Citations

Abstract Internal herniation through the foramen of Winslow is one of the rarest types of hernia. As signs and symptoms can be quite generalized, prompt identification can prove difficult, leading to increased morbidity and mortality. The majority of reported cases of foramen of Winslow herniation result in obstruction of either the small or large bowel requiring operative intervention. As they are so rare, there is no established treatment algorithm for foramen of Winslow hernias. We present here a unique case of cecal herniation through the foramen of Winslow resulting in biliary compression and acute cholecystitis without bowel obstruction that was managed with laparoscopic cholecystectomy and right hemicolectomy.

Background/Objectives: Obstructive sleep apnea (OSA) is a condition characterized by intermittent airway obstructions, leading to reduced oxygen levels and increased sympathetic nervous system activity. OSA can cause a range of health problems, including an increased risk of cardiovascular diseases and mortality. Galectin-3, a member of the galectin family, plays a significant role in inflammation and fibrosis, and studies show that it is elevated in various conditions, including heart and lung diseases. The aim of this study was to determine whether galectin-3 levels are related to the severity of sleep apnea. Methods: A total of 191 participants from the University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia, between January 2023 and May 2024, were included in the analyses. All patients were hospitalized under suspicion of OSA, and they all underwent a polysomnography test. Various demographic, respiratory, laboratory, and clinical parameters were obtained. Correlations between numerical variables and galectin-3 were assessed by the Pearson or Spearman correlation coefficients. Univariate and multivariate linear regression models were used to assess the predictors of galectin-3 values. In all analyses, the significance level was set at 0.05. Results: The mean age of the study participants was 56.2 years, mostly male (68.9%). Of the comorbidities, two-thirds of patients had hypertension (66.1%), 46.8% had hyperlipoproteinemia, and 21.1% had diabetes mellitus. Patients who had an AHI of more than fifteen events per hour more often had higher values of galectin-3. OSA severity had a significant positive correlation with galectin-3 (p = 0.014). In multivariate linear regression analysis, significant independent predictors of higher galectin-3 values were older age, presence of coronary disease, hypoventilation syndrome, higher BMI, NTproBNP, lactate, creatinine, lower LDL, and lower FEV1 (p < 0.05). Conclusions: The present study demonstrated that galectin-3 is linked to the severity of OSA and plays a crucial role in inflammation induced by intermittent hypoxia in OSA. Further screening and interventions targeting galectin-3 could aid in preventing inflammatory diseases related to sleep disturbances.

Background/Objectives: Adolescents with autonomic disorders who attend Intensive Interdisciplinary Pain Treatment (IIPT) programs report improvements in functioning. However, it is unclear whether they experience corresponding improvements in physiological measures. As such, the aim of this pilot study was to examine changes in physiological measures in youth attending an IIPT program who demonstrated excessive postural tachycardia on an active stand test. The secondary goal was to examine associations between physiological measurements and self-reported measures of chronic orthostatic intolerance (cOI) and functioning. Methods: At admission and discharge, eighteen adolescents and young adults (AYAs) attending IIPT (M age = 17.39 years; SD = 2.15 years) completed an active stand test, measures of breathing rate and muscle tension, as well as self-reported measures of cOI symptoms and functioning. Results: AYAs showed significant reduction in active stand test heart rate increase (p < 0.001; d = 1.07) and maximum heart rate (p = 0.002, d = 0.76) from admission to discharge. Improvements were also observed in resting respiration rate (p = 0.001, d = 89) and resting trapezoid tension (p = 0.03, d = 0.49). Although patients showed significant improvements on self-report measures of functioning (p < 0.001, d = 1.78), changes on subjective report of cOI symptoms did not reach significance. Exploratory analyses that only included patients with a POTS diagnosis were consistent with the overall results. Conclusions: Youth who demonstrated excessive postural tachycardia on active stand test at admission to an IIPT showed significant improvements from admission to discharge in their active stand maximum heart rate and heart rate increase, as well as respiration rate, muscle tension, and reports of their functioning. Future research is necessary to examine the mechanisms of change that contribute to symptom improvement.

