Evaluation of right ventricular function by coronary computed tomography angiography using a novel automated 3D right ventricle volume segmentation approach: a validation study.

OBJECTIVES: To evaluate right ventricle (RV) function by coronary computed tomography angiography (CTA) using a novel automated three-dimensional (3D) RV volume segmentation tool in comparison with clinical reference modalities. METHODS: Twenty-six patients with severe end-stage heart failure [left ventricle (LV) ejection fraction (EF) <35%] referred to CTA were enrolled. A specific individually tailored biphasic contrast agent injection protocol was designed (80%/20% high/low flow) was designed. Measurement of RV function [EF, end-diastolic volume (EDV), end-systolic volume (ESV)] by CTA was compared with tricuspid annular plane systolic excursion (TAPSE) by transthoracic echocardiography (TTE) and right heart invasive catheterisation (IC). RESULTS: Automated 3D RV volume segmentation was successful in 26 (100%) patients. Read-out time was 3 min 33 s (range, 1 min 50s-4 min 33s). RV EF by CTA was stronger correlated with right atrial pressure (RAP) by IC (r = -0.595; p = 0.006) but weaker with TAPSE (r = 0.366, p = 0.94). When comparing TAPSE with RAP by IC (r = -0.317, p = 0.231), a weak-to-moderate non-significant inverse correlation was found. Interobserver correlation was high with r = 0.96 (p < 0.001), r = 0.86 (p < 0.001) and r = 0.72 (p = 0.001) for RV EDV, ESV and EF, respectively. CT attenuation of the right atrium (RA) and right ventricle (RV) was 196.9 ± 75.3 and 217.5 ± 76.1 HU, respectively. CONCLUSIONS: Measurement of RV function by CTA using a novel 3D volumetric segmentation tool is fast and reliable by applying a dedicated biphasic injection protocol. The RV EF from CTA is a closer surrogate of RAP than TAPSE by TTE. KEY POINTS: • Evaluation of RV function by cardiac CTA by using a novel 3D volume segmentation tool is fast and reliable. • A biphasic contrast agent injection protocol ensures homogenous RV contrast attenuation. • Cardiac CT is a valuable alternative modality to CMR for the evaluation of RV function.

Nerve Entrapment Syndromes at the Wrist and Elbow by Sonography.

Nerve entrapment syndromes of the upper extremity are associated with structural abnormalities or by an intrinsic abnormality of the nerve. Nerve entrapment syndromes generally have a typical clinical presentation, and findings on physical examination and in conjunction with electrodiagnostic studies imaging is used to evaluate the cause, severity, and etiology of the entrapment. With the development of high-frequency linear array transducers (12-24 MHz), ultrasound (US) is incomparable in terms of spatial resolution to depict morphological aspects and changes in nerves. US can identify the abnormalities causing entrapment, such as fibrous bands, ganglia, anomalous muscles, and osseous deformities, with the advantage of dynamic assessment under active and passive examination. US is a unique diagnostic modality that allows superb visualization of both large and small peripheral terminal nerve branches of the upper extremity and enables the correct diagnosis of various nerve entrapment syndromes.

A case of anti-Rd causing fetal anemia.

BACKGROUND: Rd (SC4) is a low-frequency antigen of the Scianna blood group system. Only very few reports on anti-Rd in pregnancy exist. Mild to moderate hemolytic disease of the newborn caused by anti-Rd has been reported. This report may add further information on the clinical significance of anti-Rd for the fetus. CASE REPORT: In a case of severe fetal anemia (hemoglobin concentration, 3.0 g/dL) repeated intrauterine transfusions were required. The strongly positive direct antiglobulin test (DAT) of the fetal red blood cells led to the diagnosis of hemolytic disease. The routine antibody screen was negative, extended testing revealed a maternal anti-Rd with a titer of 256. Both the newborn and her father were confirmed to carry the SC*01.04 allele. CONCLUSION: Anti-Rd can cause fetal anemia. Low-frequency antigens including Rd are normally not present on screening cells. Antibodies directed against low-frequency antigens will usually not be detected by routine antibody screening in pregnancy. Thus, in cases of fetal anemia the DAT should always be included in the diagnostic workup.

