BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characte...Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.展开更多
Epiploic appendages can become ischemic and infarcted, which can present acute abdominal pain that mimics other diseases, such as diverticulitis or appendicitis. Particularly, inflammation of an epiploic appendage att...Epiploic appendages can become ischemic and infarcted, which can present acute abdominal pain that mimics other diseases, such as diverticulitis or appendicitis. Particularly, inflammation of an epiploic appendage attached to the vermiform appendix is a very rare cause of acute abdominal pain, and it is difficult to diagnose this condition preoperatively. We present a case of epiploic appendagitis of the vermiform appendix that was identified with a typical radiologic image and was pathologically confirmed. In addition, we review the literature of similar cases and analyze the clinical and radiologic features of EA of the vermiform appendix.展开更多
BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation...BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis. CASE SUMMARY A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up. CONCLUSION The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.展开更多
A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging m...A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.展开更多
Epiploic appendagitis should be considered to be an uncommon cause of lower abdominal pain. To diagnose accurately, typical CT findings are needed, and total colonoscopy should be done later to rule out the possibilit...Epiploic appendagitis should be considered to be an uncommon cause of lower abdominal pain. To diagnose accurately, typical CT findings are needed, and total colonoscopy should be done later to rule out the possibility of diverticulosis.展开更多
Purpose: To assess the clinical course of patients diagnosed as having “epiploic appendagitis” who are given only NSAIDs without antibiotic treatment. Materials and Methods: Between December 2010 and November 2013, ...Purpose: To assess the clinical course of patients diagnosed as having “epiploic appendagitis” who are given only NSAIDs without antibiotic treatment. Materials and Methods: Between December 2010 and November 2013, twelve patients were presented to the Emergency Surgery Department, Istanbul Medical Faculty, Istanbul University with abdominal pain and were diagnosed having “epiploic appendagitis”. The diagnoses were made using the information gathered from patients’ complaints, physical examination, biochemical results, and radiologic images (Abdominal X-Ray, Abdominal Ultrasonography [USG], and Contrast-Enhanced Computerized Tomography [CT]). We evaluated and recorded the patients’ age distribution, sex difference, laboratory results, radiologic images, length of hospital stay, and control exams after discharge. Results: Twelve out of 35,574 (0.033%) patients who were presented to our Emergency Surgery Department with abdominal pain and were hospitalized as “epiploic appendagitis”. Of these 12 patients, 7 were male (58.3%), and 5 were female (41.7%). The mean age of the patients was 43.5 (range: 22 to 60). The mean time passed between the beginning of the symptoms and presentation to the hospital was 1 day. The length of hospital stay was 1 to 2 days with a mean of 1.3 days. All patients were followed-up non-invasively under NSAID treatment without antibiotherapy. No complications were observed throughout the hospitalization period. The follow-up period of the patients was between 2 to 31 months with a mean of 16 months. Conclusion: Epiploic appendagitis is a self-limiting, benign disease, but differential diagnosis should be done carefully. Patients who are diagnosed with epiploic appendagitis may be followed-up with NSAIDs alone without hospitalization or antibiotherapy.展开更多
Scar formation resulting from burns or severe trauma can significantly compromise the structural integrity of skin and lead to permanent loss of skin appendages,ultimately impairing its normal physiological function.A...Scar formation resulting from burns or severe trauma can significantly compromise the structural integrity of skin and lead to permanent loss of skin appendages,ultimately impairing its normal physiological function.Accumulating evidence underscores the potential of targeted modulation of mechanical cues to enhance skin regeneration,promoting scarless repair by influencing the extracellular microenvironment and driving the phenotypic transitions.The field of skin repair and skin appendage regeneration has witnessed remarkable advancements in the utilization of biomaterials with distinct physical properties.However,a comprehensive understanding of the underlying mechanisms remains somewhat elusive,limiting the broader application of these