Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography - Prevalence, pattern of disease and relationship to D-dimer.

OBJECTIVES: To define the prevalence of pulmonary thromboembolic (PTE) disease diagnosed on CT pulmonary angiography (CTPA) in COVID-19 patients. To assess distribution of PTE and to evaluate for association between severity of COVID-19 disease, D-dimer values and incidence of PTE. METHODS: Patients with diagnosis of COVID-19 presenting to 5 different hospitals across Greater Manchester between 1st March 2020 and 30th April 2020 who had CTPA were included. CTPA images were evaluated for presence of PTE, distribution of PTE (in small and/or large vessels) and distribution of PTE within lungs with or without COVID-19 CT changes. Severity of COVID lung changes were graded. D-dimer values within 72 h of CTPA were obtained. Statistical analyses were performed to evaluate for any significant association between variables. p values of ≤0.05 were regarded as statistically significant. RESULTS: A total of 974 patients presented across five hospital sites with COVID-19 infection. Eighty-four (n = 84) COVID-19 patients underwent CTPA. Of these, 38 % (32/84) had PTE. PTE was seen in small vessels in 75 % (24/32) and in lungs demonstrating COVID-19 changes in 72 % (23/32). 84 % (27/32) of PTE positive patients had disease severity of moderate or higher score (p = 0.005). D-dimer values were significantly higher (p ≤ 0.001) in PTE patients, median value in PTE group was 6441mcg/L (range 219-90925). A D-dimer cut off value of 2247mcg/L provides sensitivity of 0.72 and specificity of 0.74. CONCLUSION: There is increased prevalence of PTE in patients with moderate to severe COVID-19 disease. D-dimer values may have potential in guiding anticoagulation therapy and prognostication.

IFPA meeting 2015 workshop report IV: placenta and obesity; stem cells of the feto-maternal interface; placental immunobiology and infection.

Workshops are an important part of the IFPA annual meeting as they allow for discussion of specialised topics. At the 2015 IFPA annual meeting there were 12 themed workshops, three of which are summarized in this report. These workshops related to various aspects of placental biology and collectively covered areas of obesity and the placenta, stem cells of the feto-maternal interface, and placental immunobiology and infection.

New biomarkers for the prediction of spontaneous preterm labour in symptomatic pregnant women: a comparison with fetal fibronectin.

OBJECTIVE: To identify cervicovaginal fluid (CVF) biomarkers predictive of spontaneous preterm birth in women with symptoms of preterm labour. DESIGN: Retrospective cohort study. SETTING: Melbourne, Australia. POPULATION: Women with a singleton pregnancy admitted to the Emergency Department between 22 and 36 weeks of gestation presenting with symptoms of preterm labour. METHODS: Two-dimensional electrophoresis was used to analyse the CVF proteome. Validation of putative biomarkers was performed using enzyme-linked immunosorbent assay (ELISA) in an independent cohort. Optimal concentration thresholds of putative biomarkers were determined and the predictive efficacy for preterm birth was compared with that of fetal fibronectin. MAIN OUTCOME MEASURES: Prediction of spontaneous preterm labour within 7 days. RESULTS: Differentially expressed proteins were identified by proteomic analysis in women presenting with 'threatened' preterm labour without cervical change who subsequently delivered preterm (n = 12 women). ELISA validation using an independent cohort (n = 129 women) found albumin and vitamin D-binding protein (VDBP) to be significantly altered between women who subsequently experienced preterm birth and those who delivered at term. Prediction of preterm delivery within 7 days using a dual biomarker model (albumin/VDBP) provided 66.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 96.7% negative predictive value (NPV), compared with fetal fibronectin yielding 66.7, 87.9, 36.4 and 96.2%, respectively (n = 64). Using the maximum number of screened samples, the predictive utility of albumin/VDBP yielded a sensitivity of 77.8%, specificity and PPV of 100% and NPV of 98.0% (n = 109). CONCLUSIONS: The dual biomarker model of albumin/VDBP is more efficacious than fetal fibronectin in predicting spontaneous preterm delivery in symptomatic women within 7 days. A clinical diagnostic trial is required to test this model on a larger population to confirm these findings and to further refine the predictive values.

