Optimal phase for coronary interpretations and correlation of ejection fraction using late-diastole and end-diastole imaging in cardiac computed tomography angiography: implications for prospective triggering

A typical acquisition protocol for multi-row detector computed tomography (MDCT) angiography is to obtain all phases of the cardiac cycle, allowing calculation of ejection fraction (EF) simultaneously with plaque burden. New MDCT protocols scanner, designed to reduce radiation, use prospectively acquired ECG gated image acquisition to obtain images at certain specific phases of the cardiac cycle with least coronary artery motion. These protocols do not we allow acquisition of functional data which involves measurement of ejection fraction requiring end-systolic and end-diastolic phases. We aimed to quantitatively identify the cardiac cycle phase that produced the optimal images as well as aimed to evaluate, if obtaining only 35% (end-systole) and 75% (as a surrogate for end-diastole) would be similar to obtaining the full cardiac cycle and calculating end diastolic volumes (EDV) and EF from the 35th and 95th percentile images. 1,085 patients with no history of coronary artery disease were included; 10 images separated by 10% of R–R interval were retrospectively constructed. Images with motion in the mid portion of RCA were graded from 1 to 3; with ‘1’ being no motion, ‘2’ if 0 to <1 mm motion, and ‘3’ if there is >1 mm motion and/or non-interpretable study. In a subgroup of 216 patients with EF > 50%, we measured left ventricular (LV) volumes in the 10 phases, and used those obtained during 25, 35, 75 and 95% phase to calculate the EF for each patient. The average heart rate (HR) for our patient group was 56.5 ± 8.4 (range 33–140). The distribution of image quality at all heart rates was 958 (88.3%) in Grade 1, 113 (10.42%) in Grade 2 and 14 (1.29%) in Grade 3 images. The area under the curve for optimum image quality (Grade 1 or 2) in patients with HR > 60 bpm for phase 75% was 0.77 ± 0.04 [95% CI: 0.61–0.87], while for similar heart rates the area under the curve for phases 75 + 65 + 55 + 45% combined was 0.92 ± 0.02. LV volume at 75% phase was strongly correlated with EDV (LV volume at 95% phase) (r = 0.970, P < 0.001). There was also a strong correlation between LVEF (75_35) and LVEF (95_35) (r = 0.93, P < 0.001). Subsequently, we developed a formula to correct for the decrement in LVEF using 35–75% phase: LVEF (95_35) = 0.783 × LVEF (75_35) + 20.68; adjusted R ² = 0.874, P < 0.001. Using 64 MDCT scanners, in order to acquire >90% interpretable studies, if HR < 60 bpm 75% phase of RR interval provides optimal images; while for HR > 60 analysis of images in 4 phases (75, 35, 45 and 55%) is needed. Our data demonstrates that LVEF can be predicted with reasonable accuracy by using data acquired in phases 35 and 75% of the R–R interval. Future prospective acquisition that obtains two phases (35 and 75%) will allow for motion free images of the coronary arteries and EF estimates in over 90% of patients.     

The Impact of the COVID-19 Lockdown on Sugar-Sweetened Beverage Consumption in Children in Saudi Arabia: A Mixed-Methods Study

(1) Background: In 2020, there seems to have been a global shift in lifestyle and eating habits with the emergence of the coronavirus disease 2019 (COVID-19) and the ensuing lockdowns implemented by national governments. This study assessed the impact of the COVID-19 lockdown on SSBs consumption among healthy 6–11 years old children in Saudi Arabia; (2) Methods: This is a mixed-methods study, incorporating a quantitative component, which was a validated Arabic online questionnaire completed by parents, and a qualitative component, involving structured interviews with 10 selected parents using a criterion sampling method; (3) Results: There was a small decrease in consumption reported during lockdown across all SSBs types (soft drinks, n = 58 (13.9%); juices: n = 115 (27.6%); flavored milk: n = 93 (22.3%)). The results showed that with every increase in the dental pain scale there was a positive odd (AOR:0.64; p = 0.001) of decreased consumption of SSBs. Several themes related to increase and decrease SSBs consumption emerged; (4) Conclusions: There was a small decrease in SSBs consumption during lockdown reported by parents. Several themes emerged that can be used to strategize against problematic eating behavior, enabling such provisions as family dietary interventions, which target both parents and children.     

