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The mid-Cretaceous period was one of the warmest intervals of the past 140 million years1-5, driven by atmospheric carbon dioxide levels of around 1,000 parts per million by volume6. In the near absence of proximal geological records from south of the Antarctic Circle, it is disputed whether polar ice could exist under such environmental conditions. Here we use a sedimentary sequence recovered from the West Antarctic shelf-the southernmost Cretaceous record reported so far-and show that a temperate lowland rainforest environment existed at a palaeolatitude of about 82° S during the Turonian-Santonian age (92 to 83 million years ago). This record contains an intact 3-metre-long network of in situ fossil roots embedded in a mudstone matrix containing diverse pollen and spores. A climate model simulation shows that the reconstructed temperate climate at this high latitude requires a combination of both atmospheric carbon dioxide concentrations of 1,120-1,680 parts per million by volume and a vegetated land surface without major Antarctic glaciation, highlighting the important cooling effect exerted by ice albedo under high levels of atmospheric carbon dioxide.
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Atmosfera/química , Dióxido de Carbono/análise , Dióxido de Carbono/história , Clima , Floresta Úmida , Temperatura , Regiões Antárticas , Fósseis , Sedimentos Geológicos/química , História Antiga , Modelos Teóricos , Nova Zelândia , Pólen , Esporos/isolamento & purificaçãoRESUMO
OBJECTIVES: Aim of this study was to assess the value of virtual non-contrast (VNC) reconstructions in differentiating between adrenal adenomas and metastases on a photon-counting detector CT (PCD-CT). MATERIAL AND METHODS: Patients with adrenal masses and contrast-enhanced CT scans in portal venous phase were included. Image reconstructions were performed, including conventional VNC (VNCConv) and PureCalcium VNC (VNCPC), as well as virtual monochromatic images (VMI, 40-90 keV) and iodine maps. We analyzed images using semi-automatic segmentation of adrenal lesions and extracted quantitative data. Logistic regression models, non-parametric tests, Bland-Altman plots, and a random forest classifier were used for statistical analyses. RESULTS: The final study cohort consisted of 90 patients (36 female, mean age 67.8 years [range 39-87]) with adrenal lesions (45 adenomas, 45 metastases). Compared to metastases, adrenal adenomas showed significantly lower CT-values in VNCConv and VNCPC (p = 0.007). Mean difference between VNC and true non-contrast (TNC) was 17.67 for VNCConv and 14.85 for VNCPC. Random forest classifier and logistic regression models both identified VNCConv and VNCPC as the best discriminators. When using 26 HU as the threshold in VNCConv reconstructions, adenomas could be discriminated from metastases with a sensitivity of 86.7% and a specificity of 75.6%. CONCLUSION: VNC algorithms overestimate CT values compared to TNC in the assessment of adrenal lesions. However, they allow a reliable discrimination between adrenal adenomas and metastases and could be used in clinical routine in near future with an increased threshold (e.g., 26 HU). Further (multi-center) studies with larger patient cohorts and standardized protocols are required. CLINICAL RELEVANCE STATEMENT: VNC reconstructions overestimate CT values compared to TNC. Using a different threshold (e.g., 26 HU compared to the established 10 HU), VNC has a high diagnostic accuracy for the discrimination between adrenal adenomas and metastases. KEY POINTS: ⢠Virtual non-contrast reconstructions may be promising tools to differentiate adrenal lesions and might save further diagnostic tests. ⢠The conventional and a new calcium-preserving virtual non-contrast algorithm tend to systematically overestimate CT-values compared to true non-contrast images. ⢠Therefore, increasing the established threshold for true non-contrast images (e.g., 10HU) may help to differentiate between adrenal adenomas and metastases on contrast-enhanced CT.
