Sweeneyseerup5695

Individuals with type 2 diabetes (T2DM) are at high risk for nonalcoholic fatty liver disease (NAFLD), and evidence suggests that poor glycemic control is linked to heightened risk of progressive NAFLD. We conducted an observational study based on data from a telehealth trial conducted in 2018-2020. Our objectives were to (1) characterize patterns of NAFLD testing/care in a cohort of individuals with poorly controlled T2DM; and (2) explore how laboratory based measures of NAFLD (eg, liver enzymes, fibrosis-4 [FIB-4]) vary by glycemic control. We included individuals with poorly controlled T2DM (n = 228), defined as hemoglobin A1c (HbA1c) ≥ 8.5% despite clinic-based care. Two groups of interest were (1) T2DM without known NAFLD; and (2) T2DM with known NAFLD. Demographics, medical history, medication use, glycemic control (HbA1c), and NAFLD testing/care patterns were obtained by chart review. Among those without known NAFLD (n = 213), most were male (78.4%) and self-identified as Black race (68.5%). Mean HbA1c was 9.8%. Most had liver enzymes (85.4%) and platelets (84.5%) ordered in the outpatient department over a 2-year period that would allow for FIB-4 calculation, yet only 2 individuals had FIB-4 documented in clinical notes. Approximately one-third had abnormal liver enzymes at least once over a 2-year period, yet only 7% had undergone liver ultrasound and 4.7% had referral to hepatology. Among those with known NAFLD (n = 15), mean HbA1c was 9.5%. Only 4 individuals had undergone transient elastography, half of whom had advanced fibrosis. NAFLD is underrecognized in poorly controlled T2DM, even though this is a high-risk group for NAFLD and its complications.The assessment and identification of risk/vulnerable groups and risk factors are vital elements that can help quantify the pandemic potential of the SARS-CoV-2 virus in order to plan prevention and treatment measures. The aim of the study is to identify a methodological approach of population vulnerability to the SARS-CoV-2 virus infection. The study identifies reliable data sources and sets up a unitary database with statistical variables, quantitative and qualitative indicators with potential for being updated and improved. The analysis takes into account a number of variables/indicators (e.g., elderly persons, population without physician care, number of people suffering from cardiovascular diseases, number of people suffering from respiratory diseases, dwellings not connected to the public water supply network, no. of medical staff, number of COVID-19 hospitals, PCR testing laboratories, number of vaccinated persons) grouped into the key vulnerability components exposure, sensitivity, coping capacity and adaptive capacity. They allowed the computation of the final Index of Population Vulnerability to the SARS-CoV-2 virus infection and the mapping of different dimensions of vulnerability. The study was performed using the statistical data available at NUTS3/County level provided by different institutions (e.g., the Ministry of Health, the National Institute of Public Health, the Strategic Communication Group, and the National Institute of Statistics). The mapping of the different degrees of vulnerability could solve a problem of visibility for possible areas with vulnerable population, but also a problem of communication between different institutional health and administrative levels, as well as between all of them and the local communities and/or professionals.Quantitative characterization of the pore structure and gas seepage characteristics of loaded coal is of great significance to the study of high-efficiency gas drainage in coal seams. Aiming at the problem of imperfect characterizations of coal seepage characteristics based on nuclear magnetic resonance (NMR), a calculation method for the pore permeability of coal with different pore diameters is proposed. The pore structure and seepage characteristics of coal have been quantitatively studied using a nuclear magnetic resonance (NMR) system. The results show that with increasing external load, the proportion of the pore volume of the coal sample in the range of 0.01-0.52 μm gradually decreases, while that in the range of 5.11-352.97 μm increases. In this process, the porosity increases from 0.9967 to 1.0103%, the connectivity increases from 0.1718 to 0.2391, and the permeability increases from 2.64 × 10-6 to 8.20 × 10-6 μm2. click here The calculation of the coal sample connectivity and permeability using the improved NMR permeability component proves that 94.37-352.97 μm pores are the main channel of fluid flow. When the axial pressure increases, the coal body permeability in the aperture range of 94.37-352.97 μm rapidly increases. The improved permeability component calculation model can better reflect the variation law of pore permeability of the loaded coal body.Extracorporeal membrane oxygenation (ECMO) has diverse applications. In the present report, we have described a case of tracheomalacia from a thoracic aortic aneurysm causing respiratory failure. Total arch replacement with reverse frozen elephant trunk grafting was performed. Perioperative ECMO support was accomplished with venopulmonary artery ECMO. This strategy allowed for preoperative oxygenation support, venous drainage during cardiopulmonary bypass, and