Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

Background

The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown.

Score du risque échocardiographique après un syndrome coronaire aigu

AimsIdentify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores.MethodsWe recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months.ResultsThe echocardiographic risk score has four variables: LV-EF (RR = 0.931; 95%CI = 0.885–0.979, P < 0.01), RV-AF (RR = 0.951; 95%CI = 0.903–0.999, P < 0.05), iMAE-M-strain (RR = 1.226; 95%CI = 1.081–1.390, P < 0.01) and ULCs (RR = 1.151; 95%CI = 1.081–1.224, P < 0.01). Its discrimination capacity (AUC = 0.85), greater than that of the clinical risk scores, (GRACE: AUC = 0.72, TIMI: AUC = 0.71 and CRUSADE: AUC = 0.76).DiscussionThe risk stratification can be achieved using echocardiographic score easy to acquire and interpret in the clinical setting, with a stratification power higher than the clinical risk scores. The iconoclinical model makes it possible to select a group of heterogeneous patients by their clinical presentations and iconographic data at high risk but with an echoscore or clinical score weak or intermediate.ConclusionThe developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.     

MRI characteristics of MOG-Ab associated disease in adults: An update

Our knowledge of the radiological spectrum of myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is growing rapidly. An update on the radiological features of the disease, and its evolution is thus necessary. Magnetic resonance imaging (MRI) has an increasingly important role in the differential diagnosis of MOGAD particularly from aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), and multiple sclerosis (MS). Differentiating these conditions is of prime importance because the management is different between the three inflammatory diseases, and thus could prevent further attack-related disability. Therefore, identifying the MRI features suggestive of MOGAD has diagnostic and prognostic implications. We herein review optic nerve, spinal cord and the brain MRI findings from MOGAD adult patients, and compare them to AQP4-NMOSD and MS.     

Demodex: a skin resident in man and his best friend

Demodex mites are microscopic arachnids found in the normal skin of many mammals. In humans, it is well established that Demodex mite density is higher in patients with the skin condition rosacea, and treatment with acaricidal agents is effective in resolving symptoms. However, pathophysiology of rosacea is complex and multifactorial. In dogs, demodicosis is a significant veterinary issue, particularly the generalized form of the disease which can be fatal if untreated. In each species, clinical and molecular studies have shown that the host’s immunological interactions with Demodex mites are an important, but not fully understood, aspect of how Demodex can live in the skin either as a harmless commensal organism or as a pathogenic agent. This review outlines the role of Demodex mites in humans and dogs, considering morphology, prevalence, symptoms, diagnosis, histology treatment and pathogenesis.     

Synthetic MRI is not yet ready for morphologic and functional assessment of patellar cartilage at 1.5 Tesla

PurposeThe purpose of this study was to compare morphologic assessment and relaxometry of patellar hyaline cartilage between conventional sequences (fast spin-echo [FSE] T2-weighted fat-saturated and T2-mapping) and synthetic T2 short-TI inversion recovery (STIR) and T2 maps at 1.5 T magnetic resonance imaging (MRI).MethodThe MRI examinations of the knee obtained at 1.5 T in 49 consecutive patients were retrospectively studied. There were 21 men and 28 women with a mean age of 45 ± 17.7 (SD) years (range: 18–88 years). Conventional and synthetic acquisitions were performed, including T2-weighted fat-saturated and T2-mapping sequences. Two radiologists independently compared patellar cartilage T2-relaxation time on conventional T2-mapping and synthetic T2-mapping images. A third radiologist evaluated the patellar cartilage morphology on conventional and synthetic T2-weighted images. The presence of artifacts was also assessed. Interobserver agreement for quantitative variables was assessed using intraclass correlation coefficient (ICC).ResultsIn vitro, conventional and synthetic T2 maps yielded similar mean T2 values 58.5 ± 2.3 (SD) ms and 58.8 ± 2.6 (SD) ms, respectively (P = 0.414) and 6% lower than the expected experimental values (P = 0.038). Synthetic images allowed for a 15% reduction in examination time compared to conventional images. On conventional sequences, patellar chondropathy was identified in 35 patients (35/49; 71%) with a mean chondropathy grade of 4.8 ± 4.8 (SD). On synthetic images, 28 patients (28/49; 57%) were diagnosed with patellar chondropathy, with a significant 14% difference (P = 0.009) and lower chondropathy scores (3.7 ± 4.9 [SD]) compared to conventional images. Motion artifacts were more frequently observed on synthetic images (18%) than on conventional ones (6%). The interobserver agreement was excellent for both conventional and synthetic T2 maps (ICC > 0.83). Mean cartilage T2 values were significantly greater on synthetic images (36.2 ± 3.8 [SD] ms; range: 29-46 ms) relative to conventional T2 maps (31.8 ± 4.1 [SD] ms; range: 26-49 ms) (P < 0.0001).ConclusionDespite a decrease in examination duration, synthetic images convey lower diagnostic performance for chondropathy, greater prevalence of motion artifacts, and an overestimation of T2 values compared to conventional MRI sequences.     