innovations.In this review,we present two promising biomaterial-based mechanical approaches aimed at bolstering the regenerative capacity of compromised skin.The first approach involves leveraging biomaterials with specific biophysical properties to create an optimal scarless environment that supports cellular activities essential for regeneration.The second approach centers on harnessing mechanical forces exerted by biomaterials to enhance cellular plasticity,facilitating efficient cellular reprogramming and,consequently,promoting the regeneration of skin appendages.In summary,the manipulation of mechanical cues using biomaterial-based strategies holds significant promise as a supplementary approach for achieving scarless wound healing,coupled with the restoration of multiple skin appendage functions.展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
This paper addresses the problem of a viscoelastic Euler-Bernoulli beam under the influence of a constant velocity moving mass and different types of appendages.Four types of boundary conditions are considered:pinned-...This paper addresses the problem of a viscoelastic Euler-Bernoulli beam under the influence of a constant velocity moving mass and different types of appendages.Four types of boundary conditions are considered:pinned-pinned,fixed-pinned,fixed-free(or cantilever),and fixed-fixed.Appendages considered include lumped masses,dampers,and springs.The modal decomposition method is employed to derive the equation of motion of the beam,for which an analytical closed-form expression of the dynamic vibration response is generated.The proposed method enables the study of the effect of a single appendage or a combination of the three types of appendages on the non-dimensional dynamic response of the beam.Numerical examples are presented to illustrate the effects of these appendages and compare them to the reference cases of a beam with no appendages.The results demonstrate the importance of considering these parameters in the design of structures.The proposed method is compared to other techniques in the literature and found to be advantageous due to its direct approach.The method also offers a versatile tool for investigating various configurations,aiding in engineering design and structural analysis for which establishing a precise prediction of beam vibrations is crucial.展开更多
Introduction: the left atrial appendage, a dormant embryonic vestige, would play a major role in cardiac hemodynamic changes, volume homeostasis and thrombi formation. It, therefore constitutes a therapeutic target. I...Introduction: the left atrial appendage, a dormant embryonic vestige, would play a major role in cardiac hemodynamic changes, volume homeostasis and thrombi formation. It, therefore constitutes a therapeutic target. Its morphology is extremely variable. Objective: it consisted on determining the morphological variations of the left auricle as well as their interest in the prevention of thrombi in the Senegalese. Material and Method: This study was conducted by dissecting 36 fresh hearts from Senegalese anatomical subjects with a sampling of the left atrial appendage, including specimens with normal morphological appearance. Their morphology was studied using the fresh and frozen plaster molding method. The data obtained were analyzed statistically. Results: the average age of the subjects was 33 years, with a sex ratio of 1.06, the cauliflower shape was dominant with 57% of cases and the cactus shape (4%) was less frequent. The cauliflower shape presented a clear angulation compared to the others without statistically significant differences according to age. Conclusion: This work showed a great morphological variability of the left atrial appendage. It can provide an update on the specificity of Senegalese. Taking these variations into account is important in the safe management of hemodynamic conditions and the improvement of the management of recurrent strokes.展开更多
Attitude maneuver of liquid-filled spacecraft with an appendage as a cantilever beam by momentum wheel is studied. The dynamic equations are derived by conserva- tion of angular momentum and force equilibrium principl...Attitude maneuver of liquid-filled spacecraft with an appendage as a cantilever beam by momentum wheel is studied. The dynamic equations are derived by conserva- tion of angular momentum and force equilibrium principle. A feedback control strategy of the momentum wheel is ap- plied for the attitude maneuver. The residual nutation of the spacecraft in maneuver process changes with some chosen parameters, such as steady state time, locations of the liq- uid container and the appendage, and appendage parame- ters. The results indicate that locations in the second and fourth quadrants of the body-fixed coordinate system and the second quadrant of the wall of the main body are better choices for.placing the liquid containers and the appendage than other locations if they can be placed randomly. Higher density and thicker cross section are better for lowering the residual nutation if they can be changed. Light appendage can be modeled as a rigid body, which results in a larger residual nutation than a flexible model though. The resid- ual nutation decreases with increasing absolute value of the initial sloshing angular height.展开更多
