Case Report: Expanding the phenotypic spectrum of PURA syndrome in South America with the first presentation of concurrent vitiligo.

Purine-rich element-binding protein A (PURα) regulates multiple cellular processes. Rare de novo mutations can lead to PURA syndrome, which manifests as a range of multisystem disturbances, including hypotonia, global developmental delay, swallowing disorders, apnea, seizures, visual impairments, and congenital heart defects. We report the case of a Colombian girl with no relevant medical history who was diagnosed with PURA syndrome at the age of 7, due to a heterozygous mutation located at 5q31.2, specifically the variant c.697_699del (p.Phe233del), in exon 1 of the PURA gene. This represents the first documented case of PURA syndrome in South America and the first association of the syndrome with vitiligo, thereby expanding the known phenotypic spectrum. In addition to enriching the literature concerning the phenotypic diversity of PURA syndrome, this report highlights, for the first time, the diagnostic challenges faced by developing countries like Colombia in diagnosing high-burden rare diseases such as PURA syndrome.

Novel mechanisms of diversity generation in Acinetobacter baumannii resistance islands driven by Tn7-like elements.

Mobile genetic elements play an important role in the acquisition of antibiotic and biocide resistance, especially through the formation of resistance islands in bacterial chromosomes. We analyzed the contribution of Tn7-like transposons to island formation and diversification in the nosocomial pathogen Acinetobacter baumannii and identified four separate families that recognize different integration sites. One integration site is within the comM gene and coincides with the previously described Tn6022 elements suggested to account for the AbaR resistance island. We established Tn6022 in a heterologous E. coli host and confirmed basic features of transposition into the comM attachment site and the use of a novel transposition protein. By analyzing population features within Tn6022 elements we identified two potential novel transposon-encoded diversification mechanisms with this dynamic genetic island. The activities of these diversification features were confirmed in E. coli. One was a novel natural gain-of-activity allele that could function to broaden transposition targeting. The second was a transposon-encoded hybrid dif-like site that parasitizes the host dimer chromosome resolution system to function with its own tyrosine recombinase. This work establishes a highly active Tn7-like transposon that harnesses novel features allowing the spread and diversification of genetic islands in pathogenic bacteria.

A pilot study of volumetric and density tumor analysis of ACC patients treated with vorinostat in a phase II clinical trial.

Rationale and objectives: Adenoid cystic carcinoma (ACC) is a rare salivary gland cancer. The vast majority of clinical trials evaluating systemic therapy efficacy in solid tumors use the Response Evaluation Criteria in Solid Tumors (RECIST) to measure response that is limited to 2 dimensional only evaluations, not taking volume or density into account. The indolent behavior ACC represents a challenge toward an appropriate evaluation of therapy response. Objectives: 1) To describe and contrast volumetric and density changes at each time-point, including changes noted from baseline to best response, to currently used 2 dimensional-only criteria (RECIST) and 2) To report the coefficient of variation in volume measurement among three reviewers on a subset of ACC patients. Materials and methods: We retrospectively assessed a cohort of 18 prospectively treated patients with ACC in a phase 2 trial with vorinostat using a volumetric (viable tumor volume, VTV) and density criteria. Three independent and blinded observers segmented target lesions across a sample of randomly selected computed tomography (CT) exams to examine inter-observer variation. Results: We found that the average coefficient of variation among observers for all target lesions was 16.1%, with lung lesions displaying a smaller variation at 14.0% (p-value >0.17). We describe examples of decrease in volume and density in several lesions despite stable disease by RECIST. Conclusion: This pilot study demonstrates that two-dimensional criteria such as RECIST may not be the best criteria to assess response to therapy, especially with evolving tools within picture archiving and communication system (PACS) that can assess volumetric size, density and texture, however, this should be prospectively studied.

Case report: training neck and head control in children with chronic paralysis due to acute flaccid myelitis.

