Purpose To investigate the prevalence of diffuse pulmonary ossification (DPO) in patients with fibrosing interstitial lung disease (ILD) and determine whether there are differences among the types of ...ILDs. Materials and Methods Institutional review board approval was given and patient consent was not required for this study. The study population comprised 892 consecutive patients with fibrosing ILD, including 456 patients with idiopathic pulmonary fibrosis (IPF) (men, 366; women, 90; median age, 72 years range, 38-93 years), 244 with nonspecific interstitial pneumonia (men, 79; women, 165; median age, 60.5 years range, 23-86 years), and 192 with chronic hypersensitivity pneumonitis (men, 76; women, 116; median age, 66 years range, 35-88 years). Pulmonary ossifications were recorded when nodules (<4 mm diameter) were identified on bone window images (width, 2500 HU; level, 500 HU). DPO was defined as 10 or more bilateral nodular ossifications (definition 1) or as one or more lobes with five or more bilateral nodular ossifications (definition 2). Relationships among pulmonary ossification and parenchymal patterns, clinical parameters, and multidisciplinary team diagnoses were examined. The prevalence of DPO was compared with the χ
statistic or Fisher exact test, and multivariate analysis was performed with logistic regression. Results In the whole population, the prevalence of DPO was 166 (18.6%) and 106 (11.9%) of 892 patients according to definitions 1 and 2, respectively. The prevalence of DPO (definition 1) was significantly higher in patients with IPF (28.5%) than in those without IPF (8.3%, P < .001). Nine of 192 (4.7%) had chronic hypersensitivity pneumonitis (P < .001), and 27 of 244 (11.1%) had nonspecific interstitial pneumonia (P < .001). At multivariate analysis, DPO according to definition 1 was an independent predictor of IPF diagnosis (P < .001) and male sex (P = .003). Coarseness of fibrosing ILD (P = .011) and IPF diagnosis (P = .016) were independently associated with pulmonary ossification profusion. Conclusion DPO is common in patients with fibrosing ILD and is significantly more prevalent in patients with IPF than in those with other fibrosing ILDs, and thus, computed tomographic signs of DPO may be helpful for diagnosis of IPF.
RSNA, 2017 Online supplemental material is available for this article.
Objective
In rheumatoid arthritis (RA), there are limited data on risk factors for the clinical heart failure (HF) subtypes of HF with reduced ejection fraction (HFrEF) and HF with preserved ejection ...fraction (HFpEF). This study examined the association between inflammation and incident HF subtypes in RA. Because inflammation changes over time with disease activity, we hypothesized that the effect of inflammation may be stronger at the 5‐year follow‐up than at the standard 10‐year follow‐up from general population studies of cardiovascular risk.
Methods
We studied an electronic health record (EHR)–based RA cohort with data pre‐ and post‐RA incidence. We applied a validated approach to identify HF and extract ejection fraction to classify HFrEF and HFpEF. Follow‐up started from the RA incidence date (index date) to the earliest occurrence of incident HF, death, last EHR encounter, or 10 years. Baseline inflammation was assessed using erythrocyte sedimentation rate or C‐reactive protein values. Covariates included demographic characteristics, established HF risk factors, and RA‐related factors. We tested the association between baseline inflammation with incident HF and its subtypes using Cox proportional hazards models.
Results
We studied 9,087 patients with RA; 8.2% developed HF during 10 years of follow‐up. Elevated inflammation was associated with increased risk for HF at both 5‐ and 10‐year follow‐ups (hazard ratio HR 1.66, 95% confidence interval 95% CI 1.12–2.46 and HR 1.46, 95% CI 1.13–1.90, respectively), which is also seen for HFpEF at 5 years (HR 1.72, 95% CI 1.09–2.70) and 10 years (HR 1.45, 95% CI 1.07–1.94). HFrEF was not associated with inflammation for either follow‐up time.
