High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: A real-world appraisal

Objective High-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known. Methods We reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate. For standard-pitch acquisitions, a separate CT-aortogram and CT-coronary angiogram were performed with prospective gating, unless heart rate was ≥70 beats/min, when retrospective gating was used. The aortic root and coronary arteries were assessed for artefact (significant artefact=1; artefact not limiting diagnosis=2; no artefact=3). Aortic scans were considered diagnostic if the score was > 1; the coronaries, if all three epicardial arteries scored > 1. Results There was no significant difference in diagnostic image quality for either the aorta (artefact-free high-pitch: 31 (73%) scans vs standard-pitch: 40 (79%), p=0.340) or the coronary tree as a whole (10 (23%) vs 15 (29%), p=0.493). However, proximal coronary arteries were less well visualised using high-pitch acquisitions (16 (36%) vs 30 (59%), p=0.04). The median (IQR) radiation dose was significantly lower in the high-pitch cohort (dose-length product: 347 (318-476) vs 1227 (1150-1474) mGy cm, respectively, p < 0.001), and the protocol required almost half the amount of contrast. Conclusions The high-pitch protocol significantly reduces radiation and contrast doses and is non-inferior to standard-pitch acquisitions for aortic assessment. For aortic root assessment, the high-pitch protocol is recommended. However, if coronary assessment is critical, this should be followed by a conventional standard-pitch, low-dose, prospectively gated CT-coronary angiogram if the high-pitch scan is non-diagnostic

Studies on the conformational properties of CP-10 42−55 , the hinge region of CP-10, using circular dichroism and RP-HPLC

The conformational properties of CP-10 42−55 , a peptide corresponding to the hinge region of CP-10, were investigated using circular dichroism spectroscopy and reverse-phase high-performance liquid chromatography (RP-HPLC). The circular dichroism studies indicated that CP-10 42−55 formed considerable secondary structure in the presence of hydrophobic solution environments including 50% acetonitrile, 50% trifluoroethanol and 200 mm sodium dodecyl sulfate, which comprised a mixture of α-helix and β-sheet. The effect of temperature on the conformation of CP-10 42−55 was investigated between 5 and 40°C, with very small changes in the spectra being observed.RP-HPLC was then used to investigate the effect of temperature on the conformation of CP-10 42−55 in the presence of a hydrophobic surface. Using a C 18 -adsorbent, CP-10 42−55 exhibited a conformational transition at 25°C, which was associated with an increase in the chromatographic contact area and the binding affinity of the peptide for the stationary phase. In addition, near-planar bandbroadening behaviour indicated that conformational species interconverted with rapid rate constants compared with the chromatographic time scale. These results indicated that the conformational change at 25°C in theRP-HPLC system most likely corresponds to the unfolding of an α-helical and/or β-sheet structure to an extended coil structure. Therefore, the strong chemotactic properties of this peptide may be attributed to its ability to form considerable secondary structure in the presence of a hydrophobic environment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72283/1/j.1399-3011.2000.00690.x.pd

Incidental Non-Cardiac Findings of a Coronary Angiography with a 128-Slice Multi-Detector CT Scanner: Should We Only Concentrate on the Heart?

Objective: To evaluate the spectrum, prevalence, and significance of incidental non-cardiac findings (INCF) in patients referred for a non-invasive coronary angiography using a 128-slice multi-detector CT (MDCT). Materials and Methods: The study subjects included 1,044 patients; 774 males (mean age, 59.9 years) and 270 females (mean age, 63 years), referred for a coronary CT angiography on a 128-slice MDCT scanner. The scans were acquired from the level of the carina to just below the diaphragm. To evaluate INCFs, images were reconstructed with a large field of view (> 300 mm) covering the entire thorax. Images were reviewed in the axial, coronal, and sagittal planes, using the mediastinal, lung, and bone windows. The INCFs were classified as severe, indeterminate, and mild, based on their clinical importance, and as thoracic or abdominal based on their locations. Results: Incidental non-cardiac findings were detected in 56% of patients (588 of 1,044), including 435 males (mean age, 65.6 years) and 153 females (mean age, 67.9 years). A total of 729 INCFs were observed: 459 (63%) mild (58% thoracic, 43% abdominal), 96 (13%) indeterminate (95% thoracic, 5% abdominal), and 174 (24%) severe (87% thoracic, 13% abdominal). The prevalence of severe INCFs was 15%. Two severe INCFs were histologically verified as lung cancers. Conclusion: The 128-slice MDCT coronary angiography, in addition to cardiac imaging, can provide important information on the pathology of the chest and upper abdomen. The presence of severe INCFs is not rare, especially in the thorax. Therefore, all organs in the scan should be thoroughly evaluated in daily clinical practice

