bluuebunny/crossref_metadata_2025 huggingface dataset:
208c - Noise and hearing conservation for informal sector workers in Mombasa, Kenya
Authors: Suleiman Abdulqadir Mohamad
Published: June 2024

The purpose of the project is to promote occupational health among workers in the informal sector in Kenya. It started with work on prevention of exposure to high noise among metal workers. A group of 60 workers where provided with protective devices and training on health hazards associated with exposure to high noise. From the proceedings with a group of metal workers, we obtained a good picture on the challenges faced by the workers in the informal sector.

As a follow-up to this first project, we are working on providing solutions that will contribute in reducing the noise levels. The workers do, for example, all the metal cutting with a chisel and a hammer, and further shaping by other crude tools, which are a major source of the high noise. We are looking at providing alternatives such as metal pressers to reduce the noise level.

In addition, to the metal workers, we have started with providing training to three other groups in the sector: construction workers, carpenters and joinery, and another small group metals workers with a bit different product focus than the first group.
222e - Exposure to polycyclic aromatic hydrocarbons assessed by biomonitoring of firefighters during fire operations.
Authors: Koslitz Stephan , Taeger Dirk , Käfferlein Heiko , Pelzl Tim , Heinrich Birgit , Köster Daniel , Weiß Tobias , Behrens Thomas , Harth Volker , Brüning Thomas
Published: June 2024

Exposure of firefighters to carcinogenic polycyclic aromatic hydrocarbons (PAHs) during real firefighting missions has been assessed to study the safety of the currently used operational clothing.

Firefighters (N=70) from professional and volunteer fire departments were recruited and 1-hydroxypyrene (1-OHP) was quantified in their urine samples. For this purpose, baseline levels and exposures 2-4, 6-8, and 12 h after firefighting missions were assessed. Detailed information about the firefighting operation was assessed by questionnaire.

Baseline exposure to 1-OHP in all firefighters were, dependent on the individual smoking habits, within the normal range of the general population. After the missions, there was an approx. 2-fold increase of mean 1-OHP concentrations (0.13 vs. 0.25 1-OHP µg/g creatinine). Peak exposure was observed 12 h after the mission. However, most of the post-exposure levels (77 %) remained in the range of the general population. Operations in which elevated 1-OHP has been measured were characterized by smoke (visibility <2 m), firefighting indoors, and, despite the use of respirators, being a member of the interior attack team. Nevertheless, these exposures were still low compared to many workers with industrial exposures to PAH.

The results indicate that the currently used protective clothing (including respirators) reduces exposures to PAHs. Nevertheless, the study identified specific situations such as firefighting under heavy smoke conditions which can lead to increased exposures on an individual level. Although personal protective equipment was assessed to be used during operations, skin absorption of PAHs must be assumed as a relevant route of exposure in these cases.
249a - Successful prevention strategies to prevent infectious airborne disease transmission in workers and our communities: a panel discussion
Authors: Sloan Lawrence
Published: June 2024

Introduction & Moderation of the Panel: COVID-19 is a preventable disease, primarily caused by the SARS-CoV-2 virus aerosols entering the respiratory system. There is no dose-response, no exposure limits, and no simple instrumental methods for detecting the virus. Since the virus travels with infected people, a primary challenge has been developing hazard/risk assessments and safe work procedures to prevent the virus from entering and exiting workplaces.

Four senior Occupational, Environmental, Health, and Safety (OEHS) professionals will present successful prevention initiatives that lowered the risk of occupational transmission of SARS-CoV-2. These initiatives encompass the development and content of Canada’s new respiratory protection standards; quantitative respiratory protection fit testing for South African health care workers; COVID-19 as a preventable occupational disease in the Canadian film industry. The panel is moderated by the CEO of the AIHA, an IOHA member-association, who will discuss making representations for worker and community prevention to national and state government agencies, as well as allied professional associations.
32 Case study - evaluation and management of schools with mercury-containing gymnasium floors
Authors: Lloyd Alan
Published: June 2024

In the United States, polyurethane floors are often installed in school gymnasium floors as a substitute to hard wood. In recent years, it has been identified that many of these floors were installed with the use of phenylmercuric acetate as a catalyst and has resulted in the off gassing of mercury vapors.

Some states, such as New Jersey, recommend the removal of these floors if mercury vapors are identified at 0.08 ug/m3 or greater.

This case study will describe the initial bulk sampling of a gymnasium floor, exposure monitoring, remedial design, and removal procedures of a polyurethane gymnasium floor in an elementary school in New Jersey. The case study will review the positives and negatives of removing the floor as compared to management in place with additional ventilation. It will describe the sampling and analytical methods and procedures as well as the engineering controls used during remediation.

New Jersey was one of the first states to identify and address the hazards associated with the polyurethane floors. This case study is an attempt to share the value of the testing and remediation to determine if a greater focus should be required on a global scale.
121 The factors influencing nursing staff retention in the ICU setting: a scoping review
Authors: O’ Mara Sinead
Published: June 2024

Background

The global shortage of intensive care nurses continues to be of critical concern in healthcare systems worldwide. The COVID-19 pandemic placed unprecedented pressure on healthcare units and on intensive care unit (ICU) nurses in particular, further strengthening requirements for research into the factors influencing turnover of ICU nurses and potential mitigation initiatives.

Aim

To map and synthesise the literature to identify factors influencing nursing retention/nurse turnover in ICUs and potential solutions to improve staff retention.

