Carotid plaque regression following 6-month statin therapy assessed by 3T cardiovascular magnetic resonance: comparison with ultrasound intima media thickness

<p>Abstract</p> <p>Background</p> <p>Cardiovascular magnetic resonance (CMR) allows volumetric carotid plaque measurement that has advantage over 2-dimensional ultrasound (US) intima-media thickness (IMT) in evaluating treatment response. We tested the hypothesis that 6-month statin treatment in patients with carotid plaque will lead to plaque regression when measured by 3 Tesla CMR but not by IMT.</p> <p>Methods</p> <p>Twenty-six subjects (67 ± 2 years, 7 females) with known carotid plaque (> 1.1 mm) and coronary or cerebrovascular atherosclerotic disease underwent 3T CMR (T1, T2, proton density and time of flight sequences) and US at baseline and following 6 months of statin therapy (6 had initiation, 7 had increase and 13 had maintenance of statin dosing). CMR plaque volume (PV) was measured in the region 12 mm below and up to 12 mm above carotid flow divider using software. Mean posterior IMT in the same region was measured. Baseline and 6-month CMR PV and US IMT were compared. Change in lipid rich/necrotic core (LR/NC) and calcification plaque components from CMR were related to change in PV.</p> <p>Results</p> <p>Low-density lipoprotein cholesterol decreased (86 ± 6 to 74 ± 4 mg/dL, p = 0.046). CMR PV decreased 5.8 ± 2% (1036 ± 59 to 976 ± 65 mm³, p = 0.018). Mean IMT was unchanged (1.12 ± 0.06 vs. 1.14 ± 0.06 mm, p = NS). Patients with initiation or increase of statins had -8.8 ± 2.8% PV change (p = 0.001) while patients with maintenance of statin dosing had -2.7 ± 3% change in PV (p = NS). There was circumferential heterogeneity in CMR plaque thickness with greatest thickness in the posterior carotid artery, in the region opposite the flow divider. Similarly there was circumferential regional difference in <it>change </it>of plaque thickness with significant plaque regression in the anterior carotid region in region of the flow divider. Change in LR/NC (R = 0.62, p = 0.006) and calcification (R = 0.45, p = 0.03) correlated with PV change.</p> <p>Conclusions</p> <p>Six month statin therapy in patients with carotid plaque led to reduced plaque volume by 3T CMR, but ultrasound posterior IMT did not show any change. The heterogeneous spatial distribution of plaque and regional differences in magnitude of plaque regression may explain the difference in findings and support volumetric measurement of plaque. 3T CMR has potential advantage over ultrasound IMT to assess treatment response in individuals and may allow reduced sample size, duration and cost of clinical trials of plaque regression.</p

Moderate-intensity statin therapy seems ineffective in primary cardiovascular prevention in patients with type 2 diabetes complicated by nephropathy:a multicenter prospective 8 years follow up study

Background: Although numerous studies and metanalysis have shown the beneficial effect of statin therapy in CVD secondary prevention, there is still controversy such the use of statins for primary CVD prevention in patients with DM. The purpose of this study was to evaluate the occurrence of total major adverse cardio-vascular events (MACE) in a cohort of patients with type 2 diabetes complicated by nephropathy treated with statins, in order to verify real life effect of statin on CVD primary prevention. Methods: We conducted an observational prospective multicenter study on 564 patients with type 2 diabetic nephropathy free of cardiovascular disease attending 21 national outpatient diabetes clinics and followed them up for 8 years. 169 of them were treated with statins (group A) while 395 were not on statins (group B). Results: Notably, none of the patients was treated with a high-intensity statin therapy according to last ADA position statement. Total MACE occurred in 32 patients from group A and in 68 patients from group B. Fatal MACE occurred in 13 patients from group A and in 30 from group B; nonfatal MACE occurred in 19 patients from group A and in 38 patients from group B. The analysis of the Kaplan-Meier survival curves showed a not statistically significant difference in the incidence of total (p 0.758), fatal (p 0.474) and nonfatal (p 0.812) MACE between the two groups. HbA1c only showed a significant difference in the incidence of MACE between the two groups (HR 1.201, CI 1.041-1.387, p 0.012). Conclusions: These findings suggest that, in a real clinical setting, moderate-intensity statin treatment is ineffective in cardiovascular primary prevention for patients with diabetic nephropathy

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Preparing pre-service teachers to integrate technology into inquiry-based science education:Three case studies in The Netherlands

