No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites.
...Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies.
While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%).
There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally.
To identify disease-specific profiles comprising patient characteristics and imaging biomarkers on contrast-enhanced (CE)-computed tomography (CT) that enable the non-invasive prediction of the ...hepatopulmonary shunt fraction (HPSF) in patients with hepatocellular carcinoma (HCC) before resin-based transarterial radioembolization (TARE).
This institutional review board-approved (EA2/071/19) retrospective study included 56 patients with HCC recommended for TARE. All patients received tri-phasic CE-CT within 6 weeks prior to an angiographic TARE evaluation study using technetium-99m macroaggregated albumin. Imaging biomarkers representative of tumor extent, morphology, and perfusion, as well as disease-specific clinical parameters, were used to perform data-driven variable selection with backward elimination to generate multivariable linear regression models predictive of HPSF. Results were used to create clinically applicable risk scores for patients scheduled for TARE. Additionally, Cox regression was used to identify independent risk factors for poor overall survival (OS).
Mean HPSF was 13.11% ± 7.6% (range: 2.8- 35.97%). Index tumor diameter (p = 0.014) or volume (p = 0.034) in combination with index tumor non-rim arterial phase enhancement (APHE) (p < 0.001) and washout (p < 0.001) were identified as significant non-invasive predictors of HPSF on CE-CT. Specifically, the prediction models revealed that the HPSF increased with index lesion diameter or volume and showed higher HPSF if non-rim APHE was present. In contrast, index tumor washout was associated with decreased HPSF levels. Independent risk factors of poorer OS were radiogenomic venous invasion and ascites at baseline.
The featured prediction models can be used for the initial non-invasive estimation of HPSF in patients with HCC before TARE to assist in clinical treatment evaluation while potentially sparing ineligible patients from the angiographic shunt evaluation study.
Ski jump design Savic, L; Kuzmanovic, V; Milovanovic, B
Proceedings of the Institution of Civil Engineers. Water management,
11/2010, Letnik:
163, Številka:
10
Journal Article
Recenzirano
This paper is concerned with ski jump design for overflow dams and chute spillways. Despite the vast scope of literature on this subject, research in this field is still needed. Three important ...issues are addressed: take-off angle, length of the jet trajectory and choking flow. The aim is to summarise existing experience, present new formulae for convenient design and propose directions for future research.
Summary
Results of recent studies confirmed that oxidative stress negatively affects sperm motility and causes sperm DNA damage. Produced by nitric oxide synthase 3 (NOS3), nitric oxide is considered ...to be one of the important mediators of oxidative stress in testis tissue. The aim of this study was to assess the possible association of three genetic variants (rs2070744, rs1799983 and intron variant 4a/4b) in NOS3 gene and infertility occurrence in two groups of infertile men (idiopathic azoospermia and oligoasthenozoospermia) and fertile controls. Genotypes for the single‐nucleotide genetic variants rs1799983 and rs2070744 were determined by PCR‐RFLP, while genotyping of intron 4 variant 4a/4b was performed by gel electrophoresis of PCR products. Statistical analysis was performed by SNPStats software. No significant association between the three genetic variants of the NOS3 gene and infertility risk was determined comparing allele and genotype frequencies among group of patients diagnosed with azoospermia and the control group. Nevertheless, there was a significant positive association between 4a/4b and infertility in the group of males diagnosed with oligoasthenozoospermia, under overdominant genetic model. Our findings suggest that tandem repeat variant within intron 4 of the NOS3 gene is associated with an increased risk of infertility in men diagnosed with idiopathic oligoasthenozoospermia.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/aim: Complete atrioventricular (AV) block is associated with worse in-hospital outcome in patients with ST-elevation ...myocardial infarction (STEMI), while whether it has an impact on long-term outcome is uncertain. The majority of previous studies that analyzed this issue are performed before introduction primary percutaneous coronary intervention (pPCI). The aim of this study was to analyse the incidence and the prognostic impact of complete AV block at admission on in-hospital and 6-year mortality in STEMI patients treated with pPCI.
Method
we analyzed 2863 consecutive STEMI patients without cardiogenic shock at admission. Clinical, laboratory and echocardiographic characteristics and prognosis were compared between patients with and without complete AV block at admission.
Results
Complete AV block at admission was registered in 134 (4.6%) patients; 117 (87.3%) patients with complete AV block had inferior infarction. In comparison without complete AV block, patients with complete AV block were older; they were more likely to have heart failure, lower blood pressure and lower creatinine clearance at admission, multi-vessel disease on initial coronary angiogram and lower pre-discharge left ventricular ejection fraction (EF). Temporary pacemaker was implanted in 68 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9% vs 3.6%, respectively, p < 0.001. In patients with heart block and inferior infarction in-hospital mortality was 13%, whereas in patients with heart block and anterior infarction in-hospital mortality was 53%. When we analyze patients who were discharged alive from the hospital, we also find significantly higher long-term (6-year) mortality rate in those with complete AV block at admission vs patients without AV block: 7.8% vs 3.4% respectively, p < 0.001 (Figure 1). The causes of death in patients with complete AV block during long-term follow up were cardiovascular, e.g. sudden death, reinfarction or worsening of heart failure. In Cox regression model complete AV block was an independent predictor for in-hospital and 6-year mortality: in-hospital mortality HR 2.54 85%CI 1.93-5.22, p = 0.011; six year mortality HR 1.61, 95CI 1,09-2.37, p = 0.017. Other independent predictors for both short- and long-term mortality were age, heart failure at admission, lower creatinine clearance at admission, EF and post-procedural flow TIMI <3 thorugh infarct-related artery.
