Notes

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To compare the radiation dose, diagnostic accuracy, and the resultant ablation procedures using 80 and 120-kVp cardiac computed tomography angiography (CCTA) protocols with the same contrast-to-noise ratio in patients scheduled for atrial fibrillation (AF) ablation.

This retrospective study was performed following institutional review board approval. We divided 140 consecutive patients who had undergone CCTA using a 64-MDCT scanner into two equal groups. Standard deviation (SD) of the CT number was set at 25 Hounsfield units (HU) for the 120-kVp protocol. To facilitate a reduction in radiation dose it was set at 40 HU for the 80kVp protocol. We compared the two protocols with respect to the radiation dose, the diagnostic accuracy for detecting left atrial appendage (LAA) thrombi, matching for surface registration, and the resultant ablation procedures.

At 120kVp, the dose length product (DLP) was 2.2 times that at 80kVp (1269.0 vs 559.0mGycm, p<0.01). The diagnostic accuracy for thrombus detection was 100% using both protocols. There was no difference between the two protocols with respect to matching for surface registration. The protocols did not differ with respect to the subsequent time required for the ablation procedures and the ablation fluoroscopy time, and the radiation dose (p=0.54, 0.33, and 0.32, respectively).

For the same CNR, the DLP at 80kVp (559.0mGycm) was 56% of that delivered at 120kVp (1269.0mGycm). There was no reduction in diagnostic accuracy.

Maintaining CNR allows for a reduction in the radiation dose without reducing the image quality.
Maintaining CNR allows for a reduction in the radiation dose without reducing the image quality.
The aim is to review the status of diagnostic imaging training in the English-speaking Caribbean region and to identify gaps, and opportunities for growth.

Currently, there are only three training programmes within the English-speaking Caribbean that offer a Bachelor of Science degree in Diagnostic Imaging (DI) (Radiography). Despite the demand for DI services related to the growing prevalence of chronic non-communicable diseases and an ageing Caribbean population, access to such services is very limited. buy Eflornithine While there is a gap to be closed in terms of training numbers it is clear that there is also a need to develop a wider range of competencies in other modalities beyond conventional X-ray.

The English-speaking Caribbean is relatively underserved in terms of access to diagnostic imaging services. Current training programmes are limited in scope and enrolment. There is a need to address the training gaps within the region, as this is a significant opportunity for growth in this area of health professions education.

While there is a clear rationale to support expanding and diversifying training, there is still relatively low investment in DI training. The way ahead for the Caribbean must be through enforcement of legislation, strong leadership and advocacy for training initiatives and partnership between educators and service providers.
While there is a clear rationale to support expanding and diversifying training, there is still relatively low investment in DI training. The way ahead for the Caribbean must be through enforcement of legislation, strong leadership and advocacy for training initiatives and partnership between educators and service providers.
It is claimed that a hydrophilic primer, called the moisture insensitive primer (MIP), can be used with both dry and wet enamel surfaces. This study sought to assess the shear bond strength (SBS) of APC Plus adhesive coated appliance system to enamel using MIP in wet and dry conditions.

This in vitro experimental study evaluated 24 extracted maxillary premolars with intact buccal enamel. The teeth were randomly divided into two groups (n=12), and APC Plus premolar brackets were bonded to their buccal surface using moisture insensitive primer (MIP) under wet and dry enamel conditions. The SBS values were measured by a universal testing machine. The adhesive remnant index (ARI) score was also determined under a stereomicroscope. Data were analyzed using t-test and Mann-Whitney test at P<0.05 level of significance.

The SBS in wet condition was significantly lower than that in dry condition (mean value of 18.37MPa versus 25.5MPa, P<0.001). The two groups had no significant difference regarding the ARI scores (P>0.05). However, in both groups, less adhesive was left on the tooth surface. This suggests that bond failure occurred at the adhesive-enamel interface.

APC Plus adhesive coated appliance system in combination with hydrophilic MIP can be effective in clinical conditions with high risk of moisture contamination.
APC Plus adhesive coated appliance system in combination with hydrophilic MIP can be effective in clinical conditions with high risk of moisture contamination.
The objective of the present study, which was conducted in patients undergoing transcatheter aortic valve replacement, was to compare continuous noninvasive arterial pressure measured with the ClearSight device (Edwards Lifesciences, Irvine, CA) with invasive radial artery pressure used as the reference method. The authors hypothesized that the ClearSight device is an accurate, precise, safe, and efficient method for arterial blood pressure measurement comparable with an invasive radial arterial line.

The study included the retrospective review of 20 consecutive patients scheduled for elective transcatheter aortic valve replacement with the SAPIEN 3 transcatheter heart valve (Edwards Lifesciences) at a single tertiary academic hospital, who underwent monitoring with both the ClearSight device and an invasive radial arterial pressure line. The patients underwent transcatheter aortic valve replacement from October to December 2019.

Single tertiary academic medical center.