Conclusion
Elevated inflammation early in RA diagnosis was associated with HF; this association was driven by HFpEF and not HFrEF, suggesting a window of opportunity for prevention of HFpEF in RA.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Background Our study examined whether prevalent and incident comorbidities are increased in idiopathic pulmonary fibrosis (IPF) patients when compared to matched chronic obstructive ...pulmonary disease (COPD) patients and control subjects without IPF or COPD. Methods IPF and age, gender and smoking matched COPD patients, diagnosed between 01/01/1997 and 01/01/2019 were identified from the Clinical Practice Research Datalink GOLD database multiple registrations cohort at the first date an ICD-10 or read code mentioned IPF/COPD. A control cohort comprised age, gender and pack-year smoking matched subjects without IPF or COPD. Prevalent (prior to IPF/COPD diagnosis) and incident (after IPF/COPD diagnosis) comorbidities were examined. Group differences were estimated using a t-test. Mortality relationships were examined using multivariable Cox proportional hazards adjusted for patient age, gender and smoking status. Results Across 3055 IPF patients, 38% had 3 or more prevalent comorbidities versus 32% of COPD patients and 21% of matched control subjects. Survival time reduced as the number of comorbidities in an individual increased ( p < 0.0001). In IPF, prevalent heart failure (Hazard ratio HR = 1.62, 95% Confidence Interval CI: 1.43–1.84, p < 0.001), chronic kidney disease (HR = 1.27, 95%CI: 1.10–1.47, p = 0.001), cerebrovascular disease (HR = 1.18, 95%CI: 1.02–1.35, p = 0.02), abdominal and peripheral vascular disease (HR = 1.29, 95%CI: 1.09–1.50, p = 0.003) independently associated with reduced survival. Key comorbidities showed increased incidence in IPF (versus COPD) 7–10 years prior to IPF diagnosis. Interpretation The mortality impact of excessive prevalent comorbidities in IPF versus COPD and smoking matched controls suggests that multiorgan mechanisms of injury need elucidation in patients that develop IPF.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The purpose of this study is to establish the relationship between CT markers of lung volume and pulmonary function test (PFT) parameters of lung volume in idiopathic pulmonary fibrosis (IPF).
The ...relationships between PFT-derived parameters of lung volume (forced vital capacity FVC and total lung capacity TLC) and both CT-derived automated lung volume and manually derived surrogate measurements of lung volume on CT were evaluated in 273 patients (212 men and 61 women; median age, 67 years) with a multidisciplinary diagnosis of IPF. All patients underwent unenhanced volumetric high-resolution CT of the thorax. Automated lung volume was extracted using commercially available software. Three manual CT surrogate measurements of lung volume previously tested in the setting of radiation-induced lung fibrosis were evaluated by two raters. These measurements were lung height, aortosternal distance, and oblique fissure retraction distance. Fibrosis extent on CT was scored by two observers. Correlation coefficients and multivariable regression analyses were performed to assess the relationship between CT measurements and percentage of predicted FVC (hereafter referred to as "percentage FVC") and TLC. Interobserver agreement for CT markers was evaluated on the basis of the intraclass correlation coefficient.
There was a strong correlation between CT-derived automated lung volume and TLC (
= 0.92;
< 0.0005). There was excellent interobserver agreement for all manual CT measurements (intraclass correlation coefficient, 0.82-0.96). There were significant correlations between manual CT measurements and percentage FVC. Lung height had the strongest relationship with percentage FVC (
= 0.44;
< 0.0005). In multivariable analysis, the CT measurements were independent determinants of lung volumes, after adjustment for fibrosis and emphysema (
= 0.48;
< 0.0005 and
< 0.003, respectively). Lung height had the most significant impact on the fit against lung volumes.
Automated and manual CT measurements of lung volume are significantly related to PFT-derived parameters of lung volume, independent of fibrosis and emphysema.
