Myocardial deformation in patients with a single left ventricle using 2D cardiovascular magnetic resonance feature tracking: a case–control study

The International Journal of Cardiovascular Imaging - Ventricular dysfunction is a well-known complication in single ventricle patients in Fontan circulation. As studies exclusively examining...     

Fetal circulation in left-sided congenital heart disease measured by cardiovascular magnetic resonance: a case–control study

Background

The distribution of blood flow in fetuses with congenital heart disease (CHD) is likely to influence fetal growth, organ development, and postnatal outcome, but has previously been difficult to study. We present the first measurements of the distribution of the fetal circulation in left-sided CHD made using phase contrast cardiac magnetic resonance (CMR).

Methods

Twenty-two fetuses with suspected left-sided CHD and twelve normal controls underwent fetal CMR and echocardiography at a mean of 35 weeks gestation (range 30–39 weeks).

Results

Fetuses with left-sided CHD had a mean combined ventricular output 19% lower than normal controls (p < 0.01). In fetuses with left-sided CHD with pulmonary venous obstruction, pulmonary blood flow was significantly lower than in those with left-sided CHD without pulmonary venous obstruction (p < 0.01). All three fetuses with pulmonary venous obstruction had pulmonary lymphangectasia by fetal CMR and postnatal histology. Fetuses with small but apex forming left ventricles with left ventricular outflow tract or aortic arch obstruction had reduced ascending aortic and foramen ovale flow compared with normals (p < 0.01). Fetuses with left-sided CHD had more variable superior vena caval flows than normal controls (p < 0.05). Six fetuses with CHD had brain weights at or below the 5^th centile for gestational age, while none of the fetuses in the normal control group had brain weights below the 25^th centile.

Conclusions

Measurement of the distribution of the fetal circulation in late gestation left-sided CHD is feasible with CMR. We demonstrated links between fetal blood flow distribution and postnatal course, and examined the relationship between fetal hemodynamics and lung and brain development. CMR enhances our understanding of pathophysiology of the fetal circulation and, with more experience, may help with the planning of perinatal management and fetal counselling.     

Vaginal bacterial profiles of aerobic vaginitis: a case–control study

PurposeAerobic vaginitis (AV) has drawn increasing attention because of its threat to women's reproductive health and pregnancy. However, little is known about the overall structure of vaginal bacterial communities in women with AV.MethodsThe diversity of vaginal microbiota was evaluated by amplicon sequencing targeting the 16S rRNA V4 region. Routine laboratory tests, including cultivation, were used.ResultsFirmicutes (mainly Lactobacillus crispatus and L. iners) were dominant in healthy women (n = 160), while Actinobacteria and Bacteroidetes were strongly associated with AV (n = 80). The onset of AV was marked by a striking decline in L. crispatus and an increase in multiple aerobes, including Streptococcus agalactiae, S. anginosus, etc. The overall drug resistance level of gram-positive bacteria against erythromycin and clindamycin was high, and the overall drug resistance level of gram-negative bacteria against ampicillin was high.ConclusionsMultiple aerobes and facultative anaerobes were involved in vaginal dysbiosis, which was associated with decreasing L. crispatus levels. Probiotics containing L. crispatus may be potential supplementary agents.     

Anxiety trait in patients with stress-induced cardiomyopathy: a case–control study

Background  

Stress-induced Tako-tsubo cardiomyopathy (TTC) is an acute cardiac syndrome, mimics ST elevation myocardial infarction (STEMI), largely confined to postmenopausal women, frequently precipitated by a stressful event. The pathogenesis of TTC is still unknown. Some authors hypothesized a possible connection between TTC and anxiety disease, but no previous study analyzed the relationship between anxiety trait and TTC. This study sought to assess the potential role of anxiety trait in the development and clinical course of TTC.     

Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure: a case–control study

Introduction  

Our objective was to determine the effect of ventilator-associated tracheobronchitis (VAT) on outcome in patients without chronic respiratory failure.     

