bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological Characteristics, Classifications and Difficulties in the Use of Diagnostic Criteria for Serrated Lesions of the Large Intestine
Authors: Bastos Junior Cesar de Souza , Pannain Vera Lucia Nunes , Caroli-Bottino Adriana
Published: July 2021

Introduction Colorectal carcinoma (CRC) is the most common gastrointestinal neoplasm in the world, accounting for 15% of cancer-related deaths. This condition is related to different molecular pathways, among them the recently described serrated pathway, whose characteristic entities, serrated lesions, have undergone important changes in their names and diagnostic criteria in the past thirty years. The multiplicity of denominations and criteria over the last years may be responsible for the low interobserver concordance (IOC) described in the literature.

Objectives The present study aims to describe the evolution in classification of serrated lesions, based on the last three publications of the World Health Organization (WHO) and the reproducibility of these criteria by pathologists, based on the evaluation of the IOC.

Methods A search was conducted in the PubMed, ResearchGate and Portal Capes databases, with the following terms: sessile serrated lesion; serrated lesions; serrated adenoma; interobserver concordance; and reproducibility. Articles published since 1990 were researched.

Results and Discussion The classification of serrated lesions in the past thirty years showed different denominations and diagnostic criteria. The reproducibility and IOC of these criteria in the literature, based on the kappa coefficient, varied in most studies, from very poor to moderate.

Conclusions Interobserver concordance and the reproducibility of microscopic criteria may represent a limitation for the diagnosis and appropriate management of these lesions. It is necessary to investigate diagnostic tools to improve the performance of the pathologist's evaluation, for better concordance, and, consequently, adequate diagnosis and treatment.
The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis
Authors: Placer-Galán Carlos , Enriquez-Navascués Jose Mª , Pastor-Bonel Tania , Aguirre-Allende Ignacio , Saralegui-Ansorena Yolanda
Published: July 2021

Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula.

Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano.

Design systematic review and meta-analysis.

Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases.

Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included.

Intervention The intervention assessed was the LIFT with and without prior seton placement.

Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery.

Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%)

Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels.

Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.

International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.
Traumatic Rupture and Herniation of the Peroneus Tertius Muscle Leading to Compartment Syndrome and Entrapment of the Superficial Peroneal Nerve: A Case Report
Authors: Repo Jussi , Ovaska Mikko , Suominen Eetu N. , Sandelin Henrik , Puhakka Jani
Published: July 2021

We present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.
Validation of the New International League Against Epilepsy 2017 Classification for Determining Seizure Type in Indian Patients
Authors: Manorenj Sandhya , Sagari Navya
Published: July 2021

Introduction Epilepsy is a common condition in neurology comprising several electroclinical syndromes and seizure disorders of varying known and unknown etiologies that require variable diagnostic workup, treatment, and have obviously different prognoses. Therefore, for appropriate patient management, the best possible classification system for epilepsy is required. The International League Against Epilepsy (ILAE) is continuously working on this with the latest classification provided in 2017. There is little knowledge about seizure type based on newer classification systems in Indian patients.

Aims and Objective To test the applicability of the newer ILAE 2017 classification of epilepsy in determining seizure type in Indian patients, with respect to right patient management, the best classification system for epilepsy is necessary.

Materials and Methods Prospective data of 310 consecutive patients with seizures presenting in neurology department was collected from December 2017 to June 2018 and analyzed according to the newer systems of classification of seizures proposed by ILAE in 2017.

Results All 310 patients in age ranging from one year to 72 years with seizures could be classified according to the ILAE 2017 classification system. Focal onset seizure was noted in 66 patients (21.3%), while 244 patients (78.7%) had generalized onset based on clinical onset of seizure. Awareness was impaired in 262 (84.5%) patients. Motor onset seizure was observed in 278 patients (89.6%), while nonmotor seizure included absence, sensory, cognitive, and autonomic seizures.

Conclusion The present study showed that all patients could be classified using ILAE 2017 classification system. Majority of seizure were generalized onset, predominantly motor type of seizure with impaired awareness using clinical description of classifying seizure, while focal onset seizure was the majority type of seizure when ancillary information was considered.
Intraoperative Indocyanine Green Angiography for Assessing Flap Perfusion in Skull Base Reconstruction: A Systematic Review
Authors: Shaikh Noah , O'Brien Daniel , Makary Chadi , Turner Meghan
Published: July 2021

Objective This study was aimed to study the current use of intraoperative indocyanine green (ICG) angiography during skull base reconstruction and understand its efficacy in predicting postoperative magnetic resonance imaging (MRI) enhancement and flap.

Study Design The Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar databases were searched from the date of inception until August 2020 for studies of ICG flap perfusion assessment during skull base reconstruction. The primary outcome of interest was the development of cerebrospinal fluid (CSF) leak after skull base reconstruction. Secondary outcomes of interest included postoperative meningitis, flap MRI enhancement, flap necrosis, flap perfusion measurements, and total complications.

