturbances and ameliorated LV dysfunction, without affecting its endogenous production. In conclusion, decreased tissular expression of ghrelin in healthy animals but not in PH animals suggests a negative feedback in the former that is lost in the latter. A selective increase of ghrelin mRNA levels in the RV of animals with PH might indicate distinct regulation of its cardiac expression. Finally, ghrelin administration attenuated MCT-induced PH, pulmonary vascular remodeling, and RV hypertrophy, indicating that it may modulate PH. myocardial hypertrophy; ventricular hemodymamics; pulmonary vasculature

Objective: To compare the different imagiological methods for prediction of fetal pulmonary hypoplasia (PH) in general diseases and associated with preterm rupture of membranes (PROM), and congenital diaphragmatic hernia (CDH).Methods: According to PRISMA guidelines, all the literature on PH from 1988 to 2018 was reviewed. Twenty-nine articles were selected and analyzed for two- and three- dimensional-ultrasounds (2D and 3D-US) as predictors for the lethal outcome.Results: Overall, the results identify a general gap correlating prenatal pulmonary measurements and survival at birth; discrepant predictive values for the same imagiological methods are explained by the group heterogeneity in terms of diseases and degree of severity, with the 2D measurements being more affected than 3D; 2D and 3D-US present equally predictive values for groups with 0% of survival. Regarding PROM, results demonstrate comparable accuracies for similar survival rates suggesting a useful predictive value of 2D-US in outcome estimation; they also identify ultrasonographic methods as a more accurate prognostic factor than gestational age at rupture, latency or amniotic fluid index. In CDH, consistent with previous studies, our review shows magnetic resonance imaging as a better survival predictor followed by the 3D and 2D methods, while 2D-LHR was the more precise prognosticator correlating prenatal PH, survival at birth, and the need for neonatal respiratory support.Conclusion: Ultrasonographic methods can be valuable predictors for lethal PH and should be validated for a broad set of diseases (e.g. PROM). For that, restricted studies for disease groups and correlating fetal PH with the needed of neonatal support, and survival at birth is critically recommended. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to compare trainees' laparoscopic performance concerning the pegtransfer (PT) and needle-guidance (NG) exercises after watching the original European Basic Laparoscopic Urologic Skills (E-BLUS) video or after watching a video-mentored tutorial (VMT) with 'tips and tricks', narration and didactic illustrations. Material and methods An experimental, unblinded, parallel, 2-intervention, 2-period randomized trial with an allocation ratio of 1:1 was conducted. Forty-two participants were randomized into 2 groups. Prior to task initiation, Group 1 watched the VMT in both trials and Group 2 watched, firstly, the original E-BLUS examination video and, in the second trial, the VMT. Each participant performed 2 trials for each exercise. Outcome measures were task time and total number of errors. Results In the first period, participants who visualized the PT and NG VMT had fewer errors than participants who visualized the E-BLUS video (p = 0.001 and p = 0.014, respectively). In the second period, after watching the VMT, a decrease in the total number of errors in PT and NG exercises was observed in the participants who previously watched the E-BLUS video (p = 0.001 and p = 0.002, respectively). In the second period, a decrease in median task time was observed for Group 1 and 2 after watching the PT VMT (p ≤0.001 and p = 0.003, respectively) and NG VMT (p = 0.005 and p = 0.01, respectively). Conclusions The use of VMT can lead to a smaller number of errors and, if coupled with deliberate practice, could lead to a shorter task time in exercise performance among participants with no previous laparoscopic experience. [ABSTRACT FROM AUTHOR]

Purpose: To study the role of serum levels of pro‐inflammatory factors in the identification of persistent diabetic macular oedema (DME) cases with limited anatomic response to anti‐VEGF. Additionally, possible predictive associations between serum factors and intravitreal treatment profiles were analysed. Methods: Cases with DME were treated with monthly bevacizumab (BVZ). After the sixth month of follow‐up, if the change in central foveal thickness (CFT) was <20% of baseline, combination treatment with triamcinolone was initiated. All cases underwent a baseline laboratory workup including inflammatory, metabolic and prothrombotic factors. The following outcome parameters were evaluated: percentage of CFT change from baseline, occurrence of persistent DME with <20% change in CFT, achieving CFT <330 μm with ≤6 BVZ injections, total number of intravitreal injections (IVI), number of IVI after the 6th month and number of triamcinolone acetonide (TCA) injections. Results: A total of 58 cases were included receiving a mean of 7.23 ± 1.55 IVI in 12 months, resulting in a significant improvement of visual acuity (VA) and CFT. No significant differences were found for baseline CFT, baseline LogMAR VA, diabetic retinopathy grade, age or duration of DM2 between cases initiating TCA and those treated only with anti‐VEGF. Significant correlations were found between total number of IVI and the following serum factors: high‐sensitivity C‐reactive protein (hsCRP) (p = 0.004, r = 0.395), creatinine (p = 0.023, r = 0.338) and homocysteine (p = 0.037, r = 0.309). Regression analysis revealed that hsCRP was a significant predictor of TCA treatment (p = 0.028, r2 = 0.350). Cases requiring ≤6 IVI had significantly lower values of hsCRP (1.33 ± 1.07 versus 2.46 ± 2.18 mg/l, p = 0.016) and creatinine (0.71 ± 0.28 versus 0.94 ± 0.19 mg/dl, p = 0.003). Conclusions: Serum markers of microvascular damage (hsCRP, homocysteine and creatinine) were associated with a higher frequency of IVI due to persistent DME, suggesting a role for such biomarkers in the identification of limited responders to anti‐VEGF monotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Electromagnetic tracking systems (EMTSs) have been proposed to assist the percutaneous renal access (PRA) during minimally invasive interventions to the renal system. However, the influence of other surgical instruments widely used during PRA (like ureteroscopy and ultrasound equipment) in the EMTS performance is not completely known. This work performs this assessment for two EMTSs [Aurora®Planar Field Generator (PFG); Aurora®Tabletop Field Generator (TTFG)]. Methods: An assessment platform, composed by a scaffold with specific supports to attach the surgical instruments and a plate phantom with multiple levels to precisely translate or rotate the surgical instruments, was developed. The median accuracy and precision in terms of position and orientation were estimated for the PFG and TTFG in a surgical environment using this platform. Then, the influence of different surgical instruments (alone or together), namely analogic flexible ureterorenoscope (AUR), digital flexible ureterorenoscope (DUR), two‐dimensional (2D) ultrasound (US) probe, and four‐dimensional (4D) mechanical US probe, was assessed for both EMTSs by coupling the instruments to 5‐DOF and 6‐DOF sensors. Results: Overall, the median positional and orientation accuracies in the surgical environment were 0.85 mm and 0.42° for PFG, and 0.72 mm and 0.39° for TTFG, while precisions were 0.10 mm and 0.03° for PFG, and 0.20 mm and 0.12° for TTFG, respectively. No significant differences were found for accuracy between EMTSs. However, PFG showed a tendency for higher precision than TTFG. AUR, DUR, and 2D US probe did not influence the accuracy and precision of both EMTSs. In opposition, the 4D probe distorted the signal near the attached sensor, making readings unreliable. Conclusions: Ureteroscopy‐ and ultrasonography‐assisted PRA based on EMTS guidance are feasible with the tested AUR or DUR together with the 2D probe. More studies must be performed to evaluate the probes and ureterorenoscopes' influence before their use in PRA based on EMTS guidance. [ABSTRACT FROM AUTHOR]