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Introduction: Cardiac MRI (CMR) is the gold standard for right ventricular function (RVF) because echo assessment is limited. Potential echo parameters to assess RVF include RV fractional area change (FAC), RV free wall strain (FWS), and tricuspid annular plane systolic excursion (TAPSE) on apical 4-chamber (A4C) view. We compared a new Artificial Intelligence method that tracks the RV almost instantaneously in a single 4-chamber view (AI, LVivo RV®, DiA Imaging, Figure) to quantify RVF vs CMR. Methods: We compared AI RVF against CMR in 125 pts. Abnormal LVEF and RVEF were defined as 2 ) tests were calculated for each variable against CMR RVEF. Results: Of the 125 pts, 55 (44%) were female with median age 55 [Q1 44, Q3 67] years. Thirty pts (24%) had abnormal RVEF and 78 (62.4%) had abnormal LVEF by CMR. All pts with abnormal RVEF had abnormal LVEF. Compared to CMR, AI RV sensitivities and specificities for abnormal RVEF were: FAC 87% and 60%, FWS 80% and 61%, TAPSE 77% and 54%, any 2 criteria 83% and 61%, and all 3 criteria 63% and 69%. AI RV χ 2 values were: FAC 19.9 (p Conclusions: This is the first validation of a novel AI method (LVivo RV®) that can detect RV dysfunction using 3 standard RV measurements from a single A4C view with good sensitivity and specificity compared to volumetric CMR as the gold standard.

Infant colic (IC) is a common condition in young babies seen by primary care health professionals, especially health visitors. Nevertheless, the diagnostic criteria for IC are vague, which has resulted in a lack of clarity in published guidance on its causes and treatment. Credence has been given to alternative therapies, while health professionals are sceptical about the efficacy of over-the-counter treatments. Some 4004 parents of babies considered to have IC participated in this retrospective real world evidence study on the efficacy of a simeticone suspension in the treatment of IC. They were recruited via social media sources and were eligible for inclusion if their baby had received at least one dose of the simeticone suspension. Data were collected via an online questionnaire. The results showed that crying and discomfort-associated behaviour reduced and the babies' sleeping patterns improved following use of the suspension. More than two-thirds (69.7%) of respondents, who either used the suspension on its own or alongside another treatment, reported improvements in the signs of IC within one day. Almost all (93.2%) considered that its use was associated with either complete resolution of IC or had some effect on symptoms.

This retrospective open study evaluating the efficacy of Sudocrem Antiseptic Healing Cream (SAHC) in infantile nappy rash (NR) was based on real-world evidence collected using an online questionnaire that included Likert scales. Participants who had used SAHC in the past (n=2159) were recruited via social media and email. A total of 1818 respondents who had treated NR in the previous 6 months were asked to take part in the study. Over 50% of respondents saw an improvement in NR on the same day that treatment was started, and within 3 days 94.5% of respondents reported an improvement in NR. Of 1804 subjects who answered the question, 72.5% indicated that the NR had completely healed within 3 days of starting treatment and by the fifth day, 94.7% said that the NR had completely healed. A total of 71% of 1793 respondents said that an episode of NR had either no or minimal impact disrupting their normal lives, but 29% reported a noticeable impact, even though evidence suggests that mild to moderate nappy rash can be treated quickly. Based on this real-world retrospective study, the evidence suggests SAHC is rapidly effective, reduces signs and symptoms of inflammation, and heals NR.

