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Purpose: To compare noise, contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and image quality using deep-learning image reconstruction (DLIR) vs. adaptive statistical iterative reconstruction (ASIR-V) in 0.625 and 2.5 mm slice thickness gray scale 74 keV virtual monoenergetic (VM) abdominal dual-energy CT (DECT). Methods: This retrospective study was approved by the institutional review board and regional ethics committee. We analysed 30 portal-venous phase abdominal fast kV-switching DECT (80/140kVp) scans. Data were reconstructed to ASIR-V 60% and DLIR-High at 74 keV in 0.625 and 2.5 mm slice thickness. Quantitative HU and noise assessment were measured within liver, aorta, adipose tissue and muscle. Two board-certified radiologists evaluated image noise, sharpness, texture and overall quality based on a five-point Likert scale. Results: DLIR significantly reduced image noise and increased CNR as well as SNR compared to ASIR-V, when slice thickness was maintained (p < 0.001). Slightly higher noise of 5.5–16.2% was measured (p < 0.01) in liver, aorta and muscle tissue at 0.625 mm DLIR compared to 2.5 mm ASIR-V, while noise in adipose tissue was 4.3% lower with 0.625 mm DLIR compared to 2.5 mm ASIR-V (p = 0.08). Qualitative assessments demonstrated significantly improved image quality for DLIR particularly in 0.625 mm images. Conclusions: DLIR significantly reduced image noise, increased CNR and SNR and improved image quality in 0.625 mm slice images, when compared to ASIR-V. DLIR may facilitate thinner image slice reconstructions for routine contrast-enhanced abdominal DECT. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate a novel deep learning image reconstruction (DLIR) technique for dual-energy CT (DECT) derived virtual monoenergetic (VM) images compared to adaptive statistical iterative reconstruction (ASIR-V) in low kiloelectron volt (keV) images.Methods: We analyzed 30 venous phase acute abdominal DECT (80/140 kVp) scans. Data were reconstructed to ASIR-V and DLIR-High at four different keV levels (40, 50, 74, and 100) with 1- and 3-mm slice thickness. Quantitative Hounsfield unit (HU) and noise assessment were measured within the liver, aorta, fat, and muscle. Subjective assessment of image noise, sharpness, texture, and overall quality was performed by two board-certified radiologists.Results: DLIR reduced image noise by 19.9-35.5% (p < 0.001) compared to ASIR-V in all reconstructions at identical keV levels. Contrast-to-noise ratio (CNR) increased by 49.2-53.2% (p < 0.001) in DLIR 40-keV images compared to ASIR-V 50 keV, while no significant difference in noise was identified except for 1 and 3 mm in aorta and for 1-mm liver measurements, where ASIR-V 50 keV showed 5.5-6.8% (p < 0.002) lower noise levels. Qualitative assessment demonstrated significant improvement particularly in 1-mm reconstructions (p < 0.001). Lastly, DLIR 40 keV demonstrated comparable or improved image quality ratings when compared to ASIR-V 50 keV (p < 0.001 to 0.22).Conclusion: DLIR significantly reduced image noise compared to ASIR-V. Qualitative assessment showed that DLIR significantly improved image quality particularly in thin sliced images. DLIR may facilitate 40 keV as a new standard for routine low-keV VM reconstruction in contrast-enhanced abdominal DECT.Key Points: • DLIR enables 40 keV as the routine low-keV VM reconstruction. • DLIR significantly reduced image noise compared to ASIR-V, across a wide range of keV levels in VM DECT images. • In low-keV VM reconstructions, improvements in image quality using DLIR were most evident and consistent in 1-mm sliced images. [ABSTRACT FROM AUTHOR]

Background: Current management of mesenteric ischemia is primarily endovascular stent treatment. Typical CMI symptoms are postprandial abdominal pain, food fear, weight loss, and diarrhea. Revascularization is often necessary, as mesenteric ischemia may progress to bowel necrosis and death if left untreated. This study aims to compare the outcome using bare metal stent (BMS) or covered stent (CS) in the endovascular treatment of chronic and acute on chronic mesenteric ischemia. Methods: This is an investigator-driven, prospective, randomized, single-blinded, and single-center, national cohort study at the Copenhagen University Hospital, Denmark. A total of 98 patients with chronic mesenteric ischemia (CMI) and acute-on-chronic mesenteric ischemia (AoCMI) will be randomized to treatment with either BeSmooth BMS (Bentley Innomed GmbH) or BeGraft CS (Bentley Innomed GmbH). Randomization occurs intraoperatively after lesion crossing. Discussion: There is currently no published data from prospective controlled trials regarding the preferred type of stent used for the treatment of chronic and acute-on-chronic mesenteric ischemia. This trial will evaluate the short- and long-term outcome of BMS versus CS when treating CMI and AoCMI, as well as the benefit of a more intense postoperative surveillance program. Trial registration: ClinicalTrials.gov NCT05244629. Registered on February 8, 2022. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether perioperative allogenic blood transfusions in patients undergoing surgical treatment for spinal metastases independently influence patient survival. Methods: A retrospective study including 170 consecutive patients undergoing surgical treatment for spinal metastases in 2009 and 2010 at a tertiary referral center. Variables related to postoperative survival were all included in the same multivariable logistic regression analysis with either 3- or 12-month survival as the dependent variable. The independent variables were: transfusion of allogenic red blood cells, age at surgery, gender, preoperative hemoglobin, revised Tokuhashi score and no. of instrumented levels. Results: Perioperative allogenic blood transfusion of 1-2 units was associated with increased 12-month survival [ p = 0.049, odds ratio 2.619 (confidence interval 1.004-6.831)], but not with 3-month survival. Larger transfusion volumes did not significantly influence survival. Conclusion: The results of the present study support that perioperative blood transfusion of <5 units does not decrease survival in patients operated for spinal metastases. Transfusion of 1-2 units seems to be associated with increased 12-month survival. Future studies should assess if a liberal transfusion regime can be applied to this group of patients; thereby, prioritizing early postoperative mobilization. [ABSTRACT FROM AUTHOR]

Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim of this review was to identify all published cases of the most severe condition, placenta percreta in order to describe complications associated with the three commonly used surgical strategies: local resection, hysterectomy or leaving the placenta in situ, and to describe the outcome, with respect to blood loss and transfusion requirements, with the different endovascular interventions that may be used as adjuncts in the management of the conditions. A PubMed search was performed in April 2013 and the final review included 119 published placenta percreta cases. Conservative management, where the placenta is left in situ for resorption, seems to be associated with severe long-term complications of hemorrhage and infections, including a 58% risk that a hysterectomy will eventually be needed up till nine months after the delivery. Local resection seems to be associated with fewer complications within 24 h postoperatively compared with hysterectomy or leaving the placenta in situ. A selection bias in the direction of less severe cases for the local resection technique might in part explain the lower complication rates with that approach. Future prospective data collection activities should include intended as well as actual management, and long-term follow-up of all cases is of vital importance. [ABSTRACT FROM AUTHOR]

The article presents a study which explores the association between fine-motor skills testing and the prediction of endovascular performance. The development of good fine-motor control of the non-dominant hand in clinicians with increasing levels of endovascular technical experience is highlighted. According to the study, the aplitude test of fine-motor skills cannot be suggested for the selection of novice candidates due to its inability to predict skills acquisition.

