Rosenbergcostello9371

By contrast, percutaneous mitral valve repair is still in its infancy and its results so far fall short of those of surgical repair. Nevertheless, continued investment in transcatheter procedures is of great importance to enable development and improved accessibility, particularly for patients who are considered unsuitable for surgery. In this review, we analyze the current status of management of degenerative mitral valve disease, discussing mitral valve anatomy and pathology, indications for intervention, and current surgical and transcatheter mitral valve procedures and results.

De-escalation of P2Y12 inhibitor may occur for various clinical reasons in patients with acute myocardial infarction (AMI). We aimed to assess the characteristics and outcomes of patients who underwent a de-escalation strategy in real-world clinical practice.

We studied 2604 AMI patients initially treated with prasugrel using the Japan Acute Myocardial Infarction Registry (JAMIR) database. Of these, 110 (4%) were discharged on clopidogrel [de-escalation group; switching 4 days after admission (median)] and the remaining 2494 continued prasugrel at discharge (continuation group). The de-escalation group had higher incidence of heart failure or history of cerebrovascular disease, and were more likely to receive mechanical circulatory support, and oral anticoagulation than the continuation group. selleck kinase inhibitor During mean follow-up of 309±133 days post-discharge, no significant differences were observed in ischemic events (2.2% vs. 2.8%, p=0.74) or major bleeding (1.1% vs. 1.6%, p=0.72) between the de-escalation and continuation groups.

Although, patients with de-escalation from prasugrel to clopidogrel had higher bleeding risk profile than those continued on prasugrel, post discharge ischemic and bleeding events were similar between patients with and without de-escalation. De-escalation strategy may be an option for AMI patients with high risk for bleeding.

Although, patients with de-escalation from prasugrel to clopidogrel had higher bleeding risk profile than those continued on prasugrel, post discharge ischemic and bleeding events were similar between patients with and without de-escalation. De-escalation strategy may be an option for AMI patients with high risk for bleeding.Blunt cerebrovascular injury is a very rare complication of blunt trauma and a diagnostic challenge. A 14 year old male fell 10 m sustaining multi system trauma. The atypical Glasgow Coma Score was six with a fully preserved eye component. Initial whole-body CT scanning demonstrated multiple injuries but no obvious brain injury. Trauma management involved non-operative resuscitation and was successful, however profound coma occurred and brain stem reflexes disappeared on day two. Repeat brain CT scan demonstrated multiple cerebral and cerebellar ischemic lesions and no opacification of the vertebral or basilar arteries. Secondary analysis of the first CT scan demonstrated a small focal basilar artery dissection not initially reported. Our case report highlights an unusual cause of coma after traumatic brain injury where the clinical scenario mimics locked in syndrome. In such circumstances cerebrovascular injury, and in particular traumatic basilar artery dissection, must be actively excluded.Foreign body ingestion is a common problem in children. Radiography is the mainstay of imaging, but many radiolucent items go undetected without further imaging by fluoroscopic esophagram. While studies in adults support the use of computed tomography (CT) for esophageal foreign body ingestion, CT has historically not been used in children given the typically higher radiation doses on CT compared with fluoroscopy. In distinction to an esophagram, CT does not require oral contrast nor presence of an onsite radiologist and can be interpreted remotely. At our institution, a dedicated CT protocol has been used for airway foreign bodies since 2015. Given the advantages of CT over esophagram, we retrospectively reviewed institutional radiation dose data from 2017 to 2020 for esophagrams, airway foreign body CT (FB-CT), and routine CT Chest to compare effective doses for each modality. For ages 1+ years, effective dose was lowest using the FB-CT protocol; esophagram mean dose showed the most variability, and was over double the dose of FB-CT for ages 5+ years. Routine CT chest doses were uniformly highest across all age ranges. Given these findings, we instituted a CT foreign body imaging protocol as the first-line imaging modality for radiolucent esophageal foreign body at our institution.

Patients may experience adverse health outcomes when they are unable to manage medical bills. It is currently unknown, however, whether patients talk about cost in the context of medical imaging services they received.

Retrospective qualitative analysis of twitter posts related to medical imaging and cost. Tweets were extracted from twitter, inclusion and exclusion criteria were applied, and tweets were categorized as either "positive" or "negative"; none were "neutral". A qualitative thematic analysis of all included tweets was performed to develop themes and topics expressed. A single tweet may have been assigned several different codes according to its content. A random sampling of the tweets from each topic were selected by the two reviewers, verified by the remaining reviewers, and quoted (Q).

Here, 9.8% (n = 99) of tweets relevant to medical imaging were included in the analysis. The majority had a negative sentiment (91%, n = 90) related to themes of (1) cost of care (47%, n = 42), (2) care delivery (23%, n = 21), (3) insurance Issues (23%, n = 21), and (4) need for information (7%, n = 6). A few positive tweets (9%, n = 9) were related to themes of (1) Gratitude (44%, n = 4), (2) Affordability (33%, n = 3), and (3) Better than expected (22%, n = 2).

Among tweets related to medical imaging we found that 10% relate to cost and that these are overwhelmingly negative, mostly due to perceived high cost of care, deficient care delivery, and insurance issues.

Among tweets related to medical imaging we found that 10% relate to cost and that these are overwhelmingly negative, mostly due to perceived high cost of care, deficient care delivery, and insurance issues.