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Muscle injuries of the hamstrings are among the most frequent in football and a main cause for significant time away from training and competition. The purpose of this study was to prospectively evaluate the loss of muscle volume in recreational football players three and six weeks after initial trauma. We hypothesized that significant muscle volume loss occurs within 6 weeks after the initial injury event. Twenty recreational football players (mean-age=25 ± 4years; mean-height=181 ± 8cm; mean-weight=81 ± 10kg) with type3a (minor partial muscle tear) and type3b (moderate partial muscle tear) injuries were included. Muscle volume was determined using established methods for the hamstrings and the quadriceps femoris muscle within 3 days and after 3 and 6 weeks following the initial injury. The injured hamstrings lost 6.5% (mean=64 cm3(95%CI=31-98 cm3), p

Cardiac sarcoidosis (CS) is a complex disease that can manifest as a diverse array of arrhythmias. CS patients may be at higher risk for sudden cardiac death (SCD), and, in some cases, SCD may be the first presenting symptom of the underlying disease. As such, identification, risk stratification, and management of CS-related arrhythmia are crucial in the care of these patients. Left untreated, CS carries significant arrhythmogenic morbidity and mortality. Cardiac manifestations of CS are a consequence of an inflammatory process resulting in the myocardial deposition of noncaseating granulomas. Endomyocardial biopsy remains the gold standard for diagnosis; however, biopsy yield is limited by the patchy distribution of the granulomas. As such, recent guidelines have improved clinical diagnostic pathways relying on advanced cardiac imaging to help in the diagnosis of CS. To date, corticosteroids are the best studied agent to treat CS but are associated with significant risks and limited benefits. Implantable cardioverter-defibrillators have an important role in SCD risk reduction. Catheter ablation in conjunction with antiarrhythmics seems to reduce ventricular arrhythmia burden. However, the appropriate selection of these patients is crucial as ablation is likely more helpful in the setting of a myocardial scar substrate versus arrhythmia driven by active inflammation. Further studies investigating CS pathophysiology, the pathway to diagnosis, arrhythmogenic manifestations, and SCD risk stratification will be crucial to reduce the high morbidity and mortality of this disease.

Transthoracic echocardiography (TTE) is the primary clinical imaging modality for the assessment of patients with isolated aortic regurgitation (AR) in whom TTE’s linear left ventricular (LV) dimension is used to assess disease severity to guide aortic valve replacement (AVR), yet TTE is relatively limited with regards to its integrated semi-quantitative/qualitative approach. We therefore compared TTE and cardiovascular magnetic resonance (CMR) assessment of isolated AR and investigated each modality’s ability to predict LV remodeling after AVR. AR severity grading by CMR and TTE were compared in 101 consecutive patients referred for CMR assessment of chronic AR. LV end-diastolic diameter and end-systolic diameter measurements by both modalities were compared. Twenty-four patients subsequently had isolated AVR. The pre-AVR estimates of regurgitation severity by CMR and TTE were correlated with favorable post-AVR LV remodeling. AR severity grade agreement between CMR and TTE was moderate (ρ = 0.317, P = 0.001). TTE underestimated CMR LV end-diastolic and LV end-systolic diameter by 6.6 mm (P

Purpose: Ficolin-3 deficiency is caused by a mutation (+1637delC) in the FCN3 gene. It is a rare condition and has been associated with both infection and autoimmune disease including systemic lupus erythematosus (SLE). Here we investigated if ficolin-3 deficiency is more frequent in patients than in controls and tried to identify a common phenotype among ficolin-3 deficient individuals. Since a significant part of patients identified with ficolin-3 deficiency was diagnosed with SLE, we explored whether the heterozygous state of the FCN3+1637delC variant represents a risk factor in the development of SLE. Further, we examined other possible causes of ficolin-3 deficiency when the FCN3+1637delC is not present. Methods: A systematic literature search for studies measuring ficolin-3 was carried out. We examined 362 SLE patients and 596 controls for the presence of the variant FCN3+1637delC. We established assays for measurements of ficolin-3 and of auto-antibodies against ficolin-3. We sequenced the coding and non-coding regions of the FCN3 gene in an SLE patient with ficolin-3 deficiency not carrying the +1637delC. Results: Ficolin-3 deficiency leads to an 8-time increased odds of having a disease (p < 0.05). Three out of nine patients with deficiency had SLE. The heterozygous state of the deficiency variant is not associated with increased risk of developing SLE (p = 0.18). Conclusion: By systematically reviewing the literature for the described cases of ficolin-3 deficiency, an autoimmune phenotype is emerging. Thirty-three percent of the ficolin-3 deficient patients had SLE. Heterozygosity for the FCN3 gene deletion causing the deficiency does not seem to be associated with the development of SLE.

Background and Aims ANCA-associated vasculitis (AAV) is the most common cause of rapidly progressive glomerulonephritis globally and the most common finding in renal biopsies for those above 75 years of age. Patients with AAV have had an improved outcome after the introduction of immunosuppressive therapy. However, there is still an increased risk of end stage renal failure, complications to therapy, comorbidities and death. The European Vasculitis Society (EUVAS) has run several prospective randomized clinical trials (RCT) since late -90’ies as an attempt to improve the outcome for patients with a broad spectrum of AAV. The aim of the current study was to analyze results from a 10-year follow-up of patients who have participated in EUVAS’s randomized clinical trials to report on patient outcomes using current standard of care immunosuppressive treatment. Method Data on patient outcomes were collected from questionnaires to the principal investigators of the original RCTS (74 centers from 17 countries in Europe): MEPEX, NORAM, CYCAZAREM, CYCLOPS, IMPROVE, RITUXVAS and MYCYC. All patients were well characterized at inclusion in the trials respectively, as was the type and duration of induction therapy. Long-term follow-up data regarding cumulative duration and type of immunosuppressive therapy, end stage renal failure (ESRF), renal transplantation, patient survival and comorbidities as cardiovascular events, infections were recorded. Efforts have been made to control and validate the collected data. Results The current dataset comprises 858 patients, of whom 708 were eligible to include in this study. We received questionnaires regarding patient outcomes from 70% of the cohort. The median age was 60 years at time of the diagnosis of AAV; 487 patients had GPA (57%) and 371 MPA (43%). The median follow-up time was 8.0 years (IQR: 2.9-13.6). During the observation period, there were 305 deaths: 78 patients died within the first year of follow up, 69 during the following 5 years, and another 158 patients after 5 years. The main causes of death were infections (25%), cardiovascular disease (14%) and malignancies (13%), followed by pulmonary diseases, vasculitis, others, kidney disease and gastrointestinal disease. Vasculitis were a major contributor to the causes of death in 18% of the patients. Median survival time for the whole cohort was 17.8 years (95%CI: 15.6 – 20.1). Survival rate at 5 and 10 years was 81.6% and 66.5% respectively. Advanced age, low estimated glomerular filtration rate and male sex were negative prognostic factors for patient survival in the Cox model. When we categorized the deaths according to their initial CKD stage, the highest number of deaths was found in the group of patients with low eGFR i.e. an initial CKD stage V (40%). The initial CKD stage, as shown in the Kaplan-Meier curve, was found to have an important impact on the patient survival (LR: 144.4 p In our cohort, 159 patients (18.5%) reached ESRF, of whom 110 patients died (69%); the main cause of death in this group was infection. Conclusion In a series of over 800 patients with AAV, ten-year mortality was predominantly associated with impaired renal function at onset, older age and male gender, rather than subtype of disease. The main strength of this study is that we have a well-defined cohort of patients with AAV, all with well-defined induction treatments and a long period of follow-up with the possibility to analyze possible prognostic factors regarding outcomes. Further analyses are ongoing regarding comparative statistics, cumulative incidence of malignancies, renal transplantation and comorbidities. The data supports efforts to diagnose these patients at an earlier stage, when they have a higher eGFR and to tailor therapy for the individual patient. Although newer treatment modalities are available, there is still a considerable morbidity and mortality in the long-term.