Results Search results yielded 189 studies, from which seven studies with a total of 104 patients were included in the final analysis. There were 44 nasoseptal flaps (NSF), two lateral nasal wall flaps (LNWF), 14 pericranial flaps (PCF), and 44 microvascular free flaps. The rates of CSF leak and postoperative MRI enhancement were 11 and 94%, respectively. There was one case of postoperative meningitis. Pooled analysis of the available data showed that intraoperative ICG flap perfusion was associated with flap enhancement on postoperative MRI (p = 0.008) and CSF leak (p = 0.315) by Fisher's exact test.

Conclusion The available literature suggests intraoperative ICG enhancement is associated with postoperative MRI enhancement. Given the small sample sizes in the literature and the rarity of complications associated with skull base reconstruction, intraoperative ICG enhancement has not been predictive of flap necrosis or postoperative complications such as CSF leak or meningitis.

Level of Evidence This study presents level 3 evidence as a systematic review of case studies, case reports, and retrospective and prospective trials with no blinding, controls, and inconsistently applied reference standards.
2.1.1 General Principles of Metal/Organocatalyst Dual Catalysis
Authors: Shao Z. , Deng Y.-H.
Published: July 2021

Metal/organocatalyst dual catalysis is a privileged catalytic strategy which involves both a metal-based catalyst and an organocatalyst to catalyze the organic transformation. Based on the type of activation of substrates with both catalysts, there are seven kinds of dual catalysis; namely cooperative catalysis, cascade catalysis, sequential catalysis, double activation catalysis, restorative catalysis, bifunctional catalysis, and multiple relay catalysis. The generic activation of the metal-based catalyst and the organocatalyst applied in the dual-catalytic system is summarized. In these dual-catalytic approaches, the advantages of both metal catalysis and organocatalysis are converged to achieve many transformations that were previously inaccessible or challenging by any single-catalyst paradigm, to develop new reactions, to discover unique reaction mechanisms, and even to allow for stereodivergent synthesis.
Synthesis of SnO2-nanoparticle-decorated SnSe nanosheets and their gas-sensing properties
Authors: Wang Yuanyuan , Li Nan , Zhao Haixin , Liu Xin , Li Xiaotian
Published: July 2021

Selectivity is still a major problem in gas sensors. In this study, we fabricated a novel sensor material, tin oxide (SnO2) nanoparticle decorated tin selenide (SnSe) nanosheets (SnO2/SnSe), via a simple solvothermal method. SnO2 nanoparticles of size ∼10 nm were anchored on the surface of SnSe nanosheets. The gas-sensing performances of SnO2/SnSe composites calcined at different temperatures were compared. Methylbenzene-sensing performance analysis performed at different temperatures and concentrations showed that SnO2/SnSe composites exhibited preferable sensitivity, excellent selectivity, and a good response rate. The improved sensing properties, especially the selectivity, are attributed to the appropriate heterojunction of SnO2 nanoparticle decorated SnSe nanosheets.
The Effects of Screening Brief Intervention Referral to Treatment (SBIRT) Training on Health Professional Trainees’ Regard, Attitudes, and Beliefs toward Patients who use Substances
Authors: Lukowitsky Mark R. , Balkoski Victoria I. , Bromley Nicole , Gallagher Patricia Ann
Published: July 2021

Background: Screening Brief Intervention Referral to Treatment (SBIRT) was developed as an integrated and comprehensive public health approach that includes early screening and intervention to address substance use in a variety of health care settings. Research suggests that SBIRT is effective in reducing substance use in individuals whose use places them at higher risk for negative health and social consequences. However, less is known about how training in SBIRT modifies attitudes, regard, and beliefs toward people who use substances. Methods: Participants included 461 students from a variety of healthcare related disciplines (physician assistant, nurse practitioner, pharmacy, psychiatry and psychology, and medical students). Participants were evaluated using a pre-post design to assess changes in regard, attitudes, and beliefs by completing the Short Alcohol and Alcohol Problems Perception Questionnaire, the Drug Problem Perception Questionnaire, the Medical Condition Regard Scale, and the Short Understanding of Substance Abuse Scale before and after a 7-hour SBIRT training program. We hypothesized that trainees would have more positive regard, attitudes, and beliefs toward people who use substances following training in SBIRT relative to a baseline assessment and that there would be between program differences. Results: Results were consistent with hypotheses and suggested that trainees had significantly more positive regard and changes in attitudes and beliefs toward working with patients who use substances following training in SBIRT. Results also suggested significant differences by training group at baseline and at 30-day follow up. Conclusions: Overall, the findings suggest that an important additional benefit of SBIRT is the impact it has on mitigating healthcare professional trainees’ negative regard and modifying attitudes and beliefs toward those who use substances.
Increasing Preference for Fentanyl among a Cohort of People who use Opioids in Vancouver, Canada, 2017-2018
Authors: Ickowicz Sarah , Kerr Thomas , Grant Cameron , Milloy M-J , Wood Evan , Hayashi Kanna
Published: July 2021