Chitinase 3-like 1: prognostic biomarker in clinically isolated syndromes.

Chitinase 3-like 1 (CHI3L1) has been proposed as a biomarker associated with the conversion to clinically definite multiple sclerosis in patients with clinically isolated syndromes, based on the finding of increased cerebrospinal fluid CHI3L1 levels in clinically isolated syndrome patients who later converted to multiple sclerosis compared to those who remained as clinically isolated syndrome. Here, we aimed to validate CHI3L1 as a prognostic biomarker in a large cohort of patients with clinically isolated syndrome. This is a longitudinal cohort study of clinically isolated syndrome patients with clinical, magnetic resonance imaging, and cerebrospinal fluid data prospectively acquired. A total of 813 cerebrospinal fluid samples from patients with clinically isolated syndrome were recruited from 15 European multiple sclerosis centres. Cerebrospinal fluid CHI3L1 levels were measured by enzyme-linked immunosorbent assay. Multivariable Cox regression models were used to investigate the association between cerebrospinal fluid CHI3L1 levels and time to conversion to multiple sclerosis and time to reach Expanded Disability Status Scale 3.0. CHI3L1 levels were higher in patients who converted to clinically definite multiple sclerosis compared to patients who continued as clinically isolated syndrome (P = 8.1 × 10(-11)). In the Cox regression analysis, CHI3L1 levels were a risk factor for conversion to multiple sclerosis (hazard ratio = 1.7; P = 1.1 × 10(-5) using Poser criteria; hazard ratio = 1.6; P = 3.7 × 10(-6) for McDonald criteria) independent of other covariates such as brain magnetic resonance imaging abnormalities and presence of cerebrospinal fluid oligoclonal bands, and were the only significant independent risk factor associated with the development of disability (hazard ratio = 3.8; P = 2.5 × 10(-8)). High CHI3L1 levels were associated with shorter time to multiple sclerosis (P = 3.2 × 10(-9) using Poser criteria; P = 5.6 × 10(-11) for McDonald criteria) and more rapid development of disability (P = 1.8 × 10(-10)). These findings validate cerebrospinal fluid CHI3L1 as a biomarker associated with the conversion to multiple sclerosis and development of disability and reinforce the prognostic role of CHI3L1 in patients with clinically isolated syndrome. We propose that determining cerebrospinal fluid chitinase 3-like 1 levels at the time of a clinically isolated syndrome event will help identify those patients with worse disease prognosis.

Gender-related differences in adults concerning frequency, survival and treatment quality after out-of-hospital cardiac arrest (OHCA): An observational cohort study from the German resuscitation registry.

BACKGROUND: In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men. METHODS: We present a cohort study from the German Resuscitation Registry (2006-2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: "hospital admission with return of spontaneous circulation" (ROSCadmission) for all patients and "discharge with favourable neurological recovery" (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence. RESULTS: 58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759-0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015-1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888-1.024). CONCLUSION: In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.

Evaluation of liver fat in the presence of iron with MRI using T2* correction: a clinical approach.

OBJECTIVES: To assess magnetic resonance imaging (MRI) with conventional chemical shift-based sequences with and without T2* correction for the evaluation of steatosis hepatitis (SH) in the presence of iron. METHODS: Thirty-one patients who underwent MRI and liver biopsy because of clinically suspected diffuse liver disease were retrospectively analysed. The signal intensity (SI) was calculated in co-localised regions of interest (ROIs) using conventional spoiled gradient-echo T1 FLASH in-phase and opposed-phase (IP/OP). T2* relaxation time was recorded in a fat-saturated multi-echo-gradient-echo sequence. The fat fraction (FF) was calculated with non-corrected and T2*-corrected SIs. Results were correlated with liver biopsy. RESULTS: There was significant difference (P < 0.001) between uncorrected and T2* corrected FF in patients with SH and concomitant hepatic iron overload (HIO). Using 5 % as a threshold resulted in eight false negative results with uncorrected FF whereas T2* corrected FF lead to true positive results in 5/8 patients. ROC analysis calculated three threshold values (8.97 %, 5.3 % and 3.92 %) for T2* corrected FF with accuracy 84 %, sensitivity 83-91 % and specificity 63-88 %. CONCLUSIONS: FF with T2* correction is accurate for the diagnosis of hepatic fat in the presence of HIO. Findings of our study suggest the use of IP/OP imaging in combination with T2* correction. KEY POINTS: • Magnetic resonance helps quantify both iron and fat content within the liver • T2* correction helps to predict the correct diagnosis of steatosis hepatitis • "Fat fraction" from T2*-corrected chemical shift-based sequences accurately quantifies hepatic fat • "Fat fraction" without T2* correction underestimates hepatic fat with iron overload.

