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Purpose To assess correlations of lean body weight (LBW) calculated with various formulas, total body weight (TBW), body height (BH), body mass index (BMI), body surface area (BSA) and fat-free mass (FFM) with vascular and parenchymal enhancement in multiphasic CT of the liver. Method Thirty consecutive patients underwent multiphasic CT of the liver using constant iodine dose and flow rate. Contrast enhancement of aorta, portal vein and liver was calculated by measuring mean vascular and parenchymal attenuation in pre-contrast and post-contrast phases. Correlations of TBW, BH, BMI, BSA, FFM, and LBW (calculated with formulas of Boer, Hume, James and Green&Duffull) with enhancement were tested using Spearman’s correlation coefficient. The method of Fieller et al. was used to calculate 95 % confidence intervals. A p-value ≤ 0.05 was considered statistically significant. Results Aortal enhancement correlated strongly with TBW, BSA, LBWBoer and LBWHume and moderately with BH, BMI, FFM, LBWJames and LBWGreen&Duffull. Liver enhancement in the late arterial phase correlated moderately with TBW, FFM, LBWBoer, LBWHume and LBWGreen&Duffull and weakly with BSA. Liver enhancement in the portal venous phase correlated strongly with TBW, BSA, FFM, LBWBoer, LBWHume and LBWGreen&Duffull, whereby overlap of the 95 % CI graphs demonstrated that the differences in the correlation coefficients were not statistically significant. Liver enhancement in the delayed phase correlated moderately with BH but did not correlate significantly with any other parameter. Conclusion Regardless of the form used for calculation, LBW did not correlate statistically significantly stronger than TBW with vascular or parenchymal enhancement of the liver.

Systemic sclerosis (SSc) is an intractable autoimmune disease characterized by vasculopathy and organ fibrosis. Autologous hematopoietic stem cell transplantation (AHSCT) should be considered for the treatment of selected patients with rapid progressive SSc at high risk of organ failure. It, however, remains elusive whether immunosuppressive therapies such as rituximab (RTX) are still necessary for such patients after AHSCT, especially in those with bad outcomes. In the present report, a 43-year-old man with diffuse cutaneous SSc received AHSCT. Despite AHSCT, SSc further progressed with progressive symptomatic heart failure with newly developed concomitant mitral and tricuspid valve insufficiency, thus the patient started on RTX 8 months after AHSCT. Shortly after initiation of RTX, clinical symptoms and organ functions ameliorated subsequently. Heart valve regurgitations were reversible after initiation of RTX treatment. Currently, the patient remains in a stable condition with significant improvement of clinical symptoms and organ functions. Reporting about therapies after AHSCT in SSc is a very important issue, as randomized controlled trials are lacking, and therefore this report adds to evidence that RTX can be considered as a treatment option in patients with SSc that do not respond to AHSCT.

Objectives The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA). Methods Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0–32) and power Doppler (0–14, range global ultrasound score 0–140)], and radiographs were evaluated for enthesophytes and erosions (score range 0–56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression. Results We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P =0.005), had shorter disease duration (9.7 vs 17.9 years, P=0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P=0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P Conclusion Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses.

