Podcasts about computed

In 1991, Professor Sten Nilsson and his PhD student Bo Lennernäs realised that the prostate, contrary to prevailing beliefs, is a mobile organ. A study confirmed their observations, and the new findings were included in Bo Lennernäs's doctoral thesis in 1995. The discovery quickly influenced prostate cancer radiotherapy practices across the world. In the papers of the thesis, they also demonstrated that it was possible to track the prostate's movements in a phantom model by inserting a small magnet that transmitted signals to an external receiver. These two findings led to the founding of Micropos Medical AB. Discovering more about Prostate Cancer Sten Nilsson, now a retired senior consultant at Karolinska University Hospital and Professor Emeritus at the Karolinska Institute, has dedicated over 40 years of his career to oncology, with a particular focus on prostate cancer. He has been involved in numerous pioneering research projects and developed new, crucial treatment concepts that are now used globally. Decades of Development When Sten Nilsson treated his first prostate cancer patients in the late 1970s, very few were cured. The tools and techniques for diagnosing and assessing whether the cancer was local or had spread were insufficient, as was radiotherapy. The available X-ray technology could visualise the pelvic skeleton but not the prostate, meaning its position had to be estimated based on the anatomy of the pelvic bones. Radiotherapy was cumbersome and time-consuming to administer, with limited impact on the tumours. "Patients whose cancer was assessed as local received radiotherapy with what we called a 'curative intention'. But in practice, most returned after a while, and the disease remained - eventually spreading," says Sten Nilsson. In the mid-1980s, surgery for localised prostate cancer began delivering better outcomes than radiotherapy. However, radiotherapy also advanced rapidly. Computed tomography (CT) became available, allowing the prostate and sometimes the tumour area to be visualised, which created entirely new conditions for treatment. Subsequently radiotherapy equipment, radiobiological research, and various imaging technologies like CT, MRI, ultrasound and others, also underwent enormous development. The 1990s saw the introduction of high-dose-rate brachytherapy (HDR-BT), a method to which Sten Nilsson made significant contributions. It involves inserting 15-20 hollow needles through the skin into the prostate, through which radiation is delivered. Today, HDR-BT is often combined with external beam radiotherapy in cases of locally advanced prostate cancer. A Discovery that Overturned Accepted Knowledge It was during HDR-BT procedures in 1991 that Sten Nilsson and Bo Lennernäs discovered that the prostate changes position under various conditions. "We used ultrasound to correctly position the needles in the prostate. We then observed that if a patient was anxious, perhaps coughed, raised an arm to scratch their head or simply spoke, the prostate moved. It was a true 'aha' moment. The common belief around the world was that the prostate is firmly anchored in the pelvis. We immediately realized that we had to find a way to describe and document the movement of the prostate, how much and in which directions the prostate moved", Sten Nilsson explains. Years earlier, he had treated prostate cancer patients by implanting radioactive gold seeds into the prostate to deliver a strong local radiation dose. The method was abandoned when seed production ceased, but the treated patients retained the seeds (they were not surgically removed) - creating an opportunity to document the discovery of prostate movement. "The gold seeds, and thus the prostate's position, are visible on X-rays. We called in a number of the former patients and took images under various conditions. For example, while straining versus relaxing, with full versus emptied bladder, and so forth. We found that the prostate frequently moved by ...

Miho Fukui, MD, JACC: Case Reports Associate Editor, is joined by author Ree Lu, MD, discussing this study from Cho et al presented at ACC.25 and published in JACC: Case Reports. Intravenous leiomyomatosis (IVL) is a rare benign uterine growth that extends into the venous system. This case describes a 48-year-old female who presented with 1 month of chest pain and dyspnea on exertion. She was found to have a right atrial mass that transiently crossed into the right ventricle with associated moderate tricuspid regurgitation. Computed tomography revealed a uterine mass with contiguous intravascular extension through the inferior vena cava terminating in the right atrium. This case of symptomatic tricuspid valve obstruction due to IVL illustrates the importance of maintaining preload. Chest and abdominal imaging may be necessary to identify the source of the mass and ensure appropriate surgical planning.

In this podcast Nick Vos discusses his article 'Computed tomographic observations of short incomplete parasagittal fractures of the proximal phalanx in Thoroughbred racehorses'.

Dr. Henry Schiller, Professor of Surgery, Liutenant Colonel in the US Army Reserve, and Mayo Clinic Teaching Hall of Fame inductee rejoins the show to talk about gallbladders. We review the distinction between the evaluation and management of cholelithiasis, choledocolithiasis, the role of different imaging modalities, and much more in this awesome chapter of the show - dont miss this! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS & ADDITIONAL READING  Childs DD, Lalwani N, Craven T, Arif H, Morgan M, Anderson M, Fulcher A. A meta-analysis of the performance of ultrasound, hepatobiliary scintigraphy, CT and MRI in the diagnosis of acute cholecystitis. Abdom Radiol (NY). 2024 Feb;49(2):384-398. doi: 10.1007/s00261-023-04059-w. Epub 2023 Nov 20. PMID: 37982832. de Oliveira GS, Torri GB, Gandolfi FE, Dias AB, Tse JR, Francisco MZ, Hochhegger B, Altmayer S. Computed tomography versus ultrasound for the diagnosis of acute cholecystitis: a systematic review and meta-analysis. Eur Radiol. 2024 Nov;34(11):6967-6979. doi: 10.1007/s00330-024-10783-8. Epub 2024 May 17. PMID: 38758253.  

Computed tomography...this time. Not "camel toe"—although it is Tyler.

