Nutcracker syndrome (NCS), also known as left renal vein (LRV) entrapment syndrome is a condition that leads to stenosis of the aorto-mesenteric region of the LRV, with dilatation of the distal portion of the vessel. A 43-year-old woman was admitted to the Urology department with symptoms of intermittent painless hematuria and mild to moderate left lumbar pain for the last three months. The patient underwent cystoscopy under general anesthesia. Bloody urine was noticed to appear from the left ureter ostium and an intra-venous contrast CT of the abdomen was performed. The final diagnosis was anterior Nutcracker syndrome.

Objectives To determine the rate of functionally significant (fractional flow reserve, FFR ≤ 0.80) coronary bifurcation stenoses that are considered anatomically significant based on angiographic estimation and to define predictors of functional significance of stenoses in main vessel and side branch. Background To date, the rate of functionally significant stenoses in angiographic significant coronary bifurcation stenoses has not been specifically determined. Methods Patients with significant angiographic bifurcation lesions defined as diameter stenosis >50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). The protocol was approved by the local ethics committee. Results Overall, 171 patients with bifurcation lesions were included. Mean FFR in MV was 0.80 ± 0.01 and 0.84 ± 0.09 in SB. 46% (n = 78) of bifurcation lesions were functionally significant when assessed with FFR. Diameter stenosis in main vessel, lesion length, side branch territory and SYNTAX score (SS) were found as predictors for lesion functional severity (main vessel FFR ≤ 0.80). At the time of follow-up, there were no differences between the treated and deferred group regarding rates of all-cause death, cardio-vascular death, MACEs and POCE. Conclusion Less than half of all angiographic significant bifurcation lesions were functionally significant when assessed with FFR. There was no difference in clinical outcomes at mean time of three years follow-up in treated and deferred lesion.

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This article presents a study of the advantages of virtual technologies in health education, as well as an attempt to answer the following questions. How XR could improve the educational process by boosting the current ratio of students to lecturers while maintaining the same level of efficacy. How XR technologies could provide access to critical knowledge around the clock without interfering with the workflow of healthcare facilities and without exposing patients to any undue risk. The practical application of a 360° virtual world for a clinical laboratory, central laboratory for sterilization and a virtual operating room all in partnership between the Healthcare Department of Angel Kanchev University of Ruse, The Yatrus Foundation IT Specialists and University Multidisciplinary Hospital for Active Treatment Kanev, Ruse. The virtual reality allows the trainees to explore, to make mistakes and learn from them before ultimately applying the real procedure on a patient.

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