Associations of early-life adversities with inflammatory profiles in midlife: evidence from two cohorts in the UK and USA

Background

Inflammation is one hypothesised mechanism by which early-life adversities (ELAs) impact adult health. In cohorts from the UK and USA, we aimed to establish associations between ELAs and adult inflammation, and whether adult adiposity or socioeconomic disadvantage are key intermediaries.

The inter-observer reliability is very low at clinical examination of parastomal hernia

Introduction  

Parastomal hernia in patients with a permanent colostomy is common. The aim of this study was to evaluate the reliability of the diagnosis based on clinical examination and to compare this examination with the result of a specially designed questionnaire and computerised tomography (CT) scan.     

Differences in clinical characteristics and chest CT findings between severe and critical H1N1 pneumonia

Introduction

Critical H1N1 pneumonia patients usually have one of the symptoms such as respiratory failure, septic shock, multiple organ dysfunction, or other need for intensive care management, which are associated with high risk of mortality. It is essential to differentiate the severity of H1N1 pneumonia and take corresponding target treatments.

Objectives

We aim to investigate the differences in clinical characteristics and chest computed tomography (CT) findings between severe and critical patients with H1N1 pneumonia.

Methods

A total of 27 patients diagnosed with H1N1 pneumonia from October 2018 to March 2019 were retrospectively analyzed, and the differences in clinical manifestations, laboratory tests, and chest CT findings between the severe group (15 patients) and the critical group (12 patients) were compared.

Results

Frequency of dyspnea at rest was higher in critical group than that in severe group (P = 0.019). The neutrophil percentage was higher (P = 0.014) and the lymphocyte percentage was lower (P = 0.025) in critical compared with severe group. Bilateral lung involvement was the predominant pattern in both severe and critical patients, whereas the number of involved lobes in critical patients was more than that in severe patients (P = 0.024). Peripheral distribution was the predominant pattern in severe patients (40%), whereas more diffuse involvement of the lungs was observed in critical patients (83.30%). Ground-glass opacities and consolidation were the main CT findings in both groups, and prevalence of consolidation was higher in critical relative to severe group (83.30%).

Conclusion

Compared with severe patients, those with critical H1N1 pneumonia were more likely to present with dyspnea at rest and decreased lymphocyte percentage. Chest CT showed that diffuse bilateral involvement and higher prevalence of consolidation are associated with critical outcomes.     

Clinical use conditions of lead deployment and simulated lead fracture rate in left bundle branch area pacing

Introduction

Left bundle branch area pacing (LBBAP) is achieved by advancing the lead tip deep in the septum. Most LBBAP implants are performed using the Medtronic SelectSecure™ MRI SecureScan™ Model 3830 featuring a unique 4 Fr fixed helix lumenless design. Details of lead use conditions and long-term reliability have not been reported. This study was designed to quantify the mechanical use conditions for the 3830 lead during and after LBBAP implant, and to evaluate reliability using bench testing and simulation.

Methods

Fifty bradycardia patients with implantation of the 3830 lead for LBBAP were enrolled. Use conditions of lead deployment at implantation were collected and computed tomography (CT) scans were performed at 3-month follow-up. Curvature amplitude along the pacing lead was determined with CT images. Fatigue bending was performed using accelerated testing in a more severe environment than routine clinical use conditions. Conductor fracture rate in a simulated patient population was estimated based on clinical use conditions and fatigue test results.

Results

The number of attempts to place the 3830 lead for LBBAP was 2.1 ± 1.3 (range: 1–7) with 13 ± 6 lead rotations at the final attempt. Extreme implant conditions were simulated in bench testing with 5 applications of 20 turns followed by up to 400 million bending cycles. Reliability modeling predicted a 10-year fracture rate of 0.02%.

Conclusions

LBBAP implants require more lead rotations than standard pacing implants and result in unique lead bending. Application of simulated LBBAP use conditions to the 3830 lead in an accelerated in-vitro model does not produce excess conductor fractures. IMAGE-LBBP Study ID of ClinicalTrial.GOV: NCT04119323.     