BUFFALO, NY - December 9, 2024 – A new #research paper was #published in Oncotarget's Volume 15 on November 22, 2024, entitled “Computed tomography-based radiomics and body composition model for predicting hepatic decompensation." Mayo Clinic researchers Yashbir Singh, John E. Eaton, Sudhakar K. Venkatesh, and Bradley J. Erickson have developed an innovative AI tool to predict hepatic decompensation in individuals with primary sclerosing cholangitis (PSC). PSC is a chronic disease that damages the bile ducts and can lead to liver failure. Hepatic decompensation marks a critical stage of advanced liver disease, and clinicians have long faced challenges in predicting who is at risk. The Mayo Clinic's new AI tool addresses this gap by combining body fat and muscle composition data with insights extracted from computed tomography (CT) scans using computational radiomics. By analyzing these tissues, the AI model identifies patterns linked to an increased risk of liver failure. The study involved 80 PSC patients, including 30 with hepatic decompensation, 30 without, and 20 patients in an external validation set. The AI model achieved impressive results, correctly identifying at-risk patients with 97% accuracy. By recognizing these risks early, clinicians may be able to intervene sooner and improve patient outcomes. While the study focused on PSC, the team emphasized the broader implications of their work. “It may hold promise for the detection of other PSC-related complications, such as cholangiocarcinoma, as well as applications in more prevalent chronic liver diseases like non-alcoholic fatty liver disease (NAFLD).” This non-invasive, data-driven approach offers a powerful way to assess health risks and provide more tailored treatments. Despite the promising findings, the researchers acknowledge the limitations of the study, which include a limited sample size and a single-center design. “However, further research is necessary to validate our findings on a large-scale, independent dataset, ensuring the robustness and generalizability of the model.” In conclusion, this study shows how detailed information from CT scans can help clinicians predict severe liver problems in patients with PSC. By identifying hidden patterns in the images, they can better understand risks and create personalized treatment plans. This approach could improve care for PSC and other long-term liver diseases. DOI - https://doi.org/10.18632/oncotarget.28673 Correspondence to - Bradley J. Erickson - bje@mayo.edu Video short - https://www.youtube.com/watch?v=QCekNtYni4w Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28673 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, radiomics, body composition, machine learning, primary sclerosing cholangitis, computer tomography About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. Oncotarget is indexed and archived by PubMed/Medline, PubMed Central, Scopus, EMBASE, META (Chan Zuckerberg Initiative) (2018-2022), and Dimensions (Digital Science). To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

Join hosts Nidhi Madan, MD and guest hosts Anjali Chelliah, MD, FSCCT and Cristina Fuss, MD, PhD, FSCCT as they take a deep dive into featured articles in the September – October 2024 issue of the Journal of Cardiovascular Computed Tomography (JCCT). Our hosts chat with Gareth Morgan, MD; Yoshinobu Onuma, MD, PhD; Ashton Sequeira, MD and Shone Almedia, MD. This episode will explore:Computed tomography-derived normative values and z-scores of the pulmonary valve annulus and sino-tubular junction in the pediatric populationCardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery diseaseUnlocking the Gates: Uptake of Cardiac CT and Barriers to Wider Adoption Among Primary Care ProvidersSupport the show

Spotify link... https://open.spotify.com/show/2nq6d35q9nFAFlanaJc2Do iTunes link... https://podcasts.apple.com/us/podcast/on-life-being-human/id1360368906 Continue reading Ep 337 – The Fourth Era Of Truth Spoken Measured Computed Cryptographic at Dr. Kathryn Colleen, PhD RMT.

Contributor: Ricky Dhaliwal MD Educational Pearls: Three zones of the neck with different structures and risks for injuries: Zone 1 is the most caudal region from the clavicle to the cricoid cartilage Zone 2 is from the cricoid cartilage to the angle of the mandible Zone 3 is superior to the angle of the mandible Zone 1 contains the thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins), carotid arteries, vertebral artery, apices of the lungs, trachea, esophagus, spinal cord, thoracic duct, thyroid gland, jugular veins, and the vagus nerve.  Zone 2 contains the common carotid arteries, internal and external branches of carotid arteries, vertebral arteries, jugular veins, trachea, esophagus, larynx, pharynx, spinal cord, and vagus and recurrent laryngeal nerves Lower risk than Zone 1 or Zone 3 Zone 3 contains the distal carotid arteries, vertebral arteries, jugular veins, pharynx, spinal cord, cranial nerves IX, X, XI, XII, the sympathetic chain, and the salivary and parotid glands Hard signs that indicate direct transfer to OR: Airway compromise  Active, brisk bleeding Pulsatile hematomas Hematemesis Massive subcutaneous emphysema  Soft signs that may obtain imaging to determine further interventions: Hemoptysis Oropharyngeal bleeding Dysphagia Dysphonia Expanding hematomas Soft sign management includes ABCs, type & screen, and airway interventions followed by imaging of the head & neck area Patients with dysphonia or dysphagia with subsequent negative CTAs may get further work-up via swallow studies References Asensio JA, Chahwan S, Forno W, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma. 2001;50(2):289-296. doi:10.1097/00005373-200102000-00015 Azuaje RE, Jacobson LE, Glover J, et al. Reliability of physical examination as a predictor of vascular injury after penetrating neck trauma. Am Surg. 2003;69(9):804-807. Ibraheem K, Wong S, Smith A, et al. Computed tomography angiography in the "no-zone" approach era for penetrating neck trauma: A systematic review. J Trauma Acute Care Surg. 2020;89(6):1233-1238. doi:10.1097/TA.0000000000002919 Nowicki JL, Stew B, Ooi E. Penetrating neck injuries: A guide to evaluation and managementx. Ann R Coll Surg Engl. 2018;100(1):6-11. doi:10.1308/rcsann.2017.0191 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII  

