Coronary computed tomography angiography using model-based iterative reconstruction algorithms in the detection of significant coronary stenosis : how the plaque type influences the diagnostic performance

Purpose: To evaluate the ability of coronary computed tomography angiography (CCTA) with model-based iterative reconstruction (MBIR) algorithm in detecting significant coronary artery stenosis compared with invasive coronary angiography (ICA). Material and methods: We retrospectively identified 55 patients who underwent CCTA using the MBIR algorithm with evidence of at least one significant stenosis (≥ 50%) and an ICA within three months. Patients were stratified based on calcium score; stenoses were classified by type and by coronary segment involved. Dose-length-product was compared with the literature data obtained with previous reconstruction algorithms. Coronary artery stenosis was estimated on ICAs based on a qualitative method. Results: CCTA data were confirmed by ICA in 89% of subjects, and in 73% and 94% of patients with CS < 400 and ≥ 400, respectively. ICA confirmed 81% of calcific stenoses, 91% of mixed, and 67% of soft plaques. Both the dose exposure of patients with prospective acquisition (34) and the exposure of the whole population were significantly lower than the standard of reference (p < 0.001 and p = 0.007). Conclusions: CCTA with MBIR is valuable in detecting significant coronary artery stenosis with a solid reduction of radiation dose. Diagnostic performance was influenced by plaque composition, being lower compared with ICA for patients with lower CAC score and soft plaques; the visualisation of an intraluminal hypodensity could cause false positives, particularly in D1 and MO segments

Concealed SARS-CoV-2 interstitial pneumonia unmasked by infarct-like acute myocarditis

A 38-year-old otherwise healthy man presented to the emergency department for sudden-onset oppressive chest pain. On admission, vital parameters were within normal limits and physical examination was unremarkable. Since the ECG showed mild ST-segment eleva- tion in the inferior leads (Panel A), he underwent urgent coronary angiography which ruled out obstructive coronary artery disease (Panel B). Transthoracic echocardiogram showed preserved left ven- tricular (LV) ejection fraction with inferolateral wall hypokinesis. The peak of high-sensitive troponin I was 4038 ng/L (normal value &lt;20). Acute myocarditis was suspected, and a cardiac magnetic resonance (CMR) was performed. High signal intensity (SI) of the mid-basal LV lateral wall on T2 short tau inversion recovery (STIR) sequences con- sistent with myocardial oedema (Panel C) and subepicardial late gado- linium enhancement in the same location (Panel D) were detected. Unexpectedly, areas of high SI on T2-STIR images were also noted on both lungs (Panel C), suggesting a pulmonary inflammatory pro- cess. Despite an initially negative chest X-ray, computed tomography revealed bilateral ground-glass opacity with multifocal consolidation and thickening of interlobular septa consistent with interstitial pneumonia (Panel E). Considering the ongoing coronavirus outbreak, a nasopharyngeal swab was obtained resulting positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. The patient remained free from either cardiovascular or respiratory symptoms and presented only mild fever (37.5C). Laboratory tests detected an increase of transaminases and C-reactive protein (6.73 mg/dL; normal value &lt;0.5) with stable lymphocytopenia. After 20 days of hospitalization, he was discharged with the diagnosis of infarct-like myocarditis associated with subclinical SARS-CoV-2 respiratory infection. Acute myocarditis in the setting of SARS-CoV-2 infection has been anecdotally reported and its mechanism remains to be elucidated. So far, the SARS-CoV-2 genome has never been detected within the myocardium, suggesting an immune-mediated inflammatory myocardial injury. For the first time we reported a case of subclinical SARS-CoV-2 interstitial pneumonia occasionally unmasked by CMR performed for acute myocarditis

Applied Tests to Select the Most Suitable Fungal Strain for the Recovery of Critical Raw Materials from Electronic Waste Powder

Electrical and electronic wastes (WEEEs) are a potential source of raw materials. The main challenge for scientists is to set up a reliable and eco-friendly process to recycle raw materials and precious elements from WEEEs. Today, we know that fungi could play an active role in green technologies aimed at recycling valuable elements. The bioaccumulation mechanism and bioleaching activity of filamentous fungal species have already been exploited fruitfully in extraction processes. However, not all fungal strains possess the same characteristics, and it is crucial to choose the right strains to use. In this work, we show a method to assess the precious elements’ recovery efficiency from WEEE using fungal strains. A CAS agar screening test for siderophore detection was carried out with three strains. The following plate accumulation test performed on a medium added with 120 ppm of electronic waste powder highlighted the differences in accumulation capability, growth rate, and biomass production. Among the elements in tested waste, yttrium, copper, and palladium show the highest bioconcentration factor. The results confirm the biotechnological potential of fungi to recover valuable elements at the bench scale, highlighting the importance of effective screening tests to assess the most efficient strain for each kind of waste

Role of cardiac magnetic resonance in MINOCA of unclear etiology: A case report of a suspicious paradoxical coronary embolism