The comparison of CT fistulography and MR imaging of perianal fistulae with surgical findings: a case–control study

Purpose

The purpose of this study was to evaluate the diagnostic efficacies of CT fistulography and MRI, in the diagnostic work-up of perianal fistula patients.

Materials and methods

All 41 patients who were included in the study (36 males and 5 females, with an average age of 41 years) underwent CT fistulography and MRI examinations prior to surgery. The fistula characteristics obtained from these examinations were compared with the surgical findings. The comparative results were evaluated by means of the Kappa analysis method.

Results

CT fistulography predicted the correct perianal fistula classification in 30 (73.1%) of the 41 patients, whereas MRI correctly defined fistula classification in 38 (92.7%) of these patients (the K values were 0.621 and 0.896, respectively; with p < 0.001). CT fistulography depicted 29 secondary extensions in 16 patients, whereas MR imaging revealed 28 secondary extensions in 15 patients. A substantial agreement was found between surgical findings and two modalities (K value was 0.789 and 0.793 for CT fistulography and MRI, respectively, with a p value < 0.001). In terms of locations of internal openings, CT fistulography was able to detect the locations in 28 patients (68.2%), whereas MRI was more successful in this aspect, with a number of 35 patients (85.3%). Granulation tissues, inflammation and edema around the fistula, abscesses, and fistular wall fibrosis were also evaluated.

Conclusion

CT fistulography and MRI have different advantages in the diagnosis of perianal fistulas. A good command of knowledge concerning the issue may be a key factor in modality decision.

     

Sinusitis in children and adolescents with chronic or recurrent headache: a case–control study

The aim of this study was to determine the frequency of misdiagnosis of sinus headache in migraine and other primary headache types in the children and adolescents with chronic or recurrent headaches. Children with chronic or recurrent headaches (n = 310) were prospectively evaluated. Data collection for each patient included history of previously diagnosed sinusitis due to headache, and additional sinusitis complaints (such as fever, cough, nasal discharge, postnasal discharge) at the time of sinusitis diagnosis, and improvement of the headache following treatment of sinusitis. If sinus radiographs existed they were recorded. The study included 214 patients with complete data. One hundred and sixteen (54.2%) patients have been diagnosed as sinusitis previously and 25% of them had at least one additional complaint, while 75% of them had none. Sinusitis treatment had no effect on the headaches in 60.3% of the patients. Sinus graphy had been performed in 52.8%, and 50.4% of them were normal. The prevalence of sinus headache concomitant with primary headache, and only sinus headache was detected in 7 and 1%, respectively, in our study. Approximately 40% of the patients with migraine and 60% of the patients with tension-type headache had been misdiagnosed as “sinus headache”. Children with chronic or recurrent headaches are frequently misdiagnosed as sinus headache and receive unnecessary sinusitis treatment and sinus graphy.     

Sincerity of effort versus feigned movement control of the cervical spine in patients with whiplash-associated disorders and asymptomatic persons: a case–control study

Abstract

Study design: Cross-sectional design. Objectives: To investigate whether the Fly Test can be used to differentiate patients with whiplash-associated disorders (WAD) from asymptomatic persons who deliberately feign symptoms and from WAD patients exaggerating symptoms. Background: The lack of valid clinical tests makes it difficult to detect a justifiable cause for compensation claims in traumatic neck-pain disorders. Methods: The Fly Test recorded the accuracy of neck movements in patients with WAD (n?=?34) and asymptomatic persons (n?=?31). The participants followed a moving “Fly” on a computer screen with a cursor from sensors mounted on the head. Two conditions were tested, sincere versus feigned efforts. In the former, the participants moved their neck as accurately as possible. In the latter, a short text was presented describing a fictitious accident (asymptomatic group) or imagining more intense pain/suffering (WAD group), and the test was performed as affected by these more serious conditions. Amplitude accuracy (AA), time on target (ToT) and jerk index (JI) were compared across patterns, conditions and groups. Results: The sincere effort in the WAD group was significant compared to the feigned effort of the asymptomatic group (p?<?0.001). For AA, correct categorization of 81.5% of the performances was made, where a mean score above 5.5?mm differentiated feigned versus sincere efforts in asymptomatic and WAD groups (sensitivity 79.4%, specificity 67.7%). For ToT, score above 11% indicated correctly categorized WAD patients (sensitivity 82.4%, specificity 64.5%). Conclusion: The Fly Test can provide clinicians a clue when patients with mild to moderate pain/disability are feigning or exaggerating symptoms.     

