Three-dimensional echocardiographic measurement of left and right ventricular mass and volume: in vitro validation

Introduction: Three-dimensional (3D) echocardiography has been shown to offer highly accurate measurements of left ventricular (LV) volume and mass. The present study evaluated the accuracy of 3D surface reconstruction by the piecewise smooth subdivision method in measuring volume and mass not only in the LV but also in the more complexly shaped right ventricle (RV). Methods: 3D echo scans were obtained of in vitro LV's (n = 15) and RVs (n = 10). From digitized images, ventricular borders were traced and used in surface reconstructions. Mass and volume determined from the reconstructions were compared to true volume and mass determined prior to imaging. Additionally casts of two RVs were made and laser-scanned. Distances between the laser-identified points on the RV surface and the corresponding 3D echo reconstructions were measured. Results: 3D LV volume agreed well with the true volume (y = 0.99x + 1.73, r = 0.99, SEE = 3.35 ml, p < 0.0001), as did 3D LV mass (y = 0.99x – 4.71, r = 0.99, SEE = 9.85 g, p < 0.0001). 3D RV volume overestimated true volume (y = 1.11x + 1.77, r = 0.99, SEE = 3.36 ml, p < 0.001) by 6.23 ± 3.70 ml (p < 0.0001). 3D mass agreed well with RV mass (y = 0.78x + 17.32, r ² = 0.93, SEE = 3.54 g, p < 0.0001). 3D echo reconstructions matched the laser-scanned RV closely with residual distances of 1.1 ± 0.9 and 1.4 ± 1.2 mm, respectively. Conclusions: 3D echo using freehand scanning combined with surface reconstruction by the piecewise smooth subdivision surface method enables accurate determination of LV mass and volume, of RV mass and volume, and of the RV's complex shape.     

Automated Emergency Ventilation Devices in a Simulated Unprotected Airway

Background: Automated ventilation devices are becoming more popular for emergency ventilation, but there is still not much experience concerning the optimal ventilation mode. Methods: In a bench model representing a non-intubated patient in respiratory and cardiac arrest, we compared a pressure-cycled with a time- and volume-cycled automated ventilation device in their completely automated modes. The main study endpoints were inspiratory time, respiratory rate, stomach inflation, and lung tidal volumes. Results: The pressure-cycled device inspired for 6.7 s in the respiratory arrest setting (respiratory rate 5.6/min), and never reached its closing pressure in the cardiac arrest setting (respiratory rate 1 breath/min). The time- and volume-cycled device inspired in both settings for 1.7 s (respiratory rate 13 breaths/min). In the respiratory arrest setting, mask leakage was 620 ± 20 mL for the pressure-cycled device vs. 290 ± 10 mL for the time- and volume-cycled device (p < 0.0001); lung tidal volume was 1080 ± 50 mL vs. 490 ± 20 mL, respectively (p < 0.0001); and there was no stomach inflation for either device. In the cardiac arrest setting, pressure-cycled device mask leakage was 5460 ± 60 mL vs. 240 ± 20 mL (p < 0.0001) for the time- and volume-cycled device (p < 0.0001); stomach inflation was 13,100 ± 100 mL vs. 90 ± 10 mL, respectively (p < 0.0001); and lung tidal volume 740 ± 60 mL vs. 420 ± 20 mL, respectively (p < 0.0001). Conclusion: In a simulated respiratory arrest setting, ventilation with an automated pressure-cycled ventilation device resulted in lower respiratory frequency and larger tidal volumes compared to a time- and volume-cycled device. In a simulated cardiac arrest setting, ventilation with an automated pressure-cycled ventilation device, but not a time- and volume-cycled device, resulted in continuous gastric insufflation.     