The effect of functional electrical stimulation (FES) training on body composition, assessed by computed tomography, and the effect of spasticity, assessed by both objective and subjective measures, are evaluated. Fifteen motor-complete spinal-cord-injured men participated in the study. Eight of the 15 subjects undertook FES cycling 3 times weekly for 6 months. Whole body computed tomography scans evaluated changes in body composition. Simultaneous Modified Ashworth Scale and electromyography (EMG) measurements, resistive torque (Kin-Com) and EMG measurements, and self-ratings with Visual Analogue Scale during four consecutive days were used to evaluate changes in spasticity. Lower extremity muscle volume increased by an average of 1300 cm[sup 3] (p < 0.001) in the training group compared to the control group, who experienced no change. Otherwise no changes in body composition were seen. Significant correlations (Spearman) were found between individual EMG activity recordings and movement-provoked Modified Ashworth Scale ratings in 26% of the test situations, irrespective of group and time. The objective and subjective evaluation of movement-provoked passive (viscoelastic) and active (spasticity-related) resistance remained unchanged. [ABSTRACT FROM AUTHOR]

Vascular surgery is in a transitional phase. Standard open repair is being replaced by endovascular and minimally invasive techniques. The techniques developed for elective cases are also applicable for injured patients. The introduction of endovascular treatment for emergencies has consequences for both institutional and regional organisation. Success can be achieved only by the prepared team trained with wide elective experience. Endovascular repair of vascular injuries has many advantages, such as remote approach and limited exposure with less surgical stress to the patient. Because the long term effects are only partially known a word of caution is justified. Endovascular repair of vascular trauma is still a developing form of treatment. [ABSTRACT FROM AUTHOR]

Patient-specific rehearsal (PsR) is a new concept whereby a procedure can be rehearsed virtually using the exact patient's anatomical data prior to performing the real procedure. The aim of this study was to ascertain if endovascular virtual-reality PsR simulation enhanced performance in real life. This was done by performing a systematic review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted in PubMed, Embase, The Cochrane Library and Web of Science concerning PsR in endovascular procedures. All publications were handled using Covidence. Reference lists were also screened. Data extracted from the studies were realism rating, procedure time, fluoroscopy time, contrast volume, number of angiograms and reduction of errors. Kirkpatrick's four-level model for measuring the efficiency of training was used for guidance of the relevance of studies. The search yielded 1155 results after the exclusion of duplicates, and 11 studies were included. Four studies had a control group, including one randomized trial; the remaining seven were feasibility studies. The realism was rated high, and overall, the studies showed improvements in procedure time, fluoroscopy time and contrast volume after PsR. One study assessed and confirmed the reduction in errors after PsR. Only two studies included more than 15 patients in their cohort. Kirkpatrick's model was applied to all studies, with one study reaching level 4. All studies found the concept of PsR to be feasible and realistic. The studies with a control group showed a reduction of overall procedure time, radiation exposure and potential errors in endovascular procedures following PsR. [ABSTRACT FROM AUTHOR]

Nearly one in three men develop lower urinary tract symptoms (LUTS) and 10% clinically progress despite medication. Transurethral resection of the prostate (TURP) is the reference standard for symptoms refractory to medical treatment. However, some patients cannot tolerate TURP for medical (e.g., comorbidity) or technical (e.g., large prostate) reasons. This study estimated the safety and effect of prostate artery embolization (PAE) in men unfit for surgery. A prospective, single-centre trial including men with LUTS or urinary retention secondary to benign prostatic hyperplasia (BPH) who were unfit for surgery. The primary objective was to treat urinary retention and LUTS. Outcome measures included International Prostate Symptom Score (IPSS), quality of life (IPSS-QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR), and complications. A p-value < 0.05 was considered statistically significant. Eleven consecutive patients with a mean age of 75.2 (SD ± 8.2) underwent PAE. Catheter removal was successful in 60%. IPSS-QoL improved 4.5 points (95% CI: −5.6; −3.4), and PV was reduced by 26.2 cm3 (95% CI: −50.9; −2.3). None of the remaining outcomes changed. No major complications occurred. PAE was effective and safe for LUTS and urinary retention associated with BPH in men unfit for surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic capabilities of a supplementary color ramped iodine density map compared to virtual monoenergetic images (VMIs) at 74 keV in the diagnosis of acute bowel ischemia (ABI). Methods: Data for this study were prospectively gathered and retrospectively evaluated. Patients referred to the Department of Diagnostic Radiology between October 2020 and August 2022 on the suspicion of ABI and underwent surgery < 12 h following fast kV-switching venous phase abdominal dual-energy CT (DECT) were consecutively included. Images were evaluated by two board-certified radiologists and two radiology residents. First round included only 74 keV VMIs resembling conventional 120 kVp images, and the second round included a supplementary iodine density map. Readers were asked to register presence of ABI as well as their confidence in their diagnosis based on a 5-point Likert scale. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each observer with the surgical findings as the gold-standard. McNemar's and Wilcoxon signed-rank test were used to compare registrations and diagnostic confidence across assessment rounds. Results: A total of 29 patients resulting in 31 DECT scans were included. Fourteen cases of ischemic/necrotic bowel were reported following surgery. Sensitivity and NPV were decreased with the use of supplementary iodine map images compared to 120 kVp-like images without supplementary iodine map images for three of four observers (round 1 range: 71.4–92.9% and 78.0–94.8%; round 2 range: 57.1–78.6% and 70.1–83.3%, respectively), while specificity and PPV were increased for three of four observers (round 1 range: 64.7–94.1% and 67.4–93.1%; round 2 range: 88.2–94.1% and 73.8–91.1%, respectively). However, no significant difference in ABI diagnosis or diagnostic confidence was found (p-value range: 0.07–1.00 and 0.23–0.58, respectively). Conclusion: No significant difference for the diagnosis of ABI was found using supplementary iodine mapping. Our study may suggest a trend of increased specificity and decreased sensitivity, hence, the use of supplementary iodine mapping should be carefully considered. [ABSTRACT FROM AUTHOR]

• Training is required for all doctors new to REBOA regardless of existing vascular access skills and simpler catheter systems. • Doctors skilled in vascular access benefit from an initial inter-procedural transfer of skills effect when first learning REBOA. • However, novice doctors perform equally well after a focussed simulation-based training, indicating that either group can learn the technical aspects of inserting REBOA. • A time-fixed simulation-based training program does not ensure technical proficiency of doctors learning REBOA, despite vast experience. • Individual skills assessment should be used to ensure proficiency following training for all doctors regardless of previous experience. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and potentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (experienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training. This was a prospective trial of an educational intervention. Three groups of doctors were enroled: novice residents, experienced anaesthesiologists, and endovascular experts. The novices and the anaesthesiologists completed 2.5 h of simulation-based REBOA training. Their skills were tested before and 8–12 weeks after training using a standardised simulated scenario. The endovascular experts, constituting a reference group, were equivalently tested. All performances were video recorded and rated by three blinded experts using a validated assessment tool for REBOA (REBOA-RATE). Performances were compared between groups and with a previously published pass/fail cutoff. Sixteen novices, 13 board-certified specialists in anaesthesiology, and 13 endovascular experts participated. Before training, the anaesthesiologists outperformed the novices by 30 percentage points of the maximum REBOA-RATE score (56% (SD 14.0) vs 26% (SD 17%), p <0.01). After training, there was no difference in skills between the two groups (78% (SD 11%) vs 78 (SD 14%), p = 0.93). Neither group reached the endovascular experts' skill level (89% (SD 7%), p <0.05). For doctors mastering the Seldinger technique, there was an initial inter-procedural transfer of skills advantage when performing REBOA. However, after identical simulation-based training, novices performed equally well to anaesthesiologists, indicating that vascular access experience is not a prerequisite to learning the technical aspects of REBOA. Both groups would need more training to reach technical proficiency. [ABSTRACT FROM AUTHOR]