The dental pathology of southern sea otters (Enhydra lutris nereis).

Skulls (n = 1,205) of southern sea otters were examined macroscopically according to defined criteria. The museum specimens, acquired from strandings, varied in age from juvenile to adult, with an equal sex distribution. The results from all young adult and adult specimens were pooled according to tooth type. Ninety-two percent of teeth were available for examination, with 6.5% artifactually absent, 0.6% deemed absent due to acquired tooth loss and 0.03% deemed congenitally absent. All teeth were normal in morphology, except for three pairs of fused teeth, including two instances of fused maxillary first incisor teeth. Supernumerary teeth were associated with 97 normal teeth (most commonly maxillary canine teeth) in 68 specimens. At least one persistent deciduous tooth was present in six skulls, two of which were from adults. The majority (94.6%) of alveoli, either with or without teeth, were not associated with bony changes consistent with periodontitis; however, the majority (74.4%) of specimens did have at least one tooth associated with mild periodontitis. The mesial root of the mandibular third premolar tooth was the most common location at which periodontal hard tissue lesions were observed (56.6%). Ten sea otters had lesions consistent with focal enamel hypoplasia. Approximately half of the teeth (52.0%) were abraded; almost all adult specimens (98.1%) contained at least one abraded tooth, while fewer young adults were affected (76.4%). Tooth fractures were uncommon, affecting 1,343 teeth (4.5%). Periapical lesions were associated with 409 teeth (1.3%) in a total of 176 specimens, and these would likely have caused considerable morbidity while the animals were alive.

Non-elective percutaneous nephrostomy (PCN) service in a tertiary uroradiology centre: can radiologists and urologists agree on timing?

AIM: To assess agreement between uroradiologists and urologists with regards to the timing of non-elective percutaneous nephrostomy (PCN) catheter insertion, and whether any delay produced unacceptable complications. MATERIALS AND METHODS: Standardized data collection forms detailing patient demographics, indications for PCN catheter insertion, blood results, procedural details, and immediate complications were completed by uroradiologists. At the time of referral, patients were stratified by both radiologists and urologists into three groups as follows: group 1 = PCN within 6 h; group 2 = PCN between 6 and 24 h; and group 3 = PCN between 24 and 48 h. RESULTS: One hundred and eighteen non-elective PCN catheter insertions were performed over 2 years. Radiologists stratified 12 patients (10.2%) into group 1, 65 (55.1%) patients into group 2, and 41 (34.7%) patients into group 3. Urologists stratified 14 (11.9%) patients into group 1, 68 (57.6%) patients into group 2, and 36 (30.5%) patients into group 3. There was good agreement between radiologist and urologists (κ = 0.865) on stratification in all but nine (7.6%) cases. Ninety-four point one percent of PCN catheters were inserted within the timeframe stratified by radiologists and urologists, or sooner. Sepsis was associated with a shortened timeframe. Elevated international normalized ratio (INR; >1.5) resulted in an increased timeframe. A major complication rate of 3% is within recommended limits. Fourteen percent of PCN catheter insertions were inserted outside normal working hours. Urgency stratification has decreased the number of cases performed out of hours. CONCLUSION: Radiologists and urologists had good agreement on stratification with an acceptable major complication rate of 3%.

Lower extremity and pelvic stress fractures in athletes.

Stress fractures occur following excessive use and are commonly seen in athletes, in whom the lower limbs are frequently involved. Delayed diagnosis and management of these injuries can result in significant long-term damage and athlete morbidity. A high index of suspicion may facilitate diagnosis, but clinical presentation may be non-specific. In this regard, imaging in the form of plain radiograph, CT, MRI and bone scintigraphy may be of value. This article reviews the incidence, presentation, radiological findings and management options for athletes with stress fractures of the lower limb.

The adult cystic fibrosis patient with abdominal pain: what the radiologist needs to know.

As the life expectancy of cystic fibrosis (CF) patients continues to increase, abdominal manifestations of CF are increasingly being encountered by clinicians and radiologists. Imaging plays an important role in the evaluation of adult CF patients with abdominal pain as a cause is often not discernable clinically. Accurate diagnosis is crucial in these patients as some causes may be managed conservatively, whilst others may require surgical intervention. In this review, we describe clinical presentation, imaging findings, and management of adult CF patients presenting with abdominal pain.

