Automated Inline Myocardial Segmentation of Joint T1 and T2 Mapping Using Deep Learning.

Purpose: To develop an artificial intelligence (AI) solution for automated segmentation and analysis of joint cardiac MRI short-axis T1 and T2 mapping. Materials and Methods: In this retrospective study, a joint T1 and T2 mapping sequence was used to acquire 4240 maps from 807 patients across two hospitals between March and November 2020. Five hundred nine maps from 94 consecutive patients were assigned to a holdout testing set. A convolutional neural network was trained to segment the endocardial and epicardial contours with use of an edge probability estimation approach. Training labels were segmented by an expert cardiologist. Predicted contours were processed to yield mapping values for each of the 16 American Heart Association segments. Network segmentation performance and segment-wise measurements on the testing set were compared with those of two experts on the holdout testing set. The AI model was fully integrated using open-source software to run on MRI scanners. Results: A total of 3899 maps (92%) were deemed artifact-free and suitable for human segmentation. AI segmentation closely matched that of each expert (mean Dice coefficient, 0.82 ± 0.07 [SD] vs expert 1 and 0.86 ± 0.06 vs expert 2) and compared favorably with interexpert agreement (Dice coefficient, 0.84 ± 0.06 for expert 1 vs expert 2). AI-derived segment-wise values for native T1, postcontrast T1, and T2 mapping correlated with expert-derived values (R 2 = 0.96, 0.98, and 0.87, respectively, vs expert 1, and 0.97, 0.99, and 0.92 vs expert 2) and fell within the range of interexpert reproducibility (R 2 = 0.97, 0.99, and 0.90, respectively). The AI model has since been deployed at two hospitals, enabling automated inline analysis. Conclusion: Automated inline analysis of joint T1 and T2 mapping allows accurate segment-wise tissue characterization, with performance equivalent to that of human experts.Keywords: MRI, Neural Networks, Cardiac, Heart Supplemental material is available for this article. © RSNA, 2022.

Proposed Cardiac End Points for Clinical Trials in Immunoglobulin Light Chain Amyloidosis: Report From the Amyloidosis Forum Cardiac Working Group.

Immunoglobulin light chain amyloidosis is a rare, multisystemic, phenotypically heterogenous disease affecting cardiovascular, renal, neurological, and gastrointestinal systems to varying degrees. Its underlying cause is a plasma cell dyscrasia characterized by misfolding of monoclonal immunoglobulin light chains which leads to aggregation and deposition of insoluble amyloid fibrils in target organs. Prognosis is primarily dependent on extent of cardiac involvement and depth of hematologic response to treatment. To facilitate development of new therapies, a public-private partnership was formed between the nonprofit Amyloidosis Research Consortium and the US Food and Drug Administration Center for Drug Evaluation and Research. In 2020, the Amyloidosis Forum launched an initiative to identify novel/composite end points and analytic strategies to expedite clinical trials for development of new therapies for the primary hematologic disorder and organ system manifestations. Specialized working groups identified organ-specific end points; additional working groups reviewed health-related quality of life measures and statistical approaches to data analysis. Each working group comprised amyloidosis experts, patient representatives, statisticians, and representatives from the Food and Drug Administration, the UK Medicines and Healthcare Products Regulatory Agency, and pharmaceutical companies. This review summarizes the proceedings and recommendations of the Cardiac Working Group. Using a modified Delphi method, the group identified, reviewed, and prioritized cardiac end points relevant to immunoglobulin light chain amyloidosis in the context of an antiplasma cell therapy. Prioritized cardiovascular end points included overall survival, hospitalization, N-terminal pro-B-type natriuretic peptide level, 6-minute walk test, Kansas City Cardiac Questionnaire, and cardiac deterioration progression-free survival. These recommended components will be further explored through evaluation of clinical trial datasets and formal guidance from regulatory authorities.