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Neoplasias das Glândulas Suprarrenais , Tomografia Computadorizada por Raios X , Humanos , Feminino , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/secundário , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Meios de Contraste , Adenoma/diagnóstico por imagem , Adenoma/patologia , Fótons , Sensibilidade e Especificidade , Estudos RetrospectivosRESUMO
AIM: The aims of this study were to analyse all hospitalizations for acute diverticulitis in Germany from 2010 to 2021 and to assess the effects of the first 2 years of the SARS-CoV-2 pandemic on hospitalizations for acute diverticulitis. METHOD: Using data from the German Federal Statistical Office, we analysed fully anonymized healthcare data of hospitalizations and treatment regimens with acute diverticulitis as the main diagnosis between 2010 and 2021. Logistic regression analyses for in-hospital mortality were performed. RESULTS: A total of 608,162 hospitalizations were included. While the number of hospitalizations constantly increased until 2019 (+52.4%), a relative decrease of 10.1% was observed between 2019 and 2020, followed by stable numbers of hospitalizations in 2021 (+1.1% compared with 2020). In-hospital mortality showed a relative decrease of 33.2% until 2019 and thereafter a relative increase of 26.9% in 2020 and of 7.5% in 2021. A 21.6% and a 19.3% drop in hospitalizations was observed during the first and second waves of the SARS-CoV-2 pandemic, mostly affecting hospitalizations for uncomplicated diverticulitis, with a corresponding 11.6% and 16.8% increase in admissions for complicated diverticulitis. Multivariable logistic regression analyses showed significantly higher in-hospital mortality for hospitalizations in which surgery (OR = 2.76) and CT (OR = 1.32) were given, as well as lower mortality for women (OR = 0.88), whereas percutaneous drainage was not associated with higher in-hospital mortality compared with conservative treatment (OR = 0.71). CONCLUSION: This study points out the long-term trends in inpatient treatment for acute diverticulitis and the in-hospital mortality risk factors of patients hospitalized for acute diverticulitis in a large nationwide cohort, as well as changes in these trends and factors resulting from the SARS-CoV-2 pandemic. These changes might be attributable to delayed diagnosis and thus more severe stages of disease as a result of containment measures.
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COVID-19 , Diverticulite , Humanos , Feminino , SARS-CoV-2 , Pandemias , Pacientes Internados , COVID-19/epidemiologia , Diverticulite/terapia , Hospitalização , Estudos RetrospectivosRESUMO
BACKGROUND: Photon-counting detector computed tomography (PCD-CT) is a groundbreaking technology with promising results for visualization of small bone structures. PURPOSE: To analyze the delineation of the thoracic spine in multiplanar reconstructions (MPR) on PCD-CT compared to energy-integrating detector (EID)-CT. MATERIAL AND METHODS: Two euthanized mice were examined using different scanners: (i) 20-slice EID-CT and (ii) dual-source PCD-CT at various CTDIVol values. Readers evaluated the thoracic spine and selected series with best visualization among signal-to-noise ratio (SNR)-matched pairs. RESULTS: SNR was significantly higher in PCD-CT reconstructions (Br68) and lower in Hr98 reconstructions compared to EID-CT. Bone detail visualization was superior in PCD-CT (especially in Hr98 reconstructions) compared to EID-CT. CONCLUSION: MPR on a PCD-CT had a higher SNR and better bone detail visualization even at lower radiation doses compared to EID-CT. PCD-CT with bone reconstructions showed the best delineation of small bone structures and might be considered in clinical routine.