Background: Despite increasing prevalence of illicit fentanyl use in the US and Canada, preference for fentanyl over other illicit opioids has not been fully characterized. Therefore, we sought to describe changes in illicit opioid preferences over time among people who inject drugs (PWID). Methods: Data were obtained from two prospective cohort studies between 2017 and 2018. Trends in opioid preference over time were examined using bivariable generalized estimating equation (GEE) analysis. Multivariable models were used to identify factors associated with fentanyl preference. Results: Among 732 eligible participants, including 425 (58%) males, the prevalence of preference for fentanyl increased from 4.4% in 2017 to 6.6% in 2018 (Odds Ratio [OR] = 1.27, 95% Confidence Interval [CI]: 1.05–1.52). In a multivariable analysis, younger age (Adjusted Odds Ratio [AOR] = 0.94, 95% CI: 0.92–0.96) and daily crystal methamphetamine injection (AOR = 1.68, 95% CI: 1.01–2.78) were independently associated with preference for fentanyl. The most common reasons for preferring fentanyl included “better high than other opioids” (45%), and “lasts longer than heroin” (27%). Conclusions: The current study has demonstrated that preference for fentanyl has been increasing over time among our sample of PWID who use opioids. Further work is needed to clarify risk factors surrounding transitions to illicit fentanyl.
Interventions for Hospitalized Medical and Surgical Patients with Opioid use Disorder: A Systematic Review
Authors: French Rachel , Aronowitz Shoshana V. , Brooks Carthon J. Margo , Schmidt Heath D. , Compton Peggy
Published: July 2021

Background: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.
Polysubstance use in a Brazilian National Sample: Correlates of co-use of Alcohol and Prescription Drugs
Authors: Krawczyk Noa , da Mota Jurema C. , Coutinho Carolina , Bertoni Neilane , de Vasconcellos Mauricio T.L. , Silva Pedro L. Nascimento , De Boni Raquel B. , Cerdá Magdalena , Bastos Francisco Inácio
Published: July 2021

Background: Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol and potential consequences. The current study assessed prevalence of alcohol in conjunction with nonmedical opioid and benzodiazepine use across a nationally representative sample of adults in Brazil. Methods: Cross-sectional data on prevalence were estimated from the 2015 Brazilian Household Survey on Substance Use. We estimated past month nonmedical use of benzodiazepines and alcohol and past month nonmedical use of opioids and alcohol among adults who reported any past-year alcohol use. Zero-inflated Poisson models assessed independent correlates of alcohol and nonmedical opioid use, and alcohol and nonmedical benzodiazepine use. Results: Among adults who reported past year alcohol use, 0.4% ( N = 257,051) reported past month alcohol and non-medical benzodiazepine use, and 0.5% ( N = 337,333) reported past month alcohol and non-medical opioid use. Factors independently associated with co-use of alcohol and benzodiazepines included having depression (adjusted prevalence ratio (aPR):4.61 (95%CI 1.76–12.08)), anxiety (aPR:4.21 (95%CI 1.59–11.16)) and tobacco use (aPR: 5.48 (95%CI 2.26–13.27)). Factors associated with past-month alcohol and opioid use included having experienced physical or a threat of violence (aPR: 4.59 (95%CI 1.89–11.14)), and tobacco use (aPR:2.81(95%CI:1.29–6.12)). Conclusions: Co-use of prescription drugs with alcohol remains relatively rare among Brazilians, but findings point to a unique profile of persons at risk. Results of this study are important in light of changing dynamics and international markets of prescription drugs and the need for more research on use of these substances on a global scale.
Alcohol, Cannabis, and Tobacco Polysubstance Use: A Latent Profile Analysis of Age of Onset
Authors: Stamates Amy L. , Roberts Rhiannon , Lau-Barraco Cathy
Published: July 2021

Background

Despite understanding the long-term risks associated with early substance use, less is known about the specific patterns of the age of onset (AO) across multiple substances and whether these patterns of early exposure are linked to substance use later in young adulthood. Consequently, the present study sought to (1) identify distinct classes regarding AO for alcohol, cannabis, and tobacco and (2) compare these classes on patterns of individual and simultaneous alcohol, cannabis, and tobacco use, other substance use, and mental health symptoms.

Methods

Participants were 510 emerging adults ( Mage = 21.35; 88.6% men) who reported past-year use of alcohol, cannabis, and tobacco.