Advantage of Optimizing V‐V Timing in Cardiac Resynchronization Therapy Devices

Background: There is little consensus as to the benefits of interventricular (V‐V) timing optimization in cardiac resynchronization therapy (CRT). A variety of parameters are currently used to optimize device timing. This study was designed to investigate the potential advantage of using 3D ejection fraction (EF) and aortic velocity‐time integral (VTI) as measures of global left ventricular (LV) function to optimize ventricular activation in CRT devices. Methods: Seventy‐four patients seen in the Optimization Clinic with adequate echocardiographic images were included. Three aortic VTI and two 3D EF values were recorded at five V‐V settings and the average value used. Aortic VTI and 3D EF were classified as the best, worst, and simultaneous setting values. Data were analyzed using a two‐tailed paired t‐test. Results: Comparing the best to worst V‐V timing settings, VTI improved by 4.7 ± 7.5 cm (P < 0.0001) and 3D EF by 9.9%± 5.7% (P < 0.0001). Comparing the simultaneous setting to the best V‐V timing setting, VTI improved by 2.4 ± 2.1 cm (P < 0.0001) and 3D EF by 3.8%± 4.9% (P < 0.0001). Aortic VTI improved in 85% of patients and 3D EF improved in 72%. However, only 26% of the patients had the same optimal setting using aortic VTI and 3D EF yielding an r² value of 0.003. Conclusions: Individualized echocardiographic V‐V optimization of CRT devices improves global LV function as measured by aortic VTI and 3D EF. Substantial differences in function were seen over an 80‐ms range of V‐V timing and optimization resulted in improved LV function in the majority of patients. (PACE 2010; 33:1161–1168)     

Cardiac magnetic resonance imaging in patients undergoing percutaneous mitral valve repair with the MitraClip system

Background

Percutaneous mitral valve repair (MVR) with the MitraClip^® system in patients with mitral regurgitation (MR) is known to reduce symptoms and to improve cardiac morphology and function. MitraClip has been approved for cardiac magnetic resonance imaging (MRI). To date, however, no systematic analysis exists on cardiac MRI in patients undergoing the MitraClip procedure.

Objective

The aim of this study was to (1) prove feasibility and robustness of cardiac MRI and (2) visualize effects of the procedure on cardiac morphology and function by cardiac MRI.

Methods

27 consecutive patients (age 77.5 ± 7.6 years) with symptomatic moderate to severe MR undergoing the MitraClip^® procedure were prospectively included. Cardiac MRI at 1.5 T was performed before and at 3 months after intervention. Cardiac morphology and function were evaluated using steady-state free precession (SSFP) cine sequences by assessment of left ventricular enddiastolic and endsystolic diameters (LVEDD, LVESD) and volumes (EDV, ESV), ejection fraction (LVEF) and stroke volume (SV), diameter of mitral annulus, and myocardial mass (MM). Planimetry of the left atrium (LA) was performed in identical slices in a four-chamber view.

Results

Around the clip an extinction artifact was observed which did not disturb the evaluation of cardiac morphology and function. At follow-up, we observed significant decreases of LVEDD (58.0 to 53.3 mm, p < 0.0001), EDV (167 to 159 mL, p = 0.0006) and ESV (101 to 89 mL, p < 0.0001), diameter of mitral annulus (41.4 to 37.9 mm, p < 0.0001), myocardial mass (148.4 to 144.5 g, p = 0.0004) and LA size (40.2 to 37.6 cm², p < 0.0001). LVEF improved (43.3 to 46.7 %, p = 0.0041).

Conclusions

Cardiac MRI is feasible and robust in patients with MitraClips. The clinical benefit of a successful MitraClip intervention is paralleled by significant improvements of cardiac morphology and function which can be monitored and validated using MRI in clinical follow-up examinations.     

Effect of warm and cold applications on the resolution of IV infiltrations

Differences in pain intensity, surface area measurements of induration and erythema, and interstitial fluid volume when warm versus cold applications were randomly made to an intentional intravenous infiltrate of 5 mL of a designated solution were examined. Three solutions were used: 0.5 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). Differences in volume were determined by magnetic resonance imaging (MRI) at three intervals postinfiltration. The sample was 18 healthy adults between 20 and 45 years. There was no difference in remaining infiltrate when 0.5 saline or normal saline were used, but a significant (p < 0.001) difference was found with 3% saline. For all solutions there was a significant (p < 0.001) difference in the volume of infiltrate remaining when warmth was applied and this effect held across MRI readings and solutions. Pain intensity did not differ by treatment but a significant (p < 0.005) difference was found by solution, with 3% saline producing the greatest difference. Erythema was absent with all solutions. Surface induration was affected by solution and decreased over time (p = 0.001). There was no effect of warmth or cold on surface area induration. © 1993 John Wiley & Sons, Inc.     