Background: Acute flaccid myelitis (AFM) occurs rarely in children and adolescents when damage to spinal motor neurons rapidly causes flaccid paralysis of limb, trunk, and neck muscles and potentially respiratory failure. When neck muscles are weakened or paralyzed, a child loses head control, severely compromising engagement with their environment. Compensation for lack of head control is achieved with external support devices attached to a wheelchair, but there is no indication in the AFM literature of therapeutic efforts to restore head control. In this case series, we explore the possibility of the recovery of head control when children with AFM received activity-based restorative therapies (ABRTs) guided by principles targeting motor control. Case description: Three children, two male and one female, aged 6, 9, and 7, with a history of AFM-onset at 5, 7, and 4 years respectively, enrolled in an activity-based restorative therapies outpatient program targeting activation of the neuromuscular system below the lesion. Each of them lacked head control, was either ventilator-dependent or had a tracheostomy, and was a power wheelchair user via hand/foot control. Methods: Activity-based restorative therapies were provided 5 days/week: 1.5 h of activity-based locomotor training and 1.5 h of activity-based neuromuscular electrical stimulation. Results: An approach to addressing head/neck control developed iteratively across disciplines, from complete compensation with passive external head support to emerging head control during diverse tasks, e.g., sitting, reaching, driving a power chair, sit-to-stand, standing, stepping on a treadmill, and walking. Key principles identified and employed were (a) passive facilitation, (b) external head support, (c) posterior head support, (d) graded manual facilitation, and (e) independent head control. Discussion: The recovery of head control in children with paralysis due to AFM may be accelerated when executing a step-wise progression to effectively target and challenge head control in parallel with activity-based restorative therapies. In treating three children with a chronic lack of head control, a therapeutic strategy was iteratively developed guided by scientific principles, e.g., segmental assessment of control, to promote recovery of head control. While this strategy is encouraging, gaps in sensitive and responsive measurement instruments and treatment technologies persist in guiding assistance, challenging, and promoting independent head control.

Activity-Based Restorative Therapy Promotes Progression from Asymmetry to Symmetry in Posture and Gait in a Child with Chronic, Incomplete Spinal Cord Injury.

Incomplete spinal cord injuries (ISCI) in pediatrics and adults can lead to asymmetric motor impairments exhibiting as asymmetries of posture and gait. Recently, rehabilitation guidelines for adults with neurologic injuries have focused on gaining a functional gait pattern as measured by speed and distance, even if asymmetry deficits persist. Activity-based restorative therapies (ABRT) take advantage of activity-dependent neuroplasticity to change an individual's neuromuscular capacity. This is a report of an ambulatory child with chronic ISCI presenting with significant postural and gait asymmetries who enrolled in an ABRT program. Across 79 ABRT sessions, the child gained symmetry during sitting, standing, and walking. Even though this child was a functional ambulator at enrollment, targeting symmetry of movements via improved neuromuscular capacity further enhanced her achievement of kinematically appropriate function for participation in daily activities.

Breast Cancer Tumor Board: A Radiologist's Guide to Postmastectomy Radiation Therapy.

Radiation therapy represents a pillar in the current management of breast cancer. Historically, postmastectomy radiation therapy (PMRT) has been administered only in patients with locally advanced disease and a poor prognosis. These included patients with large primary tumors at diagnosis and/or more than three metastatic axillary lymph nodes. However, during the past few decades, several factors have prompted a shift in perspective, and recommendations for PMRT have become more fluid. Guidelines for PMRT in the United States are outlined by the National Comprehensive Cancer Network and the American Society for Radiation Oncology. Because evidence to support performing PMRT is frequently discordant, the decision to offer radiation therapy often requires team discussion. These discussions are usually held in multidisciplinary tumor board meetings in which radiologists play a pivotal role by providing critical information such as the location and extent of disease. Breast reconstruction after mastectomy is optional and is safe in cases in which the patient's clinical status allows it. The preferred method in the setting of PMRT is autologous reconstruction. If this is not possible, then a two-step implant-based reconstruction is recommended. Radiation therapy does involve a risk of toxicity. Complications can be seen in acute and chronic settings and range from fluid collections and fractures to radiation-induced sarcomas. Radiologists have a key role in detecting these and other clinically relevant findings and should be prepared to recognize, interpret, and address them. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Eutanasia y estigma: ¿El derecho a la muerte digna es contrario a la ley universal? / Euthanasia and stigma: is the right to a dignified death contrary to universal law?

