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- Atesok, Kivanc, et al.
(author)
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Posttraumatic Spinal Cord Injury without Radiographic Abnormality
- 2018
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In: Advances in Orthopedics. - London : Hindawi Publishing Corporation. - 2090-3464 .- 2090-3472. ; 2018
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Research review (peer-reviewed)abstract
- “Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.
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- Escaned, Javier, et al.
(author)
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Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
- 2018
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In: JACC. - : Elsevier. - 1936-8798 .- 1876-7605. ; 11:15, s. 1437-1449
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Journal article (peer-reviewed)abstract
- OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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- Nakamae, Toshio, et al.
(author)
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Bone Marrow Edema and Low Back Pain in Elderly Degenerative Lumbar Scoliosis: A Cross-Sectional Study.
- 2016
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In: Spine. - 1528-1159. ; 41:10, s. 885-92
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Journal article (peer-reviewed)abstract
- Cross-sectional study.To examine whether bone marrow edema is associated with low back pain in elderly patients with degenerative lumbar scoliosis.The cause of low back pain in degenerative lumbar scoliosis is unclear.A total of 120 degenerative lumbar scoliosis patients 65 years of age or older were evaluated. Radiography, computed tomography (CT), magnetic resonance imaging (MRI), and tender point examination in the lumbar spine were performed. On MRI, coronal gadolinium-contrasted T1- or T2-weighed fat-saturated images were used to score the size of bone marrow edema. The prevalence of bone marrow edema in patients with and without low back pain was compared; in patients with low back pain, we tested whether the locations of lumbar tender point were consistent with that of bone marrow edema.Bone marrow edema was found in 62 of 64 (96.9%) patients with low back pain compared with 21 of 56 (37.5%) patients without it (P<0.001). Bone marrow edema located more frequently on the concave side than on the convex side of scoliosis (P<0.001). Among patients with low back pain, bone marrow edema score was associated with low back pain severity (r=0.724; P<0.001), and the location of lumbar tender point were consistent with that of bone marrow edema (κ value=0.745; P<0.001).Bone marrow edema on MRI was closely associated with the presence of low back pain in elderly degenerative lumbar scoliosis.4.
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- Okabe, Nobuhiro, et al.
(author)
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Active gas features in three HSC-SSP CAMIRA clusters revealed by high angular resolution analysis of MUSTANG-2 SZE and XXL X-ray observations
- 2021
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In: Monthly Notices of the Royal Astronomical Society. - : Oxford University Press (OUP). - 0035-8711 .- 1365-2966. ; 501:2, s. 1701-1732
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Journal article (peer-reviewed)abstract
- We present results from simultaneous modelling of high angular resolution GBT/MUSTANG-2 90 GHz Sunyaev-Zel'dovich effect (SZE) measurements and XMM-XXL X-ray images of three rich galaxy clusters selected from the HSC-SSP Survey. The combination of high angular resolution SZE and X-ray imaging enables a spatially resolved multicomponent analysis, which is crucial to understand complex distributions of cluster gas properties. The targeted clusters have similar optical richnesses and redshifts, but exhibit different dynamical states in their member galaxy distributions: a single-peaked cluster, a double-peaked cluster, and a cluster belonging to a supercluster. A large-scale residual pattern in both regular Compton-parameter y and X-ray surface brightness distributions is found in the single-peaked cluster, indicating a sloshing mode. The double-peaked cluster shows an X-ray remnant cool core between two SZE peaks associated with galaxy concentrations. The temperatures of the two peaks reach similar to 20-30 keV in contrast to the cool core component of similar to 2 keV, indicating a violent merger. The main SZE signal for the supercluster is elongated along a direction perpendicular to the major axis of the X-ray core, suggesting a minor merger before core passage. The S-X and y distributions are thus perturbed at some level, regardless of the optical properties. We find that the integrated Compton y parameter and the temperature for the major merger are boosted from those expected by the weak-lensing mass and those for the other two clusters show no significant deviations, which is consistent with predictions of numerical simulations.
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- Petraco, Ricardo, et al.
(author)
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Real-time use of instantaneous wave-free ratio: Results of the ADVISE in-practice: An international, multicenter evaluation of instantaneous wave-free ratio in clinical practice
- 2014
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In: American Heart Journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 168:5, s. 739-748
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Journal article (peer-reviewed)abstract
- Objectives To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians. Background The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed. Methods Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The classification agreement of coronary stenoses between iFR and FFR was calculated. Results Instantaneous wave-free ratio and FFR maintain a close level of diagnostic agreement when both are measured by clinicians in real time (for a clinical 0.80 FFR cutoff: area under the receiver operating characteristic curve [ROCAUC] 0.87, classification match 80%, and optimal iFR cutoff 0.90; for a ischemic 0.75 FFR cutoff: iFR ROCAUC 0.90, classification match 88%, and optimal iFR cutoff 0.85; if the FFR 0.75-0.80 gray zone is accounted for: ROCAUC 0.93, classification match 92%). When iFR and FFR are evaluated together in a hybrid decision-making strategy, 61% of the population is spared from vasodilator while maintaining a 94% overall agreement with FFR lesion classification. Conclusion When measured in real time, iFR maintains the close relationship to FFR reported in offline studies. These findings confirm the feasibility and reliability of real-time iFR calculation by clinicians.
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