Background: Incidental findings are common in abdominal computed tomography (CT) and often warrant further investigations with economic implications as well as implications for patients. Purpose: To evaluate the potential of dual-energy CT (DECT) in the identification and/or characterization of abdominal incidental mass lesions compared to conventional contrast-enhanced CT Material and Methods: This retrospective study from a major tertiary hospital included 96 patients, who underwent contrast-enhanced abdominal DECT. Incidental lesions in adrenals, kidneys, liver, and pancreas were evaluated by two board-certified abdominal radiologists. Observer 1 only had access to standard CT reconstructions, while observer 2 had access to standard CT as well as DECT reconstructions. Disagreements were resolved by consensus review and used as a reference for observers using McNemar's test Results: Observers 1 and 2 identified a total of 40 and 34 findings, respectively. Furthermore, observer 1 registered 13 lesions requiring follow-up, of which seven (two renal and five adrenal lesions) were resolved following consensus review using DECT (P = 0.008). The inter-observer agreement was near perfect (κ = 0.82). Conclusion: DECT has the potential to improve the immediate characterization of incidental findings when compared to conventional CT for abdominal imaging. [ABSTRACT FROM AUTHOR]

Background Renal artery duplex ultrasound (RADUS) is an established method for diagnosis of renal artery stenosis (RAS), but there is no consensus regarding optimal RADUS criteria. Purpose To define optimal cutoff values for RADUS parameters when screening for RAS using intra-arterial trans-stenotic pressure gradient measurement (PGM) as reference. Material and Methods The renal arteries of 58 consecutive patients evaluated for renovascular hypertension were examined by RADUS and PGM. Conclusive measurements with both methods were obtained in 76 arteries. Hemodynamically significant RAS was defined as PGM ≥15 mmHg and was found in 43 of the 76 arteries. RADUS parameters included renal artery peak systolic velocity (PSV) and the renal-aortic ratio (RAR) of flow velocities. Receiver operating characteristic curves (ROCs) and Youden's index were used to calculate optimal RADUS criteria for RAS. Results When traditional RADUS criteria for RAS were used, with a combination of PSV ≥180 cm/s and RAR ≥3.5, the sensitivity was 62% and the specificity was 91%. When RADUS criteria were optimized for sensitivity, then RAR ≥2.6 alone resulted in a sensitivity of 89% and a specificity of 69%. Conclusion The RAR ≥2.6 is a more sensitive criterion than traditional RADUS criteria when screening patients with clinical suspicion of RAS. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of center experience and a variety of patient- and procedure-related factors on patient radiation exposure during prostatic artery embolization (PAE) in three Scandinavian centers with different PAE protocols and levels of experience. Understanding factors that influence radiation exposure is crucial in effective patient selection and procedural planning. Methods: Data were collected retrospectively for 352 consecutive PAE procedures from January 2015 to June 2020 at the three centers. Dose area product (DAP (Gy·cm2)) was selected as the primary outcome measure of radiation exposure. Multiple patient- and procedure-related explanatory variables were collected and correlated with the outcome variable. A multiple linear regression model was built to determine significant predictors of increased or decreased radiation exposure as reflected by DAP. Results: There was considerable variation in DAP between the centers. Intended unilateral PAE (p = 0.03) and each 10 additional patients treated (p = 0.02) were significant predictors of decreased DAP. Conversely, increased patient body mass index (BMI, p < 0.001), fluoroscopy time (p < 0.001), and number of digital subtraction angiography (DSA) acquisitions (p < 0.001) were significant predictors of increased DAP. Conclusions: To minimize patient radiation exposure during PAE radiologists may, in collaboration with clinicians, consider unilateral embolization, pre-interventional CTA for procedure planning, using predominantly anteroposterior (AP) projections, and limiting the use of cone-beam CT (CBCT) and fluoroscopy. Key Points: • Growing center experience and intended unilateral embolization decrease patient radiation exposure during prostatic artery embolization. • Patient BMI, fluoroscopy time, and number of DSA acquisitions are associated with increased DAP during procedures. • Large variation in radiation exposure between the centers may reflect the use of CTA before and CBCT during the procedure. [ABSTRACT FROM AUTHOR]

We assessed the correlation between liver fat percentage using dual-energy CT (DECT) and Hounsfield unit (HU) measurements in contrast and non-contrast CT. This study included 177 patients in two patient groups: Group A (n = 125) underwent whole body non-contrast DECT and group B (n = 52) had a multiphasic DECT including a conventional non-contrast CT. Three regions of interest were placed on each image series, one in the left liver lobe and two in the right to measure Hounsfield Units (HU) as well as liver fat percentage. Linear regression analysis was performed for each group as well as combined. Receiver operating characteristic (ROC) curve was generated to establish the optimal fat percentage threshold value in DECT for predicting a non-contrast threshold of 40 HU correlating to moderate-severe liver steatosis. We found a strong correlation between fat percentage found with DECT and HU measured in non-contrast CT in group A and B individually (R2 = 0.81 and 0.86, respectively) as well as combined (R2 = 0.85). No significant difference was found when comparing venous and arterial phase DECT fat percentage measurements in group B (p = 0.67). A threshold of 10% liver fat found with DECT had 95% sensitivity and 95% specificity for the prediction of a 40 HU threshold using non-contrast CT. In conclusion, liver fat quantification using DECT shows high correlation with HU measurements independent of scan phase. [ABSTRACT FROM AUTHOR]

Local pressure differences estimated using vector flow imaging (VFI) and direct catheterization in seven carotid bifurcation phantoms were compared with simulated pressure fields. VFI correlated strongly with simulated peak pressure differences (r = 0.99, p < 0.00001), with an average overestimation of 12.3 Pa (28.6%). The range between the lowest and highest pressure difference of VFI underestimated simulations by 4.6 Pa (8.06%; r = 0.99, p < 0.0001). The catheter method exhibited no correlation (r = -0.09, p = 0.85). Ten repeated measurements on one phantom revealed a small standard deviation (SD) for VFI (SD = 8.4%, mean estimated SD = 11.5%), but not for the catheter method (SD = 785.6%). An in vivo peak systolic pressure difference of 97.9 Pa (estimated SD = 30%) was measured using VFI in one healthy individual. This study indicates that VFI pressure difference estimation is feasible in phantoms and in vivo and realistic estimates of the SD can be attained from the data. [ABSTRACT FROM AUTHOR]

Summary: Trauma accounts for approximately 1 in 10 deaths worldwide. The presence of a pelvic fracture increases this mortality risk. Successful management depends on accurate diagnostic staging and control of fracture-related haemorrhage. From the standpoint of the trauma surgeon, this necessitates thorough compression and stabilisation of the fracture using external compression, combined with retroperitoneal or preperitoneal packing. However, vascular injury in many parts of the body can preferentially and effectively be treated on an emergency basis with angiographic procedures, using superselective embolisation in combination with other interventional techniques. The option of combining open surgery and angiographic methods should be kept in mind, but there are no uniform guidelines. In the literature, numerous studies and reports have documented the feasibility of interventional radiological procedures in trauma cases with pelvic fracture. Thus all level I trauma centres should be able to provide this service on a 24h basis. [Copyright &y& Elsevier]

