ß

For the first time, the (d,^{2}He) reaction was successfully used in inverse kinematics to extract the Gamow-Teller transition strength in the ß^{+} direction from an unstable nucleus. The new technique was made possible by the use of an active-target time-projection chamber and a magnetic spectrometer, and opens a path to addressing a range of scientific challenges, including in astrophysics and neutrino physics. In this Letter, the nucleus studied was ^{14}O, and the Gamow-Teller transition strength to ^{14}N was extracted up to an excitation energy of 22 MeV. The data were compared to shell-model and state-of-the-art coupled-cluster calculations. Shell-model calculations reproduce the measured Gamow-Teller strength distribution up to about 15 MeV reasonably well, after the application of a phenomenological quenching factor. In a significant step forward to better understand this quenching, the coupled-cluster calculation reproduces the full strength distribution well without such quenching, owing to the large model space, the inclusion of strong correlations, and the coupling of the weak interaction to two nucleons through two-body currents.

Beam particle identification and tagging of incompletely stripped heavy beams with HEIST.

A challenge preventing successful inverse kinematics measurements with heavy nuclei that are not fully stripped is identifying and tagging the beam particles. For this purpose, the HEavy ISotope Tagger (HEIST) has been developed. HEIST utilizes two micro-channel plate timing detectors to measure the time-of-flight, a multi-sampling ion chamber to measure energy loss, and a high-purity germanium detector to identify isomer decays and calibrate the isotope identification system. HEIST has successfully identified 198Pb and other nearby nuclei at energies of about 75 MeV/A. In the experiment discussed, a typical cut containing 89% of all 198Pb80+ in the beam had a purity of 86%. We examine the issues of charge state contamination. The observed charge state populations of these ions are presented and, using an adjusted beam energy, are well described by the charge state model GLOBAL.

Mastitis granulomatosa: desafío diagnóstico y terapéutico en paciente joven / Granulomatous mastitis: A diagnostic and therapeutic challenge in young people

La mastitis granulomatosa idiopática es una rara enfermedad que afecta sobre todo a mujeres jóvenes. Supone un importante desafío diagnóstico y terapéutico al presentarse en ocasiones como una lesión mamaria indicativa de malignidad. No se conoce su etiología ni existen pruebas de imagen que permitan diagnosticar con certeza la enfermedad, requiriendo de un estudio anatomopatológico para confirmar el diagnóstico. El tratamiento puede ir desde la mera observación, pasando por la toma prolongada de corticosteroides orales, hasta la cirugía. Dado que esta dolencia es infrecuente en la práctica clínica, no existen protocolos unificados acerca del mejor tratamiento y seguimiento de las pacientes. Presentamos un caso de mastitis granulomatosa idiopática diagnosticado en nuestro centro, así como el tratamiento propuesto y el seguimiento realizado. Por último, revisamos la literatura existente en relación con esta infrecuente entidad.

Granulomatous mastitis is an uncommon disease that primarily affects young women. It represents a diagnostic and therapeutic challenge, as it might be confused with breast carcinoma. There are no mammographic or ultrasonographic findings that correlate imaging features with histological results. Therapeutic management of this disease can range from simple observation to long-term corticosteroid treatment or surgery. Because granulomatous mastitis is infrequent in clinical practice, there are no standardised protocols regarding the best treatment and follow-up for these patients. We present the case of a women diagnosed in our department, and her treatment and follow-up. We also selectively examine the available literature to support our case.

First Direct Measurement of

Type-I x-ray bursts can reveal the properties of an accreting neutron star system when compared with astrophysics model calculations. However, model results are sensitive to a handful of uncertain nuclear reaction rates, such as ^{22}Mg(α,p). We report the first direct measurement of ^{22}Mg(α,p), performed with the Active Target Time Projection Chamber. The corresponding astrophysical reaction rate is orders of magnitude larger than determined from a previous indirect measurement in a broad temperature range. Our new measurement suggests a less-compact neutron star in the source GS1826-24.