Impact of four direct oral anticoagulants on rotational thromboelastometry (ROTEM)

Introduction

Rotational Thromboelastometry (ROTEM) is a point of care method used to monitor coagulation during surgery and to guide transfusion strategies in patients presenting with severe bleeding. The aim of our study was to determine the impact of four direct oral anticoagulants (DOACs) on 3 commonly used ROTEM tests.

Methods

Whole blood samples from 20 healthy donors were spiked in vitro with apixaban, edoxaban, rivaroxaban or dabigatran at 5 different plasma concentrations (0‐1000 ng/mL). EXTEM, INTEM and FIBTEM tests were systematically performed.

Results

There was a linear relationship between the increase in clotting time (CT) and plasma DOAC concentrations in both the EXTEM and INTEM tests. We found that the DOAC concentration required to double EXTEM CT was 1042 ± 225 ng/mL for apixaban, 134 ± 38 ng/mL for edoxaban, 176 ± 26 ng/mL for rivaroxaban and 284 ± 73 ng/mL for dabigatran. INTEM CT was less sensitive than EXTEM CT whatever the anticoagulant. EXTEM CT was above the normal range for 5 of 5 spiked samples when the plasma concentrations were ~1000 ng/mL for apixaban, ~100 ng/mL for edoxaban, ~200 ng/mL for rivaroxaban and ~200 ng/mL for dabigatran. Maximum Clot Firmness in EXTEM, INTEM and FIBTEM tests was not affected whatever the DOAC or its concentration.

Conclusion

This study found a DOAC dose‐dependent increase in ROTEM CTs. ROTEM tests were only poorly impacted by low levels of edoxaban, rivaroxaban or dabigatran. Apixaban had only a low effect even at high concentrations.     

Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma

Background  

Reports concerning the clinical usefulness of ¹⁸F 2-fluoro-2-deoxy-d-glucose integrated positron emission and computed tomography (¹⁸F-FDG PET-CT) for patients with gallbladder cancer and cholangiocarcinoma are relatively scarce. The purpose of this study was to assess the diagnostic value of PET-CT in relation to a conventional imaging modality, multidetector row CT (MDCT), for patients with gallbladder cancer and cholangiocarcinoma.     

Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort

Objectives

The aim of the study was to investigate the resting levels of novel cardiovascular biomarkers in common types of noncardiac syncope.

Design and setting

An observational study was conducted including 255 patients (mean age 60 years, range 15–93; 45% men) with unexplained syncopal attacks. Subjects underwent an expanded head‐up tilt test including carotid sinus massage, and nitroglycerin provocation if indicated. Using logistic regression, we explored the associations between specific diagnoses of syncope and resting levels of circulating biomarkers: C‐terminal pro‐arginine vasopressin (CT‐proAVP), C‐terminal endothelin‐1 precursor fragment (CT‐proET‐1), midregional fragments of pro‐atrial natriuretic peptide (MR‐proANP) and pro‐adrenomedullin (MR‐proADM).