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PURPOSE: To assess the reliability of virtual non-contrast (VNC) derived coronary artery calcium quantities in relation to heart rate and the VNC algorithm used compared to reference true non-contrast (TNC), considering several clinically established acquisition modes. MATERIAL AND METHODS: An ad hoc built coronary phantom containing four calcified lesions and an iodinated lumen was scanned using three cardiac acquisition modes three times within an anthropomorphic cardiac motion phantom simulating different heart rates (0, 60, 80, 100 bpm) and reconstructed with a conventional (VNCconv) and a calcium-sensitive (VNCpc) VNC algorithm. TNC reference was scanned at 0 bpm with non-iodinated lumen. Calcium scores were assessed in terms of number of lesions detected, Agatston and volume scores and global noise was measured. Paired t-test and Wilcoxon test were performed to test measurements for significant difference. RESULTS: For both VNC algorithms used, calcium levels or noise were not significantly affected by heart rate. Measurements on VNCpc reconstructions best reproduced TNC results, but with increased variability (Agatston scores at 0 bpm for TNC, VNCconv, and VNCpc were 47.1 ± 1.1, 6.7 ± 2.8 (p < 0.001), and 45.3 ± 7.6 (p > 0.05), respectively). VNC reconstructions showed lower noise levels compared to TNC, especially for VNCpc (noiseheart on TNC, VNCconv and VNCpc at 0 bpm was 5.0 ± 0.4, 4.5 ± 0.2, 4.2 ± 0.2). CONCLUSION: No significant heart rate dependence of VNC-based calcium scores was observed in an intra-reconstruction comparison. VNCpc reproduces TNC scores better than VNCconv without significant differences and decreased noise, however, with an increasing average deviation with rising heart rates. VNC-based CACS should be used with caution as the measures show higher variability compared to reference TNC and therefore hold the potential of incorrect risk categorization.
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Cálcio , Tomografia Computadorizada por Raios X , Humanos , Frequência Cardíaca , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , TóraxRESUMO
OBJECTIVES: To assess epicardial adipose tissue (EAT) volume and attenuation of different virtual non-contrast (VNC) reconstructions derived from coronary CTA (CCTA) datasets of a photon-counting detector (PCD) CT-system to replace true non-contrast (TNC) series. METHODS: Consecutive patients (n = 42) with clinically indicated CCTA and coronary TNC were included. Two VNC series were reconstructed, using a conventional (VNCConv) and a novel calcium-preserving (VNCPC) algorithm. EAT was segmented on TNC, VNCConv, VNCPC, and CCTA (CTA-30) series using thresholds of -190 to -30 HU and an additional segmentation on the CCTA series with an upper threshold of 0 HU (CTA0). EAT volumes and their histograms were assessed for each series. Linear regression was used to correlate EAT volumes and the Euclidian distance for histograms. The paired t-test and the Wilcoxon signed-rank test were used to assess differences for parametric and non-parametric data. RESULTS: EAT volumes from VNC and CCTA series showed significant differences compared to TNC (all p < .05), but excellent correlation (all R2 > 0.9). Measurements on the novel VNCPC series showed the best correlation (R2 = 0.99) and only minor absolute differences compared to TNC values. Mean volume differences were -12%, -3%, -13%, and +10% for VNCConv, VNCPC, CTA-30, and CTA0 compared to TNC. Distribution of CT values on VNCPC showed less difference to TNC than on VNCConv (mean attenuation difference +7% vs. +2%; Euclidean distance of histograms 0.029 vs. 0.016). CONCLUSIONS: VNCPC-reconstructions of PCD-CCTA datasets can be used to reliably assess EAT volume with a high accuracy and only minor differences in CT values compared to TNC. Substitution of TNC would significantly decrease patient's radiation dose. KEY POINTS: ⢠Measurement of epicardial adipose tissue (EAT) volume and attenuation are feasible on virtual non-contrast (VNC) series with excellent correlation to true non-contrast series (all R2>0.9). ⢠Differences in VNC algorithms have a significant impact on EAT volume and CT attenuation values. ⢠A novel VNC algorithm (VNCPC) enables reliable assessment of EAT volume and attenuation with superior accuracy compared to measurements on conventional VNC- and CCTA-series.