Teratoma gigante asintomático en gestante. Anexectomía unilateral laparotómica en segundo trimestre de embarazo y parto eutócico a término. Revisión de la literatura / Asymptomatic giant teratoma in a pregnant woman. Unilateral laparotomic adnexectomy in the second trimester of pregnancy, and full-term eutocic delivery. Literature review

Los embarazos cursan simultáneamente con una masa anexial de forma inusual; y cuando lo hacen, son en su mayoría de manera asintomática. En casi el 25% identificaremos un teratoma quístico maduro. Tanto el diagnóstico, como el seguimiento y tratamiento de dichas tumoraciones pueden dificultarse en esta etapa y la valoración de los pros y contras para optar por un tratamiento quirúrgico durante la gestación suponen un dilema importante. Entre las características a valorar está el tamaño de la tumoración. Cuando dichas masas son mayores de 10 cm, a pesar de tener características ecográficas benignas, pueden estar enmascarando una neoplasia en uno de cada 10 casos; lo que haría considerar el tratamiento quirúrgico durante la gestación; y en estas ocasiones se opta con frecuencia por realizar un abordaje laparotómico para evitar, en la medida de lo posible, la rotura de dichas tumoraciones gigantes. Presentamos el caso de una paciente gestante asintomática a la que se le diagnostica un quiste anexial gigante. Tras su estudio, se realiza una laparotomía exploradora en semana 16 de embarazo completando la anexectomía unilateral, con el diagnóstico definitivo de un teratoma quístico maduro. La recuperación posterior y la finalización a término de una gestación normoevolutiva se completa con éxito. Se hace una revisión del diagnóstico, seguimiento y abordaje quirúrgico de las masas anexiales encontradas durante la gestación

It is rare for pregnancies to occur simultaneously with an adnexal mass, and when they do, they are mostly asymptomatic. In almost 25%, it is identified as a mature cystic teratoma. Both the diagnosis, monitoring, and treatment of these diseases can be difficult at this stage, and the assessment of the pros and cons for surgical treatment during pregnancy, which can lead to controversy, is a major problem. Among the characteristics to be assessed is the size of the tumour. When these masses are larger than 10 cm, despite having benign ultrasound characteristics, they may be masking a neoplasm in 1 out of 10 cases. In which case, surgical treatment would be considered during the pregnancy and a laparoscopy approach is often carried out to avoid, as far as possible, the rupture of these giant tumour masses. The case is presented of an asymptomatic pregnant patient who is diagnosed with an adnexal giant cyst. After the work-up study, an exploratory laparotomy was performed in the 16th week of pregnancy, with a unilateral adnexectomy being performed, with the definitive diagnosis of a mature cystic teratoma. The subsequent recovery and the conclusion to full-term using standardised management was completed successfully. A review is presented on the diagnosis, follow-up and surgical approach of adnexal masses during pregnancy

Erratum: Direct Observation of Proton Emission in

This corrects the article DOI: 10.1103/PhysRevLett.123.082501.

Herniación de intestino delgado a través de defecto en el ligamento ancho de origen idiopático en paciente sin antecedentes quirúrgicos / Herniation of the small intestine through a defect in the broad ligament of idiopathic origin in a patient without surgical history

Las hernias intestinales a través de defectos en el ligamento ancho son un cuadro clínico poco frecuente y de difícil diagnóstico. La sospecha diagnóstica y el tratamiento precoz de esta entidad son de vital importancia. Su etiología está ampliamente relacionada con intervenciones quirúrgicas previas y traumatismos asociados a gestaciones y partos previos. Tanto la clínica como las determinaciones analíticas asociadas a esta patología son inespecíficas; siendo la tomografía axial computarizada la prueba de imagen complementaria de elección para el diagnóstico y valoración de la viabilidad de los órganos afectados herniados. Históricamente la resolución de las hernias se asociaba al abordaje laparotómico. Hoy en día sabemos que las vías de abordaje mínimamente invasivas, como la laparoscópica, son factibles, y deben ser la primera elección, pudiendo además aportar beneficios en términos de recuperación y postoperatorio favorable. Presentamos el caso clínico de una hernia interna de intestino delgado a través de un defecto del ligamento ancho izquierdo, en una paciente sin antecedentes quirúrgicos ni traumáticos previos, cuyo diagnóstico y resolución requirió de la realización de una laparotomía exploradora