Objectives: The first objective was to investigate the correlations between anthropometrical measurements and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in two cohorts differing in age using magnetic resonance imaging (MRI) as reference. A second objective was to investigate the potential usage of abdominal diameters in practical estimation of adipose tissue compartments using these cohorts. Methods: Measurements of body mass index, waist circumference, sagittal abdominal diameter (sagittal AD) and transverse abdominal diameter (transverse AD) were obtained from 336 volunteers of age 14–70 years. Manual measurements of VAT and SAT from single slice MRI at the L4-L5 level were used as reference. The abdominal diameters were measured from the MR images. Linear correlations between the anthropometrical measurements and the reference were studied. Results: Sagittal AD showed the strongest correlation to VAT ( r ≥ 0·780, P<0·0001) and transverse AD was found to give information about the amount of SAT ( r ≥ 0·866, P<0·0001). The ellipse spanned by the sagittal AD and the transverse AD was strongly correlated to the total amount of adipose tissue ( r ≥ 0·962, P<0·0001). Conclusion: Strong correlations were found between sagittal and transverse abdominal diameters, assessed using MRI, and VAT and SAT, respectively. These results suggest the use of abdominal diameters in practical estimations of VAT and SAT depots. [ABSTRACT FROM AUTHOR]

Insulin-resistant subjects have a slow onset of insulin action, and the underlying mechanism has not been determined. To evaluate whether a delayed transcapillary transport is part of the peripheral insulin resistance, we followed the kinetics of infused insulin and inulin in plasma and muscle interstitial fluid in obese insulin-resistant patients and control subjects. A total of 10 lean and 10 obese men (BMI 24 +/- 0.8 vs. 32 +/- 0.8 kg/m(2), P < 0.001) was evaluated during a hyperinsulinemic-euglycemic clamp (insulin infusion rate 120 mU. m(-2). min(-1)) combined with an inulin infusion. Measurements of insulin and inulin in plasma were taken by means of arterial-venous catheterization of the forearm and microdialysis in brachioradialis muscle combined with forearm blood flow measurements with vein occlusion pletysmography. The obese subjects had a significantly lower steady-state glucose infusion rate and, moreover, demonstrated a delayed appearance of insulin (time to achieve half-maximal concentration [T(1/2)] 72 +/- 6 vs. 46 +/- 6 min in control subjects, P < 0.05) as well as inulin (T(1/2) 83 +/- 3 vs. 53 +/- 7 min, P < 0.01) in the interstitial fluid. Also, the obese subjects had a delayed onset of insulin action (T(1/2) 70 +/- 9 vs. 45 +/- 5 min in control subjects, P < 0.05), and their forearm blood flow rate was significantly lower. These results demonstrate a delayed transcapillary transport of insulin and inulin from plasma to the muscle interstitial fluid and a delayed onset of insulin action in insulin-resistant obese subjects. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic heart failure demonstrate several skeletal muscle abnormalities. The underlying mechanisms are unclear. After cardiac transplantation, cardiac function is restored, but exercise capacity is still impaired.Aim: To evaluate the influence of cardiac transplantation on skeletal muscle fibre composition, fibre area and capillarization as well as muscle enzymes, lactate, thigh muscle area and strength.Methods: Ten patients were longitudinally investigated before, 1-3 and 6-9 months after transplantation. Ten healthy individuals served as controls. A biopsy from the lateral vastus muscle was obtained and the thigh muscle area was measured with computed tomography. Muscle strength in the knee extensors and exercise capacity were also evaluated.Results: Muscle lactate was elevated in patients vs. controls (3.6+/-3.0 vs. 1.5+/-0.7 mmol/kg wet wt., P=0.037), and decreased to normal (1.4+/-0.3 mmol/kg wet wt., P=0.038) after transplantation. Citrate synthase activity was decreased in patients (5.6+/-1.5 micromol/g wet wt./min) vs. controls (8.1+/-1.6 micromol/g wet wt./min, P=0.0018), and did not change post transplantation. Patients had decreased number of capillaries in contact with each fibre vs. controls (2.6+/-0.5 vs. 3.5+/-1.0, P=0.039) which persisted post transplantation. Exercise capacity increased after transplantation (74+/-22 vs. 118+/-26 W, P=0.0002), whereas muscle strength did not improve significantly.Conclusion: The persisting intrinsic abnormalities in skeletal muscle after cardiac transplantation may contribute to the impaired exercise capacity observed in cardiac transplant recipients. [ABSTRACT FROM AUTHOR]

Non-invasive assessment is preferred for monitoring arteriovenous dialysis fistulas (AVFs). Vector concentration assesses flow complexity, which may correlate with stenosis severity. We determined whether vector concentration could assess stenosis severity in dysfunctional AVFs. Vector concentration was estimated in four stenotic phantoms at different pulse repetition frequencies. Spectral Doppler peak velocity and vector concentration were measured in 12 patients with dysfunctional AVFs. Additionally, 5 patients underwent digital subtraction angiography (DSA). In phantoms, vector concentration exhibited an inverse relationship with stenosis severity and was less affected by aliasing in severe stenoses. In nine stenoses of 5 patients undergoing DSA, vector concentration correlated strongly with stenosis severity (first stenosis: r = -0.73, p = 0.04; other stenoses; r = -0.69, p = 0.02) and mid-stenotic diameter (first stenosis: r = 0.87, p = 0.006; other stenoses: r = 0.70, p = 0.02) as opposed to peak velocities (p > 0.05). Vector concentration is less affected by aliasing in severe stenoses and correlates with DSA in patients with dysfunctional AVF. [ABSTRACT FROM AUTHOR]

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving but high-risk emergency procedure in patients with haemorrhagic shock. Lack of physicians with competence in the procedure is a barrier to implementation of REBOA. It is currently unclear how training and assessment of competence should be done.Objectives: To report and evaluate research in training and assessment of competence in REBOA and femoral arterial access with the aim to investigate the effect of simulation-based training in the procedure and to provide suggestions for the future design of training programs and assessment tools.Methods: Following PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched for studies on training or assessment of competence in REBOA and femoral arterial access. Bias assessment was done using the Medical Education Research Study Quality Instrument. Evidence level was assessed using GRADE.Results: Sixteen studies were included, six of them published as abstracts. Full-text studies included 189 trainees ranging in experience level from military medics to surgical specialists. Outcome measures were heterogenous; the most used were rater checklists, knowledge testing, and procedure time. All studies confirmed an effect of training of REBOA on procedural competence in a simulation setting but had a high degree of bias. No study developed or used an assessment tool supported by validity evidence and no study investigated mid and long-term outcomes.Conclusion: Simulation-based training of REBOA improves skills, however, the evidence level is very low and data cannot answer important questions on effect size, skill transfer and retention, and optimal course design. To advance research and training programmes, an assessment tool supported by validity evidence with broad applicability is needed. [ABSTRACT FROM AUTHOR]