Impact of serum levels of lipoprotein lipase,hepatic lipase,and endothelial lipase on the progression of coronary artery disease

PurposeThe purpose of this study was to investigate the relationship between serum levels of lipoprotein lipase (LPL), hepatic lipase (HL), and endothelial lipase (EL) and the progression of coronary artery disease (CAD).Materials and methodsAccording to the inclusion criteria, exclusion criteria, diagnostic criteria, angiography results, and the random matching scheme, the enrolled patients were divided into the following two groups: the progression-free group (n = 47) and the progression group (n = 15). The baseline characteristics and various biochemical parameters were obtained from the medical records and medical history. Serum LPL, HL, and EL levels were detected by ELISA. The correlation between serum LPL, HL, and EL levels and coronary lesions was statistically analyzed with SPSS software.ResultsSignificant differences were observed in serum levels of HL and EL between the progression-free group and the progression group (HL, 75.5 ± 39.2 ng/mL vs. 125.1 ± 42.1 ng/mL, P < 0.05; EL, 139.2 ± 59.6 pg/mL vs. 175.1 ± 40.1 pg/mL, P < 0.05), while the difference in the LPL level was not significant (P > 0.05). Receiver operating characteristic curve (ROC) analysis showed that the area under the curve (AUC) values of LPL, HL, and EL were 0.506 (95% CI: 0.369–0.642, P = 0.9470), 0.792 (95% CI: 0.664–0.888, P < 0.0001), and 0.693 (95% CI: 0.553–0.811, P = 0.0095), respectively. Additionally, logistic regression analysis showed that the serum level of HL was an independent risk factor for coronary artery lesion progression.ConclusionSerum levels of EL and HL, but not the serum level of LPL, were positively correlated with the progression of CAD. The serum level of HL was an independent risk factor for the progression of CAD, while the serum level of EL or LPL was not an independent risk factor for the progression of CAD. For the diagnosis of CAD progression, the serum level of HL was better than the serum level of EL or LPL.     

Compensated hepatitis C: unenhanced MR imaging correlated with pathologic grading and staging

Abstract Background We prospectively examined unenhanced MR imaging findings in relation to pathologic fibrosis, inflammation and steatosis in patients with compensated chronic hepatitis C viral infection (HCV). Methods Unenhanced MRI at 1.5 T was obtained within one month of core liver biopsy in 64 consecutive candidates for antiviral therapy for compensated HCV. Two pathologists independently graded inflammatory activity index (HAI) and steatosis, and staged fibrosis (grades 0–6). Morphologic MRI findings of cirrhosis, periportal lymph nodes, and MR fat signal ratio from dual gradient echo images were assessed independently by two radiologists blinded to clinical data. MRI and laboratory liver function results were correlated with pathologic results, using Spearman correlation coefficient and stepwise multiple regression. Results MR fat signal ratio correlation coefficient with pathologic steatosis was 0.71 (p < 0.0001). Coefficients with fibrosis stage were highest for surface nodularity (r _s = 47, p < 0.0001) and expanded gallbladder fossa (r _s = 0.42, p = 0.0006). Coefficients with HAI were highest for lymph node size (r _s = 0.355, p = 0.0040), surface nodularity (r = 0.47, p < 0.0001), expanded gallbladder fossa (r = 0.332, p = 0.0073), and caudate/right lobe ratio (r = 0.326, p = 0.0110). Combined lab and MRI variables provided the best prediction of fibrosis stage (r ² = 0.656) and HAI (r ² = 0.597). Conclusions A combination of MRI and laboratory findings was most predictive of fibrosis and inflammation.     