Results

Latent profile analysis was used to identify classes based on three indicators: AO for alcohol, cannabis, and tobacco. Results revealed that four classes best fit the data: Earliest AO for Alcohol (19.8%); Latest AO for Substances (6.5%); Late AO for Substances (67.8%); Earliest AO for Cannabis and Tobacco (5.9%). Classes varied on current patterns of individual substance use, co-use of substances, other illicit drug use, and mental health symptomology. The Latest AO of Substances class reported the lowest alcohol use, cannabis use, other illicit drug use, and mental health symptomology than the other classes. The Earliest AO for Alcohol and the Late AO of Substances reported a lower frequency of tobacco compared to the other classes. The Late AO of Substance class reported the highest past-year frequency of simultaneous alcohol and cannabis use.

Conclusions

The current study contributed to the larger polysubstance literature by identifying profiles that may signify risky patterns of use. Findings may help guide prevention and intervention work with adolescents and young adults.
Twenty-Four-Hour Blood Pressure Variability Is Associated With Lower Cognitive Performance in Young Women With a Recent History of Preeclampsia
Authors: Nuckols Virginia R , Stroud Amy K , Hueser Jared F , Brandt Debra S , DuBose Lyndsey E , Santillan Donna A , Santillan Mark K , Pierce Gary L
Published: July 2021

Background

Women with a history of preeclampsia (hxPE) exhibit sustained arterial stiffness and elevated blood pressure postpartum. Aortic stiffness and 24-hour blood pressure variability (BPV) are associated with age-related cognitive decline. Although hxPE is related to altered cognitive function, the association between aortic stiffness and BPV with cognitive performance in young women with hxPE has not been investigated. The objectives of this study were to (i) test whether cognitive performance is lower in young women with hxPE and (ii) determine whether aortic stiffness and BPV are associated with cognitive performance independent of 24-hour average blood pressure.

Methods

Women with hxPE (N = 23) and healthy pregnancy controls (N = 38) were enrolled 1–3 years postpartum. Cognitive performance was assessed in domains of memory, processing speed, and executive function. Twenty-four-hour ambulatory blood pressure monitoring and carotid–femoral pulse wave velocity (cfPWV) were used to measure BPV and aortic stiffness, respectively.

Results

Women with hxPE had slower processing speed (−0.56 ± 0.17 vs. 0.34 ± 0.11 Z-score, P < 0.001) and lower executive function (−0.43 ± 0.14 vs. 0.31 ± 0.10 Z-score, P = 0.004) compared with controls independent of education, whereas memory did not differ. BPV and cfPWV (adjusted for blood pressure) did not differ between women with hxPE and controls. Greater diastolic BPV was associated with lower executive function independent of 24-hour average blood pressure and education in women with hxPE (r = −0.48, P = 0.03) but not controls (r = 0.15, P = 0.38).

Conclusions

Select cognitive functions are reduced postpartum in young women with a recent hxPE and linked with elevated 24-hour diastolic BPV.
Pathogenic mechanisms underlying SLC6A1 variant-mediated neurodevelopmental disorders
Authors: Cheng Jennifer Z , Carvill Gemma L
Published: July 2021

This scientific commentary refers to ‘Common molecular mechanisms of SLC6A1 variant-mediated neurodevelopmental disorders in astrocytes and neurons’ by Mermer et al. (doi:10.1093/brain/awab207).
A capability approach to evaluating the social impact of music residencies and touring in remote Australia
Authors: Howell Gillian , Bartleet Brydie-Leigh
Published: July 2021

Evaluation is a driving concern for arts organizations the world over, and a growing requirement from philanthropic, government, and corporate funders. There is increasing recognition of the need for evaluations of socially engaged arts programs to be appropriate for the communities, cultural contexts, participants, and stakeholders involved in their activities. This article directly addresses this need, and outlines the process of developing a bespoke framework for evaluating the social impact of a music program in the Kimberley region of far north-west Australia, a region with a majority First Nations’ population. It describes the methods used to develop this evaluation framework and indicators that were grounded in community perspectives on the difference that this music program makes to community life. It situates the methods chosen within a theoretical orientation towards a capability approach and an ecological understanding of externally provided arts activities. The authors argue that this methodology offers a culturally relevant, holistic way to track and measure the direct and indirect outcomes that engagement with the arts can bring.
Low bone mineral density is associated with coronary arterial calcification progression and incident cardiovascular events in patients with chronic kidney disease
Authors: Kim Hyoungnae , Lee Joongyub , Lee Kyu-Beck , Kim Yeong-Hoon , Hong Namki , Park Jung Tak , Han Seung Hyeok , Kang Shin-Wook , Choi Kyu Hun , Oh Kook-Hwan , Yoo Tae-Hyun
Published: July 2021

Background

Although it is well known that low bone mineral density (BMD) is associated with an increased risk of cardiovascular disease (CVD) and mortality in the general population, the prognostic role of bone mineral density (BMD) has not been established in the chronic kidney disease (CKD) population. Therefore we aimed to evaluate the association between BMD and the risk of CVD and cardiovascular mortality in patients with predialysis CKD.

