The D-HCM score, a new diagnostic tool for distinguishing hypertrophic cardiomyopathy from hypertensive cardiopathy.

AIM: The diagnosis of hypertrophic cardiomyopathy (HCM) with moderate hypertrophy is challenging. Hypertensive heart disease (HHD) is the most common differential diagnosis that mimics the LVH of HCM. The aim of this study was to compare the QRS duration in HCM and HHD to create a novel diagnostic tool to identify primary HCM. METHODS AND RESULTS: We conducted an international retrospective multicentre study enrolling patients with true HCM and HHD. A total of 547 individuals with HCM and 139 with HHD were included. The median QRS duration was significantly shorter in HCM than in HHD (88 ms [80-94] vs. 98 ms [88-108]; P < 0.01). Multivariable logistic regression identified for the novel diagnostic HCM (D-HCM) score: absence of antihypertensive drugs (+2); family history of unexplained sudden death (+2); QRS duration [<95 ms] = +1; maximum wall thickness (mm) [≥17] = +1. A cumulative QRS-HCM score ≥2 supports the diagnostic certainty of true HCM with a sensitivity of 79%, specificity of 99%, negative predictive value (NPV) of 55%, and positive predictive value (PPV) of 99%. CONCLUSION: The QRS duration in patient with HCM is significantly shorter compared with patients with HHD-related LVH. QRS duration can be used as a diagnosis marker to distinguish between HCM and HHD. The D-HCM score is a novel, simple, and accurate diagnosis tool for HCM patients with mild to moderate phenotypes.

[Comprehensive review of 3D printing use in medicine: Comparison with practical applications in urology]. / Revue compréhensive de l'apport de l'impression 3D en médecine : mise en perspective des différentes applications en urologie.

INTRODUCTION: Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. METHODS: In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. RESULTS: Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. CONCLUSION: 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Recovery of hydrothermal vent communities in response to an induced disturbance at the Lucky Strike vent field (Mid-Atlantic Ridge).

So far, the natural recovery of vent communities at large scales has only been evaluated at fast spreading centers, by monitoring faunal recolonisation after volcanic eruptions. However, at slow spreading ridges, opportunities to observe natural disturbances are rare, the overall hydrothermal system being more stable. In this study, we implemented a novel experimental approach by inducing a small-scale disturbance to assess the recovery potential of vent communities along the slow-spreading northern Mid-Atlantic Ridge (nMAR). We followed the recovery patterns of thirteen Bathymodiolus azoricus mussel assemblages colonising an active vent edifice at the Lucky Strike vent field, in relation to environmental conditions and assessed the role of biotic interactions in recolonisation dynamics. Within 2 years after the disturbance, almost all taxonomic richness had recovered, with the exception of a few low occurrence species. However, we observed only a partial recovery of faunal densities and a major change in faunal composition characterised by an increase in abundance of gastropod species, which are hypothesised to be the pioneer colonists of these habitats. Although not significant, our results suggest a potential role of mobile predators in early-colonisation stages. A model of post-disturbance succession for nMAR vent communities from habitat opening to climax assemblages is proposed, also highlighting numerous knowledge gaps. This type of experimental approach, combined with dispersal and connectivity analyses, will contribute to fully assess the resilience of active vent communities after a major disturbance, especially along slow spreading centers targeted for seafloor massive sulphide extraction.

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive guidelines for the management of Atrial Fibrillation

The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.

Le programme de lignes directrices de la Société canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a été élaboré pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les décideurs politiques et les systèmes de soins de santé sur des questions connexes. La dernière édition complète des lignes directrices de la SCC en matière de FA a été publiée en 2010. Depuis lors, des mises à jour périodiques ont été publiées, traitant de domaines en évolution rapide. Cependant, en 2020, un grand nombre de développements s'y étaient ajoutés, couvrant un large éventail de domaines, ce qui a motivé le comité à créer une refonte complète des lignes directrices. L'édition 2020 des lignes directrices de la SCC en matière de FA représente un renouvellement complet qui intègre, met à jour et remplace les lignes directrices, les recommandations et les conseils pratiques des dix dernières années. Elle est destinée à être utilisée par les cliniciens praticiens de toutes les disciplines qui s'occupent de patients souffrant de FA. L'approche GRADE (Gradation des Recommandations, de l'Appréciation, du Développement et des Évaluations) a été utilisée pour évaluer la pertinence des recommandations et la qualité des résultats. Les domaines d'intérêt incluent : la classification et les définitions de la FA, son épidémiologie, sa physiopathologie, l'évaluation clinique, le dépistage de la FA, la détection et la gestion des facteurs de risque modifiables, l'approche intégrée de la gestion de la FA, la prévention des accidents vasculaires cérébraux, la gestion de l'arythmie, les différences entre les sexes et la FA dans des populations particulières. Des tableaux et figures ont été largement utilisés pour synthétiser les éléments importants et présenter les concepts clés. Ce document devrait représenter une aide importante pour l'intégration des connaissances et un outil pour aider à améliorer la gestion clinique de cette arythmie importante et difficile à traiter.

