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OBJECTIVE: This paper examines the incidence, clinical presentation, and pathophysiology of portal vein thrombosis (PVT) in cirrhosis. Additionally, we have reviewed the literature regarding the current status of medical and interventional radiology management of PVT and have proposed a novel algorithm for the management given different clinical scenarios. Lastly two representative cases displaying endovascular treatment options are provided. BACKGROUND: Portal vein thrombus in the setting of cirrhosis is an increasingly recognized clinical issue with debate on its pathophysiology, natural course, and optimal treatment. Approximately one-third of patients are asymptomatic, and detection of the thrombus is an incidental finding on imaging performed for other reasons. In 30% to 50% of patients, PVT resolves spontaneously. However, there is increased post-transplant mortality in patients with completely occlusive PVT, therefore effective early revascularization strategies are needed for patients with complete PVT who are expected to undergo liver transplant. Additionally, no consensus has been reached regarding PVT treatment in terms of timing and type of interventions as well as type and duration of anticoagulation. METHODS: Computerized literature search as well as discussion with experts in the field. CONCLUSIONS: Management of PVT is complex, as many variables affect which treatments can be used. Anticoagulation appears to be the optimal first-line treatment in patients with acute PVT but without bleeding varices or mesenteric ischemia. Minimally invasive treatments include various methods of mechanical thrombectomy, chemical thrombolysis, and transjugular intrahepatic portosystemic shunt (TIPS) placement with or without variceal embolization. Definitive recommendations are difficult due to lack of high quality data and continued research is needed to evaluate the efficacy of different anticoagulants as well as the timing and use of various minimally invasive therapies in specific circumstances.

Opium has been used traditionally for lowering blood lipids, diabetes, cancer, and postpone of cardiac diseases. The coronary angiography patients were divided to opium user and control group. SYNT...

Portal vein thrombosis (PVT) is a rare but severe entity that can cause clinically significant sequela such as worsening portal hypertension or mesenteric ischemia. Those cases refractory to medical management may be referred for endovascular intervention. Several technical considerations have been described in the literature, but a cohesive comparison of these multiple techniques is lacking.The purpose of this article is to review the diagnosis and endovascular management of PVT, including areas in which further research is warranted.Cases of PVT can be readily diagnosed using ultrasound, computed tomography, or magnetic resonance imaging. Treatment often begins with systemic anticoagulation and endovascular interventions may be used in selected cases. Determining the optimal approach to accessing the portal venous system depends on the underlying disease and chronicity of the thrombus and the degree of occlusion. Once access to the portal venous system is established, catheter-directed therapy may be performed to achieve recanalization.Despite the heterogeneity in patient presentation, cases of PVT can be readily diagnosed across several imaging modalities. Strategizing interventional approaches involves evaluation of the underlying disease and the chronicity of the thrombus.· This review will enable interventionalists to establish a framework for treating portal vein thrombosis by identifying patient risk factors and thrombus characteristics that determine patient management.. · The unique risks and benefits for transhepatic, transsplenic, and transmesenteric approaches for establishing portal venous access will be discussed.. · Advantages and complications of thrombolysis, thrombectomy, and transjugular intrahepatic portosystemic shunt creation for treating portal vein thrombosis will be reviewed in detail based on our extensive institutional experience..· Ju C, Li X, Gadani S et al. Portal Vein Thrombosis: Diagnosis and Endovascular Management. Fortschr Röntgenstr 2022; 194: 169 - 180.Die Pfortaderthrombose (PVT) ist eine seltene, aber schwere Erkrankung, die klinisch signifikante Folgeerscheinungen wie eine Verschlechterung der portalen Hypertonie oder eine mesenteriale Ischämie verursachen kann. Fälle, die auf eine medizinische Behandlung nicht ansprechen, können zur endovaskulären Intervention überwiesen werden. In der Literatur sind verschiedene technische Gesichtspunkte beschrieben worden, aber ein umfassender Vergleich dieser verschiedensten Methoden fehlt.In diesem Artikel werden die Diagnose und die endovaskuläre Behandlung der PVT besprochen, einschließlich der Bereiche, in denen weitere Forschung erforderlich ist.PVT-Fälle lassen sich mit Ultraschall, Computertomografie oder Magnetresonanztomografie leicht diagnostizieren. Die Behandlung beginnt häufig mit einer systemischen Antikoagulation, und in ausgewählten Fällen können endovaskuläre Interventionen eingesetzt werden. Die Bestimmung des optimalen Zugangs zum Pfortadersystem hängt von der Grunderkrankung und der Chronizität des Thrombus sowie vom Grad der Okklusion ab. Sobald der Zugang zum Pfortadersystem hergestellt ist, kann eine Katheter-gesteuerte Therapie durchgeführt werden, um eine Rekanalisierung zu erreichen.Trotz der Heterogenität der Patienten bei Vorstellung können Fälle von PVT mit verschiedenen bildgebenden Verfahren leicht diagnostiziert werden. Bei der Planung von Interventionen müssen die Grunderkrankung und die Chronizität des Thrombus berücksichtigt werden.· Diese Übersicht ermöglicht es den interventionell tätigen Ärzten, Rahmenbedingungen für die Behandlung von Pfortaderthrombosen zu schaffen, indem Risikofaktoren für Patienten und Thrombusmerkmale identifiziert werden, die das Patientenmanagement bestimmen.. · Die besonderen Risiken und Vorteile transhepatischer, transsplenischer und transmesenterialer Ansätze zur Etablierung eines portalvenösen Zugangs werden diskutiert.. · Vorteile und Komplikationen der Thrombolyse, der Thrombektomie und der Anlage eines transjugulären intrahepatischen portosystemischen Shunts zur Behandlung von Pfortaderthrombosen werden basierend auf der umfangreichen Erfahrung in unserem Institut im Detail besprochen..

Background Cefazolin surgical prophylaxis is associated with better patient outcomes; however, its use in penicillin-allergic patients is controversial. We evaluated the safety of cefazolin as surgical prophylaxis in penicillin-allergic patients, including those with anaphylaxis histories. Methods We conducted a pre and postintervention quality improvement evaluation of an institution-wide policy change at a tertiary-care hospital, before (October 2017–January 2018), during (February 2018–September 2018), and after (October 2018–October 2019) transition to routine cefazolin prophylaxis for penicillin-allergic patients, including those with anaphylaxis histories but excluding severe delayed reactions (eg, Stevens-Johnson syndrome). Retrospective data was collected on all surgical prophylaxis patients with penicillin-anaphylactic histories between October 2017 and September 2018. From October 2018, we prospectively reviewed adverse events with cefazolin. Primary outcome was adverse events in penicillin-allergic patients receiving cefazolin perioperatively. Results From October 2017 to October 2019, 27,467 operations were performed. Of 220 patients with penicillin-anaphylactic histories reviewed prior to the full policy change, no statistically significant differences were reported in allergic reactions (P = .70), surgical site infections (P = 1.00), or adverse events (P = .32) with cefazolin compared to other antibiotics. Postpolicy implementation, cefazolin usage increased 18.2%, while vancomycin and clindamycin decreased by 11.4% and 62.0%, respectively. No anaphylaxis was documented in penicillin-allergic patients receiving cefazolin in either the review or quality assurance follow-up after the change. Of 3 patients developing reactions to cefazolin, none had histories of penicillin allergy. Surgical site infection rates were similar between pre and postpolicy time periods (P = .842). Conclusion Administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe.