OBJECTIVE Lateral lumbar interbody fusion (LLIF) is an increasingly popular technique used to treat degenerative lumbar disease. The technique of using an intraoperative cone-beam CT (iCBCT) and an ...image-guided navigation system (IGNS) for LLIF cage placement has been previously described. However, other than a small feasibility study, there has been no clinical study evaluating its accuracy or safety. Therefore, the purpose of this study was to evaluate the accuracy and safety of image-guided spinal navigation in LLIF. METHODS An analysis of a prospectively acquired database was performed. Thirty-one consecutive patients were identified. Accuracy was initially determined by comparison of the planned trajectory of the IGNS with post-cage placement intraoperative fluoroscopy. Accuracy was subsequently confirmed by postprocedural CT and/or radiography. Cage placement was graded based on a previously described system separating the disc space into quarters. RESULTS The mean patient age was 63.9 years. A total of 66 spinal levels were treated, with a mean of 2.1 levels (range 1-4) treated per patient. Cage placement was noted to be accurate using IGNS in each case, as confirmed with intraoperative fluoroscopy and postoperative imaging. Sixty-four (97%) cages were placed within Quarters 1 to 2 or 2 to 3, indicating placement of the cage in the anterior or middle portions of the disc space. There were no instances of misguidance by IGNS. There was 1 significant approach-related complication (psoas muscle abscess) that required intervention, and 8 patients with transient, mild thigh paresthesias or weakness. CONCLUSIONS LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures.
Lateral-access spine surgery has many benefits, but adoption has been limited by a steep learning curve. Virtual reality (VR) is gaining popularity and lends itself as a useful tool in enhancing ...neurosurgical resident education. We thus sought to assess whether VR-based simulation could enhance the training of neurosurgery residents in lateral spine surgery.
Neurosurgery residents completed a VR-based lateral spine module on lateral patient positioning and performing lateral lumbar interbody fusion using the PrecisionOS VR system on the Meta Quest 2 headset. Simulation occurred 1×/week every other week for a total of 3 simulations over 6 weeks. Pre- and postintervention surveys as well as intrasimulation performance metrics were assessed over time.
The majority of resident participants showed improvement in performance scores, including an automated PrecisionOS precision score, number of radiographs used within the simulation, and time to completion. All participants showed improvement in comfort with anatomic landmarks for lateral access surgery, confidence performing lateral surgery without direct supervision, and assessing fluoroscopy in spine surgery for hardware placement and image interpretation. Participant perception on the utility of VR as an educational tool also improved.
VR-based simulation enhanced neurosurgical residents’ ability to understand lateral access surgery. Immersive surgical simulation resulted in improved resident confidence with surgical technique and workflow, perceived improvement in anatomical knowledge, and simulation performance scores. Trainee perceptions on virtual simulation and training as a curriculum supplement also improved following completion of VR training.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
This study investigates a low-temperature three-circuit cooling system for a 55 kW industrial electric motor. The cooling system provides an increase of the power-to-dimension ratio by 63%, together ...with an improvement in motor performance. The three-circuit cooling system includes water cooling of the housing and stator and air-cooling of the motor’s interior. The test results show that the motor efficiency was maintained in the range between 92.5 and 94.5%, with respect to the motor’s power. With power increases up to 90 kW, a winding temperature of 67 °C was observed during three hours of operation. This advancement is particularly valuable for vehicles, ships, and aircraft applications, where maximizing power within limited space is crucial. An analysis of the experimental data showed that the cooling system operates at an average efficiency of 79.2%, indicating that roughly 20% of heat was accumulated in the rotor. This leads to a gradual temperature rise, particularly in the rotor, posing a risk of overheating and failure during motor overloads above 90 kW. Enhancing the cooling efficiency within the motor’s interior can be achieved by incorporating extra heat exchangers, implementing evaporative heat transfer, and employing water-cooling circuits at lower temperatures. This, in turn, can boost the electric motor’s power-to-dimension ratio.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
No single pulmonary function test captures the functional effect of emphysema in idiopathic pulmonary fibrosis (IPF). Without experienced radiologists, other methods are needed to determine emphysema ...extent. Here, we report the development and validation of a formula to predict emphysema extent in patients with IPF and emphysema.
The development cohort included 76 patients with combined IPF and emphysema at the Royal Brompton Hospital, London, United Kingdom. The formula was derived using stepwise regression to generate the weighted combination of pulmonary function data that fitted best with emphysema extent on high-resolution computed tomography. Test cohorts included patients from two clinical trials (n = 455 n = 174 with emphysema; NCT00047645, NCT00075998) and a real-world cohort from the Royal Brompton Hospital (n = 191 n = 110 with emphysema). The formula is only applicable for patients with IPF and concomitant emphysema and accordingly was not used to detect the presence or absence of emphysema.