BACKGROUND Literature reporting [18F]fluorodexoyglucose positron emission tomography (FDG-PET) of small bowel adenocarcinoma, a rare tumor, is sparse. To assess FDG uptake in small bowel adenocarcinoma, we retrospectively analyzed a large, single-center database and determined the expression of glucose-transporter type 1 (GLUT-1). METHODS Screening of PET datasets in the database (N.=28,961 scans) for untreated histologically-confirmed primary small bowel adenocarcinoma revealed evaluable PET datasets for eight patients. Maximum and peak standardized uptake values (SUV max and SUV peak , respectively) were calculated via volume-of-interest (VOI) analysis. Additionally, GLUT-1 expression on tumor specimens was prospectively immunohistochemically assessed. RESULTS All primary tumors showed high FDG uptake: mean SUVmax was 9.5±2.6 (range: 5.0-13.0) and SUVpeak, 8.1±2.3 (range: 3.9-10.7). Corresponding biopsy specimens (N.=7) demonstrated high GLUT-1 expression. CONCLUSIONS Primary small bowel adenocarcinomas have a high GLUT-1 expression. Tumor lesions consistently demonstrated high FDG uptake pre-treatment, suggesting FDG-PET utility in staging and follow-up of these tumors.

Introduction This study sought to assess ocular surface disease changes following cataract surgery combined with trabecular micro-bypass stent(s) implantation (iStent or iStent inject). Methods This prospective interventional single-arm clinical trial enrolled 47 eyes with mild-to-moderate open-angle glaucoma (OAG) on 1–4 glaucoma medications who underwent phacoemulsification and trabecular micro-bypass stent(s) implantation. Key glaucoma and ocular surface data through 3 months postoperatively included the Ocular Surface Disease Index score (OSDI), corneal/conjunctival staining (Oxford Schema), fluorescein tear break-up time (FTBUT), conjunctival hyperemia (Efron Scale), glaucoma medications, and intraocular pressure (IOP). Results Mean OSDI scores improved from 40.1 ± 21.6 (severe) preoperatively to 17.5 ± 15.3 (mild) at 3 months (p

Non-invasive imaging plays a pivotal role in modern-day medicine from diagnosis to management of disease. It is crucial to have a solid understanding of the various indications and limitations of these techniques to be able to best utilize the different modalities in risk assessment and clinical decision-making. Through this chapter, we will go through the fundamentals of the different modalities and selection of an image modality based on the disease being investigated and individual patient characteristics. A multimodality approach to patient evaluation is needed more times than not, and it is important to choose modalities that complement each other rather than repeating the same evaluation.

Purpose To develop and evaluate an imaging sequence to simultaneously quantify the epicardial fat volume and myocardial T1 relaxation time. Methods We introduced a novel simultaneous myocardial T1 mapping and fat/water separation sequence (joint T1 -fat/water separation). Dixon reconstruction is performed on a dual-echo data set to generate water/fat images. T1 maps are computed using the water images, whereas the epicardial fat volume is calculated from the fat images. A phantom experiment using vials with different T1 /T2 values and a bottle of oil was performed. Additional phantom experiment using vials of mixed fat/water was performed to show the potential of this sequence to mitigate the effect of intravoxel fat on estimated T1 maps. In vivo evaluation was performed in 17 subjects. Epicardial fat volume, native myocardial T1 measurements and precision were compared among slice-interleaved T1 mapping, Dixon, and the proposed sequence. Results In the first phantom, the proposed sequence separated oil from water vials and there were no differences in T1 of the fat-free vials (P = .1). In the second phantom, the T1 error decreased from 22%, 36%, 57%, and 73% to 8%, 9%, 16%, and 26%, respectively. In vivo there was no difference between myocardial T1 values (1067 ± 17 ms versus 1077 ± 24 ms, P = .6). The epicardial fat volume was similar for both sequences (54.3 ± 33 cm3 versus 52.4 ± 32 cm3 , P = .8). Conclusion The proposed sequence provides simultaneous quantification of native myocardial T1 and epicardial fat volume. This will eliminate the need for an additional sequence in the cardiac imaging protocol if both measurements are clinically indicated.

To assess long-term efficacy and safety of salsalate to improve glycemia in persons with diabetes risk, who are overweight with statin-treated, stable coronary heart disease.Glycemic status was assessed in 192 persons without diabetes at baseline in a pre-specified secondary analysis from Targeting INflammation Using SALsalate in CardioVascular Disease (TINSAL-CVD), a multi-center, double-masked, randomized (1:1), placebo-controlled, parallel clinical trial.Participants were mostly Caucasian males, age 60±7 years, BMI 31.4±3.0 kg/mSalsalate improves glycemia in obese persons at increased risk for diabetes, and hence may decrease risk of incident type 2 diabetes. Salsalate may inform new therapeutic approaches for diabetes prevention, but renal safety may limit clinical utility.

Background The European League Against Rheumatism (EULAR) Recommendation for primary and small vessel vasculitis were published in 2009. Objectives To update the 2009 recommendations with the focus being ANCA-Associated Vasculitis (AAV) using systematic literature review, as well as expert opinion where appropriate. Methods A combined taskforce from European League Against Rheumatism (EULAR), the European Renal Association (ERA-EDTA) and European Vasculitis Society (EUVAS) conducted a modified Delphi exercise to identify key areas of guideline for update. The identified themes were then used to generate keywords for literature searches. For the purpose of update a date period of 1st January 2007 to 1st February 2015 was chosen, to interrogate the main medical literature databases (MEDLINE, EMBASE, CENTRAL). From an initial 1,347 hits, 82 clinically relevant studies were identified. The evidence presented was discussed and summarized by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Results The 15 recommendations cover general aspects, such as attainment of remission and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting immunosuppressive therapy using a strategy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance. For remission induction of life or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy. Azathioprine, rituximab and methotrexate are the preferred choices for remission maintenance. The recommendations address plasma exchange which is recommended, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. To enable the recommendations to have maximum validity the voting process was also repeated amongst the members of EUVAS. Conclusions The recommendations have been updated and changes include; choice of drug therapy (both for induction, relapse and remission maintenance), monitoring for complications, the usefulness of repeated biopsy in those thought to having relapsing disease, monitoring for hypoimmunoglobulinaemia and recommendations on patient education. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations. Disclosure of Interest None declared

The development of radiofrequency ablation for the treatment of atrial fibrillation has led to an increased interest in the accurate determination of pulmonary vein anatomy and left atrial fibrosis assessment to help plan the procedure and to monitor for postablation stenosis. Contrast-enhanced magnetic resonance angiography readily demonstrates the pulmonary veins and is the method of choice for these imaging studies. In this chapter, we review the methods used to image the pulmonary veins, normal and anomalous pulmonary venous anatomy. We describe how late gadolinium enhancement imaging is used to identify fibrosis and scar. The utility of cardiovascular magnetic resonance before and after atrial fibrillation ablation is described.