Screening for proximal coronary artery anomalies with 3-dimensional MR coronary angiography

Under 35 years of age, 14% of sudden cardiac death in athletes is caused by a coronary artery anomaly (CAA). Free-breathing 3-dimensional magnetic resonance coronary angiography (3D-MRCA) has the potential to screen for CAA in athletes and non-athletes as an addition to a clinical cardiac MRI protocol. A 360 healthy men and women (207 athletes and 153 non-athletes) aged 18–60 years (mean age 31 ± 11 years, 37% women) underwent standard cardiac MRI with an additional 3D-MRCA within a maximum of 10 min scan time. The 3D-MRCA was screened for CAA. A 335 (93%) subjects had a technically satisfactory 3D-MRCA of which 4 (1%) showed a malignant variant of the right coronary artery (RCA) origin running between the aorta and the pulmonary trunk. Additional findings included three subjects with ventral rotation of the RCA with kinking and possible proximal stenosis, one person with additional stenosis and six persons with proximal myocardial bridging of the left anterior descending coronary artery. Coronary CT-angiography (CTA) was offered to persons with CAA (the CAA was confirmed in three, while one person declined CTA) and stenosis (the ventral rotation of the RCA was confirmed in two but without stenosis, while two people declined CTA). Overall 3D MRCA quality was better in athletes due to lower heart rates resulting in longer end-diastolic resting periods. This also enabled faster scan sequences. A 3D-MRCA can be used as part of the standard cardiac MRI protocol to screen young competitive athletes and non-athletes for anomalous proximal coronary arteries

Unrequested Findings on Cardiac Computed Tomography: Looking Beyond the Heart

Objectives: To determine the prevalence of clinically relevant unrequested extra-cardiac imaging findings on cardiac Computed Tomography (CT) and explanatory factors thereof. Methods: A systematic review of studies drawn from online electronic databases followed by meta-analysis with metaregression was performed. The prevalence of clinically relevant unrequested findings and potentially explanatory variables were extracted (proportion of smokers, mean age of patients, use of full FOV, proportion of men, years since publication). Results: Nineteen radiological studies comprising 12922 patients met the inclusion criteria. The pooled prevalence of clinically relevant unrequested findings was 13 % (95 % confidence interval 9–18, range: 3–39%). The large differences in prevalence observed were not explained by the predefined (potentially explanatory) variables. Conclusions: Clinically relevant extra-cardiac findings are common in patients undergoing routine cardiac CT, and their prevalence differs substantially between studies. These differences may be due to unreported factors such as different definitions of clinical relevance and differences between populations. We present suggestions for basic reporting whic

Linear and Branched Glyco-Lipopeptide Vaccines Follow Distinct Cross-Presentation Pathways and Generate Different Magnitudes of Antitumor Immunity

Glyco-lipopeptides, a form of lipid-tailed glyco-peptide, are currently under intense investigation as B- and T-cell based vaccine immunotherapy for many cancers. However, the cellular and molecular mechanisms of glyco-lipopeptides (GLPs) immunogenicity and the position of the lipid moiety on immunogenicity and protective efficacy of GLPs remain to be determined.We have constructed two structural analogues of HER-2 glyco-lipopeptide (HER-GLP) by synthesizing a chimeric peptide made of one universal CD4(+) epitope (PADRE) and one HER-2 CD8(+) T-cell epitope (HER(420-429)). The C-terminal end of the resulting CD4-CD8 chimeric peptide was coupled to a tumor carbohydrate B-cell epitope, based on a regioselectively addressable functionalized templates (RAFT), made of four alpha-GalNAc molecules. The resulting HER glyco-peptide (HER-GP) was then linked to a palmitic acid moiety, attached either at the N-terminal end (linear HER-GLP-1) or in the middle between the CD4+ and CD8+ T cell epitopes (branched HER-GLP-2). We have investigated the uptake, processing and cross-presentation pathways of the two HER-GLP vaccine constructs, and assessed whether the position of linkage of the lipid moiety would affect the B- and T-cell immunogenicity and protective efficacy. Immunization of mice revealed that the linear HER-GLP-1 induced a stronger and longer lasting HER(420-429)-specific IFN-gamma producing CD8(+) T cell response, while the branched HER-GLP-2 induced a stronger tumor-specific IgG response. The linear HER-GLP-1 was taken up easily by dendritic cells (DCs), induced stronger DCs maturation and produced a potent TLR- 2-dependent T-cell activation. The linear and branched HER-GLP molecules appeared to follow two different cross-presentation pathways. While regression of established tumors was induced by both linear HER-GLP-1 and branched HER-GLP-2, the inhibition of tumor growth was significantly higher in HER-GLP-1 immunized mice (p<0.005).These findings have important implications for the development of effective GLP based immunotherapeutic strategies against cancers

