Risk factors of distal segment aortic enlargement after complicated type B aortic dissection

Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a multivariate analysis was performed to find potential factors predictive of DSAE.Methods:A single-center retrospective study was performed from 1999 to 2016.Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears.Based on the diameter of the distal segment of the uncovered aorta,we assigned patients to an enlargement group and a non-enlargement group.Data extracted from the medical records included demographic and clinical characteristics and followup computed tomography angiography data.The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period.Results:For the 333 patients,all-cause mortality was 38(11.41%),and 76(22.82%)patients underwent reintervention.A total of 70(21.02%)patients experienced DSAE,among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention.Multivariate analysis reviewed independent risk factors of postoperative DSAE,including current smoking,the residual length of the patent false lumen,the postoperative number of dissection tears in the thoracic aorta and type III aortic arch;as well as protective factors,including the application of a restrictive bare stent(RBS),the length of covered stent in the descending thoracic aorta,and the distance from the residual first tear to the left subclavian artery(LSA).Conclusion:DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit,the residual length of patent false lumen,the postoperative number of dissection tears in the thoracic aorta and the aortic arch type.Meanwhile,RBS usage,the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.

Hematoma enlargement-related factors in hypertensive cerebral hemorrhage

BACKGROUND：Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE： To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING： A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology between April 2005 and February 2007. PARTICIPANTS： Fifty-eight males and thirty-one females aged （52.7 ± 5.23） years （range, 28-73 years）. METHODS： Cranial CT was performed twice to objectively identify hematoma enlargement. Patients with hematoma enlargement prior to surgery were selected as the observation group （n = 30）, and those with no obvious hematoma changes served as the control group （n = 60）. Following cranial CT localization, the two groups underwent minimally invasive hematoma aspiration and drainage, according to Standardized Treatment Guidelines for Micro-invasive Aspiration and Drainage of Intracranial Hematoma. MAIN OUTCOME MEASURES： Hemorrhage site, coagulation function, diabetes history, and clinical symptoms. RESULTS： There were no significant differences in hemorrhage sites between the two groups （χ2 = 2.262, P 〉 0.05）. The percent of intemperance patients in the observation group was significantly larger than the control group （χ2 = 6.923, P 〈 0.01）. No significant differences in terms of percent of coagulation dysfunction or diabetes were determined between the two groups （χ2 = 0.03, 0.08, P 〉 0.05）. The percent of patients with clinical deterioration was significantly higher in the observation group, compared to the control group （χ2 = 25.57, P 〈 0.01）. CONCLUSION： Intemperance and preoperative clinical deterioration may increase incidence of hematoma enlargement prior to minimally invasive surgery in patients with hypertensive cerebral hemorrhage.

Image of tumor metastasis and inflammatory lymph node enlargement by contrast-enhanced ultrasonography

AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induced lymph node metastasis was prepared by embedding a VX2 tumor into the hind paws of white rabbits.A model of inflammation-induced enlargement was prepared by injecting a suspension of Escherichia coli into separate hind paws of white rabbits.Then,a solution of SonazoidTM(GE Healthcare,Oslo,Norway)was injected subcutaneously in the proximity of the lesion followed by contrast-enhanced ultrasonography of the enlarged popliteal lymph nodes. RESULTS:In the contrast-enhanced ultrasonography of the tumor-induced metastasis model,the sentinel lymph node was imaged.An area of filling defect was observed in that enlarged lymph node.In the histology examination,the area of filling defect corresponded to the metastatic lesion of the tumor.Contrast-enhanced ultrasonography of the model on inflammation-induced lymph node enlargement,and that of the acute inflam-mation model performed 3-7 d later,revealed dense staining that was comparatively uniform.The pathological findings showed acute lymphadenitis mainly due to infiltration of inflammatory cells.Contrast-enhanced ultrasonography that was performed 28 d post-infection in the acute inflammation model showed speckled staining.Inflammation-induced cell infiltration and fiberization,which are findings of chronic lymphadenitis, were seen in the pathological findings. CONCLUSION:Sentinel lymph node imaging was made possible by subcutaneous injection of SonazoidTM.Contrast-enhanced ultrasonography was suggested to be useful in differentiating tumor-induced enlargement and inflammation-induced enlargement of lymph nodes.