In marine engineering,appendages such as fin stabilizers and/or T-foils are made to rotate and to reduce the motion of ships.Research on the hydrodynamics of ships fitted with active appendages has significantly impro...In marine engineering,appendages such as fin stabilizers and/or T-foils are made to rotate and to reduce the motion of ships.Research on the hydrodynamics of ships fitted with active appendages has significantly improved the design and control of such ships.However,most studies focus on fixed rather than rotating appendages,thereby ignoring the hydrodynamic unsteadiness of active appendages.To enhance the reliability and precision of the numerical simulations,we propose the use of overlapping grids for simulating advanced catamarans fitted with a pair of rotating T-foils under each bow.The fundamental purpose of the overlapping grid technique is to realize information exchange via regional overlap sharing in each subdomain of the computing domain,instead of using the method of boundary sharing,thus greatly alleviating the difficulty of generating the subdomain grid;moreover,the technique guarantees the quality of the subdomain grid.Within the main computational domain,a subdomain was allocated to accommodate the T-foil.Overlapping meshes near the interface between the two domains enable information flow during the simulation;the overlapping grids are updated at every iteration step because the subdomain rotates.The instantaneous trim and sinkage responses of the catamaran to the T-foil rotation were reproduced.From the moment the active T-foil stopped moving,there was no change in the ship’s sailing attitude,indicating that the response was in real time.By comparing with EFD data,the numerical results showed reasonable agreement,indicating the feasibility and effectiveness of the technique in simulating the hydrodynamics of ships fitted with active appendages.展开更多
Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. ...Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. As it hasbeen reported previously, 3-year survival rate among pa-tients with AF over 75 years of age after stroke is less than50%, and almost 90% of those patients will remain dis-abled.展开更多
This paper is mainly concerned with the coupling dynamic analysis of a complex spacecraft consisting of one main rigid platform, multiple liquid-filled cylindrical tanks, and a number of flexible appendages. Firstly, ...This paper is mainly concerned with the coupling dynamic analysis of a complex spacecraft consisting of one main rigid platform, multiple liquid-filled cylindrical tanks, and a number of flexible appendages. Firstly, the carrier potential function equations of liquid in the tanks are deduced according to the wall boundary conditions. Through employ- ing the Fourier-Bessel series expansion method, the dynamic boundaries conditions on a curved free-surface under a low-gravity environment are transformed to general simple differential equations and the rigid-liquid coupled sloshing dynamic state equations of liquid in tanks are obtained. The state vectors of rigid-liquid coupled equations are composed with the modal coordinates of the relative potential func- tion and the modal coordinates of wave height. Based on the B ernoulli-Euler beam theory and the D＇Alembert＇s prin- ciple, the rigid-flexible coupled dynamic state equations of flexible appendages are directly derived, and the coordi- nate transform matrixes of maneuvering flexible appendages are precisely computed as time-varying. Then, the cou- pling dynamics state equations of the overall system of the spacecraft are modularly built by means of the Lagrange＇s equations in terms of quasi-coordinates. Lastly, the cou-piing dynamic performances of a typical complex spacecraft are studied. The availability and reliability of the presented method are also confirmed.展开更多