Methods

This prospective cohort study was conducted with 1957 patients with predialysis CKD Stages 1–5. BMD was measured using dual-energy X-ray absorptiometry and coronary arterial calcification (CAC) scores were evaluated using coronary computed tomography. The primary outcome was a major adverse cardiovascular event (MACE).

Results

When patients were classified based on total hip BMD T-score tertiles stratified by sex, the lowest BMD tertile was significantly associated with an increased risk of MACE {hazard ratio 2.16 [95% confidence interval (CI) 1.25–3.74]; P = 0.006}. This association was also shown with BMD at the femur neck but not with BMD at lumbar spine. In the subgroup of 977 patients with follow-up CACs at their fourth year, 97 (9.9%) showed accelerated CAC progression (>50/year), and BMD was inversely associated with accelerated CAC progression even after adjusting for the baseline CAC score [odds ratio 0.75 (95% CI 0.58–0.99); P = 0.039]. In addition, baseline CAC was associated with an increased risk of MACEs after adjusting for total hip T-score.

Conclusions

Low BMD was significantly associated with CAC progression and MACEs in patients with predialysis CKD.
Testosterone therapy and cardiovascular diseases
Authors: Cittadini Antonio , Isidori Andrea M , Salzano Andrea
Published: July 2021

Since it was first synthesized in 1935, testosterone (T) has been viewed as the mythical Fountain of Youth, promising rejuvenation, restoring sexual appetites, growing stronger muscles, and quicker thinking. T is endowed with direct effects on myocardial and vascular structure and function, as well as on risk factors for cardiovascular (CV) disease. Indeed, low serum T levels are a risk factor for diabetes, metabolic syndrome, inflammation, and dyslipidaemia. Moreover, many studies have shown that T deficiency per se is an independent risk factor of CV and all-cause mortality. On this background and due to direct-to-patient marketing by drug companies, we have witnessed to the widespread use of T replacement therapy without clear indications particularly in late-life onset hypogonadism. The current review will dwell upon current evidence and controversies surrounding the role of T in the pathophysiology of CV diseases, the link between circulating T levels and CV risk, and the use of replacing T as a possible adjuvant treatment in specific CV disorders. Specifically, recent findings suggest that heart failure and type 2 diabetes mellitus represent two potential targets of T therapy once that a state of hypogonadism is diagnosed. However, only if ongoing studies solve the CV safety issue the T orchid may eventually ‘bloom’.
Incremental prognostic value of calcified vs non-calcified plaque burden on computed tomography angiography and myocardial perfusion imaging
Authors: Ahmed AI , Han Y , Al Rifai M , Alnabelsi T , Nabi F , Chang SM , Chamsi-Pasha MA , Nasir K , Mahmarian JJ , Cainzos-Achirica M , Al-Mallah MH
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary computed tomography angiography (CCTA) is currently guideline-endorsed for diagnosing suspected coronary artery disease (CAD) in low-intermediate risk patients. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has an established role in both the accurate detection of ischemia and identification of patients at high risk of future cardiovascular events. Recent studies have shown that the burden of atherosclerotic plaque is an independent predictor of cardiovascular events, and that this effect depends on the degree of calcification.

Purpose

To compare the incremental prognostic value of calcified vs non-calcified plaque burden to CCTA anatomic assessment and SPECT physiologic assessment in patients evaluated with both tests.

Methods

Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Ischemia on SPECT was defined as summed difference score > 0 using perfusion graded on a 5-point scale. Anatomically obstructive CAD by CCTA was defined as ≥50% in the left main artery and ≥70% stenosis severity in proximal, mid and distal branches of the left anterior descending, left circumflex and right coronary artery without including side branches. Segment involvement score was defined as the sum of segments with plaque irrespective of the degree of stenosis using an 18-segment coronary artery model. A Hounsfield unit threshold of > =130 was used to classify plaques composition as calcified/mixed (C-SIS) vs non-calcified plaque (NC-SIS). Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.)

Results

A total of 956 patients were included. (Mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥ 50%, all other coronary segments ≥ 70%) and ischemia were observed in similar number of patients (14%). After a median follow-up of 31 months, 102 patients (11%, 29.2 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models, C-SIS, but not NC-SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.14 95% CI 1.08 - 1.20 p= <0.001; Harrel’s C 0.74, p = 0.011) and SPECT ischemia (HR 1.14 95% CI 1.08 - 1.20, p < 0.001; Harrel’s C 0.76, p = 0.015).