Deviation of tracheal pressure from airway opening pressure during high-frequency oscillatory ventilation in a porcine lung model.

Oxygenation during high-frequency oscillatory ventilation is secured by a high level of mean airway pressure. Our objective was to identify a pressure difference between the airway opening of the respiratory circuit and the trachea during application of different oscillatory frequencies. Six female Pietrain pigs (57.1 ± 3.6 kg) were first ventilated in a conventional mechanical ventilation mode. Subsequently, the animals were switched to high-frequency oscillatory ventilation by setting mean airway opening pressure 5 cmH(2)O above the one measured during controlled mechanical ventilation. Measurements at the airway opening and at tracheal levels were performed in healthy lungs and after induction of acute lung injury by surfactant depletion. During high-frequency oscillatory ventilation, the airway opening pressure was set at a constant level. The pressure amplitude was fixed at 90 cmH(2)O. Starting from an oscillatory frequency of 3 Hz, the frequency was increased in steps of 3 Hz to 15 Hz and then decreased accordingly. At each frequency, measurements were performed in the trachea through a side-lumen of the endotracheal tube and the airway opening pressure was recorded. The pressure difference was calculated. At every oscillatory frequency, a pressure loss towards the trachea could be shown. This pressure difference increased with higher oscillatory frequencies (3 Hz 2.2 ± 2.1 cmH(2)O vs. 15 Hz 7.5 ± 1.8 cmH(2)O). The results for healthy and injured lungs were similar. Tracheal pressures decreased with higher oscillatory frequencies. This may lead to pulmonary derecruitment. This has to be taken into consideration when increasing oscillatory frequencies and differentiated pressure settings are mandatory.

Impact of the route of adrenaline administration in patients suffering from out-of-hospital cardiac arrest on 30-day survival with good neurological outcome (ETIVIO study).

BACKGROUND: Over the past decades, international guidelines for cardiopulmonary resuscitation (CPR) have changed the recommendation for alternative routes for drug administration. Until now, evidence for the substantial superiority of one route with respect to treatment outcome after CPR has been lacking. The present study compares the effects of intravenous (IV), intraosseous (IO) and endotracheal (ET) adrenaline application during CPR in out-of-hospital cardiac arrest (OHCA) on clinical outcomes within the database of the German Resuscitation Registry (GRR). METHODS: This registry analysis was based on the GRR cohort of 212,228 OHCA patients between 1989 and 2020. Inclusion criteria were: OHCA, application of adrenaline, and out-of-hospital CPR. Excluded from the study were patients younger than 18 years, those who had trauma or bleeding as suspected causes of cardiac arrest, and incomplete data sets. The clinical endpoint was hospital discharge with good neurological outcome [cerebral performance category (CPC) 1/2]. Four routes of adrenaline administration were compared: IV, IO, IO + IV, ET + IV. Group comparisons were done using matched-pair analysis and binary logistic regression. RESULTS: In matched-pair group comparisons of the primary clinical outcome hospital discharge with CPC 1/2, the IV group (n = 2416) showed better results compared to IO (n = 1208), [odds ratio (OR): 2.43, 95% confidence interval (CI): 1.54-3.84, p < 0.01] and when comparing IV (n = 8706) to IO + IV (n = 4353), [OR: 1.33, 95% CI: 1.12-1.59, p < 0.01]. In contrast, no significant difference was found between IV (n = 532) and ET + IV (n = 266), [OR: 1.26, 95% CI: 0.55-2.90, p = 0.59]. Concurrently, binary logistic regression yielded a highly significant effect of vascular access type (χ² = 67.744(3), p < 0.001) on hospital discharge with CPC1/2, with negative effects for IO (regression coefficient (r.c.) = - 0.766, p = 0.001) and IO + IV (r.c. = - 0.201, p = 0,028) and no significant effect for ET + IV (r.c. = 0.117, p = 0.770) compared to IV. CONCLUSIONS: The GRR data, collected over a period of 31 years, seem to emphasize the relevance of an IV access during out-of-hospital CPR, in the event that adrenaline had to be administered. IO administration of adrenaline might be less effective. ET application, though removed in 2010 from international guidelines, could gain importance as an alternative route again.

