Notes

Intense Lagophthalmos due to Bell's Palsy could be a Manifestation of COVID-19.
Most clinicians (83%) found the structured format with headers to be the most coherent report. Conversely, 53% found the unstructured FT and 43% found the highly SI templates to be the most disjointed. CONCLUSION Based on responses to surveys of knee MRI report templates, our results show that our orthopedic clinicians prefer some level of structure in the reports but not the rigorous itemization of anatomic tissues. A "middle ground" reporting structure which includes headers for different anatomic compartments and allows for grouping of relevant pathology, is shown to be the preferred format. RATIONALE AND OBJECTIVES To evaluate the depictability of intracranial small arteries using high-resolution CTA with model-based iterative reconstruction (MBIR). MATERIALS AND METHODS We retrospectively analyzed 21 patients who underwent brain 3D-CTA. Axial and volume-rendered (VR) images were reconstructed from the 3D-CTA raw data using adaptive statistical image reconstruction (ASIR) and MBIR. As a quantitative assessment, intra-arterial CT values of the ICA and contrast-to-noise ratio were measured to evaluate vessel enhancement. Additionally, CT values and standard deviations (SDs) of CT values and signal to noise ratio in white matter parenchyma were measured to evaluate background noise. As a qualitative assessment, the degree of vessel depictability in the anterior choroidal artery (AchoA) and the perforating branches of thalamoperforating arteries (TPA) on VR images using two different reconstruction algorithms was visually evaluated using a 3-point grading system. RESULTS The CT value of the ICA [605.27± 89.76 Hounsfield units (HU)] was significantly increased and the SD value (i.e., image noise) of the white matter parenchyma [6.79 ± 0.81(HU)] was decreased on MBIR compared with ASIR [546.76 ± 85.27 (HU)] and [8.04 ± 1.08 HU)] (p less then .05 for all). Contrast-to-noise ratio of ICA [84.48 ± 20.17] and signal to noise ratio of white matter [6.18 ± 0.75] with MBIR were significantly higher than ASIR [65.98 ± 13.08] and [5.28 ± 0.78] (p less then 0.05 for all). In addition, depictions of the AchoA and TPA on VR images were significantly improved using MBIR compared with ASIR (p less then 0.05). CONCLUSION MBIR allows depiction of small intracranial arteries such as AchoA and TPA with better visibility than ASIR without increasing the dose of radiation and the amount of contrast agent. RATIONALE AND OBJECTIVE Epilepsy is a common pediatric disease that often leads to cognitive and intellectual impairments. Here, we explore the reorganized functional networks in children and adolescents with focal epilepsy (CAFE) and analyze the relationship between network reorganization and intellectual deficits to reveal the underlying link between them. MATERIALS AND METHODS Fifty-four CAFE (6-16 years old; right-handed) and 42 well-matched healthy controls were recruited. Subjects underwent resting-state functional magnetic resonance imaging, and functional networks were analyzed by graph analysis. Intelligence testing (Wechsler Intelligence Scale for Children-Chinese revision) included measures for verbal IQ (VIQ), performance IQ, and full-scale IQ. RESULTS (1) In the CAFE compared with the healthy controls, (a) the local efficiency, clustering coefficient and standardized clustering coefficient were significantly decreased (p less then 0.05); (b) the degree centrality and nodal efficiency of the lefe a significant effect on intelligence. RATIONALE AND OBJECTIVES To assess if vessel suppression (VS) improves nodule detection rate, interreader agreement, and reduces reading time in oncologic chest computed tomography (CT). MATERIAL AND METHODS One-hundred consecutive oncologic patients (65 male; median age 60y) who underwent contrast-enhanced chest CT were retrospectively included. For all exams, additional VS series (ClearRead CT, Riverrain Technologies, Miamisburg) were reconstructed. Two groups of three radiologists each with matched experience were defined. Each group evaluated the SD-CT as well as VS-CT. Each reader marked the presence, size, and position of pulmonary nodules and documented reading time. In addition, for the VS-CT the presence of false positive nodules had to be stated. Cohen's Kappa (k) was used to calculate the interreader-agreement between groups. Reading time was compared using paired t test. RESULTS Nodule detection rate was significantly higher in VS-CT compared to the SD-CT (+21%; p less then 0.001). Interreader-agreement was higher in the VS-CT (k = 0.431, moderate agreement) compared to SD-CT (k = 0.209, fair agreement). Almost all VS-CT series had false positive findings (97-99 out of 100). Average reading time was significantly shorter in the VS-CT compared to the SD-CT (154 ± 134vs. 194 ± 126; 21%, p less then 0.001). CONCLUSIONS Vessel suppression increases nodule detection rate, improves interreader agreement, and reduces reading time in chest CT of oncologic patients. Due to false positive results a consensus reading with the SD-CT is essential. BACKGROUND Lipoprotein (a) [Lp(a)] has been reported to be a residual risk factor in patients who have achieved target lipid levels. The aim of the present study was to investigate the associations of Lp(a) with plaque progression and major cardiovascular events in patients with acute coronary syndromes (ACS). METHODS The Yokohama-ACS study included 102 patients with ACS who underwent intravascular ultrasound (IVUS) at baseline and at 10-month follow-up after percutaneous coronary intervention (PCI). The patients were randomly assigned to receive either moderate- or low-intensity statin therapy. IVUS was performed to measure the plaque volume