[Use of personalized 3D printed kidney models for partial nephrectomy]. / Utilisation de l'impression 3D avant néphrectomie partielle pour tumeur du rein.

Partial nephrectomy is a first-line treatment option for the management of renal tumors. It is a surgical procedure whose complexity and stakes vary according to the specific anatomy of the patient and his tumor. 3D modeling and 3D printing have become a means of representing and thus visualizing the tumor lesion and its anatomical relationships within the organ. This mode of visualization allows the surgeon and his team, but also the patient, to easily realize the tumor complexity, the predictable difficulty of the surgery and therefore the risks of complications. Various publications have reported the benefit to the patient in terms of pre-therapy education. Some have shown a benefit for the operator in terms of surgical planning. Finally, studies on preoperative surgical simulation showed shorter kidney lumpectomy times and less bleeding when surgeons were able to train before the operation on the corresponding 3D printed model. 3D printing therefore represents an innovative tool that would improve patient management prior to partial nephrectomy, through the information it can deliver, but also through surgical simulation.

High environmental stress and productivity increase functional diversity along a deep-sea hydrothermal vent gradient.

Productivity and environmental stress are major drivers of multiple biodiversity facets and faunal community structure. Little is known on their interacting effects on early community assembly processes in the deep sea (>200 m), the largest environment on Earth. However, at hydrothermal vents productivity correlates, at least partially, with environmental stress. Here, we studied the colonization of rock substrata deployed along a deep-sea hydrothermal vent gradient at four sites with and without direct influence of vent fluids at 1,700-m depth in the Lucky Strike vent field (Mid-Atlantic Ridge [MAR]). We examined in detail the composition of faunal communities (>20 µm) established after 2 yr and evaluated species and functional patterns. We expected the stressful hydrothermal activity to (1) limit functional diversity and (2) filter for traits clustering functionally similar species. However, our observations did not support our hypotheses. On the contrary, our results show that hydrothermal activity enhanced functional diversity. Moreover, despite high species diversity, environmental conditions at surrounding sites appear to filter for specific traits, thereby reducing functional richness. In fact, diversity in ecological functions may relax the effect of competition, allowing several species to coexist in high densities in the reduced space of the highly productive vent habitats under direct fluid emissions. We suggest that the high productivity at fluid-influenced sites supports higher functional diversity and traits that are more energetically expensive. The presence of exclusive species and functional entities led to a high turnover between surrounding sites. As a result, some of these sites contributed more than expected to the total species and functional ß diversities. The observed faunal overlap and energy links (exported productivity) suggest that rather than operating as separate entities, habitats with and without influence of hydrothermal fluids may be considered as interconnected entities. Low functional richness and environmental filtering suggest that surrounding areas, with their very heterogeneous species and functional assemblages, may be especially vulnerable to environmental changes related to natural and anthropogenic impacts, including deep-sea mining.

Structured surface reflector design for oblique incidence beam splitter at 610 GHz.

An iterative alternate projection-based algorithm is developed to design structured surface reflectors to operate as beam splitters at GHz and THz frequencies. To validate the method, a surface profile is determined to achieve a reflector at 610 GHz that generates four equal-intensity beams towards desired directions of ±12.6° with respect to the specular reflection axis. A prototype is fabricated and the beam splitter behavior is experimentally demonstrated. Measurements confirm a good agreement (within 1%) with computer simulations using Feko, validating the method. The beam splitter at 610 GHz has a measured efficiency of 78% under oblique incidence illumination that ensures a similar intensity between the four reflected beams (variation of about 1%).