AN ENLARGEMENT OF FILTRATION FOR BROWNIAN MOTION

Let Bt be an Ft Brownian motion and Gt be an enlargement of filtration of Ft from some Gaussian random variables. We obtain equations for ht such that Bt ht is a Gt-Brownian motion.

Ring Enlargement of Alkaloids

The procedure for the ring enlargement of N-heterocycles with the net result of CH2 insertion was successfully carried out with certain alkaloids such as tetrahydroberberine and strychnine.

Image Enlargement Via Local Matching

This paper gives a new algorithm to enlarge images based on local matching. Its main advantage is capable of preserving the edge of the enlarged image and improving both the subjective effect and the objective effect.

On the Method of Multiplier-enlargement and Approximation of Unbounded Continuous Functions

By combining the classical appropriate functions “1, x, x 2” with the method of multiplier enlargement, this paper establishes a theorem to approximate any unbounded continuous functions with modified positive linear operators. As an example, Hermite Fejér interpolation polynomial operators are analysed and studied, and a general conclusion is obtained.

Training of Multi-layered Neural Network for Data Enlargement Processing Using an Activity Function

In this paper, we present a study on activity functions for an MLNN (multi-layered neural network) and propose a suitable activity function for data enlargement processing. We have carefully studied the training performance of Sigmoid, ReLu, Leaky-ReLu and L & exp. activity functions for few inputs to multiple output training patterns. Our MLNNs model has L hidden layers with two or three inputs to four or six outputs data variations by BP (backpropagation) NN (neural network) training. We focused on the multi teacher training signals to investigate and evaluate the training performance in MLNNs to select the best and good activity function for data enlargement and hence could be applicable for image and signal processing (synaptic divergence) along with the proposed methods with convolution networks. We specifically used four activity functions from which we found out that L & exp. activity function can suite DENN (data enlargement neural network) training since it could give the highest percentage training abilities compared to the other activity functions of Sigmoid, ReLu and Leaky-ReLu during simulation and training of data in the network. And finally, we recommend L & exp. function to be good for MLNNs and may be applicable for signal processing of data and information enlargement because of its performance training characteristics with multiple teacher training patterns using original generated data and hence can be tried with CNN (convolution neural networks) of image processing.

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.

Post-gastrectomy spleen enlargement and esophageal varices: Distal vs total gastrectomy

AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-to-spleen diameter ratios were com-pared between the 2 groups. RESULTS: EVs were not detected during the first 6 mo after surgery in either group; however, at 12 mo after surgery, EVs were detected in 2 patients (3%) in the DG group and in 1 patient (3.6%) in the TG group; their mean platelet count-to-spleen diameter ratio was 2628 ± 409, and 2604 ± 360, respectively.CONCLUSION: Endoscopy should be performed to detect EVs when the platelet count-to-spleen diameter ratio is < 2600.

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients

BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.

Familial Atrial Enlargement,Conduction Disorder and Symmetric Cardiac Hypertrophy Are Early Signs of PRKAG2 R302Q

PRKAG2 cardiac syndrome(PS)is a rare inherited disease due to PRKAG2 gene mutation and characterized by Wolff-Parkinson-White syndrome(WPWs),conduction system lesions and myocardial hypertrophy.It can also lead to serious consequences,such as sudden death.But the genetic and clinical heterogeneity makes the early diagnosis of PS difficult.Here we studied a family with familial hypertrophic cardiomyopathy and other diverse manifestations.Gene analysis identified a missense mutation(Arg302Gln)in the five affected subjects of the family.The electrocardiograph performance of the five was composed of sinus bradycardia(SB),WPWs,right bundle branch block(RBBB),atrioventricular block(AVB),left bundle branch block(LBBB),supraventricular tachycardia(SVT)and atrial premature beat(APB).Among them,the youngest one began to show paroxysmal palpitation at the age of nine and was confirmed to have WPWs at 17 years old;two members progressed over time to serious conduction damage,and the proband received a pacemaker at the age of 27 due to AVB.Besides,according to cardiac magnetic resonance and echocardiography,the youngest one showed symmetric hypertrophy;three older members showed asymmetric myocardial hypertrophy characterized with a diffuse pattern of middle-anterior-lateral-inferior wall hypertrophy and especially interventricular septal hypertrophy;all five affected patients showed atrial enlargement regardless of myocardial hypertrophy at an earlier stage.In conclusion,the conduction system disorder,familial atrial enlargement and symmetric cardiac hypertrophy may occur in the early stage of PRKAG2 R302Q mutation.