Serum tau protein elevation in migraine: a cross-sectional case–control study

Background

Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood.

Objective

A systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL.

Methods

Embase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized.

Results

A total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies).

The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies.

Conclusion

There is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.

     

Metabolic factors and oxidative stress in osteoarthritis: a case–control study

Previous studies suggest that metabolic disturbances might be involved in the development of osteoarthritis (OA). Associations have been found between the individual components of metabolic syndrome (MetS) and OA. MetS has been associated with increased oxidative stress (OxS). The study aimed to clarify the role of MetS components in OA and to evaluate the levels of OxS in OA patients and in age-matched controls. Fifty-five patients with end-stage OA (age 63?±?7 years) prior to hip or knee joint replacement surgery and 55 age-, gender- and body mass index matched controls (61?±?8 years) were enrolled in the study. Serum levels of glucose, insulin, c-peptide, cholesterols and OxS markers were recorded. Homeostasis model assessment for insulin resistance was used as the proxy measure of insulin resistance. Radiographic severity was assessed using the Kellgren–Lawrence score. The OA patients had higher total peroxide concentration and oxidative stress index [488 (250–612) μmol/L vs. 326 (168–442) μmol/L, p?=?.011 and 34 (17–51) vs. 20 (11–28), p?=?.002, respectively] and decreased total antioxidant capacity (1.49?±?0.27 vs. 1.66?±?0.27?mmol trolox equivalent/L, p=?.008) compared with the controls. In addition, OA group had significantly higher level of C-peptide compared with the controls [1.8 (0.94–2.47) vs. 1.3 (0.46–1.42) ng/mL, p?<?.001, respectively]. Furthermore, OA radiographic severity was independently associated with LDL-cholesterol (p?=?.007) and oxidized LDL (p?=?.022). This study demonstrates that end-stage OA patients have increased levels of OxS and decreased antioxidant capacity. OA is associated with impaired lipid metabolism and dysglycemia. Our results underline the importance OxS and metabolic disturbances in the pathogenesis of OA.     

Troponin release following endurance exercise: is inflammation the cause? a cardiovascular magnetic resonance study

Background

The aetiology and clinical significance of troponin release following endurance exercise is unclear but may be due to transient myocardial inflammation. Cardiovascular magnetic resonance (CMR) affords us the opportunity to evaluate the presence of myocardial inflammation and focal fibrosis and is the ideal imaging modality to study this hypothesis. We sought to correlate the relationship between acute bouts of ultra endurance exercise leading to cardiac biomarkers elevation and the presence of myocardial inflammation and fibrosis using CMR.

Methods

17 recreation athletes (33.5 +/- 6.5 years) were studied before and after a marathon run with troponin, NTproBNP, and CMR. Specific imaging parameters to look for inflammation included T2 weighted images, and T1 weighted spin-echo images before and after an intravenous gadolinium-DTPA to detect myocardial hyperemia secondary to inflammation. Late gadolinium imaging was performed (LGE) to detect any focal regions of replacement fibrosis.

Results

Eleven of the 17 participant had elevations of TnI above levels of cut off for myocardial infarction 6 hrs after the marathon (0.075 +/- 0.02, p = 0.007). Left ventricular volumes were reduced post marathon and a small increase in ejection fraction was noted (64+/- 1% pre, 67+/- 1.2% post, P = 0.014). Right ventricular volumes, stroke volume, and ejection fraction were unchanged post marathon. No athlete fulfilled criteria for myocardial inflammation based on current criteria. No regions of focal fibrosis were seen in any of the participants.

Conclusion

Exercise induced cardiac biomarker release is not associated with any functional changes by CMR or any detectable myocardial inflammation or fibrosis.     