The vestibulocochlear nerve (VIII).

The vestibulocochlear nerve (8th cranial nerve) is a sensory nerve. It is made up of two nerves, the cochlear, which transmits sound and the vestibular which controls balance. It is an intracranial nerve which runs from the sensory receptors in the internal ear to the brain stem nuclei and finally to the auditory areas: the post-central gyrus and superior temporal auditory cortex. The most common lesions responsible for damage to VIII are vestibular Schwannomas. This report reviews the anatomy and various investigations of the nerve.

The lower cranial nerves: IX, X, XI, XII.

The lower cranial nerves innervate the pharynx and larynx by the glossopharyngeal (CN IX) and vagus (CN X) (mixed) nerves, and provide motor innervation of the muscles of the neck by the accessory nerve (CN XI) and the tongue by the hypoglossal nerve (CN XII). The symptomatology provoked by an anomaly is often discrete and rarely in the forefront. As with all cranial nerves, the context and clinical examinations, in case of suspicion of impairment of the lower cranial nerves, are determinant in guiding the imaging. In fact, the impairment may be located in the brain stem, in the peribulbar cisterns, in the foramens or even in the deep spaces of the face. The clinical localization of the probable seat of the lesion helps in choosing the adapted protocol in MRI and eventually completes it with a CT-scan. In the bulb, the intra-axial pathology is dominated by brain ischemia (in particular, with Wallenberg syndrome) and multiple sclerosis. Cisternal pathology is tumoral with two tumors, schwannoma and meningioma. The occurrence is much lower than in the cochleovestibular nerves as well as the leptomeningeal nerves (infectious, inflammatory or tumoral). Finally, foramen pathology is tumoral with, outside of the usual schwannomas and meningiomas, paragangliomas. For radiologists, fairly hesitant to explore these lower cranial pairs, it is necessary to be familiar with (or relearn) the anatomy, master the exploratory technique and be aware of the diagnostic possibilities.

Facial nerve: from anatomy to pathology.

The facial nerve (CN VII) emerges from the facial nerve nucleus in the pons. It is accompanied by CN VIII along its cisternal pathway, as well as at the internal auditory meatus. Its petrous pathway includes a labyrinthine segment, a horizontal tympanic segment and a vertical mastoid segment until the stylomastoid foramen. It then continues to the parotid gland. Pontine impairment is usually associated with other neurological symptoms. Lesions of the cerebellopontine angle (most often meningioma and schwannoma) initially result in impairment of CN VIII. The impairment of CN VII takes second place. Peripheral impairment (outside of a traumatic context) is most often due to Bell's palsy.

Brain infections.

Brain infections are relatively rare, but they are potentially serious and have a poor prognosis. The cornerstone of the diagnosis is cerebrospinal fluid (CSF) analysis. Imaging is not systematic, but the indications of imaging are broad, particularly when faced with suspected focal damage, depending on the characteristics of the patient (child, immunosuppressed patient, geographic origin, etc.). It is based on MRI, which allows for aetiological diagnosis and an extension evaluation. In addition, in a certain number of cases, the type of infection is not known and it is up to the MRI via use of an exhaustive technique to diagnose an infectious origin when faced with a mass syndrome. This technical mastery, associated with knowledge of major brain infections, their method of contamination and their particular appearance on the MRI, should make it possible for the radiologist to fulfill his or her diagnostic role.

[Skull base osteomyelitis]. / Ostéite de la base du crâne.

Skull base osteomyelitis is a rare but serious infection. It typically afflicts immunosuppressed patients and should be suspected in patients with persistent otitis complicated by cranial nerve palsy (VII, IX and XII). The most frequent germ is pseudomonas aeruginosa. Contiguous spread of infection occurs along neurovascular structures and weaker regions of the skull base, then into the soft tissue compartments of the face and nasopharynx. Diagnosis and treatment should be made early for this disease with poor prognosis and high mortality.

Temporal change in deep-sea benthic ecosystems: a review of the evidence from recent time-series studies.