Intestinal hernias through the broad ligament are a rare entity and difficult to diagnose. The diagnostic suspicion and early treatment are of vital importance. Its aetiology is widely associated with previous surgical interventions and trauma associated with previous pregnancies and deliveries. Both the clinical and the analytical tests associated with this entity are non-specific. Computed axial tomography is the complementary imaging test of choice for the diagnosis and assessment of the viability of the organs involved in the hernia. Historically, the resolution of hernias was associated with the laparotomy approach. Nowadays, it is known that the use of the minimum invasion by laparoscopy is feasible, and should be of first choice, and may also provide benefits in recovery and a more favourable post-operative period. A clinical case is presented of an internal hernia of the small intestine, through a defect of the left broad ligament, in a patient with no prior surgical or traumatic history, in which the diagnosis and resolution of the condition involved the performing of an exploratory laparotomy

Direct Observation of Proton Emission in

The elusive ß^{-}p^{+} decay was observed in ^{11}Be by directly measuring the emitted protons and their energy distribution for the first time with the prototype Active Target Time Projection Chamber in an experiment performed at ISAC-TRIUMF. The measured ß^{-}p^{+} branching ratio is orders of magnitude larger than any previous theoretical model predicted. This can be explained by the presence of a narrow resonance in ^{11}B above the proton separation energy.

Comparativa entre 2 técnicas de insuflación laparoscópica cerrada con aguja de Veress. Estudio prospectivo multicéntrico de 300 casos / Comparison between 2 closed laparoscopic insufflation techniques using a Veress needle. Multicentre prospective study of 300 cases

Objetivo: Verificar que la técnica de acceso laparoscópico tras insuflación con aguja de Veress en punto de Palmer a presiones elevadas no produce efectos adversos anestésicos relevantes en pacientes sanas y que, además, es útil para la reducción del riesgo de lesiones mayores, comparada con la técnica clásica de insuflación umbilical a presiones estándar. Material y métodos: Estudio analítico observacional prospectivo de cohortes. La cohorte expuesta al factor estudiado la conforman 150 pacientes intervenidas mediante cirugías laparoscópicas ginecológicas en las que se ha utilizado, para las maniobras de acceso a cavidad abdominal, la insuflación con aguja de Veress en punto de Palmer hasta presiones elevadas de 20-25mmHg (grupo 1). La cohorte no expuesta la conforman 150 pacientes en las que se ha utilizado, para las maniobras de acceso a cavidad abdominal, la técnica clásica de insuflación con aguja de Veress a nivel umbilical hasta presiones estándar de 12-14mmHg (grupo 2). Resultados: En el grupo 1 el porcentaje de complicaciones fue del 5,3%, mientras que en el grupo 2 fue del 6,7% (p=0,62). Por otro lado, el porcentaje de cambios de técnica/localización de acceso y de conversión a laparotomía secundaria a efectos adversos durante las maniobras de insuflación/entrada fue del 2% y del 0% en el grupo 1, y del 2,7% y del 2% en el grupo 2, respectivamente. Conclusión: La insuflación en punto de Palmer a presiones elevadas presenta ventajas comparada con la técnica umbilical clásica respecto a la prevención de complicaciones durante las maniobras de acceso laparoscópico

Objective: To demonstrate that the laparoscopic access technique at Palmer's point at elevated pressures does not cause significant anaesthetic adverse effects in healthy patients, and is also useful for reducing the risk of major injuries compared to the classic umbilical insufflation technique at standard pressures. Material and methods: Prospective observational analytical study of cohorts. The cohort exposed to the studied factor consisted of 150 patients undergoing gynaecological laparoscopic surgery in which insufflation with Veress needle in Palmeŕs point until high pressures of 20-25mmHg (Group 1) has been used for access manoeuvres into the abdominal cavity. The unexposed cohort consisted of 150 patients in whom the classical technique of insufflation has been used for access manoeuvres to the abdominal cavity, with the needle at umbilical level up to standard pressures of 12-14mmHg (Group 2). Results: The percentage of complications in Group 1 was 5.3%, whereas it was 6.7% in Group 2 (p=0.62). On the other hand, the percentage of technique changes/access location and conversion to laparotomy due to adverse effects during insufflation/entry manoeuvres was 2% and 0% in Group 1, and 2.7% and 2% in Group 2, respectively. Conclusion: Palmer's point insufflation at elevated pressures has advantages compared to the classical umbilical technique, as regards the prevention of complications during laparoscopic access manoeuvres

Chronic inflammation: A key role in degeneration of bicuspid aortic valve.

