Highly automatic quantification of myocardial oedema in patients with acute myocardial infarction using bright blood T2-weighted CMR

<p>Background: T2-weighted cardiovascular magnetic resonance (CMR) is clinically-useful for imaging the ischemic area-at-risk and amount of salvageable myocardium in patients with acute myocardial infarction (MI). However, to date, quantification of oedema is user-defined and potentially subjective.</p> <p>Methods: We describe a highly automatic framework for quantifying myocardial oedema from bright blood T2-weighted CMR in patients with acute MI. Our approach retains user input (i.e. clinical judgment) to confirm the presence of oedema on an image which is then subjected to an automatic analysis. The new method was tested on 25 consecutive acute MI patients who had a CMR within 48 hours of hospital admission. Left ventricular wall boundaries were delineated automatically by variational level set methods followed by automatic detection of myocardial oedema by fitting a Rayleigh-Gaussian mixture statistical model. These data were compared with results from manual segmentation of the left ventricular wall and oedema, the current standard approach.</p> <p>Results: The mean perpendicular distances between automatically detected left ventricular boundaries and corresponding manual delineated boundaries were in the range of 1-2 mm. Dice similarity coefficients for agreement (0=no agreement, 1=perfect agreement) between manual delineation and automatic segmentation of the left ventricular wall boundaries and oedema regions were 0.86 and 0.74, respectively.</p&gt

Use of Inherited Differences among Strains of Inbred Mice to Study Genetic Determinants of Steroid Biosynthesis a

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72865/1/j.1749-6632.1984.tb38364.x.pd

CMR Features in Cardiac Sarcoidosis

Sarcoidosis is a multisystemic disorder of unknown aetiology characterised by the formation of noncaseating epithelioid cell granuloma involving various organ systems. Cardiac involvement has an important prognostic factor as it can present with life-threatening arrythmias and sudden death. Here, we present a case of cardiac sarcoidosis in a 46-year-old gentleman who presented with nonspecific signs and symptoms. We also discuss diagnostic difficulties especially when cardiac involvement is the only clinical sign. In this case, cardiac magnetic resonance (CMR) played an important role in the diagnosis and followup of our patient

Left ventricular outcomes following multivessel PCI vs. infarct artery-only PCI in patients with acute STEMI: the Glasgow PRAMI CMR sub-study

No abstract available

Development of a ‘Universal’ Rubric for Assessing Undergraduates’ Scientific Reasoning Skills Using Scientific Writing

We developed a rubric for measuring students’ ability to reason and write scientifically. The Rubric for Science Writing (Rubric) was tested in a variety of undergraduate biology laboratory courses (total n = 142 laboratory reports) using science graduate students (teaching assistants) as raters. Generalisability analysis indicates that the Rubric provides a reliable measure of students’ abilities (g = 0.85) in these conditions. Comparison of student performance in various biology classes indicated that some scientific skills are more challenging for students to develop than others and identified a number of previously unappreciated gaps in the curriculum. Our findings suggest that use of the Rubric provides three major benefits in higher education: (1) to increase substance and consistency of grading within a course, particularly those staffed by multiple instructors or graduate teaching assistants; (2) to assess student achievement of scientific reasoning and writing skills; and (3) when used in multiple courses, to highlight gaps in alignment among course assignments and provide a common metric for assessing to what extent the curriculum is achieving programmatic goals. Lastly, biology graduate students reported that use of the Rubric facilitated their teaching and recommended that training on the Rubric be provided to all teaching assistants

Accurate Coordinates and 2MASS Cross-IDs for (Almost) All Gliese Catalog Stars

We provide precise J2000, epoch 2000 coordinates and cross-identifications to sources in the 2MASS point source catalog for nearly all stars in the Gliese, Gliese and Jahreiss, and Woolley catalogs of nearby stars. The only Gliese objects where we were not successful are two Gliese sources that are actually QSOs, two proposed companions to brighter stars which we believe do not exist, four stars included in one of the catalogs but identified there as only optical companions, one probable plate flaw, and two stars which simply remain un-recovered. For the 4251 recovered stars, 2693 have coordinates based on Hipparcos positions, 1549 have coordinates based on 2MASS data, and 9 have positions from other astrometric sources. All positions have been calculated at epoch 2000 using proper motions from the literature, which are also given here.Comment: accepted to PASP, Full version of Table 1 available electronicall

Using drones with infrared capabilities to monitor fire behavior

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Microvascular resistance predicts myocardial salvage and infarct characteristics in ST-elevation myocardial infarction