What makes Python an interpreter? Today we're talking about ceval.c, the wonders of frame evaluation, and how it changed over the years. # Timestamps (00:00:00) INTRO (00:00:59) BACK TO PYTHON 2.6 (00:02:53) Stack virtual machine (00:04:41) First encounter with opcodes (00:08:06) What even is frame evaluation? (00:12:51) Stack! Which stack? (00:15:46) PRESENT DAY (00:16:41) Computed gotos (00:21:22) PEP 523: JIT me, maybe (00:26:53) Let's generate the interpreter (00:29:08) The JIT is coming (00:33:13) Python function call inlining (00:37:23) Instrumentation: DTrace, PEP 669 (00:41:50) lltrace and pystats (00:44:02) Eval breaker (00:47:54) Signal handling (00:50:47) Recursion limits (00:54:27) String concatenation special case (00:58:24) WHAT'S GOING ON IN CPYTHON? (00:58:42) 3.12.0a2 (00:59:12) Critical section API adoption (00:59:34) PyOnceFlag (01:00:28) PyDict_GetItemRef() (01:03:36) PyList_Extend() and PyDict_Pop() (01:04:18) Parser: better error messages for non-matching elif/else (01:05:39) glob.translate() (01:07:22) TLS-PSK in the ssl module (01:08:35) IDLE debugger improvements (01:10:50) First micro-op in the Tier 2 interpreter (01:11:18) OUTRO

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj's unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you've ever wondered how any radiology tool works, this episode is for you. We discuss: Raj's road from engineering to radiology [2:45]; How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [13:00]; Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [22:45]; Ultrasound: Benefits and limitations, and a special use for the heart [36:00]; Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity' and ‘specificity' [46:15]; Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [59:00]; Brain aneurysms: Using MRI to find them and save lives [1:18:45]; Raj's unique MRI technology [1:25:15]; The risk of false positives in cancer detection, and how Raj's MRI can reduce the number of false positives (i.e., increase specificity) [1:38:45]; The unique software Raj created to pair with his MRI machine [1:46:15]; Comparing the radiation exposure of a whole-body PET-CT to Raj's equipment (DWIBS-MRI) [1:48:45]; How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:50:15]; Why a DW-MRI is still not a perfect test [1:54:15]; The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [1:58:00];/li> Are there any commercially available scanners that can match the resolution of Raj's images? [2:01:00]; Machine learning: When and where might machine learning/AI impact the field of radiology? [2:03:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Join hosts Anjali Chelliah, MD, and Anna Reid, MBChB, PhD and guest host Armin Zadeh, MD, PhD, MPH, MSCCT as they take a deep dive into two featured articles in the March – April 2023 issue of the Journal of Cardiovascular Computed Tomography (JCCT). Dr. Chelliah and Dr. Reid will chat with Dr. Rebecca Beroukhim, Dr. Gianluca Pontone and Dr. Saima Mushtaq.This episode will explore:Computed tomography angiography (CTA) of anomalous aortic origin of a coronary artery (AAOCA): Which measurements are accurate and reliable? The journal of cardiovascular computed tomography: A year in review: 2022Support the show

CardioNerds (Drs. Amit Goyal and Dan Ambinder) join Dr. Emily Lee (LAC+USC Internal medicine resident) and Dr. Charlie Lin (LAC+USC Cardiology fellow) as the discuss an important case of stimulant-related (methamphetamine) cardiovascular toxicity that manifested in right ventricular dysfunction due to severe pulmonary hypertension. Dr. Jonathan Davis (Director, Heart Failure Program at Zuckerberg San Francisco General Hospital and Trauma Center) provides the ECPR for this episide. Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig. With the ongoing methamphetamine epidemic, the incidence of stimulant-related cardiovascular toxicity continues to grow. We discuss the following case: A 36-year-old man was hospitalized for evaluation of dyspnea and volume overload in the setting of previously untreated, provoked deep venous thrombosis. Transthoracic echocardiogram revealed severe right ventricular dysfunction as well as signs of pressure and volume overload. Computed tomography demonstrated a prominent main pulmonary artery and ruled out pulmonary embolism. Right heart catheterization confirmed the presence of pre-capillary pulmonary arterial hypertension without demonstrable vasoreactivity. He was prescribed sildenafil to begin management of methamphetamine-associated cardiomyopathy and right ventricular dysfunction manifesting as severe pre-capillary pulmonary hypertension. CardioNerds is collaborating with Radcliffe Cardiology and US Cardiology Review journal (USC) for a ‘call for cases', with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ). CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - stimulant-related (methamphetamine) cardiovascular toxicity Pearls - stimulant-related (methamphetamine) cardiovascular toxicity 1. Methamphetamine, and stimulants in general, can have a multitude of effects on the cardiovascular and pulmonary systems. Effects of methamphetamine are thought to be due to catecholamine toxicity with direct effects on cardiac and vascular tissues. Acutely, methamphetamine can cause vascular constriction and vasospasm, while chronic exposure is associated with endothelial damage. Over time, methamphetamine can cause pulmonary hypertension, atherosclerosis, cardiac arrhythmias, and dilated cardiomyopathy. 2. Methamphetamines are the second most commonly misused substances worldwide after opiates. Patients with methamphetamine-associated pulmonary arterial hypertension (PAH) have more severe pulmonary vascular disease, more dilated and dysfunctional right ventricles, and worse prognoses when compared to patients with idiopathic PAH. Additionally, patients with methamphetamine-associated cardiomyopathy and PAH have significantly worse outcomes and prognoses when compared to those with structurally normal hearts without evidence of PAH. Management includes multidisciplinary support, complete cessation of methamphetamine use, and guideline-directed treatment of PAH. 3. The diagnosis of pulmonary hypertension (PH) begins with the history and physical, followed by confirmatory testing using echocardiography and invasive hemodynamics (right heart catheterization). Initial serological evaluation may include routine biochemical, hematologic, endocrine, hepatic, and infectious testing. Though PH is traditionally diagnosed and confirmed in a two-step, echocardiogram-followed-by-catheterization model, other diagnostics often include electrocardiography, blood gas analysis, spirometry, ventilation/perfusion assessment,

