Effect of delayed acquisition times on Gadolinium-enhanced MRI of the presumably normal canine brain

A delay in imaging following intravenous contrast medium administration has been recommended to reduce misdiagnoses. However, the normal variation of contrast enhancement in dogs following a delay has not been characterized. Contrast enhanced MR imaging of 22 dogs was assessed, in terms of identification of normal anatomic structures, to investigate the variation associated with 10 minute delay between contrast medium administration and imaging. All dogs had a normal brain MR imaging study and unremarkable CSF. Specific ROIs were assessed both objectively, using computer software, and subjectively using three observers. Mean contrast enhancement greater than 10% was seen in the pituitary gland, choroid plexus, meninges, temporal muscle, trigeminal nerve and the trigeminal nerve root. Structures with an active blood-brain-barrier had minimal contrast enhancement (<6%). Enhancing structures had significantly more contrast enhancement at t=1min versus t=10min, except in temporal muscle, the trigeminal nerve and the trigeminal nerve root. Inter-observer agreement was moderate to good in favor of the initial post contrast T1w sequence. The observers found either no difference or poor agreement in identification of the non-vascular structures. Intra-observer agreement was very good with all vascular structures and most non-vascular structures. A degree of meningeal enhancement was a consistent finding. The initial acquisition had higher enhancement characteristics and observer agreement for some structures; however, contrast-to-noise was comparable in the delayed phase or not significantly different. We provide baseline references and suggest that the initial T1w post contrast sequence is preferable but not essential should a delayed post contrast T1w sequence be performed

Transient erosion in the Valencia Trough turbidite systems, NW Mediterranean Basin

Submarine canyons can efficiently drain sediments from continental margins just as river systems do in subaerial catchments. Like in river systems, submarine canyons are often arranged as complex drainage networks that evolve from patterns of erosion and deposition. In the present paper we use a morphometric analysis of submarine canyon-channel long-profiles to study the recent sedimentary history of the Valencia Trough turbidite system (VTTS) in the NW Mediterranean Sea. The VTTS is unique in that it drains sediment from margins with contrasting morphologies through a single "trunk" conduit, the Valencia Channel. The Valencia Channel has been active since the late Miocene, evolving in response to Plio-Quaternary episodes of erosion and deposition. The integrated analysis of long-profiles obtained from high-resolution bathymetric data across the entire turbidite system shows evidence for transient canyon incision in the form of knickpoints and hanging tributaries. Multiple factors appear to have triggered these periods of incision. These include a large debris flow at 11,500 yr BP that disrupted the upper reaches of the VTTS and glacio-eustatic lowstands that forced shifting of sediment input to the VTTS. Based on these inferences, long-term time-averaged incision rates for the Valencia Channel have been estimated. The evidence we present strongly suggests that Foix Canyon has played a key role in the drainage dynamics of the VTTS in the past. This study builds conceptually on a recent modeling study that provides a morphodynamic explanation for the long-term evolution of submarine canyon thalweg profiles. The procedure and results from this work are of potential application to other submarine sediment drainage systems, past and present, including those containing mid-ocean type valleys like the Valencia Channel

Biomarker-guided implementation of the KDIGO guidelines to reduce the occurrence of acute kidney injury in patients after cardiac surgery (PrevAKI-multicentre) : protocol for a multicentre, observational study followed by randomised controlled feasibility trial

Acute kidney injury (AKI) is a frequent complication after cardiac surgery with adverse short-term and long-term outcomes. Although prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommended a bundle of supportive measures in high-risk patients. In a single-centre trial, we recently demonstrated that the strict implementation of the KDIGO bundle significantly reduced the occurrence of AKI after cardiac surgery. In this feasibility study, we aim to evaluate whether the study protocol can be implemented in a multicentre setting in preparation for a large multicentre trial. We plan to conduct a prospective, observational survey followed by a randomised controlled, multicentre, multinational clinical trial including 280 patients undergoing cardiac surgery with cardiopulmonary bypass. The purpose of the observational survey is to explore the adherence to the KDIGO recommendations in routine clinical practice. The second phase is a randomised controlled trial. The objective is to investigate whether the trial protocol is implementable in a large multicentre, multinational setting. The primary endpoint of the interventional part is the compliance rate with the protocol. Secondary endpoints include the occurrence of any AKI and moderate/severe AKI as defined by the KDIGO criteria within 72 hours after surgery, renal recovery at day 90, use of renal replacement therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint major adverse kidney events consisting of persistent renal dysfunction, RRT and mortality at day 90 and safety outcomes. The PrevAKI multicentre study has been approved by the leading Research Ethics Committee of the University of Münster and the respective Research Ethics Committee at each participating site. The results will be used to design a large, definitive trial. Trial registration number NCT03244514