Objective We aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T 1 with complex ventricular arrhythmia (ComVA) in mitral valve prolapse (MVP). Methods A retrospective analysis was performed on 41 consecutive patients with MVP referred for CMR between 2006 and 2011, and 31 healthy controls. Arrhythmia analysis was available in 23 patients with MVP with Holter/event monitors. Left ventricular (LV) septal T 1 times were derived from Look-Locker sequences after administration of 0.2 mmol/kg gadopentetate dimeglumine. Late gadolinium enhancement (LGE) CMR images were available for all subjects. Results Patients with MVP had significantly shorter postcontrast T 1 times when compared with controls (334±52 vs 363±58 ms; p=0.03) despite similar LV ejection fraction (LVEF) (63±7 vs 60±6%, p=0.10). In a multivariable analysis, LV end-diastolic volume, LVEF and mitral regurgitation fraction were all correlates of T 1 times, with LVEF and LV end-diastolic volume being the strongest (p=0.005, p=0.008 and p=0.045, respectively; model adjusted R 2 =0.30). Patients with MVP with ComVA had significantly shorter postcontrast T 1 times when compared with patients with MVP without ComVA (324 (296, 348) vs 354 (327, 376) ms; p=0.03) and only 5/14 (36%) had evidence of papillary muscle LGE. Conclusions MVP may be associated with diffuse LV myocardial fibrosis as suggested by reduced postcontrast T 1 times. Diffuse interstitial derangement is linked to subclinical systolic dysfunction, and may contribute to ComVA in MVP-related mitral regurgitation, even in the absence of focal fibrosis.

We developed a deep convolutional neural network (CNN) based method to remove streaking artefact from accelerated radial acquisitions of myocardial T 1-mapping images. A deep CNN based on a modified U-Net architecture was developed and trained to remove the streaking artefacts from under-sampled T 1 mapping images. A total of 2090 T 1-weighted images for 33 patients (55 ± 15 years, 19 males) and five healthy subjects (30 ± 14 years, 2 males) were used for training and testing the network. The images were acquired using radial slice interleaved T 1 mapping sequence (STONE) and retrospectively under-sampled to achieve acceleration rate of 4 (corresponding to 48 spokes). The dataset was split into training and testing subsets with 23 subjects (60%) and 15 subjects (40%), respectively. For generating voxel-wise T 1 maps, a two-parameter fitting model was used. Network performance was evaluated using normalized mean square error (NMSE), structural similarity index (SSIM) and peak signal-to-noise ratio (PSNR) metrics. The proposed network allowed fast (T 1-weighted testing images and the corresponding T 1 maps with PSNR = 64.3 ± 1.02, NMSE = 0.2 ± 0.09 and SSIM = 0.9 ± 0.3 × 10−4. There was no statistically significant difference between the measured T 1 maps for both per-subject (reference: 1085 ± 37 ms, CNN: 1088 ± 37 ms, p = 0.4) and per-segment (reference: 1084 ± 48 ms, CNN: 1083 ± 58 ms, p = 0.9) analyses. In summary, deep CNN allows fast and reliable removal of streaking artefact from under-sampled radial T 1 mapping images. Our results show that the highly non-linear operations of deep CNN processing of T 1 mapping images do not impact accurate reconstruction of myocardial T 1 maps.

Podeu consultar la correcció d'errades a: http://dx.doi.org/10.1136/annrheumdis-2016-209133corr1, In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in life-threatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations.

Attention to resource utilization has led to increased scrutiny of the appropriateness of initial diagnostic imaging studies on the basis of current guidelines. Far less attention has been paid to examining the lack of appropriate follow-up studies.A retrospective cross-sectional analysis was performed of 3,781 consecutive outpatients referred for transthoracic echocardiography (TTE) from July to December 2008. Data from the electronic medical records were extracted to see if patients with at least moderate left-sided valvular stenosis or regurgitation underwent subsequent echocardiographic studies within 60 days of the period recommended by the 2006 American College of Cardiology and American Heart Association valve guidelines document.Of 342 outpatients with at least moderate valve dysfunction, 38 (11%) were excluded for reasons that precluded the need for a follow-up study (e.g. death, surgery). Of the remaining 304 patients, only 179 (59%) underwent follow-up echocardiography within the recommended period. Rates of timely follow-up TTE were higher when ordering physicians were cardiologists or cardiovascular surgeons (65%) compared with primary care physicians or internal medicine specialists (45%) (P.01). Follow-up rates were significantly different for aortic stenosis (77%), mitral stenosis (67%), aortic regurgitation (49%), and mitral regurgitation (49%) (P.01). Patients receiving timely follow-up TTE were younger (66 ± 15 vs 71 ± 15 years, P = .002) and more likely to be male (odds ratio, 1.79; 95% CI, 1.12-2.85; P = .01).To the authors' knowledge, this is the first study demonstrating low rates of compliance with guideline-recommended monitoring TTE in patients with at least moderate valve dysfunction. Cardiac practitioners have significantly better compliance. Strategies are needed to improve timely follow-up care in this population.

ObjectivesThe RITUXVAS trial reported similar remission induction rates and safety between rituximab and cyclophosphamide based regimens for antineutrophil cytoplasm antibody (ANCA)-associated vasculitis at 12 months; however, immunosuppression maintenance requirements and longer-term outcomes after rituximab in ANCA-associated renal vasculitis are unknown.MethodsForty-four patients with newly diagnosed ANCA-associated vasculitis and renal involvement were randomised, 3:1, to glucocorticoids plus either rituximab (375 mg/m2/week×4) with two intravenous cyclophosphamide pulses (n=33, rituximab group), or intravenous cyclophosphamide for 3–6 months followed by azathioprine (n=11, control group).ResultsThe primary end point at 24 months was a composite of death, end-stage renal disease and relapse, which occurred in 14/33 in the rituximab group (42%) and 4/11 in the control group (36%) (p=1.00). After remission induction treatment all patients in the rituximab group achieved complete B cell depletion and during subsequent follow-up, 23/33 (70%) had B cell return. Relapses occurred in seven in the rituximab group (21%) and two in the control group (18%) (p=1.00). All relapses in the rituximab group occurred after B cell return.ConclusionsAt 24 months, rates of the composite outcome of death, end-stage renal disease and relapse did not differ between groups. In the rituximab group, B cell return was associated with relapse.Trial registration numberISRCTN28528813.

