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Pulmonary throughout vitro devices for the replacement of canine studies.
Overall, the authors suggest the development of a unit for EBP to deal with issues related to clinical practice guidelines. Conclusions Expected outcomes for the introduction of the EBP unit and its policy include increase research utilization and accelerated adoption of new evidence, increase the quality of care provided, increase patient, staff, and managers satisfaction, and decrease staff workload by reducing complications associated with medical errors and outdated interventions.Introduction The reaction between susceptible and infected subjects has been studied under the well-mixed hypothesis for almost a century. Here, we present a consistent analysis for a not well-mixed system using fractal kinetics' principles. Methods We analyzed COVID-19 data to get insights on the disease spreading in absence/presence of preventive measures. We derived a three-parameter model and show that the "fractal" exponent h of time larger than unity can capture the impact of preventive measures affecting population mobility. Results The h=1 case, which is a power of time model, accurately describes the situation without such measures in line with a herd immunity policy. The pandemic spread in four model countries (France, Greece, Italy and Spain) for the first 10 months has gone through four stages stages 1 and 3 with limited to no measures, stages 2 and 4 with varying lockdown conditions. For each stage and country two or three model parameters have been determined using appropriate fitting procedures. The fractal kinetics model was found to be more akin to real life. Conclusion Model predictions and their implications lead to the conclusion that the fractal kinetics model can be used as a prototype for the analysis of all contagious airborne pandemics.
Mesenchymal stem cell extracellular vesicles (MSC EVs) reverse pulmonary hypertension, but little information is available regarding what dose is effective and how often it needs to be given. This study examined the effects of dose reduction and use of longer dosing intervals and the effect of hypoxic stress of MSC prior to EV collection.

Adult male rats with pulmonary hypertension induced by Sugen 5416 and three weeks of hypoxia (SuHx-pulmonary hypertension) were injected with MSC EV or phosphate buffered saline the day of removal from hypoxia using one of the following protocols (1) Once daily for three days at doses of 0.2, 1, 5, 20, and 100 µg/kg, (2) Once weekly (100 µg/kg) for five weeks, (3) Once every other week (100 µg/kg) for 10 weeks, (4) Once daily (20 µg/kg) for three days using EV obtained from MSC exposed to 48 h of hypoxia (HxEV) or MSC kept in normoxic conditions (NxEV).

MSC EV reversed increases in right ventricular systolic pressure (RVSP), right ventricular to left ventricle + septumviously reported. Hypoxic stress does not enhance the efficacy of MSC EV at reversing pulmonary hypertension. These findings support the feasibility of MSC EV as a long-term treatment for pulmonary hypertension.Leiomyomas are benign mesenchymal tumors derived from smooth muscles. this website Uterus is the commonest site of origin for leiomyomas; however, unusual growth patterns and locations have been reported posing diagnostic challenges, clinically and radiologically. Histological diagnosis remains the gold standard of diagnosis. Here, we present a 17-year-old female with a 3-month history of chest pain, cough, difficulty in breathing and chest tightness. Chest CT scan showed a 12.3 cm × 14.4 cm × 22.8 cm mass occupying the entire left posterior hemithorax. The patient underwent thoracotomy and recovered well after surgery. Histopathology of the excised specimen confirmed it to be leiomyoma. Despite its rarity, primary mediastinal leiomyoma should be considered in the differential diagnosis of an unexplained mediastinal mass. Its accurate pre-operative diagnosis is difficult. Respiratory compromise and risk of transformation to sarcoma mandate complete surgical resection for a definitive diagnosis and good prognosis.Essential thrombocythemia (ET) is a rare myeloproliferative disorder characterized by pathologic expansion of the megakaryocytic elements in the bone marrow leading to persistent thrombocytosis and platelet dysfunction. The incidence of coronary artery disease can reach 9.4% and this is accompanied by high incidence of acute myocardial infractions. There are no clear guidelines for best management approach to these patients when cardiac surgery is planned. A case of ET required coronary artery bypass graft surgery for stent occlusion is presented with careful preoperative planning leading to full recovery with no complications.Myeloid sarcoma, and, with it, Acute Myeloid Leukaemia (AML), is a rare but important differential diagnosis in the consideration of unilateral nasal blockage. These lesions are often misdiagnosed as lymphoma or poorly differentiated carcinoma. We report the case of a patient with unilateral nasal blockage who underwent Endoscopic Sinus Surgery and biopsy. Histology revealed myeloid sarcoma and she was diagnosed with AML. Genetic testing could not be fully undertaken as the biopsy samples were preserved in formalin, which can degrade the quality of the DNA required for the more sensitive fms-like tyrosine kinase 3-internal tandem duplication (FLT3 ITD) test. Given that these levels have a significant impact on treatment decisions, a further biopsy, preserved in saline, was required. This case exemplifies the need for Ear, Nose and Throat clinicians to have a high index of suspicion for this lesion, and a working knowledge of the testing requirements for samples taken.Nutcracker syndrome can present with various disabling symptoms. To our knowledge, there are no reports that describe a robotic-assisted approach in its management. We present a patient who underwent robotic-assisted nephrectomy after the failure of conservative