Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Vago-spinal anastomosis in the pig: anatomical and functional studies

International audienc

Selective vago-spinal anastomosis to study function in the pig

International audienc

Glial plasticity in the dorsal vagal complex in response to western diet in rodents

International audienceGrowing evidence indicates that glial plasticity plays a role in feeding control, by adapting neuronal transmission to metabolic needs. Astroglial morphological changes and microglial activation occurs in response to feeding, in the hypothalamus and in other brain area involved in feeding regulation such as the olfactory bulb. Glial plasticity seems to evolve to glial activation in response to high-fat-high-sugar western diets (WD) consumption generating pro-inflammatory/obesogenic states. There is an abundant glial population in the dorsal vagal complex (DVC), a brainstem area involved in the integration of digestive signals. A thick border of astrocytes delineates the area postrema (AP), a circumventricular organ with permeable blood barrier, from the nucleus of the tractus solitarius (NTS) homing neuronal species involved in satiety, and astrocytes. Microglia are also abundant in the AP and NTS, where pro-inflammatory signals may arrive from the gut in response to dietary load and digestion. However, little isknown about the involvement of these glial populations in the satietogenic signals from the DVC.Our aim was to evaluate astrocytes and microglial changes in response to chronic or repeated episodes of western diet in the DVC of rats or mice.We have analysed the extent of the astrocyte spreading and the number and morphological phenotype of microglia in the AP and NTS by immunohistochemistry, on two rodent models: rats submitted to a high-fat/high-sugar diet (WD), and mice submitted to several 1-week-episodes of WD. Brainstems were taken after killing, fixed in formalin, and cryostat-cut coronal sections were labelled and analysed for astrocytes (GFAP) and microglia (Iba1). We found an increase in the astrocyte spreading (GFAP labelled area and thickness) between the AP and the NTS (but not in the astrocytes within the NTS) after one month of WD in rats as well as in mice after the repeated episodes of WD, as compared to control animals. We did not observe any increase in the microglial number or morphology within the AP in WD fed animals whereas we found an increased number of microglial cells in the NTS of WD fed rats as compared to controls. These glial changes were associated with several digestive markers alteration.These results show morphological changes enlarging the astroglial barrier between the AP and NTS in the DVC of rodents receiving a western diet. This was observed after a chronic exposition in rats or repeated expositions in mice, suggesting a persistence of the influence of the diet on the size of the astroglial barrier. Such an astroglial morphological plasticity in the DVC, between the AP and the NTS, may play a role in the adaptation of the satietogenic activity of the neurons to the type of diet

Role of 18F-FDG PET-CT imaging for the detection of an unknown primary tumour: preliminary results in 21 patients.

PURPOSE: Metastatic cancer of unknown primary origin is a syndrome characterised by a poor prognosis, with a typical survival rate from diagnosis of no longer than 1 year. Only 20-27% of primary tumours are identified by conventional radiological imaging. By contrast, it has been reported that 18F-fluorodeoxyglucose positron emission tomography (FDG PET) allows the identification of 24-40% of otherwise unrecognised primary tumours. To our knowledge, the studies on this topic have been conducted using 18F-FDG PET imaging alone. The aim of this study was to evaluate the potential additional diagnostic role of fused 18F-FDG PET-CT imaging for the detection of metastatic occult primary tumours. METHODS: The study population consisted of 21 consecutive patients with biopsy-proven metastatic disease and negative conventional diagnostic procedures. Each patient underwent a PET scan, carried out according to a standard procedure (6 h of fasting, i.v. injection of 370 MBq of 18F-FDG and image acquisition with a dedicated PET-CT scanner for 4 min per bed position). RESULTS: 18F-FDG PET-CT detected the occult primary tumour in 12 patients (57% of cases), providing a detection rate higher than that reported with any other imaging modality, including conventional 18F-FDG PET. CONCLUSION: The favourable results of this study need to be confirmed in larger patient populations with long-term follow-up