Resumen: La palabra eutanasia (del griego "eu" (bueno o feliz) y "thanatos" (muerte)( designa a un procedimiento cuestionado por múltiples grupos sociales y religiosos. Las personas que la practican, como sus familias, son estigmatizados por sus detractores. A pesar de que Colombia es uno de los pocos países que ha regulado esta práctica desde el 2015, incluso permitiéndola en menores, el proyecto de ley no ha pasado los debates en el Congreso, y los intentos de acceder a él se ven frustrados por trámites burocráticos (1). Este artículo de reflexión tiene como objetivo abordar el concepto de la eutanasia desde la filosofía, historia, medicina y la jurisprudencia.

Abstract: The word euthanasia (from the Greek "eu" (good or happy) and "thanatos" (death)) designates a procedure questioned by multiple social and religious groups. The people who practice it, like their families, are stigmatized by their detractors. Despite the fact that Colombia is one of the few countries that has regulated this practice since 2015, even allowing it in minors, the bill has not passed the debates in Congress, and attempts to access it are frustrated by procedures bureaucratic (1). This reflection article aims to address the concept of euthanasia from philosophy, history, medicine, and jurisprudence.

Relato de experiência multiprofissional com grupo de gestantes de alto-risco / Report on a multiprofessional experience with a group of high-risk pregnant women / Relato de experiencia multiprofesional con un grupo de gestantes de alto riesgo

Introdução: A gestação é um período onde as atitudes e escolhas da mãe irão refletir no crescimento e desenvolvimento do bebê, por isso as ações educativas e promocionais da saúde são fundamentais. Essas ações, desenvolvidas por uma equipe multiprofissional, são ainda mais eficientes, por ter uma diversidade maior de informações para a gestante. Objetivo: Descrever a experiência multiprofissional de ações de promoção da saúde com gestantes de alto risco e seus acompanhantes. Métodos: Trata-se de um relato de experiência que contempla encontros realizados semanalmente em um Hospital Universitário, no setor de alojamento conjunto, que comporta quatro leitos para gestantes de alto risco. Os momentos dialógicos ocorreram em rodas de conversa, com as gestantes e acompanhantes, discentes e docentes de fonoaudiologia e enfermeiros da equipe local. Foram desenvolvidos materiais informativos para os participantes e um pôster que permaneceu disponível ao público no setor. Resultados: Notou-se que os participantes se apresentaram receptivos e interessados nos assuntos da roda de conversa propostos, que foram gradativamente trabalhados, cada um contribuindo com suas vivências, bem como com suas dúvidas e questionamentos. Conclusão: O trabalho multiprofissional gerou reflexões sobre a amamentação e o sistema estomatognático, expandindo o diálogo sobre outros temas de abordagem fonoaudiológica. Ações promotoras da saúde podem empoderar os participantes para intervir como agentes na compreensão das necessidades de saúde, como o cuidado com o binômio mãe-bebê.

Introduction: The mother's attitudes and choices during pregnancy reflect on the baby's growth and development, which makes it essential to have educational and health promotion actions. When developed by a multiprofessional team, such actions are even more efficient, as they have a greater diversity of information for pregnant women. Objective: To describe the multiprofessional experience of health promotion actions with high-risk pregnant women and their companions. Methods: This is an experience report of meetings held weekly in the rooming-in ward of a university hospital, in which four beds are available to high-risk pregnant women. Conversation groups were organized with pregnant women and their companions, speech-language-hearing students and professors, and the hospital's nurses. Informational material was developed for the participants, as well as a poster exposed to the public in the rooming-in ward. Results: Participants were receptive to and interested in the conversation group topics, which were gradually developed as each one shared their experiences and questions. Conclusion: The multiprofessional work led to reflections on breastfeeding and the stomatognathic system, expanding the dialog about other speech-language-hearing topics. Health-promotion actions empower participants to actively contribute to their understanding of health needs, such as mother/baby care.