The acronym MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) refers to myocardial infarction with normal or near-normal coronary arteries on invasive angiography. The broad spectrum of pathological mechanisms responsible for myocardial injury in MINOCA makes defining the exact underlying etiology challenging. We report the uncommon case of an acute myocardial infarction with normal coronary arteries suggestive of MINOCA caused by paradoxical coronary embolism due to a wide right-to- left shunting through a patent fossa ovalis. Integrated multimodality imaging diagnostic work-up, including cardiac magnetic resonance, transesophageal contrast echocardiography, and transcranial contrast Doppler, has been crucial for identifying the most likely mechanism underlying MINOCA

An unusual presentation of anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome in a 70-year-old man: a case report

Background: We present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly. Case presentation: A 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II). He was asymptomatic for angina, syncope, and palpitations. Cardiac magnetic resonance imaging was performed after echocardiography because a hypertrophic cardiomyopathy was suspected; a plausible coronary artery anomaly was demonstrated as collateral evidence. Subsequently, coronary computed tomographic angiography showed the anomalous origin of left coronary artery from the pulmonary artery; the coronary vessels appeared markedly dilated and tortuous. Dilated intercoronary vessels along the epicardial surface of the heart and dilated bronchial arteries, corresponding to collateral pathways, were observed. Left ventricular hypertrophy, delayed subendocardial enhancement, and mitral insufficiency were better evaluated on magnetic resonance images. Invasive coronary angiography confirmed the main findings. Given the patient’s age and clinical performance, surveillance with medical management was considered appropriate, and surgical repair was avoided. Conclusions: Confidence with the anatomic pattern and clinical significance of this anomalous condition is necessary to improve cardiac imaging evaluation ability. In our patient, coronary computed tomographic angiography proved to be a reliable imaging approach, superior to invasive coronary angiography in terms of diagnostic performance and patient safety

2020 taxonomic update for phylum Negarnaviricota (Riboviria: Orthornavirae), including the large orders Bunyavirales and Mononegavirales.

In March 2020, following the annual International Committee on Taxonomy of Viruses (ICTV) ratification vote on newly proposed taxa, the phylum Negarnaviricota was amended and emended. At the genus rank, 20 new genera were added, two were deleted, one was moved, and three were renamed. At the species rank, 160 species were added, four were deleted, ten were moved and renamed, and 30 species were renamed. This article presents the updated taxonomy of Negarnaviricota as now accepted by the ICTV

Technology-Supported Education: Old Questions for New Strategies

Technology-supported education (TSE) is raising a growing interest in management education. Many business schools are introducing TSE in their programs, undertaking significant investments, but often complaining about actual returns. In this paper, we underline the importance to root TSE in a clear-cut, traditional strategic view. Building on the literature review, we develop a framework to support the technology adoption process. As a starting point, we propose a typology of technological applications, among which choices should be based on their strategic value. Main indications to evaluate each option are provided, so that a road map is developed according to the specific goals and context, aiming at making the strategic rationale of TSE choices explicit. To better develop this approach, we also analyze as a case study a new international executive education program to point out the key variables that have been taken into account and the matters that have been addressed. From a managerial point of view, adopting the proposed road map should lead to choosing the best technological tool both with regard to the efficiency and the efficacy dimension

An Analysis of Technology-mediated Management Education. Proposing a Framework

Although technology-mediated education programs are gathering growing interest, little attention has been paid to the strategic aspects of those innovative programs. In order to create programs able to build competitive advantage, business schools should decide very carefully first of all what kind of strategy they want to implement. In our review we highlights that previous experimentations are generally referred as a matter of technology, while they are strongly related to the strategy and the organization of a business school. Technology will follow. We then propose a framework to guide business school in their decisions

Coronary computed tomography angiography using model-based iterative reconstruction algorithms in the detection of significant coronary stenosis: how the plaque type influences the diagnostic performance

Purpose: To evaluate the ability of coronary computed tomography angiography (CCTA) with model-based iterative reconstruction (MBIR) algorithm in detecting significant coronary artery stenosis compared with invasive coronary angiography (ICA). Material and methods: We retrospectively identified 55 patients who underwent CCTA using the MBIR algorithm with evidence of at least one significant stenosis (≥ 50%) and an ICA within three months. Patients were stratified based on calcium score; stenoses were classified by type and by coronary segment involved. Dose-length-product was compared with the literature data obtained with previous reconstruction algorithms. Coronary artery stenosis was estimated on ICAs based on a&nbsp;qualitative method. Results: CCTA data were confirmed by ICA in 89% of subjects, and in 73% and 94% of patients with CS &lt; 400 and ≥ 400, respectively. ICA confirmed 81% of calcific stenoses, 91% of mixed, and 67% of soft plaques. Both the dose exposure of patients with prospective acquisition (34) and the exposure of the whole population were significantly lower than the standard of reference (p &lt; 0.001 and p = 0.007). Conclusions: CCTA with MBIR is valuable in detecting significant coronary artery stenosis with a&nbsp;solid reduction of radiation dose. Diagnostic performance was influenced by plaque composition, being lower compared with ICA for patients with lower CAC score and soft plaques; the visualisation of an intraluminal hypodensity could cause false positives, particularly in D1 and MO segments

Valvola polmonare bicuspide associata ad aneurisma dell'arteria polmonare [Bicuspid pulmonary valve associated with pulmonary artery aneurysm]

No abstract availabl