Abstract Aims Stent graft placement is a safe and effective treatment option for vascular complications in the context of transcatheter aortic valve implantation (TAVI). This study aimed to provide long-term angiological follow-up of stent grafts used for this indication. Methods and results Seventy-one patients (64.8% female, log EuroScore 14.7 ± 6.8%) who had undergone TAVI between March 2010 and October 2015 with implantation of a Viabahn or Fluency stent graft to treat access-site or access-related vascular injury (ASARVI) were analyzed. Implantations were mostly due to access-site bleeding complications (83.1%) in the common femoral artery (97.1%). Follow-up was performed with duplex sonography in all patients after a median of 3.9 years after TAVI (interquartile range [IQR]: 895–1749 days). Ultrasound revealed tri- or biphasic flow patterns in 16.9% and 77.6%, respectively. Stent graft patency was 100% without signs of stent graft stenosis (mean peak velocity ratio 1.0 ± 0.2). Pseudo-aneurysms or endoleaks were diagnosed in 5.6% of patients. Additional fluoroscopic and/or computed tomography (CT)-imaging was available in 36.6% of patients and did not reveal any stent fracture. Conclusion Self-expanding stent grafts provide excellent long-term function with few complications when implanted in the context of TAVI-related ASARVI. Highlights • Long-term data on stent grafts used in TAVI-related vascular complications is missing. • In this study we analyzed seventy-one patients treated with two different stent grafts. • After a median of 3.9 years, no stent stenosis or stent fracture was observed. • Pseudo-aneurysms or endoleaks were observed in 5.6% of patients. • Stent grafts provide a durable treatment for TAVI-related vascular complications. [ABSTRACT FROM AUTHOR]

Respiratory variability of peak velocities (RVPV) in the common femoral vein measured with ultrasound can reveal venous outflow obstruction. Pulse wave (PW) Doppler is the gold standard for venous velocity estimation of the lower extremities. PW Doppler measurements are angle dependent, whereas vector flow imaging (VFI) can yield angle-independent measures. The hypothesis of the present study was that VFI can provide RVPV estimations without the angle dependency of PW Doppler for an improved venous disease assessment. Sixty-seven patients with symptomatic chronic venous disease were included in the study. On average, VFI measured a lower RVPV than PW Doppler (VFI: 14.11 cm/s; PW: 17.32 cm/s, p = 0.002) with a non-significant improved precision compared with PW Doppler (VFI: 21.09%; PW: 26.49%, p = 0.08). In a flow phantom, VFI had improved accuracy (p < 0.01) and equal precision compared with PW Doppler. The study indicated that VFI can characterize the hemodynamic fluctuations in the common femoral vein. [ABSTRACT FROM AUTHOR]

The study described here investigated whether angle-independent vector flow imaging (VFI) technique estimates peak velocities in the portal vein comparably to pulsed wave Doppler (PWD). Furthermore, intra- and inter-observer agreement was assessed in a substudy. VFI and PWD peak velocities were estimated with from intercostal and subcostal views for 32 healthy volunteers, and precision analyses were conducted. Blinded to estimates, three physicians rescanned 10 volunteers for intra- and inter-observer agreement analyses. The precision of VFI and PWD was 18% and 28% from an intercostal view and 23% and 77% from a subcostal view, respectively. Bias between VFI and PWD was 0.57 cm/s (p = 0.38) with an intercostal view and 9.89 cm/s (p <0.001) with a subcostal view. Intra- and inter-observer agreement was highest for VFI (inter-observer intra-class correlation coefficient: VFI 0.80, PWD 0.3; intra-observer intra-class correlation coefficient: VFI 0.90, PWD 0.69). Regardless of scan view, VFI was more precise than PWD. [ABSTRACT FROM AUTHOR]

Ultrasound is used for evaluating the veins of the lower extremities. Operator and angle dependency limit spectral Doppler ultrasound (SDUS). The aim of the study was to compare peak velocity measurements in a flow phantom and the femoropopliteal vein of 20 volunteers with the angle-independent vector velocity technique vector flow imaging (VFI) and SDUS. In the flow phantom, VFI underestimated velocity (p = 0.01), with a lower accuracy of 5.5% (p = 0.01) and with no difference in precision, that is, error factor, compared with SDUS (VFI: 1.02 vs. SDUS: 1.02, p = 0.58). In vivo, VFI estimated lower velocities (femoral: p = 0.001; popliteal: p = 0.001) with no difference in precision compared with SDUS (femoral: VFI 1.09 vs. SDUS 1.14, p = 0.37; popliteal: VFI 1.13 vs. SDUS 1.06, p = 0.09). In conclusion, the precise VFI technique can be used to characterize venous hemodynamics of the lower extremities despite its underestimation of velocities. [ABSTRACT FROM AUTHOR]

Background Preoperative embolization is based on the preoperative digital subtraction angiography (DSA) tumor blush, and as such is considered the "gold standard" for determining tumor vascularity. However, to our knowledge reliability studies evaluating vascularity ratings of DSA tumor blush in spinal metastases have not been published previously. Purpose To evaluate inter- and intra-rater agreement in the assessment of the vascularity of spinal metastases using DSA tumor blush. Material and Methods This reliability study included 46 patients with symptomatic metastatic spinal cord compression requiring surgery. DSA data stored in the hospital picture archiving and communication system (PACS) from the participants of a randomized controlled trial were used. Inter- and intra-rater agreement on vascularity assessment using DSA tumor blush according to a three-step ordinal scale was evaluated: no hypervascularity; moderate hypervascularity; and pronounced hypervascularity. The statistical analysis was based on the linear weighted kappa's for multiple raters that extend Cohen's κ. Three raters and κ = 0.2 in the null hypothesis implied that the power of the study was 0.96. Results Inter- and intra-rater agreements were moderate in rating the vascularity of spinal metastases and the agreements were significantly higher than the κ = 0.20 in the null hypothesis ( P = 0.0002 and P = 0.0001). The κ value for inter-rater agreement was 0.57 (95% confidence interval [CI], 0.41-0.72) and for intra-rater agreement 0.55 (95% CI, 0.38-0.71). Conclusion There is moderate inter-rater and intra-rater agreement in classifying the vascularity of spinal metastases on a three-step ordinal scale for DSA tumor blush. [ABSTRACT FROM AUTHOR]

Objectives: Disruption of the endothelial lining may be one of the events linking intraluminal thrombus and abdominal aortic aneurysm growth. In the present study, we examined whether von Willebrand factor activity in plasma, contact proteins of blood coagulation, and inflammatory biomarkers may be associated with intraluminal thrombus volume in search of a biochemical marker of endothelial damage and thrombus size. Design: Prospective study, correlating potential endothelial biomarkers and intraluminal thrombus volume acquired by computed tomography angiography. Materials and Methods: Plasma was consecutively obtained from 38 patients with asymptomatic infrarenal abdominal aortic aneurysm. von Willebrand factor activity, thrombin generation time, factor XII, and prekallikrein concentration were measured in plasma on automated and in-house platforms. In total, 8 patients were excluded due to ongoing anticoagulant therapy, renal impairment, or nonappearance, thus leaving 30 patients for further analysis. All patients had computed tomography angiography, and intraluminal volume was quantified off-line by OsiriX 6.5. Results: Median intraluminal thrombus volume was 42.7 mL. Spearman correlation analysis revealed a positive correlation between thrombus volume, von Willebrand factor activity (ρ = 0.56, P = .0013), and prekallikrein concentration in plasma (ρ = 0.54, P = .002). Conclusion: von Willebrand factor activity and concentration of prekallikrein may both be of importance regarding the evolution of thrombus in abdominal aortic aneurysm and possible biomarkers for aneurysm growth. [ABSTRACT FROM AUTHOR]