INTRODUCTION: Bicuspid aortic valve (BAV) is the most common congenital valvular heart defect resulting from abnormal aortic cusp formation during heart development, where two of the three normal and equal sized cusps fuse into a single large cusp resulting in a two cusps aortic valve. Over the past years, much interest has been given in understanding the pathogenesis of BAV and its complications. In this review, we focused on the role of inflammation, involved in the degeneration of BAV and the development of its complications. ROLE OF INFLAMMATION: From a pathophysiological point of view, BAV may rapidly progress into aortic stenosis (AS) and is related to aortopathy. Several histopathologic studies have demonstrated that the development and progression of alterations in bicuspid aortic valve are related to an active process that includes: oxidative stress, shear stress, endothelial dysfunction, disorganized tissue architecture, inflammatory cells and cytokines. These factors are closely related one to each other, constituting the basis of the structural and functional alterations of the BAV. CONCLUSION: Chronic inflammation plays a key role in the degeneration of BAV. Severe aortic stenosis in bicuspid aortic valves is associated with a more aggressive inflammatory process, increased inflammatory cells infiltration and neovascularization when compared to tricuspid AS. These findings might help to explain the more frequent onset and rapid progression of AS and the heavy aortic valve calcification seen in patients with BAV.

Strong Neutron Pairing in core+4n Nuclei.

The emission of neutron pairs from the neutron-rich N=12 isotones ^{18}C and ^{20}O has been studied by high-energy nucleon knockout from ^{19}N and ^{21}O secondary beams, populating unbound states of the two isotones up to 15 MeV above their two-neutron emission thresholds. The analysis of triple fragment-n-n correlations shows that the decay ^{19}N(-1p)^{18}C^{*}→^{16}C+n+n is clearly dominated by direct pair emission. The two-neutron correlation strength, the largest ever observed, suggests the predominance of a ^{14}C core surrounded by four valence neutrons arranged in strongly correlated pairs. On the other hand, a significant competition of a sequential branch is found in the decay ^{21}O(-1n)^{20}O^{*}→^{18}O+n+n, attributed to its formation through the knockout of a deeply bound neutron that breaks the ^{16}O core and reduces the number of pairs.

Quasifree (p, 2p) Reactions on Oxygen Isotopes: Observation of Isospin Independence of the Reduced Single-Particle Strength.

Quasifree one-proton knockout reactions have been employed in inverse kinematics for a systematic study of the structure of stable and exotic oxygen isotopes at the R^{3}B/LAND setup with incident beam energies in the range of 300-450 MeV/u. The oxygen isotopic chain offers a large variation of separation energies that allows for a quantitative understanding of single-particle strength with changing isospin asymmetry. Quasifree knockout reactions provide a complementary approach to intermediate-energy one-nucleon removal reactions. Inclusive cross sections for quasifree knockout reactions of the type ^{A}O(p,2p)^{A-1}N have been determined and compared to calculations based on the eikonal reaction theory. The reduction factors for the single-particle strength with respect to the independent-particle model were obtained and compared to state-of-the-art ab initio predictions. The results do not show any significant dependence on proton-neutron asymmetry.

Efficacy of a high quality O1/Campos foot-and-mouth disease vaccine upon challenge with a heterologous Korean O Mya98 lineage virus in pigs.