management of nutcracker syndrome and a second patient who underwent robotic-assisted nephrectomy with autotransplant. Surgery and immediate post-op courses were uncomplicated. Robotic-assisted nephrectomy with or without autotransplant can be a feasible, minimally invasive option for select patients with nutcracker syndrome.Ectopic thyroid tissue, 90% presenting in lingual zone, is often scanned by ultra-sonography or computed tomography. Most surgeons regard ectopic thyroid as metastatic foci from thyroid cancer, thus resection is recommended. Here, we reported a man with bilateral papillary thyroid cancer, accompany with normal ectopic thyroid tissue in right sternocleidomastoid muscle. In this case, we highlighted (i) It is rarely reported that ectopic normal thyroid tissue presented in sternocleidomastoid muscle. (ii) The ectopic thyroid tissue may not always be metastatic foci even though bilateral thyroid tumors were confirmed to be papillary cancer. (iii) Contrary to radical excision of all ectopic thyroid tissue, we advocate that only patients who need to receive the radioactive iodine therapy after total thyroidectomy should remove the ectopic normal thyroid tissue.With recent advances in the treatment of esophageal cancer and long-term survival after esophagectomy, the number of gastric tube cancer (GTC) has been increasing. Total gastric tube resection with lymph node dissection is considered to be a radical treatment, but it causes high post-operative morbidity and mortality. We report an elderly patient with co-morbidities who developed pyloric obstruction due to GTC after esophagectomy with retrosternal reconstruction. The patient was treated using distal partial gastric tube resection (PGTR) and Roux-en-Y reconstruction with preservation of the right gastroepiploic artery and right gastric artery. Intraoperative blood flow visualization using indocyanine green (ICG) fluorescence demonstrated an irregular demarcation line at the distal side of the preserved gastric tube, indicating a safe surgical margin to completely remove the ischemic area. PGTR with intraoperative ICG evaluation of blood supply in the preserved gastric tube is a safe and less-invasive surgical option in patients with poor physiological condition.Pelvic apophyseal avulsion fractures are uncommon injuries that typically occur in adolescents during sporting activities. Iliac crest (IC) apophyseal injuries represent a small percentage avulsion fracture around the pelvis with a reported incidence rate of 5%. We present a rare case of an adolescent boy who sustained a combined anterior superior iliac spine/iliac crest apophyseal avulsion fracture while playing football. With painful limited hip range of movement and inability to weight-bear, plain film and computed tomography scan illustrated a displaced fracture which was managed conservatively with an excellent clinical and radiological outcome. A review of apophyseal fractures around the pelvis, including incidence, mechanism of injury and treatment options regarding surgical versus conservative treatment, are discussed.Gastrointestinal stromal tumors (GISTs) can arise from any site of the gastrointestinal tract. These tumors are known to originate from the interstitial cells of Cajal, located in the gastrointestinal mesenchyme. In the case presented, a 37-year-old Caucasian male was admitted to our Surgery department with 2-month history of mild abdominal pain, early satiety and flatulence. The computed tomography revealed a huge mass in the left hepatic lobe consisting of both spindle and epithelial cells. Immunohistochemistry revealed strong CD117 positivity expression. Only a few other cases of liver GIST have been reported in the literature.Double aortic arch is the most common vascular ring anomaly. It usually presents with symptoms related to tracheal and oesophageal compression. The constricting vascular ring may lead to stridor in infants and young children, which could be mistaken for upper respiratory tract infections or foreign body aspiration. It is therefore prudent to have a high index of suspicion when evaluating cases of paediatric stridor. Contrast-enhanced computed tomography and cardiac magnetic resonance imaging are the diagnostic modalities of choice to investigate vascular rings. We report a case of a stridulous infant with a double aortic arch.Primary renal angiosarcoma (AS) encompasses only 1% of soft tissue sarcomas, and it is seldom seen in literature. Because of its rarity, few risk factors for its development have been established. Due to lack of screening guidelines for kidney cancer, it is often found late when patients become symptomatic. We present the case of a male patient who presented with gross hematuria and flank pain and was discovered to have a large renal mass. Following successful resection, pathology showed it to be AS. The patient had a post-operative course complicated by two separate COVID-19 infections and expired 200 days after surgery. This case not only highlights an extremely rare renal cancer but also illustrates the challenges patients with complex medical issues faced in the era of COVID-19.If multiple treatments are performed within a short time, when something occurs, it is difficult to identify its cause. Here, we present a case of thoracic endovascular aortic repair (TEVAR) for acute aortic dissection (AAD) after multiple treatments. A 76-year-old woman underwent minimally invasive aortic valve replacement, transcatheter lumbar artery embolism and retroperitoneal tumor resection within a short period of time. After a series of procedures, the patient experienced sudden back pain, and computed tomography revealed an AAD Type B. Her back pain persisted; therefore, we performed TEVAR, and the post-operative course was uneventful. In this case, the relationship between AAD and treatment before AAD was unclear, but AAD should considered when performing treatments that may cause AAD.
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