Automated Quantification of Right Ventricular Fat at Contrast-enhanced Cardiac Multidetector CT in Arrhythmogenic Right Ventricular Cardiomyopathy

International audiencePurpose: To evaluate an automated method for the quantification of fat in the right ventricular (RV) free wall on multidetector computed tomography (CT) images and assess its diagnostic value in arrhythmogenic RV cardiomyopathy (ARVC). Materials and Methods: This study was approved by the institutional review board, and all patients gave informed consent. Thirty-six patients with ARVC (mean age 6 standard deviation, 46 years 6 15; seven women) were compared with 36 age-and sex-matched subjects with no structural heart disease (control group), as well as 36 patients with ischemic cardiomyopathy (ischemic group). Patients underwent contrast material– enhanced electrocardiography-gated cardiac multidetector CT. A 2-mm-thick RV free wall layer was automatically segmented and myocardial fat, expressed as percentage of RV free wall, was quantified as pixels with attenuation less than 210 HU. Patient-specific segmentations were registered to a template to study fat distribution. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of fat quantification by using task force criteria as a reference. Results: Fat extent was 16.5% 6 6.1 in ARVC and 4.6% 6 2.7 in non-ARVC (P , .0001). No significant difference was observed between control and ischemic groups (P = .23). A fat extent threshold of 8.5% of RV free wall was used to diagnose ARVC with 94% sensitivity (95% confidence interval [CI]: 82%, 98%) and 92% specificity (95% CI: 83%, 96%). This diagnostic performance was higher than the one for RV volume (mean area under the ROC curve, 0.96 6 0.02 vs 0.88 6 0.04; P = .009). In patients with ARVC, fat correlated to RV volume (R = 0.63, P , .0001), RV function (R = 20.67, P = .001), epsilon waves (R = 0.39, P = .02), inverted T waves in V 1 –V 3 (R = 0.38, P = .02), and presence of PKP2 mutations (R = 0.59, P = .02). Fat distribution differed between patients with ARVC and those without, with posterolateral RV wall being the most ARVC-specific area

The Politics of (and Behind) the UNFCCC’s Loss and Damage Mechanism

Despite being one of the most controversial issues to be recently treated within climate negotiations, Loss and Damage (L&D) has attracted little attention among scholars of International Relations (IR). In this chapter we take the “structuralist paradox” in L&D negotiations as our starting point, considering how IR theories can help to explain the somewhat surprising capacity of weak parties to achieve results while negotiating with stronger parties. We adopt a multi-faceted notion of power, drawing from the neorealist, liberal and constructivist schools of thought, in order to explain how L&D milestones were reached. Our analysis shows that the IR discipline can greatly contribute to the debate, not only by enhancing understanding of the negotiation process and related outcomes but also by offering insights on how the issue could be fruitfully moved forward. In particular, we note the key importance that discursive power had in the attainment of L&D milestones: Framing L&D in ethical and legal terms appealed to standards relevant beyond the UNFCCC context, including basic moral norms linked to island states’ narratives of survival and the reference to international customary law. These broader standards are in principle recognised by both contending parties and this broader framing of L&D has helped to prove the need for action on L&D. However, we find that a change of narrative may be needed to avoid turning the issue into a win-lose negotiation game. Instead, a stronger emphasis on mutual gains through adaptation and action on L&D for both developed and developing countries is needed as well as clarity on the limits of these strategies. Examples of such mutual gains are more resilient global supply chains, reduction of climate-induced migration and enhanced security. As a result, acting on L&D would not feel as a unilateral concession developed countries make to vulnerable ones: it would rather be about elaborating patterns of collective action on an issue of common concern

Obs. sous Circulaire du 8 février 2021 : La Convention de La Haye de 1996 au service de la protection des mineurs marocains non accompagnés ?

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Prévision de la description de l'anisotropie de soudures austénitiques multipasses pour leur contrôle ultrasonore

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Chronique annuelle au Recueil Dalloz

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Chronique annuelle au Recueil Dalloz

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Chronique annuelle au Recueil Dalloz

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