71 research outputs found

    Assessment of coronary artery remodelling by dual-source CT: a head-to-head comparison with intravascular ultrasound

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    Background: While it is widely assumed that coronary CT angiography permits detection and quantification of ‘positive remodelling’ of coronary atherosclerotic lesions, there is a paucity of data comparing CT with established reference methods. Objective: To assess the accuracy of dual-source CT for detecting positive versus absent or negative coronary artery remodelling of coronary atherosclerotic lesions as compared with intravascular ultrasound (IVUS). Methods: The datasets were evaluated of 38 patients referred for invasive coronary angiography and in whom an IVUS study of one coronary vessel was performed. Coronary CT angiography was performed within 24 h before invasive coronary angiography. Using dual-source CT (Siemens Healthcare, Forchheim, Germany), a contrast-enhanced volume dataset was acquired (120 kV, 400 mA/rot, collimation 2×64×0.6 mm, 60–80 ml contrast agent, intravenous). IVUS was performed using a 40 MHz IVUS catheter (Atlantis, Boston Scientific Corporation, Natick, Massachusetts, USA) and motorised pullback at 0.5 mm/s. 48 corresponding non-calcified and partially calcified plaques within the coronary artery system were identified in both CT and IVUS using bifurcation points as fiducial markers. In CT datasets, multiplanar reconstructions orthogonal to the centre line of the coronary artery were rendered and cross-sectional vessel area was measured at the site of maximal narrowing as well as at a reference segment proximal to the lesion for each of the 48 plaques. The remodelling index (RI) was calculated by dividing the vessel area at the site of maximal narrowing by the area of the reference segment. Corresponding vessel areas and RIs were also determined in IVUS. Results: CT classified 41 plaques as positively remodelled (RI≥1.05) and seven as having either absent or negative remodelling (RI0.9, p<0.0001) than for remodelling indices (r=0.7, p<0.0001) with Bland–Altman analysis showing a systematic overestimation of vessel areas and RI in CT. Interobserver agreement was moderate for CT and IVUS measurements. Receiver operating characteristic curve analysis showed that a RI of 1.1 in CT identified positively remodelled plaques in IVUS with a sensitivity of 83% and a specificity of 78% (area under the curve=0.8, 95% CI 0.7 to 1.0). Using the standard cut-off point of 1.05 to identify positively remodelled plaques in CT resulted in a sensitivity of 100%, and a specificity of 45%. Conclusion: Coronary CT angiography allows analysis of coronary artery remodelling. The degree of positive remodelling is typically overestimated by CT. A threshold of 1.1 for the RI may be optimal to classify plaques as ‘positively remodelled’ in coronary CT angiography

    Mastering the brain in critical conditions:an update

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    Acute brain injuries, such as traumatic brain injury and ischemic and hemorragic stroke, are a leading cause of death and disability worldwide. While characterized by clearly distict primary events-vascular damage in strokes and biomechanical damage in traumatic brain injuries-they share common secondary injury mechanisms influencing long-term outcomes. Growing evidence suggests that a more personalized approach to optimize energy substrate delivery to the injured brain and prognosticate towards families could be beneficial. In this context, continuous invasive and/or non-invasive neuromonitoring, together with clinical evaluation and neuroimaging to support strategies that optimize cerebral blood flow and metabolic delivery, as well as approaches to neuroprognostication are gaining interest. Recently, the European Society of Intensive Care Medicine organized a 2-day course focused on a practical case-based clinical approach of acute brain-injured patients in different scenarios and on future perspectives to advance the management of this population. The aim of this manuscript is to update clinicians dealing with acute brain injured patients in the intensive care unit, describing current knowledge and clinical practice based on the insights presented during this course

    Mastering the brain in critical conditions:an update

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    Acute brain injuries, such as traumatic brain injury and ischemic and hemorragic stroke, are a leading cause of death and disability worldwide. While characterized by clearly distict primary events-vascular damage in strokes and biomechanical damage in traumatic brain injuries-they share common secondary injury mechanisms influencing long-term outcomes. Growing evidence suggests that a more personalized approach to optimize energy substrate delivery to the injured brain and prognosticate towards families could be beneficial. In this context, continuous invasive and/or non-invasive neuromonitoring, together with clinical evaluation and neuroimaging to support strategies that optimize cerebral blood flow and metabolic delivery, as well as approaches to neuroprognostication are gaining interest. Recently, the European Society of Intensive Care Medicine organized a 2-day course focused on a practical case-based clinical approach of acute brain-injured patients in different scenarios and on future perspectives to advance the management of this population. The aim of this manuscript is to update clinicians dealing with acute brain injured patients in the intensive care unit, describing current knowledge and clinical practice based on the insights presented during this course

    The genetic architecture of the human cerebral cortex

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    The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

    Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

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    RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

    Epidemiology of trauma: From medico-administrative database to large prospective registry

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