Patient with atrial fibrillation(AF) are at risk of developing stroke with the left atrial appendage(LAA) being the most common site for thrombus formation. If left untreated, AF is associated with 4 to 5 folds increa...Patient with atrial fibrillation(AF) are at risk of developing stroke with the left atrial appendage(LAA) being the most common site for thrombus formation. If left untreated, AF is associated with 4 to 5 folds increase in the risk of ischemic stroke in all age groups. About 5% to 15% of AF patients have atrial thrombi on transesophageal echocardiography, and 91% of those thrombi are located in the LAA in patient with nonrheumatic AF. Although oral anticoagulants are the gold-standard treatment for stroke prevention in patients with non-valvular AF,some patients are at high risk of bleeding and deemed not candidates for anticoagulation. Therefore, LAA occlusion(LAAO) has emerged as alternative approach for stroke prevention in those patients. Surgical LAAO is associated with high rate of unsuccessful closure and recommended only in patients with AF and undergoing cardiac surgery. Percutaneous LAAO uses transvenous access with trans-septal puncture and was first tested using the PLAATO device.Watchman is the most common and only Food and Drug Administration(FDA)approved device for LAAO. LAAO using Watchman device is non-inferior to warfarin therapy in preventing ischemic stroke/systemic thromboembolism.However, it is associated with lower rates of hemorrhagic stroke, bleeding and death. Amplatzer is another successful LAAO device that has CE mark and is waiting for FDA approval. Optimal antithrombotic therapy post LAAO is still under debate and highly patient-specific. The aim of this paper is to systematically review the current literature to evaluate the efficacy and safety of different LAAO devices.展开更多
Heart rhythm disturbances become of special importancewhen patients reach a senior age. Atrial fibrillation （AF） isthe most prevalent arrhythmia among the old age groups,and its impact on morbidity and mortality bec...Heart rhythm disturbances become of special importancewhen patients reach a senior age. Atrial fibrillation （AF） isthe most prevalent arrhythmia among the old age groups,and its impact on morbidity and mortality becomes of para-mount significance. In this population, AF is responsible forsignificant amount of thromboembolic cerebrovascularevents, especially for disabling and fatal strokes, Follow-ing announcement of the special issue of the Journal of Geri-atric Cardiology devoted to heart rhythm disorders in theelderly, a number of submissions have been received withAF as the major topic of authors＇ researches.展开更多
Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients...Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.展开更多
An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when th...An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.展开更多
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
文摘Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.
文摘Epiploic appendages can become ischemic and infarcted, which can present acute abdominal pain that mimics other diseases, such as diverticulitis or appendicitis. Particularly, inflammation of an epiploic appendage attached to the vermiform appendix is a very rare cause of acute abdominal pain, and it is difficult to diagnose this condition preoperatively. We present a case of epiploic appendagitis of the vermiform appendix that was identified with a typical radiologic image and was pathologically confirmed. In addition, we review the literature of similar cases and analyze the clinical and radiologic features of EA of the vermiform appendix.
文摘BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis. CASE SUMMARY A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up. CONCLUSION The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.
文摘A rare differential diagnosis for severe abdominal pain is acute epiploic appendagitis. Its symptoms resemble those of acute diverticulitis, acute appendicitis, or omental infarction quite a bit. The primary imaging method used for diagnosis is computed tomography (CT). We are describing the case of a 27-year-old guy who underwent an abdominal ultrasonography after complaining of severe left lower quadrant abdominal pain. It identified an oval and non-compressible hyperechoic mass in the left iliac fossa. The mass was surrounded by a hypoechoic rim and there was no color Doppler signal. In the absence of CT, radiologists must be able to diagnose acute epiploic appendagitis on ultrasound in order to avoid unnecessary hospital admission, pricey laboratory tests, antibiotic treatment, and unnecessary surgery. In this instance, the patient was spared from ionization exposure from a potential CT scan and other invasive treatments including surgery with associated costs because of the reliable ultrasound diagnosis of epiploic appendagitis. After receiving conservative medical treatment, the patient was placed under surveillance and then discharged.
文摘Epiploic appendagitis should be considered to be an uncommon cause of lower abdominal pain. To diagnose accurately, typical CT findings are needed, and total colonoscopy should be done later to rule out the possibility of diverticulosis.