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Angiografia , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Reprodutibilidade dos Testes , Fótons , Tecido Adiposo/diagnóstico por imagem , Estudos RetrospectivosRESUMO
OBJECTIVES: Virtual monoenergetic images (VMIs) from photon-counting CT (PCCT) may change quantitative coronary plaque volumes. We aimed to assess how plaque component volumes change with respect to VMIs. METHODS: Coronary CT angiography (CTA) images were acquired using a dual-source PCCT and VMIs were reconstructed between 40 and 180 keV in 10-keV increments. Polychromatic images at 120 kVp (T3D) were used as reference. Quantitative plaque analysis was performed on T3D images and segmentation masks were copied to VMI reconstructions. Calcified plaque (CP; > 350 Hounsfield units, HU), non-calcified plaque (NCP; 30 to 350 HU), and low-attenuation NCP (LAP; - 100 to 30 HU) volumes were calculated using fixed thresholds. RESULTS: We analyzed 51 plaques from 51 patients (67% male, mean age 65 ± 12 years). Average attenuation and contrast-to-noise ratio (CNR) decreased significantly with increasing keV levels, with similar values observed between T3D and 70 keV images (299 ± 209 vs. 303 ± 225 HU, p = 0.15 for mean HU; 15.5 ± 3.7 vs. 15.8 ± 3.5, p = 0.32 for CNR). Mean NCP volume was comparable between T3D and 100-180-keV reconstructions. There was a monotonic decrease in mean CP volume, with a significant difference between all VMIs and T3D (p < 0.05). LAP volume increased with increasing keV levels and all VMIs showed a significant difference compared to T3D, except for 50 keV (28.0 ± 30.8 mm3 and 28.6 ± 30.1 mm3, respectively, p = 0.63). CONCLUSIONS: Estimated coronary plaque volumes significantly differ between VMIs. Normalization protocols are needed to have comparable results between future studies, especially for LAP volume which is currently defined using a fixed HU threshold. CLINICAL RELEVANCE STATEMENT: Different virtual monoenergetic images from photon-counting CT alter attenuation values and therefore corresponding plaque component volumes. New clinical standards and protocols are required to determine the optimal thresholds to derive plaque volumes from photon-counting CT. KEY POINTS: ⢠Utilizing different VMI energy levels from photon-counting CT for the analysis of coronary artery plaques leads to substantial changes in attenuation values and corresponding plaque component volumes. ⢠Low-energy images (40-70 keV) improved contrast-to-noise ratio, however also increased image noise. ⢠Normalization protocols are needed to have comparable results between future studies, especially for low-attenuation plaque volume which is currently defined using a fixed HU threshold.
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Placa Aterosclerótica , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Razão Sinal-Ruído , Tomografia Computadorizada por Raios X/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodosRESUMO
It was long thought that solely three different transposable elements (TEs)-the I-element, the P-element, and hobo-invaded natural Drosophila melanogaster populations within the last century. By sequencing the "living fossils" of Drosophila research, that is, D. melanogaster strains sampled from natural populations at different time points, we show that a fourth TE, Tirant, invaded D. melanogaster populations during the past century. Tirant likely spread in D. melanogaster populations around 1938, followed by the I-element, hobo, and, lastly, the P-element. In addition to the recent insertions of the canonical Tirant, D. melanogaster strains harbor degraded Tirant sequences in the heterochromatin which are likely due to an ancient invasion, likely predating the split of D. melanogaster and D. simulans. These degraded insertions produce distinct piRNAs that were unable to prevent the novel Tirant invasion. In contrast to the I-element, P-element, and hobo, we did not find that Tirant induces any hybrid dysgenesis symptoms. This absence of apparent phenotypic effects may explain the late discovery of the Tirant invasion. Recent Tirant insertions were found in all investigated natural populations. Populations from Tasmania carry distinct Tirant sequences, likely due to a founder effect. By investigating the TE composition of natural populations and strains sampled at different time points, insertion site polymorphisms, piRNAs, and phenotypic effects, we provide a comprehensive study of a natural TE invasion.
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Elementos de DNA Transponíveis , Drosophila melanogaster/genética , Animais , Feminino , RNA Interferente PequenoRESUMO
See also the editorial by Dodd and MacDermott in this issue.