Squashing bugs in your code can be as easy as finding a missing semicolon, but sometimes it can be a grueling process filled with torn out hair and console logs. In this episode, Matt and Mike discuss the various ways that you can debug your code using methods that span HTML, CSS, and JavaScript. For HTML, the DOM inspector, markup validation, and accessibility checkers can ensure you have a clean structure for the rest of your code to work from. Then in the layout department, CSS debugging methods can include things like using the Computed tab in your dev tools, obvious visual markers (ie red borders on targeted elements), and various Chrome extensions. And finally, JavaScript - the part of your website that is most likely already acquainted with debugging includes methods like using alerts, breakpoints, asking AI to correct errors, and much more. Show Notes: www.htmlallthethings.com/podcasts/debugging-html-css-and-javascript

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 This week's BrainWaves episode features a case of a middle-aged woman with progressive headaches and cranial neuropathies. The diagnosis of aseptic meningitis is made, and a differential diagnosis is illustrated. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. REFERENCES Chamberlain MC, Glantz M. Myelomatous meningitis. Cancer 2008;112(7):1562-7. PMID 18260094 Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol 2008;8(6):348-61. PMID 19015295 Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001;345(24):1727-33. PMID 11742046 Jolles S, Sewell WA, Leighton C. Drug-induced aseptic meningitis: diagnosis and management. Drug Saf 2000;22(3):215-26. PMID 10738845 Lee BE, Chawla R, Langley JM, et al. Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of aseptic meningitis. BMC Infect Dis 2006;6:68. PMID 16603090 Logan SA, MacMahon E. Viral meningitis. BMJ 2008;336(7634):36-40. PMID 18174598 Negrini B, Kelleher KJ, Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics 2000;105(2):316-9. PMID 10654948 Nieuwenhuizen L, Biesma DH. Central nervous system myelomatosis: review of the literature. Eur J Haematol 2008;80(1):1-9. PMID 17961180 Nigrovic LE. Aseptic meningitis. Handb Clin Neurol 2013;112:1153-6. PMID 23622323 Sobol U, Stiff P. Neurologic aspects of plasma cell disorders. Handb Clin Neurol 2014;120:1083-99. PMID 24365373 van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351(18):1849-59. PMID 15509818  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

CME credits: 1.00 Valid until: 30-06-2023 Claim your CME credit at https://reachmd.com/programs/cme/vq-scans-and-computed-tomographic-approaches-to-ph-diagnosis-finding-cteph/14188/ TBD

It's 1AM and the emergency department is calling about *insert terrifying foregut problem you haven't seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington's Minimally Invasive Surgery team.  Referenced articles and videos:  1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017 https://www.dovepress.com/getfile.php?fileID=35414 2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017 https://www.youtube.com/watch?v=vq6cZL2-pho 3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014.  https://pubmed.ncbi.nlm.nih.gov/25278244/ 4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019.  https://pubmed.ncbi.nlm.nih.gov/30403524/ 5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021. https://pubmed.ncbi.nlm.nih.gov/34079912/ 6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018. https://pubmed.ncbi.nlm.nih.gov/30036134/ 7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.) https://www.uptodate.com/contents/gastric-volvulus-in-adults Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Moderator Tobias Mattei, MD chats with author Max Hans-Peter Gay, PhD about his article titled, "Computed tomography osteoabsorptiometry for imaging of degenerative disc disease." Access article here. Disclosures: Gay, Max Hans-Peter: Nothing to Disclose Mattei, Tobias Alecio: Nothing to Disclose

How do you determine oxygen flow during anesthesia? Are you a "set it and forget it" type of anesthetist, or do you adjust your O2 constantly? Do you live on the edge and try "low-flow"? Is there a magic number when it comes to Oxygen flow rate? Listen in as Dr. Ben Brainard makes sense out of it all... and shakes out some common myths when it comes to flow rates. Articles referenced: Staffieri F et al. Computed tomographic analysis of the effects of two inspired oxygen concentrations on pulmonary aeration in anesthetized and mechanically ventilated dogs :https://pubmed.ncbi.nlm.nih.gov/17764405/ Ambrisko T et al. Evaluation of isoflurane and sevoflurane vaporizers over a wide range of oxygen flow rates. https://pubmed.ncbi.nlm.nih.gov/16740083/

Dr. Christof Koch, Ph.D. (https://alleninstitute.org/what-we-do/brain-science/about/team/staff-profiles/christof-koch/) is Chief Scientist of the MindScope Program at the Allen Institute for Brain Science, originally funded by a donation of more than $500 million from Microsoft founder and philanthropist Paul G. Allen. With his B.S. and M.S. in physics from the University of Tübingen in Germany and his Ph.D. from the Max-Planck Institute for Biological Cybernetics, Dr. Koch spent four years as a postdoctoral fellow in the Artificial Intelligence Laboratory and the Brain and Cognitive Sciences Department at MIT, and from 1987 until 2013, was a professor at Caltech, from his initial appointment as Assistant Professor, Division of Biology and Division of Engineering and Applied Sciences, to his final position as Lois and Victor Troendle Professor of Cognitive & Behavioral Biology. Dr. Koch joined the Allen Institute for Brain Science as Chief Scientific Officer in 2011 and became it's President in 2015. Dr. Koch's passion are neurons, or what he refers to as the atoms of perception, memory, behavior and consciousness, including their diverse shapes, electrical behaviors, and their computational function within the mammalian brain, in particular in neocortex, and he leads the Allen Institute for Brain Science effort to identify all the different types of neurons in the brains of mice and humans – known as their cell census effort. Dr. Koch's writings and interests integrate theoretical, computational and experimental neuroscience with philosophy and contemporary trends, in particular artificial intelligence, and he has authored more than 300 scientific papers and multiple books including, The Feeling of Life Itself – Why Consciousness is Everywhere But Can't be Computed, Consciousness: Confessions of a Romantic Reductionist, The Quest for Consciousness: A Neurobiological Approach, Biophysics of Computation: Information Processing in Single Neurons, and Methods in Neuronal Modeling: From Ions to Networks. He has also served as editor for several books on neural modeling and information processing.

