Efectividad de las Técnicas de Retratamiento Endodóntico en la Remoción de ementos Biocerámicos como Material de Obturación Radicular: Revisión Sistemática

El retratamiento no quirúrgico es la primera opción ante el fracaso del tratamiento endodóntico, por lo que se vuelve importante asegurar el completo retiro del material de relleno del conducto radicular, para mejorar el pronóstico del procedimiento. Los cementos biocerámicos en base a silicatos cálcicos han aparecido en los últimos años, caracterizados principalmente por su bioactividad, lo que adicionalmente se puede traducir en una mayor dificultad para su retiro del conducto radicular. El objetivo de esta revisión es determinar qué técnica de retratamiento es más efectiva en la eliminación de cementos selladores biocerámicos, en base al volumen de material remanente en el conducto radicular, evaluado a través del análisis de imágenes con micro-CT. Se realizó una revisión sistemática mediante la búsqueda de publicaciones en las bases de datos Pubmed, ScienceDirect y SciELO, de los últimos 10 años, en idioma español e inglés. Se incluyeron sólo estudios in vitro de dientes obturados con cemento biocerámico y diferentes técnicas de retratamiento endodóntico, en los que se evalúe la limpieza del conducto post eliminación del relleno mediante micro-CT. De un total de 174 artículos encontrados, 7 fueron seleccionados, analizados y se incluyeron en esta revisión sistemática. Los resultados de los estudios seleccionados no encuentran diferencias significativas en la eliminación de material entre las diferentes técnicas de retratamiento evaluadas. A pesar de la heterogeneidad presente en las metodologías de los artículos analizados, ninguna técnica de retratamiento ni técnicas complementarias lograron dejar completamente limpios los conductos radiculares, por lo que se sugiere realizar nuevos estudios en el futuro que evalúen nuevas técnicas de desobturación radicular.

Non-surgical retreatment is the first option in the case of endodontic treatment failure, so it becomes important to ensure complete removal of the root canal filling material, to improve the prognosis of the procedure. Bioceramic cements based on calcium silicate have appeared in recent years, characterized mainly for their bioactivity, which can additionally translate into greater difficulty in their removal from the root canal. The aim of this review is to determine which retreatment technique is most effective in the removal of bioceramic sealer cements, evaluated through micro-CT image analysis. A systematic review was performed by searching for publications in Pubmed, ScienceDirect and SciELO databases, of the last 10 years in Spanish and English. Only in vitro studies of teeth filled with bioceramic cement and different endodontic retreatment techniques were included, in which the cleaning of the canal after removal of the filling was evaluated by micro- CT. From a total of 174 articles found, 7 were selected, analyzed and included in this systemic review. The results of the included studies did not find significant differences in the removal of material between the different retreatment techniques evaluated. Despite the heterogeneity in the methodologies of the studies, no retreatment technique or complementary techniques were able to completely clean the root canals, it is therefore suggested that new studies be carried out in the future to evaluate new techniques.

Endodoncia guiada estática, una opción para obliteración del canal pulpar: serie de casos / Static guided endodontics, an option for pulpal canal obliteration: a case series

En la práctica endodóntica, la etapa del acceso al canal radicular es fundamental para el éxito de las siguientes etapas del tratamiento. En casos de canales pulpares obliterados o calcificados (PCO), lograr encontrar la entrada a estos es un reto en la endodoncia convencional dado el alto riesgo de sufrir un accidente intraoperatorio. Actualmente, existen los tratamientos de endodoncia guiada o accesos guiados digitalmente, una alternativa innovadora y con múltiples beneficios para el abordaje de este tipo de dientes. El objetivo de este reporte de casos fue describir el protocolo de cuatro casos de accesos guiados estáticos para endodoncia en canales obliterados, indicando las ventajas y consideraciones del tratamiento. Se presenta un reporte de casos de cuatro pacientes atendidos entre julio 2021 y junio 2022, que requerían tratamientos endodónticos en dientes anteriores con canales pulpares obliterados. Para la realización de estos procedimientos se requirió una Tomografía Computarizada de Haz Cónico (CBCT) y el escaneo intraoral de la zona a tratar, para poder a través de la ayuda de un software, planificar virtualmente la dirección y longitud de acceso al conducto radicular. Posteriormente, se realizó la impresión en 3D de la guía estática, la cual dirige la entrada de la fresa que se utiliza para encontrar el acceso al canal radicular. En los cuatro casos clínicos en que se realizó la planificación virtual e impresión de la guía de acceso, fue posible encontrar el canal radicular en una sesión, pudiendo realizar el tratamiento endodóntico de manera exitosa y conservadora. En conclusión, la endodoncia guiada estática permite realizar los tratamientos endodónticos en PCO de manera segura, a pesar de la alta complejidad que presentaban.