Methods

A scoping review of European literature was conducted on six databases. European studies focusing on factors influencing ICU nurse retention between 2010-2023 in the English language were considered.

Results

A total of 19 studies, including 17 cross-sectional studies, 1 mixed method, and 1 qualitative study, were reviewed. Four themes emerged; demographic factors; job satisfaction; patient-related factors and moral distress amongst ICU nurses; and work environment and moral distress amongst ICU nurses. Moral distress emerged as an overarching theme affecting ICU nurse retention.

Conclusion

A high prevalence of turnover was observed, influenced by multifaceted factors which occur simultaneously. Moral distress emerged as a central theme impacting both job satisfaction and burnout leading to turnover. It is paramount that healthcare organisations address these factors to improve ICU nurse retention and the quality of patient care through job satisfaction and a positive working environment, thereby reducing moral distress.
142 Comparative analysis of permeation test results: EN 14325 vs. ISO 16602 for chemical protective clothing
Authors: Lin Yu-Wen , Chu Wei-Ming , Chang Cheng-Ping , Liu Li-Wen , Hung Po-Chen
Published: June 2024

Introduction

EN 14325:2018 and ISO 16602:2012 provide guidelines for testing chemical protective clothing against chemicals with different criteria. Taiwan’s CNS primarily favours ISO 16602. This research tested Type 4 chemical protective clothing according to EN and ISO standards to evaluate data consistency and unity.

Methodology

Type 4 protective clothing from two manufacturers were selected for this study. Both fabric and seam components were encompassed for examinations. The tested chemicals were sulfuric acid, sodium hydroxide, and toluene. The permeation experiment procedures followed ISO and EN standards by applying horizontal and vertical permeation test apparatus in triplication. In total, 36 samples were tested. The breakthrough times (BT) were recorded according to the definitions of EN at a permeation rate of 1.0 μg/cm2-min and ISO at 0.1 μg/cm2-min.

Results

There were no significant differences in the BTs between the ISO and EN criteria with the p-Value > 0.05 by the Mann–Whitney U test. However, comparing types of test apparatus (vertical vs. horizontal), types of seams (binding vs. taping), and components (fabric vs. seam), all the BTs are significantly different (p-Value < 0.05). Toluene immediately broke through the tested Type 4 clothing, i.e., less than 15 seconds.

Conclusions

The BTs of the vertical test apparatus are shorter than the BTs of horizontal results. The effect of gravity might be counted for the results. Seams are usually considered to be the weak parts of protective clothing. The binding seams were more vulnerable than the fabric. The chemical resistance tests of these components should be included as ISO requirements.
156 Evaluation of cough and sneeze aerosol distribution while maintaining social distance in a confined space
Authors: Lu Ping-Feng
Published: June 2024

During the coronavirus disease 2019 (COVID-19) pandemic, many countries recommended social distances to prevent aerosol transmission. But in some cases, if there is insufficient ventilation condition especially in a stagnant air space, or other ventilation conditions, droplets from coughs or sneezes may have different potential infection impacts.

In this study, a TSI Aerodynamic Particle Sizer® (APS™) 3321 spectrometer was used to measure the aerosol size distributions of coughs and sneezes from volunteer subjects. The APS detects particles in the 0.37 to 20 μm range, with high-resolution sizing from 0.5 to 20 μm aerodynamic diameter. And it was placed in the sitting breathing area (80 cm height) in front of the volunteers in a testing chamber (2.0*2.0*2.1 m³). The social distance was 6 feet. The APS was used to sample for 1 minute after each action and was continued to sample the self-preserving distribution for aerosol coagulation for 30 minutes. The results showed after continuous monitoring for 30 minutes, the sneezing droplet range of male and female was between 0.523 ~ 5.425 μm, and the coughing droplet was in 0.523 ~ 4.371 μm; the mode droplet size of sneezing was 17.154 μm (0.08 mg/m³) for male and was about 14.855 μm (0.11 mg/m³) for female. Moreover, the mode droplet size of coughing for male was 10.366 μm (0.06 mg/m³), and 11.14 μm (0.02 mg/m³) for female, the droplet of a sneeze was larger and heavier than that of a cough while maintaining social distance after 30 minutes’ suspension and coagulation.
273 The provision of low cost, accessible OHTA training in the Asian environment - ANOH’s inputs
Authors: Hibbs Philip , PARK Dooyong , Elms Terry , Eva Brian
Published: June 2024

The Asian Network of Occupational Hygienists [ANOH] has as its primary goal the enhancement of occupational hygiene practice within its sphere of influence. The multi cultural environment presents a very broad spectrum of Occupational Health and Safety systems, ranging from embryonic to fully operational.

Demand for OH training and services sharply increased with economic development and industrialization in the last decades in the Asian region. However, in the lesser developed systems and regions, the cost of quality OHTA, training packages is commercially prohibitive, and thus limiting Occupational Hygiene influence in the associated workforces.

ANOH is providing various training opportunities including OHTA training packages, at both the W201 and selected W5XX levels, which are delivered free of cost to selected participants by experienced, qualified, volunteer trainers.

The establishment and ongoing program, including selection of location, logistic issues, availability of equipment and the management of associated costs will be described/discussed within this paper.
82 AIHA Exposure assessment strategy for assessing industrial hygiene exposures
Authors: Gruetzmacher George
Published: June 2024

The American Industrial Hygiene Association has developed an exposure assessment strategy and has emphasized the use of statistical methods for the evaluation of industrial hygiene sampling data. Professional industrial hygienists typically underestimate exposures without analytical aids. The use of heuristics and mathematical methods reduce professional bias. To support statistical analysis, they have free online analytical tools, and free online training.

