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Refroidissement A virus portions a few and six can easily harbor man-made introns making it possible for extended html coding potential.
OBJECTIVE To determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. MATERIAL AND METHODS We compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. RESULTS The mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. CONCLUSIONS The concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. The treatment of cancer has improved drastically in recent decades. Better understanding of tumor biology has enabled the development of new treatments, called targeted therapy. These drugs target specific signaling pathways that are necessary for the development of cancer. Immunotherapy is even more novel. These new agents can be classified into different groups, mainly according to their mechanism of action VEGF inhibitors or anti-angiogenic agents, EGFR inhibitors, mTOR inhibitors, CTLA-4 inhibitors, or PD-1/PD-L1 inhibitors, etc. All these new treatments are accompanied by new adverse effects that radiologists need to know. Understanding the molecular mechanisms of targeted therapies and knowing their adverse effects are vital to imaging assessment and ensuring appropriate treatment. BACKGROUND Left ventricle (LV) unloading during VenoArterial ExtraCorporeal Membrane Oxygenation (VA-ECMO) reduces the risk of LV distention, stagnation and pulmonary congestion resulting from the increased afterload. Lacking direct comparisons between unloading strategies we used network meta-analysis to indirectly compare different unloading approaches. METHODS A literature research was performed to include all studies on VA-ECMO reporting data on mechanical LV unloading. The pre-specified outcome was in-hospital death. RESULTS Literature search identified 389 studies 16 were included in the analysis (3930 patients). Two strategies of mechanical LV unloading were compared afterload reduction (IABP) and preload reduction (Impella pump, right upper pulmonary/trans-septal catheters, LV surgical vents). Any LV unloading strategy was associated with mortality reduction with overall OR = 0.54; 95% CI 0.42-0.70; p less then .001. Targeting afterload was associated with reduced mortality (OR = 0.61 95% CI 0.46-0.81; p less then .001; I2 = 61%), as targeting preload (OR = 0.34 95% CI 0.21-0.55; p less then .001; I2 = 0%). Significant between group difference was observed (p = .04) to further explore this we performed a network meta-analysis. Indirect comparisons between afterload and preload reduction were estimated. Any unloading technique was confirmed better than none but preload targeting resulted better than afterload targeting. CONCLUSION Any unloading strategy in VA-ECMO patients was associated with lower mortality as compared to no-unloading. Preload reduction strategies resulted superior to afterload reduction. BACKGROUND Diagnosis and grading of diastolic dysfunction (DD) is challenging, with different studies using heterogeneous criteria and guidelines not routinely applied in clinical practice. Our aim was to apply the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging classification of DD among a contemporary population of patients with acute coronary syndromes (ACS) by analyzing its correlation with N-terminal pro b-type natriuretic peptide (NT-proBNP) and impact on clinical outcomes. METHODS Independent investigators blinded to each other and to the clinical history reviewed digitally stored images to apply 2016 and 2009 DD definitions to 380 patients (mean age 66 ± 13 years, 75% men) with ACS admitted to the coronary care unit between January 2016 and March 2018. RESULTS DD was frequent with both definitions, yet the concordance was weak (kappa =0.21, p less then 0.01). Inter-observer reliability was greater by applying the 2016 algorithm (kappa = 0.89, p less then 0.001). There was a significant correlation between NT-proBNP and worsening DD (Spearman's rho r = 0.54 for 2016 and r = 0.24 for 2009 algorithms, both p less then 0.001). Worse DD was associated with worse clinical presentation and increased risk of events (HR for the cumulative incidence of heart failure and death during follow-up 2.15 [95% CI 1.66-2.78, p less then 0.001] and 1.82 [95% CI 1.39-2.40, p less then 0.001] for 2016 and 2009 classifications, respectively, all p less then 0.001). CONCLUSIONS The agreement between 2016 and 2009 DD definitions was poor, with newer guidelines having grater interobserver reliability. The positive graded association between 2016 DD classification and NT-proBNP and its association with clinical outcomes provide a validation of the latest guideline algorithm in ACS patients. BACKGROUND Sudden cardiac death (SCD) due to ventricular arrhythmias (VA) is an important mode of death in adults with congenital heart disease (CHD). Risk stratification is difficult in this heterogeneous population. Insertable cardiac monitors (ICM) may be