SUMMARY: In endodontics, the access to the root canal is essential for the treatment success. Pulp canal obliteration (PCO) is a challenge for conventional endodontic treatments with a high risk of fracture of endodontic instruments.Currently, guided endodontic treatments, or digitally guided accesses, are novel alternatives with multiple benefits for the treatment of PCO. The objective of this case report is to describe the protocol for static guided access in PCO, indicating the advantages and considerations of the treatment. A case report of four patients treated between July 2021 and June 2022 is presented. These patients required endodontic treatments in anterior teeth with PCO. In order to virtually plan the direction and length of the access, using a software, we used a cone Beam Computed Tomography (CBCT) and an intraoral scan. Then, a 3D printing of the static guide was made, which directs the entry of the drill. With this method, it was possible to find the root canal in one session and perform the endodontic treatment successfully and conservatively. In conclusion, although static guided endodontics requires planification, it allows a safe endodontic treatment in patients with PCO.

Obesidad y fibrilación auricular / Obesity and atrial fibrillation

Resumen La obesidad ha aumentado en proporciones epidémicas en el mundo y cada vez es mayor su asociación con otras condiciones como la hipertensión, la apnea obstructiva del sueño y la diabetes mellitus. De acuerdo con los efectos adversos que tiene la obesidad sobre la estructura, función y hemodinámica cardiovascular, no es sorprendente que en el contexto de obesidad, la mayoría de enfermedades cardiovasculares aumenten su frecuencia, incluida la hipertensión, la enfermedad coronaria y la insuficiencia cardíaca, adicional al incremento significativo del riesgo de presentar fibrilación auricular de novo y su recurrencia. Factores cardíacos estructurales y, probablemente, cardiometabólicos explican gran parte de este efecto. Se realizó una búsqueda de artículos y estudios científicos en bases de datos (PubMed, Medline, EMBASE), y concluyó que la obesidad contribuye en gran parte al riesgo de fibrilación auricular. La literatura proporciona evidencia sólida a favor de incorporar el ejercicio como una estrategia complementaria para el manejo de la fibrilación auricular, demostrando que niveles más altos de actividad física dentro del rango óptimo pueden ser beneficiosos.

Abstract Obesity has increased in epidemic proportions worldwide and is increasingly associated with other conditions such as hypertension, obstructive sleep apnea and diabetes. Considering the adverse effects that obesity has on cardiovascular hemodynamicsm structure and function, it is not surprising that in the context of obesity most cardiovascular diseases increase in frequency, including hypertension, coronary artery disease and heart failure, in addition to the significant increase in the risk of de novo atrial fibrillation and its recurrence. Structural cardiac factors, and probably cardiometabolic factors, account for much of this effect. A search for articles and scientific studies in databases (PubMed, Medline, EMBASE) was carried out, concluding that obesity contributes significantly to the risk of atrial fibrillation. The literature provides solid evidence in favor of incorporating exercise as a complementary strategy for atrial fibrillation management, demonstrating that higher levels of physical activity within the optimal range can be beneficial.

Miocinas: su rol en la obesidad y en las enfermedades cardiometabólicas / Myokines: their role in obesity and cardiometabolic diseases