We present a case of acute blunt traumatic bilateral renal artery thrombosis in the setting of multisystem trauma. Catheter-directed thrombolysis with tissue plasminogen activator afforded kidney salvage with return of glomerular filtration rate to normal values at the time of patient discharge. included a small left subdural hematoma, a left hemothorax and lung contusion. Bilateral renal infarctions with traumatic renal vascular thrombosis, and a right renal pelvis tear with minimal contrast extravasation was demonstrated. The remaining abdominal viscera were without acute injury. The right renal infarct was extensive compared to the left and involved the majority of the right kidney (Figure 1). A visceral angiogram confirmed bilateral renal infarctions, greater in the right kidney. The thrombus on the right renal artery was large and extending to several interlobar arteries (Figure 2). A catheter was placed in the right main renal artery for infusion of tissue plasminogen activator (TPA) at 2 mg/hr for four hours after an initial bolus of 8 mg for a total dose of 16 mg. The time from injury to the treatment with TPA was approximately 5 hours. The patient was also placed on systemic heparin drip due to the bilateral nature of the renal artery thrombosis. This decision was made following consultation with a neurosurgeon as the patient also had an acute subdural bleed. A collaborative decision was reached to proceed with

Masa remaja merupakan masa yang amat meresahkan (unsettling) di dalam kehidupan seseorang (masa transisi) karena banyak perubahan yang dialami baik secara fisik, maupun perubahan lain dari masa kanak-kanak ke masa dewasa. Masa remaja juga merupakan masa bertanya artinya mereka mulai mempertanyakan banyak hal yang sudah diajarkan kepada mereka dan seringkali remaja menolak sebagian atau bahkan seluruh nilai-nilai dan kepercayaan yang dipelajari sewaktu masa kanak-kanak. Dengan memahami perubahan pola pikir dalam diri remaja ke arah yang lebih rasional inilah maka akan berbahaya jika gereja hanya memberikan para remaja dengan aktivitas atau kegiatan gerejawi yang tidak berarti. Menurut penulis, kegiatan tahun remaja di HKBP Kedaton pada tahun 2014 terkesan monoton karena kegiatannya hanya mengikuti kegiatan-kegiatan tahun lalu seperti: Cerdas Cermat Alkitab (CCA), Cerdas Cermat Buku Ende (CCBE), tortor dan vocal grup. HKBP Kedaton belum bersungguh-sungguh dalam membuat sebuah kegiatan terutama di tahun 2014, Kegiatan tahun remaja HKBP dan ini merupakan kegiatan besar yang dirayakan oleh seluruh Gereja HKBP di dunia. Dalam tulisan ini, penulis menggunakan teori perkembangan iman James Fowler dan perkembangan remaja. Dalam tulisan ini pula, penulis menggunakan metode deskripsi-analisis dan jenis penelitian kualitatif. Dalam hal ini penulis menggunakan teknik wawancara dan focus grup discussion dengan responden yaitu pendeta ressort, pendeta remaja-pemuda, majelis di kategorial remaja, ketua remaja dan ketua panitia tahun remaja HKBP. Kegiatan yang telah dilaksanakan di HKBP Kedaton dalam rangka tahun remaja HKBP tidak mempertimbangkan tahapan perkembangan iman remaja ( sintetis-konvensional) dan tanpa mempertimbangkan aspek ego, fisik, moral, kognitif dari remaja sehingga tidak ada tujuan yang ingin dicapai dari kegiatan tersebut

Transesophageal echocardiography (TEE) is an invaluable diagnostic tool, particularly in patients with inadequate transthoracic echocardiographic examinations. In addition, continuous TEE has been used to monitor ventricular and valvular performance in the intensive care unit and the operating room. However, current generation transesophageal probes have limitations in the critical care setting due to their size. Recently, a prototype miniaturized transesophageal probe was developed to overcome these limitations. This probe was used by five medical centers for 194 examinations. A large proportion of these patients were in the intensive care unit (43%), as well as mechanically ventilated (39%). Seventy percent (70%) of the subjects in this study were intubated nasally with the prototype probe, with a success rate of 88.5%. Oral intubation was successful in every case. Subject tolerance was good, and 25% of the patients were intubated for > 1 h. Nasal intubation with the probe was more likely in intensive care patients, ventilated subjects, and patients who were intubated for > 1 hour. TEE with this miniaturized probe is feasible and safe even in multi-instrumented critical care patients. This probe provides adequate diagnostic imaging capabilities and may allow imaging over prolonged periods of time, making it suitable for the serial monitoring of ventricular performance.