Migraine with aura: visual disturbances and interrelationship with the pain phase. Vågå study of headache epidemiology

In the Vågå study of headache epidemiology, 1838 or 88.6% of the available 18–65-year-old inhabitants of the commune were included. Everyone was questioned and examined personally by the principal investigator (OS). There were 178 cases of various types of visual disturbances during the migraine attack, which corresponds to 9.7% of the study group. The prevalence among females was 11.9% and among males 7.4%; female/male ratio was 1.70, as against 1.05 in the total Vågå study population. By far the most frequently occurring visual disturbance pattern was (A) 1. Visual disturbances → 2. pain-free interlude → 3. pain phase (in 78% of the cases). Other frequent patterns were: (B). Visual disturbances, but no pain phase (24%); and: (C) 1. Pain phase → 2. visual disturbances (23%). Evidently, in the solitary case, there might be more than one visual disturbance pattern. The most frequently occurring solitary visual disturbances were: scintillating scotoma (62%) and obscuration (33%); but also more rare ones were identified, like anopsia, autokinesis (movement of stationary objects), tunnel vision and micropsia. Among the non-visual aura disturbances, paraesthesias and speech disturbances were the most frequent ones. The prevalence of migraine with aura seemed to be considerably higher than in similar studies. This also includes studies that have been carried out with a face-to-face interview technique.     

A case of a GH–producing pituitary adenoma associated with a unilateral headache with autonomic signs

A 66–year–old man suffered from a drug–resistant, leftsided headache with autonomic signs, triggered by the supine position. The acromegalic facies initially suggested a possible increase in basal plasma levels of GH, but routine haematological controls excluded abnormal values of GH. Cerebral and facial CT scan and MRI did not detect any alterations in the nasal sinuses, except for a mucous cyst. Surgical ablation of the cyst did not alleviate the pain. Further endocrinological tests demonstrated an increase of IGF–1 (somatomedin C), and another MRI scan of the sellar region confirmed the presence of a pituitary macroadenoma on the left paramedian side. After an initial improvement of the symptomatology due to trans–sphenoidal ablation of a benign GH–producing macroadenoma, the headache worsened again. Pain was well correlated with the increased plasma levels of IGF–1. The patient died suddenly for myocardial infarct.     

In vivo magnetic resonance imaging of endogenous neuroblasts labelled with a ferumoxide–polycation complex

Neurogenesis occurs at the subependymal zone (SEZ) of the adult brain. Neural progenitor cells give rise to neuroblasts, which migrate to the olfactory bulb (OB) via the rostral migratory stream (RMS). Development of methods capable of labelling and tracking these cells in vivo would be of great benefit to the understanding of neuroblast migration away from the SEZ under normal and pathological conditions. In this study, we demonstrate that endogenous neuroblasts can be labelled in vivo with an MRI contrast agent and that they can be visualised using MRI. We compared two labelling strategies: intraventricular injection of the ferumoxide Endorem, with or without the transfection agent protamine sulphate. Administration of Endorem alone resulted in its distribution outside of the ventricle and into the periventricular space after 48 h. In contrast, we observed that intraventricular injection of Endorem complexed to protamine sulphate – forming the FePro complex – is restricted to the ventricular walls after 48 h. The FePro complex successfully labelled Doublecortin⁺ neuroblasts in vivo up to 28 days post-injection. FePro-labelled neuroblasts in the RMS could be visualised using MRI in vivo and ex vivo on a 2.35 T MRI system, and FePro-labelled cells were identified in the OB on a 9.4 T MRI system. This study demonstrates the feasibility of in vivo imaging of endogenous neuroblast migration using MRI.     

Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study

Objective Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii. Design Pairwise, retrospective exposed–unexposed study. Setting Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia). Patients Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy. Interventions Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously. Measurements and results Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5 ± 3.8 days (range 5–22 days) with colistin and 8.9 ± 2.8 days (range 5–20 days) with imipenem (p = 0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p = 0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure. Conclusions We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.