Resumen Introducción: La obesidad es uno de los principales problemas de salud pública en el mundo. Se considera detonante de múltiples enfermedades cardiometabólicas, como el infarto agudo de miocardio, la hipertensión arterial, la diabetes mellitus tipo 2 y el accidente isquémico cerebral. Es interesante conocer diversos factores fisiopatológicos que no dependen solo de la adiposidad, sino también de la masa muscular. Al entender que el músculo como órgano endocrino corresponde al 40% del peso corporal, las miocinas, como sustancias propias de este órgano liberadas desde la contracción, cobran importancia por su efecto antiinflamatorio y cardioprotector, y suponen un esfuerzo mayor para, a partir de su comprensión, realizar una prescripción adecuada del ejercicio. Objetivo: Estudiar las funciones de las miocinas como sustancias reguladoras de diversos procesos metabólicos, fundamentales en la homeostasis corporal. Método: Se hizo una revisión de tema, resultado de la revisión crítica de la literatura disponible sobre las miocinas, sus funciones y los efectos de la actividad física y el ejercicio en su liberación y acción. Conclusiones: El estudio de las miocinas viene en aumento y cobra relevancia clínica. Los efectos antiinflamatorios y cardioprotectores de las miocinas dependen del tipo de entrenamiento y de las cargas aplicadas al músculo una vez ha sido sometido a diferentes tipos de estímulo (aeróbico/anaeróbico, fuerza). Por tanto, la prescripción correcta del ejercicio es crucial en la modulación de estos mediadores: la optimización de su efecto, el acondicionamiento físico y el mantenimiento del peso adecuado.

Abstract Introduction: Obesity is one of the main public health problems worldwide being considered as a trigger for multiple cardiometabolic diseases such as acute myocardial infarction, high blood pressure, type 2 diabetes mellitus, cerebral ischemic accident among others. For this reason, it is of interest to know the various pathophysiological factors which depend not only on adiposity but also on muscle mass. Taking into account that the muscle as an endocrine organ corresponds to 40 % of the body weight, the importance that myokines charge as substances of this organ with an anti-inflammatory and cardioprotective character and which are released from muscle contraction is an additional study to perform an adequate Prescription of the exercise. Objective: To study the functions of myokines as regulatory substances in various metabolic processes, being essential in body homeostasis. Method: It is presented a topic review article, the result of a critical review of the available literature on myokines, their functions and the effects of physical activity and exercise on their release and action. Conclusions: that the study of myokines is increasing and is becoming more important clinical. The anti-inflammatory and cardioprotective effects of myokines depend on the type of training and loads applied to the muscle once subjected to different types of stimulation (aerobic/anaerobic, strength). Therefore, the proper prescription of exercise becomes crucial in the physical conditioning and in the maintenance of the appropriate weight.

Rehabilitación cardiaca: una transformación acelerada durante la pandemia de COVID-19 / Cardiac rehabilitation: an accelerated transformation during the COVID-19 pandemics

Resumen La rehabilitación cardiaca es un tratamiento valioso para pacientes con enfermedades cardiacas establecidas, y en general para personas con riesgo cardiovascular elevado. La prescripción de la rehabilitación cardiaca debe ser progresiva y con metas individualizadas. Tradicionalmente se inicia en entornos hospitalarios luego de eventos cardiovasculares agudos y se continúa de manera ambulatoria en instituciones de menor complejidad. Se realizó una revisión no sistemática de la literatura sobre la evolución de la rehabilitación cardiaca en el tiempo, su relevancia en el cuidado de los pacientes con enfermedad cardiovascular, las diferentes modalidades en la prestación de este servicio con la tendencia a la rehabilitación cardiaca en casa y la telerrehabilitación, y su transformación acelerada durante la pandemia de COVID-19. Es fundamental garantizar la continuidad en el acceso, así como la suficiente participación de los pacientes en programas remodelados de rehabilitación cardiaca, capaces de transgredir hábitos en la prestación del servicio y de superar las barreras que puede representar la situación actual para la entrega de una atención de alta calidad.

Abstract Cardiac rehabilitation is a valuable treatment for patients with established heart disease, and in general, for people with high cardiovascular risk. The prescription of cardiac rehabilitation must be progressive and with individualized goals. Traditionally, it is performed in hospital settings after an acute cardiovascular event and it's continued as outpatient basis in less complex institutions. A non-systematic review of literature was conducted in terms of the evolution of cardiac rehabilitation over time, it's relevance in cardiovascular disease patient's care, different access modalities, including the evolving tendency towards home based cardiac rehabilitation and tele-rehabilitation, as well as its accelerated transformation during the COVID-19 pandemics. It is essential to guarantee continuity of access as well as sufficient participation of patients in restructured cardiac rehabilitation programs, capable of surpassing service delivery habits and overcoming the barriers that the current situation may represent for the delivery of a high-quality care.