Is there a correlation between arthroscopic findings and the clinical signs and symptoms of patients with internal derangement of the temporomandibular joint? A prospective study

The aim of this study was to evaluate the correlation between clinical signs and symptoms of patients with internal derangement of the temporomandibular joint (TMJ) and arthroscopic findings. The study included a sample of 67 patients who underwent TMJ arthroscopy. The variables evaluated were the arthroscopic findings of synovitis, chondromalacia, adhesion, and roofing. The Spearman correlation index was used to correlate these findings with the clinical signs and symptoms of internal derangement of the TMJ, namely maximum mouth opening, pain (visual analogue scale, VAS), and the Wilkes classification. The mean age of the population was 36.16 years, and 85% were female. There was a correlation between pain and synovitis (P = 0.0029, r = 0.3508), between mouth opening limitation and the amount of adhesion (P = 0.0004, r = ?0.4084), and between Wilkes classification and the presence of chondromalacia and disc displacement (P = 0.001, r = 0.374 and P = 0.0045, r = ?0.3357, respectively). No correlation was found between age and the presence of chondromalacia (P = 0.3444, r = 0.1147). Patients who had worse pain symptoms had more advanced stages of synovitis, and the increased presence of adhesions was associated with limitations in mouth opening. Furthermore, those with more advanced Wilkes stages had greater disc displacement and more severe stages of chondromalacia.     

An open-label,prospective, randomized,controlled, multicenter,phase 1b study of StrataGraft skin tissue versus autografting in patients with deep partial-thickness thermal burns

ObjectiveThis open-label, controlled, randomized study assessed the safety, tolerability, and efficacy of StrataGraft tissue compared to autograft in the treatment of deep partial-thickness (DPT) burns.MethodsThirty subjects with DPT thermal burns (3%–43% total body surface area) were treated with StrataGraft tissue as follows: cohort 1, ≤220 cm² refrigerated tissue; cohort 2, ≤440 cm² refrigerated tissue; and cohort 3, ≤440 cm² cryopreserved tissue. On each subject, two comparable areas of DPT burn were randomized to receive StrataGraft tissue or autograft. Coprimary end points were the percent area of the StrataGraft tissue treatment site undergoing salvage autografting by Day 28 and wound closure of treatment sites by 3 months.ResultsBy Day 28, no StrataGraft tissue treatment sites underwent autografting. By 3 months, 93% and 100% of the StrataGraft tissue and autograft treatment sites achieved complete wound closure, respectively. No significant differences in observer total and overall opinion POSAS scores between StrataGraft tissue and autograft treatment sites were observed at any timepoint. The most common adverse event was pruritus (17%).ConclusionsStrataGraft tissue treatment of DPT thermal burns reduced the need for autograft, resulted in wound closure and treatment-site cosmesis comparable to that of autograft, and was well tolerated.