腹腔镜胆囊切开取石术中圈套器套扎胆囊壁切口法与丝线缝合胆囊壁切口法的临床疗效对比

目的 比较腹腔镜胆囊切开取石术中圈套器套扎胆囊壁切口法与丝线缝合胆囊壁切口法的临床疗效。方法 回顾性分析同济大学附属东方医院胆石中心2020年1月-2022年1月收治的206例胆石病患者的临床资料,按照手术方式分为圈套组（n=86）和缝合组（n=120）,对比两组患者手术情况、手术并发症情况和术后胆囊恢复情况。结果 所有患者顺利完成手术,圈套组手术时间较缝合组短[（19.98±2.31）和（34.97±2.21） min],差异有统计学意义（P <0.01）。圈套组术中出血量较缝合组少[（5.29±1.00）和（16.98±2.17） mL],差异有统计学意义（P <0.01）;两组患者住院时间[（2.28±0.75）和（3.46±0.66） d]比较,差异有统计学意义（P <0.01）。两组患者手术并发症比较,差异无统计学意义（P> 0.05）,圈套组术后无胆囊内血凝块形成和胆囊急性炎症发生。两组患者术后胆囊结石复发率比较,差异无统计学意义（P> 0.05）。圈套组术前与术后的胆囊排空率和胆囊壁厚度比较,差异无统计学意义（P> 0.05）。结论圈套...     

The accuracy of transrectal ultrasound prostate volume estimation: Clinical correlations

Sonographic estimates of prostate volume have been applied to the diagnosis and management of prostate cancer. However, we have observed wide variation between transrectal sonographic estimates of prostate volume (TRUS-V) and the corresponding volumes of unfixed radical prostatectomy specimens (P-V). Because TRUS-V may influence the management of men with prostate disease, the relationship between TRUS-V and P-V was characterized for 100 consecutive men undergoing a radical retropubic prostatectomy (RRP). For the entire cohort, TRUS-V (35.9 ± 16.9 mL) underestimated P-V (45.4 ± 22.9 mL, p < .01). Mean signed percentage error between TRUS-V and P-V was − 16 ± 32%. The relationship of TRUS-V to P-V was volume dependent (p < .001). For volumes (P-V) <30 mL, TRUS-V overestimated P-V. For volumes (P-V) >30 mL, TRUS-V increasingly underestimated P-V. In summary, transrectal ultrasound estimates of prostate volumes differ significantly from the volume of unfixed RRP specimens. The direction and magnitude of TRUS-V error is volume dependent. Applied clinically, treatment paradigms employing prostate-volume-dependent management algorithms derived from nonuniform methods of volume estimation may not accurately reflect volume nomograms derived from uniform methods of measurement, and thus alter patient management. © 1996 John Wiley & Sons, Inc.     

High-density lipoprotein subfractions and influence of endothelial lipase in a healthy Turkish population: A study in a land of low high-density lipoprotein cholesterol

Abstract

Purpose. Low concentration of high-density lipoprotein (HDL) is prevalent in Turkey. Endothelial lipase (EL) regulates lipoprotein metabolism. Small, lipid-poor HDL particles represent more-efficient cholesterol acceptors than their large, lipid-rich counterparts. The aim of this study was to investigate HDL subfractions and the effect of EL on HDL concentrations in healthy Turkish population. Methods. 102 healthy subjects were included in the study (mean age 33.6 ± 10.3 years, 42 female). HDL subfractions were assayed by single precipitation method and EL concentrations were measured by competitive enzyme immunoassay. Results. Mean HDL concentrations were 1.45 ± 0.37 mmol/L in women, 1.10 ± 0.30 mmol/L in men. Small HDL subfraction levels did not differ statistically between < 1 mmol/L and ≥ 1.6 mmol/L total HDL groups. Small HDL was not correlated with EL, low density lipoprotein cholesterol (LDL), triglyceride (TG) and age but positively correlated with total cholesterol and HDL (r = 0.2, p = 0.017; r = 0.2, p = 0.028, respectively). Large HDL was not correlated with age, EL and total cholesterol, and negatively correlated with HDL, LDL, TG (r = ? 0.7, p < 0.001; r = ? 0.2, p = 0.045; r = ? 0.3, p < 0.001, respectively). If subjects were divided into two groups as HDL< 1 mmol/L and HDL > 1.6 mmol/L, mean EL concentrations were 475.83 ± 521.77 nmol/L and 529.71 ± 276.92 nmol/L, respectively (p = 0.086). Conclusion. There were no differences between small HDL concentrations in the HDL low and high groups. Our data did not support EL to be the reason for low HDL in a healthy Turkish population. Our results in a healthy population may serve as a reference for clinical studies on HDL subfractions.     