Comparative evaluation of the neuromuscular and cardiovascular effects of pipecuronium, pancuronium, atracurium, and vecuronium under isoflurane anesthesia.

The neuromuscular and cardiovascular effects of intubating doses of pipecuronium 80 micrograms/kg, pancuronium 100 micrograms/kg, atracurium 500 micrograms/kg, and vecuronium 100 micrograms/kg were compared in 62 patients under isoflurane (end-tidal concentration = 0.5-1%) anesthesia. Pipecuronium, pancuronium, and vecuronium had no significant effect on systolic or diastolic blood pressure. In one patient the administration of atracurium resulted in significant hypotension. Heart rate was significantly increased only after the administration of pancuronium. The neuromuscular-blocking effect of pipecuronium and pancuronium appears to be twice as long as that of vecuronium and atracurium. Administration of neostigmine resulted in significantly faster recovery of muscle function in patients receiving vecuronium or atracurium. Although pipecuronium's neuromuscular-blocking effect is similar to that of pancuronium, its lack of cardiovascular effects more closely resembles that of vecuronium.     

Behavioral characteristics in 3- to 12-month-old infant with atopic dermatitis: a case–control study

There have been reports that refer to the personality of the patients with atopic dermatitis (AD) especially adult patients but there are few studies regarding the behavioral characteristics in AD infants. The aim of this study was to compare behavioral characteristics of 30 AD infants (3-12 months old) with 40 controls. The infants with the definite diagnosis of AD (according to Hanifin and Rajka criteria) referring to children medical center were included in this study. For assessing behavioral characteristics we used revised version of Infant Behavior Questionnaire for measuring 11 scales of behavioral characteristics (Fear, Perceptual Sensitivity, Distress to Limitations, Sadness, High Pleasure, Low pleasure, Approach, Rate of Recovery from Distress, Soothability, Smiling and Laugher, and Duration of Orienting). Questionnaires were filled out by the physicians with the cooperation of the parents. The AD group showed significantly higher scores in Perceptual Sensitivity, Soothability, and High Pleasure compared with control group (p = 0.000). In other characteristics no significant difference were noticed between atopic and non-patients. For eight characteristics, scores of atopic infants were similar healthy infants, but they tend to show more pleasure when subjected to an intense, novel or incongruity stimuli compared with healthy infants. Theoretically, higher scores in Perceptual Sensitivity, Soothability, and High Pleasure are concordant with the pervious studies about adrenomedullary system over activity.     

Evaluating the Correlation Between the Survival Rate of Patients with Esophageal Squamous Cell Carcinoma and Expression of p53 and Cyclin D1 Biomarkers Along with Other Prognostic Factors

Objective

In the present study, we aimed to evaluate the relationship between the survival rate of patients with esophageal squamous cell carcinoma (SCC) and expression of two biomarkers along with age, gender, tumor margin, depth of invasion, site of tumor, tumor diameter, tumor grade, number of involved nodes, and vascular invasion.

Materials and Methods

In this retrospective survey, medical records of patients referred to the Shohada-e Tajrish hospital during 2001 to 2005 were reviewed and subjects with definite diagnosis of SCC were included. Required data were extracted from the patients’ records, and their prepared paraffin-embedded tissue blocks were collected under supervision of two pathologists. Immunohistochemistry (IHC) analysis was performed at the Firoozgar hospital in Tehran, Iran.

Results

The studied population included 20 men (74%) and 7 women (26%). The mean age at diagnosis was 58 ± 22. Results showed significantly higher survival rates in women compared to men (85.7 vs. 40%) (p = 0.001) and in patients with well-differentiated tumors compared to poor-differentiated cases (20 vs. 5%) (p = 0.004). No significant relationship was found between p53 expression and prognostic factors like age, gender, the site, grade, and size of the tumor, depth of invasion, involvement of lymph nodes, and vascular invasion.

Conclusion

Positivity of p53 and cyclin D1 was not found to be predictive of survival in patients with esophageal SCC which might be due to the small sample size of the present survey. Further investigations with larger sample populations and longer follow-ups are required to evaluate this correlation.

