Effect of Aging on Human Mesenchymal Stem Cell Therapy in Ischemic Cardiomyopathy Patients

AbstractBackgroundThe role of patient age in the efficacy of mesenchymal stem cell (MSC) therapy in ischemic cardiomyopathy (ICM) is controversial.ObjectivesThis study sought to determine whether the therapeutic effect of culture-expanded MSCs persists, even in older subjects.MethodsPatients with ICM who received MSCs via transendocardial stem cell injection (TESI) as part of the TAC-HFT (Transendocardial Autologous Cells in Ischemic Heart Failure) (n = 19) and POSEIDON (Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis) (n = 30) clinical trials were divided into 2 age groups: younger than 60 and 60 years of age and older. Functional capacity was measured by 6-min walk distance (6MWD) and quality of life using the Minnesota Living With Heart Failure Questionnaire (MLHFQ) score, measured at baseline, 6 months, and 1 year post-TESI. Various cardiac imaging parameters, including absolute scar size, were compared at baseline and 1 year post-TESI.ResultsThe mean 6MWD was similar at baseline and increased at 1 year post-TESI in both groups: 48.5 ± 14.6 m (p = 0.001) for the younger and 35.9 ± 18.3 m (p = 0.038) for the older participants (p = NS between groups). The older group exhibited a significant reduction in MLHFQ score (−7.04 ± 3.54; p = 0.022), whereas the younger than 60 age group had a borderline significant reduction (−11.22 ± 5.24; p = 0.058) from baseline (p = NS between groups). Although there were significant reductions in absolute scar size from baseline to 1 year post-TESI, the effect did not differ by age.ConclusionsMSC therapy with TESI in ICM patients improves 6MWD and MLHFQ score and reduces myocardial infarction size. Importantly, older individuals did not have an impaired response to MSC therapy

Arterial splenic calcifications in children with AIDS: two case reports

Splenic calcifications in AIDS patients are usually round and result from infections with opportunistic pathogens such as Pneumocystis carinii, Mycobacterium avium-intracellulare and Cytomegalovirus. We describe here a remarkable echopattern of the spleen in two pediatric patients, resulting from linear, branching calcifications in the splenic parenchymal arteries. We believe this echopattern represents the ultrasonographic manifestation of an HIV-associated vasculopathy

23 - Computed Tomography in Renal Cell Carcinoma

This chapter presents the role of multidetector computed tomography (MDCT) in conservative treatment of renal cell carcinoma. Approximately 10% of renal cell carcinomas manifest primarily as a fluid-filled unilocular or multiloculated cystic mass. MDCT play an important role in differentiating these renal cell carcinomas from simple renal cysts and, more importantly, from benign renal cysts complicated with hemorrhage, infection, inflammation, or ischemia. On MDCT, either cystic renal cell carcinomas or benign complicated renal cysts are characterized by one or more of these features: calcification, high attenuation at unenhanced CT scan, septations, multiple locules, enhancement, wall thickening, and nodularity. Papillary renal cell carcinoma, which probably originates from the distal convoluted tubule, stands for 7-14% of all renal cell carcinomas. On MDCT these tumors are characterized by weak, mostly homogeneous enhancement and calcifications are relatively more common in 32% of cases. Collecting duct carcinoma is a rare type of renal cell carcinoma that originates from the collecting duct (of Bellini). It affects younger patients and is associated with aggressive regional and distant spread. These tumors are characterized on MDCT by medullary location, weak and heterogeneous enhancement, involvement of the renal sinus, infiltrative growth, preserved renal contour, and presence of a cystic component. MDCT differentiates renal neoplasms that require surgical resection, including renal cell carcinoma, transitional cell carcinoma, and oncocytoma, from renal neoplasms that do not routinely require surgical resection, such as angiomyolipoma, lymphoma, and metastatic disease. The renal cell carcinomas rarely contain intratumoral fat and calcifications, therefore meticulous evaluation of all solid renal masses, using an unenhanced dedicated MDCT examination, for the presence of fat is mandatory to avoid misdiagnosing an angiomyolipoma as renal cell carcinoma