Background In clinical trials radiographic damage is frequently quantified by conventional x-ray but neither the thoracic spine nor the posterior parts of the vertebral column including the intervertebral joints, the vertebral arch and the spinous process can be evaluated reliably with this instrument. Bone inflammation and areas of enthesitis can easily be detected by magnetic tomography imaging (MRI) and the introduction of high-resolution 3-tesla MRI allows analysis of bone structures more precisely than with x-ray without radiation exposure [1]. Patients with axial SpA frequently present with reduced spinal mobility and functional impairment, but radiographic signs of ankylosis are missing on plain radiographs. These particular clinical findings are reinforced by data in the literature showing, that the relation between radiographic damage, spinal mobility and function is low. Radiographic damage to the posterior parts of the vertebral column may be responsible for the discrepancy found between clinical and radiographic results as suggested by a Dutch group [2]. Objectives To evaluate the localisation and incidence of new bone formation in the posterior part of the vertebral bodies with MRI. Methods In a cohort of 56 patients with diagnosed axial SpA (mean age 50.29y, mean disease duration 14.4y, 76.4% men, 88.7% HLA-B27 positive) we performed a MRI (3 Tesla scanner Skyra, Siemens Healthcare, Erlangen, Germany). The whole spine was scanned with T1 weighted and Turbo-Inversion Recovery Magnitude (TIRM) sequences in sagittal planes and each segment of the vertebral column was divided into four areas (ventral and posterior part of the vertebral bodies, intervertebral joints andspinous processes) to assess osseous changes like sclerosis, erosion, syndesmophytes, ankylosis, (partial) fusion of intervertebral joints and fibroostosis of spinous processes. Results Syndesmophytes and ankylosis of the ventral segments were present from C7/Th1 down to L5/S1 with a maximum in Th5/6 (62.5%). In the posterior segments of the vertebral bodies we detected a contrary accumulation inside the cervical and lumbar spine with a max. in C5/6 (55.4%) respectively L2/3 (66.1%). Erosions were mainly found at the ventral edges with an accumulation in middle cervical, lower thoracic and the whole lumbar spine (max. Th9/10 24.5%) Ankylosis of the intervertebral joints was present over the whole spine with a preference of the cervical (max. C5/6 27.7%) and lumbar column (max. L2/3 47.3%). Fibroostosis of the spinous processeswere rarely found in the middle and lower thoracic spine (Th5-11, each 2.7%). In up to 57.10% of the cervical spine (54.78% for lumbar, 32.18% for thoracic spine) with detectable new bone formation of the posterior segments we found no changes of the ventral part. Conclusion With high resolution MRI we were able to detect structural in the dorsal part of the spine, which can hardly be assessed by conventional radiographs. These findings may explain functional disability in patients with non-corresponding findings in x-ray. References [1] Lee CH, et al. (2015) Correlation of structural abnormalities of the wrist and metacarpophalangeal joints evaluated by high-resolution peripheral quantitative computed tomography, 3 Tesla magnetic resonance imaging and conventional radiographs in rheumatoid arthritis. International journal of rheumatic diseases [2] Maas F, et al. (2015) Comparison of radiographic damage of the zygapophyseal joints and the vertebral bodies of the cervical spine in patients with ankylosing spondylitis before and after 4 years of TNF-alpha blocking therapy. Annals of the rheumatic diseases Disclosure of Interests Andreas Haidmayer Speakers bureau: Roche, MSD, BMS, Abbvie, Celgene, Gabriel Adelsmayr Speakers bureau: BMS, Rusmir Husic Speakers bureau: BMS, UCB, Celgene, MSD, Franz Quehenberger: None declared, Angelika Lackner: None declared, Joesf Hermann Speakers bureau: Abbvie, MSD, UCB, BMS, Celgene

To analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics. Fifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1. Septal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249 ± 58 ms vs. 1186 ± 33 ms, p

The ‘renal threshold for glucose’ has never been evaluated in critically ill patients. Therefore, we aimed to investigate the renal glucose threshold in this patient group using high-sensitivity urine glucose assays. In this retrospective analysis of prospectively collected data, we analysed 100 consecutive critically ill patients from a medical intensive care unit (ICU). Arterial blood glucose and spot urine glucose were simultaneously quantified daily during the first week after ICU admission. Three hundred seventy-three pairs of blood/urine glucose were plotted in five pre-defined categories of blood glucose (

