Interaction of AI-Enabled Quantitative Coronary Plaque Volumes on Coronary CT Angiography, FFRCT, and Clinical Outcomes: A Retrospective Analysis of the ADVANCE Registry.

BACKGROUND: Luminal stenosis, computed tomography-derived fractional-flow reserve (FFRCT), and high-risk plaque features on coronary computed tomography angiography are all known to be associated with adverse clinical outcomes. The interactions between these variables, patient outcomes, and quantitative plaque volumes have not been previously described. METHODS: Patients with coronary computed tomography angiography (n=4430) and one-year outcome data from the international ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) registry underwent artificial intelligence-enabled quantitative coronary plaque analysis. Optimal cutoffs for coronary total plaque volume and each plaque subtype were derived using receiver-operator characteristic curve analysis. The resulting plaque volumes were adjusted for age, sex, hypertension, smoking status, type 2 diabetes, hyperlipidemia, luminal stenosis, distal FFRCT, and translesional delta-FFRCT. Median plaque volumes and optimal cutoffs for these adjusted variables were compared with major adverse cardiac events, late revascularization, a composite of the two, and cardiovascular death and myocardial infarction. RESULTS: At one year, 55 patients (1.2%) had experienced major adverse cardiac events, and 123 (2.8%) had undergone late revascularization (>90 days). Following adjustment for age, sex, risk factors, stenosis, and FFRCT, total plaque volume above the receiver-operator characteristic curve-derived optimal cutoff (total plaque volume >564 mm3) was associated with the major adverse cardiac event/late revascularization composite (adjusted hazard ratio, 1.515 [95% CI, 1.093-2.099]; P=0.0126), and both components. Total percent atheroma volume greater than the optimal cutoff was associated with both major adverse cardiac event/late revascularization (total percent atheroma volume >24.4%; hazard ratio, 2.046 [95% CI, 1.474-2.839]; P<0.0001) and cardiovascular death/myocardial infarction (total percent atheroma volume >37.17%, hazard ratio, 4.53 [95% CI, 1.943-10.576]; P=0.0005). Calcified, noncalcified, and low-attenuation percentage atheroma volumes above the optimal cutoff were associated with all adverse outcomes, although this relationship was not maintained for cardiovascular death/myocardial infarction in analyses stratified by median plaque volumes. CONCLUSIONS: Analysis of the ADVANCE registry using artificial intelligence-enabled quantitative plaque analysis shows that total plaque volume is associated with one-year adverse clinical events, with incremental predictive value over luminal stenosis or abnormal physiology by FFRCT. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02499679.

Transient Postoperative Hemorrhage from Elbow Arthroscopy Portals following Intra-Articular Pentosan Polysulfate Sodium Injection.

Four adult, client owned dogs with diagnosed bilateral elbow dysplasia undergoing elbow arthroscopy for removal of fragmented medial coronoid process were identified via a retrospective database search, who also received intra-articular administration of pentosan polysulfate sodium (PPS) (Cartrophen Vet, Biopharm Australia Pty Ltd., Bondi Junction, New South Wales). Dogs had postoperative administration of 5 ml PPS injected into each elbow joint following elbow arthroscopy. Within 1-3 hours of administration, each dog experienced hemorrhage from arthroscopy incisions that was determined to be independent of surgical trauma given lack of hemorrhage intraoperatively. Pressure bandages were placed, and the hemorrhage and elevated coagulation parameters resolved 12-18 hours following intra-articular injection. No further intervention was required, and the dogs were discharged 20-26 hours postoperatively. The purpose of this case series is to describe 4 dogs who experienced transient and focal hemorrhage following off-label intra-articular administration of pentosan polysulfate sodium (PPS). While this case series is limited due to small number of cases, results following bilateral, intra-articular injection of PPS support a transient systemic coagulopathy. Though this report represents administration of PSS via a route and at doses beyond that recommended on the label, results suggest that administration of PSS in the manner described in this report should be avoided.

Evaluating validity evidence for 2 instruments developed to assess students' surgical skills in a simulated environment.