Evaluating intra-abdominal pressures in a porcine model of acute lung injury by using a wireless motility capsule.

BACKGROUND: Intra-vesical pressure measurement as the reference standard for assessing intra-abdominal pressures is mainly indirect and discontinuous. We therefore evaluated a motility capsule for continuous intra-abdominal pressure measurement in an animal model with a high probability for capillary leakage and intestinal edema. MATERIAL/METHODS: Motility capsules were inserted into the stomachs of 8 anesthetized and ventilated pigs. Stomach pH, pressure, and temperature data were wirelessly transmitted to a recorder attached to each animal's abdomen. Intra-gastric pressures measured by the capsule were compared to intra-vesical pressures measured by a pressure transducer system. RESULTS: The intra-abdominal pressures ranged from 3 to 15 mmHg (7.8 ± 2.4 mmHg [mean ± SD]) measured via the bladder. The capsule pressure recordings ranged from 1 to 3 mmHg (1.7 ± 0.5 mmHg [mean ± SD]). Bland-Altman analysis revealed an unacceptable bias between the 2 methods. The test bias was 6.2 (± 1.4) mmHg and the limits of agreement were from 3.3 to 8.9 mmHg. CONCLUSIONS: Pressures in the stomach as measured by motility capsule underestimated the intra-vesical pressures. Discrepancies between gastric and intra-vesical pressures could be caused by gastric dilatation or different position of the 2 devices to the zero reference point.

Correlation between bispectral index, observational sedation scale, and lower esophageal sphincter pressure in volunteers using dexmedetomidine or propofol.

BACKGROUND: Many anesthetics reduce lower esophageal sphincter pressure (LESP) and consequently the gastro-esophageal pressure gradient (GEPG); thus they may promote gastro-esophageal reflux and contribute to aspiration pneumonia. Our goals were to evaluate the association between LESP and 2 measures of sedation: bispectral index (BIS) and the responsiveness component of the Observer's Assessment of Alertness score (OAA/S). MATERIAL/METHODS: Eleven healthy volunteers were each sedated on 2 separate days. Subjects were given sedative infusions of increasing target plasma concentrations of dexmedetomidine or propofol. LESP and GEPG were recorded after starting each infusion phase. Generalized estimating equation modeling was used to assess the relationship between LESP and, respectively, BIS and OAA/S. The existence of a drug-dependent association was evaluated within these models by testing an interaction term. Wald tests were used to evaluate the relationships within the models. RESULTS: We found a significant relationship between LESP and BIS (P=0.0043) after adjusting for the main effect of sedative type--a deepening of sedation as measured by a decrease in BIS of 10% was associated with a decrease [Bonferroni-adjusted 95% CI] in LESP of -1.34 [-2.39, -0.29] mmHg. After adjusting for the main effect of sedative drug, LESP significantly declined with declining OAA/S (P=0.001); a unit decrease of OAA/S was associated with a decrease [Bonferroni-adjusted 95% CI] in LESP of -2.01 [-3.20, -0.81] mmHg. CONCLUSIONS: Deeper sedation, as measured by either BIS or OAA/S, significantly reduces LESP.

Mechanical chest compression devices under special circumstances.