Purpose To evaluate the value of dual-phase parenchymal blood volume (PBV) C-arm mounted cone-beam-CT (CBCT) to enable assessment of radiopaque, doxorubicin-loaded drug-eluting embolics (rDEE) based on the visual degree of embolization, embolic density and residual tumor perfusion as early predictors for tumor recurrence after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Material and Methods Thirty patients (50 HCCs) were prospectively enrolled, underwent cross-sectional imaging before and after TACE using 100–300 µm rDEE and had regular follow-up examinations. Directly before and after the TACE procedure, PBV-CBCT was acquired. The response was evaluated and compared to visual degree of embolization (DE) and embolic density (ED) of rDEE deposits, as well as the presence of residual tumor perfusion (RTP) derived from PBV-CBCT. Outcome was assessed by mid-term tumor response applying mRECIST and patient survival after 12 months. Results RTP was detected in 16 HCCs and correlated negatively with DE (p = .03*) and ED (p = .0009*). The absence of RTP significantly improved lesion-based mid-term response rates regarding complete response (CR, 30/34 (88%) vs 2/16 (12.5%), p = .0002*), lesion-based complete response rate was 75% (21/28) for DE ≥ 50% vs. 50% (11/22) for DE p = .08) and 82% (27/33) for ED ≥ 2 vs. 29% for ED p = .005*). Thirteen patients were treated with re-TACE within 12 months, 11 of which had shown RTP. 12-month survival rate was 93%. Conclusion Residual tumor perfusions as assessed by PBV-CBCT during rDEE-TACE proved to be the best parameter to predict mid-term response. “Level of Evidence: Level 3”

Late vena cava/hepatic outflow obstruction after orthotopic liver transplantation (OLT), while rare, is among the most challenging complications. The cause may be an organized thrombus, reactive edema, fibrosis/scarring with calcification, or neointimal hyperplasia. Moreover, the obstruction can involve different anatomical parts of the vena cava. Surgical approaches have classically included anastomotic revision, hepatopexy, thrombectomy, cavoatrial shunt, and retransplantation. We present a case report of an innovative approach to combined inferior vena cava (IVC)/hepatic outflow obstruction in a 62-year-old female who underwent OLT using a piggyback technique for end-stage liver disease secondary to hepatitis C virus and alcohol, approximately 10 months post-transplant. A right atrial approach and hypothermic circulatory (cardiac) arrest were employed. The IVC stricture was easily resolved by performing a side to side cavo-cavostomy using an endovascular stapler (endo-GIA). In conclusion, this innovative approach is safe and effective in resolving severe outflow obstruction after liver transplantation.

Summary: Inferior vena cava (IVC) filter has been used to manage patients with pulmonary embolism and deep venous thrombosis. Its ease of use and the expansion of relative indications have led to a dramatic increase in IVC filter placement. However, IVC filters have been associated with a platitude of complications. Therefore, there exists a need to examine the current indications and identify the patient population at risk. In this paper, we comprehensively reviewed the current indications and techniques of IVC filter placement. Further, we examined the various complications associated with either permanent or retrievable IVC filters. Lastly, we examined the current data on filter retrieval.

Gastrointestinal malignancy encompasses a wide range of disease processes. Its incidence and mortality rate rank among the highest of all cancers. Venous thromboembolic disease is a common complication of gastrointestinal malignancy. Anticoagulation remains the first-line therapy. However, for patients who cannot tolerate or have failed anticoagulation, inferior vena cava (IVC) filter placement may be an option. Furthermore, to improve symptom resolution and reduce the severity of postthrombotic syndrome, catheter-directed thrombolysis (CDT) may be an option. Recent randomized trials including the ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial have shed new light on the efficacy and safety of CDT and related methods. Overall, the decision to proceed with IVC filter placement or CDT must be individualized.

The manuscript discusses the application of CT pulmonary angiography, ventilation–perfusion scan, and magnetic resonance angiography to detect acute pulmonary embolism and to plan endovascular therapy. CT pulmonary angiography offers high accuracy, speed of acquisition, and widespread availability when applied to acute pulmonary embolism detection. This imaging modality also aids the planning of endovascular therapy by visualizing the number and distribution of emboli, determining ideal intra-procedural catheter position for treatment, and signs of right heart strain. Ventilation–perfusion scan and magnetic resonance angiography with and without contrast enhancement can also aid in the detection and pre-procedural planning of endovascular therapy in patients who are not candidates for CT pulmonary angiography.

Objective The manuscript discusses landmark studies using abbreviated MRI for breast cancer screening. This includes abbreviated dynamic contrast enhanced MRI and diffusion weighted imaging. Our institutional experience with abbreviated MR protocol for breast cancer screening is also described. Conclusion Abbreviated MRI protocols were found to demonstrate value for screening of breast cancer. It has been shown that abbreviated protocol MRI provides similar diagnostic sensitivities to full protocol MRI for breast cancer in women with increased lifetime risk. Our institutional abbreviated MRI protocol for breast cancer offers improved time and workflow efficiencies and has the potential to increase the number of breast cancers detected and the detection of pathologically relevant invasive breast cancer at earlier stages.

Objectives To demonstrate proof of concept/feasibility of a novel digital platform using real-time capture of patient-reported outcomes for real-world research involving patients with epilepsy. Methods The phone app collects multi-faceted patient-reported outcomes including seizure frequency, medication side effects, mood, anxiety, quality of life and cognition along with voice and digital images. Patients are invited through a national consortium of 18 adult epilepsy centres in Australia. The patient-reported information potentially allows feedback to their treating specialists and tertiary centre in near real-time, along with deidentified aggregation across all participating centres for comparison. Currently, more than 40 patients are enrolled. We present the outcomes of one patient, with the longest-running data points. The new platform was developed by KeyLead Health TM, Melbourne Australia. Results The results report a single patient’s composite scores for mood, sleep, cognition seizures and medication side-effects from the first 1.5 months. Conclusions Our digital phone platform has the potential to facilitate the more effective and efficient capture of longitudinal data enhancing real-world research data integrity along with patient and specialist engagement. Table: Patient reported outcomes for single patient captured using digital phone app date 4/1 7/1 10/1 15/1 20/1 1/2 15/2 18/2 Side effects 4.5 3.8 3.4 3.4 3.4 3.4 3.3 3.8 Memory 9 1 7 5 5 6 7 6 Seizures 3 0 0 1 1 1 2 0 Reaction time 7.7 7.1 12.4 7.0 7.7 7.7 7.9 6.7 Mood 17 16 15 15 12 15 18 16 Sleep 12 6 8 4 3 10 8 5

Background: One of the most important foodborne pathogen which causes enteritis is Salmonella enteritidis (SE). Human cases are mostly associated with the consumption of eggs and poultry meat. Objective: An experiment has been carried out to evaluate the impacts of a yeast product as liquid prebiotic on bacterial shedding, performance indices, and some breast meat characteristics of broiler chickens challenged with SE. Materials and Methods: A total of 90 one-day-old male broiler chicks (Ross 308) were randomly assigned to three different groups with three replicates for each treatment. The treatments were as follows: (1) CONT: birds were not challenged, (2) SE: birds were challenged with SE and fed with a control diet without prebiotic, and (3) SE+PREB: birds were challenged with SE and fed with liquid prebiotic. The challenge with SE was performed on birds in groups 2 and 3 at 28 days of age. Performance parameters and Salmonella shedding were determined on days 7 and 14 post infection. Twelve birds per treatment were sampled at the end of the trial for evaluating characteristics of breast meat. Results: The challenged birds which received prebiotic showed significantly higher body weight gain, lower feed intake, and lower SE shedding than SE group (P