Results

A total of 142 (56%) patients were diagnosed with vasovagal syncope (VVS), 85 (33%) with orthostatic hypotension (OH) and 47 (18%) with carotid sinus hypersensitivity (CSH); in addition, 74 (29%) patients had more than one diagnosis. Thirty‐five patients (14%) demonstrated a cardioinhibitory reflex. The probability of VVS was highest in the first quartile of MR‐proANP [Q1 vs. Q4: odds ratio (OR) 5.57, 95% confidence interval (CI) 1.86–16.74; P < 0.001] and CT‐proET‐1 (OR 7.17, 95% CI 2.43–21.13; P < 0.001). By contrast, the probability of OH was highest in the fourth quartile of CT‐proET‐1 (Q4 vs. Q1: OR 8.66, 95% CI 2.49–30.17; P < 0.001). Furthermore, CSH was most frequently observed in the first quartile of MR‐proANP (Q1 vs. Q4: OR 6.57, 95% CI 1.62–26.62; P = 0.008) among those over 60 years of age, whereas the cardioinhibitory reflex was strongly associated with low CT‐proET‐1 levels (Q1 vs. Q4: OR 69.7, 95% CI 6.97–696.6; P < 0.001). Moreover, in patients with VVS, a high concentration of CT‐proET‐1 was predictive of OH (OR per 1 SD 2.4, 95% CI 1.15–5.02; P = 0.02), whereas low CT‐proET‐1 suggested involvement of the cardioinhibitory reflex (OR per 1SD 0.42, 95% CI 0.25–0.70; P = 0.001).

Conclusions

The levels of MR‐proANP and CT‐proET‐1 are markedly changed in common forms of syncope, suggesting the involvement of novel neurohormonal mechanisms in syncopal attacks.     

Impact of FDG PET/CT in the staging and the follow-up of anal carcinoma

Purpose  

The purpose of the study was to assess the diagnostic performance of positron emission tomography/computed tomography and fluorodeoxyglucose (18F) (FDG PET/CT) for the staging and the follow-up of anal carcinoma, and to evaluate the impact of FDG PET/CT on patient management.     

The value of thoracic computed tomography scans in clinical diagnosis: A prospective study

BACKGROUND:

Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.

OBJECTIVE:

To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.

DESIGN:

A before and after survey of physicians who had ordered thoracic CT scans.

SETTING:

Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.

SUBJECTS:

Physicians who had ordered CT scans.

INTERVENTION:

Physicians completed a standard questionnaire before and after the CT scan result was available.

MEASUREMENTS:

Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.

RESULTS:

Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).

CONCLUSIONS:

The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.     

Prognostic value of coronary artery calcium and epicardial adipose tissue assessed by non-contrast cardiac computed tomography

Objective

Epicardial adipose tissue (EAT) accumulation is believed to be associated with development of coronary atherosclerosis. We investigated whether EAT volume as assessed by computed tomography (CT) has value in prediction of future cardiac events.

Methods

We studied 722 patients without proven coronary artery disease (CAD) who underwent non-contrast cardiac CT. EAT volume and coronary artery calcium (CAC) score were measured simultaneously. Patients were followed as to the occurrence of coronary events (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and late coronary revascularization ≥3 months after CT examination).

Results

During a 3.7 ± 1.7 years follow-up period, 37 coronary events were documented. Annual event rates increased across CAC score categories (0.3%, 1.0%, 2.4%, and 4.3%, in 0, 1–99, 100–399, and ≥400, respectively, p < 0.001); these were significantly higher in the higher EAT volume group (>median; 107.2 mL, 0.7% vs., 2.1%, adjusted hazard ratio; 2.65, p = 0.0090). Cox-proportional hazard analysis demonstrated that a combination of CAC score ≥ 100 and high EAT volume had a significantly higher event rate than CAC score < 100 and low EAT volume group (adjusted hazard ratio 11.6, p < 0.0001). Using Cox regression models, incremental prognostic values were identified by adding high EAT volume to clinical risks plus CAC score ≥ 100 (global χ², 6.7; p = 0.059).

Conclusion

We suggest that high EAT volume may be an independent predictor of future coronary events and increases predictive values of CAC score in patients without proven CAD.     

Growth rates of small abdominal aortic aneurysms assessed by computerised tomography – A systematic literature review

Background

Most current evidence examining abdominal aortic aneurysm (AAA) growth is based on ultrasound surveillance.

Objective

This review aimed to systematically analyse studies which have assessed small AAA growth using computed tomography (CT) to monitor outcome.

Method

Studies investigating small AAA expansion rates using CT images were identified by searching the PubMed database and hand searching article reference lists. Eligible studies must have focused on monitoring small AAA growth using CT and included patients with baseline AAA diameters <55 mm for which growth rates were reported.

