ABSTRACT
OBJECTIVES: To summarize the status of the SCMR Registry at 150,000 exams. BACKGROUND: Cardiovascular magnetic resonance (CMR) is increasingly utilized to evaluate expanding cardiovascular conditions. The SCMR Registry is a central repository for real-world clinical data to support cardiovascular research, including those relating to outcomes, quality improvement, and machine learning. The SCMR Registry is built on a regulatory-compliant, cloud-based infrastructure that houses searchable content and Digital Imaging and Communications in Medicine (DICOM) images. METHODS: The processes for data security, data submission, and research access are outlined. We interrogated the Registry and present a summary of its contents. RESULTS: Data were compiled from 154,458 CMR scans across 20 United States sites, containing 299,622,066 total images (~100 terabytes of storage). The human subjects had an average age of 58 years (range 1 month to >90 years old), were 44% female, 72% Caucasian, and had a mortality rate of 8%. The most common indication was cardiomyopathy (27%), and most frequently used current procedural terminology (CPT) code was 75561 (35%). Macrocyclic gadolinium-based contrast agents represented 89% of contrast utilization after 2015. Short-axis cines were performed in 99% of scans, short-axis LGE in 66%, and stress perfusion sequences in 30%. Mortality data demonstrated increased mortality in patients with left ventricular ejection fraction (LVEF) < 35%, the presence of wall motion abnormalities, stress perfusion defects, and infarct late gadolinium enhancement (LGE), compared to those without these markers. There were 456,678 patient-years of all-cause mortality follow-up, with a median follow-up time of 3.6 years. CONCLUSIONS: The vision of the SCMR Registry is to promote evidence-based utilization of CMR through a collaborative effort by providing a web mechanism for centers to securely upload de-identified data and images for research, education, and quality control. The Registry quantifies changing practice over time and supports large-scale real-world multicenter observational studies of prognostic utility. CONDENSED ABSTRACT: The SCMR Registry is a central regulatory-compliant cloud-based repository for real-world clinical data and DICOM images for multicenter cardiovascular research, including outcomes-based data. The Registry contains 299,622,066 DICOM images and 456,678 patient-years follow-up. Data compiled from 154,458 CMR scans across 20 US sites demonstrated cardiomyopathy as the most common indication and 89% macrocyclic gadolinium contrast utilization after 2015. There was an overall mortality rate of 8%, with higher rates in those with LVEF<35%, abnormal wall motion, ischemia presence, or infarct LGE. The Registry aims to promote evidence-based CMR utilization through a collaborative effort to positively impact cardiovascular outcomes.
ABSTRACT
Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration:ClinicalTrials.gov identifier NCT02793141.
ABSTRACT
2-Hydroxymethyl-2-methyl-1,3-propanediol (A) was reacted with (Me(3)Si)(2)NH and toluenesulfonyl chloride (TsCl) to give mainly CH(3)C(CH(2)OSiMe(3))(3) (1), and CH(3)C(CH(2)OTs)(3) (2), respectively. With allyl bromide, the products were CH(3)C(CH(2)OCH(2)CH[double bond]CH(2))(2)(CH(2)OH) (3) and CH(3)C(CH(2)OCH(2)CH[double bond]CH(2))(CH(2)OH)(2) x H(2)O (4). The reactions of 4 with perfluoroalkyl iodides (R(f)I) were catalyzed by Cu(I)Cl to form 2-methyl-2-polyfluoroalkenyloxymethyl-1,3-propanediols: (R(f)CH=CHCH(2)OCH(2))C(Me)(CH(2)OH)(2) [R(f) = C(4)F(9) (5), C(8)F(17) (6), and (CF(2)CF(2))(4)OCF(CF(3))(2) (7)]. Reduction of 5 and 6 with hydrogen gave two new 2-methyl-2-polyfluoroalkyloxymethyl-1,3-propanediols, 8 and 9. The sodium salt of 9 was reacted with allyl bromide or acetyl chloride to form (C(8)F(17)CH(2)CH(2)CH(2)OCH(2))C(Me)(CH(2)OX)(CH(2)OH)(2) [where X = CH(2)CH=CH(2) (10) or C(O)CH(3) (12)] and (C(8)F(17)CH(2)CH(2)CH(2)OCH(2))C(Me)(CH(2)OX)(2) [where X = CH(2)CH[double bond]CH(2) (11) or C(O)CH(3) (13)]. Reaction of tolenesulfonyl chloride with 7 gave the monotosylate, 14, as the sole product. With 4-trifluoromethylbenzyl bromide, the sodium salt of 4 gave (4-CF(3)C(6)H(4)CH(2)OCH(2))C(Me)(CH(2)CH[double bond]CH(2))(CH(2)OH) x H(2)O (15). The compounds were characterized by NMR ((1)H, (13)C, (19)F, (29)Si), GC-MS, and high-resolution MS or elemental analyses. UV evidence was obtained for partitioning of 9, 12, 14, and 15 between perfluorodecalin and n-octanol. The test compounds acted as surfactants by facilitating the solubility of phenol and Si(CH[double bond]CH(2))(4) in perfluorodecalin. The single-crystal X-ray structure of 8 was also obtained. It crystallized in the monoclinic space group P2(1)/c, and unit cell dimensions were a = 24.966(2) A (alpha = 90), b = 6.1371(6) A (beta = 100.730(2)), and c = 10.5669(10) A (gamma = 90).
