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Frontiers in Cardiovascular Medicine 2024High blood pressure is a major risk factor for cardiac remodeling and left ventricular hypertrophy, increasing cardiovascular risk and leading to heart failure with...
BACKGROUND
High blood pressure is a major risk factor for cardiac remodeling and left ventricular hypertrophy, increasing cardiovascular risk and leading to heart failure with preserved ejection fraction (HFpEF). Since renal sympathetic denervation (RDN) reduces blood pressure in the long term, we aimed to investigate the long-term effect of RDN in patients with HFpEF in the present analysis.
METHODS
Patients previously enrolled in a local RDN registry who underwent high-frequency RDN with the use of the Symplicity Flex® renal denervation system between 2011 and 2014 were followed up. The patients were assessed by 24-h ambulatory blood pressure measurement, transthoracic echocardiography, and laboratory tests. We used the echocardiographic and biomarker criteria of the Heart Failure Association (HFA)-PEFF (Pre-test assessment, Echocardiography and Natriuretic Peptide Score, Funkctional testing, and Final aetiology) score to identify patients with HFpEF.
RESULTS
Echocardiographic assessment was available for 70 patients at a 9-year long-term follow-up. Of these patients, 21 had HFpEF according to the HFA-PEFF score. We found a significant reduction of the HFA-PEFF score from 5.48 ± 0.51 points at baseline to 4.33 ± 1.53 points at the 9-year follow-up ( < 0.01). This decrease was due to a greater reduction in morphological and biomarker subcategories [from 1.95 ± 0.22 to 1.43 ± 0.51 points ( < 0.01) and from 1.52 ± 0.52 to 0.90 ± 0.63 points ( < 0.01), respectively] than in the functional one. Morphologically, there was a reduction in left ventricular hypertrophy and left atrial dilation.
CONCLUSIONS
The present analysis suggests that RDN may lead to a regression of the extent of HFpEF beyond a reduction in blood pressure and thus possibly contribute to an improvement in prognosis. More detailed information will be provided by ongoing randomized sham-controlled trials.
PubMed: 38919545
DOI: 10.3389/fcvm.2024.1408547 -
Journal of Anaesthesiology, Clinical... 2024
PubMed: 38919428
DOI: 10.4103/joacp.joacp_287_22 -
Cureus May 2024Industrial accidents involving compressed air can lead to significant colonic injuries, ranging from minor tears to complete perforations. This study investigates a case...
Industrial accidents involving compressed air can lead to significant colonic injuries, ranging from minor tears to complete perforations. This study investigates a case of colonic barotrauma in a 40-year-old male oil refinery worker who suffered symptoms of lower abdominal discomfort, distension, and tenderness following the application of compressed air to his anus. Diagnostic tests, including blood count, abdominal X-ray, and ultrasonography, indicated fecal impaction, dilated bowel loops, and free gas under the diaphragm. An exploratory laparotomy revealed a 4 cm x 2 cm hole in the colon at the hepatic flexure. There were also small breaks in the mucosa at the junction of the recto-sigmoid. We surgically repaired the perforation with primary closure, metrogyl lavage, and the placement of an intra-abdominal pelvic drain. Two weeks later, the patient recovered without any complications and was discharged. This case report highlights the severe risks of non-medical compressed air exposure, as well as the critical need for immediate surgical intervention and preventive safety measures in industrial settings.
PubMed: 38919243
DOI: 10.7759/cureus.61096 -
Cureus May 2024Ileocolic intussusception is a consideration in young pediatric patients with acute abdominal pain. Meckel's diverticulum is the most common pathologic lead point for...
Ileocolic intussusception is a consideration in young pediatric patients with acute abdominal pain. Meckel's diverticulum is the most common pathologic lead point for intussusception in children and the appendix acting as the lead point is rare. In addition, management guidelines for recurrent ileocolic intussusception (RICI) are lacking. We present two cases of RICI in which the pathological lead point was the appendix. The first patient, a two-year-old with no medical history, had intermittent abdominal pain and non-bloody vomiting for a month. Ultrasound revealed ileocolic intussusception, successfully managed with pneumatic reduction. However, symptoms recurred and a repeat ultrasound showed partial intussusception of the appendix into the cecum. Laparoscopic reduction and appendectomy were then performed. Symptomatic intussusception recurred, and a second laparoscopic reduction with stump appendectomy resolved all symptoms. The second patient, a three-year-old with no medical history, had colicky abdominal pain for 24 hours. Ultrasound revealed ileocolic intussusception that was pneumatically reduced. As pain recurred, laparoscopic reduction and appendectomy were performed, revealing ileocolic intussusception with a dilated appendix as the pathologic lead point. Recurrent ileocolic intussusception (RICI) with the appendix as the lead point is common, but RICI with the appendix as the lead point is rare. These cases demonstrate the role of the appendix as a pathologic lead point, and a review of the literature supports the need for surgical reduction. While enema reduction is the first line for recurrent intussusception, surgical reduction is preferred when a pathological lead point is suspected.
PubMed: 38919204
DOI: 10.7759/cureus.61120 -
Clinical Endoscopy Jun 2024Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the...
BACKGROUND/AIMS
Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
METHODS
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
RESULTS
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
CONCLUSIONS
Tract dilation in EUS-PDD using Tornus ES is effective and safe.
PubMed: 38919059
DOI: 10.5946/ce.2023.272 -
Social Cognitive and Affective... Jun 2024Gaze direction and pupil dilation play a critical role in communication and social interaction due to their ability to redirect and capture our attention and relevance...