The strategy is an iterative approach, starting with simpler qualitative measures and advancing to more complex quantitative measures as necessary. Qualitative tools can be easily used by observation, and then quantitative tools can be implemented when industrial hygiene sampling can be conducted. These tools include:

•IHEST - Exposure Scenario Tool

•SDM2.0 - Qualitative Assessment Tool (Excel)

•IHDA/ Expostats - Data Analysis Tools (Downloadable Program/ WebInterface)

•IHSTAT - Data Analysis Tool (Excel Spreadsheet)

After reviewing the strategy, the tools will be introduced and described. Upon completion, the attendees will be able to select, find, and use the relevant tool for exposure and risk determination.

By using a structured approach and statistical analytical tools, you will be able to make more accurate exposure assessments. This will help you identify elevated employee exposures, allow proper control targeting, and reduce the overall burden of occupational illness and disease.
298 Worker health protection team effort workshop
Authors: Kirk Leila
Published: June 2024

This 90-minutes workshop explores the contribution of a multitude of professions in the pursuit of worker health protection.

The format will be an introduction followed by brainstorming. The results from brainstorming will be used in a game of worker health risk. This is a board type game requiring tables of six to eight players.

By the end of the game, delegates should have a good understanding of the contributions made by occupational hygiene technicians, engineers, occupational health, the HR department, the health and safety department, supervisors and even the company CEO to worker health protection and crucially, how a policy or a professional error can have far reaching effects.

The workshop will continue with a discussion on how occupational hygienists could or should include feedback from each of the other professions when undertaking surveys to ensure the common goal of worker health protection.

The meeting will conclude with ideas for action to be taken by occupational hygienists to embrace and appraise the contributions made by many other professions.
23 Applied occupational hygiene in pharmaceutical industries
Authors: Mehta Maharshi , McDonnell Patricia , K Prasanth
Published: June 2024

Occupational hygiene is the highest priority in pharmaceutical industries. Potent Active Pharmaceutical Ingredients (APIs) with nanograms per cubic meter exposure limits are handled. The API manufacturing plant uses highly hazardous chemicals like methylene chloride and dimethyl formamide.

This PDC will share lessons learned from 200+ pharmaceutical industries in 20+ countries in exposure assessment and containment verification. Potent compound handling, including enzymes, hazard banding and control banding, exposure controls, work practice, and respiratory protection. Addressing unique challenges in achieving a detection limit lower than the potent compound API exposure limits, particulate containment to reduce exposure below exposure limits, and effective use of respiratory protection will be discussed.

Exposure profile from statistical analysis for 5000+ API exposure and surrogate monitoring results for various pharmaceutical unit operations (e.g., weighing, dispensing, charging, granulation) will be discussed.

Often ignored concerns for disinfectant exposure will be discussed based on a lesson learned from disinfectant exposure assessment.

A workshop will be held among the PDC participants to discuss specific exposure assessment and control challenges among participants. Upon completion of the PDC, participants will be able to learn and share:

•Representative (task-based and full-shift) exposure monitoring. Identifying excursion exposures and addressing challenges in high potent compound exposure monitoring.

•Significance of surface wipe sampling in pharmaceutical industries.

•Likely, API exposure levels, based on pharmaceutical unit operations’ exposure profiles.

•Successfully substituted potentially harmful disinfectants.

•Particulate containment technologies and their effectiveness in reducing exposure below API exposure limits. Solvent exposure profile and controls.

•Work practices, zoning, gowning-degowning for potent compounds

•Unique challenges in respiratory protection, including variability in APF.
324 Elevating occupational health, hygiene, and safety: A human and organizational performance based approach for excellence
Authors: Logan Perry
Published: June 2024

We invite you to participate in our workshop to explore the application of Human and Organizational Performance (HOP) focused on occupational health, hygiene, and safety programs. In today’s rapidly evolving workplaces, the integration of health and hygiene with safety is paramount, and HOP offers a comprehensive framework for achieving excellence in all three domains.

Our workshop will provide a deep dive into HOP principles and methodologies, empowering attendees to elevate their occupational health, hygiene, and safety initiatives. Embracing the interconnectedness of human behavior, organizational culture, and systems, we will delve into how HOP can drive transformative change in your workplace.

•Comprehensive HOP Fundamentals: Understand the core principles of HOP and its direct relevance to occupational health, hygiene, and safety programs.

•Cultivating a Holistic Safety Culture: Discover strategies to foster a culture that not only prioritizes safety but also emphasizes health and hygiene, including effective leadership, employee engagement, and open communication.

•Proactive Risk Mitigation: Explore HOP’s integration of risk assessment and management into safety programs, ensuring a healthier and safer work environment.

•Incident Learning and Continuous Improvement: Learn HOP’s innovative incident investigation techniques that encourage learning and drive continuous improvement across health, hygiene, and safety practices.

•Measuring Success Holistically: Implement leading indicators to monitor and enhance the effectiveness of your integrated occupational health, hygiene, and safety programs.

By participating in this workshop, you’ll gain the knowledge and tools needed to take a proactive stance in creating a workplace that promotes health, hygiene, and safety excellence.
Perspectives on computational modeling of biological systems and the significance of the SysMod community
Authors: Puniya Bhanwar Lal , Verma Meghna , Damiani Chiara , Bakr Shaimaa , Dräger Andreas
Published: June 2024

Motivation

In recent years, applying computational modeling to systems biology has caused a substantial surge in both discovery and practical applications and a significant shift in our understanding of the complexity inherent in biological systems.