文摘Purpose: To assess the clinical course of patients diagnosed as having “epiploic appendagitis” who are given only NSAIDs without antibiotic treatment. Materials and Methods: Between December 2010 and November 2013, twelve patients were presented to the Emergency Surgery Department, Istanbul Medical Faculty, Istanbul University with abdominal pain and were diagnosed having “epiploic appendagitis”. The diagnoses were made using the information gathered from patients’ complaints, physical examination, biochemical results, and radiologic images (Abdominal X-Ray, Abdominal Ultrasonography [USG], and Contrast-Enhanced Computerized Tomography [CT]). We evaluated and recorded the patients’ age distribution, sex difference, laboratory results, radiologic images, length of hospital stay, and control exams after discharge. Results: Twelve out of 35,574 (0.033%) patients who were presented to our Emergency Surgery Department with abdominal pain and were hospitalized as “epiploic appendagitis”. Of these 12 patients, 7 were male (58.3%), and 5 were female (41.7%). The mean age of the patients was 43.5 (range: 22 to 60). The mean time passed between the beginning of the symptoms and presentation to the hospital was 1 day. The length of hospital stay was 1 to 2 days with a mean of 1.3 days. All patients were followed-up non-invasively under NSAID treatment without antibiotherapy. No complications were observed throughout the hospitalization period. The follow-up period of the patients was between 2 to 31 months with a mean of 16 months. Conclusion: Epiploic appendagitis is a self-limiting, benign disease, but differential diagnosis should be done carefully. Patients who are diagnosed with epiploic appendagitis may be followed-up with NSAIDs alone without hospitalization or antibiotherapy.
基金supported in part by the National Nature Science Foundation of China(92268206,81830064)the CAMS Innovation Fund for Medical Sciences(CIFMS,2019-I2M-5-059)+4 种基金the Military Medical Research Projects(145AKJ260015000X,2022-JCJQ-ZB-09600)the Military Key Basic Research of Foundational Strengthening Program(2020-JCJQ-ZD-256-021)the Science Foundation of National Defense Science and Technology for Excellent Young(2022-JCJQ-ZQ-017)the Military Medical Research and Development Projects(AWS17J005,2019-126)the Specific Research Fund of The Innovation Platform for Academicians of Hainan Province(YSPTZX202317).
文摘Scar formation resulting from burns or severe trauma can significantly compromise the structural integrity of skin and lead to permanent loss of skin appendages,ultimately impairing its normal physiological function.Accumulating evidence underscores the potential of targeted modulation of mechanical cues to enhance skin regeneration,promoting scarless repair by influencing the extracellular microenvironment and driving the phenotypic transitions.The field of skin repair and skin appendage regeneration has witnessed remarkable advancements in the utilization of biomaterials with distinct physical properties.However,a comprehensive understanding of the underlying mechanisms remains somewhat elusive,limiting the broader application of these innovations.In this review,we present two promising biomaterial-based mechanical approaches aimed at bolstering the regenerative capacity of compromised skin.The first approach involves leveraging biomaterials with specific biophysical properties to create an optimal scarless environment that supports cellular activities essential for regeneration.The second approach centers on harnessing mechanical forces exerted by biomaterials to enhance cellular plasticity,facilitating efficient cellular reprogramming and,consequently,promoting the regeneration of skin appendages.In summary,the manipulation of mechanical cues using biomaterial-based strategies holds significant promise as a supplementary approach for achieving scarless wound healing,coupled with the restoration of multiple skin appendage functions.
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘This paper addresses the problem of a viscoelastic Euler-Bernoulli beam under the influence of a constant velocity moving mass and different types of appendages.Four types of boundary conditions are considered:pinned-pinned,fixed-pinned,fixed-free(or cantilever),and fixed-fixed.Appendages considered include lumped masses,dampers,and springs.The modal decomposition method is employed to derive the equation of motion of the beam,for which an analytical closed-form expression of the dynamic vibration response is generated.The proposed method enables the study of the effect of a single appendage or a combination of the three types of appendages on the non-dimensional dynamic response of the beam.Numerical examples are presented to illustrate the effects of these appendages and compare them to the reference cases of a beam with no appendages.The results demonstrate the importance of considering these parameters in the design of structures.The proposed method is compared to other techniques in the literature and found to be advantageous due to its direct approach.The method also offers a versatile tool for investigating various configurations,aiding in engineering design and structural analysis for which establishing a precise prediction of beam vibrations is crucial.