Background Vascular access complications after coronary angiography (CAG) and percutaneous coronary intervention (PCI) are known to increase morbidity, prolong hospitalization and raise hospital costs. Therefore, risk factor identification and improvement of safety strategies for vascular management are important. We aimed to assess the incidence of major vascular complications related to femoral access, and to identify potential risk factors. Methods Over a period of six years, 23,870 index procedures (CAG) were performed in two centres, prospectively entered in the database and retrospectively analysed. Data was obtained from the Eastern Danish Heart Registry and cross-matched with data from the Danish Vascular Registry. Index procedures were defined as the first trans-femoral procedure. Demographic, procedural and mortality data, as well as information on access complications requiring surgery within 30 days were collected. Mortality data were collected for minimum 12 months. Results We identified 130 (0.54%) access complications requiring surgery; 65 pseudoaneurysms (0.28%), 46 arterial occlusions (0.19%), 15 hematomas (nine groin and six retroperitoneal hematomas) (0.06%), and 4 arterial dissections (0.02%). Risk factors for complications were left sided femoral access (OR 4.11 [2.29–7.37] p < 0.001), peripheral arterial disease (PAD) (OR 2.42 [1.48–3.94] p < 0.0001) and female sex (OR 2.22 [1.51–3.24] p < 0.0001). Conclusion Vascular complications related to femoral access in coronary diagnostic and interventional procedures are low (0.54%). Risk factors were left sided access, PAD, and female sex. [ABSTRACT FROM AUTHOR]

Brain activation reduces balance between cerebral consumption of oxygen versus carbohydrate as expressed by the so-called cerebral oxygen-carbohydrate-index ( OCI). We evaluated whether preparation for surgery, anaesthesia including tracheal intubation and surgery affect OCI. In patients undergoing aortic surgery, arterial to internal jugular venous (a-v) concentration differences for oxygen versus lactate and glucose were determined from before anaesthesia to when the patient left the recovery room. Intravenous anaesthesia was supplemented with thoracic epidural anaesthesia for open aortic surgery ( n = 5) and infiltration with bupivacaine for endovascular procedures ( n = 14). The a-v difference for O2 decreased throughout anaesthesia and in the recovery room (1·6 ± 1·9 versus 3·2 ± 0·8 mmol l−1, mean ± SD), and while a-v glucose decreased during surgery and into the recovery (0·4 ± 0·2 versus 0·7 ± 0·2 mmol l−1, P<0·05), a-v lactate did not change significantly (0·03 ± 0·16 versus −0·03 ± 0·09 mmol l−1). Thus, OCI decreased from 5·2 ± 1·8 before induction of anaesthesia to 3·2 ± 1·0 following tracheal intubation ( P<0·05) because of the decrease in a-v O2 with a recovery for OCI to 4·6 ± 1·4 during surgery and to 5·6 ± 1·7 in the recovery room. In conclusion, preparation for surgery and tracheal intubation decrease OCI that recovers during surgery under the influence of sensory blockade. [ABSTRACT FROM AUTHOR]

Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI–induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients. [ABSTRACT FROM AUTHOR]

Medical ultrasound imaging using synthetic aperture sequential beamforming (SASB) has for the first time been used for clinical patient scanning. Nineteen patients with cancer of the liver (hepatocellular carcinoma or colorectal liver metastases) were scanned simultaneously with conventional ultrasound and SASB using a commercial ultrasound scanner and abdominal transducer. SASB allows implementation of the synthetic aperture technique on systems with restricted data handling capabilities due to a reduction in the data rate in the scanner by a factor of 64. The image quality is potentially maintained despite the data reduction. A total of 117 sequences were recorded and evaluated blinded by five radiologists from a clinical perspective. Forty-eight percent of the evaluations were in favor of SASB, 33% in favor of conventional ultrasound and 19 % were equal, that is, a clear, but non-significant trend favoring SASB over conventional ultrasound ( p = 0.18), despite the substantial data reduction. [ABSTRACT FROM AUTHOR]

Abnormal blood flow is usually assessed using spectral Doppler estimation of the peak systolic velocity. The technique, however, only estimates the axial velocity component, and therefore the complexity of blood flow remains hidden in conventional ultrasound examinations. With the vector ultrasound technique transverse oscillation the blood velocities of both the axial and the transverse directions are obtained and the complexity of blood flow can be visualized. The aim of the study was to determine the technical performance and interpretation of vector concentration as a tool for estimation of flow complexity. A secondary aim was to establish accuracy parameters to detect flow changes/patterns in the common carotid artery (CCA) and the carotid bulb (CB). The right carotid bifurcation including the CCA and CB of eight healthy volunteers were scanned in a longitudinal plane with vector flow ultrasound (US) using a commercial vector flow ultrasound scanner (ProFocus, BK Medical, Denmark) with a linear 5 MHz transducer transverse oscillation vector flow software. CCA and CB areas were marked in one cardiac cycle from each volunteer. The complex flow was assessed by medical expert evaluation and by vector concentration calculation. A vortex with complex flow was found in all carotid bulbs, whereas the CCA had mainly laminar flow. The medical experts evaluated the flow to be mainly laminar in the CCA (0.82 ± 0.14) and mainly complex (0.23 ± 0.22) in the CB. Likewise, the estimated vector concentrations in CCA (0.96 ± 0.16) indicated mainly laminar flow and in CB (0.83 ± 0.07) indicated mainly turbulence. Both methods were thus able to clearly distinguish the flow patterns of CCA and CB in systole. Vector concentration from angle-independent vector velocity estimates is a quantitative index, which is simple to calculate and can differentiate between laminar and complex flow. [ABSTRACT FROM AUTHOR]

Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow was estimated to be 242 mL/min and 404 mL/min lower than the ultrasound dilution technique estimate, depending on the approach. The standard deviations of the two Vector Flow Imaging approaches were 175.9 mL/min and 164.8 mL/min compared with a standard deviation of 136.9 mL/min using the ultrasound dilution technique. The study supports that Vector Flow Imaging is applicable for volume flow measurements. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the performance of strain elastography in an elasticity phantom and to assess which factors influenced visual scoring, strain histograms and strain ratios. Furthermore this study aimed to evaluate the effect of observer experience on visual scorings. Materials and Methods: Two operators examined 20 targets of various stiffness and size (16.7 to 2.5 mm) in an elasticity phantom at a depth of 3.5 cm with a 5–18 MHz transducer. Two pre-settings were used yielding 80 scans. Eight evaluators, four experienced, four inexperienced, performed visual scorings. Cut-offs for semi-quantitative methods were established for prediction of target stiffness. Data was pooled in two categories allowing calculations of sensitivity and specificity. Statistical tests chi-square test and linear regression as relevant. Results: Strain ratios and strain histograms were superior to visual scorings of both experienced and inexperienced observers (p = 0.025, strain histograms vs. experienced observers, p<0.001, strain histograms vs. inexperienced observers, p = 0.044 strain ratios vs. experienced observers and p = 0.002 strain ratios vs. inexperienced observers). No significant difference in predicting target stiffness between strain ratios and strain histograms (p = 0.83) nor between experienced and inexperienced observers (p = 0.054) was shown when using four categories. When pooling data in two groups (80 kPa/45 kPa vs. 14/8 kPa) the difference between the observers became significant (p<0.001). Target size had a significant influence on strain ratios measurements (p = 0.017) and on visual scorings (p<0.001) but not on the strain histograms(p = 0.358). Observer experience had significant effect on visual scorings(p = 0.003). Conclusion: Strain ratios and strain histograms are superior to visual scoring in assessing target stiffness in a phantom. Target size had a significant impact on strain ratios and visual scoring, but not on strain histograms. Experience influenced visual scorings but the difference between experienced and inexperienced observers was only significant when looking at two classes of target stiffness. [ABSTRACT FROM AUTHOR]