The HAWAI registry evaluated the role of heart rate variability in predicting the occurrence of ventricular tachycardia and fibrillation (VT/VF) and sinus tachycardia in patients with an implantable cardioverter-defibrillator (45 patients with 155 RR recordings). A significant decrease of the mean value of all RR intervals (MeanNN) was observed in the period starting 20 and 40 min prior to VT/VF and sinus tachycardia, respectively. The standard deviation of RR intervals (SDNN) and the power at low frequency (LF) were the only parameters with significant changes prior to VT/VF. For sinus tachycardia, the root mean square of successive differences of all successive RR intervals (r-MSSD) and the power at low and high frequency (HF) decreased, whereas SDNN and the power at very low frequency increased. Comparison of RR recordings preceding VT/VF and sinus tachycardia revealed significant differences of the MeanNN, SDNN, r-MSSD, LF and HF. Based on a classification and regression tree analysis, MeanNN, SDNN and r-MSSD showed a sensitivity of 94.4% and a specificity of 50.6% as predictors of VT/VF. Our results suggest that the temporal changes in heart rate before an arrhythmic event can be used to predict the occurrence of VT/VF. These parameters may be used to optimize pacing therapies designed to prevent VT/VF recurrences as well as for improving device-based discriminators for VT/VF and sinus tachycardia.

Until recently, standard of care for patients with generalized or severe antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) has consisted of an induction regimen with cyclophosphamide (CYC) and corticosteroids followed by maintenance treatment with azathioprine. This regimen is associated with significant toxicity resulting in considerable morbidity and mortality whereas relapses are still not infrequent. In two controlled trials, the Rituximab in ANCA-associated Vasculitis study (RAVE) and the RITUXVAS trial of the European Vasculitis Study Group (EUVAS), rituximab (RTX) proved non-inferior to CYC for induction of remission. In addition, outcome at 18 months for the RAVE trial and 12 months for the RITUXVAS trial showed that RTX without maintenance treatment was as efficacious as CYC followed by azathioprine maintenance. To prevent relapses, which occur particularly in patients positive for PR3-ANCA, 500 mg RTX given every 6 months was shown to be superior to azathioprine in a French study. Thus, RTX is a new and promising therapeutic armamentarium for AAV although long-term safety has still to be established.

Higher hemoglobin A1c (HbA1c) is associated with lower cognitive function in type 2 diabetes. To determine whether associations persist at lower levels of dysglycemia in patients who have established cardiovascular disease, cognitive performance was assessed in the Targeting INflammation Using SALsalate in CardioVascular Disease (TINSAL-CVD) trial.The age-adjusted relationships between HbA1c and cognitive performance measured by the Mini-Mental State Examination, Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Trail Making Test, and Categorical Verbal Fluency were assessed in 226 men with metabolic syndrome and established stable coronary artery disease.Of the participants, 61.5% had normoglycemia, 20.8% had impaired fasting glucose, and 17.7% had type 2 diabetes. HbA1c was associated with cognitive function tests of Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, Trail Making Test, and Categorical Verbal Fluency (all P.02), but not the Mini-Mental State Examination. In an age-adjusted model, a 1% (11 mmol/mol) higher HbA1c value was associated with a 5.9 lower Digit Symbol Substitution Test score (95% confidence interval [CI], -9.58 to -2.21; P.0001); a 2.44 lower Rey Auditory Verbal Learning Test score (95% CI, -4.00 to -0.87; P.0001); a 15.6 higher Trail Making Test score (95% CI, 5.73 to 25.6; P.0001); and a 3.71 lower Categorical Verbal Fluency score (95% CI, -6.41 to -1.01; P.02). In a multivariate model adjusting for age, education, and cardiovascular covariates, HbA1c remained associated with cognitive function tests of Rey Auditory Verbal Learning Test (R(2) = 0.27, P.0001), Trail Making Test (R(2) = 0.18, P.0001), and Categorical Verbal Fluency (R(2) = 0.20, P.0001), although association with the Digit Symbol Substitution Test was reduced.Higher HbA1c is associated with lower cognitive function performance scores across multiple domain tests in men with metabolic syndrome and coronary artery disease. Future studies may demonstrate whether glucose lowering within the normative range improves cognitive health.

© 2017 International Society of Nephrology. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., The 2016 European Vasculitis Society (EUVAS) meeting, held in Leiden, the Netherlands, was centered around phenotypic subtyping in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). There were parallel meetings of the EUVAS petals, which here report on disease assessment; database; and long-term follow-up, registries, genetics, histology, biomarker studies, and clinical trials. Studies currently conducted will improve our ability to discriminate between different forms of vasculitis. In a project that involves the 10-year follow-up of AAV patients, we are working on retrieving data on patient and renal survival, relapse rate, the cumulative incidence of malignancies, and comorbidities. Across Europe, several vasculitis registries were developed covering over 10,000 registered patients. In the near future, these registries will facilitate clinical research in AAV on a scale hitherto unknown. Current studies on the genetic background of AAV will explore the potential prognostic significance of genetic markers and further refine genetic associations with distinct disease subsets. The histopathological classification of ANCA-associated glomerulonephritis is currently evaluated in light of data coming out of a large international validation study. In our continuous search for biomarkers to predict clinical outcome, promising new markers are important subjects of current research. Over the last 2 decades, a host of clinical trials have provided evidence for refinement of therapeutic regimens. We give an overview of clinical trials currently under development, and consider refractory vasculitis in detail. The goal of EUVAS is to stimulate ongoing research in clinical, serological, and histological management and techniques for patients with systemic vasculitis, with an outlook on the applicability for clinical trials.

The European League Against Rheumatism recommendations for the management of antineutrophil cytoplasmic antibody-associated vasculitis have been recently published. Unique to recommendation development, they were also voted on by members of a learned society. This paper explores the wider validity of the recommendations among people who self-identify as clinicians caring for patients with vasculitis. In addition to the task force, a learned society (European Vasculitis Society-EUVAS) was invited, through online survey, to rate independently the strength of evidence of each recommendation to obtain an indication of the agreement among the final target audience and ultimate end-users of the recommendations. The survey took place in June 2015. Of the 158 EUVAS members surveyed, there were 88 responses (55.7%). There was a large degree of agreement in the voting patterns between EUVAS survey participants and task force members. Notable exceptions were lower grades for the recommendation of the use of rituximab for remission induction in patients with eosinophilic granulomatosis with polyangiitis and for methotrexate and mycophenolate mofetil as remission maintenance agents in patients with granulomatosis with polyangiitis/microscopic polyangiitis by EUVAS members. These results are encouraging and suggest that the voting patterns of the task force are representative of the wider vasculitis community. We recommend future recommendations adopt this approach for data/expert-based treatment guidelines, especially for multisystem diseases.

Objective To develop a simplified method to quantify liver fat using computed tomography (CT) fat % index (CT FPI ) compared to liver spleen method (CT L/S , CT L−S ). Methods Noncontrast CT of the liver was performed in 89 patients (overweight, obese, severely obese) to quantify fat, using the following: CT FPI =[(65−patient HU)/65]×100, normal live r =65 HU. Results There was a strong linear correlation between CT FPI and the standard method of assessing liver fat using CT L/S ( r =−0.901), CT L−S ( r =−0.911). Hepatic HU and CT FPI were significantly different in the severely obese group compared to other two groups ( P Conclusion Significant correlation indicates equal diagnostic accuracy of the two methods in appropriately calibrated scanners.