Results

Ten studies including 845 patients met eligibility with average baseline AAA diameters ranging from 36.2 to 50.5 mm. AAA growth was assessed using axial (n = 1), orthogonal (n = 2), anterior to posterior (n = 4), and unspecified (n = 3) measurement methods. One study reported the reproducibility of their assessment method. Mean AAA diameter growth rates ranged from 2.6 to 5.2 mm/year. Factors reported to be associated with increased AAA expansion included: large AAA thrombus size (n = 3 studies), large baseline AAA diameter (n = 2), high AAA wall stress, elevated plasma concentration of matrix metalloproteinase-9 and presence of carotid artery disease (n = 1 study each). Factors reported to be negatively associated with AAA growth included presence of diabetes mellitus and chronic limb ischaemia (n = 1 study each).

Conclusion

Many currently reported studies assessing small AAA growth on CT fail to report consistent use of reproducible measurement methods. CT offers the opportunity to assess orthogonal diameter and perform central reading which could be an advantage of this form of imaging.     

Diagnostic relevance of simultaneous testing for <Emphasis Type="Italic">Chlamydia trachomatis</Emphasis> and <Emphasis Type="Italic">Neisseria gonorrhoeae</Emphasis>

Background  

The prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection in a Swiss cohort among individuals consulting for screening or symptomatic reasons is not very well known.     

Appropriateness and clinical outcome of chest computed tomography without intravenous contrast: A study conducted in Pakistan

Background

Chest computed tomography (CT), including high-resolution CT (HRCT), has become an integral part of modern healthcare. It enables the physician to arrive at a diagnosis using a noninvasive approach. Our practice has shown that various chest CT scans without intravenous (IV) contrast, including HRCT, have no proper clinical indication. For the same reason, we have assessed the appropriateness of chest CT without IV contrast based on the evidence-based American College of Radiology (ACR) appropriateness criteria.

CT signal heterogeneity of abdominal aortic aneurysm as a possible predictive biomarker for expansion

Objective

There is a need for prognostic biomarkers for risk assessment of small abdominal aortic aneurysm (AAA). Since CT textural analysis of tissue is a recognized feature of adverse biology and patient outcome in other diseases, we investigated it as a possible biomarker in small AAA.

Methods

Fifty consecutive patients (46-men, 4-woman, median-age 75y, range 56–85) with small AAA (3–5.5 cm) under surveillance undergoing serial ultrasound were prospectively recruited and assessed at baseline with CT texture analysis (CTTA) and ¹⁸F-Fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET). We followed forty patients (36-men, 4-woman, median-age = 74 y, range 60–85, participation rate = 80% for 1 year. For each axial image, CTTA using the filtration-histogram technique was carried out using a software algorithm that selectively extracts texture features of different coarseness (fine, medium and coarse) and intensity variation. Standard-deviation (SD) and kurtosis (K) at each feature-scale were measured. The maximum standardized uptake value (SUV_max) of ¹⁸F-FDG in each axial image of the AAA was also measured with corrections for blood pool ¹⁸F-FDG activity to assess AAA metabolic activity. Specificity, sensitivity, and c-statistics were calculated with 95% confidence intervals for prediction of significant AAA expansion (≥2 mm) by CTTA measures before and after adjusting for clinical variables.

Results

The median aneurysm expansion at 12 months was 2.0 mm, (IQR 0.0–4.0). Coarse texture SD correlated inversely with AAA SUV_max (r_s = −0.456, P = 0.003). Medium coarse texture K correlated significantly with future AAA expansion adjusted for baseline size (r_s = 0.343, P = 0.030). AAA SUV_max correlated inversely with AAA expansion corrected for baseline size (r_s = −0.383, P = 0.015). Medium texture K was a strong predictor of significant AAA expansion (area under the Receiver-operating-characteristic (ROC) curve was 0.813) after adjusting for clinical variables.