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Anemia , Fótons , Humanos , Imagens de Fantasmas , Tomografia Computadorizada por Raios X , Hemoglobinas , Anemia/diagnóstico por imagemRESUMO
Minimally invasive strategies to treat valvular heart disease have emerged over the past 2 decades. The use of transcatheter aortic valve replacement in the treatment of severe aortic stenosis, for example, has recently expanded from high- to low-risk patients and became an alternative treatment for those with prohibitive surgical risk. With the increase in transcatheter strategies, multimodality imaging, including echocardiography, CT, fluoroscopy, and cardiac MRI, are used. Strategies for preprocedural imaging strategies vary depending on the targeted valve. Herein, an overview of preprocedural imaging strategies and their postprocessing approaches is provided, with a focus on CT. Transcatheter aortic valve replacement is reviewed, as well as less established minimally invasive treatments of the mitral and tricuspid valves. In addition, device-specific details and the goals of CT imaging are discussed. Future imaging developments, such as peri-procedural fusion imaging, machine learning for image processing, and mixed reality applications, are presented.
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Estenose da Valva Aórtica , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco , Ecocardiografia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Imagem Multimodal , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Anticoagulant treatment is recommended for at least three months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related acute pulmonary embolism (PE), but the persistent pulmonary clot burden after that time is unknown. METHODS: Lung perfusion was assessed by ventilation-perfusion (V/Q) SPECT/CT in 20 consecutive patients with SARS-CoV-2-associated acute PE after a minimum of three months anticoagulation therapy in a retrospective observational study. RESULTS: Remaining perfusion defects after a median treatment period of six months were observed in only two patients. All patients (13 men, seven women, mean age 55.6 ± 14.5 years) were on non-vitamin K direct oral anticoagulants (DOACs). No recurrent venous thromboembolism or anticoagulant-related bleeding complications were observed. Among patients with partial clinical recovery, high-risk PE and persistent pulmonary infiltrates were significantly more frequent (p < 0.001, respectively). INTERPRETATION: Temporary DOAC treatment seems to be safe and efficacious for resolving pulmonary clot burden in SARS-CoV-2-associated acute PE. Partial clinical recovery is more likely caused by prolonged SARS-CoV-2-related parenchymal lung damage rather than by persistent pulmonary perfusion defects.
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COVID-19 , Embolia Pulmonar , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , SARS-CoV-2 , COVID-19/complicações , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Pulmão/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Anticoagulantes/uso terapêutico , Doença Aguda , PerfusãoRESUMO
OBJECTIVES: Photon-counting detector CT (PCD-CT) promises a leap in spatial resolution due to smaller detector pixel sizes than implemented in energy-integrating detector CTs (EID-CT). Our objective was to compare the visualization of smallest bone details between PCD-CT and EID-CT using a mouse as a specimen. MATERIALS AND METHODS: Two euthanized mice were scanned at a 20-slice EID-CT and a dual-source PCD-CT in single-pixel mode at various CTDIVol values. Image noise and signal-to-noise ratio (SNR) were evaluated using repeated ROI measurements. Edge sharpness of bones was compared by the maximal slope within CT value plots along sampling lines intersecting predefined bones of the spine. Two readers evaluated bone detail visualization at four regions of the spine on a three-point Likert scale at various CTDIVol's. Two radiologists selected the series with better detail visualization among each of 20 SNR-matched pairs of EID-CT and PCD-CT series. RESULTS: In CTDIVol-matched scans, PCD-CT series showed significantly lower image noise (NoiseCTDI=5 mGy: 16.27 ± 1.39 vs. 23.46 ± 0.96 HU, p < 0.01), higher SNR (SNRCTDI=5 mGy: 20.57 ± 1.89 vs. 14.00 ± 0.66, p < 0.01), and higher edge sharpness (Edge Slopelumbar spine: 981 ± 160 vs. 608 ± 146 HU/mm, p < 0.01) than EID-CT series. Two radiologists considered the delineation of bone details as feasible at consistently lower CTDIVol values at PCD-CT than at EID-CT. In comparison of SNR-matched reconstructions, PCD-CT series were still considered superior in almost all cases. CONCLUSIONS: In this head-to-head comparison, PCD-CT showed superior objective and subjective image quality characteristics over EID-CT for the delineation of tiniest bone details. Even in SNR-matched pairs (acquired at different CTDIVol's), PCD-CT was strongly preferred by radiologists. KEY POINTS: ⢠In dose-matched scans, photon-counting detector CT series showed significantly less image noise, higher signal-to-noise ratio, and higher edge sharpness than energy-integrating detector CT series. ⢠Human observers considered the delineation of tiny bone details as feasible at much lower dose levels in photon-counting detector CT than in energy-integrating detector CT. ⢠In direct comparison of series matched for signal-to-noise ratio, photon-counting detector CT series were considered superior in almost all cases.