Commentary by Dr. Valentin Fuster

REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.

REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.

REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.

REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.

REFERÊNCIAS1.Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, et al. Role of computed tomography in COVID-19. J Cardiovasc Comput Tomogr. 2021;15(1):27-36.2.Cereser L, Da Re J, Zuiani C, Girometti R. Chest high-resolution computed tomography is associated to short-time progression to severe disease in patients with COVID-19 pneumonia. Clin Imaging. 2021;70:61-6.3.Hochhegger B, Mandelli NS, Stuker G, Meirelles GSP, Zanon M, Mohammed TL, et al. Coronavirus Disease 2019 (COVID-19) Pneumonia Presentations in Chest Computed Tomography: A Pictorial Review. Curr Probl Diagn Radiol. 2021;50(3):436-42.4.Besutti G, Ottone M, Fasano T, Pattacini P, Iotti V, Spaggiari L, et al. The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room. Eur Radiol. 2021.5.Mogami R, Lopes AJ, Araujo Filho RC, de Almeida FCS, Messeder A, Koifman ACB, et al. Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil. Radiol Bras. 2021;54(1):1-8.6.Cau R, Falaschi Z, Pasche A, Danna P, Arioli R, Arru CD, et al. CT findings of COVID-19 pneumonia in ICU-patients. J Public Health Res. 2021.7.Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, et al. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology. 2021;299(3):E262-E79.8.Pourhoseingholi MA, Jafari R, Jafari NJ, Rahimi-Bashar F, Nourbakhsh M, Vahedian-Azimi A, et al. Predicting 1-year post-COVID-19 mortality based on chest computed tomography scan. J Med Virol. 2021;93(10):5694-6.9.Kato S, Ishiwata Y, Aoki R, Iwasawa T, Hagiwara E, Ogura T, et al. Imaging of COVID-19: An update of current evidences. Diagn Interv Imaging. 2021;102(9):493-500.10.Ozer H, Kilincer A, Uysal E, Yormaz B, Cebeci H, Durmaz MS, et al. Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19. Jpn J Radiol. 2021;39(9):877-88.11.Ramanan RV, Joshi AR, Venkataramanan A, Nambi SP, Badhe R. Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective. Indian J Radiol Imaging. 2021;31(Suppl 1):S45-S52.12.Axiaq A, Almohtadi A, Massias SA, Ngemoh D, Harky A. The role of computed tomography scan in the diagnosis of COVID-19 pneumonia. Curr Opin Pulm Med. 2021;27(3):163-8.13.Ishfaq A, Yousaf Farooq SM, Goraya A, Yousaf M, Gilani SA, Kiran A, et al. Role of High Resolution Computed Tomography chest in the diagnosis and evaluation of COVID -19 patients -A systematic review and meta-analysis. Eur J Radiol Open. 2021;8:100350.14.Razek A, Fouda N, Fahmy D, Tanatawy MS, Sultan A, Bilal M, et al. Computed tomography of the chest in patients with COVID-19: what do radiologists want to know? Pol J Radiol. 2021;86:e122-e35.15.Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, et al. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology. 2021;301(1):E361-E70.16.Au-Yong I, Higashi Y, Giannotti E, Fogarty A, Morling JR, Grainge M, et al. Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19. Radiology. 2021:210986.17.Little BP. Disease Severity Scoring for COVID-19: A Welcome (Semi)Quantitative Role for Chest Radiography. Radiology. 2021:212212.18.Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stoger L, Beenen L, et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19-Definition and Evaluation. Radiology. 2020;296(2):E97-E104.19.Ozel M, Aslan A, Arac S. Use of the COVID-19 Reporting and Data System (CO-RADS) classification and chest computed tomography involvement score (CT-IS) in COVID-19 pneumonia. Radiol Med. 2021;126(5):679-87.20.Byrne D, Neill SBO, Muller NL, Muller CIS, Walsh JP, Jalal S, et al. RSNA Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19: Interobserver Agreement Between Chest Radiologists. Can Assoc Radiol J. 2021;72(1):159-66.21.Fonseca E, Loureiro BMC, Strabelli DG, Farias LPG, Garcia JVR, Gama VAA, et al. Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population. Clinics (Sao Paulo). 2021;76:e2476.22.Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2021;478(3):471-85.23.Kianzad A, Meijboom LJ, Nossent EJ, Roos E, Schurink B, Bonta PI, et al. COVID-19: Histopathological correlates of imaging patterns on chest computed tomography. Respirology. 2021;26(9):869-77.24.Aesif SW, Bribriesco AC, Yadav R, Nugent SL, Zubkus D, Tan CD, et al. Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation. Am J Clin Pathol. 2021;155(4):506-14.25.De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, et al. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth. 2021.26.Vlachou M, Drebes A, Candilio L, Weeraman D, Mir N, Murch N, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-84.27.Caruso D, Guido G, Zerunian M, Polidori T, Lucertini E, Pucciarelli F, et al. Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up. Radiology. 2021:210834.28.Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E86.29.Solomon JJ, Heyman B, Ko JP, Condos R, Lynch DA. CT of Post-Acute Lung Complications of COVID-19. Radiology. 2021:211396.30.Wells AU, Devaraj A, Desai SR. Interstitial Lung Disease after COVID-19 Infection: A Catalog of Uncertainties. Radiology. 2021;299(1):E216-E8.31.Han X, Fan Y, Alwalid O, Zhang X, Jia X, Zheng Y, et al. Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19. Radiology. 2021:210972.32.Lindahl A, Reijula J, Malmberg LP, Aro M, Vasankari T, Makela MJ. Small airway function in Finnish COVID-19 survivors. Respir Res. 2021;22(1):237.33.Small Airways Disease is a Post-Acute Sequelae of SARS-CoV-2 Infection [Internet]. 2021.34.Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, et al. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care. 2021.35.Wells AU, Devaraj A. Residual Lung Disease at 6-month Follow-up CT after COVID-19: Clinical Significance Is a Key Issue. Radiology. 2021:211284.

