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PURPOSE: The preoperative assessment of carotid plaques is necessary to render revascularization safe and effective. The aim of this study is to evaluate the usefulness of chemical exchange saturation transfer (CEST)-MRI, particularly amide proton transfer (APT) imaging as a preoperative carotid plaque diagnostic tool. METHODS: We recorded the APT signal intensity on concentration maps of 34 patients scheduled for carotid endarterectomy. Plaques were categorized into group A (APT signal intensity ≥ 1.90 E-04; n = 12) and group B (APT signal intensity < 1.90 E-04; n = 22). Excised plaques were subjected to histopathological assessment and, using the classification promulgated by the American Heart Association, they were classified as intraplaque hemorrhage-positive [type VI-positive (tVI+)] and -negative [no intraplaque hemorrhage (tVI-)]. RESULTS: Of the 34 patients, 22 (64.7%) harbored tVI+- and 12 (35.3%) had tVI- plaques. The median APT signals were significantly higher in tVI+- than tIVI- patients (2.43 E-04 (IQR = 0.98-4.00 E-04) vs 0.54 E-04 (IQR = 0.14-1.09 E-04), p < .001). Histopathologically, the number of patients with tVI+ plaques was significantly greater in group A (100%, n = 12) than group B (45%, n = 22) (p < .01). The number of symptomatic patients or asymptomatic patients with worsening stenosis was also significantly greater in group A than group B (75% vs 36%, p < .01). CONCLUSION: In unstable plaques with intraplaque hemorrhage and in patients with symptoms or progressive stenosis, the ATP signals were significantly elevated. CEST-MRI studies has the potential for the preoperative assessment of the plaques' characteristics.
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Estenose das Carótidas , Imageamento por Ressonância Magnética , Humanos , Masculino , Feminino , Idoso , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Endarterectomia das Carótidas , Placa Aterosclerótica/diagnóstico por imagem , Sensibilidade e Especificidade , Interpretação de Imagem Assistida por Computador/métodosRESUMO
Lean body mass is a significant component of survival from sepsis. Several equations can be used for calculating lean body mass based on age, sex, body weight, and height. We hypothesized that lean body mass is a better predictor of outcomes than the body mass index (BMI). This study used a multicenter cohort study database. The inclusion criteria were age ≥18 years and a diagnosis of sepsis or septic shock. BMI was classified into four categories: underweight (<18.5 kg/m2), normal (≥18.5-<25 kg/m2), overweight (≥25-<30 kg/m2), and obese (≥30 kg/m2). Four lean body mass equations were used and categorized on the basis of quartiles. The outcome was in-hospital mortality among different BMI and lean body mass groups. Among 85,558 patients, 3916 with sepsis were included in the analysis. Regarding BMI, in-hospital mortality was 36.9%, 29.8%, 26.7%, and 27.9% in patients who were underweight, normal weight, overweight, and obese, respectively (p < 0.01). High lean body mass did not show decreased mortality in all four equations. In critically ill patients with sepsis, BMI was a better predictor of in-hospital mortality than the lean body mass equation at intensive care unit (ICU) admission. To precisely predict in-hospital mortality, ICU-specific lean body mass equations are needed.
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OBJECTIVE: Acute Physiology and Chronic Health Evaluation II (APACHE II) is based on the data of intensive care unit (ICU) patients and often correlates with disease severity and prognosis. However, no prognostic predictors exist based on ICU admission data for patients with brain tumors, and no studies have reported an association between APACHE II and prognosis in patients with brain tumors. The Japanese Intensive Care Patients Database (JIPAD) was established to improve the quality of care delivered in intensive care medicine in Japan. We used JIPAD to examine factors associated with in-hospital mortality based on available data of postoperative patients with brain tumors admitted to the ICU. METHODS: Patients aged ≥16 years enrolled in JIPAD between April 2015 and March 2018 after surgical brain tumor resection or biopsy of brain tumors. We examined factors related to outcomes at discharge based on blood tests and medical procedures performed during ICU admission, tumor type, and APACHE II score. RESULTS: Among the 1454 patients (male:female ratio: 1:1.1, mean age: 62 years) in the study, 32 (2.2â¯%) died during hospital stay. In multivariate analysis, male sex (odds ratio [OR] 2.70, [95â¯% confidence interval, CI 1.22-6.00]), malignant tumor (OR 2.51 [95â¯% CI 1.13-5.55]), and APACHE II score ≥15 (OR 2.51 [95â¯% CI 3.08-14.3]) were significantly associated with in-hospital mortality. CONCLUSION: By picking up cases with a high risk of in-hospital death at an early stage, it is possible to improve methods of treatment and support for the patient's family.
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APACHE , Neoplasias Encefálicas , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Japão/epidemiologia , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/mortalidade , Idoso , Estudos Retrospectivos , Estudos de Casos e Controles , Adulto , Prognóstico , Idoso de 80 Anos ou mais , Valor Preditivo dos TestesRESUMO
BACKGROUND: A rete mirabile is a rare vascular anomaly, with posterior cerebral artery (PCA) involvement being especially rare. Its pathogenesis has been speculated as a remnant of "distal annexation" between the primitive anterior choroidal artery (AchA) and the PCA at this site, but the exact mechanisms remain unclear. OBSERVATIONS: A 29-year-old man presented with subarachnoid hemorrhage. Arteriovenous malformation in the medial temporal lobe was initially suspected, but an arteriovenous shunt was not detected. First, conservative treatment was administered; however, rebleeding occurred 1 month later. Carotid angiography revealed a network-like cluster of blood vessels at the choroidal point of the AchA, suggesting a rete mirabile; these vessel clusters led to the persistent temporo-occipital branch of the AchA. Furthermore, an aneurysm was detected at the junction between the rete mirabile and the persistent temporo-occipital branch of the AchA. Additionally, vertebral angiography demonstrated a rete mirabile at the P2 segment. These findings suggested the coexistence of AchA and PCA retia mirabilia. Consequently, the aneurysm was clipped using a subtemporal approach to prevent re-rupture, and the postoperative course was uneventful. LESSONS: This first report of coexisting AchA and PCA retia mirabilia supports the remnant of distal annexation between the primitive AchA and the PCA as the reason for rete formation at this site.