In 2010 serotype O foot-and-mouth disease virus of the Mya98 lineage/SEA topotype spread into most East Asian countries. During 2010-2011 it was responsible for major outbreaks in the Republic of Korea where a monovalent O/Manisa vaccine (belonging to the ME-SA topotype) was applied to help control the outbreaks. Subsequently, all susceptible animals were vaccinated every 6 months with a vaccine containing the O/Manisa antigen. Despite vaccination, the disease re-occurred in 2014 and afterwards almost annually. This study focuses on the in vivo efficacy in pigs of a high quality monovalent commercial O1/Campos vaccine against heterologous challenge with a representative 2015 isolate from the Jincheon Province of the Republic of Korea. Initially, viral characterizations and r1 determinations were performed on six viruses recovered in that region during 2014-2015, centering on their relationship with the well characterized and widely available O1/Campos vaccine strain. Genetic and antigenic analysis indicated a close similarity among 2014-2015 Korean isolates and with the previous 2010 virus, with distinct differences with the O1/Campos strain. Virus neutralisation tests using O1/Campos cattle and pig post vaccination sera and recent Korean outbreak viruses predicted acceptable cross-protection after a single vaccination, as indicated by r1 values, and in pigs, by expectancy of protection. In agreement with the in vitro estimates, in vivo challenge with a selected field isolate indicated that O1/Campos primo vaccinated pigs were protected, resulting in a PD50 value of nearly 10. The results indicated that good quality oil vaccines containing the O1/Campos strain can successfully be used against isolates belonging to the O Mya98/SEA topotype.

Estruma ovárico maligno con foco de carcinoma papilar / Malignant struma with ovarian carcinoma papillary spotlight

Resumen ANTECEDENTES: El estruma ovárico es una variedad infrecuente de teratoma quístico. CASO CLÍNICO: Paciente de 42 años de edad en quien durante una revisión ginecológica rutinaria se evidenció, por ecografía, un quiste anexial derecho complejo, bilobulado, de 10 cm compuesto por dos formaciones heterogéneas independientes, una de aspecto uniforme ecorrefringente de 52.6 mm y otra ecorrefringencia alternante de 36.7 mm. Se categorizó como teratoma quístico, lo que se confirmó por resonancia magnética nuclear. Se efectuó anexectomía derecha laparoscópica. El estudio anatomopatológico confirmó el diagnóstico microscópico de teratoma quístico maduro, que incluía a la tiroides (menos de 50% de todo el tumor), con un carcinoma papilar de patrón folicular (estruma ovárico). La cirugía ginecológica se complementó con histerectomía total, omentectomía, lavado peritoneal e inspección de la cavidad abdominal por vía laparotómica; se descartó la neoplasia residual. El estudio endocrinológico evidenció la normalidad de la tiroides y el diagnóstico ecográfico de un nódulo; posteriormente se confirmó que se trataba de hiperplasia benigna. Los marcadores tumorales tiroideos fueron negativos y, a pesar de ello, el comité de cáncer de tiroides acordó que se efectuara la tiroidectomía total y luego se indicara tratamiento con iodo radiactivo, sin evidenciar elementos neoplásicos malignos ni ganglios linfáticos afectados. CONCLUSIONES: Debido a la baja incidencia del estruma ovárico su tratamiento comprende a la cirugía ovárica y la tiroidectomía, y al yodo radioactivo en el caso de las variedades malignas; todo esto en un contexto de controversia consecuencia de la poca experiencia acumulada.

Abstract BACKGROUND: Struma ovarii represents a rare form of ovarial quistic teratom that contains thiroid tissue and affects mostly women between 40 and 60 years of age. Its diagnosis is based on the definitive pathological study of the piece, due to the fact that these kind of tumors lack any specific clinic and diagnostic features. CLINICAL CASE: 42 year old patient, in which during a routine gynecological examination a bilobed complex right adnexal cyst of 10 cm composed of two independent heterogeneous formations (a uniform appearance ecorrefringente of 52.6mm and one alternate ecorrefrigencia of 36.7 mm) is evidenced by ultrasound. It is categorized as cystic teratoma and confirmed by nuclear magnetic resonance. Adnexectomy is performed laparoscopically. The pathological study confirmed the microscopic diagnosis of mature cystic teratoma including thyroid tissue (less than 50% of the tumor) with papillary carcinoma follicular pattern: Struma Ovarii. Gynecological surgery was completed with a total hysterectomy, omentectomy, washing and inspection peritoneal abdominal cavity by laparotomy discarding residual neoplasia. Endocrinological study showed normal thyroid function and ultrasound diagnosis of a nodule: benign hyperplasia was confirmed later. Thyroid tumor markers were negative and despite this, the thyroid cancer committee agreed to perform a total thyroidectomy and a treatment with radioiodine, without evidence of malignant neoplastic elements and affected lymph nodes. CONCLUSIONS: Its treatment is still controversial due to its low incidence, and includes not only ovarial surgery but also thyroidectomy and radioactive iodine therapy in the event of a malignant tumor.

Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. METHODS: The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. RESULTS: At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p < 0.01) and higher decrease of pain intensity at 3 month follow-up (p < 0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes. CONCLUSIONS: Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity. SIGNIFICANCE: The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome.

Antigenic and immunogenic spectrum of foot-and-mouth disease vaccine strain O1 Campos against representative viruses of topotypes that circulated in Asia over the past decade.

Identifying vaccine strains to control outbreaks of foot-and-mouth disease virus that could spread to new regions is essential for contingency plans. This is the first report on the antigenic/immunogenic relationships of the South American O1/Campos vaccine strain with representative isolates of the three currently active Asian type O topotypes. Virus neutralization tests using O1/Campos post-vaccination sera derived from cattle and pigs predicted for both species acceptable cross-protection, even after single vaccination, established by r1 values and by expectancy of protection using monovalent or polyvalent vaccines. The results indicate that effective oil vaccines containing the O1/Campos strain can be used against Asian isolates, expanding the scope of O1/Campos strain included in vaccine banks to control emergencies caused by Asian viruses, even on single-dose vaccination, and to cover the need of effective vaccines in Asia during systematic vaccination.

Tromboembolismo pulmonar bilateral masivo puerperal, secundario a trombosis venosa profunda intraparto. A propósito de un caso / Postpartum massive bilateral pulmonary thromboembolism secondary to deep intrapartum venous thrombosis. A case report

Resumen ANTECEDENTES: la enfermedad tromboembólica es un cuadro clínico que puede manifestarse durante el embarazo, como un episodio aislado de trombosis venosa profunda en los miembros inferiores, o como tromboembolismo pulmonar. La prevalencia se considera baja: 1 caso por cada 1600 embarazos. El solapamiento de los síntomas de la enfermedad tromboembólica con el embarazo puede retrasar la sospecha clínica y complicar el establecimiento del diagnóstico. CASO CLÍNICO: paciente primigesta, de 37 años de edad, con un episodio de tromboembolismo pulmonar con inicio en el puerperio, asociado con trombosis venosa profunda intraparto como factor desencadenante que evolucionó favorablemente gracias al diagnóstico y tratamiento oportunos. CONCLUSIÓN: la importancia de este caso radica en la necesidad de actuar con rapidez para establecer el diagnóstico e indicar inmediatamente el tratamiento.

Abstract BACKGROUND: Venous thromboembolism (VTE) is a combination of pathologies, which can manifest during pregnancy as an isolated lower extremity deep vein thrombosis (DVT) or as a pulmonary embolus (PE). The global prevalence is low, which occurs in 1 to 1600 pregnancies. CLINICAL CASE: A 37-year-old primigravid patient with an episode of pulmonary thromboembolism with onset in the puerperium associated with intrapartum deep venous thrombosis as a triggering factor that evolved favorably due to timely diagnosis and treatment. CONCLUSION: The importance of this case lies in the need to act quickly to establish the diagnosis and immediately indicate the treatment.

Quantitative criteria for the diagnosis of the congenital absence of pericardium by cardiac magnetic resonance.