Drs Nuelle and Schmitz discuss Sex Differences in Patients With CAM Deformities With Femoroacetabular Impingement: 3-Dimensional Computed Tomographic Quantification

April 7, 2021--Bob Laughton and Jim Heid host Point and Click Radio, KZYX's biweekly computer radio show with call ins.

January 27, 2021--On this week's edition of Point and Click Radio, Jim Heid and Toby Malina talk about Wunderground.com personal weather station weather forcasting website; the latest security updates for Aplle ios 14 and ipad; and discuss the potential and controversies regarding Starlink Satellite Internet for bringing broadband to rural and underserved areas. Point and Click Radio airs every other Wednesday night at 7pm on KZYX and Z.

Fantastic conversation with Alexandre Blanc about the current state of responsibility in cloud computing, co-location, and on-premesis hosting.

Listen as chiropractor and founder of the Cox Technic, Dr. James Cox explains what Cox Technic is and why it is so effective for treating back pain. James M. Cox, DC, DACBR, FICC, Hon.D.Litt., FACO(H) Dr. Cox is the developer of Cox® Technic Flexion Distraction Manipulation and the proud participant in the on-going federal research projects involving the Keiser University, National University of Health Sciences, Palmer College of Chiropractic Research Center, Loyola Stritch School of Medicine, University of Illinois, University of Iowa, Auburn University, etc. He is a member of the postgraduate faculty of the National University of Health Sciences and has been privileged to speak throughout the world. Resources: About Dr. Cox curriculum vitae  More about Cox Technic Find a Back Doctor The Cox 8 Table by Haven Medical References: Chesterton P, Evans W, Wright M, Lolli L, Richardson M, Atkinson G. Influence of Lumbar Mobilizations During the Nordic Hamstring Exercise on Hamstring Measures of Knee Flexor Strength, Failure Point, and Muscle Activity: A Randomized Crossover Trial. J Manipulative Physiol Ther. 2020 Nov 25:S0161-4754(20)30201-3. doi: 10.1016/j.jmpt.2020.09.005. Epub ahead of print. PMID: 33248746. INFLUENCE OF LUMBAR MOBILIZATIONS DURING THE NORDIC HAMSTRING EXERCISE ON HAMSTRING MEASURES OF KNEE FLEXOR STRENGTH, FAILURE POINT, AND MUSCLE ACTIVITY: A RANDOMIZED CROSSOVER TRIAL. AFTER SPINAL MOBILIZATION, IMMEDIATE CHANGES IN BILATERAL HAMSTRING FORCE PRODUCTION AND PEAK TORQUE OCCURRED DURING THE NHE. THE EFFECT ON THE NHE FAILURE POINT WAS UNCLEAR. ELECTROMYOGRAPHIC ACTIVITY INCREASED ON THE IPSILATERAL SIDE. Meet the Nordic hamstring exercise, also known as the Nordic hamstring curl—your potential new favorite go-to that can help keep you healthy while boosting your performance.  me 19 Lead researcher Nicol van Dyk, Ph.D., of Aspetar Orthopaedic and Sports Medicine Hospital in Qatar, told Runner's World the move is simple: Begin in a kneeling position with both ankles secured—tucking your feet under a bar, for example, or having a running buddy hold them down—and then progressively lean forward as slowly as possible while keeping your back straight. When you can't resist anymore, just fall forward, catching yourself with your hands against the floor. Check out the video below for how to do it properly.   Ekşi MŞ, Özcan-Ekşi EE, Özmen BB, Turgut VU, Huet SE, Dinç T, Kara M, Özgen S, Özek MM, Pamir MN. Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain. J Pediatr Orthop B. 2020 Nov 27. doi: 10.1097/BPB.0000000000000833. Epub ahead of print. PMID: 33252539. FATTY INFILTRATION IN THE PARASPINAL MUSCLES AND IVDD WERE CLOSELY ASSOCIATED WITH MODIC CHANGES IN CHILDREN AND ADOLESCENTS WITH LBP. LUMBAR IVDD IN CHILDREN AND ADOLESCENTS COULD BE THE RESULT OF A MECHANICAL PATHOLOGY   Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2020 Nov 25:S0161-4754(20)30153-6. doi: 10.1016/j.jmpt.2020.07.006. Epub ahead of print. PMID: 33248744. DETERMINATION OF BIODEX BALANCE SYSTEM CUTOFF SCORES IN OLDER PEOPLE WITH NONSPECIFIC BACK PAIN: A CROSS-SECTIONAL STUDY BBS CUTOFF SCORES ARE SENSITIVE AND SPECIFIC IN DISTINGUISHING BETWEEN POOR AND GOOD POSTURAL PERFORMANCE IN OLDER PEOPLE WITH NSLBP.   