Cardiovascular magnetic resonance:Diagnostic utility and specific considerations in the pediatric population

Cardiovascular magnetic resonance is a non-invasive imaging modality which is emerging as important tool for the investigation and management of pediatric cardiovascular disease. In this review we describe the key technical and practical differences between scanning children and adults, and highlight some important considerations that must be taken into account for this patient population. Using case examples commonly seen in clinical practice, we discuss the important clinical applications of cardiovascular magnetic resonance, and briefly highlight key future developments in this field

Brain MRI and ophthalmic biomarkers of intracranial pressure

Objective: To evaluate the utility of brain MRI and ophthalmic biomarkers for the prediction of intracranial hypertension, we have studied the association between 6 biomarkers and 24-hour intracranial pressure (ICP) monitoring results in 45 patients. Methods: This single-center observational study includes patients who underwent 24-hour ICP monitoring, brain MRI (within 3 months), and ophthalmic assessment (during ICP monitoring). Six biomarkers were investigated: pituitary gland shape, vertical tortuosity of the optic nerve, distension of the optic nerve sheath, optic disc protrusion (MRI), papilledema (slit lamp biomicroscopy), and spontaneous venous pulsations (SVP, infrared video recordings). Results: Forty-five patients (mean age 39 ± 14 years, 38 women) met the inclusion criteria. All 6 biomarkers had a significant association with 24-hour ICP. Concave pituitary gland was observed with moderately elevated median ICP. Protrusion of the optic disc (MRI), papilledema, and absence of SVP were associated with the highest median ICP values. Twenty patients had raised ICP (median 24-hour ICP >5.96 mm Hg, cutoff obtained through Youden index calculation). Patients with all normal biomarkers had normal median ICP in 94% (standard error 6%) of the cases. All patients with ≥3 abnormal biomarkers had intracranial hypertension. The combination of at least 1 abnormal biomarker in MRI and ophthalmic assessments was highly suggestive of intracranial hypertension (area under the curve 0.94, 95% confidence interval 0.93–0.94) Conclusions: Brain MRI and ophthalmic biomarkers can noninvasively guide the management of patients with suspected CSF dynamics abnormalities. Patients with multiple abnormal biomarkers (≥3) or a combination of abnormal MRI and ophthalmic biomarkers are likely to have intracranial hypertension and should be managed promptly

Shock wave apparatus for studying minerals at high pressure and impact phenomena on planetary surfaces

Shock wave and experimental impact phenomena research on geological and planetary materials is being carried out using two propellant (18 and 40 mm) guns (up to 2.5 km/sec) and a two‐stage light gas gun (up to 7 km/sec). Equation of state measurements on samples initially at room temperature and at low and high temperatures are being conducted using the 40 mm propellant apparatus in conjunction with Helmholtz coils, and radiative detectors and, in the case of the light gas gun, with streak cameras. The 18 mm propellant gun is used for recovery experiments on minerals, impact on cryogenic targets, and radiative post‐shock temperature measurements

Energy dependence of kaon-to-proton ratio fluctuations in central Pb+Pb collisions from sNN\sqrt{s_{NN}} = 6.3 to 17.3 GeV

Kaons and protons carry large parts of two conserved quantities, strangeness and baryon number. It is argued that their correlation and thus also fluctuations are sensitive to conditions prevailing at the anticipated parton-hadron phase boundary. Fluctuations of the $(\mathrm{K}^+ + \mathrm{K}^-)/(\mathrm{p}+\bar{\mathrm{p}})$ and $\mathrm{K}^+/\mathrm{p}$ ratios have been measured for the first time by NA49 in central Pb+Pb collisions at 5 SPS energies between $\sqrt{s_{NN}}$= 6.3 GeV and 17.3 GeV. Both ratios exhibit a change of sign in $\sigma_{\mathrm{dyn}}$, a measure of non-statistical fluctuations, around $\sqrt{s_{NN}}$ = 8 GeV. Below this energy, $\sigma_{\mathrm{dyn}}$ is positive, indicating higher fluctuation compared to a mixed event background sample, while for higher energies, $\sigma_{\mathrm{dyn}}$ is negative, indicating correlated emission of kaons and protons. The results are compared to UrQMD calculations which which give a good description at the higher SPS energies, but fail to reproduce the transition to positive values.Comment: 5 pages, 4 figure