Acute thrombotic pulmonary embolism (PE) is a common and potentially fatal event with imaging playing a pivotal role in the diagnosis and management of these patients. This review discusses imaging techniques, diagnostic algorithms, imaging findings and endovascular treatment of acute thrombotic PE, and illustrates important differential diagnoses relating to the spectrum of acute non-thrombotic PE and non-embolic pulmonary artery disease. The review emphasizes information relevant for everyday radiological practice and highlights recent advances that can be readily applied in the clinical routine. Computed tomography pulmonary angiography (CTPA) is the current reference standard for the diagnosis of acute PE. Ventilation and perfusion (VQ) scanning or - in centers with adequate expertise - magnetic resonance imaging (MRI) is indicated in pregnant or young patients and patients with contraindications to iodinated contrast. Invasive angiography is reserved for patients with intended endovascular treatment. Artifacts, acute non-thrombotic PE, chronic PE and non-embolic pulmonary artery diseases should always be considered as differential diagnoses. · CTPA is the reference standard for the diagnosis of acute PE.. · MRI for acute PE should only be performed in centers with adequate expertise.. · Invasive angiography is reserved for patients with intended endovascular treatment.. · Artifacts and non-embolic pulmonary artery diseases can mimic acute pulmonary thromboembolism.. · Non-thrombotic and chronic PE are also differential diagnoses of acute pulmonary thromboembolism..· Palm V, Rengier F, Rajiah P et al. Acute Pulmonary Embolism: Imaging Techniques, Findings, Endovascular Treatment and Differential Diagnoses. Fortschr Röntgenstr 2020; 192: 38 - 49. Die akute thrombotische Lungenarterienembolie (LAE) ist ein häufiges und potenziell tödliches Ereignis. Die Bildgebung spielt bei diesen Patienten für Diagnose und Management eine herausragende Rolle. Dieser Übersichtsartikel diskutiert Bildgebung, diagnostische Vorgehensweisen, Bildbefunde und endovaskuläre Behandlungsmöglichkeiten der akuten thrombotischen LAE und illustriert wichtige Differenzialdiagnosen bezüglich des Spektrums akuter nicht thrombotischer LAE und nicht embolischer Lungenarterienpathologien. Der Artikel hebt Informationen mit Relevanz für den radiologischen Alltag besonders hervor und geht auch auf aktuelle Fortschritte ein, die heute in der klinischen Routine angewandt werden können. Die computertomografische pulmonale Angiografie (CTPA) ist der aktuelle Referenzstandard für die Diagnose der akuten LAE. Die Ventilations-Perfusions- (VQ-) Bildgebung oder – in Zentren mit adäquater Expertise – die Magnetresonanztomografie (MRT) sind bei schwangeren oder jungen Patienten sowie Patienten mit Kontraindikationen für jodhaltige Kontrastmittel indiziert. Die invasive Angiografie bleibt Patienten mit der Intention einer endovaskulären Behandlung vorbehalten. Artefakte, akute nicht thrombotische LAE, chronische LAE und nicht embolische Lungenarterienpathologien sollten immer als Differenzialdiagnosen in Betracht gezogen werden. · CTPA ist Referenzstandard für die Diagnose der akuten LAE.. · MRT der akuten LAE sollte nur in Zentren mit adäquater Expertise durchgeführt werden.. · Invasive Angiografie bleibt Patienten mit endovaskulärer Behandlung vorbehalten.. · Artefakte und nicht embolische Lungenarterienpathologien können die akute LAE imitieren.. · Nicht thrombotische und chronische LAE sind weitere Differenzialdiagnosen der akuten thromboembolischen LAE..

Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.

To assess the diagnostic accuracy of automated 3D volumetry of central pulmonary arteries using computed tomography pulmonary angiography (CTPA) for suspected pulmonary hypertension alone and in combination with echocardiography.This retrospective diagnostic accuracy study included 70 patients (mean age 66.7, 48 female) assessed for pulmonary hypertension by CTPA and transthoracic echocardiography with estimation of the pulmonary arterial systolic pressure (PASP). Gold standard right heart catheterisation with measurement of the invasive mean pulmonary arterial pressure (invasive mPAP) served as the reference. Volumes of the main, right and left pulmonary arteries (MPA, RPA and LPA) were computed using automated 3D segmentation. For comparison, axial dimensions were manually measured. A linear regression model was established for prediction of mPAP (predicted mPAP).MPA, RPA and LPA volumes were significantly increased in patients with vs. without pulmonary hypertension (all p 0.001). Of all measures, MPA volume demonstrated the strongest correlation with invasive mPAP (r = 0.76, p 0.001). Predicted mPAP using MPA volume and echocardiographic PASP as covariates showed excellent correlation with invasive mPAP (r = 0.89, p 0.001). Area under the curves for predicting pulmonary hypertension were 0.94 for predicted mPAP, compared to 0.90 for MPA volume and 0.92 for echocardiographic PASP alone. A predicted mPAP 25.8 mmHg identified pulmonary hypertension with sensitivity, specificity, positive and negative predictive values of 86%, 93%, 95% and 81%, respectively.Automated 3D volumetry of central pulmonary arteries based on CTPA may be used in conjunction with echocardiographic pressure estimates to noninvasively predict mPAP and pulmonary hypertension as confirmed by gold standard right heart catheterisation with higher diagnostic accuracy than either test alone.• This diagnostic accuracy study derived a regression model for noninvasive prediction of invasively measured mean pulmonary arterial pressure as assessed by gold standard right heart catheterisation. • This regression model using automated 3D volumetry of the central pulmonary arteries based on CT pulmonary angiography in conjunction with the echocardiographic pressure estimate predicted pulmonary arterial pressure and the presence of pulmonary hypertension with good diagnostic accuracy. • The combination of automated 3D volumetry and echocardiographic pressure estimate in the regression model provided superior diagnostic accuracy compared to each parameter alone.

Heart failure is a clinical condition that is associated with significant morbidity and mortality. With the advent of left ventricular assist device (LVAD), an increasing number of patients have received an artificial heart both as a bridge-to-therapy and as a destination therapy. Clinical trials have shown clear survival benefits of LVAD implantation. However, the increased survival benefits and improved quality of life come at the expense of an increased complication rate. Common complications include perioperative bleeding, infection, device thrombosis, gastrointestinal bleeding, right heart failure, and aortic hemodynamic changes. The LVAD-associated complications have unique pathophysiology. Multiple imaging modalities can be employed to investigate the complications, including computed tomography (CT), positron emission tomography-computed tomography (PET-CT), catheter angiography and echocardiography. Imaging studies not only help ascertain diagnosis and evaluate the severity of disease, but also help direct relevant clinical management and predict prognosis. In this article, we aim to review the common LVAD complications, present the associated imaging features and discuss the role of imaging in their management.

Chest pain is a clinical symptom for immediate consultation, and electrocardiogram (ECG) is a valuable diagnostic tool for use in the emergency room. Although the ST- elevation myocardial infarction (STEMI) requires urgent management, there are other ECG high-risk findings which are associated with adverse outcomes or imminent acute myocardial infarction (AMI). This is a case of STEMI equivalent pattern such as de Winter. As this ECG pattern is uncommon, it may be misinterpreted in the emergency department. We report a misinterpretation of de Winter´s pattern (dWp) in a young woman referred to the emergency department for chest pain, feeling of suffocation and hemodynamic instability who undergone reteplase treatment with the suspicion of acute massive pulmonary embolism but developed cardiogenic shock as a result of extensive myocardial infarction due to spontaneous dissection of the left anterior descending coronary artery. A prompt diagnosis of de Winter´s pattern and early angiography to detect the underlying cause of clinical manifestation can be lifesaving.