Purpose To develop and evaluate an image reconstruction technique for cardiac MRI (CMR) perfusion that uses localized spatio-temporal constraints. Methods CMR perfusion plays an important role in detecting myocardial ischemia in patients with coronary artery disease. Breath-hold k-t–based image acceleration techniques are typically used in CMR perfusion for superior spatial/temporal resolution and improved coverage. In this study, we propose a novel compressed sensing-based image reconstruction technique for CMR perfusion, with applicability to free-breathing examinations. This technique uses local spatio-temporal constraints by regularizing image patches across a small number of dynamics. The technique was compared with conventional dynamic-by-dynamic reconstruction, and sparsity regularization using a temporal principal-component (pc) basis, as well as zero-filled data in multislice two-dimensional (2D) and three-dimensional (3D) CMR perfusion. Qualitative image scores were used (1 = poor, 4 = excellent) to evaluate the technique in 3D perfusion in 10 patients and five healthy subjects. On four healthy subjects, the proposed technique was also compared with a breath-hold multislice 2D acquisition with parallel imaging in terms of signal intensity curves. Results The proposed technique produced images that were superior in terms of spatial and temporal blurring compared with the other techniques, even in free-breathing datasets. The image scores indicated a significant improvement compared with other techniques in 3D perfusion (x-pc regularization, 2.8 ± 0.5 versus 2.3 ± 0.5; dynamic-by-dynamic, 1.7 ± 0.5; zero-filled, 1.1 ± 0.2). Signal intensity curves indicate similar dynamics of uptake between the proposed method with 3D acquisition and the breath-hold multislice 2D acquisition with parallel imaging. Conclusion The proposed reconstruction uses sparsity regularization based on localized information in both spatial and temporal domains for highly accelerated CMR perfusion with potential use in free-breathing 3D acquisitions. Magn Reson Med 72:629–639, 2014. © 2013 Wiley Periodicals, Inc.

Importance Inflammation may contribute to pathological associations among obesity, diabetes mellitus, and cardiovascular disease. Objective To determine whether targeting inflammation using salsalate compared with placebo reduces progression of noncalcified coronary artery plaque. Design, Setting, and Participants In the Targeting Inflammation Using Salsalate in Cardiovascular Disease (TINSAL-CVD) trial participants were randomly assigned between September 23, 2008, and July 5, 2012, to 30 months of salsalate or placebo in addition to standard, guideline-based therapies. Randomization was computerized and centrally allocated, with patients, health care professionals, and researchers masked to treatment assignment. Participants were overweight and obese statin-using patients with established, stable coronary heart disease. Interventions Salsalate (3.5 g/d) or placebo orally over 30 months. Main Outcomes and Measures The primary outcome was progression of noncalcified coronary artery plaque assessed by multidetector computed tomographic angiography. Secondary outcomes were other measures of safety and efficacy. Results Two hundred fifty-seven participants were randomized to salsalate (n = 129) or placebo (n = 128). Their mean (SD) age was 60.8 (7.0) years, and 94.0% (236 of 251) were male. One hundred ninety participants (89 in the salsalate group and 101 in the placebo group) completed the study. Compared with baseline, there was no increase in noncalcified plaque volume in the placebo-treated patients and no difference in change between the salsalate and placebo groups (mean difference, −1 mm3; 95% CI, −11 to 9 mm3;P = .87). Salsalate treatment decreased total white blood cell, lymphocyte, monocyte, and neutrophil counts and increased adiponectin levels without change in C-reactive protein levels. Fasting glucose, triglycerides, uric acid, and bilirubin levels were decreased in the salsalate group compared with the placebo group, while hemoglobin levels were increased. Urinary albumin levels increased, with tinnitus and atrial arrhythmias more common, in the salsalate group compared with the placebo group. Conclusions and Relevance Salsalate when added to current therapies that include a statin does not reduce progression of noncalcified coronary plaque volume assessed by multidetector computed tomographic angiography in statin-using patients with established, stable coronary heart disease. The absence of progression of noncalcified plaque volume in the placebo group may limit interpretation of the trial results. Trial Registration clinicaltrials.gov Identifier:NCT00624923

Purpose To develop and evaluate a technique that uses the k-space lines rejected by prospective respiratory navigator (NAV) to improve the signal-to-noise ratio (SNR) without increasing the scan time. Methods In conventional image reconstruction, the motion-corrupted k-space lines rejected by the NAV are not used. In this study, a set of translational motion parameters for the NAV-rejected lines and a phase-corrected average for the k-space line are estimated jointly using a maximum-likelihood approach and the information from the corresponding accepted k-space lines. Left coronary artery images were acquired in 10 healthy adult subjects, and the proposed approach incorporating the NAV-rejected lines was compared with the conventional dataset with NAV-accepted lines only, as well as a simple average of all k-space lines, in terms of SNR, normalized vessel sharpness and qualitative image scores on a four-point scale (1 = poor, 4 = excellent). Late gadolinium enhancement images of the left atrium were also acquired in 21 patients with atrial fibrillation pre- or post-pulmonary vein isolation. Images reconstructed with the proposed, conventional, and simple averaging methods were compared in terms of SNR, and subjective image quality on a four-point scale. Results For coronary MRI, there was a significant improvement in SNR with the proposed technique, but no significant difference in normalized vessel sharpness or qualitative image scores were observed with respect to the conventional method. Simple averaging resulted in an SNR gain, but significant loss in vessel sharpness and image quality. For late gadolinium enhancement, there was a significant increase in SNR, but no significant differences were observed in subjective image quality scores between the proposed and conventional methods. There was an SNR gain, but image quality loss for simple averaging, when compared with the conventional technique. In both coronary MRI and late gadolinium enhancement, the SNR gain of the proposed method was not significantly different than the maximum theoretical SNR gain. Conclusion The proposed technique improves SNR using the additional information from NAV-rejected k-space lines, while providing similar image quality to standard reconstruction using motion-free k-space data only, with no increase in scan time. Magn Reson Med 70:1332–1339, 2013. © 2012 Wiley Periodicals, Inc.

It is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes.In this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes.The rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65).In patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.).

Background— In hypertrophic cardiomyopathy (HCM), the arrhythmic potential associated with a variety of left ventricular myocardial signal intensities evident on contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement (LGE) is unresolved. Methods and Results— In 145 HCM patients (43±15 years old), visually identified areas of LGE in left ventricle were analyzed quantitatively for intermediate (≥4 but P =0.003 to P =0.02–0.003) than patients without these arrhythmias. In HCM patients with either nonsustained ventricular tachycardia, couplets, or premature ventricular contractions, the extent of intermediate LGE-SI exceeded that of high LGE-SI (17±7 versus 15±6 g, 16±10 versus 14±9 g, and 13±8 versus 12±7 g, respectively; P =0.01–0.04). In addition, the receiver operating characteristic area under the curve established intermediate LGE-SI as a better discriminator of patients with nonsustained ventricular tachycardia than was high LGE-SI, with 7 additional patients with this arrhythmia identified. Conclusions— In patients with HCM, intermediate LGE-SI is a better predictor of ventricular tachyarrhythmias (including nonsustained ventricular tachycardia, a risk factor for sudden death) than is high LGE-SI. Longitudinal studies in larger HCM cohorts are justified to define the independent prognostic impact of intermediate LGE-SI.

