Acute pulmonary embolism (APE) is a hazardous disorder with a high mortality. Combination of clinical, radiological, and serological parameters can improve risk stratification of APE. Most of the ...proposed combined scores were not validated in independent cohorts. Our aim was to validate the proposed clinical-radiological scores for prognosis of 7- and 30-day mortality in APE.
Our sample comprised 531 patients with APE, mean age 64.8 ± 15.6 years, 221 (41.6%) females and 310 (58.4%) males. The following parameters were collected: Age and sex of the patients, mortality within the observation time of 30 days, simplified pulmonary embolism severity index (sPESI), pH troponin level (pg/ml), minimal systolic and diastolic blood pressures (mmHg), heart rate, O
saturation, episodes of syncope, and need for vasopressors. On CT pulmonary angiography (CTPA), short axis ratio right ventricle/left ventricle (RV/LV), and reflux of contrast medium into the inferior vena cava were obtained. The following clinical-radiological scores were calculated: BOVA score, pulmonary embolism mortality score (PEMS), European Society of Cardiology (ESC) score, Kumamaru score, and Calgary acute pulmonary embolism (CAPE) score.
Overall, 31 patients (5.8%) died within seven and 64 patients (12%) within 30 days. All scores showed high negative prognostic values ranging from 89.0 to 99.0%. PEMS and CAPE score demonstrated the highest specificity for 7-day mortality (93.4% and 85.0%), PEMS and BOVA for 30-day mortality (94.2% and 90.4%). The highest sensitivity was observed for ESC 2019 (96.8% and 95.3%). Kumamaru and CAPE scores had low sensitivity. All scores had low positive and high negative predictive values.
For prognosis of 7- and 30-day mortality in APE, PEMS score has the highest specificity. ESC 2019 shows the highest sensitivity. All scores had low positive and high negative predictive values.
Patients with unresectable biliary tract cancer (uBTC) who progress despite first-line gemcitabine plus cisplatin (GC) treatment have limited systemic options with a modest survival benefit. Data are ...lacking on the clinical effectiveness and safety of personalized treatment based on multidisciplinary discussion for patients with progressing uBTC.
This retrospective single-center study included patients with progressive uBTC who received either best supportive care or personalized treatment based on multidisciplinary discussion, including minimally invasive, image-guided procedures (MIT); FOLFIRI; or both (MIT and FOLFIRI), between 2011 and 2021.
Ninety-seven patients with progressive uBTC were identified. Patients received best supportive care (
= 50, 52%), MIT (
= 14, 14%), FOLFIRI (
= 19, 20%), or both (
= 14, 14%). Survival after disease progression was better in patients who received MIT (8.8 months; 95% CI: 2.60-15.08), FOLFIRI (6 months; 95% CI: 3.30-8.72), or both (15.1 months; 95% CI: 3.66-26.50) than in patients receiving BSC (0.36 months; 95% CI: 0.00-1.24,
< 0.001). The most common (>10%) grade 3-5 adverse events were anemia (25%) and thrombocytopenia (11%).
Multidisciplinary discussion is critical for identifying patients with progressive uBTC who might benefit the most from MIT, FOLFIRI, or both. The safety profile was consistent with previous reports.
The incidence of cholangiocellular carcinoma (CCA) is rising worldwide. As there are no specific early symptoms or specific markers of CCA, it is often diagnosed in later inoperable stages. ...Accumulating evidence underlines the importance of radiation therapy in the induction of antitumor immunity. The surface protein composition on extracellular vesicles (EVs) relates to originating cells and thus may play a role in vesicle function. We assessed immune profiles of EVs and their immune origin in patients with inoperable CCA prior and after selective internal radiotherapy (SIRT). A total of 47 CCA patients receiving SIRT and 12 healthy volunteers (HV) were included. Blood was withdrawn before therapy (pre T) and after T. EVs were purified from plasma by cluster of differentiation (CD)9-, CD63-, and CD81-immunobead isolation. To detect differently abundant surface markers, dynamic range and EVs input quality were assessed. A total of 37 EVs surface markers were measured by flow cytometry and correlated either with the administered activity dose (MBq) or with the interval until death (month). EVs phenotyping identified lymphocytes, B cells, NK cells, platelets, endothelial cells, leukocyte activation, B cell activation, T and B cell adhesion markers, stem/progenitor cells, and antigen-presenting cells (APC) as EVs-parenteral cells. CD4 and CD8 significantly declined, while other markers significantly increased in CCA patients pre T vs. HV. Platelets-deriving EVs significantly decreased, normalizing to levels of HV but still significantly increasing vs. HV post SIRT. B cells-deriving EVs significantly increased pre T vs. HV, positively correlating with administered activity dose. MHCII and CD40 EVs significantly increased pre SIRT and negatively correlated with administered activity dose, while EVs from antigen presenting cells and CD49e pre SIRT positively correlated with survival time after therapy. Increased levels of CD24 and CD44 in cancer pre T were significantly decreased post T. Among the heterogeneity of EVs that was demonstrated, in particular, B cells-deriving, MHCII, and CD40 positive or APC-deriving EVs need to be further studied for their diagnostic or prognostic relevance in clinical scenarios.