Objective. To evaluate our experience with prophylactic balloon occlusion of the internal iliac arteries as a part of a multidisciplinary algorithm for the management of placenta percreta. Design. Consecutive case series. Setting. Rigshospitalet, Copenhagen University Hospital, Denmark. Sample. Seventeen women with placenta percreta. Methods. Demographic characteristics, intraoperative data and outcomes are summarized and discussed. Main outcome measures. Feasibility of local resection, intraoperative blood loss and transfusion requirements. Results. The multidisciplinary management allowed for local resections in nine of the 11 women who requested preservation of fertility. The mean intraoperative blood loss was 4050 mL (range 450-16 000 mL, median 2500 mL). Adhesions to the bladder or the parietal peritoneum were associated with an intraoperative blood loss >6000 mL. Conclusions. Prophylactic balloon occlusion of the internal iliac arteries as part of a multidisciplinary algorithm allowed for a safe management of all cases in our consecutive series of 17 women with placenta percreta. However, intraoperative blood loss and transfusion requirements were significant. We have therefore decided to modify our multidisciplinary algorithm to include balloon occlusion of the common iliac arteries rather than the internal iliac arteries. [ABSTRACT FROM AUTHOR]

The article focuses on the thoracic endovascular aortic repair (TEVAR) for treating aortic diseases. It informs about the main diagnoses with the TEVAR which include thoracic aortic aneurysm (TAA), thoracic aortic dissection (TAD) and thoracic aortic injury (TAI). It discusses several complications after the TEVAR including brain injury, spinal cord injury and retrograde aortic dissection.

Abstract: Events during early life can affect reproductive and metabolic functions in adulthood. We evaluated the programming effects of a single early postnatal estradiol injection (within 3h after birth) in female rats. We assessed ovarian and parametrial adipose tissue morphology, evaluated gene expression related to follicular development and adipose tissue metabolism, and developed a non-invasive volumetric estimation of parametrial adipose tissue by magnetic resonance imaging. Estradiol reduced ovarian weight, increased antral follicle size and number of atretic antral follicles, and decreased theca interna thickness in atretic antral follicles. Adult estradiol-injected rats also had malformed vaginal openings and lacked corpora lutea, confirming anovulation. Estradiol markedly reduced parametrial adipose tissue mass. Adipocyte size was unchanged, suggesting reduced adipocyte number. Parametrial adipose tissue lipoprotein lipase activity was increased. In ovaries, estradiol increased mRNA expression of adiponectin, complement component 3, estrogen receptor α, and glucose transporter 3 and 4; in parametrial adipose tissue, expression of complement component 3 was increased, expression of estrogen receptor α was decreased, and expression of leptin, lipoprotein lipase, and hormone-sensitive lipase was unaffected. These findings suggest that early postnatal estradiol exposure of female rats result in long-lasting effects on the ovary and parametrial adipose tissue at adult age. [Copyright &y& Elsevier]

Objective: The amount of visceral adipose tissue is a risk factor for the metabolic syndrome. It is unclear how BMI changes during childhood and adolescence predict adult fat distribution. We hypothesized that there are critical periods during development for the prediction of adult subcutaneous and visceral fat mass by BMI changes during childhood and adolescence.Research Design and Methods: Detailed growth charts were retrieved for the men participating in the population-based Gothenburg Osteoporosis and Obesity Determinants (GOOD) Study (n = 612). Body composition was analyzed using dual-energy X-ray absorptiometry and adipose tissue areas using abdominal computed tomography at 18 to 20 years of age.Results: The main finding in the present study was that subjects with increases in BMI Z score of more than 1 SD during adolescence had, independent of prepubertal BMI, both larger subcutaneous (+138%; P < 0.001) and visceral adipose tissue areas (+91%; P < 0.001) than subjects with unchanged BMI Z-score. In contrast, subjects with increases in BMI Z score of more than 1 SD during late childhood had a larger amount of adult subcutaneous adipose tissue (+83%; P < 0.001) than subjects with unchanged BMI Z score but an unaffected amount of visceral adipose tissue. BMI changes during adolescence predict both visceral and subcutaneous adipose tissue of the abdomen, whereas BMI changes during late childhood predict only the subcutaneous adipose tissue.Conclusions: The amount of visceral adipose tissue in young adult men was associated with BMI changes specifically during adolescence, whereas the amount of subcutaneous adipose tissue was associated with BMI changes during both late childhood and adolescence. [ABSTRACT FROM AUTHOR]

OBJECTIVE--The amount of visceral adipose tissue is a risk factor for the metabolic syndrome. It is unclear how BMI changes during childhood and adolescence predict 'adult fat distribution. We hypothesized that there are critical periods during development for the prediction of adult subcutaneous and visceral fat mass by BMI changes during childhood and adolescence. RESEARCH DESIGN AND METHODS--Detailed growth charts were retrieved for the men participating in the population-based Gothenburg Osteoporosis and Obesity Determinants (GOOD) Study (n = 612). Body composition was analyzed using dual-energy X-ray absorptiometry and adipose tissue areas using abdominal computed tomography at 18 to 20 years of age. RESULTS--The main finding in the present study was that subjects with increases in BMI Z score of more than 1 SD during adolescence had, independent of prepubertal BMI, both larger subcutaneous (+138%; P < 0.001) and visceral adipose tissue areas (+91%; P < 0.001) than subjects with unchanged BMI Z-score. In contrast, subjects with increases in BMI Z score of more than 1 SD during late childhood had a larger amount of adult subcutaneous adipose tissue (+83%; P < 0.001) than subjects with unchanged BMI Z score but an unaffected amount of visceral adipose tissue. BMI changes during adolescence predict both visceral and subcutaneous adipose tissue of the abdomen, whereas BMI changes during late childhood predict only the subcutaneous adipose tissue. CONCLUSIONS--The amount of visceral adipose tissue in young adult men was associated with BMI changes specifically during adolescence, whereas the amount of subcutaneous adipose tissue was associated with BMI changes during both late childhood and adolescence. Diabetes 58:867-874, 2009 [ABSTRACT FROM AUTHOR]

The role of puberty and normal variations in pubertal timing for the development of obesity in men is unclear. The aim of the current study was to investigate the impact of pubertal timing and prepubertal BMI (kg/m²) for young adult BMI and fat mass distribution. Detailed growth charts from birth to age 18-20 years were retrieved for the men participating in the population-based Gothenburg Osteoporosis and Obesity Determinants study. Age at peak height velocity (PHV) and BMI at age 10 years were estimated for 579 subjects, and PHV was used as an assessment of pubertal timing. The fat mass characterization and distribution were analyzed using dual X-ray absorptiometry and peripheral as well as abdominal computed tomography at age 18.9 ± 0.5 years. We demonstrate that age at PHV is an independent negative predictor of young adult BMI and whole-body fat mass. Interestingly, age at PHV is an independent negative predictor of central, but not peripheral, fat mass. In contrast, BMI at 10 years of age predicts both central and peripheral subcutaneous fat mass. In conclusion, we demonstrate that early pubertal onset specifically predicts a central fat mass distribution, while a predominantly subcutaneous obese phenotype is strongly predicted by a high prepubertal BMI. Diabetes 55:3047-3052, 2006 [ABSTRACT FROM AUTHOR]