Complications following pancreatic transplantations: imaging features.

Whole organ vascularized pancreatic transplant is a recognized treatment for diabetes and is increasingly being performed worldwide. The procedure itself is complex and is associated with significant mortality and morbidity. Despite improvements in surgical techniques, postoperative complications of pancreatic transplantation are still common and include graft rejection, pancreatitis, peripancreatic fluid collections, exocrine leaks, vascular thrombosis, and hemorrhage. In this pictorial essay, we review clinical presentation and imaging features of these complications. We also briefly discuss technique and complications of islet cell transplants.

Lightweight mesh improves functional outcome in laparoscopic totally extra-peritoneal inguinal hernia repair.

BACKGROUND: Prosthetic mesh reinforcement is standard practice for inguinal hernia repair but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in a lighter weight mesh. The aim of this prospective study was to compare the outcome after laparoscopic totally extra-peritoneal (TEP) inguinal repair using new lightweight or traditional heavyweight mesh performed in a single specialist centre. METHODS: Between November 2004 and July 2005, 250 patients underwent laparoscopic TEP inguinal repair using either lightweight (Ultrapro, 30 g/m(2)) or heavyweight (Prolene, 100 g/m(2)) mesh. Follow-up data was obtained using case note review and telephone-based questionnaire. Patients were followed up within the early and late post-operative periods to assess any changes in outcome. RESULTS: Follow-up information was obtained for 188 (75%) out of 250 patients. There was no difference between lightweight and heavyweight groups in the incidence or severity of pain/discomfort at mean 4 and 15 months follow-up. There was significantly less interference with physical activity at short and long term follow-up in the lightweight group, in particular lifting (9% vs 21% at mean 4 months, Mann-Whitney U, P = 0.024), walking (1% vs 11% at mean 15 months, Mann-Whitney U, P = 0.006) and vigorous activities (7% vs 19% at mean 15 months, Mann-Whitney-U, P = 0.012). There was no significant difference in awareness of mesh or stiffness in the groin. CONCLUSIONS: Laparoscopic TEP inguinal hernia repair with a lightweight mesh improves functional outcome in the short and long term. There was significantly less interference with all aspects of physical activity with the lightweight mesh. Pain in both groups was very mild, highlighting the benefits of laparoscopic surgery.

Sensitization of rhabdo-, lenti-, and spumaviruses to human serum by galactosyl(alpha1-3)galactosylation.

Vesicular stomatitis virus, human immunodeficiency virus type 2, and human foamy virus, which were produced by cell lines expressing galactosyl(alpha1-3)galactosyl (alphaGal) sugars, were found to be less stable in human serum than those from alphaGal-negative cells, indicating that galactosyl(alpha1-3)galactosylation sensitizes these viruses as well as mammalian type C oncoviruses (Rother et al., J. Exp. Med. 182:1345-1355, 1995; Takeuchi et al., Nature (London) 379:85-88, 1996) to complement killing via natural anti-alphaGal antibodies. Thus, virus killing mediated by anti-alphaGal antibodies may play a role as a barrier to animal-to-human infection of various enveloped viruses. Virus vectors for human in vivo gene therapy based on the viruses mentioned above should be produced from alphaGal-negative cells.

Treatment of adult acute non-lymphoblastic leukemia using intermittent combination chemotherapy with daunomycin, cytosine arabinoside, 6-mercaptopurine and prednisolone-DCMP two step therapy.

A regime of treatment of acute non-lymphoblastic leukemia in adult, employing DMCP protocol, especially two step method consisting of daunorubicin, cytosine arabinoside, 6-mercaptopurine and prednisolone is described. Out of 32 adult patients with ANLL treated with DCMP regime 26 (81.3%) achieved complete remission. The median durations of complete remission and survival were 53 weeks and 54 weeks, respectively. The longest duration of complete remission was more than 220 weeks, and 3 cases are still maintaining initial complete remission more than 3 years.