Gaze direction and pupil dilation play a critical role in communication and social interaction due to their ability to redirect and capture our attention and relevance for emotional information. The present study aimed to explore whether the pupil size and the gaze direction of the speaker affect language comprehension. Participants listened to sentences that could be correct or contain a syntactic anomaly, while the static face of a speaker was manipulated in terms of gaze direction (direct, averted) and pupil size (mydriasis, miosis). Left anterior negativity (LAN) and P600 linguistic ERP components were observed to syntactic anomalies for all conditions. The speaker's gaze did not impact syntactic comprehension. However, the amplitude of the LAN component for mydriasis (dilated pupil) was larger than for miosis (constricted pupil) condition. Larger pupils are generally associated with care, trust, interest, and attention, which might facilitate syntactic processing at early automatic stages. The result also supports the permeable and context-dependent nature of syntax. Previous studies also support an automatic nature of syntax (fast and efficient), which combined with the permeability to relevant sources of communicative information, such as pupil size and emotions, is highly adaptive for language comprehension and social interaction.
PubMed: 38918898
DOI: 10.1093/scan/nsae047 -
Endoscopy Dec 2024
Topics: Humans; Stents; Endosonography; Ultrasonography, Interventional; Male; Gastrostomy; Dilatation; Aged; Female
PubMed: 38917980
DOI: 10.1055/a-2340-8631 -
Cureus May 2024Peripherally inserted central catheter (PICC) placement under real-time ultrasound guidance has emerged as a favorable procedure in children as a method to efficiently...
Peripherally inserted central catheter (PICC) placement under real-time ultrasound guidance has emerged as a favorable procedure in children as a method to efficiently obtain central access. Nevertheless, small infants with hemodynamic instability are at high risk of complications and extra precautions are necessary. We present a case of an inadvertent arterial placement of a PICC in a two-month-old infant with dilated cardiomyopathy and decompensated heart failure. Differentiation of arteries and veins under ultrasonographic evaluation may sometimes be difficult when the applied tourniquet pressure exceeds the patient's arterial blood pressure. In particular, arterial flow can be easily compromised by applying tourniquet pressure in small children with low blood pressure. A thorough understanding of the upper extremity vascular anatomy, basic scanning techniques, and meticulous preparation especially in small infants with hemodynamic instability are essential for maintaining the safety and efficacy of this procedure.
PubMed: 38916025
DOI: 10.7759/cureus.61053 -
Cureus May 2024A 25-year-old male with no prior medical history presented with a one-month history of nausea, weight loss, and dyspnea that progressed to syncope. The initial...
A 25-year-old male with no prior medical history presented with a one-month history of nausea, weight loss, and dyspnea that progressed to syncope. The initial echocardiogram showed a dilated right ventricle with signs of systolic failure. The patient was admitted for suspected pulmonary embolism, but chest computed tomography (CT) revealed interstitial pneumonia. A transthoracic echocardiogram on day 6 of admission diagnosed cor triatriatum sinister (CTS), severe pulmonary hypertension, chronic cor pulmonale, and reduced right ventricular function. The patient was managed conservatively in the intensive care unit (ICU) without the need for mechanical ventilation and discharged after clinical improvement. This case highlights the importance of the early diagnosis of rare congenital heart defects such as cor triatriatum sinister, which can present with nonspecific symptoms and rapidly progress to right heart failure.
PubMed: 38916021
DOI: 10.7759/cureus.61039 -
Cureus May 2024In the intricate field of obstetrics and gynecology, few scenarios present as complex a diagnostic challenge as the differentiation between heterotopic pregnancy,...
In the intricate field of obstetrics and gynecology, few scenarios present as complex a diagnostic challenge as the differentiation between heterotopic pregnancy, hyperdecidual reaction, and ectopic pregnancy. These conditions, while distinct, often blur together in clinical presentation, necessitating a nuanced understanding to achieve accurate diagnosis and timely intervention. A heterotopic pregnancy is a rare and potentially life-threatening condition in which a woman simultaneously carries two pregnancies in different locations. One pregnancy is typically located within the uterus (an intrauterine pregnancy), while the other is located outside the uterus, most commonly in one of the fallopian tubes (an ectopic pregnancy). This condition is sometimes referred to as a combined intrauterine and extrauterine pregnancy. The diagnosis of heterotopic pregnancy can be challenging because the symptoms can mimic those of a normal intrauterine pregnancy or an ectopic pregnancy. A combination of clinical symptoms, physical examination, and imaging studies, such as transvaginal ultrasound, can help in the diagnosis. After surgical or medical treatment, close monitoring and follow-up with a healthcare provider are essential. The remaining intrauterine pregnancy will need careful observation to ensure it continues to develop normally. However, in some cases of ectopic pregnancy, there will be hyperdecidual reaction within the uterus, which may sometimes create confusion with intrauterine pregnancy. Here, a case of ectopic pregnancy that was radiologically misdiagnosed as heterotopic pregnancy is presented to highlight the possibility of ectopic pregnancies being misdiagnosed as heterotopic pregnancy due to the hyperdecidual reaction. The index case underwent laparoscopic salpingectomy for tubal ectopic and dilatation and evacuation for suspected failed intrauterine pregnancy. The histopathological report of the intrauterine products of conception confirmed it to be decidua without any trophoblastic tissue.
PubMed: 38915974
DOI: 10.7759/cureus.61073