Soluble receptor for advanced glycation end products predicts 28-day mortality in critically ill patients with sepsis

Abstract

Objective. Multiple biomarkers are used to assess sepsis severity and prognosis. Increased levels of the soluble receptor for advanced glycation end products (sRAGE) were previously observed in sepsis but also in end-organ injury without sepsis. We evaluated associations between sRAGE and (i) 28-day mortality, (ii) sepsis severity, and (iii) individual organ failure. Traditional biomarkers procalcitonin (PCT), C-reactive protein (CRP) and lactate served as controls. Methods. sRAGE, PCT, CRP, and lactate levels were observed on days 1 (D1) and 3 (D3) in 54 septic patients. We also assessed the correlation between the biomarkers and acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and acute heart failure. Results. There were 38 survivors and 16 non-survivors. On D1, non-survivors had higher sRAGE levels than survivors (p = 0.027). On D3, sRAGE further increased only in non-survivors (p < 0.0001) but remained unchanged in survivors. Unadjusted odds ratio (OR) for 28-day mortality was 8.2 (95% CI: 1.02–60.64) for sRAGE, p = 0.048. Receiver operating characteristic analysis determined strong correlation with outcome on D3 (AUC = 0.906, p < 0.001), superior to other studied biomarkers. sRAGE correlated with sepsis severity (p < 0.00001). sRAGE showed a significant positive correlation with PCT and CRP on D3. In patients without ARDS, sRAGE was significantly higher in non-survivors (p < 0.0001) on D3. Conclusion. Increased sRAGE was associated with 28-day mortality in patients with sepsis, and was superior compared to PCT, CRP and lactate. sRAGE correlated with sepsis severity. sRAGE was increased in patients with individual organ failure. sRAGE could be used as an early biomarker in prognostication of outcome in septic patients.     

Gallbladder wall thickening in dengue hemorrhagic fever: An ultrasonographic study

This study attempts to investigate whether gallbladder wall thickening (GBWT) measured by ultrasonography can be used in children as a reliable criterion to predict the onset of severe dengue hemorrhage fever (DHF). In this prospective study, we performed ultrasound examinations focusing on the gallbladder wall and the presence of intraperitoneal free fluid in 48 mild DHF cases (grades I–II) and 48 severe cases (grades III–IV). GBWT varied between 1 mm and 8 mm with a mean of 3.77 mm ± 2.04 mm. The mean value of DHF grades I and II (2.39 mm ± 1.48 mm) is significantly lower than that of grades III and IV (5.14 mm ± 1.54 mm), p < 0.001. GBWT exceeded 3 mm in only 16 of 48 (33.3%) grade I–II patients and in 45 of 48 (93.8%) grade III–IV patients. A significant positive correlation was apparent between GBWT and the severity of illness, p < 0.001. Patients with ascites have significantly thicker gallbladder walls than those without, p < 0.01. In clinically confirmed DHF cases, the sonographic finding of GBWT >3 mm to 5 mm, with 93.8% sensitivity, can be used as a criterion indicating the need for admission and monitoring. A GBWT of ?5 mm, with 91.7% specificity, is useful as a criterion for identifying DHF patients at high risk of developing hypovolemic shock. © 1995 John Wiley & Sons, Inc.     

Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study

Aortic stenosis (AS) results in several left ventricular (LV) disturbances as well as progressive left atrial (LA) enlargement and dysfunction. Transcatheter aortic valve implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective, longitudinal study was to investigate the effects of TAVI on LA structure and function. We studied thirty-two patients with severe symptomatic AS who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up. Following TAVI, mean transvalvular gradient decreased (p < 0.001). Both LA area index and LA volume index decreased at 40-day follow-up (16.2 ± 6.4 vs. 12.5 ± 2.9 cm²/m², and 47.3 ± 12.0 vs. 42.8 ± 12.5 mL/m², respectively, p < 0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global peak atrial longitudinal strain (14.4 ± 3.9 vs. 19.1 ± 4.7 %, p < 0.001) and in global peak atrial contraction strain (8.4 ± 2.5 vs. 11.0 ± 4.1 %, p < 0.05) at 3-month follow-up. LA stiffness measurements significantly decreased 3 months after TAVI (0.93 ± 0.59 vs. 0.65 ± 0.37, respectively, p < 0.001). Trans-aortic mean gradient change and pre-procedural LA volume were identified as predictors of global peak atrial longitudinal strain increase (β = ?0.41, β = ?0.35, respectively, p < 0.0001) while pre-procedural LA volume and trans-aortic mean gradient change as predictor of LA volume index reduction 3 months after TAVI (β = ?0.37, β = ?0.28, respectively, p < 0.0001). TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is primarily determined by the severity of pre-procedural valve stenosis.     