Uso do lítio no tratamento de Alzheimer / Use of lithium in Alzheimer's treatment

A doença de Alzheimer (DA) é a causa mais comum de demência em idosos. As principais lesões cerebrais encontradas nesses pacientes são placas neuríticas com depósitos extracelulares de proteína ß-amiloide e um emaranhado neurofibrilar localizado normalmente no citoplasma perinuclear e composto de proteínas Tau hiperfosforiladas. Nos estágios iniciais, nota-se deficiência da memória recente, lapsos de memória, confusão e queda no rendimento funcional em tarefas complexas. Apesar de todo o conhecimento de sua fisiopatogenia, ainda não foram descritas terapias completamente eficazes para seu tratamento, sendo que o tratamento de primeira escolha é feito com fármacos inibidores da colinesterase. Estudos sugerem que o tratamento crônico com lítio potencializa a sobrevivência de novas células induzida por enriquecimento ambiental no hipocampo, proporcionando um ambiente favorável para os estímulos ambientais exercerem um efeito protetor mais forte. Deste modo, o tratamento combinado com lítio e enriquecimento ambiental poderia constituir uma estratégia para promover a sobrevivência de novos neurônios e, assim, melhorar a função cognitiva na doença de Alzheimer, especialmente em estágio inicial.

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. The two major brain lesions found in patients with Alzheimer's disease are neuritic plaques, which contain extracellular deposits of amyloid ß-protein and neurofibrillary tangle typically located in the perinuclear cytoplasm and composed of hyperphosphorylated Tau protein. In the early stages, the patient has a deficiency of recent memory, tends to commit lapses and to blur easily, besides presenting drop in its functional performance in complex tasks. Despite all the knowledge about the pathogenesis of Alzheimer's disease, have not yet been described completely effective therapies for the treatment of disease and the first choice of treatment is done with cholinesterase inhibitor drugs. Studies suggest that chronic treatment with lithium enhances the survival of new cells induced by environmental enrichment in the hippocampus, providing an environment conducive to environmental stimuli exert a stronger protective effect. Thus, combined treatment with lithium and environmental enrichment could be a strategy to promote the survival of new neurons and thus improve cognitive function in Alzheimer's disease, particularly in the initial stage.

LIVER TRANSPLANTATION AFTER SEVERE HEPATIC TRAUMA: CURRENT INDICATIONS AND RESULTS / TRANSPLANTE DE FÍGADO APÓS TRAUMA HEPÁTICO GRAVE: INDICAÇÕES ATUAIS E RESULTADOS

Background : The liver is the most injured organ in abdominal trauma. Currently, the treatment in most cases is non-operative, but surgery may be necessary in severe abdominal trauma with blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesaving last resource Aim : Analyze the use of liver transplantation as a treatment option for severe liver trauma. Methods : Were reviewed 14 articles in the PubMed, Medline and Lilacs databases, selected between 2008-2014 and 10 for this study. Results : Were identified 46 cases undergoing liver transplant after liver trauma; the main trauma mechanism was closed/blunt abdominal trauma in 83%, and severe trauma (>grade IV) in 81 %. The transplant can be done, in this context, performing one-stage procedure (damaged organ removed with immediate transplantation), used in 72% of cases. When the two-stage approach is performed, end-to-side temporary portacaval shunt is provided, until new organ becomes available to be transplanted. If two different periods are considered - from 1980 to 2000 and from 2000 to 2014 - the survival rate increased significantly, from 48% to 76%, while the mortality decreased from 52% to 24%. Conclusion : Despite with quite restricted indications, liver transplantation in hepatic injury is a therapeutic modality viable and feasible today, and can be used in cases when other therapeutic modalities in short and long term, do not provide the patient survival chances.

Introdução : O fígado é um dos órgãos mais afetados nos traumas abdominais. Atualmente, o tratamento de escolha na maioria dos casos é o não operatório; porém, a intervenção cirúrgica pode ser necessária nos traumas abdominais severos com lesão hepática grave, principalmente naqueles que provocam hemorragias de difícil controle. Apesar das abordagens de controle de danos visando a estabilidade hemodinâmica, muitos pacientes evoluem para choque hipovolêmico, insuficiência hepática aguda, falência múltipla de órgãos e óbito. Nesse contexto, o transplante hepático surge como última opção de tratamento. Objetivo : Analisar a utilização do transplante hepático como modalidade terapêutica em traumas hepáticos graves. Método : Foram revisados 14 artigos obtidos nas bases de dados Pubmed, Medline e Lilacs entre 2008-2014, sendo selecionados 10 para o presente estudo. Resultados : Foram identificados 46 relatos de casos de pacientes submetidos à transplante de fígado após trauma hepático; o principal mecanismo de trauma foi o fechado/contuso com 83%, e traumas graves (>grau IV) em 81%. O transplante pôde ser realizado em uma etapa (paciente com órgão lesado removido e imediatamente recebia o enxerto), utilizado em 72% dos casos. Nos procedimentos em duas etapas realizava-se shunt temporário portocava até que um órgão fosse disponibilizado. Na análise de dois períodos distintos - 1980 a 2000 e 2000 a 2014 -, taxa de sobrevida aumentou significativamente, passando de 48% para 76% e a mortalidade caiu de 52% para 24%. Conclusão : O transplante hepático apesar de ter indicações bastante restritas no cenário do trauma hepático, representa modalidade terapêutica nos dias de hoje viável e factível, podendo ser empregada em casos onde o tratamento cirúrgico, assim como outras modalidades terapêuticas, não ofereçam ao paciente chances de sobrevida a curto e longo prazo.