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Cardiac sarcoidosis (CS) causes substantial morbidity and sudden death. Early diagnosis and risk stratification are warranted.Ambulatory patients with sarcoidosis were interviewed to determine whether they experienced palpitations, syncope, or presyncope, and were evaluated with ECG, Holter monitoring, and echocardiography (transthoracic echocardiogram [TTE]). Those with symptoms or abnormal results were studied with cardiac MRI (CMRI) or positron emission tomography (PET) scanning. The diagnosis of CS was based on abnormalities detected by these imaging studies. Patients with CS were referred for risk stratification by electrophysiology study (EPS).Among the 62 patients evaluated, the prevalence of CS was 39%. Patients with CS had more cardiac symptoms than those without CS (46% vs 5%, respectively; p0.001), and were more likely to have abnormal Holter monitoring findings (50% vs 3%, respectively; p0.001) and TTE findings (25% vs 5%, respectively; p = 0.02). The degree of pulmonary impairment did not predict CS. Two of the 17 patients who underwent EPS had abnormal test findings and received implantable cardioverter-defibrillators. No patients died, had ventricular arrhythmias that triggered defibrillator therapy, or had heart failure develop during almost 2 years of follow-up. This diagnostic approach was more sensitive than the established criteria for identifying CS.CS is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with PET scanning or CMRI is more sensitive than the established criteria for the identification of CS. Sarcoidal lesions seen on CMRI or PET scanning do not predict arrhythmias in ambulatory patients with preserved cardiac function, who appear to be at low risk for short-term mortality.

When expertly utilized, perioperative echocardiography can lead to improved outcome in patients requiring cardiovascular surgery and in those suffering perioperative cardiovascular instability. However, prior publications have not specified the requisite training for perioperative echocardiography. Therefore, the American Society of Echocardiography (ASE) and the Society of Cardiovascular Anesthesiologists (SCA) appointed a joint task force to delineate guidelines for training in perioperative echocardiography including the prerequisite medical knowledge and training, echocardiographic knowledge and skills, training components and duration, training environment and supervision, and equivalence requirements for postgraduate physicians already in practice. This document is the result of the task force’s deliberations and recommendations.

We randomly assigned patients with a clinical diagnosis of acute myocardial infarction to one of four treatment groups: intracoronary streptokinase, intracoronary nitroglycerin, intracoronary streptokinase and intracoronary nitroglycerin, or conventional therapy without initial angiography. Of 124 patients 122 sustained acute myocardial infarction. Initial angiography revealed total occlusion of the coronary artery responsible for infarction in 67 per cent (61 of 91). Acute recanalization occurred in 74 per cent (32 of 43) of patients receiving streptokinase but in only 6 per cent (1 of 18) of patients treated with nitroglycerin alone (P less than 0.01). At angiography of all four groups on Day 10 to 14 the vessel responsible for acute myocardial infarction was patent in 77 per cent (71 of 92) of patients; there was no difference among groups, indicating gradual, endogenous thrombolysis in patients not treated with streptokinase. Patients with subtotal obstruction initially had significant improvement in left ventricular function, significantly lower peak creatine kinase levels, and a trend toward lower mortality than patients with total occlusion initially. Mortality at six months in patients receiving streptokinase (21 per cent, 13 of 62) did not differ significantly from that in patients not treated with streptokinase (10 per cent, 6 of 61). Additional studies will be necessary to assess treatment effects in the angiographic subsets identified by this trial.

In this paper we construct directly the effective potential, in the many-component limit, for φ ∗ φ) 2 in four dimensions, and ( ψψ ) 2 in two dimensions. We investigate an alternative formulation using a very massive scalar field, the potential of which is shown not to obey the homogeneous Callan-Symanzik equations. We use this method to investigate the physical mass of the fermions, when a non-zero bare input mass is used. We find that the theory exhibits a ‘Meissner effect’ type of behaviour; there is a dynamical component to the fermion mass up to some critical input mass (or external field), when the usual vacuum becomes the stable one.