Gingival enlargement induced by cyclosporine in Medullary aplasia:A case report

BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(GE)which compromises aesthetics,phonetics and chewing,and also predisposes patients to periodontitis.CASE SUMMARY This clinical case reports a 41-year-old woman who presented with cyclosporineinduced GE with underlying periodontitis and medullary aplasia.The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology.The diagnosis was confirmed through histopathological analysis.The treatment was carried out in phases:Initial(oral hygiene motivation,mechanical supragingival plaque control,and non-surgical therapy);systemic treatment,corrective treatment,and maintenance.CONCLUSION Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.

The Impact of the Morphologic Characteristics of Type B Aortic Dissection in the Acute Phase on the Aortic Enlargement in the Late Stage

Objectives: According to the International Registry of Acute Aortic Dissection, >70% of patients with type-B aortic dissection (AD) have delayed aortic growth. The objective of this study was to investigate the morphologic characteristics of aortic enlargement in type-B AD. Methods: A total of 120 patients with uncomplicated acute type-B aortic dissection (uATBAD) were divided into 4 groups according to the presence of a patent or thrombosed false lumen (FL) with or without aortic enlargement. In all groups, the area of the true lumen (TL) and the FL were measured on axial computed tomography images. Results: A total of 120 uATBAD patients were evaluated: patent FL with (PE, N = 28, 23%) or without aortic enlargement (PU, N = 17, 14%) and thrombosed FL with (TE, N = 34, 28%) or without enlargement (TU, N = 41, 34%). The initial aortic diameter was not significantly different among the 4 groups (PE vs. PU = 39 ± 8 vs. 37 ± 10 (p = 0.354);TE vs. TU = 38 ± 6 vs. 37 ± 6 (p = 0.391)). The area of the FL tended to be larger in the PE group. In contrast, the area of the TL was significantly larger in the TE group. Late outcomes of uATBAD treated with optimal medical treatment were acceptable. Conclusions: In patients with uATBAD and a thrombosed FL, the patients with aortic enlargement tended to be increased TL size. In contrast, in patients with a patent FL, the patients with aortic enlargement tended to be increased FL size.

Two cases of juvenile hypertrophic cardiomyopathy presenting with marked bi-atrial enlargement on standard 12-lead electrocardiogram

This report describes two cases of juvenile hypertrophic cardiomyopathy (HCM) in which prominent bi-atrial enlargement was observed on standard 12-lead electrocardiogram, suggesting inherent predis-position to extreme enlargement and/or hypertrophy may exist in atrial myocardium in juvenile HCM. Comparative study between juvenile and adult HCM patients using a large sample size is required to confirm this hypothesis.

Incidence of Malignancy in Asymmetrical Tonsillar Enlargement

Objective: To determine the incidence of carcinoma in patients with asymmetrical tonsillar enlargement. Study Design: A clinical retrospective case series based on medical records of our medical complex. Results: During a two-year period, 990 patients underwent tonsillectomy at Salmaniya Medical Complex (SMC). 59 (5.9%) of those patients had asymmetrical enlargement of their tonsils, three of whom had suspicious clinical findings at presentation. The latter were found to have tonsillar malignancy on histopathological testing. Malignancy was excluded in all other specimen. Conclusions: Since the incidence of malignancy in asymmetrical tonsils is negligible in the absence of other associated risk factors, watchful waiting may be appropriate prior to any surgical intervention. Diagnostic tonsillectomy is indicated in patients with asymmetrical tonsillar enlargement with associated suspicious clinical findings, including cervical lymphadenopathy and rapid tonsillar enlargement.