<b>Background:</b> The pathophysiology of myocardial injury and repair in patients with ST‐elevation myocardial infarction is incompletely understood. We investigated the relationships among culprit artery microvascular resistance, myocardial salvage, and ventricular function.<p></p> <b>Methods and Results:</b> The index of microvascular resistance (IMR) was measured by means of a pressure‐ and temperature‐sensitive coronary guidewire in 108 patients with ST‐elevation myocardial infarction (83% male) at the end of primary percutaneous coronary intervention. Paired cardiac MRI (cardiac magnetic resonance) scans were performed early (2 days; n=108) and late (3 months; n=96) after myocardial infarction. T2‐weighted‐ and late gadolinium–enhanced cardiac magnetic resonance delineated the ischemic area at risk and infarct size, respectively. Myocardial salvage was calculated by subtracting infarct size from area at risk. Univariable and multivariable models were constructed to determine the impact of IMR on cardiac magnetic resonance–derived surrogate outcomes. The median (interquartile range) IMR was 28 (17–42) mm Hg/s. The median (interquartile range) area at risk was 32% (24%–41%) of left ventricular mass, and the myocardial salvage index was 21% (11%–43%). IMR was a significant multivariable predictor of early myocardial salvage, with a multiplicative effect of 0.87 (95% confidence interval 0.82 to 0.92) per 20% increase in IMR; P<0.001. In patients with anterior myocardial infarction, IMR was a multivariable predictor of early and late myocardial salvage, with multiplicative effects of 0.82 (95% confidence interval 0.75 to 0.90; P<0.001) and 0.92 (95% confidence interval 0.88 to 0.96; P<0.001), respectively. IMR also predicted the presence and extent of microvascular obstruction and myocardial hemorrhage.<p></p> <b>Conclusion:</b> Microvascular resistance measured during primary percutaneous coronary intervention significantly predicts myocardial salvage, infarct characteristics, and left ventricular ejection fraction in patients with ST‐elevation myocardial infarction.<p></p&gt

Infarct size and left ventricular remodelling after preventive percutaneous coronary intervention

Objective: We hypothesised that, compared with culprit-only primary percutaneous coronary intervention (PCI), additional preventive PCI in selected patients with ST-elevation myocardial infarction with multivessel disease would not be associated with iatrogenic myocardial infarction, and would be associated with reductions in left ventricular (LV) volumes in the longer term. Methods: In the preventive angioplasty in myocardial infarction trial (PRAMI; ISRCTN73028481), cardiac magnetic resonance (CMR) was prespecified in two centres and performed (median, IQR) 3 (1, 5) and 209 (189, 957) days after primary PCI. Results: From 219 enrolled patients in two sites, 84% underwent CMR. 42 (50%) were randomised to culprit-artery-only PCI and 42 (50%) were randomised to preventive PCI. Follow-up CMR scans were available in 72 (86%) patients. There were two (4.8%) cases of procedure-related myocardial infarction in the preventive PCI group. The culprit-artery-only group had a higher proportion of anterior myocardial infarctions (MIs) (55% vs 24%). Infarct sizes (% LV mass) at baseline and follow-up were similar. At follow-up, there was no difference in LV ejection fraction (%, median (IQR), (culprit-artery-only PCI vs preventive PCI) 51.7 (42.9, 60.2) vs 54.4 (49.3, 62.8), p=0.23), LV end-diastolic volume (mL/m2, 69.3 (59.4, 79.9) vs 66.1 (54.7, 73.7), p=0.48) and LV end-systolic volume (mL/m2, 31.8 (24.4, 43.0) vs 30.7 (23.0, 36.3), p=0.20). Non-culprit angiographic lesions had low-risk Syntax scores and 47% had non-complex characteristics. Conclusions: Compared with culprit-only PCI, non-infarct-artery MI in the preventive PCI strategy was uncommon and LV volumes and ejection fraction were similar

Predictors of digital amputation in diabetic patients with surgically treated finger infections

BACKGROUND: Diabetes is a well-established risk factor for severe digital infection, and patients are more likely to require digital amputation for adequate source control. This study aims to identify factors predictive of digital amputation compared with preservation in patients with diabetes who present with surgically treated finger infections. METHODS: Current Procedural Terminology (CPT) and International Classification of Diseases Versions 9 and 10 (ICD-9/10) databases from a single academic medical center were queried to identify patients with type 1 or type 2 diabetes mellitus who underwent surgical treatment in the operating room for treatment of a digital infection from 2010 to 2020. Electronic medical records were reviewed to obtain historical and acute clinical variables at the time of hospital presentation. Bivariate and multivariable regression were used to identify factors associated with amputation. RESULTS: In total, 145 patients (61 digital amputation, 84 digital preservation) met inclusion criteria for this retrospective cohort study. Mean hospital stay was 6 days, and the average patient underwent 2 operations. Multivariable analysis revealed that the presence of osteomyelitis, ipsilateral upper extremity dialysis fistula, end-stage renal disease, and vascular disease each had significant independent predictive value for amputation rather than digital preservation. CONCLUSIONS: Digital amputation is common in the setting of diabetic finger infection. The 4 variables found to independently predict the outcome of amputation can be understood as factors which decrease the likelihood of successful digital salvage and increase the potential consequence of ongoing uncontrolled infection. Further study should focus on clinical factors affecting surgical decision making and how the treatment rendered affects patient outcomes