Conclusion

In the current study of high-risk patients with suspected CAD, calcified plaque burden, but not non-calcified plaque incrementally added to measures in predicting incident cardiovascular outcomes
Ethnicity and coronary artery calcification
Authors: Koulaouzidis G
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although individuals of South Asian (S. Asian) origin represent 20% of the world population, they are under-represented in studies investigating the presence of coronary artery calcification (CAC).

Aim

We compared the prevalence of CAC in Caucasians and Asians who underwent electron beam computed tomography (EBCT). CAC score (CACS) was performed on an Imatron C300 Ultrafast EBCT scanner (GE Healthcare), using a standard method with calcium deposition scored according to Agatston method. Demographic information and the presence of risk factors were abstracted from referral letters and questionnaires completed by the patients prior to their test.

Results

CACS was assessed in 935 S. Asians (739 males and 196 females) and 13,501 Caucasians (10,232 males and 3269 females). Gender distribution between Caucasians and S. Asians was similar (p = 0.1); conversely, the Caucasians group was older to its S. Asians counterpart (52.8 ± 9.6 vs. 50.6 ± 10.3; p < 0.001); while on the other hand, S. Asians appeared to have a higher prevalence of diabetes mellitus (17.5% vs. 4.3%; p <0.0001). There was no difference in the prevalence of smoking between the 2 groups (15% vs. 12.1%; p = 0.06), of hypertension (31.3% vs. 25.3%; p =0.4), family history of CHD (22.8% vs. 16.1%; p = 0.3), and hyperlipidemia (24.5% vs. 17.3%; p = 0.3). The prevalence of CAC (CACS >0) was similar between Caucasians and S. Asians (50.9% vs. 50.8%; p = 0.9), although a statistically significant difference in the prevalence of CAC in South Asians >50 years was noted (p = 0.01). S. Asian males showed a higher mean CACS as compared to Caucasians (179.6 ± 545.1 vs. 144.1 ± 420.1; p = 0.03). In males <50 years, there was no statistically significantly difference in mean CACS between S. Asians and Caucasians (36.1 ± 277.8 vs. 23.8 ± 104.2; p = 0.06), but in males >50 years old the difference in mean CACS was significant (S. Asians, 339.1 ± 702.9 vs. Caucasians 232.3 ± 528.7; p < 0.0001). On the other hand, no difference was observed in the mean CACS between South Asian and Caucasian females (59.2 ± 224.9 vs. 56.6 ± 219.2; p = 0.86). S. Asian females <50 years and S. Asian females >50 years had similar mean CACS compared to Caucasians.

Conclusion

S. Asians seem more prone to extensive calcification. Age seems to play an important role as the prevalence of CAC was similar in S. Asians and Caucasians <50 years but there was a difference in prevalence of CAC after the age of 50, but this deference was statistically significant only in males. Our results support current evidence in showing that the pattern of CAC is influenced by ethnicity. If this reflects a difference in traditional risk factors or has genetic origin it has to be clarified.
Role of inpatient coronary CT angiography on clinical decision making during COVID- 19 pandemic
Authors: Mangion K , Dewantoro D , Mclennan E , Tynan N , Dymock L , Woodward R , Hopkins T , Berry C , Adams J , Stobo D , Roditi GH , Byrne J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 pandemic has had a profound effect on healthcare delivery. Here we describe the effect of repurposing of a research Computed Tomography scanner on clinical care of cardiology patients in an urban academic medical centre which did not have routine access to CCTA prior to the pandemic. 

Patients requiring invasive coronary angiography require transfer to a regional cardiac centre (no ICA available on site).

Purpose

We investigated the effect of CCTA on i) diagnostic certainty ii) avoidance of clinician defined unnecessary invasive angiography in hospitalised patients.

Methods

This was a prospective, longitudinal cohort study involving hospitalized patients admitted to an urban academic medical centre (catchment population 650 000) between March 29 and September 21, 2020. Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. High-sensitivity Troponin-I was measured on admission and 3- and 6– hours after if mandated (Abbott Architect TnI assay).

A 320-detector scanner (Aquilon ONE, Canon) was used. Intravenous metoprolol was used where required to control the heart rate (target 60 b.p.m.) and sublingual glyceryl trinitrate will be given to all patients immediately before the scan acquisition.

Results

Forty-three patients underwent inpatient CCTA, mean age: 61 ± 13 years (range 30-88y), 54% female. The presenting complaint was typical chest pain in 28 (65%), atypical chest pain in 10 (23%), and a variety of symptoms in 5 (12%) including palpitations, syncope, breathlessness.

Thirty-six (84%) of patients had a detectable TnI above the 99% centile. Median(IQR) peak TnI was 127 (33-635)ng/L.

CCTA was carried out on average 1 day post request. 