Introduction: This randomized clinical trial was designed to investigate the effect of carbon dioxide laser on the treatment of minor recurrent aphthous stomatitis (miRAS) as a painful and common oral ulcer. Methods: Fifteen patients with miRAS entered into this study after compliance with the inclusion and exclusion criteria. The patients were assigned to three groups of pulsed CO(2) laser, continuous CO(2) laser, and control. A pulsed CO(2) laser with power of 261 W and pulse duration of 180 microseconds and continuous CO(2) lasers with the power of 1 W and radiation duration of 5-10 seconds were used. In the control group, topical triamcinolone ointment of 0.1% was used. The degree of pain was measured using the visual analogue scale (VAS). The patients were evaluated in terms of pain intensity before and immediately after the treatment and at follow-up hours, 12, 24, 48, and 72 hours after the intervention, and changes in the size of the ulcers were measured before the treatment and on third, fifth, and seventh days. Results: The effect of CO(2) laser with pulsed and continuous radiation on the pain intensity of aphthous lesions, immediately after the treatment and at subsequent follow-up hours were similar and even better than the control group (P0.05). Conclusion: The results of this randomized controlled trial (RCT) showed that the carbon dioxide laser, whether with pulsed radiation or continuous radiation compared to the control group, had a better impact on the pain relief of aphthous lesions.

Chronic kidney disease (CKD) is a common medical problem with well-known dermatologic manifestations, some of which highly disturb the patients' quality of life. This cross-sectional study was designed to identify the prevalence and type of cutaneous involvement in CKD patients. The skin manifestations of 49 patients with CKD undergoing hemodialysis at Akhavan Hospital in Kashan, Iran, were recorded over 2 months. Diabetes (35%) was the most common cause of chronic renal failure in the patients, and the most common skin manifestations were xerosis (95.9%), uremic pigmentation (89.8%), scleral discoloration (87.8%), dental discoloration (85.2% among the patients with natural teeth), dry mouth (65.3%), varicosity (61.2%), pruritus (57.1%), skin atrophy (49%), lentigo (46.9%), subungual hyperkeratosis (42.9%), half and half nail dystrophy (34.7%), and purpura (26.5%). Mucocutaneous involvement has a very high prevalence in CKD patients undergoing hemodialysis, and some of the cases are medically and cosmetically disturbing; therefore, with better knowledge about the type and prevalence of these involvements, the consequences can be better predicted and managed. Further studies are recommended to be conducted on the association between these signs and CKD grade, and clinical trials are also required for establishing the treatment options available for these signs and then assessing the patients' quality of life as a primary outcome measure.

Background: Cardiovascular Disease (CVD) is one of the most important causes of mortality and morbidity in developed and developing countries. Objectives: This study aimed to evaluate the risk factors associated with the extent of coronary vessel involvement across the spectrum of Coronary Artery Disease (CAD) in patients referring to the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran. Methods: A cross-sectional study was conducted on 3,394 patients undergoing coronary angiography at the Cardiac Ward of Vali-Asr Hospital of Birjand, Iran, in 2011-2015. Subjects were assigned to four groups in terms of the extent of coronary vessel involvement: Normal CAD, non-significant CAD, CAD, and non-obstructive CAD. Adjusted odds ratios and 95% confident intervals were calculated by including all variables with P values < 0.05 into the multivariate model to control for confounding factors. Data were analyzed using SPSS version 22. Results: Among male and female patients, those aged 45-65 years needed angiography more than other groups. Multiple logistic regression analysis showed that diabetes, male gender, FBS, and history of hypertension significantly increased the likelihood of coronary vessel involvement (P ≤ 0.05). Conclusions: The findings of the present study imply that age, male gender, FBS, and history of hypertension are the independent risk factors for the extent of coronary vessel involvement in CAD and non-significant CAD groups. To reduce the rates and consequences of CAD, it is paramount to control cardiovascular risk factors, screen susceptible populations at risk, and improve coronary interventional services.

Objective: This study was conducted to investigate the effect of contrast agent used in angiography on sensorineural hearing loss . Methodology: This Quasi experimental study was conducted at Valiasr hospital, Birjand, Iran on 157 coronary artery disease patients hospitalized for angiography. The hearing level of the right and left ears was measured individually before and after the angiography. Then, to calculate the mean auditory threshold of the patients, the hearing level was averaged at three different frequencies of 500, 1000, and 2000 Hz. After data collection and introducing them into SPSS 22, descriptive statistics (frequency percentage distribution, mean and standard deviation) were used along with Mann-Whitney and Kruskal-Wallis tests at the significance level of 0.05. Results: Out of the 157 patients studied, 79 (50.3%) were male. The mean age of the subjects was 57.62±10.17 years (29-85 years), which was 57.67±9.31 in women and 56.85±11 in men. The hearing level of the right ear before and after injection of the radiocontrast agent was 23.69±13.18 and 23.33±13.30 db, respectively, while in the left ear, the values were 25.14±15.01 and 25.02±15.16, respectively, where this difference was not significant (p>0.05). Conclusion: There is no appreciable effect of radiocontrast agent on neurosensory auditory disorder of patients undergoing angiography of coronary artery disease Keywords: Contrast agent, hearing loss, Angiography.

Introduction The term “carotidynia” has been used to describe a symptom or a nosologic entity characterized by pain in the lateral neck region and over the carotid bifurcation. Recent advances in diagnostic imaging and the introduction of diagnostic criteria have led to the adoption of term “Transient perivascular inflammation of the carotid artery” (TIPIC) syndrome. Method A retrospective analysis of the Radiology Department’s database was performed to identify cases with the diagnosis of TIPIC syndrome. The purpose was to identify ultrasound images including B-mode technique, colour, power Doppler technique and contrast-enhanced ultrasound (CEUS). Findings In total, five patients with the diagnosis of TIPIC syndrome are presented in this review. TIPIC syndrome is a clinic-radiologic entity characterized by pain over the carotid area, a symptom referring to a wide differential diagnosis where imaging plays a crucial role for proper diagnosis and treatment. Characteristic imaging findings on conventional ultrasound and CEUS are presented in this review. Discussion TIPIC syndrome can be investigated with virtually any imaging modality. Ultrasound typically reveals perivascular infiltration and a hypoechoic intimal plaque, while no significant luminal narrowing is appreciated. Computed tomography angiography and magnetic resonance angiography also demonstrate these vascular wall changes primarily affecting the distal common carotid artery, the carotid bulb and possibly the internal carotid artery proximal part. Contrast enhancement is a very characteristic and constant finding of TIPIC lesions, suggestive of the inflammatory nature of the disease and can be appreciated on computed tomography angiography and magnetic resonance angiography. CEUS has been recently used and successfully observed contrast enhancement of the lesions, similar to computed tomography angiography and magnetic resonance angiography. Conclusion Ultrasound remains the first-line modality for the evaluation of TIPIC syndrome, capable of providing all the information needed, especially if supplemented with the administration of microbubbles so that the enhancement of lesions can be evaluated.

The use of invasive cerebral angiography with CTA for active treatment of patients with suspected ischemic strokes has been increasing recently. This study aimed to identify the incidence of postcontrast acute kidney injury using baseline renal function when CTA and cerebral angiography were performed sequentially.This retrospective observational study evaluated adults (18 years of age or older) with ischemic stroke who underwent CTA and cerebral angiography sequentially between 2010 and 2018. The incidence of postcontrast acute kidney injury was determined using the baseline estimated glomerular filtration rate. The value of the baseline estimated glomerular filtration rate at which the occurrence of postcontrast acute kidney injury increased was also determined.Postcontrast acute kidney injury occurred in 57/601 (9.5%) patients. Those with a baseline estimated glomerular filtration rate of30 mL/min/1.73 mPatients with low baseline renal function had the highest incidence of postcontrast acute kidney injury after CTA and cerebral angiography, but no fatal adverse effects were documented. Thus, patients suspected of having a stroke should be actively managed with respect to neurovascular function.