AIM: According to the current resuscitation guidelines, the use of mechanical chest compression devices could be considered under special circumstances like transport with ongoing resuscitation or long-term resuscitation. The aim of this study was to investigate whether survival is improved using mechanical devices under such circumstances. METHODS: Out-of-hospital cardiac arrests from all high-quality data centres of the German Resuscitation Registry from 2007 to 2020 were investigated. The use of mechanical devices was compared separately for transport with ongoing resuscitation, prolonged resuscitation (>45 min), and resuscitation with fibrinolytic agents applied. Baseline characteristics, 30-day survival/discharged alive, and neurological function at discharge were analysed descriptively; and 30-day survival/discharged alive was additionally analysed using multivariate logistic regression. RESULTS: Overall, patients who were treated with a mechanical device tended to be younger and were significantly more likely to have a witnessed cardiac arrest and a shockable initial rhythm. During the study period, 4,851 patients were transported to hospital with ongoing resuscitation (devices used in 44.2%). The 30-day survival was equal (odds ratio, OR: 1.13, 95%-CI: 0.79-1.60). In 3,920 cases, a resuscitation duration > 45 min was documented (9.5% with device). When a device was used, 30-day survival was significantly increased (OR 2.33, 95%-CI: 1.30-4.15). Fibrinolytic agents were used in 2,106 patients (22.2% with device). Here, 30-day survival was significantly worse with a device (OR: 0.52, 95%-CI: 0.30-0.91). CONCLUSION: Mechanical devices are not associated with better survival when used during transport, but rescuer safety could still be an important argument for their use. Devices are associated with better survival in prolonged resuscitation, but worse survival when a fibrinolytic was used.

Gastric pH and motility in a porcine model of acute lung injury using a wireless motility capsule.

BACKGROUND: Evaluation of gastric pH and motility in a porcine model of acute lung injury using a novel, wireless motility capsule. MATERIAL/METHODS: A motility capsule was applied into the stomach of 7 Pietrain pigs with acute lung injury induced by high volume saline lavage. Wireless transmission of pH, pressure and temperature data was performed by a recorder attached to the animal's abdomen. Gastric motility was evaluated using pH and pressure values, and capsule location was confirmed by autopsy. RESULTS: Gastric pH values were statistically significantly different (P<0.003) in the animals over time and ranged from 1.15 to 9.94 [5.73 ± 0.47 (mean ± SD)] with an interquartile range of 0.11 to 2.07. The capsule pressure recordings ranged from 2 to 4 mmHg [2.6 ± 0.5 mmHg (mean ± SD)]. There was no change in pressure patterns or sudden rise of pH >3 pH units during 24 hours. All animals had a gastroparesis with the capsules located in the stomach as indicated by the pressure and pH data and confirmed by necropsy. CONCLUSIONS: The preliminary data show that Pietrain pigs with acute lung injury have a high variability in gastric pH and severely disturbed gastric motility.

The Effect of Vitamin D on Coronary Atherosclerosis: A Propensity Score Matched Case-Control Coronary CTA Study.

BACKGROUND: Vitamin D supplementation may be associated with lower cardiovascular (CV) events, but the data are controversial. It remains speculative whether vitamin D supplementation has a direct effect on coronary atherosclerosis. We therefore set out to assess the influence of vitamin D supplementation on the coronary atherosclerosis profile quantified by coronary computed tomography angiography (CTA) in a retrospective case-control cohort study. METHODS: 176 patients (age: 62.4 ± 10.4) referred to coronary CTA for clinical indications were included. A total of 88 patients receiving vitamin D supplementation (mean duration 65.3 ± 81 months) were 1:1 propensity score matched with 88 controls for age, gender, smoking, arterial hypertension, positive family history, dyslipidemia, and diabetes. Coronary stenosis severity (CAD-RADSTM), mixed plaque burden (weighted for non-calcified), high-risk-plaque (HRP) features, and plaque density (HU) were quantified by CTA. Serum 25-hydroxyvitamin D (OH)-levels were measured in 138 patients and categorized into four groups (0: <20 ng/mL; 1: 20-40 ng/mL; 2: 40-60 ng/mL; and 3: >60 ng/mL) and compared with CTA. RESULTS: The prevalence of atherosclerosis by CTA was similar in both groups (75.6% versus 74.3%, p = 0.999), >50% coronary stenosis was slightly higher in controls (p = 0.046), but stenosis severity score (CAD-RADS) was not different (p = 0.106). Mixed plaque burden (weighted for non-calcified) was lower in patients receiving vitamin D supplementation (p = 0.002) and high-risk-plaque prevalence was markedly lower (3.8% versus 32%, p < 0.001). CT plaque density (HU) was higher (p < 0.001) in the vitamin D group. Patients with serum vitamin D (OH) levels >60 ng/mL had higher plaque density (p = 0.04), indicating more calcified and less vulnerable plaque. CONCLUSIONS: In this retrospective case-control cohort study, vitamin D supplementation was associated with less high-risk plaque, less non-calcified plaque burden, and a higher calcified plaque independent of CV risk factors.