The study comprised 20 patientsentage bias = 0.4%, and mean error = 18.3%. The concordance rates of systolic blood pressure, diastolic blood pressure, and mean arterial pressure were 100%, 95.1%, and 98.8%, respectively.

The accuracy, agreement, and precision of the ClearSight device were convincing for mean arterial pressure, systolic blood pressure, and diastolic blood pressure for patients with severe aortic stenosis undergoing elective transcatheter aortic valve replacement.
The accuracy, agreement, and precision of the ClearSight device were convincing for mean arterial pressure, systolic blood pressure, and diastolic blood pressure for patients with severe aortic stenosis undergoing elective transcatheter aortic valve replacement.
To evaluate the association of intraoperative urinary biomarker excretion during cardiac surgery and the subsequent development of acute kidney injury (AKI).

Prospective, nonrandomized, observational study.

Single tertiary-level, university-affiliated hospital.

Ninety patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

None.

Urinary samples were collected every 30 minutes intraoperatively and then at four, 12, and 24 hours after CPB. Samples were measured for interleukin 18 (IL-18), kidney injury molecule-1 (KIM1), and creatinine concentrations. Urinary biomarker excretion (raw and indexed to creatinine) for four intraoperative and three postoperative points were compared between patients with and those without subsequent AKI defined by increased serum creatinine concentration ≥0.3 mg/dL within the first 48 hours or ≥1.5 times baseline within seven days. Raw and indexed median IL-18 values were similar between AKI groups at all intraoperative points, but became significantly different at 12 hours after CPB. Raw and indexed median KIM1 values were significantly different between AKI groups at multiple intraoperative points and at four and 12 hours after CPB. During intraoperative and postoperative points, patients in the fourth quartile of KIM1 excretion had greater AKI incidence and longer intensive care and hospital lengths of stay than those in the first quartile. Only postoperatively did the differences in these outcomes between the fourth and first quartile of IL-18 excretion occur.

Intraoperative KIM1 but not IL-18 excretion was associated with postoperative development of AKI.
Intraoperative KIM1 but not IL-18 excretion was associated with postoperative development of AKI.Acute aortic dissection is a rare but catastrophic condition. When the dissection extends through the adventitia, blood can extravasate into the extrapleural or intrapleural spaces, causing an extrapleural hematoma or hemothorax. The early recognition of extrapleural hematoma and distinguishing it from hemothorax is critical because the management of those two entities is different. The authors present a case of a late diagnosis of a large extrapleural hematoma in a patient with Stanford type B acute aortic dissection that required thoracotomy for hematoma evacuation. The patient underwent successful thoracic endovascular aortic repair (TEVAR). Postoperatively, the patient had worsening pulmonary function, with a large fluid collection on imaging that was not drained by the thoracostomy tubes. Surgical exploration revealed a large extrapleural hematoma. Timely recognition of the extrapleural hematoma was key in the patient's clinical management. Without clear radiographic diagnostic features of extrapleural hematoma, unsuccessful drainage of hematoma after insertion of a chest tube may suggest an extrapleural hematoma or a clotted hemothorax. If patients continue to have circulatory or respiratory compromises, prompt surgical exploration should be considered. It is important for clinicians to be aware of extrapleural hematoma in complicated acute aortic dissection, especially when chest tube drainage of an apparent hemothorax is unsuccessful.
The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program developed and manages a framework for identification, replication, and diffusion of promising practices throughout the nation's largest integrated health care system. DoE identifies promising practices through a "Shark Tank" competition with winning bidders receiving external implementation facilitation. DoE further supports diffusion of successful practices across the VHA.

This article presents results of a mixed methods implementation evaluation of DoE, focusing on program reach, program participation and decisions to adopt innovative practices, implementation processes, and practice sustainment. Data sources include practice adoption metrics, focus groups with bidders (two focus groups), observations of DoE events (seven events), surveys of stakeholders (five separate surveys), and semistructured interviews of facility directors, practice developers, implementation teams, and facilitators (133 participants).

In the first fcandidate practices, promoted adoption of promising practices by facility directors, and supported practice implementation and diffusion across the VHA.
Does an association exist between ovarian reserve, ovarian response and embryonic euploidy in female patients under age 35 years?

This was a retrospective analysis of intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidies cycles among patients enrolled at Bahceci Fulya IVF Center between January 2016 and August 2019. A total of 133 patients in POSEIDON group 1 (suboptimal responder; female age <35 years, antral follicle count [AFC] ≥5, number of oocytes retrieved <10) (group A), 133 patients in POSEIDON group 3 (expected low responder; female age <35 years, AFC <5) (group B) and 323 in the non-low-prognosis group (female age <35 years, AFC ≥5 and number of oocytes retrieved >9) (group C) were included.

There was no significant difference in euploidy rate per embryo among the three groups (61.7% [145/235] for group A versus 53.5% [68/127] for group B versus 62% [625/1008] for group C; P = 0.13). The cancellation rate in cycles without a euploid blastocyst was significantly lower in group C than groups A and B (8.
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