     

Is the pattern of dietary amino acids intake associated with serum lipid profile and blood pressure among individuals with spinal cord injury?

Objective: The probable effect of dietary amino acids intake pattern on serum lipid profile and blood pressure (BP) have not yet been described among individuals with spinal cord injury (SCI).

Design: Cross-sectional.

Setting: Tertiary rehabilitation center.

Participants: People with SCI referred to Brain and Spinal Cord Injury Research Center between 2011 and 2014.

Outcome measures: Dietary intakes were assessed by recording consumed foods by 24-hour dietary recall interviews using Nutritionist IV 3.5.3 modified for Iranian foods. Partial correlation test with adjustment for age, weight, body mass index, total energy intake, total fat, cholesterol and carbohydrate intake, and injury-related variables was used.

Results: Dietary intake of lysine was positively related to levels of fasting plasma glucose (FPG), triglyceride (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P?Conclusion: In the present study, the pattern of relationships between dietary intake of amino acids and serum lipid profile and BP has been described among people with SCI.     

Priming with atracurium

Priming with atracurium was evaluated by dividing 39 patients into 2 groups. All received 0.2 mg IV glycopyrrolate and fentanyl, 50 micrograms IV. Group 1 received saline, group 2 received 0.06 mg/kg atracurium and a stop watch was started. After 3.5 min the patients were asked to lift their heads and maximum negative inspiratory pressure (MIP) was measured. Anesthesia then commenced with thiopental and a twitch monitor was applied to the ulnar nerve. At 5 min group 1 received 0.36 mg/kg atracurium and group 2 was given 0.30 mg/kg atracurium. At 6.5 min intubation was accomplished in all but one patient in group 1 and all but one in group 2. Mean T4/T1 ratios at 90 sec were 0.73 in group 1 and 0.51 in group 2. This difference was statistically significant (P less than 0.001). Bucking on the endotracheal tube occurred in 72% of patients in group 1 and 62% of those in group 2 (not significant). Intubating conditions were "excellent" in 56% of those in group 1 and 75% in group 2 (not significant). "Good" conditions were seen in 33% of group 1 and 15% of group 2 patients (not significant). "Fair" conditions were noted in 6% of patients in group 1 and 5% of group 2 patients (not significant). The time to maximum twitch depression was 11.3 min and 11.5 min in groups 1 and 2 respectively (not significant). All patients in group 1 could sustain head lift whereas four patients in group 2 could not (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)     

Withdrawal reasons of randomized controlled trials on type 2 diabetes: a systematic review

PurposeType 2 diabetes mellitus (T2DM) is the subject of numerous randomized controlled trials (RCTs). The validity of RCTs may be threatened by attrition bias due to the discontinuation of the study. The aim of this systematic review is to evaluate the reasons of patient’s withdrawal from these RCTs.MethodsA systematic literature search on PubMed, Cochrane Library, Web of Science, and Scopus databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The aim was to obtain all relevant blinded RCTs published before January 2017 in which the effectiveness of synthetic drugs, vitamins/minerals were compared to that of placebo or active control in T2DM. The quality of RCTs was assessed using the Jadad score. The frequency of withdrawal reasons was presented based on treatments with placebo/active control, national/international level of the studies, and publication year. Meta-analysis was not performed due to the heterogeneity.ResultsOverall, 1368 articles comprising of 640,780 subjects were included. In the majority of the RCTs (75.0%), the intervention and the placebo arms were compared. Most of the included studies (96%) were classified in the high-quality category (Jadad score≥3). The highest proportion of reported withdrawal cases was found in international studies, national RCTs conducted in Japan, and RCTs published in 2011. The withdrawal reasons were reported for 91,669 (63.75%) of the total 143,794 participants who had withdrawn from these studies. The main reported reasons were “adverse effects” (24.04%), “withdraw consent” (16.10%), and “missing data” (11.08%). Variations in the reported withdrawal reasons were based on the country or published year. RCTs with triple blinded design as well as those in which anti-hyperlipidemia and anti-obesity medications were applied, showed significantly higher probability of reported the withdrawal.ConclusionHigh proportion of reported discontinuation in blinded RCTs on patients with T2DM was related to drug adverse effects. Overall, the total number and reason of drop out were unsatisfactory.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40199-020-00380-7.