Forest Patch Connectivity: The Case of the Kranj–Sora Basin, Slovenia

This article features a spatial analysis of forest patches, trees, and shrubs outside forests in part of the Kranj–Sora Basin in central Slovenia. Forest patch connectivity is explored using methods derived from graph theory. The graph nodes represent the forest patches and the edges between them represent the shortest connections calculated using a raster layer containing data on the resistance of individual land-use types. The contribution of an individual forest patch to habitat connectivity and availability is calculated using selected indicators. The findings show that the largest forest patches complemented by smaller patches constitute the basic connectivity tool. Thus, habitat size and close-to-nature structure are vital for the conservation of species over short distances. In conclusion, guidelines are presented for managing and mitigating the effects of further clearing the remaining natural vegetation

Competence of radiologists in cardiac CT and MR imaging in Europe:insights from the ESCR Registry

Rationale: To provide an overview of the current status of cardiac multimodality imaging practices in Europe and radiologist involvement using data from the European Society of Cardiovascular Radiology (ESCR) MRCT-registry. Materials and methods: Numbers on cardiac CT and MRI examinations were extracted from the MRCT-registry of the ESCR, entered between January 2011 and October 2023 (n = 432,265). Data collection included the total/annual numbers of examinations, indications, complications, and reporting habits. Results: Thirty-two countries contributed to the MRCT-registry, including 29 European countries. Between 2011 and 2022, there was a 4.5-fold increase in annually submitted CT examinations, from 3368 to 15,267, and a 3.8-fold increase in MRI examinations, from 3445 to 13,183. The main indications for cardiac CT were suspected coronary artery disease (CAD) (59%) and transcatheter aortic valve replacement planning (21%). The number of patients with intermediate pretest probability who underwent CT for suspected CAD showed an increase from 61% in 2012 to 82% in 2022. The main MRI indications were suspected myocarditis (26%), CAD (21%), and suspected cardiomyopathy (19%). Adverse event rates were very low for CT (0.3%) and MRI (0.7%) examinations. Reporting of CT and MRI examinations was performed mainly by radiologists (respectively 76% and 71%) and, to a lesser degree, in consensus with non-radiologists (19% and 27%, respectively). The remaining examinations (4.9% CT and 1.7% MRI) were reported by non-radiological specialties or in separate readings of radiologists and non-radiologists. Conclusions: Real-life data on cardiac imaging in Europe using the largest available MRCT-registry demonstrate a considerable increase in examinations over the past years, the vast majority of which are read by radiologists. These findings indicate that radiologists contribute to meeting the increasing demands of competent and effective care in cardiac imaging to a relevant extent. Clinical relevance statement: The number of cardiac CT and MRI examinations has risen over the past years, and radiologists read the vast majority of these studies as recorded in the MRCT-registry. </p

CAN THE DEGREE OF CORONARY COLLATERALISATION BE USED IN CLINICAL ROUTINE AS A VALID ANGIOGRAPHIC PARAMETER OF VIABILITY

Namen: Stopnja uspešnosti perkutanih koronarnih arterijskih posegov (PCI) na lezijah s kronično popolno okluzijo (CTO) se je v zadnjih letih povečala, vendar je izboljšanje funkcije možno le, če je prisotna viabilnost miokarda. Eden najpomembnejših dejavnikov ohranjanja viabilnoti miokarda je odpiranje in razvoj kolateral. Naša hipoteza je bila, da višja stopnja kolateral pomeni izboljšano viabilnost miokarda. Metode: Pri 38 bolnikih smo primerjali stopnjo kolateral, ocenjeno s konvencionalnim koronarnim angiogramom (CCA) in razvrščeno po klasifikaciji Rentrop, s parametri viabilnosti (delež brazgotine, krčljivost in EDWT), ki smo jih pridobili s preiskavo ocene viabilnosti z magnetno resonanco. Rezultati: Ugotovili smo statistično pomembno povezavo med stopnjo kolateral, določeno z metodo Rentrop, in deležem brazgotine, izmerjenim s CMR (p = 0,001T = - 0,144). Naša študija kaže tudi močno statistično pomembno povezavo med stopnjo kolateral in krčljivostjo, ki je bila izmerjena na ordinalni način (normalna, blaga hipokinezija, huda hipokinezija, diskinezija in akinezija) (p = 8,86 × 10-8T = 0,215). Obe asociaciji sta pokazali povečano razmerje med viabilnim in neviabilnimi miokardom glede na stopnjo kolateral. Ugotovili smo, da ima stopnja kolateral nizko NPV za neviabilen miokard (29%) in visoko PPV za viabilen miokard (82%) s skupno natančnostjo 74%. Zaključek: naša študija kaže, da bi bilo koristno rutinsko oceniti kolaterale pri angiografiji pri bolnikih s CTO za oceno viabilnosti miokarda.Purpose: The success rate of percutaneous coronary artery intervention (PCI) of chronic total occlusion (CTO) lesions have increased in the recent years. However, improvement of function is only possible when significant myocardial viability is present. One of the most important factors of maintaining myocardial viability is the opening and development of collaterals. Our hypothesis was that with a higher degree of collaterals more viable myocardium is present. Methods: In 38 patients we compared the degree of collaterals, evaluated with a conventional coronary angiogram (CCA) and graded by the Rentrop classification, to viability parameters (transmural extent of the scar, contractility and EDWT) obtained in a viability study with magnetic resonance (MRI). Results: We found a statistically significant association of the degree of collaterals determined with Rentrop method and transmural extent of the scar as measured by CMR (p=0.001T= -0.144). Our study also shows strong statistically significant association between the degree of collaterals and contractility measured in ordinal manner (normal, mild hypokinesia, severe hypokinesia, dyskinesia and akinesia) (p=8.86×10-8T=0.215). Additionally, both associations showed an increase in the ratio between viable vs. non-viable myocardium with the degree of collaterals. We found that that the degree of collateralization has a low NPV for non-viable myocardium (29%) and high PPV for viable myocardium (82%) with overall accuracy of 74%. Conclusion: Our study suggests that it may be beneficial to routinely grade the collaterals at angiography in patients with CTO as an assessment of myocardial viability

Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

The aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients’ individual anatomy, including breast volume

Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

The aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients% individual anatomy, including breast volume. Patients and methods. In the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV. Results. Mean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly. Conclusions. Our study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique

Veno-arterial extracorporeal membrane oxygenation for post-infarction ventricular septal defect in a low-volume center

Managing patients with post-ischaemic ventricular septal defects (VSD) and postcardiotomy cardiogenic shock can be extremely challenging in a low-volume cardiac surgery unit. We present a case of a 68-year-old patient who received veno-arterial extracorporeal membrane oxygenation support due to cardiogenic shock after VSD repair. The patient was successfully weaned off support after 86 h. In the postoperative period, mediastinitis occurred, and negative pressure wound therapy was instituted

Veno-arterial extracorporeal membrane oxygenation for post-infarction ventricular septal defect in a low-volume center

Managing patients with post-ischaemic ventricular septal defects (VSD) and postcardiotomy cardiogenic shock can be extremely challenging in a low-volume cardiac surgery unit. We present a case of a 68-year-old patient who received veno-arterial extracorporeal membrane oxygenation support due to cardiogenic shock after VSD repair. The patient was successfully weaned off support after 86 h. In the postoperative period, mediastinitis occurred, and negative pressure wound therapy was instituted