Accuracy of the long-axis area-length method for the measurement of left ventricular volumes and ejection fraction using multidetector computed tomography

Multidetector computed tomography (MDCT) is useful for assessing left ventricular (LV) volumes and function. Validation has mainly been carried out using Simpson's method of summing up consecutive short-axis areas. Because the latter method is time-consuming, many users prefer using a quicker method, based on a single view or a pair of views. To evaluate the accuracy of the long-axis area-length method (AL), which has not been validated for MDCT, using Simpson's method as the gold standard, as well as right anterior oblique LV angiography as a clinical standard. Twenty-three patients admitted with acute chest pain were clinically evaluated with electrocardiogram-gated MDCT and invasive LV angiography. MDCT-based end-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were calculated using Simpson's method, biplane AL and single-plane AL. For LV angiography, EF was calculated using single-plane AL. A Bland-Altman analysis showed a close agreement between biplane AL and Simpson's method for EF, with 1% underestimation, 95% CI of ±11% and a correlation of 0.89. For end-diastolic, end-systolic and stroke volumes, overestimations of 7 mL, 4 mL and 2 mL, and 95% CI of ±27 mL, ±15 mL and ±26 mL, respectively were found. Correlation coefficients were 0.95, 0.97 and 0.82, respectively. Comparisons with LV angiography were considerably weaker. The vertical long-axis AL method by MDCT correlated better with both LV angiography and Simpson's method than the horizontal long-axis AL method. The biplane AL method gives results for EF, which correspond closely with the more cumbersome Simpson's method, although volumes are slightly overestimated. La tomographie à multidétecteurs (TGMD) est utile pour évaluer les volumes et la fonction ventriculaires gauches (VG). La validation a été pour une bonne part réalisée à l’aide de la méthode de Simpson établissant la somme des aires axe court consécutives. Parce que cette dernière méthode est fastidieuse, de nombreux utilisateurs préfèrent une méthode plus rapide basée sur une ou deux perspectives. Évaluer la précision de la méthode aire-longueur (AL) long axe, qui n’a pas été validée pour la TGMD, à l’aide de la méthode de Simpson comme étalon-or et à l’aide de l’angiographie VG droite antérieure oblique comme norme clinique. Vingt-trois patients admis pour DRS aiguë ont été évalués sur le plan clinique au moyen d’une TGMD synchronisée avec l’électrocardiogramme et d’une angiographie VG effractive. Les volumes télédiastoliques, télésystoliques, le volume d’éjection systolique et la fraction d’éjection (FÉ) ont été calculés à l’aide de la méthode de Simpson AL bidimensionnelle et AL unidimensionnelle. Pour l’angiographie VG, la FÉ a été calculée à l’aide de la méthode AL unidimensionnelle. Une analyse de Bland-Altman a montré une concordance étroite entre la méthode AL bidimensionnelle et la méthode de Simpson pour la FÉ, avec une sous-estimation de 1% et un IC à 95% de ± 11% et un coefficient de 0,89. Pour les volumes télédiastoliques, télésystoliques et d’éjection systolique, on a observé des surestimations de 7 mL, 4 mL, 2 mL, et des IC à 95% de ± 27 mL, ± 15 mL et ± 26 mL. Les coefficients de corrélation étaient de 0.95, 0.97 et 0.82, respectivement. Les comparaisons avec l’angiographie VG ont été considérablement plus faibles. La méthode AL long axe par TGMD a été en meilleure corrélation avec l’angiographie VG et avec la méthode de Simpson, comparativement à la méthode AL long axe horizontale. La méthode AL bidimensionnelle donne des résultats de FÉ qui correspondent étroitement avec la méthode de Simpson, plus fastidieuse, même si les volumes sont légèrement surestimés