Solitary fibrous tumors (SFTs) are mesenchymal, fibroblastic tumors with mostly favorable, but still unpredictable prognosis. Their rarity and occurrence at a variety of locations coupled with variable histological appearance make the diagnosis a challenge. This can be resolved by histological and immunohistochemical analysis on the histologic material eventually coupled with demonstration of NAB2-STAT6 gene fusion by next generation sequencing (NGS) analysis. Tumor removal with clear surgical margins is sufficient for complete cure in most cases. Percutaneous transcatheter embolization in well-vascularized lesions may minimize the risk of bleeding during subsequent removal. In this article we present a rare case of SFT arising from the external auditory canal and treated with preoperative endovascular arterial embolization. A literature review with focus on diagnostics and treatment of this entity in the head and neck region is following. [ABSTRACT FROM AUTHOR]

In vivo monitoring of the microvasculature is relevant since diseases such as diabetes, ischemia, or cancer cause microvascular impairment. Super-resolution ultrasound imaging allows in vivo examination of the microvasculature by detecting and tracking sparsely distributed intravascular microbubbles over a minute-long period. The ability to create detailed images of the renal vasculature of Sprague-Dawley rats using a modified clinical ultrasound platform was investigated in this study. Additionally, we hypothesized that early ischemic damage to the renal microcirculation could be visualized. After a baseline scan of the exposed kidney, 10 rats underwent clamping of the renal vein (n = 5) or artery (n = 5) for 45 min. The kidneys were rescanned at the onset of clamp release and after 60 min of reperfusion. Using a processing pipeline for tissue motion compensation and microbubble tracking, super-resolution images with a very high level of detail were constructed. Image filtration allowed further characterization of the vasculature by isolating specific vessels such as the ascending vasa recta with a 15–20 μm diameter. Using the super-resolution images alone, it was only possible for six assessors to consistently distinguish the healthy renal microvasculature from the microvasculature at the onset of vein clamp release. Future studies will aim at attaining quantitative estimations of alterations in the renal microvascular blood flow using super-resolution ultrasound imaging. [ABSTRACT FROM AUTHOR]

Dual-energy computed tomography (DECT) can estimate tissue vascularity and perfusion via iodine quantification. The aim of this systematic review was to outline current and emerging clinical applications of iodine quantification within the gastrointestinal tract using DECT. The search was conducted with three databases: EMBASE, Pubmed and The Cochrane Library. This identified 449 studies after duplicate removal. From a total of 570 selected studies, 30 studies were enrolled for the systematic review. The studies were categorized into four main topics: gastric tumors (12 studies), colorectal tumors (8 studies), Crohn's disease (4 studies) and miscellaneous applications (6 studies). Findings included a significant difference in iodine concentration (IC) measurements in perigastric fat between T1–3 vs. T4 stage gastric cancer, poorly and well differentiated gastric and colorectal cancer, responders vs. non-responders following chemo- or chemoradiotherapy treatment among cancer patients, and a positive correlation between IC and Crohn's disease activity. In conclusion, iodine quantification with DECT may be used preoperatively in cancer imaging as well as for monitoring treatment response. Future studies are warranted to evaluate the capabilities and limitations of DECT in splanchnic flow. [ABSTRACT FROM AUTHOR]

Postembolization syndrome (PES) is the most common side effect of vascular embolization of solid organs. The aim of this review was to determine the incidence of PES and its individual components after prostatic artery embolization (PAE). A systematic review with a pre-specified search strategy for PubMed, Embase, Web of Science and Cochrane Library was performed according to PRISMA guidelines. Studies in English regarding PAE in humans with 10 or more participants were eligible for inclusion. No restrictions on participant demographics or PAE technique were imposed. The search returned 378 references, of which 32 studies with a total of 2116 patients met the inclusion criteria. The results for overall PES frequency and individual PES components were presented as median (interquartile range, (IQR)). Overall median PES frequency was 25.5% (12.5–45.8). The two most frequent individual PES components were dysuria/urethral burning and local pain, with a median frequency of 21.7% (13.8–33.3) and 20% (5.4–29.4), respectively. Most outcome measures were characterized by a marked lack of uniformity and inconsistency in reporting across studies. Development of a uniform reporting system would help the clinicians recognize and treat PES accordingly. [ABSTRACT FROM AUTHOR]

Prostate artery embolization (PAE) is an emerging therapy for benign prostatic hyperplasia (BPH). Optimal patient selection is an important step when introducing new treatments and several characteristics associated with a good clinical outcome has previously been proposed. However, no prognostic tool is yet available for PAE. Computed tomography perfusion is an imaging technique that provides hemodynamic parameters making it possible to estimate the prostatic blood flow (PBF). This study investigated the relationship between PBF and the response to PAE. A post hoc analysis including prostate-specific antigen (PSA) measurements before and 24-h after embolization from two prospective studies on sixteen patients undergoing PAE with BPH or prostate cancer were performed. The primary outcome was the correlation between baseline PBF and the change in PSA as a surrogate measure of treatment response. Prostate volume strongly correlated with treatment response and the response was greater with incremental amounts of injected embolic material. PBF was not associated with elevation in PSA and added no information that could guide patient selection. [ABSTRACT FROM AUTHOR]

Background: Provoked gluteal claudication is a known risk after endovascular aortic repair (EVAR). Lowered gluteal muscle oxygenation (SgmO2) may be demonstrated by near-infrared spectroscopy (NIRS). Purpose: To evaluate NIRS-determined SgmO2 in EVAR patients. Material and Methods: NIRS-determined SgmO2 was used in an observational study design (n = 17). From the ambulatory setting, seven EVAR patients were included with reported gluteal claudication from medical records. In 10 patients scheduled for EVAR, SgmO2 was measured before and after the procedure. NIRS sensors were applied bilaterally on the gluteal region. Treadmill walking (12% incline, 2.4 km/h) was introduced to stress gluteal muscles. Results: A reduced SgmO2 with regional side difference (P < 0.05) was noted in all 10 patients following EVAR and four reported gluteal claudication. In patients with gluteal claudication (n = 7), treadmill decreased SgmO2. The time to recover the SgmO2 was prolonged for tissue exposed to occluded hypogastric artery (median = 512 s, range = 73–1207 s vs. median = 137, range = 0–643 s; P = 0.046). Conclusions: EVAR affects gluteal muscle oxygenation. NIRS could be used to assess whether gluteal claudication is related to lowered SgmO2. [ABSTRACT FROM AUTHOR]

Invasive catheterization is associated with a low risk of serious complications. However, although it is the gold standard for measuring pressure gradients, it induces changes to blood flow and requires significant resources. Therefore, non-invasive alternatives are urgently needed. Pressure gradients are routinely estimated non-invasively in clinical settings using ultrasound and calculated with the simplified Bernoulli equation, a method with several limitations. A PubMed literature search on validation of non-invasive techniques was conducted, and studies were included if non-invasively estimated pressure gradients were compared with invasively measured pressure gradients in vivo. Pressure gradients were mainly estimated from velocities obtained with Doppler ultrasound or magnetic resonance imaging. Most studies used the simplified Bernoulli equation, but more recent studies have employed the expanded Bernoulli and Navier–Stokes equations. Overall, the studies reported good correlation between non-invasive estimation of pressure gradients and catheterization. Despite having strong correlations, several studies reported the non-invasive techniques to either overestimate or underestimate the invasive measurements, thus questioning the accuracy of the non-invasive methods. In conclusion, more advanced imaging techniques may be needed to overcome the shortcomings of current methods. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the impressive regression of primary liver cancer after treatment with sirolimus.