Evaluation of the Influence of Fixed Orthodontic Treatment Duration on the Severity of Inflammatory Gingival Enlargement (Fixed Orthodontic Induced Gingival Enlargements) and Some Properties of Saliva

Background: Inflammatory gingival enlargement is a more common clinical feature with orthodontic therapy than other features. Therefore, this study was designed to the evaluation of the influence of fixed orthodontic treatment duration on the severity of inflammatory gingival enlargement (fixed orthodontic induced gingival enlargements) and some properties of saliva. Material and Methods: The sample size comprised 145 patients undergoing fixed orthodontic treatment for at least 6 months aged 13 - 32 years. They were divided according to orthodontic treatment duration into three groups. Group I (n = 47) included the patients who were treated for less than 6 months, group II (n = 51) included the patients who were treated for a period of 6 - 12 months, and group III (n = 47) included the patients who were managed for more than 12 months. Data were obtained from the outpatient clinics, college of dentistry, King Khalid University, Abha, Saudi Arabia, and some dental centers in Sana’a city, the Republic of Yemen. This study was conducted from October 2021 G to January 2022 G. Clinical examination was done for plaque index (PLI), gingival index (GI), and gingival enlargement indexes (GEI). Saliva was collected in sterile test tubes then salivary flow and pH were measured. Statistical analysis was done with SPSS (version 23) and ANOVA test to evaluate the impact of orthodontic treatment duration on the severity of inflammatory gingival enlargement and some properties of saliva. Results: The statistical analysis demonstrated the highest mean plaque index (PLI) was among groups III and I participants whereas, the highest mean gingival index and mean gingival enlargement were among groups II and III participants. The present study revealed an increase in salivary flow with decreased salivary pH values with an increase in orthodontic therapy duration. There were statistically significant differences in clinical findings and salivary flow and pH values were observed in the comparison between groups I, II and III except PLI (p Conclusion: There was a higher inflammatory gingival enlargement associated with a higher plaque index in patients under orthodontic treatment for more than 12 months more than the patients for less than 6 months and the patients for a period of 6 - 12 months. There were correlations between an increase of salivary flow and pH values and an increase of other variables in this study, such as plaque index, gingival index, and gingival enlargement index with an increased orthodontic therapy duration.

Benign Prostatic Enlargement, the International Prostate Symptoms Score and a Review of Other Symptom Scores

Benign prostatic hyperplasia (BPH) is the most common benign prostate disease in elderly men, and its incidence increases with age and is associated with lower urinary tract symptoms (LUTS). The international prostate symptoms score (IPSS) is the most common symptom score used to assess LUTS even though other symptom scores exist. This study aims to evaluate the LUTS of patients secondary to BPH presenting to the urology clinic of UPTH using the IPSS and to review other scoring systems. Materials and Methods: This was a prospective hospital based descriptive cross-sectional study carried out in University of Port Harcourt Teaching Hospital (UPTH). All adult male patients with LUTS secondary to BPE were given an IPSS questionnaire to fill. Another IPSS questionnaire was filled by the patient assisted by the researcher. The data were collated using Microsoft Excel 2016 version and they were analyzed using SPSS version 20. Results were presented in tables. Results: Sixty-nine (69%) patients had at least secondary level of education. Sixty-four (64%) could complete their questionnaire without any aid. The mean IPSS was 22.13 ± 6.34 as most patients presented with severe symptoms. The mean Quality of Life score was 4.60 ± 1.38. There was a significant positive correlation between Quality of Life and IPSS. Conclusion: A level of literacy is needed to complete the questionnaire. Most patients in our study presented late with severe symptoms and significant level of bother. Nocturia was the worst symptom.

Relationship between enlargement of traumatic intracerebral hematoma and irregular rate of hematoma morphous

To study the relationship between incidence and time course of traumatic intracerebral hematoma enlargement and that between hematoma irregular rate (IR) and hematoma enlargement after brain injury.Methods After brain injury,164 cases with traumatic supratentorial intracerebral hematoma were examined by cranial CT scan within 72 hours thereafter reexamined 120 hours there after so as to compare the hematoma volumes (V1 and V2) and analyze the relation between hematoma IR and hematoma enlargement.Results After brain injury,enlargement of hematoma was confirmed in 70 cases (42.7%),in which the cutpoint for hematoma enlargement was determined as V2/V1=1.45 by using receiver operating characteristic curves (ROC).Hematoma IR had positive correlation with hematoma enlargement (r=0.857,P<0.01).Conclusion Since the incidence of traumatic hematoma enlargement is high,we can tell the possibility of hematoma enlargement based on hematoma IR in order to make a timely reexamination of CT scan and apply active treatments.7 refs,1 tab.