Background Autism spectrum disorder (ASD) is a pediatric heterogeneous psychiatric and neurodevelopmental disorder with social and communication deficits, language impairment and ritualistic or repetitive behaviors. ASD has significant genetic bases but candidate genes and molecular mechanisms of disorder are not clarified. Neuregulin1 (NRG1) gene, located in 8p12 is involved in development of central nervous system and was indicated as candidate gene in schizophrenia. Methods mRNA level of types I, II and III of NRG1 gene were studied in peripheral blood of 1540 ASD patients (IQ > 70) and 1490 control children by quantitative Real Time PCR. Also three domains of executive functions (working memory, response inhibition and vigilance) were examined in all subjects. Findings All three types were significantly down regulated in ASD patients. Significant deficiencies in executive functions (EF) were found in ASD patients. EF deficiencies mostly were associated with down expression of mRNA level of types I and III. Also correlations were found between NRG1 expression with gender and severity of ASD symptoms. Interpretations Findings primarily have been suggested involvement of NRG1 in etiology of ASD. Also correlation of NRG1 mRNA level with EF deficiencies could shed lights on EF mechanisms and may suggest targeted treatments to improve particular executive functions. Fund Young researchers and elites club funded the project due to the annual grant of special talents of Club that gave to Arvin Haghighatfard.

Nonvariceal upper gastrointestinal bleeding (UGIB) is associated with significant morbidity and mortality among hospitalized patients and thus presents a treatment challenge for the interventional radiologist. Common causes of nonvariceal UGIB include peptic ulcer disease, Mallory–Weiss tear, erosive inflammatory changes, ulcer disease, malignancy, and vascular malformations. Noninvasive imaging workup for this condition may include computed tomography angiography and tagged red blood cell scan. Invasive angiography allows for both the diagnosis and endovascular treatment of nonvariceal UGIB. Transcatheter embolization can be performed using a variety of embolic agents, such as coils, vascular plugs, and Gelfoam. For patients with negative angiography results despite the presence of clinically and endoscopically significant UGIB from a known source such as gastric ulcer or duodenal ulcer, the left gastric or gastroduodenal artery can be empirically embolized. In high-risk patients with multiple comorbidities who have failed endoscopic therapy, endovascular embolization is associated with lower complication rates compared with open surgery. In this review, we discuss current management strategy and endovascular techniques for the management of the nonvariceal upper GI hemorrhage.

The hematological side effects associated with mycophenolic acid (MPA) are relatively common and have severe consequences. The majority of literature data have not shown clear consistency in the MPA exposure-neutropenia relationship. We hypothesized that (i) adult de novo kidney transplant recipients who develop neutropenia have relatively higher dose-normalized MPA exposure than patients without neutropenia, and (ii) the observed neutropenia may be explained by polymorphisms in metabolism and/or transporter genes responsible for MPA disposition. Adult kidney transplant recipients on steady-state tacrolimus and MPA, not receiving a corticosteroid, and with stable renal function were recruited for investigation at three periods post-transplant (1, 3, and 12 months; n = 21, 17, and 13, respectively). Clinical variables (age, weight, MPA daily dose, albumin, serum creatinine, absolute neutrophil count), tacrolimus and MPA concentrations (for exposure calculation), and genotypes (UGT2B7 G211T, UGT2B7 C802T, UGT1A9 T-275A, UGT1A9 T98C, MRP2 C-24T, MRP2 G1249A, OATP1B1 A388G, OATP1B1 C463A) were characterized. A significant inverse association between dose-normalized MPA exposure (a surrogate marker for apparent MPA clearance) and absolute neutrophil count in all three study periods (r2 ~ 0.3–0.7) was observed. No associations between characterized single nucleotide polymorphisms and MPA exposure or absolute neutrophil count were established. However, significant alterations in the minor allele frequencies of UGT2B7*2 C802T, UGT1A9 T275A, and MRP2 G1249A were evident. These findings support the clinical strategy for conducting MPA therapeutic drug monitoring in adult kidney transplant patients on steroid-free immunosuppressant therapy. The novel population genomic analysis data warrant further epidemiological investigations in a larger study sample.

Partial circulatory support is a promising concept for the treatment of heart failure patients. A better understanding of induced hemodynamic changes is essential for optimizing treatment efficacy. Computational fluid dynamics (CFD) is an alternative method to gain insight into flow phenomena difficult to obtain in vivo. In 10 patients implanted with a Circulite Synergy Micro-pump (HeartWare, Framingham, Massachusetts) (a continuous flow partial circulatory assist device connecting the left atrium to the right subclavian artery), transient CFD simulations were performed. Patients were divided into two groups depending on their cardiac output (CO; high CO group: 5.5 ± 1.1 L/min, low CO group: 1.7 ± 0.7 L/min). The partial assist device provided a supporting flow of 1.5 ± 0.8 L/min. Support was highest at diastole and decreased during systole because of a collision of the blood flows from the partial assist device and the CO. Reversed flow counteracting the flow of the device was significantly higher for the high CO group (mean flow in peak systole: -2.18 ± 1.08 vs. 0.23 ± 0.59 L/min; p = 0.002) showing an inverse correlation between CO and amount of reversed flow during peak systole (R = -0.7; p < 0.02). The flow collision lead to higher total pressures at the point of collision and consequently in the Circulite outflow graft. The CFD simulations allow quantifying hemodynamic alterations in patients with partial support consisting of a flow collision, thereby reducing effectiveness of the circulatory support. Partial support in heart failure patients alternates their hemodynamics not only in providing support for the circulation but also inducing unfavorable changes in flow patterns.

Aorto-enteric fistula (AEF) is a rare life-threatening condition. Early recognition and diagnosis are of paramount importance to improve outcome. In this article four cases of AEF with relevant pre- and post-procedural images are presented to demonstrate the utility of cross-sectional imaging in the work-up of AEF. The literature is reviewed to describe the typical presentation of AEF, the diagnostic work-up of AEF, and the different methods used to treat AEF. Endovascular repair of AEF is gaining increasing attention due to its decreased short-term mortality compared to open surgical techniques.

Venous thrombosis (VT) is a common yet complex clinical condition that has shown minimal alteration in clinical management for decades. It is well known that thrombus evolves structurally over time, with complex changes resulting from the interplay between coagulation factors, cytokines, leukocytes and a myriad of other factors. Our current treatment options are most effective in the acute thrombus, which is composed predominantly of a loose mesh of fibrin and red blood cells (RBCs), making current anticoagulation therapies and thrombolytics quite effective in treatment. Later stages of thrombus are more cellular containing leukocytes, and develop a fibrotic collagenous framework that is more resistant to our current treatments. Understanding the biology of an evolving thrombus will allow us to tailor our treatment and optimize outcomes, as well as focus on novel therapies for the treatment of chronic thrombus. Given the morbidity and mortality of both post thrombotic syndrome (PTS) in patients with deep VT, as well as chronic thromboembolic pulmonary hypertension (CTEPH) in patients with pulmonary embolism (PE), new and innovative therapies must continue to be explored to help prevent these potentially devastating conditions.

Often discovered late during the clinical course of burns, bone loss is widely accepted by clinicians as a de facto consequence of burn. Literature on this bone loss is limited and contradictory in details. More insight into the prevalence and magnitude of bone loss may facilitate its prevention. To this end, over a period of two years, we gathered a test group of 34 male patients with at least six-month-old thermal burns and a control group of 50 male members of similar age and geographical background as our test group. All members with any history of metabolic or endocrine disease or ICU admission were excluded from both groups. Using dual energy X-ray absorptiometry (DXA), we measured bone mineral density (BMD), Z-score and T-score in lumbar vertebra, femoral neck, and total femur and compared the results between the two groups. T-test of density scores against total body surface area of burns was performed. We found that the average T-scores, Z-scores and BMDs in the test group were significantly smaller than the averages in the control group (P

Purpose This manuscript describes the technique of real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck based on our institutional experience. Materials and methods Ethanolamine oleate is used as the sclerosant and is mixed with gadolinium for visualization during the procedure. The five procedural steps include: (I) an initial tri-plane T2-weighted sequence to visualize the lesion; (II) a T1 FSE or trueFISP sequence to assess needle placement and advancement within the lesion; (III) a tri-plane T1 FLASH sequence to monitor sclerosant injection; (IV) a T1 FSE or VIBE sequence to assess sclerosant coverage of the malformation before needle removal; (V) a post-procedural tri-plane T1 fat-saturated sequence to confirm sclerosant coverage of the lesion. Periprocedural medications typically include steroids, antibiotic prophylaxis, and non-steroidal anti-inflammatory medication. Patients are typically admitted for overnight observation. Conclusion Real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck is effective and safe.