Purpose
To analyze relationships betweenapparent diffusion coefficient (ADC) and activity parameters of Crohn’s disease, e.g., length and wall thickness, CRP, FCP, MaRIA, CDAI, SES-CD, histologic ...inflammatory activity score, and the histological fibrotic score, based upon published data.
Materials and methods
MEDLINE library, Scopus, and Embase databases were screened for association between ADC and activity parameters of Crohn’s disease in patients with Crohn’s disease up to Mai 2021. Overall, 21 studies with 1053 patients were identified. The following data were extracted from the literature: number of patients, correlation coefficients between ADC and length as well as wall thickness, CRP, FCP, MaRIA, CDAI, and SES-CD, inflammatory activity score, and fibrotic score. Associations between ADC and activity parameters were analyzed by Spearman’s correlation coefficient. The studies’ methodologic quality was evaluated by using the Quality Assessment of Diagnostic Studies (QUADAS 2) instrument, revealing a low risk of bias.
Results
In the overall sample, the pooled correlation coefficient between ADC and CDAI was −0.8 (95% CI = −0.94; −0.65), between ADC and MaRIA −0.66 (95% CI = −0.79; −0.53). A strong association was observed between ADC and SES-CD with a pooled correlation of −0.66 (95% CI = −0.87; −0.46). The pooled sensitivity to discriminate between involved and non-involved bowel segments was 0.89, with an area under the curve of 0.89
Conclusions
ADC showed strong inverse correlations with CDAI, MaRIA, and SES-CD scores. However, the role of ADC in assessing fibrotic changes in the bowel wall is limited. ADC can reflect acute inflammatory reactions but not systemic inflammation.
Key Points
•
ADC value can reflect acute inflammatory reactions but not systemic inflammation.
•
ADC is inversely correlated with CDAI, MaRIA, and SES-CD.
•
The role of ADC in assessing fibrotic changes in the bowel wall is limited.
Computed tomography (CT) defined muscle mass can be used as a surrogate parameter for sarcopenia. The present study used thoracic CT to assess pectoralis muscle area and density as an imaging ...biomarker for prognosis of 30-day mortality in patients with acute pulmonary embolism (PE)
The clinical database was retrospectively screened for patients with thoracic CT in 3 centers. Pectoralis musculature was measured on axial slices of the thoracic CT at the level of T4 of contrast enhanced pulmonary angiography CT. Skeletal muscle area (SMA), skeletal muscle index (SMI), muscle density and gauge were calculated.
Overall, 981 patients (440 female, 44.9%) with a mean age of 63.5 ± 15.9 years were included into the study and 144 patients (14.6%) died within the 30-days period. Every pectoral muscle value was higher in survivors compared to non-survivors (exemplarily for SMI 9.9 ± 3.5 cm2/m2 versus 7.8 ± 2.6 cm2/m2, p < 0.001). Moreover, 91 patients were defined as hemodynamically instable (9.3%). Comparable, every pectoral muscle parameter was higher in patients with hemodynamically stable course compared to instable course. Different muscle variables are related to 30-day mortality: SMA, OR = 0.94 (95%CI= (0.92; 0.96), p < 0.001); SMI, OR = 0.78 (95%CI= (0.72; 0.84), p < 0.001); muscle density, OR = 0.96 (95%CI = (0.94; 0.97), p < 0.001); muscle gauge OR = 0.96 (95%CI = (0.94; 0.99), p < 0.001). SMI and muscle density were independently associated with 30-days mortality: SMI, OR = 0.81 (95%CI = (0.75; 0.88), p < 0.001); muscle density: OR = 0.96 (95%CI= (0.95; 0.98), p < 0.001).
Parameters of the pectoralis musculature are associated with 30-day mortality in patients with acute PE. These findings should lead to an independent validation study and ultimately to the inclusion into clinical routine as a prognostic factor.
•CAC score > 3 is associated with 30-day mortality in patients with acute PE.•CAC score can be easily calculated in clinical routine.•Coronary calcifications derived from CT images could be used as ...an imaging marker.
•This article discusses a multicenter analysis investigating the prognostic role of body composition in COVID-19.•This study includes an analysis of overall 447 patients.•The presence of myosteatosis ...was independently associated with 30-d mortality: odds ratio = 2.72 (95% CI, 1.71–4.32); P = 0.0001.
Body composition on computed tomography can predict prognosis in patients with COVID-19. The reported data are based on small retrospective studies. The aim of the present study was to analyze the prognostic relevance of skeletal muscle parameter derived from chest computed tomography for prediction of 30-d mortality in patients with COVID-19 in a multicenter setting.
The clinical databases of three centers were screened for patients with COVID-19 between 2020 and 2022. Overall, 447 patients (142 female; 31.7%) were included into the study. The mean age at the time of computed tomography acquisition was 63.8 ± 14.7 y and median age was 65 y. Skeletal muscle area and skeletal muscle density were defined on level T12 of the chest.