Results

In this perspective article, we briefly overview computational modeling in biology, highlighting recent advancements such as multi-scale modeling due to the omics revolution, single-cell technology, and integration of artificial intelligence and machine learning approaches. We also discuss the primary challenges faced: integration, standardization, model complexity, scalability, and interdisciplinary collaboration. Lastly, we highlight the contribution made by the Computational Modeling of Biological Systems (SysMod) Community of Special Interest (COSI) associated with the International Society of Computational Biology (ISCB) in driving progress within this rapidly evolving field through community engagement (via both in person and virtual meetings, social media interactions), webinars, and conferences.

Availability and implementation

Additional information about SysMod is available at https://sysmod.info.
Assessing the merits: an opinion on the effectiveness of simulation techniques in tumor subclonal reconstruction
Authors: Lai Jiaying , Yang Yi , Liu Yunzhou , Scharpf Robert B , Karchin Rachel
Published: June 2024

Neoplastic tumors originate from a single cell, and their evolution can be traced through lineages characterized by mutations, copy number alterations, and structural variants. These lineages are reconstructed and mapped onto evolutionary trees with algorithmic approaches. However, without ground truth benchmark sets, the validity of an algorithm remains uncertain, limiting potential clinical applicability. With a growing number of algorithms available, there is urgent need for standardized benchmark sets to evaluate their merits. Benchmark sets rely on in silico simulations of tumor sequence, but there are no accepted standards for simulation tools, presenting a major obstacle to progress in this field.

Availability and implementation

All analysis done in the paper was based on publicly available data from the publication of each accessed tool.
Rapidly destructive hip osteoarthritis: a diagnosis not to miss
Authors: Chau Hoi Ting Hatty , Wong Pui Yi , Pan Nin Yuan , Ma Ka Fai Johnny
Published: June 2024

This review illustrates the imaging features of rapidly destructive hip osteoarthritis (RDHO) across different imaging modalities. RDHO is a rare joint disease of unknown aetiology resulting in rapid deterioration of the hip joints. Patients often present with severe hip pain and can progress to complete joint destruction in 6 months to 3 years causing disability. Since its clinical and imaging features often overlap with other conditions, the diagnosis is easily missed in daily practice. The purpose of this paper is to outline the characteristic imaging features of RDHO, aiming to enhance awareness of this disease entity and promote timely treatment for patients. Sequential radiographs are particularly important in demonstrating the rapid progression of radiographic findings and with the early recognition of characteristic features, diagnosis can be made to avoid treatment delay. Although CT scan is not necessary for diagnosis, it is useful in evaluating the extent of joint destruction and guiding surgical planning. MRI can provide additional information and rule out other pathologies with similar symptoms. Overall, radiographs, CT and MRI are common modalities used in the evaluation of RDHO.
Comparative analysis of volume and distribution of body fat in patients with lymphoma before and after chemotherapy
Authors: Soares Brandao S , Cavalcanti Amorim Martins R J C A M , Saura Martins A G S M , Duarte Ribeiro Sobrinho J M D R S , De Moraes Chaves Becker M M C B , De Oliveira Buril R O B , De Oliveira Menezes V O M , Alves Mourato F A M
Published: June 2024

Introduction

Obesity and chemotherapy with anthracyclines are risk factors for the development of cardiovascular diseases. Additionally, the higher the deposition of visceral fat (VF) and epicardial fat (EpF) in relation to subcutaneous fat (SF), the worse the cardiac risk. In lymphoma patients, whole-body positron emission tomography (PET) combined with computed tomography (CT) should be routinely performed before, during, and after the completion of cancer treatment for prognostic and therapeutic evaluation. However, whole-body PET/CT can also be useful in monitoring metabolic changes occurring in these patients due to cancer and chemotherapy, particularly those related to body fat.

Purpose

To evaluate the effects of chemotherapy on the distribution and volume of body fat using PET/CT.

Materials and Methods

A blind, comparative, observational, and analytical study. The measurement of SF, VF, and EpF volumes and attenuation densities was performed on PET/CT scans of 20 lymphoma patients before and after anthracycline chemotherapy using the LifeX software by two independent researchers who were blind to the phase of cancer treatment. A p-value < 0.05 was considered statistically significant.

Results

The mean age of the patients was 42.5 ± 17 y/o, 12 out of 20 (60%) being female and a median body weight of 60.5 kg before and 63.5 kg after chemotherapy (p=0.21). After chemotherapy, there was an increase in SF (from 1635.5mL to 2304.0mL, 41% increase, p=0.0037), VF (from 768.5mL to 1431.0mL; 86% increase, p=0.0094), and EpF (from 60.9mL to 99.4mL; 63% increase, p<0.0001), compared to the pre-chemotherapy phase. Regarding the intensity of attenuation of SF, VF, and EpF densities, no significant changes were observed before and after chemotherapy.