Objectives The aim of this study was to evaluate whether coronary heart disease (CHD)-susceptibility loci identified by genome-wide association studies of the general population also contribute to CHD in type 2 diabetes. Background No study has examined the effects of these genetic variants on CHD in diabetic patients. Methods We genotyped 15 genetic markers of 12 loci in 3 studies of diabetic patients: the prospective Nurses' Health Study (309 CHD cases, and 544 control subjects) and Health Professional Follow-up Study (345 CHD cases, and 451 control subjects) and the cross-sectional Joslin Heart Study (422 CHD cases, and 435 control subjects). Results Five single-nucleotide polymorphisms, rs4977574 ( CDKN2A/2B ), rs12526453 ( PHACTR1 ), rs646776 ( CELSR2-PSRC1-SORT1 ), rs2259816 ( HNF1A ), and rs11206510 ( PCSK9 ) showed directionally consistent associations with CHD in the 3 studies, with combined odds ratios (ORs) ranging from 1.17 to 1.25 (p = 0.03 to 0.0002). None of the other single-nucleotide polymorphisms reached significance in individual or combined analyses. A genetic risk score (GRS) was created by combining the risk alleles of the 5 significantly associated loci. The OR of CHD/GRS unit was 1.19 (95% confidence interval: 1.13 to 1.26; p Conclusions Our results illustrate the consistency and differences in the determinants of genetic susceptibility to CHD in diabetic patients and the general populations.

BACKGROUND: Even with standardization and increasing experience, laparoscopic cholecystectomy still entails the risk of injury to the bile ducts. The incidence of iatrogenic bile-duct injury is currently estimated at 0.3–0.9%. In spite of the downward trend compared to the historical course, the incidence of iatrogenic bile duct injuries is still higher and so continues to be a determining factor for morbidity with LCHE. METHODS AND RESULTS: Independent of the frequency, the nature of bile duct lesions has also changed. There are not only direct injuries, similar to the direct transection of the bile duct with open LCHE, but there are also long substance defects due to resection of the hepatic duct up to or beyond the bifurcation. In one-quarter of cases, neighboring vascular structures are also injured. With inadequate treatment, the life quality suffers due to functional long-term damage reflected in cholangitis or secondary biliary cirrhosis with portal hypertension up to loss of liver function. CONCLUSIONS: Corrective surgery requires suitable surgical expertise in hepatobiliary surgery as well as institutional resources that allow an individual treatment plan based on interdisciplinary cooperation among surgeon, interventional radiologist and gastroenterologist. The long-term prognosis will depend on early diagnosis and efficient therapeutic management.

BACKGROUND: Unlike colon surgery, gastric surgery developed only slowly. Standardized stomach surgery can be said to have begun in 1881 with Billroth's successful gastric resection. The Department of Surgery in Graz was involved in the development and then rapid dissemination of gastric surgery, with respect to both ulcer and cancer surgery. Since the introduction of the modern proton-pump inhibitors, surgery for gastric ulcers today is mainly limited to the treatment of complications. In spite of the worldwide decrease in the incidence of stomach cancer, it is still of great clinical importance in Austria. METHODS: The development of gastric surgery at the Department of Surgery in Graz is presented on the basis of the literature. RESULTS: Still today, the only curative option for stomach cancer is radical surgical removal with lymphadenectomy as indicated. In the period of January 1, 1994 to December 31, 2004, 341 patients with stomach cancer were treated at the Division of General Surgery in Graz; 265 of them could be operated and the average 5-year survival rate was 36% without regard to tumor stage. CONCLUSIONS: It may be said that more than one hundred years of development have led to the standardization and optimization of gastric surgery, and that the contributions of surgeons in Austria and in Graz were considerable.

Purpose: To investigate the efficacy of distributed compressed sensing (CS) to accelerate free-breathing, electrocardiogram (ECG)-triggered noncontrast pulmonary vein (PV) magnetic resonance angiography (MRA). Materials and Methods: Fully sampled ECG-triggered noncontrast PV MRA, using a spatially selective slab inversion preparation sequence, was acquired on seven healthy adult subjects (27 ± 17 years, range: 19–65 years, 4 women). The k-space data were retrospectively randomly undersampled by factors of 2, 4, 6, 8, and 10 and then reconstructed using distributed CS and coil-by-coil CS methods. The reconstructed images were evaluated by two blinded readers in consensus for assessment of major PV branches as well as the presence of artifacts in left atrium (LA) and elsewhere. Diameters of right inferior and right superior PV branches were measured. Additionally, mean square errors (MSE) of the reconstructions were calculated. Results: Both CS methods resulted in image quality scores similar to the fully sampled reference images at undersampling factors up to 6-fold for distributed CS and 4-fold for coil-by-coil CS reconstructions. There was no difference in the presence of artifacts in LA and freedom from important artifacts elsewhere between the two techniques up to undersampling factors of 10 compared to the fully sampled reconstruction. For the PV diameters, no systematic variation between the reference and the reconstructions were observed for either technique. There were no significant differences in MSE between the two methods when compared at a given rate, but the difference was significant when compared across all rates. Conclusion: The sparsity of noncontrast PV MRA and the joint sparsity of different coil images allow imaging at high undersampling factors (up to 6-fold) when distributed CS is used. J. Magn. Reson. Imaging 2011;33:1248–1255. © 2011 Wiley-Liss, Inc.

Angesichts einer immer alter werdenden Bevolkerung sind wir mit dem Problem einer zunehmenden Zahl an Patienten mit Demenzerkrankungen konfrontiert. In der Fruhdiagnostik einer Demenz spielen neben klinischen, neuropsychologischen und laborchemischen Untersuchungen nichtinvasive Bildgebungsverfahren wie die MRT eine bedeutende Rolle. Wichtig ist dabei die Fruhdiagnostik einer Demenz bereits im Vorstadium der leichten kognitiven Beeintrachtigung („mild cognitive impairment“, MCI), da dieses Krankheitsbild mit einem deutlich erhohten Demenzrisiko einhergeht und durch eine fruhzeitige Therapie der Krankheitsverlauf abgemildert oder deutlich verzogert werden kann. Neben morphologischen Veranderungen helfen verschiedene funktionelle MR-Verfahren bei der Fruhdiagnostik einer Demenz. Daruber hinaus ist es von groser Bedeutung, diejenigen MCI-Patienten zu detektieren, die in besonderem Mase von einer Demenz bedroht sind. Bei der Differenzierung von Konvertern zu Nonkonvertern deuten erste Studien darauf hin, dass v. a. die voxelbasierte Morphometrie, die MR-Spektroskopie und die Diffusionstensorbildgebung wichtige Zusatzinformationen liefern konnten.

Two-dimensional “pencil-beam” navigator, placed on the right hemidiaphragm (RHD), is used for free-breathing late gadolinium enhancement (LGE) of the left atrium (LA) in patients with atrial fibrillation (AF). The pencil-beam navigator creates an inflow artifact in the right PVs and atrial wall that may obscure local PV and LA scars. To reduce this artifact, we propose a large slab RHD projection navigator that measures the respiratory motion while reducing the associated inflow artifact. Eighteen subjects underwent pulmonary vein LGE using the pencil-beam and projection navigator. Subjective inflow and respiratory motion artifact scores (1=severe, 2=moderate, 3=mild, and 4=none) from two blinded readers were compared. The artifact scores were 3.8±0.4 and 2.1±0.7 for the projection and pencil-beam navigators, respectively (p

In this study, we present a motion correction technique using coil arrays (MOCCA) and evaluate its application in free-breathing respiratory self-gated cine MRI. Motion correction technique using coil arrays takes advantages of the fact that motion-induced changes in k-space signal are modulated by individual coil sensitivity profiles. In the proposed implementation of motion correction technique using coil arrays self-gating for free-breathing cine MRI, the k-space center line is acquired at the beginning of each k-space segment for each cardiac cycle with 4 repetitions. For each k-space segment, the k-space center line acquired immediately before was used to select one of the 4 acquired repetitions to be included in the final self-gated cine image by calculating the cross correlation between the k-space center line with a reference line. The proposed method was tested on a cohort of healthy adult subjects for subjective image quality and objective blood-myocardium border sharpness. The method was also tested on a cohort of patients to compare the left and right ventricular volumes and ejection fraction measurements with that of standard breath-hold cine MRI. Our data indicate that the proposed motion correction technique using coil arrays method provides significantly improved image quality and sharpness compared with free-breathing cine without respiratory self-gating and provides similar volume measurements compared with breath-hold cine MRI.

