PURPOSE:To fabricate a three-dimensional biomodels of intracranial aneurysms, using rapid prototyping technology, to facilitate optimal anatomical visualization of aneurysms prior to and during surgery. METHODS:Four intracranial aneurysms cases were selected for this study. Using CT angiography images, the rapid prototyping process was completed using a PolyJet technology machine. The size and morphology of the prototypes were compared to brain digital subtraction arteriography of the same patients. RESULTS:The biomodels reproduced the exact location and morphology of the intracranial aneurysms, particularly the necks, in lifesize dimensions and exactly the same as measured by digital subtraction arteriography. The arterial segments adjacent to the aneurysm and arteries anatomically known by the surgeon were also shown, which could guide the surgeon to the aneurysmal segment. The models showed an average unit cost of US$ 130 and each one took an average of 20 hours to be fabricated. CONCLUSIONS:It is possible to fabricate 3D physical biomodels of intracranial aneurysms from CT angiography images. These prototypes may be useful in the surgical planning for intracranial aneurysms to clarify the anatomy, define surgical techniques and facilitate the choice of suitable materials, such as clips and clip appliers.

This meta-analysis summarizes the available evidence on the effectiveness of citrate supplement for preventing the recurrence of nephrolithiasis in patients undergoing extracorporeal shock wave lithotripsy (SWL). Electronic searches were conducted using Medline-PubMed, Web of Science, Embase, BVS (Scielo, Lilacs), and Google Scholar literature databases. The authors worked in pairs to select studies that met the following criteria: randomized controlled trials that were conducted in adults and assessed the effect of potassium citrate supplement before or after SWL therapy for urolithiasis. Our primary aim was to asses the stone-free rate among the groups included in the studies. Fixed effect was used in the meta-analysis with 95% confidence interval (95% CI). Heterogeneity was analyzed by the I value. A total of 2505 references were initially selected. Of those, four were subjected to meta-analysis contributing five samples. These four studies included 374 participants who were followed for a period of 12 months after SWL. Mean potassium citrate dosage was approximately 55 mEq/day (18 mmol). The results showed that citrate supplement significantly protected against the recurrence of nephrolithiasis during 1 year after SWL [RR; 95% CI 0.21 (0.13, 0.31)]. The heterogeneity was not significant across the analyzed studies (p = 0.224). The quality of the analyzed studies was generally low. The available evidence shows that citrate supplement effectively reduces the recurrence of nephrolithiasis in patients undergoing SWL. However, statistical analysis of a larger trial conducted with methodological rigor is warranted.

Background Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy. Methods Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics). Results The average perimeter and area of the defects were smaller by 15.3% (p = 0.034) and 21.8% (p = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% (p = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group. Conclusions Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.

ObjectiveThe aim of the present investigation was to determine whether the difference in inflammatory tissue reaction between the Riccinus communis (castor) polymer with calcium carbonate and the titanium implant is statistically significant.MethodsThirty-two Cavia porcellus were allocated into four groups of eight animals each. We implanted the two types of materials in the retroperitoneal space of all the animals. They were euthanized at 7, 20, 30 and 40 days after surgery, and an histological study of the samples was conducted.ResultsAll implants showed characteristics of chronic inflammation regardless of the material and timepoint of evaluation. There was no statistically significant difference between Pm+CaCO3 and Ti with regard to the presence of granulation tissue, tissue congestion, histiocytes, lymphocytes, neutrophils, giant cells, and fibrosis (P> 0.05).ConclusionThe castor oil polymer plus calcium carbonate implant was not statistically different from the titanium implant regarding inflammatory tissue reaction.

BackgroundIt remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts’ opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment.MethodsWe searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design.ResultsEleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59–0.88) and all-cause mortality (RR 0.86, 95% CI 0.75–0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg.ConclusionsAmong older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0672-4) contains supplementary material, which is available to authorized users.

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Introduction Most cardiomyocytes do not regenerate after myocardial infarction. Porcine small intestinal submucosa has been shown to be effective in tissue repair. Objective To evaluate myocardial tissue regeneration and functional effects of SIS implantation in pigs after left ventriculotomy. Methods Fifteen pigs were assigned to two groups: porcine small intestinal submucosa (SIS) (N=10) and control (N=5). The SIS group underwent a mini sternotomy, left ventriculotomy and placement of a SIS patch. The control group underwent a sham procedure. Echocardiography was performed before and 60 days after the surgical procedure. Histological analysis was performed with hematoxylin-eosin stain and markers for actin 1A4, anti sarcomeric actin, connexin43 and factor VIII. Results Weight gain was similar in both groups. Echocardiography analysis revealed no difference between groups regarding end diastolic and systolic diameters and left ventricular ejection fraction, both pre (P=0.118, P=0.313, P=0.944) and post procedure (P=0.333, P=0.522, P=0.628). Both groups showed an increase in end diastolic (P<0,001 for both) and systolic diameter 60 days after surgery (P=0.005, SIS group and P=0.004, control group). New cardiomyocytes, blood vessels and inflammatory reactions were histologically identified in the SIS group. Conclusion SIS implantation in pigs after left ventriculotomy was associated with angiomuscular regeneration and no damage in cardiac function.

Perforating veins contribute to chronic venous valvular insufficiency (CVVI, subset of CVI) of lower extremities (LE). We investigated the role of medial, proximal calf paratibial perforating veins (PTPV). Women with PTPV reflux, diameter ≥3 mm, or tortuosity were selected among 2199 LE mappings. Duplex ultrasonography (US) was performed standing. Reflux &gt;0.5 s was abnormal. PTPV conditions were related to great saphenous vein (GSV) patterns of reflux. US of 442 LE of 379 women were analyzed, all being Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification C1, C2, and/or having intermittent, conditional swelling. Etiology was primary. Pathophysiology was reflux, not thrombosis or obstruction. Most PTPV drained (n=281, 64% of 442 or 13% of 2199), or were source (n=73, 17%/442, 3%/2199) of GSV reflux; 49 (11%/442, 2%/2199) had reflux not associated with GSV; 39 (9%/442, 2%/2199) did not have reflux. PTPV, when significative for CVVI, primarily drained-GSV reflux. PTPV was linked to reflux in 1 of 5 and was a major source of reflux in 1 of 20 legs. Detailed US of PTPV insured over 80% accuracy in CVVI mapping.