Background. Diabetes mellitus is recognized as one of the most common, serious, and costly chronic diseases. Opium addiction is also a common health problem in Iran. Given the high prevalence of opium use in South Khorasan Province and the increasing prevalence of opioid abuse in the community, this study was performed to investigate the effect of opioid abuse on the extent of disease in diabetic patients undergoing coronary angiography in the cardiology department of Vali-e-Asr Hospital in Birjand city, South Khorasan Province, Iran. Methods. This study recruited a total of 1051 diabetic patients who underwent coronary angiography in the cardiology department of Vali-e-Asr Hospital of Birjand city from 2011 to 2015. The collected data were analyzed using SPSS version 22.0 with the chi-square test and univariate regression analysis. P value Results. Among opiate-addicted diabetics, the risk of coronary artery disease was 0.44 times higher than among nonaddicted diabetics (range 0.24–0.77, P=0.004). The extent of coronary vessel involvement, when present, was not different between the two groups. Conclusion. Opiate-addicted diabetics appear to be more susceptible to CAD than their nonaddicted counterparts. The determinants and correlates of this interaction must be the subject of further study.

Background Acute kidney injury (AKI) in the setting of liver transplantation is a common and multifaceted complication. Studies in the general population have demonstrated worse prognosis with AKI episodes that persist for a longer duration. Our primary objective was to evaluate the impact of early AKI episodes that are persistent or progressive in nature, on patient outcomes and graft survival. Methods This was a retrospective cohort study including all patients who received a liver transplant between 2011 and 2015 at our center. Moderate to severe AKI episodes (AKIN II or III) were recorded immediately before transplantation and after surgery until hospital discharge. We evaluated the incidence density rate (IDR) of graft failure and the time to graft failure in patients with persistent or progressive AKI (ppAKI) as compared to controls. Results Two hundred seventy-nine patients received 301 deceased donor liver allografts. Progressive or persistent AKI was documented in more than half of transplant cases (152/301). The rate of graft loss was 3 times higher in the ppAKI group (25%) versus the controls (8.7%). The IDR of graft failure was 13.79 per 100 case-years in the ppAKI group as compared with 3.79 per 100 case-years in the controls (IDR ratio, 3.64; 95 % confidence interval, 1.88-7.50). After adjusting for hepatic artery thrombosis, ischemic cholangiopathy, infectious complications and Model for End-stage Liver Disease, ppAKI was associated with a decreased graft survival time. Conclusions Persistent or progressive AKI after liver transplantation is associated with an increased incidence rate of graft failure and is an independent predictor of decreased graft survival time.

Introduction: Diabetes is one of the usual medical problems that had an important negative effect on patient’s health. Researches demonstrate that there is a wide gap between recommended medical actions and received care by patients with diabetes. The aim of study was to assess the quality of care provided to patients with type 2 diabetes. Materials and methods: A cross-sectional study was carried out among 180 people with type 2 diabetes in diabetic’s clinics using convenience sampling method in Tabriz, Iran in 2011. Using a questionnaire we assessed the reported adherence to minimum recommended annual care for 23 processes indicators based on Iranian Diabetes Guidelines. Results: The proportions of the participants who received recommended annual care for all three top clinical and all six top lifestyle indicators were 82.26% and 43.96%, respectively. For lifestyle and management indicators, reported adherence rates to guidelines were low (38.9% for medication review, 67.7% for self-management evaluation, 55% for physical activity review, and 58.3% for nutrition consultation). From the participants' perspective, most of the participants (87%) had well-controlled diabetes. Conclusion: A substantial proportion of people with type 2 diabetes indicated receiving suboptimal care and there is a notable gap between their expectations and what they have actually received in most aspects of the provided care.

New oral anticoagulants (NOAC) serve as alternatives for patients currently using warfarin for the prevention and treatment of venous thromboembolic (VTE) disease. This article provides a brief summary of the clinical use of these drugs as well as a review of the landmark clinical trials which evaluated described their safety and efficacy. As more data becomes available, a fundamental understanding of these medications will be vital to cardiovascular practitioners managing patients with VTE.

Aims: To systematically evaluate the literature for evidence to support the use of bile acids in non-cholestatic liver conditions. Methods: Searches were conducted on the databases of Medline (1948-March 31, 2015), Embase (1980-March 31, 2015) and the Cochrane Central Register of Controlled Trials, and on Google and Google Scholar to identify articles describing ursodeoxycholic acid (UDCA) and its derivatives for non-cholestatic hepatic indications. Combinations of the following search terms were used: ursodeoxycholic acid, ursodiol, bile acids and/or salts, non alcoholic fatty liver, non alcoholic steatohepatitis, fatty liver, alcoholic hepatitis, alcohol, liver disease, autoimmune, autoimmune hepatitis, liver transplant, liver graft, transplant rejection, graft rejection, ischemic reperfusion injury, reperfusion injury, hepatitis B, hepatitis C, viral hepatitis, chronic hepatitis, acute hepatitis, transaminases, alanine transaminase, liver enzymes, aspartate aminotransferase, gamma-glutamyl transferase, gamma-glutamyl transpeptidase, bilirubin, alkaline phosphatase. No search limits were applied. Additionally, references of the included studies were reviewed to identify additional articles. Results: The literature search yielded articles meeting inclusion criteria for the following indications: non-alcoholic fatty liver disease (n = 5); alcoholic liver disease (n = 2); autoimmune hepatitis (n = 6), liver transplant (n = 2) and viral hepatitis (n = 9). Bile acid use was associated with improved normalization of liver biochemistry in non-alcoholic fatty liver disease, autoimmune hepatitis and hepatitis B and C infections. In contrast, liver biochemistry normalization was inconsistent in alcoholic liver disease and liver transplantation. The majority of studies reviewed showed that normalization of liver biochemistry did not correlate to improvement in histologic disease. In the prospective trials reviewed, adverse effects associated with the bile acids were limited to minor gastrointestinal complaints (most often, diarrhea) and did not occur at increased frequency as compared to controls. As administration of bile acids was often limited to durations of 12 months or less, long-term side effects for non-cholestatic indications cannot be excluded. Conclusions: Based on the available literature, bile acids cannot be widely recommended for non-cholestatic liver diseases at present.

Background: Identifying patients likely to have improved renal function after percutaneous transluminal renal angioplasty and stenting (PTRA) for renal artery stenosis (RAS) is challenging. The purpose of this study was to use a comprehensive multimarker assessment to identify those patients who would benefit most from correction of RAS. Methods: In 127 patients with RAS and decreased renal function and/or hypertension referred for PTRA, quantification of hemodynamic cardiac stress using B-type natriuretic peptide (BNP), renal function using estimated glomerular filtration rate (eGFR), parenchymal renal damage using resistance index (RI), and systemic inflammation using C-reactive protein (CRP) were performed before intervention. Results: Predefined renal function improvement (increase in eGFR ≥10%) at 6 months occurred in 37% of patients. Prognostic accuracy as quantified by the area under the receiver-operating characteristics curve for the ability of BNP, eGFR, RI and CRP to predict renal function improvement were 0.59 (95% CI, 0.48–0.70), 0.71 (95% CI, 0.61–0.81), 0.52 (95% CI, 0.41–0.65), and 0.56 (95% CI, 0.44–0.68), respectively. None of the possible combinations increased the accuracy provided by eGFR (lower eGFR indicated a higher likelihood for eGFR improvement after PTRA, P=ns for all). In the subgroup of 56 patients with pre-interventional eGFR 2 , similar findings were obtained. Conclusions: Quantification of renal function, but not any other pathophysiologic signal, provides at least moderate accuracy in the identification of patients with RAS in whom PTRA will improve renal function.