Introducción: El embarazo es un período en el que las actitudes y elecciones de la madre se reflejarán en el crecimiento y desarrollo del bebé, por lo que las acciones educativas y promocionales de la salud son fundamentales. Estas acciones, desarrolladas por un equipo multiprofesional, son aún más eficientes, ya que cuentan con una mayor diversidad de información para la gestante. Objetivo: Describir la experiencia multiprofesional de acciones de promoción de la salud con gestantes de alto riesgo y sus acompañantes. Métodos: Se trata de un relato de experiencia que incluye reuniones que se realizan semanalmente en un Hospital Universitario, en el sector de alojamiento conjunto, que comprende cuatro camas para gestantes de alto riesgo. Los momentos dialógicos se desarrollaron en círculos de conversación, con gestantes y acompañantes, estudiantes y profesores de logopedia y enfermeras del equipo. Se desarrollaron materiales informativos para los participantes y una pancarta que quedó a disposición del público del sector. Resultados: Se notó que los participantes se mostraron receptivos e interesados en los temas del círculo de conversación propuesto, los cuales se fueron trabajando paulatinamente, cada uno aportando con sus vivencias, así como con sus dudas y preguntas. Conclusión: El trabajo multiprofesional generó reflexiones sobre la lactancia materna y el sistema estomatognático, ampliando el diálogo sobre otros temas. Las acciones de promoción de la salud pueden empoderar a los participantes para que intervengan como agentes en la comprensión de las necesidades de salud, como el cuidado del binomio madre-bebé.

Spinal Cord Injury at Birth, Expected Medical and Health Complexity in Chronic Injury Guided Anew by Activity-Based Restorative Therapy: Case Report.

As infancy is characterized by rapid physical growth and critical periods of development, disruptions due to illness or disease reveal vulnerability associated with this period. Spinal cord injury (SCI) has devastating consequences at any age, but its onset neonatally, at birth, or within the first year of life multiplies its impact. The immediate physical and physiological consequences are obvious and immense, but the effects on the typical trajectory of development are profound. Activity-based restorative therapies (ABRT) capitalize on activity-dependent plasticity of the neuromuscular system below the lesion and when provided to children with SCI aim to improve the child's neuromuscular capacity, health and quality of life. This is a report of an infant with a cervical SCI at birth resulting in paralysis of leg and trunk muscles and paresis of arm and hands who was enrolled in an ABRT program at 3 years of age. After 59 sessions of ABRT, the child demonstrated significant improvements in trunk control and arm function, as well as social and emotional development. Despite the chronicity of injury and low expectations for improvement with therapeutic interventions, ABRT had a positive impact on the child's physical capacity and provided benefits across multiple developmental domains.

Rare cause of postoperative acute abdominal pain: Giant omental infarct later complicated by colonic fistulization.

Omental infarction is caused by vascular obstruction with resulting tissue ischemia, representing a rare cause of abdominal pain. It has been described as a rare complication of gastric bypass. It is important to recognize omental infarction and its possible complications as The management is usually conservative with surgery deferred to specific cases. We present the case of a 56-year-old male with a history of gastric adenocarcinoma who underwent esophagogastrectomy with Roux-n-y reconstruction and 3 months later presented with severe persistent abdominal pain, due to a path proven giant omental infarction. Patient later was complicated with a colonic fistula to the omentum.

Oligosecretory multiple myeloma: a devastating presentation of a difficult diagnosis.

A 57-year-old man with lumbar pain and fever was diagnosed with spondylodiscitis. Afterward, he acquired full paraplegia. Image studies showed a mass extending from D9 to the vertebral canal, plus numerous adjacent osteolytic lesions. Serum immunoelectrophoresis was normal, bone marrow had 0.5% of monoclonal plasmocytes, but D9's biopsy found a plasmacytoma. Despite bone marrow aspiration results, skeleton osteolytic lesions made multiple myeloma (MM) a more plausible diagnosis, later confirmed by the biopsy. The absence of classical MM findings, alongside a medullary compression syndrome, suggested an oligosecretory MM, which was proved by an altered FLC essay. This delayed diagnosis, with multiple diagnostic misguiding leads, also presents rare IgA and lambda chains production and normal levels of uninvolved immunoglobulins. Oligosecretory MM can lead to an inaccurate and delayed diagnosis, with devastating consequences to patient's morbidity and mortality. Therefore, FLC essay is essential in early assessment of potential MM patients.