at non-culprit lesions. We enrolled 76 patients for whom Lp(a) levels at 10-month follow-up were available. RESULTS The patients were divided into 2 groups according whether their Lp(a) levels were ≤20 mg/dl [low Lp(a) group; n = 49] or >20 mg/dl [high Lp(a) group; n = 27]. Baseline characteristics and low-density lipoprotein cholesterol levels at 10-month follow-up were similar in the low Lp(a) group and high Lp(a) group (87 ± 29 mg/dl vs. 93 ± 27 mg/dl, p = 0.42). The low Lp(a) group had significant plaque regression, whereas the high Lp(a) group showed slight plaque progression (-6.8% vs. Adavosertib Wee1 inhibitor 2.5%, p = 0.02). Ninety-five percent of the prognostic data were obtained 5 years after PCI. The cumulative event-free survival rate was significantly lower in the high Lp(a) group (p = 0.02; log-rank test). CONCLUSIONS Lp(a) levels may be an alternative predictor of further plaque regression and the likelihood of major adverse cardiovascular events in statin-treated ACS patients. BACKGROUND It has been shown that most paroxysmal atrial fibrillation (AF) can be terminated by pulmonary vein (PV) isolation alone, suggesting that rapid discharges from PV drive AF. To define the driving mechanism of AF, we compared the activation sequence in the body of left atrium (LA) to that within PV. METHODS Endocardial noncontact mapping of LA body (LA group; n = 16) and selective endocardial mapping of left superior PV (LSPV) (PV group; n = 13) were performed in 29 paroxysmal AF patients. The frequency of pivoting activation, wave breakup, and wave fusion observed in LA were compared to those in LSPV to define the driving mechanism of AF. Circumferential ablation lesion around left PV was performed after right PV isolation to examine the effect of linear lesion around PV on AF termination both in LA and PV groups. RESULTS The frequency of pivoting activation, wave breakup, and wave fusion in PV group were significantly higher than those in LA group (36.5 ± 17.7 vs 5.0 ± 2.2 times/seconds, p  less then  0.001, 10.1 ± 4.3 vs 5.0 ± 2.2 times/seconds, p = 0.004, 18.1 ± 5.7 vs 11.0 ± 5.2, p = 0.002). Especially in the PV group, the frequency of pivoting activation was significantly higher than that of wave breakup and wave fusion (36.5 ± 17.7 vs 10.1 ± 4.3 times/seconds, p  less then  0.001, 36.5 ± 17.7 vs 18.1 ± 5.7 times/seconds, p  less then  0.001). These disorganized activations in LSPV were eliminated by the circumferential ablation lesion around left PV (pivoting activation; 36.5 ± 17.7 vs 9.3 ± 2.3 times/seconds, p  less then  0.001, wave breakup; 10.1±1.3 times/seconds, p = 0.003, wave fusion; 18.1 ± 5.7 vs 5.7 ± 1.8, p  less then  0.001), resulted in AF termination in all patients in both LA and PV groups. CONCLUSIONS Activation sequence within PV was more disorganized than that in LA body. Frequent episodes of pivoting activation rather than wave breakup and fusion observed within PV acted as the driving sources of paroxysmal AF. BACKGROUND We investigated the effect of inter-arm blood pressure differences (IABPD) on the percutaneous coronary intervention (PCI) outcomes of patients with coronary artery diseases. METHODS We retrospectively reviewed the data of blood pressures measured simultaneously in the bilateral arms of 855 patients (560 males) who underwent PCI with drug-eluting stents for coronary artery diseases. IABPD was defined as the difference of blood pressure in both arms. The primary outcome was the presence of major adverse cardiac events (MACE) consisting of cardiovascular death, myocardial infarction, stroke, and ischemia-driven target vessel revascularization. RESULTS The mean age of the included patients was 66.2 ± 11.6 years, with a mean follow-up period of 44.5 ± 26.4 months. MACE occurred in 15.2% of patients, showing a higher rate in the higher IABPD group (≥10 mmHg) than in the lower IABPD group ( less then 10 mmHg) (22.5% vs 14.5%, p = 0.081). The difference was induced by a higher rate of ischemia-driven target vessel revascularization (17.5% vs 8.3%, p = 0.011). The Kaplan-Meier survival analysis revealed a greater incidence of MACE in patients with a higher IABPD (log rank p = 0.054). The Cox proportional hazard analysis showed that IABPD was an independent predictor of long-term MACE (hazard ratio, 1.028; 95% confidence interval, 1.002-1.055; p = 0.037), along with age, diabetes mellitus, and number of implanted stents. CONCLUSION Among patients treated with PCI, the incidence of MACE was significantly higher in those with a higher IABPD (≥10 mmHg) than in those with a lower IABPD ( less then 10 mmHg), which was mainly driven by ischemia-driven target vessel revascularization. BACKGROUND The incidence of cardiac implantable electronic device (CIED) infection is increasing worldwide. However, data regarding this phenomenon in Japan and information on factors associated with developing CIED infection are limited. Our aim was to compare the incidence of CIED infection between pre-current (past 10-20 years) and current (past 10 years) clinical settings and to investigate risk factors for CIED infection in current clinical settings in a Japanese population. METHODS This observational study included 1749 patients (age 77 ± 12 years, 824 males) who underwent a CIED-related procedure between August 1999 and July 2019 at our institution. We defined the pre-current and current clinical setting periods as August 1999-July 2009 (period I) and August 2009-July 2019 (period II), respectively. We compared the incidence rate of CIED infection between periods and evaluated the risk factors for CIED infection in period II by multivariate analysis. RESULTS A CIED infection was identified in 0.7% (5/709 patients) and 1.
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