Elevated plasmatic level of soluble IL-7 receptor is associated with increased mortality in septic shock patients

Purpose

Adjunctive immunoadjuvant therapies are now proposed in the treatment of septic patients that develop immune dysfunctions. However, a prerequisite is to identify patients at high risk of death that would benefit from such therapy. Knowing that rhIL-7 is a putative candidate for septic shock treatment, we evaluated the association between increased plasmatic level of soluble CD127 (sCD127, IL-7 receptor alpha chain) and mortality after septic shock.

Methods

sCD127 plasmatic level was measured in 70 septic shock patients sampled at day 1–2 (D1) and day 3–4 (D3) after the onset of shock and 41 healthy volunteers.

Results

Compared with survivors, non-survivors presented with significantly higher sCD127 concentrations at D1 and D3 (p < 0.001 and p = 0.002). At D1, the area under the receiver operating characteristic curve for sCD127 level association with mortality was 0.846 (p < 0.0001). Kaplan–Meier survival curves illustrated that mortality was significantly different after stratification based on D1 sCD127 level (log rank test, hazard ratio 9.10, p < 0.0001). This association was preserved in multivariate logistic regression analysis including clinical confounders (age, SAPS II and SOFA scores, odds ratio 12.71, p = 0.003). Importantly, patient stratification on both D1 sCD127 value and SAPS II score improved this predictive capacity (log rank test, p = 0.0001).

Conclusions

Increased sCD127 plasmatic level enables the identification of a group of septic shock patients at high risk of death. After confirmation in a larger cohort, this biomarker may be of interest for patient stratification in future clinical trials.     

经腋窝入路无充气腔镜下手术对早期甲状腺肿瘤患者免疫功能及美容效果的影响

目的 探讨经腋窝入路无充气腔镜下手术对早期甲状腺肿瘤患者免疫功能及美容效果的影响。方法 选取2019年5月-2021年6月该院收治的98例早期甲状腺肿瘤患者为研究对象,随机分为观察组和对照组,观察组(n=49)给予经腋窝入路无充气腔镜手术,对照组(n=49)给予开放性甲状腺肿瘤切除术。对比两组患者手术相关指标、淋巴结清除效果、免疫功能、并发症发生率及术后3个月美容效果。结果 观察组术中出血量为(12.27±4.53) mL,术后引流量为(78.25±19.36) mL,明显少于对照组的(23.71±6.86)和(136.24±45.28) m L (均P <0.05)。观察组手术时间为(110.16±11.57) min,明显长于对照组的(61.34±6.27) min (P <0.05)。观察组淋巴结清扫数目为(2.02±1.03)枚,与对照组的(1.98±1.05)枚比较,差异无统计学意义(P> 0.05)。术后1周,观察组CD3⁺为(56.84±5.06)%,CD4⁺为(33.72±4.08)%,明显高于对照组的(50...     

Effects of Tiotropium Combined with Theophylline on Stable COPD Patients of Group B,D and its Impact on Small Airway Function: A Randomized Controlled Trial

Introduction

Tiotropium bromide has been widely used in clinical practice, while theophylline is another treatment option for chronic obstructive pulmonary disease (COPD). However, only a few relevant studies have investigated the long-term outcomes and efficacy of both in patients with COPD. We evaluated the effects of tiotropium and low-dose theophylline on stable COPD patients of groups B and D.

