Blood-wall fluttering instability as a physiomarker of the progression of thoracic aortic aneurysms.

The diagnosis of aneurysms is informed by empirically tracking their size and growth rate. Here, by analysing the growth of aortic aneurysms from first principles via linear stability analysis of flow through an elastic blood vessel, we show that abnormal aortic dilatation is associated with a transition from stable flow to unstable aortic fluttering. This transition to instability can be described by the critical threshold for a dimensionless number that depends on blood pressure, the size of the aorta, and the shear stress and stiffness of the aortic wall. By analysing data from four-dimensional flow magnetic resonance imaging for 117 patients who had undergone cardiothoracic imaging and for 100 healthy volunteers, we show that the dimensionless number is a physiomarker for the growth of thoracic ascending aortic aneurysms and that it can be used to accurately discriminate abnormal versus natural growth. Further characterization of the transition to blood-wall fluttering instability may aid the understanding of the mechanisms underlying aneurysm progression in patients.

Coronary Computed Tomography Angiography Results in More Computed Tomography Chest Follow-up for Incidental Findings at 1 Year Relative to Stress-perfusion Cardiac Magnetic Resonance Imaging.

RATIONALE AND OBJECTIVES: The aim of this study is to elucidate the prevalence and factors associated with follow-up chest computed tomography (CT) imaging in patients undergoing stress-perfusion cardiac magnetic resonance imaging (sCMR) and coronary CT angiography (cCTA). MATERIALS AND METHODS: Cardiac imaging encounters between January 1, 2015 and May 16, 2020 were selected for analysis. Follow-up was tracked within 1-year of initial cardiac imaging, up to May 16, 2021. Patient demographics, comorbidities, and cardiopulmonary outcomes were also analyzed. RESULTS: Between 2015 and 2020, there were 4024 cCTA and 837 sCMR imaging procedures on unique patients with 1.1% and 0.5% of patients having follow-up CT chest studies within 1 year, respectively. When controlling for patient demographic factors, body mass index, insurance status, smoking history, and comorbid diagnostic codes, there was statistically significant increased odds (adjusted odds ratio [95% confidence interval]: 2.864 [1.129-7.265]) of undergoing follow-up within the cCTA cohort. Pulmonary nodules represented the most common incidental finding, with cCTA associated with higher rates of pulmonary nodules detected on imaging (adjusted odds ratio [95% confidence interval]: 5.947 [4.136-8.552]). sCMR was associated with higher rates of MI, percutaneous coronary intervention, and lung malignancy within 1 year, with no difference in all-cause mortality. CONCLUSIONS: Patients undergoing either cCTA and sCMR demonstrated a low prevalence of follow-up CT chest imaging; however, follow-up was 2 times greater after cCTA due to greater pulmonary nodule detection. Potential for follow-up should be considered when evaluating the comparative effectiveness of these modalities, including the impact of follow-up imaging on cost and patient outcomes. Strategies to improve lung nodule detection and characterization at the time of sCMR may provide added value in these patients.

Excipient lung disease in a patient taking the benzodiazepine derivative etizolam: A case report.

Excipient Lung Disease is an inflammatory response to the intravenous administration of oral formulations of drugs and their excipients (additives). Previously described offenders include opioids and Ritalin, whose excipients, when crushed and administered intravenously, lead to inflammation and are demonstrated by centrilobular nodules and ground-glass formations on Chest Computed Tomography. In this case report, we demonstrate Chest CT findings of excipient lung disease in a patient using etizolam, a benzodiazepine derivative commonly used as an anxiolytic in Japan. Of note, the patient acquired etizolam for purchase through online retailers without prescription, which is becoming more common occurrence and offers the additional risk of unknown formulations.

Temporal Factors Associated With Opioid Prescriptions for Patients With Pain Conditions in an Urban Emergency Department.

Importance: Opioid prescriptions for treatment of pain in emergency departments (EDs) are associated with long-term opioid use. The temporal pattern of opioid prescribing in the context of the opioid epidemic remains unknown. Objective: To examine the temporal pattern of opioid prescribing within an ED for varying pain conditions between 2009 and 2018. Design, Setting, and Participants: A population-based, cross-sectional study was conducted at the ED of an urban academic medical center. All patients treated within that ED between January 1, 2009, and December 31, 2018, were included. Main Outcomes and Measures: The proportion of patients prescribed an opioid for treatment of pain in the ED temporally by condition, condition type, patient demographics, and physician prescriber. Results: Between 2009 and 2018, 556 176 patient encounters took place in the ED, with 70 218 unique opioid prescriptions ordered. A total of 316 632 patients (55.9%) were female, 45 070 (42.6%) were of white race, and 43 412 (40.6%) were privately insured; the median age group was 41 to 45 years. Yearly opioid prescriptions decreased by 66.3% (from 16.3 to 5.5 opioids per 100 encounters) between 2013 and 2018, with a yearly adjusted odds ratio (aOR) of 0.808 (95% CI, 0.802-0.814) compared with the prior year. In patients with musculoskeletal pain (back, joint, limb, and neck pain), opioid prescribing decreased by 71.1% (from 36.7 to 10.6 opioids per 100 encounters between 2013 and 2018; aOR, 0.758; 95% CI, 0.744-0.773). In patients with musculoskeletal trauma (fracture, sprain, contusion, and injury), opioid prescribing decreased by 58.0% (from 34.2 to 14.8 opioids per 100 encounters; aOR, 0.811; 95% CI, 0.797-0.824). In patients with nonmusculoskeletal pain (abdominal pain, kidney stone, respiratory distress, and pharyngitis) opioid prescribing decreased by 53.7% (from 20.1 to 9.3 opioids per 100 encounters; aOR, 0.850; 95% CI, 0.834-0.868). Between 2009 and 2018, patients who were black (aOR, 0.760; 95% CI, 0.741-0.779) and those who were Asian (aOR, 0.714; 95% CI, 0.665-0.764) had the lowest odds of receiving an opioid compared with other racial/ethnic groups. Conclusions and Relevance: There was a substantial temporal decrease in the number of opioid prescriptions within this ED during the study period. This decrease was associated with substantial relative reductions in opioid prescribing for treatment of musculoskeletal pain compared with fractures and kidney stones.