Stress and its contribution to the development of depression symptoms are reduced in caregivers of elderly with higher educational level.

Caregivers of elderly people with neurodegenerative diseases are highly vulnerable to stressful situations and mood disorders due to their work conditions. Stress has been associated with an increased risk of developing depression, and studies have supported that caffeine consumption can act as an independent protective factor for disorder. This study investigated indexes of stress and depression symptoms in caregivers of the elderly with neurodegenerative diseases, their caffeine intake and the association between stress and depressive symptoms with the salivary biomarkers cortisol, nitric oxide and DNA damage. Participants (n = 81) were recruited from the community between July 2018 and April 2019. Stress was assessed using Lipp's Inventory of Stress Symptoms, and depressive symptoms were measured using the Hamilton Depressive Rating Scale. Participants provided a 72-hour recall of their diet to measure caffeine intake. Saliva samples were used to measure cortisol and nitric oxide. DNA damage was measured through micronuclei frequency after swabbing on the buccal mucosa. The majority of caregivers displayed stress and depressive symptoms. Stress was associated with educational level, tobacco use and total DNA damage. The indexes found in this population were not associated with caffeine intake or other salivary biomarkers, indicating that only some salivary molecules could be used as biomarkers for stress-related disorders. Caregivers of the elderly are exposed to stressful situations daily, however, we observed that educational level can reduce the psychological symptoms of stress and thus reduce the negative impact on quality of life.

100 Years of Scientific Evolution of Work and Organizational Psychology: A Bibliometric Network Analysis From 1919 to 2019.

In this study, we explore a 100 years of Work and Organizational Psychology (WOP). To do this, we carry out a bibliometric performance and network analysis (BPNA) to understand the evolution structure and the most important themes in the field of study. To perform the BNPA, 8,966 documents published since 1919 were exported from the Web of Science and Scopus databases. The SciMAT software was used to process data and to create the evolution structure, the strategic diagram, and the thematic network structure of the strategic themes of the field of WOP. We identified 29 strategic clusters and discuss the most important themes (motor themes) and their relationship with other clusters. This research presents the complete evolution of the field of study, identifying emerging themes and others with a high degree of development. We hope that this work will support researchers and future research in the field of WOP.

Augmented Radiologist Workflow Improves Report Value and Saves Time: A Potential Model for Implementation of Artificial Intelligence.

RATIONALE AND OBJECTIVES: Our primary aim was to improve radiology reports by increasing concordance of target lesion measurements with oncology records using radiology preprocessors (RP). Faster notification of incidental actionable findings to referring clinicians and clinical radiologist exam interpretation time savings with RPs quantifying tumor burden were also assessed. MATERIALS AND METHODS: In this prospective quality improvement initiative, RPs annotated lesions before radiologist interpretation of CT exams. Clinical radiologists then hyperlinked approved measurements into interactive reports during interpretations. RPs evaluated concordance with our tumor measurement radiologist, the determinant of tumor burden. Actionable finding detection and notification times were also deduced. Clinical radiologist interpretation times were calculated from established average CT chest, abdomen, and pelvis interpretation times. RESULTS: RPs assessed 1287 body CT exams with 812 follow-up CT chest, abdomen, and pelvis studies; 95 (11.7%) of which had 241 verified target lesions. There was improved concordance (67.8% vs. 22.5%) of target lesion measurements. RPs detected 93.1% incidental actionable findings with faster clinician notification by a median time of 1 hour (range: 15 minutes-16 hours). Radiologist exam interpretation times decreased by 37%. CONCLUSIONS: This workflow resulted in three-fold improved target lesion measurement concordance with oncology records, earlier detection and faster notification of incidental actionable findings to referring clinicians, and decreased exam interpretation times for clinical radiologists. These findings demonstrate potential roles for automation (such as AI) to improve report value, worklist prioritization, and patient care.