Methods

Eligible participants (n?=?170) were randomized and received either tiotropium 18 µg once daily with theophylline 100 mg twice daily (Group I) or tiotropium 18 µg once daily (Group II) for 6 months. COPD assessment test (CAT), modified Medical Research Council (mMRC) dyspnea scores and pulmonary function tests were measured before randomization and during the treatment.

Results

After 6 months of treatment, the CAT scores in both groups decreased significantly (11.41?±?3.56 and 11.08?±?3.05, p?<?0.0001). The changes of CAT (p?=?0.028) and mMRC scores (p?=?0.049) between the two groups differed after 1 month of treatment. In Group I, forced expiratory flow after 25% of the FVC% predicted (MEF₂₅% pred) was significantly improved after 3 months (4.84?±?8.73%, p?<?0.0001) and 6 months (6.21?±?8.65%, p?<?0.0001). There was a significant difference in small airway function tests (MEF₅₀% pred, MEF₂₅% pred, and MMEF% pred) between the two groups after 6 month of treatment (p?=?0.003, p?<?0.0001, and p?=?0.021, respectively).

Conclusions

Tiotropium combined with low-dose theophylline significantly improved the symptoms and general health of patients with stable COPD of groups B and D after 6 months of follow-up. Additionally, this therapy also improved the indicators of small airway function.

Trial Registration

Chinese Clinical Trial Registry (Registry ID: ChiCTR1800019027).

     

True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging

Background Mitral annulus assessment is of great importance for the diagnosis and treatment of mitral valve disease. The present study sought to assess the value of real-time three-dimensional echocardiography for the assessment of true mitral annulus diameter (MAD). Methods One hundred and fifty patients (mean age 38 ± 18 years) with adequate two-dimensional (2D) echocardiographic image quality underwent assessment of MAD_2D and MAD_3D (with real-time three-dimensional echocardiography). In a subgroup of 30 patients true MAD was validated with magnetic resonance imaging (MRI). Results There was a good interobserver agreement for MAD_2D (mean difference = −0.25 ± 2.90 mm, agreement: −3.16, 2.66) and MAD_3D (mean difference = 0.29 ± 2.03, agreement = −1.74, 2.32). Measurements of MAD_2D and MAD_3D were well correlated (R = 0.81, P < 0.0001). However, MAD_3D was significantly larger than MAD_2D (3.7 ± 0.9 vs. 3.3 ± 0.8 cm, P < 0.0001). In the subgroup of 30 patients with MRI validation, MAD_3D and MAD_MRI were significantly larger than MAD_2D (3.3 ± 0.5 and 3.4 ± 0.5 cm vs. 2.9 ± 0.4 cm, both P < 0.001). There was no significant difference between MAD_MRI and MAD_3D. Conclusion MAD_3D can be reliably measured and is superior to MAD_2D in the assessment of true mitral annular size.     

CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination

Purpose

To objectively compare the volume, density, and distribution of luminal fluid for same-day oral-contrast-enhanced CTC following incomplete optical colonoscopy (OC) vs. deferred CTC on a separate day utilizing a dedicated CTC bowel preparation.

Methods

HIPAA-compliant, IRB-approved retrospective study compared 103 same-day CTC studies after incomplete OC (utilizing 30 mL oral diatrizoate) against 151 CTC examinations performed on a separate day after failed OC using a dedicated CTC bowel preparation (oral magnesium citrate/dilute barium/diatrizoate the evening before). A subgroup of 15 patients who had both same-day CTC and separate-day routine CTC was also identified and underwent separate analysis. CTC exams were analyzed for opacified fluid distribution within the GI tract, as well as density and volume. Data were analyzed utilizing Kruskal–Wallis and Wilcoxon Signed Rank tests.

Results

Opacified luminal fluid extended to the rectum in 56% (58/103) of same-day CTC vs. 100% (151/151) of deferred separate-day CTC (p < 0.0001). For same-day CTC, contrast failed to reach the colon in 11% (11/103) and failed to reach the left colon in 26% (27/103). Volumetric colonic fluid segmentation for fluid analysis (successful in 80 same-day and 147 separate-day cases) showed significantly more fluid in the same-day cohort (mean, 227 vs. 166 mL; p < 0.0001); the actual difference is underestimated due to excluded cases. Mean colonic fluid attenuation was significantly lower in the same-day cohort (545 vs. 735 HU; p < 0.0001). Similar findings were identified in the smaller cohort with direct intra-patient CTC comparison.