The formula was: predicted emphysema extent = 12.67 + (0.92 x percent predicted forced vital capacity) - (0.65 x percent predicted forced expiratory volume in 1 second) - (0.52 x percent predicted carbon monoxide diffusing capacity). A significant relationship between the formula and observed emphysema extent was found in both cohorts (R
= 0.25, P < 0.0001; R
= 0.47, P < 0.0001, respectively). In both, the formula better predicted observed emphysema extent versus individual pulmonary function tests. A 15% emphysema extent threshold, calculated using the formula, identified a significant difference in absolute changes from baseline in forced vital capacity at Week 48 in patients with baseline-predicted emphysema extent < 15% versus ≥ 15% (P = 0.0105).
The formula, designed for use in patients with IPF and emphysema, demonstrated enhanced ability to predict emphysema extent versus individual pulmonary function tests.
NCT00047645; NCT00075998.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Influenza leads to significant cardiopulmonary morbidity and mortality—particularly in patients with cardiovascular disease—that may be prevented with a standard influenza vaccine. However, patients ...with cardiovascular conditions have a reduced immune response to influenza vaccine, potentially resulting in reduced effectiveness for preventing clinical events. High-dose vaccine augments immune response in cardiac patients, suggesting that a high-dose influenza vaccination strategy may further reduce morbidity and mortality. Alternatively, broader coverage with an influenza vaccine containing an increased number of viral strains is an alternative strategy without direct evaluation.
INfluenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated heart failure (INVESTED) is a pragmatic, randomized, double-blind, parallel-group, active-controlled trial comparing the effectiveness of an annual vaccination strategy of high-dose trivalent versus standard-dose quadrivalent influenza vaccine in patients with a history of recent heart failure or myocardial infarction hospitalization. The trial will enroll approximately 9,300 patients over 4 influenza seasons. The primary hypothesis is that high-dose influenza vaccine will reduce the composite outcome of all-cause mortality and hospitalization from a cardiovascular or pulmonary cause compared with standard-dose influenza vaccine within each enrolling season. Approximately 1,300 primary outcome events will provide >90% power to detect an 18% relative risk reduction at a 2-sided α level of .05.
INVESTED is the largest and longest study to assess whether high-dose influenza vaccine is superior to standard-dose influenza vaccine in reducing cardiopulmonary events in a high-risk cardiovascular population (ClinicalTrials.gov Identifier: NCT02787044).
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Galectin-3 is an emerging biomarker of myocardial fibrosis, inflammation, and immune response. We sought to examine the relation of plasma galectin-3 with cardiovascular (CVD) mortality, ...all-cause mortality and incident heart failure. We performed a literature search for all relevant publications using Ovid MEDLINE, Google Scholar and other databases up to January 2016. Two reviewers independently extracted data and assessed risk of bias. We extracted hazard ratios from regression models that adjusted for age, sex, race, body mass index, smoking, hypertension, hyperlipidemia, diabetes, natriuretic peptides, and renal function, when available. A total of 18 studies with 32,350 participants (323,090 person-years of follow-up) met criteria for analysis. The mean age was 57.3 years and 47.2% of participants were women, with a follow-up duration median of 5 years, IQR: 2.9-10 years. Of the 18 studies, 13 (72%) adjusted for NT-proBNP and renal function in the multivariable adjusted models. Using a random effects meta-analysis, we found a HR of 1.10 (95% CI: 1.05-1.14) for all-cause mortality, 1.22 (95% CI: 1.05-1.39) for CVD mortality, and 1.12 (95% CI: 1.04-1.21) for heart failure risk for each one standard deviation increase in galectin-3 level. In a subgroup analysis of CVD mortality, the HR was 1.44 (1.09-1.79) for patients with heart failure, and 1.09 (0.91-1.27) for the general population. In conclusion, our results suggest that elevated plasma galectin-3 is associated with a higher risk of all-cause mortality, CVD mortality and heart failure. It may add prognostic value beyond that provided by traditional CVD risk factors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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