Societal concerns over the potential impacts of recent global change have prompted renewed interest in the long-term ecological monitoring of large ecosystems. The deep sea is the largest ecosystem on the planet, the least accessible, and perhaps the least understood. Nevertheless, deep-sea data collected over the last few decades are now being synthesised with a view to both measuring global change and predicting the future impacts of further rises in atmospheric carbon dioxide concentrations. For many years, it was assumed by many that the deep sea is a stable habitat, buffered from short-term changes in the atmosphere or upper ocean. However, recent studies suggest that deep-seafloor ecosystems may respond relatively quickly to seasonal, inter-annual and decadal-scale shifts in upper-ocean variables. In this review, we assess the evidence for these long-term (i.e. inter-annual to decadal-scale) changes both in biologically driven, sedimented, deep-sea ecosystems (e.g. abyssal plains) and in chemosynthetic ecosystems that are partially geologically driven, such as hydrothermal vents and cold seeps. We have identified 11 deep-sea sedimented ecosystems for which published analyses of long-term biological data exist. At three of these, we have found evidence for a progressive trend that could be potentially linked to recent climate change, although the evidence is not conclusive. At the other sites, we have concluded that the changes were either not significant, or were stochastically variable without being clearly linked to climate change or climate variability indices. For chemosynthetic ecosystems, we have identified 14 sites for which there are some published long-term data. Data for temporal changes at chemosynthetic ecosystems are scarce, with few sites being subjected to repeated visits. However, the limited evidence from hydrothermal vents suggests that at fast-spreading centres such as the East Pacific Rise, vent communities are impacted on decadal scales by stochastic events such as volcanic eruptions, with associated fauna showing complex patterns of community succession. For the slow-spreading centres such as the Mid-Atlantic Ridge, vent sites appear to be stable over the time periods measured, with no discernable long-term trend. At cold seeps, inferences based on spatial studies in the Gulf of Mexico, and data on organism longevity, suggest that these sites are stable over many hundreds of years. However, at the Haakon Mosby mud volcano, a large, well-studied seep in the Barents Sea, periodic mud slides associated with gas and fluid venting may disrupt benthic communities, leading to successional sequences over time. For chemosynthetic ecosystems of biogenic origin (e.g. whale-falls), it is likely that the longevity of the habitat depends mainly on the size of the carcass and the ecological setting, with large remains persisting as a distinct seafloor habitat for up to 100 years. Studies of shallow-water analogs of deep-sea ecosystems such as marine caves may also yield insights into temporal processes. Although it is obvious from the geological record that past climate change has impacted deep-sea faunas, the evidence that recent climate change or climate variability has altered deep-sea benthic communities is extremely limited. This mainly reflects the lack of remote sensing of this vast seafloor habitat. Current and future advances in deep-ocean benthic science involve new remote observing technologies that combine a high temporal resolution (e.g. cabled observatories) with spatial capabilities (e.g. autonomous vehicles undertaking image surveys of the seabed).

[Pathology of the cerebellopontine angle]. / Pathologie de l'angle pontocérébelleux.

The pathology of the cistern of the cerebellopontine angle is primarily that of the nervous and vascular structures that it contains and of the meninges that line it. Knowledge of its anatomy makes it possible to understand and search for a rare pathology, the hemifacial spasm, due to a conflict between the facial nerve and the vertebral artery and the posterior inferior cerbellerar artery. However, the pathology of the cerebellopontine angle remains especially tumoral. Imaging should not only make the diagnosis but also make an exhaustive, pretherapy, and accurate assessment of the three main tumours found in this area: the vestibular schwannoma, the meningioma, and the epidermoid cyst.

[Infra tentorial tumors]. / Tumeurs de la fosse postérieure.

Infra tentorial tumors in adults are half as frequent as supra tentorial tumors. Extra-axial tumours are more frequent, mainly in the cerebellopontine angle cistern: vestibular schwannomas, meningiomas and epidermoid cysts. Tumors of the pons and cerebellum are fewer but medulloblastomas and hemangioblastomas are located primarily in the cerebellum: they are typical tumors of this area. Tumors of the IV ventricle are represented primarily by papilloma and ependymoma. The role of imaging is to ascertain the tumoral nature of the lesion and to determine its location.

The halo sign and peripancreatic fluid: useful CT signs of hypovolaemic shock complex in adults.