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Fótons , Tomografia Computadorizada por Raios X , Humanos , Imagens de Fantasmas , Razão Sinal-Ruído , Tomógrafos Computadorizados , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: To analyze trends of in-hospital treatment of patients admitted due to peripheral artery disease (PAD) from 2009 to 2018 with special focus on comorbidities, revascularization procedures, resulting costs, and outcome. METHODS: Using data from the research data center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine stage IIb or higher from 2009 to 2018. To analyze comorbidities, Elixhauser diagnostic groups and linear van Walraven score (vWS) were assessed. RESULTS: A total of 1.8 million hospitalizations resulting in 10.3 billion in reimbursement costs were included. From 2009 to 2018, the absolute number of hospitalizations due to PAD increased by 13.3% (163,547 to 185,352). The average cost per hospitalization increased by 20.8% from 5,261 to 6,356. The overall in-hospital mortality decreased from 3.1 to 2.6%. Median vWS of all PAD cases increased by 3 points (2 to 5). The number of percutaneous transluminal angioplasties (PTA) increased by 43.9% while some surgical procedures such as bypasses and embolectomies decreased by 30.8% and 6.8%, respectively. Many revascularization procedures showed a disproportionate increase of those performed in vessels below the knee for example in PTA (+ 68.5%) or in endarterectomies (+ 38.8%). CONCLUSIONS: This decade-long nationwide analysis shows a rising number of hospitalizations due to PAD with more comorbid patients resulting in increasing reimbursement costs. Interventions are shifting from surgical to endovascular approaches with a notable trend towards interventions in smaller vessels below the knee. KEY POINTS: ⢠The number of hospitalizations due to peripheral artery disease is rising and it is associated with increasing reimbursement costs. ⢠Admitted patients are older and show an increasing number of comorbidities while overall in-hospital mortality is decreasing. ⢠Revascularization procedures are shifting from surgical to endovascular approaches and show a trend towards intervention in smaller vessels below the knee. ⢠Major amputations are decreasing while the number of minor amputations is increasing.
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Procedimentos Endovasculares , Doença Arterial Periférica , Atenção à Saúde , Hospitalização , Humanos , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/terapia , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate feasibility and diagnostic performance of coronary CT angiography (CCTA)-derived fractional flow reserve (CT-FFR) for detection of significant coronary artery disease (CAD) and decision-making in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to potentially avoid additional pre-TAVR invasive coronary angiography (ICA). METHODS: Consecutive patients with severe AS (n = 95, 78.6 ± 8.8 years, 53% female) undergoing pre-procedural TAVR-CT followed by ICA with quantitative coronary angiography were retrospectively analyzed. CCTA datasets were evaluated using CAD Reporting and Data System (CAD-RADS) classification. CT-FFR measurements were computed using an on-site machine-learning algorithm. A combined algorithm was developed for decision-making to determine if ICA is needed based on pre-TAVR CCTA: [1] all patients with CAD-RADS ≥ 4 are referred for ICA; [2] patients with CAD-RADS 2 and 3 are evaluated utilizing CT-FFR and sent to ICA if CT-FFR ≤ 0.80; [3] patients with CAD-RADS < 2 or CAD-RADS 2-3 and normal CT-FFR are not referred for ICA. RESULTS: Twelve patients (13%) had significant CAD (≥ 70% stenosis) on ICA and were treated with PCI. Twenty-eight patients (30%) showed CT-FFR ≤ 0.80 and 24 (86%) of those were reported to have a maximum stenosis ≥ 50% during ICA. Using the proposed algorithm, significant CAD could be identified with a sensitivity, specificity, and positive and negative predictive value of 100%, 78%, 40%, and 100%, respectively, potentially decreasing the number of necessary ICAs by 65 (68%). CONCLUSION: Combination of CT-FFR and CAD-RADS is able to identify significant CAD pre-TAVR and bears potential to significantly reduce the number of needed ICAs. KEY POINTS: ⢠Coronary CT angiography-derived fractional flow reserve (CT-FFR) using machine learning together with the CAD Reporting and Data System (CAD-RADS) classification safely identifies significant coronary artery disease based on quantitative coronary angiography in patients prior to transcatheter aortic valve replacement. ⢠The combination of CT-FFR and CAD-RADS enables decision-making and bears the potential to significantly reduce the number of needed invasive coronary angiographies.