Introduction: Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes and can lead to several retinal abnormalities including microaneurysms, exudates, dot and blot hemorrhages, and cotton wool spots. Automated early detection of these abnormalities could limit the severity of the disease and assist ophthalmologists in investigating and treating the disease more efficiently. Segmentation of retinal image features provides the basis for automated assessment. In this study, exudates lesion on retinopathy retinal images was segmented by different image processing techniques. The objective of this study is detection of the exudates regions on retinal images of retinopathy patients by different image processing techniques. Methods: A total of 30 color images from retinopathy patients were selected for this study. The images were taken by Topcon TRC-50 IX mydriatic camera and saves with TIFF format with a resolution of 500 × 752 pixels. The morphological function was applied on intensity components of hue saturation intensity (HSI) space. To detect the exudates regions, thresholding was performed on all images and the exudates region was segmented. To optimize the detection efficiency, the binary morphological functions were applied. Finally, the exudates regions were quantified and evaluated for further statistical purposes. Results: The average of sensitivity of 76%, specificity of 98%, and accuracy of 97% was obtained. Conclusion: The results showed that our approach can identify the exudate regions in retinopathy images.

Author(s): Morris, Christopher S; Baerlocher, Mark O; Dariushnia, Sean R; McLoney, Eric D; Abi-Jaoudeh, Nadine; Nelson, Kari; Cura, Marco; Abdel Aal, Ahmed Kamel; Mitchell, Jason W; Madassery, Sreekumar; Partovi, Sasan; McClure, Timothy D; Tam, Alda L; Patel, Sheena

Background: Normal thyroid function during pregnancy is critical for fetal development. Experimental studies suggest that certain perfluoroalkyl substances (PFAS) may disrupt thyroid function but f...

Introduction: Cardiovascular (CV) disease is a significant cause of mortality after lung transplant. However, the prevalence of diabetes and CV risk factors has not been well-characterized in this setting. Methods: Using an electronic database and chart review, we collected and analyzed retrospective data before and 12-months after lung transplant at our institution between 2010-2016 (n=172). Results: Between pre-transplant and 12-months post-transplant, there were increases in diastolic BP (71.2 vs. 76.5 mmHg, p Conclusion: The prevalence of diabetes and CV risk factors observed 12-months after lung transplant was increased compared to pre-transplant. The reasons for this are unclear, but may be related to immunosuppressive medication. Although the prevalence of diabetes is higher after transplant, the lack of differences in A1C and FPG may reflect the greater use of long-acting insulin in post-transplant patients with diabetes. Further study is needed to determine whether these risk factors contribute to an increased risk of adverse clinical outcomes and whether more systematic surveillance and management of these risk factors might mitigate this risk. Disclosure J.M. Leung: None. M. Almehthel: None. N. Partovi: None. J. Yee: None. R. Levy: None. B. Paty: None.

Object: The purpose of this study was to evaluate peripheral non-enhanced-MRA (NE-MRA) acquired with a 3D Turbo Spin Echo sequence with electrocardiographt (ECG) triggering in comparison to Digital Subtraction Angiography (DSA) as the gold standard in symptomatic peripheral artery occlusive disease (PAOD) patients. Materials and methods: This IRB approved prospective study included 23 PAOD patients from whom three patients had to be excluded. The remaining 20 subjects were included in the analysis (15 male; mean age 62.4±15.3years). The patients first underwent DSA followed by NE-MRA on a 1.5-T whole body scanner within 24h after the DSA study. A NATIVE (Non-contrast Angiography of the Arteries and Veins) SPACE (Sampling Perfection with Application Optimized Contrast by using different flip angle Evolution) sequence at four levels (pelvis, upper leg, knee region and lower leg) was acquired. For evaluation purposes, subtracted standardized MIP (maximum intensity projection) images were generated from the NE-MRA data sets. Qualitative assessment of NE-MRA images in reference to the corresponding DSA images, as well as blinded stenosis grading of preselected segments in NE-MRA images were performed by two experienced readers. Image quality in 95 corresponding arterial segments was rated from 1 (good) to 4 (inadequate) directly comparing the NE-MRA with the corresponding DSA segment as the gold standard. Blinded stenosis grading consisted of 66 preselected stenoses rated from 1 (90%) in NE-MRA which were compared to the grade in the corresponding DSA. Results: The mean image quality of NE-MRA in comparison to DSA was 2.7±1.1 (reader 1) and 3.0±1.0 (reader 2). The kappa value indicating interobserver agreement was 0.34; readers 1 and 2 rated the image quality as good in 21% and 3%, sufficient in 19% and 41%, limited in 29% and 14% and inadequate in 31% and 42%, respectively. Stenosis graduation revealed significantly higher grades in NE-MRA (reader 1: 3.0±0.7, p

The recently published Prevention of Serious Adverse Events Following Angiography (PRESERVE) trial is presently the largest and most comprehensive clinical trial comparing commonly applied strategies for prevention of iodinated contrast-induced acute kidney injury in high-risk patients. The fundamental conclusion of the PRESERVE trial is that oral acetylcysteine and i.v. sodium bicarbonate are not superior to simple i.v. hydration with isotonic saline for the prevention of contrast-induced renal sequelae. In this commentary, we discuss the results in the context of selected past major trials, and provide insights into the strengths and potential weaknesses of the PRESERVE trial. In the future, developing individualized preventive approaches to avoid contrast-induced acute kidney injury for different patient populations is recommended.

Abstract. The pulmonary arteries are affected by a variety of congenital and acquired abnormalities. Multiple state-of-the art imaging modalities are available to evaluate these pulmonary arterial abnormalities, including computed tomography (CT), magnetic resonance imaging (MRI), echocardiography, nuclear medicine imaging and catheter pulmonary angiography. In part one of this two-part series on state-of-the art pulmonary arterial imaging, we review these imaging modalities, focusing particularly on CT and MRI. We also review the utility of these imaging modalities in the evaluation of pulmonary thromboembolism.