De curandis hominum morbis: An 18th century medical prescription for measles and smallpox in the Nuevo Reino de Granada / De curandis hominum morbis: una receta médica del siglo XVIII para el sarampión y las viruelas en el Nuevo Reino de Granada

A collection of more than one hundred medical recipes from the late 18th century was donated by Presbyter Cipriano Rodríguez Santa María, institutional eponym of the collection at the Historical Archive "Octavio Arizmendi Posada" of the library of the Universidad de La Sabana in Colombia. These texts represent an important historical and medical legacy and they constitute an important basis for understanding the colonial and traditional therapeutics related to various diseases. In this article, we describe one of these recipes for the treatment of smallpox and measles as a contribution to the history of medicine in Colombia.

En el Archivo Histórico de la Biblioteca "Octavio Arizmendi Posada" de la Universidad de La Sabana, se encuentra una colección de más de un centenar de recetas médicas de finales del siglo XVIII donadas por el presbítero Cipriano Rodríguez Santa María, epónimo institucional del archivo. Estos textos son un legado histórico médico y un fundamento para comprender la terapéutica colonial y tradicional de diversas enfermedades. En este artículo, se describen algunas recetas para el tratamiento de la viruela y el sarampión, como aporte a la historia de la medicina en Colombia.

De curandis hominum morbis: una receta médica del siglo XVIII para el sarampión y las viruelas en el Nuevo Reino de Granada / De curandis hominum morbis: An 18th century medical prescription for measles and smallpox in the Nuevo Reino de Granada

En el Archivo Histórico de la Biblioteca "Octavio Arizmendi Posada" de la Universidad de La Sabana, se encuentra una colección de más de un centenar de recetas médicas de finales del siglo XVIII donadas por el presbítero Cipriano Rodríguez Santa María, epónimo institucional del archivo. Estos textos son un legado histórico médico y un fundamento para comprender la terapéutica colonial y tradicional de diversas enfermedades. En este artículo, se describen algunas recetas para el tratamiento de la viruela y el sarampión, como aporte a la historia de la medicina en Colombia.

A collection of more than one hundred medical recipes from the late 18th century was donated by Presbyter Cipriano Rodríguez Santa María, institutional eponym of the collection at the Historical Archive "Octavio Arizmendi Posada" of the library of the Universidad de La Sabana in Colombia. These texts represent an important historical and medical legacy and they constitute an important basis for understanding the colonial and traditional therapeutics related to various diseases. In this article, we describe one of these recipes for the treatment of smallpox and measles as a contribution to the history of medicine in Colombia.

Strengths and validity of three methods for assessing rat body fat across the life course.

There are several different methods available for the determination of body fat composition. Two current methods requiring special instrumentation are magnetic resonance imaging (MRI) and dual energy x-ray absorptiometry (DXA). The use of these techniques is very limited despite desirable properties, due to their high costs. Dissection of all fat depots (DF) requires no special instrumentation and allows examination and evaluation of each fat depot in more detail. MRI, DXA, and DF each have their unique advantages and disadvantages when they are applied to animal models. Most studies have determined body fat in young animals, and few studies have been performed in aging models. The aim of this study was to compare MRI, DXA, and DF data in offspring (F1) of mothers fed with control and high-fat diet. We studied rats that varied by age, sex, and maternal diet. The relationships between the three methods were determined via linear regression methods (using log-transformed values to accommodate relativity in the relationships), incorporating when useful age, sex, or diet of the animal. We conclude that the three methods are comparable for measuring body fat, but that direct equivalence gets masked by age, sex, and sometimes dietary group. Depending on the equipment available, the budget of the laboratory, and the nature of the research questions, different approaches may often suggest themselves as the best one.

Valor pronóstico de biomarcadores cardíacos en la enfermedad por COVID-19 / value of cardiac biomarkers in COVID-19 disease

Resumen Introducción: En la enfermedad por COVID-19 se ha establecido que los pacientes con enfermedad cardiometabólica de base tienen mayor riesgo de presentar desenlaces adversos. Esto ha incrementado el interés en estudiar variables cardiovasculares relevantes, para plantear su correlación con los desenlaces clínicos en esta población. Objetivo: Describir el valor pronóstico de los biomarcadores cardíacos en la enfermedad por COVID-19. Métodos: Revisión no sistemática de la literatura en bases de datos como PubMed, Google Scholar, Clinical Key, SciELO, entre otras, utilizando palabras clave, términos planos y términos MeSh. Resultados: Se eligieron 22 bibliografías, entre ellas artículos de revisión de tema, revisiones sistemáticas, metaanálisis, estudios observacionales y artículos originales publicados hasta la fecha (mayo 13 de 2020), que en su mayoría describen la alteración de biomarcadores cardiacos y su relación con la evolución clínica de los pacientes con COVID-19. Discusión: Se encontró que la troponina y el péptido natriurético se comportan como factores de riesgo independientes para compromiso clínico severo, requerimiento de soporte ventilatorio o hemodinámico, estancia en la UCI, y aumento de la mortalidad. Conclusiones: Es razonable plantear el uso de estos biomarcadores en la estratificación del riesgo en pacientes con COVID-19 y enfermedad cardiovascular establecida.