Clonal haematopoiesis is not prevalent in survivors of childhood cancer

This project was funded by the Wellcome Trust Sanger Institute (grant number WT098051). G.S.V. is funded by a Wellcome Trust Senior Fellowship in Clinical Science (WT095663MA). F.F. is funded by Compagnia di San Paolo Grant: “Le cellule staminali del sangue nei guariti di leucemia” Codice SIME 2013-0958 (codice ROL 4201). I.V is funded by the Spanish Ministerio de Economía y Competitividad, Programa Ramón y Cajal

Antideuteron and deuteron production in mid-central Pb+Pb collisions at 158AA GeV

Production of deuterons and antideuterons was studied by the NA49 experiment in the 23.5% most central Pb+Pb collisions at the top SPS energy of $\sqrt{s_{NN}}$=17.3 GeV. Invariant yields for $\bar{d}$ and $d$ were measured as a function of centrality in the center-of-mass rapidity range $-1.2<y<-0.6$. Results for $\bar{d}(d)$ together with previously published $\bar{p}(p)$ measurements are discussed in the context of the coalescence model. The coalescence parameters $B_2$ were deduced as a function of transverse momentum $p_t$ and collision centrality.Comment: 9 figure

Phase-space dependence of particle-ratio fluctuations in Pb+Pb collisions from 20A to 158A GeV beam energy

A novel approach, the identity method, was used for particle identification and the study of fluctuations of particle yield ratios in Pb+Pb collisions at the CERN Super Proton Synchrotron (SPS). This procedure allows to unfold the moments of the unknown multiplicity distributions of protons (p), kaons (K), pions ($\pi$) and electrons (e). Using these moments the excitation function of the fluctuation measure $\nu_{\text{\text{dyn}}}$[A,B] was measured, with A and B denoting different particle types. The obtained energy dependence of $\nu_{\text{dyn}}$ agrees with previously published NA49 results on the related measure $\sigma_{\text{dyn}}$. Moreover, $\nu_{\text{dyn}}$ was found to depend on the phase space coverage for [K,p] and [K,$\pi$] pairs. This feature most likely explains the reported differences between measurements of NA49 and those of STAR in central Au+Au collisions

Production of deuterium, tritium, and 3^3He in central Pb+Pb collisions at 20A, 30A, 40A, 80A, and 158A GeV at the CERN SPS

Production of $d$, $t$, and $^3$He nuclei in central Pb+Pb interactions was studied at five collision energies ($\sqrt{s_{NN}}=$ 6.3, 7.6, 8.8, 12.3, and 17.3 GeV) with the NA49 detector at the CERN SPS. Transverse momentum spectra, rapidity distributions, and particle ratios were measured. Yields are compared to predictions of statistical models. Phase-space distributions of light nuclei are discussed and compared to those of protons in the context of a coalescence approach. The coalescence parameters $B_2$ and $B_3$, as well as coalescence radii for $d$ and $^3$He were determined as a function of transverse mass at all energies.Comment: 22 pages, 29 figures, 8 tables, for submission to Phys. Rev.

Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Bone metastases in advanced cancer frequently cause painful complications that impair patient physical activity and negatively affect quality of life. Pain is often underreported and poorly managed in these patients. The most commonly used pain assessment instruments are visual analogue scales, a single-item measure, and the Brief Pain Inventory Questionnaire-Short Form. The World Health Organization analgesic ladder and the Analgesic Quantification Algorithm are used to evaluate analgesic use. Bone-targeting agents, such as denosumab or bisphosphonates, prevent skeletal complications (i.e., radiation to bone, pathologic fractures, surgery to bone, and spinal cord compression) and can also improve pain outcomes in patients with metastatic bone disease. We have reviewed pain outcomes and analgesic use and reported pain data from an integrated analysis of randomized controlled studies of denosumab versus the bisphosphonate zoledronic acid (ZA) in patients with bone metastases from advanced solid tumors. Intravenous bisphosphonates improved pain outcomes in patients with bone metastases from solid tumors. Compared with ZA, denosumab further prevented pain worsening and delayed the need for treatment with strong opioids. In patients with no or mild pain at baseline, denosumab reduced the risk of increasing pain severity and delayed pain worsening along with the time to increased pain interference compared with ZA, suggesting that use of denosumab (with appropriate calcium and vitamin D supplementation) before patients develop bone pain may improve outcomes. These data also support the use of validated pain assessments to optimize treatment and reduce the burden of pain associated with metastatic bone disease