Os Efeitos do Climatério na Pressão Arterial Sistêmica / The Effects of Climacteric on Systemic Blood Pressure

Introdução: Nas mulheres, o surgimento do quadro hipertensivo comumente está associado à chegada do climatério, fase em que apresentam uma redução da produção de estrógeno e aumento dos níveis de andrógenos. Nesse período, existe uma associação linear entre o aumento do peso e o aumento da pressão arterial sistólica (PAS), além de alterações no perfil de lipoproteínas, que resultam em um maior e risco para doenças cardiovasculares.Objetivos: Avaliar a influência do climatério sobre o controle da pressão arterial em mulheres hipertensas. Métodos:Estudo prospectivo observacional do tipo caso controle realizado com 224 mulheres hipertensas atendidas na cidade de Barbacena-MG entre os meses de janeiro a dezembro de 2018.Foram realizadas aferição da PAS e diastólica (PAD), coleta de sangue venoso para dosagens bioquímicas, anamnese completa e avaliações antropométricas. Resultados: Com base nas informações sobre a menstruação e os valores dosados de hormônio folículo estimulante, as participantes foram divididas em três grupos: menacme, pré-menopausa e pós-menopausa. As mulheres mostraram apropriada adesão ao tratamento farmacológico, o que influenciou nos parâmetros pressóricos observados. As classes de anti-hipertensivos mais utilizadas foram os diuréticos e bloqueadores do receptor de angiotensina II, apresentando baixa frequência de efeitos colaterais. Não foram encontradas diferenças quanto a circunferência abdominal e o índice de massa corporal entre os três grupos. Por outro lado, a PAD mostrou-se reduzida no grupo pós-menopausa.Conclusão: As mulheres na pós-menopausa mantiveram os valores pressóricos dentro da faixa recomendada, destacando a importância da adesão adequada ao tratamento anti-hipertensivo nessa fase da vida. (AU)

Introduction: In women, the onset of hypertension is commonly associated with the climacteric, a phase in which they present a reduction in estrogen production and an increase in androgen levels. During this stage of life, there is a linear association between increased body weight and increased systolic blood pressure (SBP), in addition to changes in the lipoprotein profile, which result in greater risk for cardiovascular diseases. Objectives: To evaluate the influences of climacteric on blood pressure control in hypertensive women. Methods: A prospective observational case-control study was performed with 224 hypertensive women in the city of Barbacena-MG between January and December of 2018. A complete anamnesis was performed, women had their systolic (SBP) and diastolic blood pressure (DBP) measured and anthropometric assessments were realized. Blood sample was collected for biochemical dosages. Results: Based on information on menstruation and the level of follicle-stimulating hormone, participants were divided into three groups: menacme, premenopausal and postmenopausal. The women showed adequate adherence to the pharmacological treatment, influencing the pressure parameters evaluated. The most commonly used classes of antihypertensive agents were diuretics and angiotensin II receptor blockers, with a low frequency of side effects. No differences were found in waist circumference and body mass index between the three groups. Postmenopausal women had a higher cardiovascular risk despite reduced DBP. Conclusion: Postmenopausal women studied maintained their blood pressure values within the recommended range, emphasizing the importance of adequate adherence to the antihypertensive treatmentin this stage of life. (AU)

Postoperative results of 407 patients submitted to Doppler-guided transanal hemorrhoidal dearterialization / Resultados pós-operatórios de 407 doentes submetidos à desarterialização hemorroidária guiada pelo Doppler

ABSTRACT Introduction: The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective: To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods: This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results: The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion: The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.