Abstract Introduction: It has been established that patients with an underlying cardiometabolic disease and COVID-19 infections, have a higher risk of an adverse outcome. This has led to an increase in the interest of studying relevant cardiovascular variables, in order to establish their association with clinical outcomes in this population. Objective: To describe the prognostic value of cardiac biomarkers in disease caused by COVID-19. Methods: A non-systematic review of the literature was carried out in data bases that included PubMed, Google Scholar, Clinical Key, SciELO, using the key words, plain terms, and MeSH terms. Results: A total of 22 articles were chosen. They consisted of review articles on the subject, systematic reviews, meta-analyses, observational studies, and original articles published up until 13 May 2020. The majority of them described the changes in cardiac biomarkers and their relationship with the clinical outcome of patients COVID-19. Discussion: It was found that Troponin and Natriuretic Peptide behaved as independent risk factors for severe clinical compromise, requiring ventilatory or haemodynamic support, admission to ICU, and an increase in mortality. Conclusions: It is reasonable to recommend the use of these biomarkers in the risk stratification in patients with COVID-19 and an established cardiovascular disease.

Evaluation of PET quantitation accuracy among multiple discovery IQ PET/CT systems via NEMA image quality test.

INTRODUCTION: Quantitative imaging biomarkers are becoming usual in oncology for assessing therapy response. The harmonization of image quantitation reporting has become of utmost importance due to the multi-center trials increase. The NEMA image quality test is often considered for the evaluation of quantitation and is more accurate with a radioactive solid phantom that reduces variability. The goal of this project is to determine the level of variability among imaging centers if acquisition and imaging protocol parameters are left to the center's preference while all other parameters are fixed including the scanner type. METHODS: A NEMA-IQ phantom filled with radioactive 68Ge solid resin was imaged in five clinical sites throughout Europe. Sites reconstructed data with OSEM and BSREM algorithms applying the sites' clinical parameters. Images were analyzed according with the NEMA-NU2-2012 standard using the manufacturer-provided NEMA tools to calculate contrast recovery (CR) and background variability (BV) for each sphere and the lung error (LE) estimation. In addition, a 18F-filled NEMA-IQ phantom was also evaluated to obtain a gauge for variability among centers when the sites were provided with identical specific instructions for acquisition and reconstruction protocol (the aggregate of data from 12 additional sites is presented). RESULTS: The data using the 68Ge solid phantom showed no statistical differences among different sites, proving a very good reproducibility among the PET center models even if dispersion of data is higher with OSEM compared to BSREM. Furthermore, BSREM shows better CR and comparable BV, while LE is slightly reduced. Two centers exhibit significant differences in CR and BV values for the 18F NEMA NU2-2012 experiments; these outlier results are explained. CONCLUSION: The same PET system type from the various sites produced similar quantitative results, despite allowing each site to choose their clinical protocols with no restriction on data acquisition and reconstruction parameters. BSREM leads to lower dispersion of quantitative data among different sites. A solid radioactive phantom may be recommended to qualify the sites to perform quantitative imaging.

Renal Graft Embolization as a Treatment for Graft Intolerance Syndrome.