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Investigation of bone mineral density and the distribution of lean and fat mass in greek hemiplegic patients

Objectives: We aimed to evaluate body composition and bone changes in the paretic forearm, hip and total body 3, 6 and 12 months post stroke. Methods: Fifty-eight (58) hemiplegic patients were enrolled in this prospective study, both paretic and normal forearms were examined by peripheral quantitative computed tomography (pQCT) at the 4 and 20% site of the distal radius, Hip and total body was examined by dual-energy X-ray absorptiometry (DXA). Results: The trabecular and cortical BMD and the stress-strain-index (SSI) of the ultradistal radius were significantly reduced (p<0.05) at the hemiplegic side of both sexes. The lean mass of the paretic leg was significantly reduced (p<0.05) and the fat mass was significantly increased (p<0.05) in both sexes. The total body fat mass showed significant increase (p<0.05) and the total body bone mass significant decrease (p<0.05) in both males and females. Conclusions: A significant loss of BMD and bone strength was found during the first year after stroke in both trabecular and cortical bone at the paretic forearm along with a significant loss of bone mass and a significant increase of fat at the paretic leg, Most prominent BMD reduction was evident in men compared to perimenopausal women in the same age.Σκοπός: Ο σκοπός της παρούσας μελέτης είναι να εκτιμήσει τις μεταβολές της οστικής μάζας, του λίπους και της μυϊκής μάζας στα αντιβράχια, στα ισχία και σε ολόκληρο το σώμα 3, 6 και 12 μήνες μετά το ΑΕΕ. Υλικό και μέθοδος: Πενήντα οκτώ (58) ημιπληγικοί ασθενείς (36 άνδρες και 22 γυναίκες) με ιστορικό ενός οξέος ΑΕΕ περιλήφθηκαν σ’ αυτή την προοπτική μελέτη. Όλοι οι ασθενείς υποβλήθηκαν σε μετρήσεις οστικής πυκνότητας 3, 6 και 12 μήνες μετά το ΑΕΕ. Εξετάστηκαν τόσο τα παρετικά όσο και τα φυσιολογικά αντιβράχια με τη μέθοδο της περιφερικής ποσοτικής υπολογιστικής τομογραφίας (pQCT) στο 4% και 20% του άπω τμήματος της κερκίδας. Εξετάστηκαν επίσης τα ισχία και όλο το σώμα των ασθενών, με τη μέθοδο της διπλοενεργειακής απορρόφησης των ακτίνων Χ (DXA). Η διάγνωση του ΑΕΕ σε κάθε περίπτωση επιβεβαιώθηκε με υπολογιστική τομογραφία. Η κινητικότητα των ασθενών ελέγχθηκε με την κλίμακα Functional Ambulation Category (FAC) και η σπαστικότητα με την Τροποποιημένη Κλίμακα Ashworth (MAS). Αποτελέσματα: Η οστική πυκνότητα του σπογγώδους και φλοιώδους οστού και ο δείκτης stress-strain-index (SSI) στο άπω τμήμα της κερκίδας είχαν σημαντική μείωση (p<0.05) στην ημιπληγική πλευρά και των δύο φύλων. Η μυϊκή μάζα και το λίπος του παρετικού ποδιού μειώθηκαν σημαντικά (p<0.05) και στα δύο φύλα. Η μάζα λίπους ολόκληρου του σώματος αυξήθηκε σημαντικά (p<0.05) και η οστική μάζα ολόκληρου του σώματος μειώθηκε σημαντικά (p<0.05) σε άνδρες και γυναίκες. Συμπέρασμα: Σημαντική απώλεια της οστικής πυκνότητας και μυϊκής ισχύος βρέθηκε κατά τη διάρκεια του πρώτου χρόνου μετά το ΑΕΕ στο σπογγώδες και φλοιώδες οστό του αντιβραχίου, καθώς και στον αυχένα και στον μείζονα τροχαντήρα του παρετικού ισχίου. Η σημαντικότερη απώλεια οστικής πυκνότητας παρατηρήθηκε στους άνδρες σε σύγκριση με τις μετεμμηνοπαυσιακές γυναίκες