Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease

BACKGROUND: We assessed the relationship between coronary artery calcium (CAC) score, myocardial blood flow (MBF) and coronary flow reserve (CFR) in patients undergoing hybrid 82Rb positron emission tomography (PET)/computed tomography (CT) imaging for suspected CAD. We also evaluated if CAC score is able to predict a reduced CFR independently from conventional coronary risk factors. METHODS: A total of 637 (mean age 58 ± 13 years) consecutive patients were studied. CAC score was measured according to the Agatston method and patients were categorized into 4 groups (0, 0.01-99.9, 100-399.9, and ≥400). Baseline and hyperemic MBF were automatically quantified. CFR was calculated as the ratio of hyperemic to baseline MBF and it was considered reduced when <2. RESULTS: Global CAC score showed a significant inverse correlation with hyperemic MBF and CFR (both P < .001), while no correlation between CAC score and baseline MBF was found. At multivariable logistic regression analysis age, diabetes and CAC score were independently associated with reduced CFR (all P < .001). The addition of CAC score to clinical data increased the global chi-square value for predicting reduced CFR from 81.01 to 91.13 (P < .01). Continuous net reclassification improvement, obtained by adding CAC score to clinical data, was 0.36. CONCLUSIONS: CAC score provides incremental information about coronary vascular function over established CAD risk factors in patients with suspected CAD and it might be helpful for identifying those with a reduced CFR

The Melbourne Study of Psychoanalytic Psychotherapy III: Patients' and psychotherapists’ perspectives on progress and challenges

Qualitative exploration of the experience of psychoana-lytic psychotherapy complemented the quantitative eval-uation of mental health and life functioning improvements in the Melbourne Study of Psychoanalytic Psychotherapy. Twice-weekly treatment was offered to adults for 2years by the private sector Glen Nevis Clinic for Psychoanalytic Psychotherapy, established by the Victorian Association of Psychoanalytic Psychotherapists as a subsidized, low-cost community service over 8years. This paper is the second of two presenting the qualitative arm of the study, involv-ing in-depth narrative interviews with patients and psycho-therapists. Analysis of 143 transcripts further contributes to evidence of the Reach, Effectiveness, Adoption, Imple-men tation and Maintenance of psychoanalytic psycho-therapy in a community setting. The first qualitative paper reports themes concerning patient expectations of psycho-therapy and perspectives of both patients and psychother-apists on the experience and benefits of the treatment. This paper reports what was perceived by participants as facili-tative or challenging for therapeutic progress, illuminating how experiences of the nature of psychoanalytic psycho-therapy may have affected the Implementation, Effectivenessand Maintenance of the program. The most notable facilita-tive factors emerging were the exploratory, insight-oriented nature of the work, elements of the patient-psychotherapist relationship, and the frame of the treatment. Challenges were also often seen as inherent to Effectiveness; however, proposing the frame of 2-year treatment, as both an expecta-tion and a limit, probably inhibited program Reach, Adoptionand overall Implementation. The limitations and strengths of the qualitative arm of the research, together with implica-tions for further investigation, are discussed

The Melbourne Study of Psychoanalytic Psychotherapy II: Patients' and psychotherapists' perspectives on expectations, therapeutic experience and benefits

The naturalistic, longitudinal Melbourne Study of Psycho-analytic Psychotherapy was conducted in a subsidized community clinic established by the Victorian Association of Psychoanalytic Psychotherapists as a demonstration project operating over 8years. It offered lower SES adults twice-weekly psychoanalytic psychotherapy for 2years. An independent research program used the RE-AIM planning and evaluation framework to investigate the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. Complementary quantitative and qualitative methodologies studied mental health and general-life functioning outcomes and underlying processes of treatment. Two papers pres-ent the qualitative arm of the research, exploring the lived experience of the psychotherapy, reported contemporane-ously and retrospectively by patients and psychotherapists. This first paper details the qualitative design and methods employed. In-depth semi-structured narrative interviews during psychotherapy, upon completion at 2years, and at an additional 8-month follow-up point for patients, were conducted. Analysis of the narrative transcripts of 143 participant interviews revealed themes regarding patient expectations of treatment and the perceptions of both patients and psychotherapists of the long-term psychoana-lytic psychotherapy experience and its benefits. Narratives thus provided evidence of the Reach, Effectiveness, Adoption, Implementation and Maintenance of the service. The findings enrich understanding of the effective processes underlying the outcomes of the quantitative arm of the study reported separately. The second qualitative paper presents the find-ings concerning participants' experiences of facilitative and challenging aspects of the treatment, as well as the implica-tions of the qualitative findings overall

The Melbourne Study of Psychoanalytic Psychotherapy low‐cost clinic I: Implementation, mental health and life functioning gains

The Melbourne Study of Psychoanalytic Psychother-apy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychother-apy in a low-cost, private-sector community clinic. A first in Australia, this 8-year demonstration project allowed natural-istic study of the impact and process of intensive, long-term, time-limited psychoanalytic psychotherapy delivered to self-referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE-AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effec-tiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psycho-therapy, with Adoption of the full 2-year treatment program being 60%. Improvements in mental health and life function-ing provided quantitative evidence of Effectiveness for those completing the 2-year treatment program, with Maintenanceat 8-month follow-up. Patient age, gender and personality

Small RNA changes en route to distinct cellular states of induced pluripotency

MicroRNAs (miRNAs) are critical to somatic cell reprogramming into induced pluripotent stem cells (iPSCs), however, exactly how miRNA expression changes support the transition to pluripotency requires further investigation. Here we use a murine secondary reprogramming system to sample cellular trajectories towards iPSCs or a novel pluripotent ‘F-class’ state and perform small RNA sequencing. We detect sweeping changes in an early and a late wave, revealing that distinct miRNA milieus characterize alternate states of pluripotency. miRNA isoform expression is common but surprisingly varies little between cell states. Referencing other omic data sets generated in parallel, we find that miRNA expression is changed through transcriptional and post-transcriptional mechanisms. miRNA transcription is commonly regulated by dynamic histone modification, while DNA methylation/demethylation consolidates these changes at multiple loci. Importantly, our results suggest that a novel subset of distinctly expressed miRNAs supports pluripotency in the F-class state, substituting for miRNAs that serve such roles in iPSCs

Utilisation of Backscattered Gamma Photons in Tc-99m SPECT Imaging

A number of report have suggested that some Comptom-scattered gamma-photons do carry true spatial information even after multiple deflections in the imaged object, and scattered data have been used for the enhancement of image quality. This study attempts to examine that conclusion via the use of simple energy windowing technique. In the work reported here, data straddling the 81-154 keV range were segmented into three disjoints energy windows: photopeak, backscaterring, and angle-scattered regions. It is shown how image quality may be manipulated by appropriate combination of the sub-images derived from this data sets. Image were compared with those reconstructed from the data acquired within the conventional energy window (126-154 keV). It is found that the conventional view is the more correct one: scattered gamma-photons do, in general, reduce image quality . This conclusion is reinforced by the demonstration that some of the image enhancements claimed when scattered data is incorporated, may in fact be mimicked by processing the photopeak image alone