OBJECTIVE: To gather and evaluate validity evidence in the form of content and reliability of scores produced by 2 surgical skills assessment instruments, 1) a checklist, and 2) a modified form of the Objective Structured Assessment of Technical Skills (OSATS) global rating scale (GRS). STUDY DESIGN: Prospective randomized blinded study. SAMPLE POPULATION: Veterinary surgical skills educators (n =10) evaluated content validity. Scores from students in their third preclinical year of veterinary school (n = 16) were used to assess reliability. METHODS: Content validity was assessed using Lawshe's method to calculate the Content Validity Index (CVI) for the checklist and modified OSATS GRS. The importance and relevance of each item was determined in relation to skills needed to successfully perform supervised surgical procedures. The reliability of scores produced by both instruments was determined using generalizability (G) theory. RESULTS: Based on the results of the content validation, 39 of 40 checklist items were included. The 39-item checklist CVI was 0.81. One of the 6 OSATS GRS items was included. The 1-item GRS CVI was 0.80. The G-coefficients for the 40-item checklist and 6-item GRS were 0.85 and 0.79, respectively. CONCLUSION: Content validity was very good for the 39-item checklist and good for the 1-item OSATS GRS. The reliability of scores from both instruments was acceptable for a moderate stakes examination. IMPACT: These results provide evidence to support the use of the checklist described and a modified 1-item OSAT GRS in moderate stakes examinations when evaluating preclinical third-year veterinary students' technical surgical skills on low-fidelity models.

A perineal cystic hamartoma causing constipation in an intact female Irish water spaniel.

A perineal fluid-filled structure was discovered in a 6-year-old intact female Irish water spaniel suffering from intermittent constipation. Diagnostic tests revealed the structure was immediately caudal to the vagina and compatible with a cyst. Surgical excision was required for resolution of clinical signs. Histology confirmed the structure was a cyst. The exact origin is unknown; however, the variety of lining epithelia, including sections with mucin production, and a well-differentiated smooth muscle layer, were most consistent with development from the lower hindgut or urogenital sinus during embryonic growth. The histologic and anatomical similarities with human retrorectal cystic hamartomas were key in establishing the diagnosis of a perineal cystic hamartoma. Following removal, constipation resolved, and the cyst did not recur.

Hamartome kystique périnéal causant de la constipation chez une femelle intacte de race épagneul d'eau irlandais. Une structure périnéale remplie de liquide fut découverte chez une chienne intacte de race épagneul d'eau irlandais âgée de 6 ans souffrant de constipation intermittente. Les tests diagnostiques ont révélé que la structure était immédiatement caudale au vagin et était compatible avec un kyste. L'excision chirurgicale était requise pour la résolution des signes cliniques. L'histologie confirma que la structure était un kyste. L'origine exacte est inconnue; toutefois, la diversité de l'épithélium de couverture, incluant des sections avec production de mucine, et une couche bien différenciée de muscle lisse, étaient plus cohérentes avec un développement à partir du tractus digestif postérieur ou du sinus urogénital lors de la croissance embryonnaire. Les similarités histologique et anatomique avec l'hamartome rétro-rectal humain étaient critiques pour établir le diagnostic d'hamartome kystique périnéal. À la suite du retrait, la constipation s'est résolue, et il n'y a pas eu de récurrence du kyste.(Traduit par Dr Serge Messier).

Modification of the superficial cervical axial pattern skin flap for oral reconstruction.

OBJECTIVE: To describe an extended pedicle flap based on the superficial cervical artery (SCA) for closure of oral defects in dogs. STUDY DESIGN: Anatomic study; in vivo experimental study. ANIMALS: Canine cadavers (13) and 3 dogs. METHODS: The prescapular branch of the SCA was cannulated and perfused with a lead oxide gelatin mixture. The area perfused by 1 SCA was examined as was the rostral extent of the flap. Staged implantation was performed to evaluate flap performance in vivo. In stage 1, the flap was prepared for implantation into the oral cavity. In stage 2, the flap was fully developed to include the 1 degrees, 2 degrees, and partial 3 degrees angiosome of 1 SCA pedicle. The flap was transposed by a bridging incision and a parapharyngeal tunnel into the oral cavity. The flap was used to reconstruct a partial-thickness defect created in the palate. RESULTS: The territory of the contralateral SCA was captured in all cadavers. The full flap reached the level of the canine teeth in all cadavers. In live dogs, necrosis was not observed after implantation into partial-thickness defects and dehiscence was minimal. Loss of pliability secondary to de-epithelialization and staging resulted in a limitation of rostral reach of the flap. CONCLUSIONS: Whereas the flaps did not reach as far rostrally as anticipated, they survived well in the harsh oral environment. The flap may be modified to reconstruct full-thickness palatal defects. CLINICAL RELEVANCE: The extended SCA pattern flap may be adapted for closure of oral defects.