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Estenose da Valva Aórtica , Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Constrição Patológica , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
We have experimentally determined the adsorption structure, charge state, and metalation state of porphin, the fundamental building block of porphyrins, on ultrathin Ag(001)-supported MgO(001) films by scanning tunneling microscopy and photoemission spectroscopy, supported by calculations based on density functional theory. By tuning the substrate work function to values below and above the critical work function for charging, we succeeded in the preparation of 2H-P monolayers which contain negatively charged and uncharged molecules. It is shown that the porphin molecules self-metalate at room temperature, forming the corresponding Mg-porphin, irrespective of their charge state. This is in contrast to self-metalation of tetraphenyl porphyrin (TPP), which occurs on planar MgO(001) only if the molecules are negatively charged. The different reactivity is explained by the reduced molecule-substrate distance of the planar porphin molecule compared to the bulkier TPP. The results of this study shed light on the mechanism of porphyrin self-metalation on oxides and highlight the role of the adsorption geometry on the chemical reactivity.
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Obstructive sleep apnea (OSA) might influence disease severity in acute pulmonary embolism (PE). 253 survivors of acute PE were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. PE patients with an apnea-hypopnoea index (AHI) ≥ 15/h were significantly older (p < 0.001), had significantly impaired renal (p < 0.001) and left ventricular functions (p = 0.003), showed significantly elevated troponin I (p = 0.005) and D-dimer levels (p = 0.024), were hospitalised significantly longer (p < 0.001), and had significantly elevated PE severity scores (p = 0.015). Moderate or severe OSA was significantly (p = 0.006) more frequent among intermediate- and high-risk PE patients (81.0%) compared to the low-risk PE cohort (16.3%). Multiple logistic regression analysis revealed that PE patients in the AHI ≥ 15/h cohort were at significant risk for myocardial injury (p = 0.015). Based on clinical risk stratification models, patients with no relevant OSA syndrome tended to be at a lower risk for short-term mortality (p = 0.068). Acute PE might present more severely in OSA patients, possibly due to nocturnal hypoxemia or OSA-related hypercoagulability.
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Embolia Pulmonar/patologia , Apneia Obstrutiva do Sono , Doença Aguda , Idoso , Estudos de Coortes , Comorbidade , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Pessoa de Meia-Idade , Polissonografia , Medição de Risco , Troponina I/sangueRESUMO
INTRODUCTION: The aims of the present study are to evaluate the potential of high-resolution black-blood MRI (hr-bb-cMRI) to differentiate common cervical arteriopathies and to evaluate interobserver reproducibility. METHODS: Forty-three consecutive patients with distinct cervical arteriopathies were examined with cervical hr-bb-cMRI at 3.0 Te with fat-saturated pre- and post-contrast T1w, T2w, and TOF images using dedicated carotid surface coils at our institution. Twenty-three patients had atherosclerotic disease, causing significant stenosis in 12 patients while 11 patients had moderate stenosis. Eight patients presented with cervical vasculitis, and five patients had arterial dissection. Furthermore, seven control subjects with no evidence of carotid disease were included. Two experienced readers blinded to all clinical information reviewed all MR images and classified both carotid and vertebral arteries as affected either by atherosclerosis, dissection, vasculitis, or no disease. Finally, a consensus reading was performed. RESULTS: On a per-vessel level, test performance parameters (sensitivity, specificity, positive predictive value, negative predictive value) were 95, 97.7, 92.9, and 98.5 % for atherosclerotic disease; 91, 100, 100, and 98.7 % for vasculitis; and 100, 100, 100, and 100 % for dissection, respectively. On a per-patient level, performance parameters were 95.7, 85.7, 97.2, and 85.7 % for the diagnosis of atherosclerosis and 100, 100, 100, and 100 % for the diagnosis of dissection and of vasculitis, respectively. Accuracy rates were all above 95 % for all entities. There was a high agreement between observers both in a per-vessel (κ = 0.83) and in a per-patient analysis (κ = 0.82). CONCLUSION: This study demonstrates that hr-bb-cMRI is able to non-invasively differentiate between the most common cervical arteriopathies with an excellent interreader reproducibility.