Effects of dexmedetomidine and propofol on lower esophageal sphincter and gastroesophageal pressure gradient in healthy volunteers.

BACKGROUND: Many anesthetics reduce lower esophageal sphincter pressure (LESP). Reduced pressure and consequent reduction in the gastroesophageal pressure gradient (GEPG) thus promotes gastroesophageal reflux and may contribute to aspiration pneumonia and associated morbidity. Therefore, the authors compared LESP and GEPG during dexmedetomidine and propofol sedation. METHODS: Using a randomized, double-blind, crossover design, 11 healthy volunteers were sedated on 2 separate days. Baseline LESP and GEPG were recorded each day. Subsequently, on each day volunteers received three 40-min-long sedative infusions of increasing doses of 0.6, 1.2, and 2.4 ng/ml dexmedetomidine or 1, 2, and 4 microg/ml propofol. LESP and GEPG were recorded during inhalation and expiration at 20 and 40 min after starting each infusion phase, and these measurements were averaged. Results are presented as mean (95% confidence interval). RESULTS: Two subjects did not return for the dexmedetomidine study day, and the dexmedetomidine results were unusable in another; propofol results in these volunteers were nonetheless retained for analysis. There were no significant differences in LESP and GEPG as a function of drug. However, there was a small but significant 7.4 (-1.6 to -13.2) mmHg (approximately 25%) dose-dependent decrease in LESP over the range of targeted low to high blood levels of each drug. CONCLUSIONS: Both dexmedetomidine and propofol have similar effects on LESP and GEPG. Although both of the drugs cause some decrease in LESP at high concentrations, it is unlikely that this effect would promote gastroesophageal reflux during sedation.

The effect of aminophylline on loss of consciousness, bispectral index, propofol requirement, and minimum alveolar concentration of desflurane in volunteers.

BACKGROUND: Adenosine is a soporific neuromodulator; aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine in the central nervous system. Thus, we tested the hypothesis that aminophylline delays loss of consciousness (LOC) and speeds recovery of consciousness (ROC) with propofol anesthesia, and that aminophylline increases the minimum alveolar concentration (MAC) of desflurane. METHODS: In this double-blind crossover study, volunteers were randomized to either aminophylline or saline on different days. Aminophylline 6 mg/kg was given IV, followed by 1.5 mg x kg(-1) x h(-1) throughout the study day. After 1 h of aminophylline or saline administration, propofol 200 mg was given at a rate of 20 mg/min. The bispectral index was continuously monitored, as were times to LOC and ROC. After recovery from propofol, general anesthesia was induced with sevoflurane and subsequently maintained with desflurane. The Dixon "up-and-down" method was used to determine MAC in each volunteer after repeated tetanic electrical stimulation. RESULTS: Eight volunteers completed both study days. Time to LOC was prolonged by aminophylline compared with saline (mean +/- SD) (7.7 +/- 2.03 min vs 5.1 +/- 0.75 s, respectively, P = 0.011). The total propofol dose at LOC was larger with aminophylline (2.2 +/- 0.9 vs 1.4 +/- 0.4 mg/kg, P = 0.01), and the time to ROC was shorter (6.18 +/- 3.96 vs 12.2 +/- 4.73 min, P = 0.035). The minimum bispectral index was greater with aminophylline (51 +/- 15 vs 38 +/- 9, P = 0.034). There was no difference in MAC. CONCLUSION: Aminophylline decreases the sedative effects of propofol but does not affect MAC of desflurane as determined by tetanic electrical stimulation.