Conclusion

In lymphoma patients after completing chemotherapy cycles, there was a significant increase in body fat and a change in its distribution pattern, with a relatively greater growth in the volume of VF, followed by EpF. These results could reflect the worsening of the cardiometabolic profile and cardiovascular risk in these patients in the post- chemotherapy context.
Computed tomography-derived myocardial extracellular volume as a prognosis predictor in patients with severe aortic stenosis
Authors: Reis Santos R , Carvalho R , Lopes P M , Gama F , Freitas P , Guerreiro S , Abecasis J , Saraiva C , Teles R C , Almeida M S , Adragao P , Ferreira A M
Published: June 2024

Background

Patients with severe aortic stenosis (AS) face a higher risk of mortality, but prognosis is still heterogeneous and tools for prioritizing intervention are needed. Myocardial extracellular volume (ECV), measured non-invasively in pre-TAVR computed tomography (CT), is a marker of fibrosis that may reflect the degree of irreversible damage. The aim of this study was to assess the prognostic value of CT- derived ECV (ECVCT) in patients with severe AS referred for TAVR-planning CT.

Methods

Consecutive patients with severe symptomatic AS undergoing TAVR-planning CT between April and December 2022 at single centre were prospectively included. CT was performed on a 192-slice dual-source 3rd generation scanner. ECVCT was acquired during TAVR-planning using an additional post-contrast low-radiation-dose prospective acquisition. ECVCT was calculated as the ratio of change in CT attenuation (Hounsfield units [HU]) of the septal myocardium and the left ventricle (LV) blood pool before and after contrast administration, according to the equation: ECVCT = (1 – hematocrit) x (DHUmyo/DHUblood) – Figure 1A. The primary endpoint was all-cause mortality. The secondary endpoint was a composite endpoint including all-cause mortality and heart failure hospitalization.

Results

A total of 138 patients were included (mean age 81 ± 7 years; 46% male; mean transaortic gradient 51 ± 15 mmHg; mean aortic valve area 0.75 ± 0.19 cm2; mean LV ejection fraction (EF) by 2D echocardiogram 57 ± 11%). No patient had a clinical diagnosis of cardiac amyloidosis. Mean ECVCT was 33.9 ± 8.0%. During a median follow-up period of 386 days (IQR 332 – 464), there were 18 deaths (13%), 13 before intervention and 5 after intervention; the secondary endpoint occurred in 26 patients (19%), 17 of which before intervention and 9 after. Patients who attained the primary endpoint were significantly older [81 ± 7 vs. 85 ± 7 years, P = 0.011], had lower left ventricular ejection fraction [51 ± 11 vs. 58 ± 11%, P = 0.015], higher NTproBNP levels [4739 (IQR 2003 – 9970) vs. 751 (IQR 314 – 2541), P <0.001] and higher ECV values (39.9 ± 7.4% vs. 33.0 ± 7.7%, P <0.001). After adjustment for age, LVEF and NTproBNP levels, ECVCT remained an independent predictor of all-cause mortality (adjusted HR 1.09 per 1% ECV increase, 95%CI 1.02 – 1.17, p=0.005 – Figure 1B) and also the secondary endpoint (adjusted HR 1.07 per 1% ECV increase, 95%CI 1.01 – 1.13, p=0.002).

Conclusion

In this prospective observational cohort study, interstitial fibrosis assessed by CT-derived ECV was associated with poor outcomes in patients with severe AS. ECVCT values may be useful to identify a subgroup of patients with higher risk who may benefit from earlier intervention.
Value of coronary CT angiography in ruling out obstructive coronary artery disease in high-risk patients candidates for TAVI
Authors: Amico M A , Virgili G , Busi G , Acquafresca M , Moroni M , Migliorini A , Meucci F , Di Mario C , Valenti R , Carrabba N
Published: June 2024

Background

Coronary computed tomography angiography (CTA) is currently considered a reliable method to rule out obstructive coronary artery disease (O-CAD) before valvular heart surgery in patients with low to intermediate pre-test probability. However, its role in excluding O-CAD in high-risk patients before transcatheter aortic valve implantation (TAVI) is less well established. Our aim is to assess the value of coronary CTA in safely and effectively ruling out O-CAD in high-risk patients undergoing TAVI in a tertiary care center.

Methods

We conducted a single-center, retrospective study, enrolling patients with severe symptomatic aortic stenosis indicated for TAVI, who underwent coronary CTA and subsequent invasive coronary angiography (ICA) before valvular heart replacement. O-CAD was defined as a ≥ 50% stenosis in an epicardial vessel ≥ 2 mm diameter, in both coronary CTA and ICA. Patients were divided into two groups: those with a CTA scan negative for O-CAD, in whom invasive ICA was omitted, and those with a positive or inconclusive CTA scan, who underwent ICA. PCI was performed in those suitable for revascularization. A 12-month clinical follow-up was carried out in all patients.

Results

Our registry included 163 patients, 31 of whom did not undergo coronary CTA for clinical reasons. Thus, 132 patients (63% female; mean age 84.1 ± 4.9 years) underwent coronary CTA, with 85 patients (64.4%) having negative results for O-CAD. Among those with positive coronary CTA (n=21 [15.9%]), O-CAD was confirmed by ICA in 81.0% (n=17), with over half undergoing PCI (n=11; 52.4%). In patients with inconclusive coronary CTA (n=26 [19.7%]), O-CAD was confirmed in 61.5% (n=16), with 52.4% (n=11) undergoing PCI. The mean time interval from CTA to ICA was 32.8 ± 42.9 days. At 12 months, no statistically significant differences in periprocedural complications, cardiovascular events, or mortality were observed between the two groups. The incidence of myocardial infarction was 1.2% (n=1) and 4.3% (n=2) in patients with no evidence of O-CAD at coronary CTA and those with a positive or inconclusive scan, respectively (p = 0.2885).