Conclusion

We have shown evidence that CT signal heterogeneity measurements in small aortic aneurysm may be considered as a risk stratification tool in future prospective studies to identify aneurysms at risk of significant expansion. CT textural data appears to reflect AAA metabolism measured by PET.     

Accuracy of left atrial anatomical maps acquired with a multielectrode catheter during catheter ablation for atrial fibrillation

Introduction  

Left atrial geometry provided by preprocedural MRI/CT imaging studies is often used to guide pulmonary vein isolation. Rapid 3D reconstruction of the left atrium (LA) can be obtained using multielectrode catheters in conjunction with electro-anatomical mapping (EAM) and can also be used to guide ablation. The objective of this study is to assess the accuracy of electro-anatomical left atrial maps acquired with the multispine catheter by comparing them to CT and MRI images.     

Neoadjuvant chemotherapy affects staging of colorectal liver metastasis��a comparison of PET, CT and intraoperative ultrasound

Purpose  

Surgery for colorectal liver metastasis facilitates long-term survival, and neoadjuvant chemotherapy improves resectability but may also alter staging accuracy. The aim of this study was to evaluate the effects of neoadjuvant chemotherapy on the efficacy of positron emission tomography (PET), PET–computed tomography (CT), CT and intraoperative ultrasound (IUS) in the detection of liver metastasis.     

The clinical significance of 18F-FDG-PET/CT in early detection of second primary malignancy in cancer patients

Purpose  

This retrospective study evaluated the diagnostic value of integrated whole-body ¹⁸F-fluorodeoxyglucose positron-emission tomography and computed tomography (¹⁸F-FDG-PET/CT) in early detection of second primary malignancies in cancer patients.     

Staging chest computed tomography and positron emission tomography in patients with pancreatic adenocarcinoma: utility or futility?

Objectives

This study was conducted to determine if routine staging chest computed tomography (CT) or positron emission tomography (PET) scanning alters the clinical management of patients with newly diagnosed pancreatic adenocarcinoma.

Methods

All new pancreas cancers seen in medical oncology, radiation oncology and surgery from 1 June 2008 to 20 June 2010 were retrospectively reviewed. Patients with metastatic disease on chest CT or PET, that had been unsuspected on initial imaging, were identified.

Results

Pancreatic adenocarcinoma was present in 247 consecutive patients. Abdominal CT demonstrated metastases in 108 (44%) and localized disease in 139 (56%) patients. Chest CT and PET were not performed in 15 (11%) of these 139 patients. In the remaining 124 patients, CT imaging suggested resectable disease in 46, borderline resectable disease in 52 and locally advanced disease in 26 patients. Chest CT demonstrated an unsuspected lymphoma in one patient with borderline resectable disease and PET identified extrapancreatic disease in two patients with locally advanced disease. Chest CT and PET added no information in 121 (98%) of the 124 patients.

Conclusions

The addition of chest CT and PET to high-quality abdominal CT is of little clinical utility; additional sites of metastasis are rarely found. As the quality of abdominal imaging declines, the yield from other imaging modalities will increase. Dedicated pancreas-specific abdominal CT remains the cornerstone of initial staging in suspected or biopsy-proven pancreatic cancer.     

Prognostic value of 18F-FDG PET-CT metabolic index for nasopharyngeal carcinoma

Purpose  

The purpose of this study was to evaluate the prognostic value of metabolic tumor volume (MTV) and metabolic index (MI) from fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in patients with nasopharyngeal carcinoma (NPC).     

Prevalence of Advanced Adenomas in Small and Diminutive Colon Polyps Using Direct Measurement of Size

Background and Aims  

Most studies reporting polyp size use visual estimates. Determining the prevalence of advanced histology based on direct measurement of polyp size may help guide the management of polyps found at optical colonoscopy (OC) and CT colonography (CTC).