Differences in coronary vasodilatory capacity and atherosclerosis in endurance athletes using coronary CTA and computational fluid dynamics (CFD): Comparison with a sedentary lifestyle.

BACKGROUND: The aim was to assess the effect of endurance exercise on coronary vasodilatory capacity and atherosclerosis by coronary computed tomography angiography (CTA) and computational fluid dynamic (CFD) modelling. METHODS: 100 subjects (age 56.2y±11, 29 females) who underwent coronary CTA were included into this retrospectively matched cohort study. Endurance athletes (≥1 h per unit and ≥3 times per week training) were compared to controls with a sedentary lifestyle, and within subgroups with and without sublingual nitroglycerin preparation. CTA image analysis included coronary stenosis severity (CADRADS), total (segment involvement score = SIS) and mixed plaque burden (G-score), high-risk plaque criteria, the coronary artery calcium score (CACS) and CFD analysis including Fractional Flow Reserve (FFRCT), myocardial mass (M), total vessel lumen volume (V) and volume-to-mass (V/M) ratio. RESULTS: The prevalence of atherosclerosis by CTA was 65.4 % and >50 % coronary stenosis was found in 17.3 % of athletes. Coronary stenosis severity (CADRADS), total and mixed non-calcified plaque burden (SIS and G-score) were lower in athletes (p = 0.003 and p < 0.001) but not CACS (p = 0.055) and less high-risk plaques were found (p < 0.001). The G-score was correlated with distal FFRCT (p = 0.025). V/M-ratio was different between athletes who received nitroglycerin compared with those who did not (V/M: 21.1 vs. 14.8; p < 0.001), but these differences were not observed in the control subjects. CONCLUSION: Endurance training improves coronary vasodilatory capacity and reduces high-risk plaque and mixed non-calcifed plaque burden as assessed by coronary CTA angiography. Our study may advocate coronary CTA with FFRCT for evaluation of coronary artery disease in endurance athletes.

The correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol.

BACKGROUND: Bispectral index (BIS) is a widely used quantitative parameter for evaluating anesthesia and sedation levels. Dexmedetomidine is a novel sedative, providing sedation while patients remain cooperative and can be easily aroused; as a consequence, BIS used with dexmedetomidine may poorly characterize sedation. Thus, we tested the hypothesis that BIS values are lower with dexmedetomidine than with propofol at comparable Observer's Assessment of Alertness and Sedation (OAA/S) scores. METHODS: This was a randomized, 2-day, crossover study. On the first study day, healthy volunteers were randomly allocated to either propofol or dexmedetomidine sedation. Drugs were administered using computer-controlled infusions targeting an effect-site concentration of 1, 2, and 4 microg/mL for propofol or a plasma concentration of 0.6, 1.2, and 2.4 ng/mL for dexmedetomidine. The relationship between BIS and OAA/S score was obtained 20 and 40 min after changing each drug concentration. BIS values at each OAA/S score were compared between drugs. The cutoff values of BIS for OAA/S score of < or =2 were obtained by analysis of receiver operating characteristic curves. RESULTS: Nine volunteers were included in our analysis. Heart rates decreased significantly with dexmedetomidine sedation. ETco(2) was significantly increased with high doses of propofol but did not increase with high doses of dexmedetomidine. BIS values at OAA/S scores of 1, 2, 3, 4, and 5 during propofol sedation were 95.5 (90-97), 78 (71-84.5), 67 (64-70), 57 (51.5-60), and 34 (30-37), respectively. BIS values at OAA/S scores of 1, 2, 3, 4, and 5 during dexmedetomidine sedation were 95 (79-98), 62 (53.5-68.5), 45.5 (45.3-52), 39.5 (34.3-41.8), and 24.5 (22.5-30.5), respectively. BIS values were significantly less with dexmedetomidine than propofol at OAA/S responsiveness scores of 2, 3, and 4. The calculated cutoff BIS values for OAA/S scores of < or =2 were 67 (sensitivity of 86%, specificity of 97%, and area under the curve of 0.98) for propofol and 46 (sensitivity of 84%, specificity of 91%, and area under the curve of 0.96) for dexmedetomidine. CONCLUSION: The combination of both BIS and sedative scales could provide different and complementary data to the clinician evaluating the patient's response to sedation than would either tool alone, especially when dexmedetomidine is used.