Posttransplant lymphoproliferative disorder (PTLD) is a major complication following kidney transplantation.We undertook this study to characterize PTLD in kidney transplant patients in British Columbia with regard to incidence, patient and graft survival, histological subtypes, treatment modalities, and management of immunosuppression.Retrospective cohort analysis.British Columbia.All adult patients who underwent kidney transplantation in British Columbia between January 1, 1996, and December 31, 2012, were included. Patients less than 18 years of age at the time of first transplant and multiple organ transplant recipients were excluded from analysis.Patients with lymphoproliferative disorders that occurred subsequent to kidney transplantation were considered to have developed PTLD.Cases of PTLD were identified by cross-referencing data abstracted from the provincial transplant agency's clinical database with the provincial cancer agency's lymphoma registry. Patients were followed up for the development of PTLD until December 31, 2012, and for outcomes of death and graft failure until December 31, 2014. Data collection was completed via an electronic chart review.Of 2217 kidney transplant recipients, 37 (1.7%) developed PTLD. Nine cases were early-onset PTLD, occurring within 1 year of transplant; of these cases, 6 were known/presumed Epstein-Barr virus mismatch, compared with only 2 of 28 late-onset cases. Patient survival for early-onset PTLD was 100% at 2 years post diagnosis. Late-onset PTLD had survival rates of 71.4% and 67.9% at 1 and 2 years, respectively. PTLD was associated with significantly decreased patient survival (Limitations to this study include its retrospective nature and the unknown adherence of patients to prescribed immunosuppressant regimens. In addition, cumulative doses of immunosuppression received and the degree of immunosuppression reduction for PTLD management were not effectively captured.The incidence of PTLD in British Columbia following kidney transplantation was low and consistent with rates reported in the literature. The incidence of late-onset PTLD and its association with reduced patient and graft survival warrant further analysis of patients' long-term immunosuppression.Le syndrome lymphoprolifératif post-greffe (SLPG) est une complication grave survenant à la suite d’une transplantation rénale.Nous avons mené cette étude afin de caractériser le SLPG chez les receveurs d’une greffe rénale en Colombie-Britannique en ce qui a trait à son incidence, à la survie du patient et du greffon, aux sous-types histologiques, aux modalités de traitement et à la gestion de l’immunosuppression.Il s’agit d’une étude de cohorte rétrospective effectuée en Colombie-Britannique.Ont été inclus dans l’étude tous les patients adultes ayant subi une transplantation rénale entre le 1Tout cas de SL apparu après une greffe rénale étaient considérés comme un SLPG.Les cas de SLPG ont été répertoriés en recoupant les données extraites de la base de données cliniques de l’agence provinciale de transplantation avec les données du registre des lymphomes tenu par l’agence provinciale de lutte contre le cancer. Les participants ont été suivis jusqu’au 31 décembre 2012 pour l’apparition du SLPG et jusqu’au 31 décembre 2014 pour les issues défavorables telles que la mort du patient ou le rejet du greffon. L’examen du dossier électronique des patients a complété la collecte des données.Des 2 217 receveurs d’une greffe rénale répertoriés, seuls 37 (1,7 %) ont développé un SLPG. L’apparition du SLPG s’est faite de façon précoce, soit dans la première année post-greffe, pour neuf de ces patients, dont six représentaient un cas connu ou présumé de non-concordance pour le virus d’Epstein Barr (EBV). En comparaison, seuls deux des 28 patients ayant expérimenté un développement tardif du SLPG étaient présumés non-concordants pour l’EBV. Deux ans après le diagnostic, 100 % des patients ayant eu une apparition précoce du SLPG avaient survécu. Dans les cas de développement tardif de la maladie, le taux de survie passait à 71,4 % après un an et à 67,9 % après deux ans pour les patients. Le développement du SLPG a été associé avec une réduction significative de la chance de survie du patient (p = 0,031) et du greffon (p = 0,017, cas de décès non censurés). La survie médiane du greffon était de 9,5 ans pour les patients ayant développé un SLPG alors qu’elle était de 16 ans pour les autres. L’intensité du traitement immunosuppresseur a pu être réduite pour la majorité des patients. Les traitements additionnels incluaient la monothérapie au rituximab, le R-CHOP, la radiation et la chirurgie.La nature rétrospective de l’étude est un facteur limitant la portée de nos résultats, de même que l’absence de données sur l’adhérence des patients au traitement immunosuppressif. De plus, nous n’avons pu mesurer précisément les doses cumulatives d’immunosuppresseurs reçues, ni le degré de réduction de ces derniers dans la prise en charge du SLPG.En Colombie-Britannique, l’incidence du SL post-greffe rénale s’est avérée faible et cohérente avec les taux rapportés dans la littérature. L’incidence de l’apparition tardive du SLPG et son association à un taux et une durée de survie amoindris (à la fois pour le patient et pour le greffon) justifient une analyse plus poussée de l’immunosuppression à long terme dans la population en question.

Ultrasound (US) represents the initial modality in the workup of abdominal aortic pathology based on the plethora of advantages including widespread availability, low cost, safety profile and repeatability. However, US has inherent limitations including limited spatial information of pathologic processes to neighboring structures, lower sensitivity to slow blood flow and aortic luminal irregularities. For evaluation of aortic pathology angiography has long been considered the gold standard. Non-invasive cross-sectional imaging techniques like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have gradually replaced interventional angiography for the evaluation of aorta, currently being regarded as the diagnostic imaging modalities of choice for diagnosis of virtually every aortic disease. Interventional angiography is currently primarily performed for treatment purposes of aortic pathology. The introduction of microbubbles as ultrasonographic contrast agents has rendered contrast-enhanced ultrasound (CEUS) an evolving valuable complementary technique with markedly increased diagnostic accuracy for certain aortic applications. CEUS is characterized by the potential to be performed in patients with impaired renal function. Due to its superior spatial and temporal resolution, ability for prolonged scanning and dynamic and real-time imaging, it provides clinically significant additional information compared to the standard Duplex US. The purpose of this paper is to discuss the currently available literature regarding abdominal aortic applications of CEUS, briefly elaborate on CEUS technique and safety and present cases in order to illustrate the added value in aortic pathologies. Conditions discussed include abdominal aortic aneurysm (AAA), aneurysm rupture, aneurysm surveillance after endovascular repair, dissection and aortitis.

Background The association between psoriasis and cardiovascular disease is well documented, but the underlying mechanisms remain unknown. The relationship between osteopontin and psoriasis has been studied. High serum levels of osteopontin are reported in psoriasis, with increased cardiovascular risk factors in these patients. Objectives We evaluate the extent of subclinical atherosclerosis by measuring the mean intima–media wall thickness (MIMT) of the common carotid artery (CCA) in patients with psoriasis and assessing its correlation with osteopontin to identify vascular risk factors associated with psoriasis. Methods Intima–media wall thickness of the CCA and plasma osteopontin were determined in 40 patients and 40 age- and sex-matched healthy control subjects. Results Median serum osteopontin was significantly higher in patients with psoriasis than in healthy control subjects. Mean intima–media wall thickness of the CCA was positively associated with plasma osteopontin level (r = 0.47, P < 0.0001), body mass index (r = 0.62, P < 0.0001), age (r = 0.54, P < 0.0001), total cholesterol (r = 0.54, P < 0.0001), and triglycerides (r = 0.65, P < 0.0001). Conclusions This study shows higher levels of plasma osteopontin and MIMT-CCA in psoriasis patients than in healthy controls. This is the first study to show a positive correlation between plasma osteopontin and MIMT-CCA.

Although major advances have occurred in treating patients with hepatitis C virus (HCV) with the development of new direct-acting antivirals (DAAs), treatment of liver transplant recipients with HCV, human immunodeficiency virus (HIV) coinfection, and renal disease is challenging due to the lack of efficacy and safety data in this population. We report a case of successful HCV therapy in a postliver transplant HIV coinfected patient, with stage 4 chronic kidney disease, using an all-oral regimen of simeprevir, sofosbuvir, and ribavirin. The 51-year-old male achieved SVR24, and no specific HIV-related or transplant-related adverse events were documented during the treatment period. The new DAAs show promise for HIV coinfected patients and those with severe to end-stage renal disease (ESRD); however, robust clinical trials or large cohort studies will need to be conducted to confirm the efficacy and safety of these newer agents in this setting.

Venous disease, particularly venous thromboembolism, is associated with significant mortality and morbidity. Over 200,000 first lifetime cases of venous thromboembolism occur every year in the United States. If the disease remains undetected, long-term morbidity can be significant. Up to 40% of patients with symptomatic deep vein thrombosis (DVT) develop post-thrombotic syndrome within 2 years, with markedly increased risk for those who suffer from recurrent episodes of DVT. Furthermore, approximately 5% of patients with pulmonary embolism (PE) secondary to venous thrombotic disease develop chronic pulmonary hypertension with decreased cardiopulmonary capacity.