Diagnosis of apical hypertrophic cardiomyopathy: T-wave inversion and relative but not absolute apical left ventricular hypertrophy.

BACKGROUND: Diagnosis of apical HCM utilizes conventional wall thickness criteria. The normal left ventricular wall thins towards the apex such that normal values are lower in the apical versus the basal segments. The impact of this on the diagnosis of apical hypertrophic cardiomyopathy has not been evaluated. METHODS: We performed a retrospective review of 2662 consecutive CMR referrals, of which 75 patients were identified in whom there was abnormal T-wave inversion on ECG and a clinical suspicion of hypertrophic cardiomyopathy. These were retrospectively analyzed for imaging features consistent with cardiomyopathy, specifically: relative apical hypertrophy, left atrial dilatation, scar, apical cavity obliteration or apical aneurysm. For comparison, the same evaluation was performed in 60 healthy volunteers and 50 hypertensive patients. RESULTS: Of the 75 patients, 48 met conventional HCM diagnostic criteria and went on to act as another comparator group. Twenty-seven did not meet criteria for HCM and of these 5 had no relative apical hypertrophy and were not analyzed further. The remaining 22 patients had relative apical thickening with an apical:basal wall thickness ratio >1 and a higher prevalence of features consistent with a cardiomyopathy than in the control groups with 54% having 2 or more of the 4 features. No individual in the healthy volunteer group had more than one feature and no hypertension patient had more than 2. CONCLUSION: A cohort of individuals exist with T wave inversion, relative apical hypertrophy and additional imaging features of HCM suggesting an apical HCM phenotype not captured by existing diagnostic criteria.

LIVER TRANSPLANTATION AFTER SEVERE HEPATIC TRAUMA: CURRENT INDICATIONS AND RESULTS.

BACKGROUND: The liver is the most injured organ in abdominal trauma. Currently, the treatment in most cases is non-operative, but surgery may be necessary in severe abdominal trauma with blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesaving last resource Aim : Analyze the use of liver transplantation as a treatment option for severe liver trauma. METHODS: Were reviewed 14 articles in the PubMed, Medline and Lilacs databases, selected between 2008-2014 and 10 for this study. RESULTS: Were identified 46 cases undergoing liver transplant after liver trauma; the main trauma mechanism was closed/blunt abdominal trauma in 83%, and severe trauma (>grade IV) in 81 %. The transplant can be done, in this context, performing one-stage procedure (damaged organ removed with immediate transplantation), used in 72% of cases. When the two-stage approach is performed, end-to-side temporary portacaval shunt is provided, until new organ becomes available to be transplanted. If two different periods are considered - from 1980 to 2000 and from 2000 to 2014 - the survival rate increased significantly, from 48% to 76%, while the mortality decreased from 52% to 24%. CONCLUSION: Despite with quite restricted indications, liver transplantation in hepatic injury is a therapeutic modality viable and feasible today, and can be used in cases when other therapeutic modalities in short and long term, do not provide the patient survival chances.

Bacteriocins Pep5 and epidermin inhibit Staphylococcus epidermidis adhesion to catheters.

Pep5 and epidermin bacteriocins were tested on clinical strains of Staphylococcus epidermidis and S. aureus isolated from catheter-related infections. These bacteriocins were inhibitory to several isolates at a concentration of 640 activity units mL(-1). The ability of bacteriocins in inhibiting adhesion of S. epidermidis to silicone catheters was evaluated. When Pep5 and epidermin were added to in vitro catheter colonization experiments, there was a significant decrease in the cell number of S. epidermidis adhered to silicone catheters. Bacteriocins used to decrease bacterial attachment to medical devices may represent a novel strategy to control catheter-related infections.