Conclusions

Dedicated CTC bowel preparation on a separate day following incomplete OC results in a much higher quality examination compared with same-day CTC.

     

Quantification of mitral valve regurgitation with color flow Doppler using baseline shift

Vena contracta width (VCW) and effective regurgitant orifice area (EROA) are well established methods for evaluating mitral regurgitation using transesophageal echocardiography (TEE). For color-flow Doppler (CF) measurements Nyquist limit of 50–60 cm/s is recommended. Aim of the study was to investigate the effectiveness of a baseline shift of the Nyquist limit for these measurements. After a comprehensive 2-dimensional (2D) TEE examination, the mitral regurgitation jet was acquired with a Nyquist limit of 50 cm/s (NL50) along with a baseline shift to 37.5 cm/s (NL37.5) using CF. Moreover a real time 3-dimensional (RT 3D) color complete volume dataset was stored with a Nyquist limit of 50 cm/s (NL50) and 37.5 cm/s (NL37.5). Vena contracta width (VCW) as well as Proximal Isovelocity Surface Area (PISA) derived EROA were measured based on 2D TEE and compared to RT 3D echo measurements for vena contracta area (VCA) using planimetry method. Correlation between VCA 3D NL50 and VCW NL50 was 0.29 (p < 0.05) compared to 0.6 (p < 0.05) using NL37.5. Correlation between VCA 3D NL50 and EROA 2D NL50 was 0.46 (p < 0.05) vs. 0.6 (p < 0.05) EROA 2D NL37.5. Correlation between VCA 3D NL37.5 and VCW NL50 was 0.45 (p < 0.05) compared to 0.65 (p < 0.05) using VCW NL37.5. Correlation between VCA 3D NL37.5 and EROA 2D NL50 was 0.41 (p < 0.05) vs. 0.53 (p < 0.05) using EROA 2D NL37.5. Baseline shift of the NL to 37.5 cm/s improves the correlation for VCW and EROA when compared to RT 3D NL50 planimetry of the vena contracta area. Baseline shift in RT 3D to a NL of 37.5 cm/s shows similar results like NL50.     

Intra-procedural imaging of the left atrium and pulmonary veins with rotational angiography: a comparison of anatomy obtained by pre-procedural cardiac computed tomography and trans-thoracic echocardiography

This study evaluated the feasibility and accuracy of three-dimensional rotational angiography (3DRA) to determine the anatomy of the left atrium (LA) and pulmonary veins (PVs) compared with cardiac computed tomography (CCT) and trans-thoracic echocardiography (TTE). One hundred two patients (56.1 ± 9.9 years, 86 males) with an indication for atrial fibrillation ablation were prospectively enrolled. Intra-procedural 3DRA was performed with power injected contrast medium (20 cc/s for 4 s, 240°) in the LA. 3DRA images of the LA and PVs were assessed qualitatively and then compared quantitatively. LA volume measured by 3DRA, CCT and TTE were compared. The majority of 3DRA acquisitions were optimal in delineating the right-side LA–PV (95 % for right superior PV and 96 % for right inferior PV) and left inferior PV anatomy (91 %), whereas it was optimal in only 63 % of left superior PV and 73 % of the LA appendage. The circumferences of PV ostia identified by 3DRA and CCT were correlated in four PVs (r = 0.57 for right superior PV, r = 0.67 for right inferior PV, r = 0.60 for left superior PV, and r = 0.52 for left inferior PV, p < 0.001). The mean LA volume measured by 3DRA (120 ± 32 mL) was greater than that found by CCT (109 ± 35 mL) or TTE (64 ± 23 mL), but the 3DRA LA volume measurements correlated well with those of CCT (r = 0.83, p < 0.001) and TTE (r = 0.69, p < 0.001). Intra-procedural 3DRA provided anatomical accuracy of LA and PVs comparable to those of CCT. However, optimal delineation of the left superior PV and LA appendage was limited. The LA volume determined by 3DRA was well correlated with those of CCT and TTE, despite different absolute values of each.