文摘Introduction: the left atrial appendage, a dormant embryonic vestige, would play a major role in cardiac hemodynamic changes, volume homeostasis and thrombi formation. It, therefore constitutes a therapeutic target. Its morphology is extremely variable. Objective: it consisted on determining the morphological variations of the left auricle as well as their interest in the prevention of thrombi in the Senegalese. Material and Method: This study was conducted by dissecting 36 fresh hearts from Senegalese anatomical subjects with a sampling of the left atrial appendage, including specimens with normal morphological appearance. Their morphology was studied using the fresh and frozen plaster molding method. The data obtained were analyzed statistically. Results: the average age of the subjects was 33 years, with a sex ratio of 1.06, the cauliflower shape was dominant with 57% of cases and the cactus shape (4%) was less frequent. The cauliflower shape presented a clear angulation compared to the others without statistically significant differences according to age. Conclusion: This work showed a great morphological variability of the left atrial appendage. It can provide an update on the specificity of Senegalese. Taking these variations into account is important in the safe management of hemodynamic conditions and the improvement of the management of recurrent strokes.
基金supported by the National Natural Science Foundation of China (11072030)
文摘Attitude maneuver of liquid-filled spacecraft with an appendage as a cantilever beam by momentum wheel is studied. The dynamic equations are derived by conserva- tion of angular momentum and force equilibrium principle. A feedback control strategy of the momentum wheel is ap- plied for the attitude maneuver. The residual nutation of the spacecraft in maneuver process changes with some chosen parameters, such as steady state time, locations of the liq- uid container and the appendage, and appendage parame- ters. The results indicate that locations in the second and fourth quadrants of the body-fixed coordinate system and the second quadrant of the wall of the main body are better choices for.placing the liquid containers and the appendage than other locations if they can be placed randomly. Higher density and thicker cross section are better for lowering the residual nutation if they can be changed. Light appendage can be modeled as a rigid body, which results in a larger residual nutation than a flexible model though. The resid- ual nutation decreases with increasing absolute value of the initial sloshing angular height.
基金Supported by the National Natural Science Foundation of China(Grant No.51509053)
文摘In marine engineering,appendages such as fin stabilizers and/or T-foils are made to rotate and to reduce the motion of ships.Research on the hydrodynamics of ships fitted with active appendages has significantly improved the design and control of such ships.However,most studies focus on fixed rather than rotating appendages,thereby ignoring the hydrodynamic unsteadiness of active appendages.To enhance the reliability and precision of the numerical simulations,we propose the use of overlapping grids for simulating advanced catamarans fitted with a pair of rotating T-foils under each bow.The fundamental purpose of the overlapping grid technique is to realize information exchange via regional overlap sharing in each subdomain of the computing domain,instead of using the method of boundary sharing,thus greatly alleviating the difficulty of generating the subdomain grid;moreover,the technique guarantees the quality of the subdomain grid.Within the main computational domain,a subdomain was allocated to accommodate the T-foil.Overlapping meshes near the interface between the two domains enable information flow during the simulation;the overlapping grids are updated at every iteration step because the subdomain rotates.The instantaneous trim and sinkage responses of the catamaran to the T-foil rotation were reproduced.From the moment the active T-foil stopped moving,there was no change in the ship’s sailing attitude,indicating that the response was in real time.By comparing with EFD data,the numerical results showed reasonable agreement,indicating the feasibility and effectiveness of the technique in simulating the hydrodynamics of ships fitted with active appendages.
文摘Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. As it hasbeen reported previously, 3-year survival rate among pa-tients with AF over 75 years of age after stroke is less than50%, and almost 90% of those patients will remain dis-abled.