BACKGROUND: Renal graft intolerance syndrome is an inflammatory process that occurs in up to 40% of patients with graft loss. It is characterized by fever, graft pain, hematuria, and anemia. Traditionally, the treatment has been nephrectomy; however, this procedure is associated with high morbidity and mortality rates. As an alternative, graft embolization is associated with success rates of up to 92%. In this study, we describe the graft embolization experience of 1 center, its clinical outcomes and complications. METHODS: An observational, retrospective study was conducted. It included all patients with graft intolerance syndrome undergoing graft embolization between 2012 and 2018. The success of the procedure was defined by the resolution of the symptoms that motivated the embolization. RESULTS: We found 12 cases of patients undergoing embolization. The time of presentation of the graft intolerance syndrome after admission to dialysis was 6 months (range, 0.6-13). The main clinical manifestation was pain in the area of the graft and macroscopic hematuria. Except for 1 patient, all continued with the immunosuppressive treatment regimen after graft loss for 4 months (range, 0.6-9), received antibiotics for 5.5 days (range, 2-14), and 10 patients received steroid treatment for 6.5 days (range, 5-10). The main complication, secondary to the procedure, was hematoma at the puncture site in 3 patients. Only 1 patient had postembolization syndrome, which resolved with steroid administration. Two patients required postembolization nephrectomy due to persistent renal blood flow and symptoms such as pain and hematuria. The average hospital stay was 5.5 days (range, 1-24). CONCLUSIONS: Renal graft embolization is an effective technique as a treatment strategy in patients with clinical signs of intolerance syndrome, with a success rate ≥83.3%, low morbidity, and short hospital stay; furthermore, it avoids the potential complications of a surgical nephrectomy. Graft infection should be ruled out before embolization, and the use of prophylactic antibiotics and steroid therapy is recommended to reduce the risk of postembolization syndrome and infectious complications.

Performance characteristics of silicon photomultiplier based 15-cm AFOV TOF PET/CT.

BACKGROUND: This paper describes the National Electrical Manufacturers Association (NEMA) system performance of the Discovery MI 3-ring PET/CT (GE Healthcare) installed in Bruges, Belgium. This time-of-flight (TOF) PET camera is based on silicon photomultipliers instead of photomultiplier tubes. METHODS: The NEMA NU2-2012 standard was used to evaluate spatial resolution, sensitivity, image quality (IQ) and count rate curves of the system. Timing and energy resolution were determined. RESULTS: Full width at half maximum (FWHM) of spatial resolution in radial, tangential and axial direction was 4.69, 4.08 and 4.68 mm at 1 cm; 5.58, 4.64 and 5.83 mm at 10 cm; and 7.53, 5.08 and 5.47 mm at 20 cm from the centre of the field of view (FOV) for the filtered backprojection reconstruction. For non-TOF ordered subset expectation maximization (OSEM) reconstruction without point spread function (PSF) correction, FWHM was 3.87, 3.69 and 4.15 mm at 1 cm; 4.80, 3.81 and 4.87 mm at 10 cm; and 7.38, 4.16 and 3.98 mm at 20 cm. Sensitivity was 7.258 cps/kBq at the centre of the FOV and 7.117 cps/kBq at 10-cm radial offset. Contrast recovery (CR) using the IQ phantom for the TOF OSEM reconstruction without PSF correction was 47.4, 59.3, 67.0 and 77.0% for the 10-, 13-, 17- and 22-mm radioactive spheres and 82.5 and 85.1% for the 28- and 37-mm non-radioactive spheres. Background variability (BV) was 16.4, 12.1, 9.1, 6.6, 5.1 and 3.8% for the 10-, 13-, 17-, 22-, 28- and 37-mm spheres. Lung error was 8.5%. Peak noise equivalent count rate (NECR) was 102.3 kcps at 23.0 kBq/ml with a scatter fraction of 41.2%. Maximum accuracy error was 3.88%. Coincidence timing resolution was 375.6 ps FWHM. Energy resolution was 9.3% FWHM. Q.Clear reconstruction significantly improved CR and reduced BV compared with OSEM. CONCLUSION: System sensitivity and NECR are lower and IQ phantom's BV is higher compared with larger axial FOV (AFOV) scanners like the 4-ring discovery MI, as expected from the smaller solid angle of the 3-ring system. The other NEMA performance parameters are all comparable with those of the larger AFOV scanners.

Trends in the Quantiles of the Life Table Survivorship Function.

We offer a new approach for modeling past trends in the quantiles of the life table survivorship function. Trends in the quantiles are estimated, and the extent to which the observed patterns fit the unit root hypothesis or, alternatively, an innovative outlier model, are conducted. Then a factor model is applied to the detrended data, and it is used to construct quantile cycles. We enrich the ongoing discussion about human longevity extension by calculating specific improvements in the distribution of the survivorship function, across its full range, and not only at the central-age ranges. To illustrate our proposal, we use data for the UK from 1922 to 2013. We find that there is no sign in the data of any reduction in the pace of longevity extension during the last decades.