Conclusions

Pre-procedural coronary CTA may be safe and effective in ruling out O-CAD in a significant proportion of eligible high-risk patients undergoing TAVI. The results suggest that performing an ICA is unnecessary, avoiding the need for additional contrast medium, with no occurrence of unexpected cardiovascular events during the 12-month follow-up. However, the added value of coronary CTA scan in ruling in patients with O-CAD is uncertain and remains to be clarified.
Clinical likelihood models calibrated against observed obstructive coronary artery disease by computed tomography angiography
Authors: Rasmussen L D , Schmidt S E , Knuuti J , Maaniitty T , Saraste A , Cerci R J , Newby D E , Douglas P S , Boettcher M , Baskaran L , Winther S
Published: June 2024

Background

Models predicting the likelihood of obstructive coronary artery disease (CAD) on invasive coronary angiography are available.(1,2) However, as stable de novo chest pain patients frequently have lower clinical likelihood and preferably undergo index testing by non-invasive tests such as coronary computed tomography angiography (CCTA)(3,4), clinical likelihood models calibrated against observed obstructive CAD at CCTA are warranted.

Purpose

To develop and validate CCTA-calibrated risk-factor-weighted and coronary artery calcium-score-weighted clinical likelihood models (i.e., RF-CL-CCTA and CACS-CL-CCTA models, respectively).

Methods

Based on age, sex, symptoms and cardiovascular risk factors, an advanced machine learning algorithm utilized a training cohort (n=38,269) of symptomatic outpatients with suspected obstructive CAD to develop both a RF-CL-CCTA and a CACS-CL-CCTA model to predict observed obstructive CAD at CCTA. The models were compared to a currently European Society of Cardiology-endorsed basic pre-test probability (Basic PTP) model(5), and findings were validated widely in a pooled validation cohort (n=26,141), including cohorts from United States of America, Brazil, Finland, United Kingdom, Singapore, and Denmark.

Results

Obstructive CAD at CCTA was present in 5,984 (22.9%) patients in the pooled validation cohort. While the Basic PTP underestimated the prevalence of observed obstructive CAD at CCTA, the RF-CL-CCTA and CACS-CL-CCTA models showed superior calibration (Figure 1). Compared to the Basic PTP model, the RF-CL-CCTA and CACS-CL-CCTA models showed superior discrimination (area under the receiver-operating curve (AUC) 0.71 (95% confidence interval (CI) 0.70-0.72) vs. 0.74 (95%CI 0.73-0.75) and 0.86 (95%CI 0.85-0.87), p<0.001 for both comparisons) (Figure 2).

Conclusions

CCTA-calibrated clinical likelihood models improve calibration and discrimination of observed obstructive CAD at CCTA.Figure 1:Calibration.  Figure 2:Discrimination.
CT-free attenuation correction for cardiac-dedicated CZT SPECT: first results of the CASCTEC study
Authors: Hesse M , Dupont F , Gheysens O , Lhommel R , Roelants V
Published: June 2024

Aim/Introduction

The diagnostic accuracy of myocardial perfusion scintigraphy (MPS) for detecting coronary artery diseases (CAD) is improved when using attenuation-corrected (AC) images. However, for economic reasons, most clinical cardiac-dedicated CZT cameras are marketed without a CT. Therefore, the CASCTEC clinical study aims at developing an approach to generate AC images only from emission scans on a pinhole CZT camera, without the need for CT.

Materials & Methods

Up to now 25 patients referred for MPS have been enrolled in the CASCTEC single-center prospective study. Two-day stress/rest myocardial SPECT imaging was performed on a pinhole CZT camera. A standard of care (SOC) 5-10 minutes acquisition was immediately followed by an additional 5 minutes acquisition after radially retracting the detectors (FAR) without moving the patient. Subsequently all patients underwent SPECT/CT imaging to be used as reference. The FAR acquisition allowed to delineate the patient body contour, and together with the SOC acquisition, enabled the segmentation of soft and lung tissues to produce an attenuation map. Non-corrected (NC) and AC images were compared together and with respect to the SPECT/CT images using the AHA 17-segment model polar maps and a polar sub-segmentation of these maps (104 segments). All (sub-)segments were scored according to their relative perfusion uptake, and combined to generate stress and rest summed scores.

Results

The tracer distribution was found more homogeneous for CASCTEC-AC patient stress and rest perfusion images compared to NC images, and similar to the reference. All perfusion defects observed on the SPECT/CT-AC images were also visible on CASCTEC-AC images. The CASCTEC mean relative uptake increased by up to 40% in the inferior segments compared to the NC image. Changes by less than 10% were observed for all other segments, except for the apical segment that decreased by up to 25%. The differences of the changes in the (17-segment) right coronary artery territories (RCA) summed scores from NC to AC between CASCTEC and SPECT/CT images were 0.2±3.0 (p=0.41) and 0.6±2.2 (p=0.21), respectively for stress and rest scans. Similar results were obtained for the differences of the changes in the (104-segment) RCA summed scores, i.e. 0.1±2.7 (p=0.20) and 0.1±2.4 (p=0.14), respectively for stress and rest scans.