RESUMO Introdução: O tratamento da doença hemorroidária pelas técnicas convencionais cursa com significante redução da qualidade de vida do doente, principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária associada à mucopexia retal é uma opção cirúrgica pouco invasiva, a qual é utilizada com o objetivo de tratar a doença hemorroidária e reduzir seus inconvenientes. Objetivo: Analisar os resultados encontrados após sete anos de seguimento em doentes submetidos à técnica da desarterialização hemorroidária associada à mucopexia para o tratamento da doença hemorroidária. Método: Foram estudados 407 portadores de doença hemorroidária de graus II, III e IV, submetidos à técnica da desarterialização hemorroidária no Hospital das Clínicas Luzia de Pinho Melo de Mogi das Cruzes, durante o período de Dezembro de 2010 a Dezembro de 2017. Vinte e sete doentes (6,6%) apresentavam doença hemorroidária de grau II, 240 (59,0%) do grau III e 117 (28,8%) do grau IV. Em 23 doentes (5,7%) não foram encontradas a classificação nos prontuários. Todos os doentes foram operados pelo mesmo cirurgião e sob anestesia raquidiana. Os 407 doentes foram submetidos à desarterialização, variando de um até seis ramos arteriais seguidos de mucopexia por sutura contínua. Oitenta e dois (20,14%) necessitaram ressecções associadas por plicomas ou hemorroidas externas. No pós-operatório foram avaliados os seguintes parâmetros: dor, tenesmo, sangramento, prolapso, trombose e recidiva. Resultados: O tenesmo foi a queixa pós-operatória referida por 93,36% dos doentes. Quarenta e três (10,5%) apresentaram tenesmo intenso e 44 (22%) de moderado a intenso. Quatro (0,98%) doentes apresentaram sangramento de maior intensidade no pós-operatório e em 1 (0,5%) houve necessidade de hemostasia cirúrgica, em nenhum deles houve necessidade de reposição sanguínea. O prolapso ocorreu em 18 (4,42%) doentes, trombose em 11 (2,7%) e houve 19 (4,67%) recidivas reoperados durante o período. Conclusão: A desarterialização hemorroidária apresenta bons resultados, complicações leves e de fácil resolução e pouca dor pós-operatória.

Fractional Anisotropy of Thalamic Nuclei Is Associated With Verticality Misperception After Extra-Thalamic Stroke.

Verticality misperception after stroke is a frequent neurological deficit that leads to postural imbalance and a higher risk of falls. The posterior thalamic nuclei are described to be involved with verticality perception, but it is unknown if extra-thalamic lesions can have the same effect via diaschisis and degeneration of thalamic nuclei. We investigated the relationship between thalamic fractional anisotropy (FA, a proxy of structural integrity), and verticality perception, in patients after stroke with diverse encephalic extra-thalamic lesions. We included 11 first time post-stroke patients with extra-thalamic primary lesions, and compared their region-based FA to a group of 25 age-matched healthy controls. For the patient sample, correlation and regression analyses evaluated the relationship between thalamic nuclei FA and error of postural vertical (PV) and haptic vertical (HV) in the roll (PVroll/HVroll) and pitch planes (PVpitch/HVpitch). Relative to controls, patients showed decreased FA of anterior, ventral anterior, ventral posterior lateral, dorsal, and pulvinar thalamic nuclei, despite the primary lesions being extra-thalamic. We found a significant correlation between HVroll, and FA in the anterior and dorsal nuclei, and PVroll with FA in the anterior nucleus. FA in the anterior, ventral anterior, ventral posterior lateral, dorsal and pulvinar nuclei predicted PV, and FA in the ventral anterior, ventral posterior lateral and dorsal nuclei predicted HV. While prior studies indicate that primary lesions of the thalamus can result in verticality misperception, here we present evidence supporting that secondary degeneration of thalamic nuclei via diaschisis can also be associated with verticality misperception after stroke.

Multimedia-enhanced Radiology Reports: Concept, Components, and Challenges.

Multimedia-enhanced radiology report (MERR) development is defined and described from an informatics perspective, in which the MERR is seen as a superior information-communicating entity. Recent technical advances, such as the hyperlinking of report text directly to annotated images, improve MERR information content and accessibility compared with text-only reports. The MERR is analyzed by its components, which include hypertext, tables, graphs, embedded images, and their interconnections. The authors highlight the advantages of each component for improving the radiologist's communication of report content information and the user's ability to extract information. Requirements for MERR implementation (eg, integration of picture archiving and communication systems, radiology information systems, and electronic medical record systems) and the authors' initial experiences and challenges in MERR implementation at the National Institutes of Health are reviewed. The transition to MERRs has provided advantages over use of traditional text-only radiology reports because of the capacity to include hyperlinked report text that directs clinicians to image annotations, images, tables, and graphs. A framework is provided for thinking about the MERR from the user's perspective. Additional applications of emerging technologies (eg, artificial intelligence and machine learning) are described in the crafting of what the authors believe is the radiology report of the future. ©RSNA, 2018.