The use of direct regional intraarterial low dose fibrinolytic therapy was retrospectively studied in a group of 25 patients with acute lower limb ischemia. Bleeding problems were minimized due to careful monitoring of fibrinogen lev els. However two bleeding complications developed during lytic therapy on pa tients who had undergone recent surgical intervention. Following lysis a surgically correctable lesion was seen in one recently occluded conduit and in four late bypass occlusions. Eighty-three percent of the patients who had some lytic response required surgical intervention. The average time of fibrinolytic infusion was 46.7 hours.

Renal vein thrombosis in children can be a diagnostic and therapeutic dilemma for the clinician. Guided by information obtained by standard intravenous contrast studies as well as serial computerized body tomography, the correct diagnosis was made, and effective conservative management was carried out.

Twenty-five patients with ureteral obstruction caused by malignant or benign obstetrical or gynecological conditions were managed by nonoperative measures using indwelling ureteral stents. Bilateral obstruction was present in 15 patients. Immediate indications for stent placement were azotemia or uremia in 11, pain in 8, and preservation of function in 6. Four patients who failed endoscopie ureteral stent placement had successful percutaneous nephrostomy placement and one of these was converted to internal ureteral diversion through a percutaneous nephrostomy. Indwelling ureteral stents were generally well tolerated. Seven had to be replaced from 4 to 12 weeks after placement because of occlusions of the catheters by debris. The length of stent placement ranged from 1 month to 21 months. Three different types of commercially available stents were used (Gibbons, Cook double pigtail, Finney double J). Local anesthesia was utilized in the majority of cases. Protection and improvement in renal function has allowed radiotherapy and longterm chemotherapy to progress in several patients with Stage IV carcinoma of the cervix. Three are in complete remission and have had successful removal of the ureteral stents. Several other patients have been able to return to normal homemaking for significant periods of time.

To the Editor.— We recently treated a 91-year-old man with severe tetanus who exhibited a marked degree of hemodynamic instability and recurrent supraventricular tachyarrhythmia. Early in his course, he was given propranolol hydrochloride, 10 mg every six hours by nasogastric tube. This decreased the frequency of arrhythmia. Several episodes of hypotension responded promptly to appropriate fluid challenge. However, eventually hypotension occurred that was refractory to fluid challenge and for which no cardiovascular or septic cause could be identified. A dopamine infusion was started, but the patient's blood pressure responded erratically, with extremes of hypertension and hypotension observed. Administration of dopamine was discontinued. The patient's hands and feet were cold and blue; he was oliguric, his urine output was less than 10 mL/hr, and his systolic blood pressure by Doppler technique was 40 mm Hg. The patient was given 5 mg of phentolamine intravenously (IV). Several minutes after the phentolamine infusion

• In good-risk patients, abdominal aortic aneurysmectomy can be accomplished with a mortality of 2% to 5%. However, in poor-risk patients, ie, those with severe reduction of cardiac, respiratory, and/or renal function, the mortality of this procedure has been reported to be as high as 60%. Fifteen poor-risk patients with abdominal aortic aneurysms have been treated with acute, induced thrombosis and simultaneous axillobilateral femoral bypass. Each patient had preoperative ultrasound and radionucleide flow studies and the runoff from the aneurysm was determined angiographically. Thrombosis, induced by interruption of the iliac outflow vessels, occurred in 12 patients within 72 hours. Flow persisted in three patients, and thrombosis was induced by transaxiliary catheter deposition of bucrylate in the residual outflow vessels. There were two operative deaths (less than 30 days), both due to myocardial infarctions, and four late deaths, three of which were caused by the problems that initially contraindicated direct graft replacement of the aneurysm. Preliminary experience with this approach indicates that this is a simple and potentially effective method of treatment of abdominal aortic aneurysm where direct graft replacement is contraindicated. ( Arch Surg 114:1402-1408, 1979)

THIS preliminary investigation was undertaken in an effort to apply the Doebner condensation to the synthesis of aroylacrylic acids according to the following equation