Conclusions

The CASCTEC CT-free patient-specific attenuation map enhances NC perfusion in the inferior wall similarly to CT-based AC images from a SPECT/CT acquisition. This method looks promising to improve the diagnostic accuracy of current cardiac pinhole CZT systems for detecting obstructive CAD but requires further studies.60 years old man – BMI = 30  73 years old man – BMI = 38.5
Descriptive analysis of patients with systemic sclerosis: pilot cohort study
Authors: Aguirre E , Guillen Del Castillo A , Palomar Munoz A , Cardozo-Saavedra A , Aguade-Bruix S , Cuellar-Calabria H , Pizzi M N , Roque A , Simeon Aznar C P , Romero-Farina G
Published: June 2024

Background

In systemic sclerosis (SSc) primary heart involvement, although not exhaustively studied, is frequent and may have prognostic consequences.

Purpose

This pilot cohort study reports a descriptive analysis of patients’ evaluation in a Nuclear Cardiology Unit.

Methods

Prospective study. Between 2012 and 2016, 62 patients (age 56.8 ± 12.9 years, men 12.9%) with SSc referred from the Autoimmune Systemic Diseases Unit for cardiac evaluation were prospectively analyzed. All patients were studied with gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (gSPECT-MPI) during rest, exercise and cold test. Ventricular synchrony was assessed by Emory Cardiac ToolboxTM program, and coronary anatomy was evaluated by coronary computed tomography angiography (CCTA) in all patients. Statistical analyses were performed using STATA 18. StataCorp, College Station, TX, USA.

Results

Most patients were women (86.9%). The prevalence of arterial hypertension (55.7%) and hypercholesterolemia (39.3%) was high, in contrast, the prevalence of diabetes mellitus (4.9%), tobacco (8.2%) and chronic renal failure (3.2%) was low. The prevalence of angina (19.4%), dyspnea (35.5%) and the clinical history of cardiac event (myocardial infarction [n=5], heart failure [n=2], unstable angina [n=4], coronary revascularization [n=1], pericardial diseases [n=2], syncope [n=1]) was high (19.3%). A quarter of the patients had pulmonary arterial hypertension. Electrical conduction disorder was observed in 27.4% of patients (left bundle branch block, right bundle branch block, and left anterior hemiblock), and no patient had a pacemaker. Myocardial ischemia (MIs) (Summed Difference Score ≥ 2) was observed in 24.2% of patients who underwent SPECT exercise-rest and in 22.6% of patients who underwent SPECT cold-rest test. Five percent of patients without MIs in the SPECT cold-rest test presented MIs in the SPECT exercise-rest test, and 8.5% of patients without MIs in the SPECT exercise-rest test had it in the SPECT cold-rest test. The overall agreement for MIs tests was 85.5%. Left ventricular ejection fraction <50% was observed in 12% of patients. Ventricular dyssynchrony (BD > 51º) was observed in 64.5% of patients. A calcium score > 100 AU and a calcium score ≥ 400 AU was observed in 33.9% and 11.5% of patients, respectively. Coronary artery disease was detected in 29% of patients, of which 44% presented significant coronary stenosis (≥ 50%).

Conclusion

This pilot and descriptive study reveals that patients with SSc have cardiac involvement in a non-negligible percentage of the cases and may benefit of a comprehensive evaluation using Nuclear Cardiology techniques among others tests.
Current practices and access to cardiac bone scans for the detection of transthyretin cardiac amyloidosis based on the results of a large national electronic survey
Authors: Hyafil F , Amara W , Andres E , Bardin T , Fournier P , Guignard S , Labeyrie C , Legallois D , Oghina S , Piriou N , Sabouret P , Toulza O , Tresorier R , Walle M , Damy T
Published: June 2024

Background

The diagnosis of transthyretin cardiac amyloidosis (ATTR-CM) requires a good collaboration between physicians to confirm the diagnosis.

Purpose

This study aimed to assess current practices of nuclear medicine (NM) physicians for cardiac scintigraphy with bone radiotracers and to evaluate access to cardiac bone scintigraphy in the healthcare circuit for the diagnosis of ATTR-CM.

Methods

A nationwide electronic survey was sent to 13 830 French physicians including 775 nuclear medicine (NM) physicians to assess their knowledge of 1. clinical signs of amyloidosis and 2. the recommended diagnostic algorithm to identify TTR cardiac amyloidosis. In addition, accessibility, appointment delays and results interpretation difficulties for each of the explorations required to confirm the diagnosis of ATTR-CM were evaluated among different medical specialists. A part of the questionnaire was exclusively dedicated to NM to understand their current practice regarding acquisitions protocols and reporting of cardiac bone scans.

Results

1264 physicians including 148 NM physicians (19 % of all NM physicians contacted) completed the survey. NM physicians who answered to the survey worked in academic hospitals (35 %), general hospitals (31 %), or private practices (26 %). Cardiac bone scans using early acquisitions were performed by 20 % of NM and SPECT acquisitions by 72 %. Grading of cardiac uptake of bone tracers using the Perugini score was carried out by 93 % of the NM, but only 31% and 5% of NM systematically performed heart/whole body or heart/mediastinum signal quantification, respectively. Median (Q1; Q3) delay to obtain results for a cardiac bone scan was estimated at 2 weeks (2; 4) compared to 4 (3; 8) weeks for cardiac MRI, and 2 (2 ; 4) weeks for a biopsy. Among physicians involved in clinical management of patients with ATTR-CM, 68% rarely or never faced difficulties for cardiac scintigraphy. Main difficulties encountered by physicians were: appointment delay (60%), geographical distance (17%), interpretation (12%).