AIM: To report two new, useful computed tomography (CT) signs of the hypovolaemic shock complex (HSC) in adults admitted after blunt abdominal trauma: the halo sign (ring of fluid around a collapsed intra-hepatic inferior vena cava (IVC)), and peripancreatic retroperitoneal fluid. MATERIALS AND METHODS: CT images of 498 consecutive patients admitted after blunt abdominal trauma were reviewed, of which 27 had CT signs of the HSC. The CT images of these 27 patients were analysed. A control group of 101 patients examined using CT for suspected blunt abdominal trauma who did not have the HSC were chosen for comparison. RESULTS: The most common features involved the vascular compartment: diminished IVC diameter n = 27 a positive halo sign n = 21 diminished anteroposterior diameter of the aorta n = 13 and abnormal vascular enhancement n = 10. Peripancreatic retroperitoneal fluid in the absence of pancreatic injury, pancreatitis or pancreatic disease was observed in eight patients. Hollow visceral abnormalities included: diffuse increased mucosal enhancement of both the small and large bowel n = 19 diffuse thickening of the small bowel wall n =11 and small bowel dilatation n = 7. Solid visceral abnormalities included both decreased and or increased enhancement. Several concomitant intra- and extra-abdominal injuries were also identified. CONCLUSION: In the setting of blunt abdominal trauma, early abdominal CT can show diffuse abnormalities due to the HSC, which occasionally may alert clinicians of unsuspected shock. Recognition of these signs as distinguished from injured viscera is important in order to avoid unnecessary laparotomy. Two new signs are described: the halo sign and peripancreatic retroperitoneal fluid.

[Imaging of postoperative lumbar spine]. / Imagerie du rachis lombaire opéré

Complications following lumbar spine surgery are reported to occur in 15 to 30% of cases. Acute postsurgical complications (hematoma, infection.) require urgent imaging. Imaging of recurrent pain following lumbar surgery, often with a clinical presentation that is poorly specific in nature, is sometimes difficult. Selection of the initial imaging technique must simplify the diagnostic work-up. Because of its high contrast resolution, pre- and postcontrast MRI is the most effective imaging technique. Noncontrast CT may be added to facilitate detection of bony abnormalities. Diskography with post-diskogram CT can be added as well in patients with discordant results at clinical and imaging work up. The main causes of failed back syndrome are recurrent disk herniation (usually easily diagnosed), postsurgical granulation tissue/epidural fibrosis (diagnosed based on imaging) and central or lateral bony spinal stenosis. Spondylodiskitis, arachnoiditis and pseudomeningocele are other less frequent etiologies.

Functional MR imaging in assessment of language dominance in epileptic patients.

The value of functional MR Imaging (fMRI) in assessing language lateralization in epileptic patients candidate for surgical treatment is increasingly recognized. However few data are available for left-handed patients. Moreover determining factors for atypical dominance in patients investigated with contemporary imaging have not been reported. We studied 20 patients (14 males, 6 females; 9 right handed, 11 left handed) aged from 9 to 48 years, investigated for intractable partial epilepsy. Epileptic focus location was temporal in 14 cases, extratemporal in 6, and lateralized in the left hemisphere in 11/20. Hemispheric dominance for language was evaluated by both Wada test and fMRI using a silent word generation paradigm in all patients. Furthermore, a postictal speech test was performed in 15 patients. An fMRI language lateralization index was calculated from the number of activated pixels (Student's t test, P < 0.0001) in the right and left hemispheres. The Wada test showed a right hemispheric dominance in 8 patients (6 were left handed and 2 right handed) and a left hemispheric dominance in 12 patients (5 were left handed and 7 right handed). These results were concordant with clinical postictal examination in 11/15 patients (73%). Clinical status did not allow a conclusion about hemispheric dominance for the remaining 4 patients. FMRI was concordant with the Wada test in 19/20 cases. For one left-handed patient, fMRI showed bilateral activation, whereas the Wada test demonstrated a right hemispheric dominance. Right language lateralization was significantly correlated with left lateralized epilepsy (P < 0.05) but was not correlated with age at epilepsy onset, early brain injury (before 6 years), and lobar localization of epileptogenic focus. However the lack of a significant relationship between these factors and atypical language lateralization may be related to the small sample size.