AbstractAimWe investigated whether a commercial bi‐level positive airway pressure (BPAP) device, would improve peripheral oxygen saturation (SpO2) during recreational aviation up to 12,500 feet without supplemental oxygen. Ten adults with recreational flight experience (age:47 ± 14; female = 5) completed a standardized flight profile in an unpressurised aircraft, involving randomized crossover design at 8,000 feet and 12,500 feet with BPAP or control. SpO2, middle cerebral artery velocity (MCAv), heart rate (HR), respiratory rate (RR), and relative tidal volume (TV) index were measured continuously. Psychomotor vigilance test (3‐min) assessed reaction time halfway through taxi and altitude stages. Altitude significantly (p < 0.05) decreased mean SpO2, MCAv, and RR, and increased TV index and HR. There was no effect of altitude (p > 0.05) on reaction time. BPAP increased mean SpO2 at 8,000 feet [Control: 92 ± 1%; BPAP: 94 ± 2%; mean difference (MD) = 2 ± 2%; p = 0.002] and 12,500 feet [Control: 86 ± 4%; BPAP: 89 ± 4%; MD = 2 ± 3%; p = 0.013]. BPAP lowered MCAv at 8,000 feet [Control: 53 ± 10 cm/s; BPAP: 50 ± 9 cm/s; MD = ‐3 ± 2 cm/s; p = 0.001] and 12,500 feet [Control: 52 ± 10 cm/s; BPAP: 50 ± 8 cm/s; MD = ‐2 ± 3 cm/s; p = 0.041]. BPAP increased TV index at 8,000 feet (Control: 6.6 ± 1.3; BPAP:8.1 ± 1.8; MD = 1.9 ± 0.8; p < 0.001) but not 12,500 feet, without effect on RR or reaction time. This study provides preliminary results that BPAP may improve mean SpO2 for recreational aviators up to 12,500 feet without supplemental oxygen.

AbstractWhile pediatric epilepsy shares some features with adult epilepsy, the growing and developing brain during childhood is associated with differences in epilepsy etiologies, syndromes, comorbidities, management, and outcomes. We must also consider the long-term effects of epilepsy and treatments. This section highlights unique considerations for pediatric epilepsy. These include pediatric onset electroclinical syndromes that commonly resolve prior to adulthood, treatment duration of self-limited pediatric epilepsy syndromes, pediatric-onset epilepsy with etiology-specific treatment, and therapies used more commonly in the pediatric population. In addition, pediatric-onset epilepsy is associated with a higher risk for developmental, psychiatric, and behavioral comorbidities in a bidirectional fashion. Family dynamics are affected by a child with epilepsy, and transitioning to the adult clinic is a particular challenge for this population. Finally, there are special issues that occur in pediatric epilepsy, including the lack of pediatric FDA approvals for newly available therapies and the need for sedation for investigations.

AbstractLiver transplantation is becoming increasingly common in the United States, with very favorable 1- and 5-year survival rates. With increasing long-term survival rates, postprocedural vascular complications can occur with increased frequency. Familiarity with posttransplant vascular anatomy is essential for interventional radiologists dealing with this patient population. This article discusses the posttransplant venous, arterial, and biliary anatomy and the implications for minimally invasive interventions.

Abstract Background Incorporating image guidance into ion beam therapy is critical for minimizing beam range uncertainties and realizing the modality's potential. One promising avenue for image guidance is to capture transmission ion radiographs (iRads) before and/or during treatment. iRad image quality is typically maximized using a single‐event imaging system, which involves tracking individual ions, albeit the approach is generally not suited to clinical beam settings. An alternative faster and clinically compatible method is integrated mode imaging, where individual pencil beam data is acquired, rather than single ion data. To evaluate the usefulness of transmission ion imaging for image guidance, it is crucial to evaluate the image quality of integrated mode iRad systems. Purpose We report extensive image quality metrics of integrated mode carbon ion radiographs (cRads) and compare them with proton radiographs (pRads). Methods iRads were obtained at the Marburg Ion Beam Therapy Center using a plastic volumetric scintillator equipped with CCD cameras. The detector captures orthogonal views of the 3D energy deposition in the scintillator from individual pencil beams. Four phantoms were scanned using a field of view and a beam spacing of 1 mm. First, 9 tissue‐substitute inserts were used to evaluate water equivalent thickness (WET) accuracy. Radiographs of those inserts were reconstructed for beam spacings ranging from 1 to 7 mm to evaluate the impact of spacing on quantitative accuracy. For spatial resolution, custom 3D printed line pair (lp) modules ranging from 0.5 to 10 lp/cm were scanned. To evaluate low contrast detectability, a custom 3D printed low contrast module consisting of 20 holes with depths ranging from 1 to 8 mm and diameters from 1 to 10 mm was scanned. iRads of an anthropomorphic head phantom were also obtained. Results Spatial resolution and low contrast detection are systematically improved for cRads compared to pRads. Image resolution was 3.7 lp/cm for cRads and 1.7 lp/cm for pRads in the center of the field of view. Spatial resolution was found to vary with the object's location in the field of view. While pRads could mostly resolve low contrast holes of 10 mm in diameter, cRads could resolve holes of up in 4 mm diameter. WET accuracy is similar for both ion species, with a root mean squared error of approximately 1 mm. WET accuracy was stable (maximum of 0.1 mm increase) across beam spacings, although important under‐sampling artifacts were observed for iRads reconstructed using large beam spacings, especially for cRads. iRads of the anthropomorphic head phantom showed improved apparent contrast using cRads, especially to identify bony structures. Conclusions This work is the first investigation of image quality metrics such as spatial resolution and low contrast detectability for integrated mode cRads, with a full comparison with pRads. Enhanced image quality is obtained with cRads compared to pRads, although pRads still maintain high WET accuracy and deliver image quality within acceptable bounds.