Fat Embolism and Nonconvulsive Status Epilepticus.

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.

Refractory Giant Cell Arteritis Complicated by Vision Loss From Optic Atrophy and Maculopathy Associated With Pachymeningitis.

BACKGROUND: We describe a 75-year-old woman who experienced vision loss in her left eye due to biopsy-proven giant cell arteritis (GCA). She subsequently developed pachymeningitis causing refractory headaches and bilateral optic neuropathy and maculopathy. METHODS: Case report with literature review. RESULTS: Eighteen months after the initial diagnosis of GCA, imaging studies in our patient demonstrated pachymeningeal enhancement, and meningeal biopsy confirmed lymphoplasmacytic tissue infiltrates with low frequencies of IgG4+ plasma cells. Laboratory investigation revealed the presence of 3 antiretinal antibodies and antimyeloperoxidase antibodies, consistent with autoimmune retinopathy. Treatment with B-cell-depleting anti-CD20 antibodies suppressed meningeal inflammation and prevented further vision loss. CONCLUSIONS: This case illustrates that bilateral vision loss and chronic headaches in patients with GCA may result from retina-directed autoimmunity and pachymeningitis.

Construct validity of a novel, objective evaluation tool for the basics of open laparotomy training using a simulated model.

BACKGROUND: We describe initial success in designing and implementing an objective evaluation for opening and closing a simulated abdomen. METHODS: (1) An assessment for laparotomy was created using peer-reviewed literature, texts, and the input of academic surgeons nationally; (2) the assessment was evaluated for construct validity, comparing the videotaped performance of laparotomy by surgical experts and novices on a viscoelastic model; and (3) the basics of open laparotomy training (BOLT) curriculum was piloted with junior residents to evaluate efficacy at improving performance. RESULTS: Experts performed better than novices opening (.94 vs .51; P < .001), closing (.85 vs .16; P < .001), and overall performance (.88 vs .27; P < .001). Novices caused bowel injury more frequently (5 vs 1; P < .05) and took longer to open the abdomen (6:06 vs 3:43; P = .01). After completing the BOLT curriculum, novices improved for opening (1.00 vs .50; P = .014), closing (.80 vs .10; P = .014), and overall score (.87 vs .23; P = .014). CONCLUSIONS: We demonstrate construct validity of an evaluation tool for simulated laparotomy, and pilot efforts with the BOLT curriculum have shown promise.

Studies of a Next-Generation Silicon-Photomultiplier-Based Time-of-Flight PET/CT System.

This article presents system performance studies for the Discovery MI PET/CT system, a new time-of-flight system based on silicon photomultipliers. System performance and clinical imaging were compared between this next-generation system and other commercially available PET/CT and PET/MR systems, as well as between different reconstruction algorithms. Methods: Spatial resolution, sensitivity, noise-equivalent counting rate, scatter fraction, counting rate accuracy, and image quality were characterized with the National Electrical Manufacturers Association NU-2 2012 standards. Energy resolution and coincidence time resolution were measured. Tests were conducted independently on two Discovery MI scanners installed at Stanford University and Uppsala University, and the results were averaged. Back-to-back patient scans were also performed between the Discovery MI, Discovery 690 PET/CT, and SIGNA PET/MR systems. Clinical images were reconstructed using both ordered-subset expectation maximization and Q.Clear (block-sequential regularized expectation maximization with point-spread function modeling) and were examined qualitatively. Results: The averaged full widths at half maximum (FWHMs) of the radial/tangential/axial spatial resolution reconstructed with filtered backprojection at 1, 10, and 20 cm from the system center were, respectively, 4.10/4.19/4.48 mm, 5.47/4.49/6.01 mm, and 7.53/4.90/6.10 mm. The averaged sensitivity was 13.7 cps/kBq at the center of the field of view. The averaged peak noise-equivalent counting rate was 193.4 kcps at 21.9 kBq/mL, with a scatter fraction of 40.6%. The averaged contrast recovery coefficients for the image-quality phantom were 53.7, 64.0, 73.1, 82.7, 86.8, and 90.7 for the 10-, 13-, 17-, 22-, 28-, and 37-mm-diameter spheres, respectively. The average photopeak energy resolution was 9.40% FWHM, and the average coincidence time resolution was 375.4 ps FWHM. Clinical image comparisons between the PET/CT systems demonstrated the high quality of the Discovery MI. Comparisons between the Discovery MI and SIGNA showed a similar spatial resolution and overall imaging performance. Lastly, the results indicated significantly enhanced image quality and contrast-to-noise performance for Q.Clear, compared with ordered-subset expectation maximization. Conclusion: Excellent performance was achieved with the Discovery MI, including 375 ps FWHM coincidence time resolution and sensitivity of 14 cps/kBq. Comparisons between reconstruction algorithms and other multimodal silicon photomultiplier and non-silicon photomultiplier PET detector system designs indicated that performance can be substantially enhanced with this next-generation system.