Integration of technology (e.g. measuring with sensors, video measurement, and modeling) into secondary-school science teaching is a need globally recognized. A central issue of incorporating these technologies in teaching is how to turn manipulations of equipment and software into manipulations of ideas. Therefore, preparation for pre-service teachers to apply ICT tools should be combined with the issues of minds-on inquiring and meaning-making. From this perspective, we developed a course within the post-graduate teacher-education program in the Netherlands. During the course, pre-service teachers learnt not only to master ICT skills but also to design, teach, and evaluate an inquiry-based lesson in which the ICT tool was integrated. Besides three life sessions, teachers' learning scenario also consisted of individual tasks which teachers could carry out mostly in the school or at home with support materials and online assistance. We taught three iterations of the course within a design-research framework in 2013, 2014 and collected data on the teacher learning processes and outcomes. The analyses of these data from observation, interviews, questionnaires, and documents were to evaluate implementation of the course, then suggest for revisions of the course set-up, which was executed and then assessed again in a subsequent case study. Main outcomes of the three case studies can be summarized as follows: within a limited time (3 life sessions spread over 2-3 months), the heterogeneous groups of pre-service teachers achieved a reasonable level of competence regarding the use of ICT tools in inquiry-based lessons. The blended set-up with support materials, especially the Coach activities and the lesson-plan form for an ICT-integrated inquiry-based lesson, contributed to this result under the condition that the course participants really spent considerable time outside the life sessions. There was a need for more time for hands-on, in-group activities in life sessions and more detailed feedback on individual reports of pre-service teachers. The majority of the pre-service teachers were able to design a lesson plan aimed at a certain inquiry level with integration of ICT, but just a few could implement it faithfully in the classroom. There was still a considerable difference between intended inquiry activities and actual realized inquiry which parallels results from the literature for experienced teachers. The participants had to struggle with science-ICT conceptual issues as well as getting their students to focus on inquiry and concept learning in the classroom. Each evaluation guided iteration of the course resulted in better learning outcomes

Learning to teach inquiry with ICT

Research has shown that the objectives for laboratory teaching - just as with other teaching methods - are often not achieved and that many laboratory sessions are ineffective and yet expensive in terms of pupil and teacher time, and facilities. There are several reasons for this, but one reason is that instructions for many lab activities are too prescriptive and leave too little room for thinking and creativity of pupils. Even though this problem had been pointed out already in the early 1980s, it has persisted to this day. Additionally, ICT tools such as data logging, video measurement, and modelling have been available to secondary schools for decades. These tools provide unique opportunities for authentic investigations at the secondary school level. However, even friendly software might require considerable instruction and reinforce a prescriptive approach. Therefore, we developed a course for pre-service and in-service teachers to learn to apply ICT tools in a minds-on and inquiry way. The short course (1 ECTS = 28 study hours) described in this article was tried out in three different countries (the Netherlands, Slovakia, Vietnam) and improved through different cycles of iterative development. Its pedagogical principles were validated through research and may be applicable and useful in other areas of teacher education and professional development

Development of a pre-service teacher training course on integration of ICT into inquiry based science education.

In order to be able to integrate ICT into Inquiry Based Science Education (IBSE), teachers need much time and support for mastering ICT tools, learning the basis of IBSE, and getting experience in applying these tools in pupil investigations. For this purpose, we have developed a course within the teacher education program of universities in the Netherlands. During the course, pre-service teachers learn to use and apply one of three ICT tools i.e. data logging, video measurement, or modeling to design and implement an inquiry-based lesson in the classroom. The course participants are expected to study on their own most of the time through a blended setting including life sessions, in-between tasks, and an online platform with support materials and with close supervision. The challenges are the lack of time and the heterogeneous background of pre-service teachers, many of whom opted for teaching later in life, not immediately after university and already hold first year teaching jobs. This paper presents the first case study on implementation of the course in early 2013 with 12 pre-service teachers. The learning scenario was implemented quite faithfully as the life sessions were executed pretty smoothly, and finally, almost all participants went through a complete cycle of designing, implementing, and evaluating an ICT-IBSE lesson. Within a limited time, the heterogeneous group of pre-service teachers achieved a reasonable level of competence regarding the use of ICT in IBSE. There was still a considerable difference between intended inquiry activities and actual realized inquiry which parallels result from the literature [1], [8]. The blended setting with support materials contributes to this result if course participants really spend considerable time outside the life sessions. Also discussed in this paper are revision for further rounds of development based on case studies in the Netherlands and investigation on applicability of the course setting and materials in different contexts e.g. in-service training, other countries