基金project was supported by the National Natural Science Foundation of China (Grants 11472041, 11302244, 11532002)Guangxi Natural Science Foundation (2015GXNSFBA 139013)
文摘This paper is mainly concerned with the coupling dynamic analysis of a complex spacecraft consisting of one main rigid platform, multiple liquid-filled cylindrical tanks, and a number of flexible appendages. Firstly, the carrier potential function equations of liquid in the tanks are deduced according to the wall boundary conditions. Through employ- ing the Fourier-Bessel series expansion method, the dynamic boundaries conditions on a curved free-surface under a low-gravity environment are transformed to general simple differential equations and the rigid-liquid coupled sloshing dynamic state equations of liquid in tanks are obtained. The state vectors of rigid-liquid coupled equations are composed with the modal coordinates of the relative potential func- tion and the modal coordinates of wave height. Based on the B ernoulli-Euler beam theory and the D＇Alembert＇s prin- ciple, the rigid-flexible coupled dynamic state equations of flexible appendages are directly derived, and the coordi- nate transform matrixes of maneuvering flexible appendages are precisely computed as time-varying. Then, the cou- pling dynamics state equations of the overall system of the spacecraft are modularly built by means of the Lagrange＇s equations in terms of quasi-coordinates. Lastly, the cou-piing dynamic performances of a typical complex spacecraft are studied. The availability and reliability of the presented method are also confirmed.
文摘Patient with atrial fibrillation(AF) are at risk of developing stroke with the left atrial appendage(LAA) being the most common site for thrombus formation. If left untreated, AF is associated with 4 to 5 folds increase in the risk of ischemic stroke in all age groups. About 5% to 15% of AF patients have atrial thrombi on transesophageal echocardiography, and 91% of those thrombi are located in the LAA in patient with nonrheumatic AF. Although oral anticoagulants are the gold-standard treatment for stroke prevention in patients with non-valvular AF,some patients are at high risk of bleeding and deemed not candidates for anticoagulation. Therefore, LAA occlusion(LAAO) has emerged as alternative approach for stroke prevention in those patients. Surgical LAAO is associated with high rate of unsuccessful closure and recommended only in patients with AF and undergoing cardiac surgery. Percutaneous LAAO uses transvenous access with trans-septal puncture and was first tested using the PLAATO device.Watchman is the most common and only Food and Drug Administration(FDA)approved device for LAAO. LAAO using Watchman device is non-inferior to warfarin therapy in preventing ischemic stroke/systemic thromboembolism.However, it is associated with lower rates of hemorrhagic stroke, bleeding and death. Amplatzer is another successful LAAO device that has CE mark and is waiting for FDA approval. Optimal antithrombotic therapy post LAAO is still under debate and highly patient-specific. The aim of this paper is to systematically review the current literature to evaluate the efficacy and safety of different LAAO devices.
文摘Heart rhythm disturbances become of special importancewhen patients reach a senior age. Atrial fibrillation （AF） isthe most prevalent arrhythmia among the old age groups,and its impact on morbidity and mortality becomes of para-mount significance. In this population, AF is responsible forsignificant amount of thromboembolic cerebrovascularevents, especially for disabling and fatal strokes, Follow-ing announcement of the special issue of the Journal of Geri-atric Cardiology devoted to heart rhythm disorders in theelderly, a number of submissions have been received withAF as the major topic of authors＇ researches.
文摘Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.
文摘An atrial septal defect (ASD) may cause right heart dysfunction, pulmonary hypertension and atrial fibrillation (AF), and atrial septal defect occlusion (ASDO) is the first choice for treating secundum defects when the morphology permits. ASD and AF frequently coexist, and the risk of AF and stroke persists after ASDO.[1] In recent years, left atrial appendage occlusion (LAAO) has been recognized as an effective treatment for stroke prevention in nonvalvular AF patients with a high risk of stroke, systemic embolism and bleeding who are unwilling to take oral anticoagulants or cannot tolerate them.