postoperative support without cannula exchanges. Our patient required ECMO support for 12 days postoperatively. We have illustrated a unique case of acquired tracheomalacia but also an ECMO cannulation strategy allowing for preoperative oxygenation, seamless transition to cardiopulmonary bypass, and postoperative support.A young man had presented to the clinic with unilateral leg swelling with concerns for deep vein thrombosis. Imaging studies revealed external compression of the left common femoral vein due to enlarged lymph nodes and a cystic structure in the left groin. He underwent surgical exploration with resection of multiple compressive lymph nodes but continued to remain symptomatic. He underwent reexploration of his groin to remove a cystic structure posterior to the vein, with complete resolution of his symptoms. The enlarged lymph nodes were reactive, and the cyst was consistent with a synovial cyst on pathologic examination. Complete resection is warranted when exploring the causes of external venous compression.Disseminated intravascular coagulation (DIC) is a rare complication of endovascular aortic repair, commonly associated with type I or type III endoleaks. DIC is also known as consumption coagulopathy because excessive thrombin formation and secondary fibrinolysis leads to consumption of coagulation factors with hyperfibrinolysis and activation of platelets, which can lead to excessive bleeding. We present the case of an 80-year-old woman who had undergone thoracic endovascular aortic repair for a type B aortic dissection that was complicated by a series of recurrent endoleak-induced DICs requiring multiple thoracic endovascular aortic repair extensions to cover the entire thoracoabdominal aorta. The DIC persisted despite the resolution of the endoleaks.Despite recent advancements in endovascular technology and the proven durability of open surgery, extensive thoracoabdominal aortoiliac occlusive disease (AIOD) remains challenging to treat. In the present report, we have described the case of a 58-year-old woman with AIOD and multiple medical comorbidities. She successfully underwent a novel intraoperative transesophageal echocardiography-guided combined treatment with concurrent descending thoracic aorta to bilateral femoral artery bypass and thoracic endovascular aortic repair. We have shown that this approach, which combines descending thoracic aorta to bilateral femoral artery bypass with thoracic endovascular aortic repair, is an effective treatment alternative for future cases of complex AIOD.Intravascular leiomyomatosis is a rare entity defined by benign smooth uterine muscle cells that typically originate from the uterus with the potential to spread into veins possibly up to the heart. The diagnosis for patients presenting with cardiac symptoms may be difficult and imaging often interpreted as thrombus or atrial myxoma.Vascular Ehlers-Danlos syndrome is caused by mutations in the COL3A1 (collagen type III alpha-1) gene, resulting in loss of integrity of arteries and hollow organs. Patients are predisposed to dissection, aneurysm, and organ rupture. The median life expectancy is ∼51 years. We have described a unique presentation of spontaneous compartment syndrome, likely secondary to ischemia reperfusion injury, in a 32-year-old man with vascular Ehlers-Danlos syndrome. The compartment syndrome was treated with four-compartment fasciotomy, and subsequent evaluation demonstrated a pseudoaneurysm of the tibioperoneal trunk. Endovascular intervention and stent graft deployment guided by intravascular ultrasound successfully excluded the pseudoaneurysm with three vessel run off preserved.Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.The association between thrombogenicity and coronary microvascular dysfunction (CMD) has been poorly explored in patients with acute myocardial infarction (AMI). In our real-world clinical practice (N = 116), thrombogenicity was evaluated with thromboelastography and conventional hemostatic measures, and CMD was defined as index of microcirculatory resistance of >40 U using the invasive physiologic test. High platelet-fibrin clot strength (P-FCS) (≥68 mm) significantly increased the risk of postprocedural CMD (odds ratio 4.35; 95% CI 1.74-10.89). Patients with both CMD and high P-FCS had a higher rate of ischemic events compared to non-CMD subjects with low P-FCS (odds ratio 5.58; 95% CI 1.31-23.68). This study showed a close association between heightened thrombogenicity and CMD and their prognostic implications after reperfusion in acute myocardial infarction patients.Individuals with rapidly progressing atherosclerotic plaques are at higher risk of experiencing acute complications. Currently, we lack knowledge regarding factors in human plaque that cause rapid progression. Using the 14C bomb-pulse dating method, we assessed the physical age of atherosclerotic plaques and which biological processes were associated with rapidly progressing plaques. Interestingly, increased apoptosis was the main component associated with a young physical plaque age, reflecting rapid plaque progression. Our findings in combination with recent advances in imaging techniques could guide future diagnostic imaging strategies to identify rapidly progressing plaques or therapeutic targets, halting plaque progression.