Background: The hypertensive deoxy-corticosterone acetate (DOCA)-salt-treated pig (hereafter, DOCA pig) was recently introduced as large animal model for early-stage heart failure with preserved ejection fraction (HFpEF). The aim of the present study was to evaluate cardiovascular magnetic resonance (CMR) of DOCA pigs and weight-matched control pigs to characterize ventricular, atrial and myocardial structure and function of this phenotype model.Methods: Five anesthetized DOCA and seven control pigs underwent 3 T CMR at rest and during dobutamine stress. Left ventricular/atrial (LV/LA) function and myocardial mass (LVMM), strains and torsion were evaluated from (tagged) cine imaging. 4D phase-contrast measurements were used to assess blood flow and peak velocities, including transmitral early-diastolic (E) and myocardial tissue (E’) velocities and coronary sinus blood flow. Myocardial perfusion reserve was estimated from stress-to-rest time-averaged coronary sinus flow. Global native myocardial T1 times were derived from prototype modified Look-Locker inversion-recovery (MOLLI) short-axis T1 maps. After in-vivo measurements, transmural biopsies were collected for stereological evaluation including the volume fractions of interstitium (VV(int/LV)) and collagen (VV(coll/LV)). Rest, stress, and stress-to-rest differences of cardiac and myocardial parameters in DOCA and control animals were compared by t-test.Results: In DOCA pigs LVMM (p p = 0.003/p = 0.007) were elevated. During stress, increase of LV ejection-fraction and decrease of end-systolic volume accounted for normal contractility reserves in DOCA and control pigs. Rest-to-stress differences of cardiac index (p = 0.040) and end-diastolic volume (p = 0.042) were documented. Maximal (p = 0.042) and minimal (p = 0.012) LA volumes in DOCA pigs were elevated at rest; total LA ejection-fraction decreased during stress (p = 0.006). E’ was lower in DOCA pigs, corresponding to higher E/E’ at rest (p = 0.013) and stress (p = 0.026). Myocardial perfusion reserve was reduced in DOCA pigs (p = 0.031). T1-times and VV(int/LV) did not differ between groups, whereas VV(coll/LV) levels were higher in DOCA pigs (p = 0.044).Conclusions: LA enlargement, E’ and E/E’ were the markers that showed the most pronounced differences between DOCA and control pigs at rest. Inadequate increase of myocardial perfusion reserve during stress might represent a metrics for early-stage HFpEF. Myocardial T1 mapping could not detect elevated levels of myocardial collagen in this model.Trial registration: The study was approved by the local Bioethics Committee of Vienna, Austria (BMWF-66.010/0091-II/3b/2013).

Background In patients with pulmonary hypertension (PH), duration of vortical blood flow along the main pulmonary artery enables estimation of the mean pulmonary arterial pressure (mPAP) non-invasively. It remains to date not known, if this method is applicable in patients with pulmonary arterial hypertension (PAH) and abnormal aortic-to-pulmonary shunting. Case presentation The present case analyzes the effect of a patent ductus arteriosus (PDA) on pulmonary artery flow patterns in PAH (mPAP from right heart catheterization, 75 mmHg). PH-associated vortical blood flow, which is typically observed rotating in a clockwise direction when viewed in right ventricular outflow tract orientation, was found nested in PDA left-to-right shunting. Even though rotating counter-clockwise, duration of vortical flow translated into correct non-invasive mPAP estimate. Conclusions This case indicates that PH-associated vortex rotation is not restricted to clockwise direction, and that vortex-based estimation of elevated mPAP might also be feasible in patients with PAH and PDA. Electronic supplementary material The online version of this article (doi:10.1186/s12880-016-0150-z) contains supplementary material, which is available to authorized users.

Although blood lactate and glucose both represent important markers in the intensive care setting, they have been considered quite independently. Especially, the ideal glucose target range has been the topic of recent studies with conflicting results [1,2]. Blood lactate is an acknowledged predictor of outcome in critically ill patients [3]. The aim of this study was to establish a possible correlation between elevated blood glucose and lactate levels in intensive care patients.

Results. EuroSCORE significantly increased over the years: 6 (2-12) in 2000 vs. 12 (6-18) in 2008 (P 0.026)], indicating that gradually sicker recipients were accepted for htx. Consequently ECMO support was required in 5.6% of patients in 2000 vs. 20% in 2008 (P 0.043). The incidence of sepsis and septic shock showed a tendency to increase over the years (16.7% in 2000 vs. 20% in 2008; (P 0.058)). The administration of a combination (two or more) of broad spectrum antibiotics rose significantly from 2000 (27.8% of patients, n 15/54) to 2008 (85% of patients, n 34/40) (P 0.001). In 2000 5 patients (9.3%) required concomitant antimycotic therapy compared with 20 patients (50%) in 2008 (P 0.001). Despite acceptance of more severely compromised recipients and increasing need for perioperative circulatory support with ECMO, ICU-mortality decreased over the years (ICU-mortality was 14.6% in 2000 vs. 2.5% in 2008). In 2008 none of our heart recipients died within the first 30 days after htx.