CCTA resulted in an improvement in clinician diagnostic certainty (Initial review: 21% yes, 79% probable, post-CCTA review: 84% yes, 16% probable) in providing a diagnosis.

21 (49%) of invasive coronary angiograms were avoided due to CCTA, whilst an inpatient invasive coronary angiogram (ICA) was performed in 4(9%) due to CCTA demonstrating significant disease, and in 2(%) the ICA was changed from out-patient to in-patient. Three ICA tests were requested as OP due to CCTA findings. CCTA did not overestimate disease severity in this cohort. 

We saved 21 inter hospital transfers for ICA during this time period. 

Using NHS England cost tariffs, a cost saving of >£36,000 was made for using CCTA instead of ICA in these 21 patients who would have required ICA.

Conclusion

Inpatient CCTA resulted in greater clinician diagnostic confidence, avoidance of unnecessary invasive angiograms and a significant cost saving. This also reduced the duration of patient stay, reducing the potential exposure of patients to COVID-19.
Comparison of low energy and medium energy collimators in the quantitative assessment of 123I-MIBG cardiac sympathetic innervation imaging
Authors: Casans Tormo I , Ruiz Granell R
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Clinic Hospital of Valencia

Aim

The assessment of cardiac sympathetic innervation by 123I-metayodobenzylguanidine (123I-MIBG) has proved useful in patients with heart failure and neurodegenerative disorders. The standard quantification of global cardiac uptake is to obtain the heart to mediastinum (HM) ratio in planar images, while SPECT images provide better evaluation of regional extent of denervated areas. Although low energy (LE) collimator has been widely used in these patients, septal penetration of high-energy photons of 123I could affect image quality and quantification accuracy. We have compared in the same patients the effect of collimator type on image quality and quantitative assessment of HM ratio.

Methods

In a group of 14 patients (11 men, 57-77 y/o, 66.4 ± 5.6) submitted for cardiac sympathetic study, we obtained successive planar anterior chest images 4h after the IV administration of 10 mCi of 123I-MIBG with a low-energy-high-resolution (LEHR) and a medium-energy (ME) collimators. Images were obtained with the same gammacamera Brightview Philips for 10 min on 256x256 matrix, with 159 Kev photopeak and unchanged patient position. For quantification of HM ratio, we use in each patient the same manual heart ROI and rectangular upper mediastinum ROI in the two acquired images to obtain the corresponding HM ratio.

Results

The image quality was better in all the patients with ME collimator acquisition than with LEHR collimator acquisition, and the HM ratio showed higher values with ME: 1.65-2.61 (mean 2.15 ± 0.28) than with LEHR: 1.27-1.85 (mean: 1.51 ± 0.18) with a mean difference of 0.64 ± 0.15 (0.38-0.88) between ME and LEHR and a mean ratio LEHR/ME of 0.70 ± 0.04 (0.64-0.79). In 9 patients with HM ratio ≤ 1.60 obtained from LEHR collimator acquisition, the mean difference with HM ratio obtained with ME collimator was 0.61 ± 0.12 and mean ratio LEHR/ME was 0.69 ± 0.03 and in 5 patients with HM ratio(LEHR) >1.60, mean difference with HM ratio(ME) was 0.69 ± 0.19 and mean ratio LEHR/ME was 0.71 ± 0.02.

Conclusion

Use of a ME collimator provides better image quality than LEHR collimator in planar images and higher values of HM ratio, providing a more accurate quantification of cardiac uptake in the patients submitted for evaluation of cardiac sympathetic innervation by 123I-MIBG, and could also improve the evaluation of regional impairment and extent of denervated areas by SPECT.
Diagnostic accuracy of myocardial perfusion imaging in patients evaluated for kidney transplantation: a systematic review and meta-analysis
Authors: Kelderman JR , Jolink FEJ , Benjamens S , Monroy Gonzalez AG , Pol RA , Slart RHJA
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

  A high prevalence of asymptomatic coronary artery disease (CAD) is found in patients with end-stage renal disease evaluated for kidney transplantation. 

Purpose

 We aimed to assess the diagnostic accuracy of myocardial perfusion imaging (MPI) for CAD in this patients population. 

Methods

 We performed a systematic literature search and meta-analysis. We retrieved studies investigating the diagnostic accuracy of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation.

Results

 Out of 1379 records, 9 MPI SPECT studies were included in the meta-analysis with a total of 822 patients. There were no studies available using PET with ICA or CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95%-CI 0.52-0.78), pooled specificity 0.72 (95%-CI 0.57-84) and the area under the curve (AUC) 0.74. Positive likelihood ratio (PLR) was 2.31 (95%-CI 1.57-3.39) and negative likelihood ratio (NLR) was 0.41 (95%-CI 0.25-0.68) with an overall diagnostic odds ratio (DOR) of 5.43 (95%-CI 2.87-10.28). Significant heterogeneity existed across included studies.