Assuntos
Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Meios de Contraste , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Transcatheter aortic valve replacement (TAVR) is used for the treatment of aortic stenosis (AS). Besides major bleeding, conduction blocks, stroke or atrial fibrillation, complications include cardiac perforation with possible left-to-right-shunts. Herein is reported the sixth case of a left-to-right shunt in an 87-year-old man who underwent TAVR using a 29 mm Edwards SAPIEN S3 prosthesis to treat AS. Soon after the procedure, a small channel evolving from the right coronary cusp could be detected on echocardiography. The patient was managed medically.
Assuntos
Estenose da Valva Aórtica/cirurgia , Fístula/etiologia , Traumatismos Cardíacos/etiologia , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Ecocardiografia , Fístula/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico por imagem , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagemRESUMO
Azulene (Az) is a non-alternating, aromatic hydrocarbon composed of a five-membered, electron-rich and a seven-membered, electron-poor ring; an electron distribution that provides intrinsic redox activity. By varying the attachment points of the two electrode-bridging substituents to the Az center, the influence of the redox functionality on charge transport is evaluated. The conductance of the 1,3 Az derivative is at least one order of magnitude lower than those of the 2,6 Az and 4,7 Az derivatives, in agreement with density functional theory (DFT) calculations. In addition, only 1,3 Az exhibits pronounced nonlinear current-voltage characteristics with hysteresis, indicating a bias-dependent conductance switching. DFT identifies the LUMO to be nearest to the Fermi energy of the electrodes, but to be an active transport channel only in the case of the 2,6 and the 4,7 Az derivatives, whereas the 1,3 Az derivative uses the HOMO at low and the LUMO+1 at high bias. In return, the localized, weakly coupled LUMO of 1,3 Az creates a slow electron-hopping channel responsible for the voltage-induced switching due to the occupation of a single molecular orbital (MO).
RESUMO
Besides active, functional molecular building blocks such as diodes or switches, passive components, for example, molecular wires, are required to realize molecular-scale electronics. Incorporating metal centers in the molecular backbone enables the molecular energy levels to be tuned in respect to the Fermi energy of the electrodes. Furthermore, by using more than one metal center and sp-bridging ligands, a strongly delocalized electron system is formed between these metallic "dopants", facilitating transport along the molecular backbone. Here, we study the influence of molecule-metal coupling on charge transport of dinuclear X(PP)2FeC4Fe(PP)2X molecular wires (PP = Et2PCH2CH2PEt2); X = CN (1), NCS (2), NCSe (3), C4SnMe3 (4), and C2SnMe3 (5) under ultrahigh vacuum and variable temperature conditions. In contrast to 1, which showed unstable junctions at very low conductance (8.1 × 10(-7) G0), 4 formed a Au-C4FeC4FeC4-Au junction 4' after SnMe3 extrusion, which revealed a conductance of 8.9 × 10(-3) G0, 3 orders of magnitude higher than for 2 (7.9 × 10(-6) G0) and 2 orders of magnitude higher than for 3 (3.8 × 10(-4) G0). Density functional theory (DFT) confirmed the experimental trend in the conductance for the various anchoring motifs. The strong hybridization of molecular and metal states found in the C-Au coupling case enables the delocalized electronic system of the organometallic Fe2 backbone to be extended over the molecule-metal interfaces to the metal electrodes to establish high-conductive molecular wires.