Conclusions

In this large French national survey, access to cardiac bone scintigraphy for patients with a suspicion of ATTR cardiac amyloidosis and quality of reports appear excellent thanks to good adherence of NM physicians to the recommended acquisition protocols for cardiac bone scans and the widespread use of the Perugini grading scale in reports. However, quantitative measurements of cardiac uptake of bone tracers were performed only in one third of bone scans underscoring room for improvement in the next procedural guidelines for cardiac bone scans.
Prognostic value of 99mTc-DPD quantitative SPECT/CT in patients with suspected and confirmed cardiac ATTR-Amyloidosis and preserved left ventricular function
Authors: Gozlugol N , Caobelli F C , Caobelli F C , Bakula A B , Bakula A B , Rominger A R , Rominger A R , Schepers R S , Schepers R S , Stortecky S S , Stortecky S S , Hunziker Munsch L H M , Hunziker Munsch L H M , Dobner S D , Dobner S D , Grani C G , Grani C G
Published: June 2024

Aim

Quantitative 99mTc-3,3-diphosphono-1,2 propanodicarboxylicacid (99mTc-DPD) Single Photon Emission Computed Tomography (SPECT) may be used for risk stratifying patients with transthyretin-related amyloidosis-cardiomyopathy (ATTR-CM). We aimed to analyse the predictive value of quantitative 99mTc-DPD SPECT/CT in suspected and confirmed ATTR-CM according to different disease stages.

Methods

Consecutive patients with suspected ATTR-CM referred to a single tertiary center who underwent quantitative 99mTc-DPD SPECT/CT allowing standardized uptake values (SUVmax, SUVpeak) analysis were enrolled. Patients were divided into two groups according to left ventricular ejection fraction (LVEF) at baseline (i.e. LVEF≥50% and <50%). Correlations between clinical, laboratory, and echocardiographic parameters and major adverse cardiac events (i.e. all-cause death, sustained ventricular tachyarrhythmia, hospitalization for heart failure, implantation of a cardioverter defibrillator) to quantitative uptake values were investigated.

Results

A total of 144 patients with suspected ATTR-CM were included in the study (98 with LVEF≥50% and 46 with LVEF<50%), of whom 99 were diagnosed with ATTR-CM (68,75%; 69 with LVEF≥50% and 30 with LFEV<50%). Myocardial SUVmax≥7 was predictive of MACE at 21.9±13.0 months follow-up (HR 2.875, 95%CI 1.23 – 6.71, p=0.015) in suspected ATTR-CM and in patients with confirmed ATTR-CM (global X²= 6.892, p=0.02) and LVEF≥50%. There was no predictive value for patients with LVEF<50% in suspected or confirmed ATTR-CM.

Conclusions

In patients with suspected or confirmed ATTR-CM and preserved LVEF, representing early disease stage, a myocardial SUV≥7 is a predictive marker for MACEs. Quantitative 99mTc-DPD SPECT should be considered for improved early stage risk stratification of patients with ATTR-CM.
Routine clinical reproducibility of hyperemic myocardial blood flow measurements with 15O-water-PET
Authors: Lubberink M , Nordstrom J , Sigfridsson J , Svanstrom P , Eggers K M , Sorensen J , Kero T
Published: June 2024

Background

Hyperemic myocardial blood flow (MBF) has been shown to provide the most accurate non-invasive diagnosis of hemodynamically significant CAD. A high reproducibility of hyperemic MBF measurements is important for accurate stratification of patients. Previous studies have shown that whole-myocardium hyperemic MBF measurement with 82Rb has a repeatability coefficient (RC) of 50% (1.3 mL/g/min) for a two-day test-retest using adenosine in healthy controls [1] and 21% (0.51 mL/g/min) and 38% (0.90 mL/g/min) for a single-session and two-day test-retest using dipyridamole, respectively, in patients in clinical routine [2]. For 15O-water and adenosine, an RC of 25% (0.90 mL/g/min) has been reported in 1999 for healthy controls, whereas RC at the regional level was >50% [3].

Purpose

The aim of the current work is to assess the reproducibility of hyperemic MBF measurements with 15O-water using state of the art technology.

Methods

Ten patients referred for assessment of ischemia underwent a same day test-retest protocol consisting of 4-min dynamic rest and stress scans starting simultaneously with controlled bolus injection of 400 MBq 15O-water on a digital PET-CT scanner. Patients left the scanner between test and retest sessions and time between test and retest scan sessions was circa 1 h. Adenosine infusion at 140 μg/kg/min was started 2 min prior to each stress scan and continued during the entire scan. Images were analysed using fully automated software. RC (1.96 x SD of test-retest differences), mean relative test-retest difference and within-subject coefficient of variation (wCV) were calculated at the whole myocardium, regional and segmental levels.

Results

Whole myocardium hyperemic MBF ranged from 1.3 to 4.6 mL/g/min. RC was 15% (0.43 mL/g/min), 23% (0.67) and 27% (0.80) at whole myocardium, regional and segmental levels, respectively. Mean test-retest difference was 7%, 10% and 11%, and wCV was 5.5%, 8.3% and 9.8%, respectively. Figure 1 shows scatter plots of MBF values and figure 2 shows stress MBF polarmaps of a typical patient.

Conclusion

Automated data analysis and use of modern PET scanners results in a large improvement of reproducibility of hyperemic MBF measurements with 15O-water. Reproducibility of hyperemic MBF with 15O-water is superior to previously published values for 82Rb.Scatter plot of test-retest MBF values  Stress MBF polar maps of one subject