Overall, 118 patients (26.3%) died within the 30-d observation period. Of the patient sample, 255 patients (57.0%) were admitted to an intensive care unit and 122 patients needed mechanical ventilation (27.3%). The mean skeletal muscle area of all patients was 96.1 ± 27.2 cm² (range = 23.2–200.7 cm²). For skeletal muscle density, the mean was 24.3 ± 11.1 Hounsfield units (range = –5.6 to 55.8 Hounsfield units). In survivors, the mean skeletal muscle density was higher compared with the lethal cases (mean 25.8 ± 11.2 versus 20.1 ± 9.6; P < 0.0001). Presence of myosteatosis was independently associated with 30-d mortality: odds ratio = 2.72 (95% CI, 1.71–4.32); P = 0.0001.
Myosteatosis is strongly associated with 30-d mortality in patients COVID-19. Patients with COVID-19 with myosteatosis should be considered a risk group.
The effect of sarcopenia on patients with severe Covid-19 disease is unknown. We aimed to assess the influence of baseline computed tomography (CT)-based body composition parameters (pectoralis ...muscle area, pectoralis muscle index, skeletal muscle gauge) on clinical variables in patients with severe Covid-19 disease.
Chest CT scans of adult patients with confirmed Covid-19 who were hospitalized from March 2020 to May 2021 at a level-one medical center in Germany were retrospectively analyzed. Pectoralis muscle area, pectoralis muscle index and skeletal muscle gauge were measured on the first CT scan after admission. Body composition parameters were assessed for association with clinical variables and 30-day mortality.
A total of 46 patients were included. None of the body composition parameters was a predictor for 30-day mortality, duration of hospital stay, duration of intensive care unit treatment, or duration of invasive mechanical ventilation.
Pectoralis muscle composition parameters in CT chest scans did not predict outcomes in adult patients with severe Covid-19 infection.
Body composition assessment has shown promising results as a prognostic biomarker as depicted by cross-sectional imaging of several tumor entities including lymphomas. The present study sought to ...elucidate the prognostic relevance of subcutaneous and visceral fat tissue (SAT and VAT) in patients with primary central nervous system lymphoma (PCNSL).
Overall, 74 patients (36 female patients, 46.7%) with a mean age of 64.2±12.8 years (range=23-81 years) were identified in the database with sufficient clinical and imaging data and included into this retrospective study. Fat area assessment was performed on one axial slide on L3-height derived from staging computed tomography (CT) images. Subcutaneous, visceral, and intramuscular adipose tissues (SAT, VAT, IMAT) were estimated. Also, density of SAT, VAT, and IMAT were estimated. Finally, the ratio VAT/SAT (VSR) was calculated. Overall and progression-free survival (OS and PFS) were used as study end points.
In the observation period, overall, 47 patients (63.5%) died. Mean OS was 33.8±45.4 months and mean PFS was 26.6±42.7 months. The mean VAT value was 162±99.5 cm
, the mean SAT was 202.4±103.3 cm
, the mean VSR was 0.92±0.69. The hazard ratios (HRs) for overall survival were 0.87 for high VAT, 1.52 for SAT, and 0.73 for VSR in univariable analysis. For PFS it was 0.24 for VAT, 1.11 for SAT, and 1.07 for VSR. No values achieved statistical significance. Similar results were shown in Kaplan-Meier analysis for OS and PFS, respectively.
Parameters of adipose tissue are not associated with OS and PFS in patients with PCNSL.
In this thesis it is argued that the constituents of practical reasoning are necessary for good teaching; as such, the study of practical reasoning would be a valuable addition to teacher education ...programs.;
Practical reasoning is basically reasoning about what should be done. In Chapter II a conception of practical reasoning developed by Jerrold Coombs is outlined. This conception, which includes a variety of abilities, dispositions and sensitivities, as well as knowledge about a number of concepts and distinctions, is used throughout chapters III and IV to illustrate its value in typical teaching activities.;
These typical teaching activities are divided into two categories, using a distinction conceived by Thomas Green. Green has described teaching as a "practical activity" which consists of perhaps hundreds of single different activies. He divides these activities into three categories: 1) logical acts (for example, explaining, concluding, inferring, giving reasons); 2) strategic acts (motivating, planning, evaluating, disciplining); and 3) institutional acts (taking attendance, keeping reports, consulting parents). Institutional acts, he says, are not necessary to the activity of teaching. However, both logical and strategic acts are "...indispensable to the conduct of teaching wherever and whenever it is found (Green, 1975, p. 5). Furthermore, he argues that "Teaching can be improved by improving either kind of activity, but it cannot be excellent without attention to both (ibid., p. 8).";
In Chapter III, I have illustrated how practical reasoning would improve the logical acts of teaching and in Chapter IV I have argued that practical reasoning would improve the strategic acts.;
Chapter V includes a summary of the major argument and concludes with some suggestions about how to develop teachers practical reasoning abilities and dispositions.
Education, Faculty of
Graduate
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