Conclusion
Complete AV block at admission is an independent predictor for in-hospital and long-term mortality in STEMI patients treated with primary PCI. Abstract Figure 1
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objective
To analyze the impact of declining kidney function on the occurrence of the slow-flow/no-reflow phenomenon, in patients with ...ST elevation myocardial infarction (STEM) who had been treated with primary PCI (pPCI), and to analyze the prognostic impact of the slow-flow/no-reflow phenomenon on short- and long-term mortality in these patients.
Methods
We analyzed 3,115 consecutive patients. A value of estimation of the glomerular filtration rate (eGFR) at admission eGFR<90ml/min/m2 was considered to be a reduced baseline eGFR. The follow-up period was 8 years.
Results
The slow-flow/no-reflow phenomenon through the IRA was registered in 146 (4.7%) patients. Stimated GFR<90ml/min/m2 was an independent predictor for the occurrence of slow-flow/no-reflow phenomenon (OR2.91, 95%CI 1.25-3.95, p<0.001), and the risk for the occurrence of the slow-flow/no-reflow phenomenon increased with the decline of the kidney function: eGFR 60-89 ml/min/m2: OR1.94 (95%C 1.22-3.07, p=0.005), eGFR 45-59ml/min/m2: OR 2.55(95%CI 1.55-4.94, p<0.001), eGFR 30-44 ml/min/m2; OR 2.77(95%CI 1.43-5.25, p<0.001), eGFR 15-29 ml/min/m2: OR 5.84 (95%CI 2.84-8.01, p<0.001). In-hospital, 30-day, 1-year, and 8-year mortality were significantly higher in patients with the slow-flow/no-reflow phenomenon, as compared to patients with TIMI flow grade 3 – in-hospital mortality of 30.1% vs 2.9%, respectively, p<0.001; 30-day mortality: 31.5% vs 3.2%, respectively, p<0.001; 8-year mortality: 38.1% vs 6.9%, respectively, p<0.001 (Figure 1). The slow-flow/no-reflow phenomenon was a strong independent predictor of short-and long-term all-cause mortality: 30-day mortality (HR 2.62, 95%CI 1.78-3.57, p<0.001), 8-year mortality (HR 2.09, 95%CI 1.49-2.09, p<0.001).
Conclusion
Reduced baseline kidney function was an independent predictor for the occurrence of the slow-flow/no-reflow phenomenon, and its prognostic impact started with the mildest decrease of eGFR (below 90ml/min/m2), and increased with its further decline. The slow-flow/no-reflow phenomenon was a strong independent predictor for mortality in the short- and long-term follow-up of the analyzed patients.
α1-Adrenergic receptor (α1AR) antagonists are effective for relieving obstructive and irritative symptoms in patients with bladder outlet obstruction. While the α1aAR is responsible for prostate ...smooth muscle relaxation and outlet obstruction relief, to our knowledge the mechanisms underlying the relief of irritative symptoms remain to be determined. Therefore, we investigated mechanisms by which bladder α1AR subtypes may be involved in this process.
We studied 42 rats, including 6 unoperated controls, 17 sham operated controls and 19 obstructed animals. Animals were characterized for baseline voiding pattern, followed by surgical intervention or sham surgery to establish obstruction (1.09 mm. restricted opening). After 6 weeks to enable the development of detrusor hypertrophy, voiding behavior was reexamined, the animals were sacrificed and bladder tissue was immediately placed in liquid nitrogen. α1AR subtype messenger (m)RNA was quantitated using quantitative competitive reverse transcriptase-polymerase chain reaction and protein expression was determined using radioligand binding with the α1AR antagonist
125iodine2-(-4-hydroxyphenyl-ethyl-aminomethyl)tetralone (saturation analysis for total α1AR density and competition analysis with BMY7378 and 5-methylurapidel to determine α1AR subtypes).
In this model 6-week surgical obstruction produced a 6.3-fold increase in bladder weight versus sham operation (p <0.001), concurrent with increased voiding frequency versus before obstruction (p <0.004). Although bladder α1AR density did not increase overall with obstruction, striking changes in α1AR subtype expression occurred. In control animals 70% of α1AR mRNA was the α1a subtype, 5% were α1b and 25% were α1d, whereas in obstructed animals bladder α1AR expression changed to 23% α1a, 2% α1b and 75% α1d. Changes in α1AR mRNA expression were of similar magnitude throughout the bladder dome, mid body and base. Parallel changes were also evident at the protein level with 100% α1aAR expression in control animals changing to new onset α1dAR expression (mean plus or minus standard error of mean 36% ± 7%) in animals with a 5-fold or greater increase in bladder weight.
Our findings indicate a remarkable increase in bladder α1dAR mRNA and protein expression after 6 weeks of obstruction and resultant detrusor hypertrophy. This finding is potentially important since α1dARs have 10 to 100-fold higher affinity for the endogenous neurotransmitter norepinephrine than the α1a or α1bAR subtypes. These findings imply that targeting α1d may provide a new therapeutic approach for controlling bladder irritative symptoms and possibly detrusor overactivity associated with bladder outlet obstruction.
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