A multicenter assessment of the analytical performance of the routine thyroid panel on the Olympus AU3000i immunoassay system.

BACKGROUND: The AU3000i thyroid assay panel (TSH, fT4, T4, fT3, T3) was evaluated at four sites in a European multicenter study. The study was designed to assess the basic analytical performance characteristics of the Olympus thyroid assays. In addition, a comprehensive assessment of the TSH functional sensitivity was undertaken to challenge the manufacturer's claim of 4th generation assay performance. RESULTS: Repeatability (within-run precision) of TSH, ff4 and T4 was better than 3% across the measurable range, T3 and fT3 repeatability was better than 6%. Within-laboratory (total) precision was better than 10% for all assays, for fT4, it was better than 3%. Method comparisons were undertaken against the Roche Elecsys 2010, the Siemens Advia Centaur and the Abbott Architect. Overall, good to excellent correlations were seen, however in some cases there were systematic differences which can be attributed to the lack of an appropriate standard or reference method and/or heterogeneity of the analyte. The functional sensitivity of the Olympus TSH assay was confirmed to be 4th generation, giving a mean functional sensitivity (at 20% CV) of 0.0011 mIU/L with no sites exceeding 0.002 mIU/L. Plasma (Li-heparinate) was shown to be an acceptable sample type for use in these assays. CONCLUSION: The results generated in this study indicate that the assays of the Olympus AU3000i routine thyroid panel are precise, correlate well with other established assays, and are suitable for use in the routine clinical laboratory.

New Approach for B-Mode Ultrasound (US) Evaluation of the Plantar Aponeurosis (PA) Thickness in Healthy Subjects.

PURPOSE: To compare ultrasound (US) measurements in the sagittal and axial plane of the plantar aponeurosis (PA) in healthy subjects. MATERIALS AND METHODS: PA thickness was measured in 40 healthy subjects (mean age: 34 years) by two radiologists using US in sagittal, axial medial and axial lateral planes. Subjects were classified according to gender (female and male) and age (18 - 35 versus 50 - 75 years). All measurements were compared and the interobserver agreement was calculated. RESULTS: The PA was medially significantly thicker than laterally (mean ± std 3.1 ±â€Š0.7 mm versus 2.5 ±â€Š0.5 mm respectively, P< 0.001). A significant difference was found between males and females (3.3 ±â€Š0.7 mm versus 2.9 ±â€Š0.6 mm medially and 2.7 ±â€Š0.6 mm versus 2.3 ±â€Š0.4 mm laterally, p < 0.05) and between the older and younger age groups (3.8 ±â€Š0.6 mm versus 2.8 ±â€Š0.4 mm medially and 3.1 ±â€Š0.4 mm versus 2.3 ±â€Š0.4 mm laterally, p < 0.001). Good interobserver agreement was detected (0.74). CONCLUSION: Measurement of central and lateral fascicles of the plantar aponeurosis in both planes (sagittal and axial) is recommended in the daily routine. KEY POINTS: · US examination of the central and lateral fascicles of the PA was feasible.. · PA thickness measurements showed significant differences based on age and gender.. · There was good interobserver correlation between both examiners despite the major difference in experience.. · Scanning of two planes for the PA is recommended in the daily routine.. · PA thickness measurement by US is a fast and reliable method for junior radiologists.. CITATION FORMAT: · Abd Ellah MM, Kremser C, Strobl S et al. New Approach for B-Mode Ultrasound (US) Evaluation of the Plantar Aponeurosis (PA) Thickness in Healthy Subjects. Fortschr Röntgenstr 2019; 191: 333 - 339.