OBJECTIVE Insulin resistance (IR) and cardiovascular disease may share a common genetic background. We investigated the role of IR-associated ENPP1 K121Q polymorphism (rs1044498) on cardiovascular disease in high-risk individuals. RESEARCH DESIGN AND METHODS A prospective study (average follow-up, 37 months) was conducted for major cardiovascular events (myocardial infarction [MI], stroke, cardiovascular death) from the Gargano Heart Study (GHS; n = 330 with type 2 diabetes and coronary artery disease), the Tor Vergata Atherosclerosis Study (TVAS; n = 141 who had MI), and the Cardiovascular Risk Extended Evaluation in Dialysis (CREED) database (n = 266 with end-stage renal disease). Age at MI was investigated in cross-sectional studies of 339 type 2 diabetic patients (n = 169 from Italy, n = 170 from the U.S.). RESULTS Incidence of cardiovascular events per 100 person--years was 4.2 in GHS, 10.8 in TVAS, and 11.7 in CREED. Hazard ratios (HRs) for KQ+QQ versus individuals carrying the K121/K121 genotype (KK) individuals were 1.47 (95% CI 0.80–2.70) in GHS, 2.31 (95% CI 1.22–4.34) in TVAS, and 1.36 (95% CI 0.88–2.10) in CREED, and 1.56 (95% CI 1.15–2.12) in the three cohorts combined. In the 395 diabetic patients, the Q121 variant predicted cardiovascular events among obese but not among nonobese individuals (HR 5.94 vs. 0.62, P = 0.003 for interaction). A similar synergism was observed in cross-sectional studies, with age at MI being 3 years younger in Q121 carriers than in KK homozygotes among obese but not among nonobese patients (P = 0.035 for interaction). CONCLUSIONS The ENPP1 K121Q polymorphism is an independent predictor of major cardiovascular events in high-risk individuals. In type 2 diabetes, this effect is exacerbated by obesity. Future larger studies are needed to confirm our finding.

We sought to investigate the T(1) kinetics of blood and myocardium after three infusion schemes of gadobenate dimeglumine (Gd-BOPTA) and subsequently compared contrast-enhanced whole-heart coronary MRI after a bolus Gd-BOPTA infusion with nonenhanced coronary MRI at 1.5 T. Blood and myocardium T(1) was measured in seven healthy adults, after each underwent three Gd-BOPTA infusion schemes (bolus: 0.2 mmol/kg at 2 mL/sec, hybrid: 0.1 mmol/kg at 2 mL/sec followed by 0.1 mmol/kg at 0.1 mL/sec, and slow: 0.2 mmol/kg at 0.3 mL/sec). Fourteen additional subjects underwent contrast-enhanced coronary MRI with an inversion-recovery steady-state free precession sequence after bolus Gd-BOPTA infusion. Images were compared with nonenhanced T(2) -prepared steady-state free precision whole-heart coronary MRI in signal-to-noise ratio, contrast-to-noise ratio, depicted vessel length, vessel sharpness, and subjective image quality. Bolus and slow infusion schemes resulted in similar T(1) during coronary MRI, whereas the hybrid infusion method yielded higher T(1) values. A bolus infusion of Gd-BOPTA significantly improved signal-to-noise ratio, contrast-to-noise ratio, depicted coronary artery length, and subjective image quality, when all segments were collectively compared but not when compared segment by segment. In conclusion, whole-heart steady-state free precision coronary MRI at 1.5 T can benefit from a bolus infusion of 0.2 mmol/kg Gd-BOPTA.

Purpose: To investigate pulmonary vein (PV) off-resonance and blood flow as causes of signal void artifacts in noncontrast steady-slate-free-precession (SSFP) PV magnetic resonance angiography (MRA).Materials and Methods: PV blood off-resonance was measured on 11 healthy adult subjects and 10 atrial fibrillation (AF) patients. Noncontrast PV MRA was performed using a 3D slab-selective SSFP sequence at 1.5T on seven healthy subjects with signal profile shifts of 0-125 Hz. The time-resolved blood flow velocity of the PVs was measured on five healthy subjects. The impact of flow was studied on six healthy subjects, on whom SSFP PV MRA was acquired twice with the electrocardiogram (ECG) trigger delay corresponding to low and high flow, respectively.Results: The PV off-resonances were 97 +/- 27 Hz, 65 +/- 20 Hz, 74 +/- 25 Hz, and 52 +/- 17 Hz for right inferior, left inferior, right superior, and left superior PVs, respectively, on healthy subjects, and 74 +/- 20 Hz, 38 +/- 9 Hz, 51 +/- 20 Hz, and 28 +/- 11 Hz on AF patients (P

Background: Cyclophosphamide induction regimens for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis are effective in 70 to 90% of patients, but they are associated with high rates of death and adverse events. Treatment with rituximab has led to remission rates of 80 to 90% among patients with refractory ANCA-associated vasculitis and may be safer than cyclophosphamide regimens. Methods: We compared rituximab with cyclophosphamide as induction therapy in ANCA-associated vasculitis. We randomly assigned, in a 3:1 ratio, 44 patients with newly diagnosed ANCA-associated vasculitis and renal involvement to a standard glucocorticoid regimen plus either rituximab at a dose of 375 mg per square meter of body-surface area per week for 4 weeks, with two intravenous cyclophosphamide pulses (33 patients, the rituximab group), or intravenous cyclophosphamide for 3 to 6 months followed by azathioprine (11 patients, the control group). Primary end points were sustained remission rates at 12 months and severe adverse events. Results: The median age was 68 years, and the glomerular filtration rate (GFR) was 18 ml per minute per 1.73 m(sup 2) of body-surface area. A total of 25 patients in the rituximab group (76%) and 9 patients in the control group (82%) had a sustained remission (P=0.68). Severe adverse events occurred in 14 patients in the rituximab group (42%) and 4 patients in the control group (36%) (P=0.77). Six of the 33 patients in the rituximab group (18%) and 2 of the 11 patients in the control group (18%) died (P=1.00). The median increase in the GFR between 0 and 12 months was 19 ml per minute in the rituximab group and 15 ml per minute in the control group (P=0.14). Conclusions: A rituximab-based regimen was not superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis. Sustained-remission rates were high in both groups, and the rituximab-based regimen was not associated with reductions in early severe adverse events. (Funded by Cambridge University Hospitals National Health Service Foundation Trust and F. Hoffmann-La Roche; Current Controlled Trials number, ISRCTN28528813.) N Engl J Med 2010;363:211-20.

With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia.