Embolización transcatéter / Transcatheter Embolization

Emboloterapia, embolización o embolización transcatéter son nombres que actualmente se le asignan al mismo procedimiento, conocido desde comienzos del siglo XX, que tomó fuerza y se difundió desde principios de 1970 cuando se impulsó su aplicación por medio de catéteres. Desde entonces, la evolución de las técnicas y el continuo desarrollo de materiales han convertido esta terapia en una herramienta de utilidad excepcional en el control de la hemorragia y el tratamiento de diferentes neoplasias.

Embolotherapy, embolization or transcatheter embolization are names that today are assigned for the same procedure, known since the early twentieth century and that took force spreading from the beginning of the 1970s when its application was promoted through catheters. Since then the evolution of techniques and the continuous development of materials have made this technique an exceptional tool in the control of hemorrhage and treatment of different neoplasms.

Uso de complejo de protrombina ensangrado digestivo bajo en el paciente crítico anticoagulado. reporte de caso / Use of prothrombin complex concentrate in lower gastrointestinal bleeding in a critical anticoagulated patient. a case report

Se presenta el caso de un varón de 66 años en post-operatorio de cirugía de Bentall y reemplazo de válvula aórticapor prótesis metálica, anticoagulación con warfarina, que presenta un episodio de sangrado digestivo bajo secundarioa colitis isquémica localizada con INR elevado, sufriendo descompensación hemodinámica. Se realizó tratamientocon concentrado de protrombina humana con adecuada respuesta.

We present the case of a 60-year-old male patient anticoagulated with warfarin who presented with lowergastrointestinal bleeding and hemodynamic instability due to ischemic colitis with high INR after being surgicallyintervened with Bentall´s procedure and aortic valve replacement with a metallic prosthesis. Treatment withprothrombin complex concentrate was started with good response.

Multisource inverse-geometry CT. Part I. System concept and development.

PURPOSE: This paper presents an overview of multisource inverse-geometry computed tomography (IGCT) as well as the development of a gantry-based research prototype system. The development of the distributed x-ray source is covered in a companion paper [V. B. Neculaes et al., "Multisource inverse-geometry CT. Part II. X-ray source design and prototype," Med. Phys. 43, 4617-4627 (2016)]. While progress updates of this development have been presented at conferences and in journal papers, this paper is the first comprehensive overview of the multisource inverse-geometry CT concept and prototype. The authors also provide a review of all previous IGCT related publications. METHODS: The authors designed and implemented a gantry-based 32-source IGCT scanner with 22 cm field-of-view, 16 cm z-coverage, 1 s rotation time, 1.09 × 1.024 mm detector cell size, as low as 0.4 × 0.8 mm focal spot size and 80-140 kVp x-ray source voltage. The system is built using commercially available CT components and a custom made distributed x-ray source. The authors developed dedicated controls, calibrations, and reconstruction algorithms and evaluated the system performance using phantoms and small animals. RESULTS: The authors performed IGCT system experiments and demonstrated tube current up to 125 mA with up to 32 focal spots. The authors measured a spatial resolution of 13 lp/cm at 5% cutoff. The scatter-to-primary ratio is estimated 62% for a 32 cm water phantom at 140 kVp. The authors scanned several phantoms and small animals. The initial images have relatively high noise due to the low x-ray flux levels but minimal artifacts. CONCLUSIONS: IGCT has unique benefits in terms of dose-efficiency and cone-beam artifacts, but comes with challenges in terms of scattered radiation and x-ray flux limits. To the authors' knowledge, their prototype is the first gantry-based IGCT scanner. The authors summarized the design and implementation of the scanner and the authors presented results with phantoms and small animals.