useful for risk stratification. The purpose of the present study was to evaluate the use of ICM for the detection of VA in adults with CHD. METHODS In this prospective single-center observational study we included consecutive adults with CHD deemed at risk of VA who received an ICM between March 2013 and February 2019. The decision to implant an ICM was made in a Heart Team consisting of a cardiac electrophysiologist and a cardiologist specialized in CHD. RESULTS A total of 30 patients (mean age, 38 ± 15 years; 50% male) received an ICM. During a median follow-up of 16 months, 8 patients (27%) had documented nonsustained VA. Of these 8 patients, 3 (10%) received a prophylactic ICD. Furthermore, ICM-detected arrhythmias were present in 22 patients (73%) leading to a change in clinical management in 16 patients (53%). Besides the patients receiving an ICD, 10 patients (33%) had a change in their antiarrhythmic drugs, 6 patients (20%) underwent an electrophysiology study, and 1 patient (3%) received a pacemaker. CONCLUSIONS The detection of VA by the ICM contributed to the clinical decision to implant a prophylactic ICD. Furthermore, ICM-detected arrhythmias led to important changes in the clinical management. Therefore, long-term arrhythmia monitoring by an ICM seems valuable for risk stratification in adults with CHD. SKI-606 supplier BACKGROUND Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI). METHODS AND RESULTS The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1-3 years post-MI, from 25 countries. All had ≥1 risk factor age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]) CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs less then 65 years) 65-74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35). CONCLUSION In stable patients recruited 1-3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options. V.BACKGROUND Use of D-dimer for prognostication of patients with ST-segment elevation myocardial infarction (STEMI) remains controversial and undefined among those with angiographically evident thrombus or no-reflow phenomenon. METHODS We retrospectively analyzed consecutive STEMI patients who received primary percutaneous coronary intervention (PCI) at Zhongshan Hospital Fudan University from January 2008 to December 2018. Outcomes were in-hospital major adverse cardiovascular events (MACE cardiac death, non-fatal acute myocardial infarction, re-vascularization and stroke), peak troponin T and NT-proBNP levels, left ventricular ejection fraction (LVEF) and hospitalization duration. RESULTS Among 1165 patients, those with increased (≥0.8 mg/L, n = 224, 19.2%) vs. normal (n = 941, 80.8%) D-dimer level were older; more often women and non-smokers. Increased D-dimer group had similar frequency of AET (58.7% vs. 62.1%, P = .353), more frequently no-reflow phenomenon (13.1% vs. 18.8%, P = .028), higher peak values of troponin T (3.5 [0.9-7.0] vs. 4.5 [1.8-8.7], P = .001) and NT-proBNP (903.3 [532.3-2098.5] vs. 2070.0 [859.1-4378.0], p less then .001). link2 In increased D-dimer group, LVEF (53.3 ± 8.3 vs. 48.8 ± 9.8, P less then .001) was lower, hospitalization was longer (8.0 ± 4.9 vs. 10.5 ± 6.9 days, P less then .001) and risk of developing in-hospital MACE (1.5% vs. 12.1%, P less then .001) was greater. D-dimer level was an independent risk factor for MACE (OR 8.408, 95%CI 4.065-17.392, P less then .001), including the angiographically evident thrombus (OR 6.939, 95% CI 2.944-16.355, P less then .001) and the no-reflow (OR 8.114, 95% CI 1.598-41.196, P = .012) subgroups. CONCLUSIONS Increased D-dimer level was an independent risk factor for in-hospital MACE in STEMI patients undergoing primary PCI, including those with angiographically evident thrombus and no-reflow phenomenon. D-dimer was not associated to no-reflow phenomenon in STEMI patients. BACKGROUND Limited national US data are available regarding the prevalence of and trends in different arrhythmias and the use of electrophysiological procedures in patients with alcoholic cardiomyopathy. METHODS This was a cross-sectional study that used the Nationwide Inpatient Sample database (2007-2014). Hospitalizations of adults with alcoholic CMP were identified with the ICD-9 code (425.5). CAD and other causes of cardiomyopathy were excluded. Chi-square test, t-test, mixed-effect logistic regression and quantile regression were used. RESULTS Among 75,430 hospitalizations, 48% had arrhythmias. Individuals with a co-diagnosis of arrhythmia tended to be older (56.9 vs 53.2-year-old) and male (89.5% vs 81.9%). The most prevalent arrhythmias were atrial fibrillation/flutter (31.5%), followed by ventricular tachycardia (7.9%). link3 The prevalence of arrhythmias increased from 44% to 50% (2007-2014) (p  less then  0.001) and this increase was mainly secondary to the increasing prevalence AFib/AFL. Excluding cardiac arrest, arrhythmias were not associated with increased in-hospital mortality.
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