During the last decade, magnetic resonance angiography (MRA) evolved to an essential method for radiological diagnostics of extracranial arteries' diseases. Contrast enhanced MRA enables meanwhile the acquisition of angiographic series in high diagnostic quality comparable to that originating from conventional DSA. Due to MRA, conventional DSA anymore plays a crucial role in the diagnostic assessment of carotid artery disease or highly vascularised tumors of the head and neck region. Besides reliable quantification of carotid stenoses, highly resolved MRI sequences provide a promising approach for characterization of plaque morphologies and thereby contribute to turn the risk for a stroke calculable. Furthermore, MRA has nearly replaced DSA in radiographics of carotid artery dissections whereas MRA has especially emerged as an appropriate method to visualize the intramural hematoma which is evidentiary for the diagnosis. However, not all methods of MRA are equivalent in respect to their diagnostic value. While CE MRA is able to completely substitute DSA in many clinical questions, applicability of flow-dependent Time-of-flight (TOF) or phase-contrast (PC) MRA is limited due to their distinct susceptibility to motion or flow-related artefacts.

Introduction: Among the various approaches to measure response to neoadjuvant chemotherapy in breast cancer patients a significant relationship to overall (OS) and disease-free survival (DFS) has been recently demonstrated for the residual cancer burden (RCB) score. The calculated RCB- index provides additional prognostic information independently of TNM categories and stage, respectively[1]. The goal of our study was to validate the prognostic impact of the RCB score for OS and DFS on a cohort of patients selected for neoadjuvant treatment and treated either with chemotherapy with or without Her2 targeted therapy or endocrine therapy. We hypothesised that accross all histological breast cancer subtypes, the RCB-score will show significant impact on OS and DFS. Methods: All surgical specimens (n =212) were processed according to the same protocol in a single institution. The RCB score was calculated according to Symmans et al. using the MD Anderson website. Pathologic complete remission is designated RCB 0, residual disease is based on its extent categorized as RCB I-III. Additional information such as histological and molecular subtypes, therapy regimen, as well as follow up information were collected prospectively from paper based patient files. The impact of the RCB score on OS and DFS were estimated with Kaplan-Mayer curves were compared by using long rank test statistics. Results: The RCB score showed a significant correlation to DFS (p=0.000006) and OS (p=0.000306) The correlation between molecular subtypes (Luminal A, luminal B, Her2 positive and triple negative) and neoadjuvant treatment is ongoing and will be presented at the meeting. Conclusion: We were able to show a general prognostic value of the RCB-Score in a series of 212 patients with neoadjuvant treatment, without consideration of the histological and molecular subtypes and adjuvant treatment. We were further able to confirm the reproducibility of the RCB Score by a standardized pathological procedure at a single institution. Further independent evaluation of the histological and molecular subtypes as well as the therapy regimens is ongoing. [1] Loibel S.;How much information do we need to know after neoadjuvant Chemotherapy for Breast Cancer; American Society of Clinical Oncology, 24.Feb.2017. Citation Format: Balic M, Mueller DH, Hammer R, Gumpoldsberger M, Suppan C, Posch F, Stoeger H, Dandachi N, Prein K, Hauser H, Lax S. Independent evaluation of prognostic value of residual cancer burden (RCB) score on disease free and overall survival of breast cancer patients treated with neoadjuvant systemic treatment at a single institution [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-03-02.

Background: Obesity is a risk factor for left ventricular (LV) hypertrophy and excess cardiovas- cular disease and mortality. Substantial weight loss is associated with a decrease in cardiovascular mortality. Using volumetric cardiovascular magnetic resonance (CMR) imaging, we studied changes in cardiac anatomy and systolic function in women undergoing substantial weight loss in a university hospital. Methods: A total of 17 women (body mass index (BMI) 44.1 4.2 kg/m 2 ; age 44 11 yr) scheduled for bariatric surgery underwent volumetric CMR imaging before and 3 and 17 months after surgery. Results: The body weight declined by 37.2 10.5 kg (32%) with a decrease in BMI to 29.9 4.7 kg/m 2 (32%, P.004) during 17 months of observation. The LV mass decreased from 120 23 g to 82 11 g (32%, P.004), with a linear relationship between the decrease in BMI and decrease in LV mass (P.008) for the duration of the observation period. After adjustment for systolic and/or diastolic blood pressure, the relationship remained significant (P.001). The right ventric- ular (RV) mass declined from 31.7 6.7 g preoperatively to 26.6 4.5 g at 3 months (16%, P .001) but without additional changes at 17 months. No change was found in the LV or RV end-diastolic volume or ejection fraction. Conclusion: In morbidly obese women, substantial weight loss was associated with a reduction of LV and RV mass. The decrease in LV mass was linearly related to the reduction in BMI, independent of changes in blood pressure, and might partially explain the reduction in cardiovas- cular mortality associated with substantial weight loss. The BMI was a predictor of LV mass in this population. (Surg Obes Relat Dis 2009;5:648-652.) © 2009 American Society for Metabolic and Bariatric Surgery. All rights reserved.

ObjectiveTo contrast the effect of the burden of vasculitis activity with the burden of adverse events on 1-year mortality of patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).MethodsThis study assessed the outcome and adverse events in patients prospectively recruited to four European AAV clinical trials. Data on 524 patients with newly diagnosed AAV were included. The burden of adverse events was quantified using a severity score for leucopenia, infection and other adverse events, with an additional weighting for follow-up duration. A ‘combined burden of events’ (CBOE) score was generated for each patient by summing the individual scores. Vasculitis severity was quantified using the Birmingham vasculitis activity score and glomerular filtration rate (GFR).Results1-year mortality probability was 11.1%; 59% and 14% of deaths were caused by therapy-associated adverse events and active vasculitis, respectively. Using Cox regression analysis, infection score (pConclusionsThe greatest threat to patients with AAV in the first year of therapy is from adverse events rather than active vasculitis. The accumulation of adverse events, monitored using this scoring method, should prompt increased awareness that the patient is at high risk of death.

Objectives We sought to evaluate radiofrequency (RF) ablations lesions in atrial fibrillation (AF) patients using cardiovascular magnetic resonance (CMR), and to correlate the ablation patterns with treatment success.

Objectives:To develop European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis.Methods:An expert group (10 rheumatologists, 3 nephrologists, 2 immunolgists, 2 internists representing 8 European countries and the USA, a clinical epidemiologist and a representative from a drug regulatory agency) identified 10 topics for a systematic literature search through a modified Delphi technique. In accordance with standardised EULAR operating procedures, recommendations were derived for the management of large vessel vasculitis. In the absence of evidence, recommendations were formulated on the basis of a consensus opinion.Results:Seven recommendations were made relating to the assessment, investigation and treatment of patients with large vessel vasculitis. The strength of recommendations was restricted by the low level of evidence and EULAR standardised operating procedures.Conclusions:On the basis of evidence and expert consensus, management recommendations for large vessel vasculitis have been formulated and are commended for use in everyday clinical practice.

The emergence of catheter based ablation therapy for the prevention of recurrent atrial fibrillation has increased interest in the anatomy of the left atrium and pulmonary veins. In this article, we review the magnetic resonance imaging method of imaging the left atrium and the pulmonary veins, normal and variant anatomy, and the utility of imaging before and after atrial fibrillation ablation.