BACKGROUND: Congenital absence of the left ventricular pericardium (LCAP) is a rare and poorly known cardiac malformation. Cardiac Magnetic Resonance (CMR) is generally used for the diagnosis of LCAP because of its high soft tissue contrast, multiplanarity and cine capability, but the diagnosis is usually made by only qualitative criteria. The aim of the present study was to establish quantitative criteria for the accurate diagnosis of LCAP on CMR. METHODS: We enrolled nine consecutive patients affected by LCAP (mean age 26±8years, 7 males), 13 healthy controls, 13 patients with dilated cardiomyopathy (DCM), 12 patients with hypertrophic cardiomyopathy (HCM) and 13 patients with right ventricular overload (RVO). All patients underwent CMR. The whole-heart volume was measured in end-systole and end-diastole. Whole-heart volume change (WHVC), was the systo-diastolic change of volume, expressed percentage of the end-diastolic volume. The angle of clockwise-rotation of the heart was also measured in the end-diastolic phase of the axial cine stack. RESULTS: The WHVC was significantly higher in LCAP (21.9±5.4), compared to healthy subjects (8.6±2.4, p<0.001), DCM (7.1±1.8, p<0.001), HCM (9.3±2.4, p<0.001) and RVO (8±2.4, p<0.001). The clockwise-rotation was significantly higher in LCAP (76±14°) than healthy controls (40±11°, p<0.001), DCM (41±5°, p<0.001), HCM (30±6°, p<0.001) and RVO (49±8°, p<0.001). WHVC had the highest sensitivity (100%) and specificity (100%) for diagnosing LCAP, using a threshold of >13%. CONCLUSIONS: In LCAP the systo-diastolic WHVC was significantly higher than controls, DCM, HCM and RVO patients and resulted an optimal quantitative criteria for the diagnosis of LCAP.

Selective pacing sites.

he right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All these long-term changes could account for the higher morbidity and mortality rates observe in patients with chronic RVA pacing compared with atrial pacing. This observation led to the reassessment of traditional approaches and to the research of alternative pacing sites, in order to get to more physiological pattern of ventricular activation and to avoid deleterious effects. Then, attempts were made with: right ventricular outflow tract (RVOT) pacing, direct His bundle pacing (DHBP), parahisian pacing (PHP) and bifocal (RVA + RVOT) pacing. For example, RVOT pacing, especially in its septal portion, is superior to the RVA pacing and it would determine a contraction pattern very similar to the spontaneous one, not only because the septal portions are the first parts to became depolarized, but also for the proximity to the normal conduction system. RVOT is preferable in terms of safety too. DHBP is an attractive alternative to RVA pacing because it leads to a synchronous depolarization of myocardial cells and, therefore, to an efficient ventricular contraction. So it would be the best technique, however the procedure requires longer average implant times and dedicated instruments and it cannot be carried out in patients affected by His bundle pathologies; furthermore, due to the His bundle fibrous area, higher pacing thresholds are required, causing accelerated battery depletion. For all these reasons, PHP could be considered an important alternative to DHBP, to be used on a large scale. Finally, bifocal pacing in CRT candidates, provides better acute hemodynamic performance than RVA pacing, derived from a minor intra- and interventricular dyssynchrony, expressed also by the QRS shortening. Then, bifocal pacing could be taken into account when RVA pacing is likely to be the origin of serious mechanical and electrical dyssynchrony or when CRT is contraindicated or technically impossible. So, whatever chosen as selective pacing site, you must look also at safety, effectiveness and necessary equipment for an optimal pacing site.

Silicon-nanowire based attachment of silicon chips for mouse embryo labelling.

The adhesion of small silicon chips to cells has many potential applications as direct interconnection of the cells to the external world can be accomplished. Hence, although some typical applications of silicon nanowires integrated into microsystems are focused on achieving a cell-on-a-chip strategy, we are interested in obtaining chip-on-a-cell systems. This paper reports the design, technological development and characterization of polysilicon barcodes featuring silicon nanowires as nanoscale attachment to identify and track living mouse embryos during their in vitro development. The chips are attached to the outer surface of the Zona Pellucida, the cover that surrounds oocytes and embryos, to avoid the direct contact between the chip and the embryo cell membrane. Two attachment methodologies, rolling and pushpin, which allow two entirely different levels of applied forces to attach the chips to living embryos, are evaluated. The former consists of rolling the mouse embryos over one barcode with the silicon nanowires facing upwards, while in the latter, the barcode is pushed against the embryo with a micropipette. The effect on in vitro embryo development and the retention rate related to the calculated applied forces are stated. Field emission scanning electron microscopy inspection, which allowed high-resolution imaging, also confirms the physical attachment of the nanowires with some of them piercing or wrapped by the Zona Pellucida and revealed extraordinary bent silicon nanowires.