Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?

© 2016 Hamshere et al. Background: AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR). Methods: CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers. Results: 85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21 %, 95 % limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001. Conclusions: AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians

La série télévisée Duplessis (1978), dramatisation ou documentaire?

Nous étions étudiantes de niveau collégial au moment de la diffusion de cette série en février et mars 1978. Vivement impressionnées par cette réalisation, nous en avions fait un sujet de discussion entre amis. Quelques années plus tard, inscrites à des séminaires en scénarisation télévisuelle, nous avons eu l'idée de faire l'étude de cette mini-série. Aux États-Unis, ce type de production est bien implanté et très populaire auprès des téléspectateurs. Les maisons de production canadiennes sont, à l'exemple de celles des Américains, en train d'instaurer ce genre d'émission. Nous avons déjà pu voir sur notre petit écran: Riel. MacDonald. Les Fils de la liberté. Duplessis. Empire Inc., Les Plouffe... Ce n'est là qu'un début, puisque nous pourrons assister prochainement à la diffusion des séries Maria Chapdelaine et Le Crime d'Ovide Plouffe. Ces mini-séries s'adressent à un vaste auditoire. Elles suscitent parfois la controverse. Tel fut le cas pour la série télévisée Duplessis. Certains téléspectateurs l'ont vue comme une dramatisation, d'autres comme un documentaire. C'est à partir de cette constatation que nous avons élaboré l'objet de notre recherche qui consiste à faire l'étude de Duplessis comme production de masse. Notre hypothèse de départ est de reconnaître les critères selon lesquels la série appartient à une catégorie précise d'émissions. Est-ce une dramatisation? un documentaire? Voilà ce qui constitue le fil conducteur de notre mémoire

La série télévisée Duplessis (1978), dramatisation ou documentaire?

Nous étions étudiantes de niveau collégial au moment de la diffusion de cette série en février et mars 1978. Vivement impressionnées par cette réalisation, nous en avions fait un sujet de discussion entre amis. Quelques années plus tard, inscrites à des séminaires en scénarisation télévisuelle, nous avons eu l'idée de faire l'étude de cette mini-série. Aux États-Unis, ce type de production est bien implanté et très populaire auprès des téléspectateurs. Les maisons de production canadiennes sont, à l'exemple de celles des Américains, en train d'instaurer ce genre d'émission. Nous avons déjà pu voir sur notre petit écran: Riel. MacDonald. Les Fils de la liberté. Duplessis. Empire Inc., Les Plouffe... Ce n'est là qu'un début, puisque nous pourrons assister prochainement à la diffusion des séries Maria Chapdelaine et Le Crime d'Ovide Plouffe. Ces mini-séries s'adressent à un vaste auditoire. Elles suscitent parfois la controverse. Tel fut le cas pour la série télévisée Duplessis. Certains téléspectateurs l'ont vue comme une dramatisation, d'autres comme un documentaire. C'est à partir de cette constatation que nous avons élaboré l'objet de notre recherche qui consiste à faire l'étude de Duplessis comme production de masse. Notre hypothèse de départ est de reconnaître les critères selon lesquels la série appartient à une catégorie précise d'émissions. Est-ce une dramatisation? un documentaire? Voilà ce qui constitue le fil conducteur de notre mémoire

Additional file 1: Figure S1. of Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?

Consort diagram. Flow chart of study design summarizing flow of patients through study. (JPG 25 kb

Additional file 2: Figure S2. of Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?

Correlation coefficient between 3-slice MM and 10-slice MM. Association between 3-slice MM quantification and 10-slice MM quantification assessed by CMR. (TIFF 114 kb

Additional file 3: Figure S3. of Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary?

Difference between T2-STIR distributions after myocardial infarction. Screenshot demonstrating the increased signal seen in the basal, mid and apical slices in a T2-STIR imaging technique after a ST elevation myocardial infarction involving each of the major epicardial coronary arteries. (JPG 88 kb

Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion

Background. Brief normothermic machine perfusion is increasingly used to assess and recondition grafts before transplant. During normothermic machine perfusion, metabolic activity is typically maintained using red blood cell (RBC)–based solutions. However, the utilization of RBCs creates important logistical constraints. This study explored the feasibility of human kidney normothermic perfusion using William’s E–based perfusate with no additional oxygen carrier. Methods. Sixteen human kidneys declined for transplant were perfused with a perfusion solution containing packed RBCs or William’s E medium only for 6 h using a pressure-controlled system. The temperature was set at 37 °C. Renal artery resistance, oxygen extraction, metabolic activity, energy metabolism, and histological features were evaluated. Results. Baseline donor demographics were similar in both groups. Throughout perfusion, kidneys perfused with William’s E exhibited improved renal flow (P = 0.041) but similar arterial resistance. Lactic acid levels remained higher in kidneys perfused with RBCs during the first 3 h of perfusion but were similar thereafter (P = 0.95 at 6 h). Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding oxygen consumption (P = 0.41) and reconstitution of ATP tissue concentration (P = 0.55). Similarly, nicotinamide adenine dinucleotide levels were preserved during perfusion. There was no evidence of histological damage caused by either perfusate. Conclusions. In human kidneys, William’s E medium provides a logistically convenient, off-the-shelf alternative to packed RBCs for up to 6 h of normothermic machine perfusion

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)