Conclusions

 MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings.
Radiomics analysis of myocardial perfusion SPECT images in patients with cardiomyopathy and heart failure
Authors: Okuda K , Nakajima K , Saito H , Yamashita S , Hashimoto M , Kinuya S
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI Grants

Background

Although myocardial perfusion heterogeneity due to focally damaged cardiomyocytes is observed in single−photon emission computed tomography (SPECT) imaging, a current perfusion defect scoring system does not allow us to provide sufficient diagnostic information for heterogeneity.

Purpose

The aim of this study was to perform radiomics analysis of myocardial perfusion SPECT (MPS) images to investigate the potential to detect myocardial perfusion heterogeneity.

Methods

Patients with hypertrophic cardiomyopathy (n = 3), heart failure (n = 9), and with a low likelihood of coronary artery disease (n =15) (Figure 1), who underwent a rest 99mTc-MIBI myocardial perfusion SPECT, were assessed using a LIFEx software. Four shape−based features, 6 histogram−based features, and 32 textural features were computed. The relevant features for the classification of the patients were selected using the Boruta algorithm, and hierarchical clustering of the selected features using the Spearman correlation coefficient was also performed for the feature reduction. The receiver operating characteristics (ROC) analysis was performed by the support vector machine to calculate the area under the ROC curve (AUC) for the selected features.

Results

Of 40 features, 17 were selected by the classification analysis, and these features were classified into 7 classes by the correlation analysis (Figure 2). The ROC AUCs for 7 features extracted from each class were 0.99, 0.97, 0.96, 0.92, 0.90, 0.86, and 0.83 for the contrast of NDGLDM, the entropy of histogram, ZLNU of GLZLM, the energy of GLCM, the energy of histogram, SZLGE of GLZLM, and the correlation of GLCM, respectively, as compared to 0.39 for a summed rest score.

Conclusions

Radiomics analysis successfully determined the myocardial perfusion heterogeneity in patients with cardiomyopathy and heart failure. It might be promising for the evaluation of myocardial damages that cannot be analyzed by the conventional scoring method.
High Frequency QRS analysis to supplement ST-Analysis for Myocardial Ischemia: multi-center prospective cohort
Authors: Toral R Patel TRP , Jamieson Bourque JMB
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Exercise testing is a well-known non-invasive assessment method for myocardial ischemia in patients with suspected coronary artery disease (CAD).  Stress electrocardiography (ECG) alone is underutilized in this population despite guideline recommendations in part due to poor diagnostic accuracy. High frequency QRS analysis (HF-QRS) is a novel tool to supplement standard ST-analysis during stress ECG and has been shown in single-center retrospective analyses to identify any and substantial ischemia with high diagnostic accuracy. We sought to compare the diagnostic accuracy of HF-QRS + standard ST-analysis compared to standard ST-analysis alone for the identification of moderate to severe myocardial ischemia by exercise SPECT MPI.

Methods

The study population included 388 consecutive patients who underwent exercise SPECT MPI. An ischemic HF-QRS pattern was defined as an absolute reduction of ≥1 μV and a relative reduction of ≥50% between maximal and minimal values of the mean root square of the 150-250 Hz band signal in ≥3 leads. The diagnostic accuracy of HF-QRS + ST-analysis was compared with ST-analysis alone for moderate to severe myocardial ischemia using chi-square analysis and semi-quantitative gated SPECT MPI as the gold standard. The incremental diagnostic value of HF-QRS was assessed by logistic regression analysis. The likelihood of any ischemia by number of leads positive for HF-QRS was also determined.

Results

The study cohort was 71% male and 84% Caucasian with a mean age of 58.3 ± 11.8 years. ST- and HF-QRS analyses were positive in 96 (24.7%) and 121 (31.2%) of patients, respectively. HF-QRS had a substantially higher sensitivity than ST-analysis for moderate-severe ischemia (66.7% vs. 40.0%, p <0.003). There was no statistically significant difference in specificities for HF-QRS vs ST-analysis for moderate-severe ischemia. (70.5% vs 75.7%, p = 0.08). There was a stepwise increase in ischemia as number of positive HF-QRS leads increased (p = 0.0004).  HF-QRS demonstrated incremental diagnostic value to clinical risk factors without ST-analysis (p = 0.006) compared to Clinical + ST depressions (p < 0.001) versus clinical factors.

Conclusions

This multicenter, prospective study expands the literature showing the benefit of HF-QRS analysis. HF-QRS analysis substantially improves detection of moderate-severe ischemia over ST-analysis and clinical risk factors in patients undergoing exercise stress ECG. This noninvasive adjunct may improve CAD risk stratification and encourage use of stress ECG without imaging, reducing costs and radiation exposure.