TRACTION EFFECTS: TRACTION AND DISTRACTION STUDIES ON WHICH OUR WORK IS BASED. Luigi Albano, DC introduced the first paper on which I built the remaining studies. This gives us foundational understanding as to the benefits of placing a spine into distraction prior to producing ranges of motion – IT FIRST REDUCES STENOTIC EFFECTS THAT COULD CAUSE GREATER NERVE AND DRG COMPRESSION AND CHEMICAL INFLAMMATORY IRRITATION. - JMC   Gaowgzeh RAM, Chevidikunnan MF, BinMulayh EA, Khan F. Effect of spinal decompression therapy and core stabilization exercises in management of lumbar disc prolapse: A single blind randomized controlled trial. J Back Musculoskelet Rehabil. 2020;33(2):225-231. doi: 10.3233/BMR-171099. PMID: 31282394. A COMBINATION OF SPINAL DECOMPRESSION THERAPY WITH CORE STABILIZATION EXERCISE HAS PROVEN TO BE MORE SIGNIFICANT WHEN COMPARED WITH CSE ALONE TO REDUCE PAIN AND DISABILITY IN SUBJECTS WITH CHRONIC LDP.   Demirel A, Yorubulut M, Ergun N. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial. J Back Musculoskelet Rehabil. 2017 Sep 22;30(5):1015-1022. doi: 10.3233/BMR-169581. PMID: 28505956. THIS STUDY SHOWED THAT PATIENTS WITH LHNP RECEIVED PHYSIOTHERAPY HAD IMPROVEMENT BASED ON CLINICAL AND RADIOLOGIC EVIDENCE. NON-INVASIVE SPINAL DECOMPRESSION THERAPY (NSDT) CAN BE USED AS ASSISTIVE AGENT FOR OTHER PHYSIOTHERAPY METHODS IN TREATMENT OF LUMBAR DISC HERNIATION.   Karimi N, Akbarov P, Rahnama L. Effects of segmental traction therapy on lumbar disc herniation in patients with acute low back pain measured by magnetic resonance imaging: A single arm clinical trial. J Back Musculoskelet Rehabil. 2017;30(2):247-253. doi: 10.3233/BMR-160741. PMID: 27636836. SEGMENTAL TRACTION THERAPY MIGHT PLAY AN IMPORTANT ROLE IN THE TREATMENT OF ACUTE LBP STIMULATED BY LDH.   Kamanli A1, Karaca-Acet G, Kaya A, Koc M, Yildirim H Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 247-253, 2017 CONVENTIONAL PHYSICAL THERAPIES WITH LUMBAR TRACTION WERE EFFECTIVE IN THE TREATMENT OF PATIENT WITH SUBACUTE LDH. THESE RESULTS SUGGEST THAT CLINICAL IMPROVEMENT IS NOT CORRELATED WITH THE FINDING OF MRI. PATIENTS WITH LDH SHOULD BE MONITORED CLINICALLY   Choi J, Lee S, Hwangbo G. Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation. J Phys Ther Sci. 2015 Feb;27(2):481-3. doi: 10.1589/jpts.27.481. Epub 2015 Feb 17. PMID: 25729196; PMCID: PMC4339166. SPINAL DECOMPRESSION THERAPY AND GENERAL TRACTION THERAPY ARE EFFECTIVE AT IMPROVING THE PAIN, DISABILITY, AND SLR OF PATIENTS WITH INTERVERTEBRAL DISC HERNIATION. THUS, SELECTIVE TREATMENT MAY BE REQUIRED   JUDOVICH BD. Herniated cervical disc; a new form of traction therapy. Am J Surg. 1952 Dec;84(6):646-56. doi: 10.1016/0002-9610(52)90127-x. PMID: 12986095. CLINICAL STUDIES INDICATE THAT IN THE AVERAGE INTRACTABLE CASE THE CERVICAL SPINE SHOULD BE STRETCHED BY FORCE RANGING FROM 25 TO 45 POUNDS. ALMOST HALF THE PATIENTS IN A SERIES OF SIXTY CASES EXPERIENCED PARTIAL OR COMPLETE MOMENTARY RELIEF WHEN THIS FORCE WAS APPLIED. ROENTGEN STUDIES REVEAL THAT IN THE AVERAGE PATIENT THE INTERVERTEBRAL SPACES OF THE CERVICAL SPINE BEGIN TO SHOW MEASURABLE WIDENING WITH TRACTION FORCE RANGING FROM 25 TO 50 POUNDS. THE NECESSARY FORCE TO RELIEVE PAIN CANNOT BE TOLERATED BY THE AVERAGE PATIENT WHEN IT IS ADMINISTERED AS A CONSTANT PULL. IF ADMINISTERED INTERMITTENTLY, ADEQUATE AND MUCH GREATER TRACTION LOAD CAN BE TOLERATED WITHOUT THE DISCOMFORT WHICH WOULD NORMALLY ACCOMPANY SUCH FORCE. A NEW METHOD OF MOTORIZED INTERMITTENT TRACTION IS PRESENTED. THE CLINICAL RESULTS OF INTERMITTENT TRACTION, BECAUSE OF ADEQUATE FORCE, HAVE BEEN EXCELLENT AS COMPARED TO CONVENTIONAL TRACTION METHODS.   Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000 Jun;9(3):202-7. doi: 10.1007/s005869900113. PMID: 10905437; PMCID: PMC3611397. BECAUSE OSTEOPATHIC MANIPULATION PRODUCED A 12-MONTH OUTCOME THAT WAS EQUIVALENT TO CHEMONUCLEOLYSIS, IT CAN BE CONSIDERED AS AN OPTION FOR THE TREATMENT OF SYMPTOMATIC LUMBAR DISC HERNIATION, AT LEAST IN THE ABSENCE OF CLEAR INDICATIONS FOR SURGERY. Further study into the value of manipulation at a more acute stage is warranted.   Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low-back pain. Can Fam Physician. 1985 Mar;31:535-40. PMID: 21274223; PMCID: PMC2327983. RESULTS OF SPINAL MANIPULATION IN 283 PATIENTS WITH LOW BACK PAIN ARE PRESENTED. THE PHYSICIAN WHO MAKES USE OF THIS RESOURCE WILL PROVIDE RELIEF FOR MANY PATIENTS.   Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210. doi: 10.1016/j.jmpt.2003.12.023. PMID: 15129202. THE APPARENT SAFETY OF SPINAL MANIPULATION, ESPECIALLY WHEN COMPARED WITH OTHER “MEDICALLY ACCEPTED” TREATMENTS FOR LDH, SHOULD STIMULATE ITS USE IN THE CONSERVATIVE TREATMENT PLAN OF LDH.   Kane MD, Karl RD, Swain JH. Effects of Gravity-Facilitated Traction on lntervertebral Dimensions of the Lumbar Spine*. J Orthop Sports Phys Ther. 1985;6(5):281-8. doi: 10.2519/jospt.1985.6.5.281. PMID: 18802302. MEAN POSTERIOR SEPARATION WAS SIGNIFICANT AT ALL LEVELS EXCEPT L1-L2 AND L5-S1. MEAN INTERVERTEBRAL FORAMINAL SEPARATION WAS SIGNIFICANT AT ALL LEVELS BUT L5-S1. IF INCREASES IN INTERVERTEBRAL DIMENSIONS PLAY A ROLE IN THE RELIEF OF LOW BACK SYNDROME, THEN GRAVITY-FACILITATED TRACTION MAY BE AN EFFECTIVE MODALITY IN THE TREATMENT OF THIS CONDITION.   Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther. 2008 Mar;31(3):191-8. doi: 10.1016/j.jmpt.2008.02.001. PMID: 18394495. TRACTION, ULTRASOUND, AND LOW POWER LASER THERAPIES WERE ALL EFFECTIVE IN THE TREATMENT OF THIS GROUP OF PATIENTS WITH ACUTE LDH. THESE RESULTS SUGGEST THAT CONSERVATIVE MEASURES SUCH AS TRACTION, LASER, AND ULTRASOUND TREATMENTS MIGHT HAVE AN IMPORTANT ROLE IN THE TREATMENT OF ACUTE LDH   Chung TS, Yang HE, Ahn SJ, Park JH. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction. Radiology. 2015 Jun;275(3):755-62. doi: 10.1148/radiol.14141400. Epub 2015 Jan 22. Erratum in: Radiology. 2015 Jun;275(3):934-5. PMID: 25611735. HERNIATED LUMBAR DISKS: REAL-TIME MR IMAGING EVALUATION DURING CONTINUOUS TRACTION CONTINUOUS TRACTION ON HERNIATED LUMBAR DISKS AND SURROUNDING STRUCTURES RESULTED IN CHANGE IN DISK SHAPE, DISK REDUCTION WITH OPENING IN THE INTERVERTEBRAL DISK, REDUCTION OF HERNIATED DISK VOLUME, SEPARATION OF THE DISK AND ADJOINING NERVE ROOT, AND WIDENING OF THE FACET JOINT.   Isner-Horobeti ME, Dufour SP, Schaeffer M, Sauleau E, Vautravers P, Lecocq J, Dupeyron A. High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial. J Manipulative Physiol Ther. 2016 Nov-Dec;39(9):645-654. doi: 10.1016/j.jmpt.2016.09.006. Epub 2016 Nov 9. PMID: 27838140. HIGH-FORCE VERSUS LOW-FORCE LUMBAR TRACTION IN ACUTE LUMBAR SCIATICA DUE TO DISC HERNIATION: A PRELIMINARY RANDOMIZED TRIAL PATIENTS WITH ACUTE LUMBAR SCIATICA SECONDARY TO DISC HERNIATION WHO RECEIVED 2 WEEKS OF LUMBAR TRACTION REPORTED REDUCED RADICULAR PAIN AND FUNCTIONAL IMPAIRMENT AND IMPROVED WELL-BEING REGARDLESS OF THE TRACTION FORCE GROUP TO WHICH THEY WERE ASSIGNED. THE EFFECTS OF THE TRACTION TREATMENT WERE INDEPENDENT OF THE INITIAL LEVEL OF MEDICATION AND APPEARED TO BE MAINTAINED AT THE 2-WEEK FOLLOW-UP. DURING THE 2-WEEK FOLLOW-UP AT DAY 28, ONLY THE LT10 GROUP IMPROVED (P < .05) IN VAS (–52%) AND EIFEL SCORES (–46%).   Onel D, Tuzlaci M, Sari H, Demir K. Computed tomographic investigation of the effect of traction on lumbar disc herniations. Spine (Phila Pa 1976). 1989 Jan;14(1):82-90. doi: 10.1097/00007632-198901000-00017. PMID: 2913674. COMPUTED TOMOGRAPHIC INVESTIGATION OF THE EFFECT OF TRACTION ON LUMBAR DISC HERNIATIONS. CHANGES OCCURRING UNDER THE EFFECT OF A TRACTION LOAD OF 45 KG HAVE BEEN EVALUATED IN 30 PATIENTS WITH LUMBAR DISC HERNIATION WITH CT INVESTIGATION. THE HERNIATED NUCLEAR MATERIAL (HNM) HAS RETRACTED IN 11 (78.5%) OF MEDIAN, SIX (66.6%) OF POSTEROLATERAL, AND FOUR (57.1%) OF LATERAL HERNIATIONS.   Clarke J, van Tulder M, Blomberg S, de Vet H, van der Heijden G, Bronfort G. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine (Phila Pa 1976). 2006 Jun 15;31(14):1591-9. doi: 10.1097/01.brs.0000222043.09835.72. PMID: 16778694. INTERMITTENT OR CONTINUOUS TRACTION AS A SINGLE TREATMENT FOR LBP CANNOT BE RECOMMENDED FOR MIXED GROUPS OF PATIENTS WITH LBP WITH AND WITHOUT SCIATICA. NEITHER CAN TRACTION BE RECOMMENDED FOR PATIENTS WITH SCIATICA BECAUSE OF INCONSISTENT RESULTS AND METHODOLOGICAL PROBLEMS IN MOST OF THE STUDIES INVOLVED. HOWEVER, BECAUSE HIGH-QUALITY STUDIES WITHIN THE FIELD ARE SCARCE, BECAUSE MANY ARE UNDERPOWERED, AND BECAUSE TRACTION OFTEN IS SUPPLIED IN COMBINATION WITH OTHER TREATMENT MODALITIES, THE LITERATURE ALLOWS NO FIRM NEGATIVE CONCLUSION THAT TRACTION, IN A GENERALIZED SENSE, IS NOT AN EFFECTIVE TREATMENT FOR PATIENTS WITH LBP   Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study. Arch Phys Med Rehabil. 2008 Feb;89(2):269-74. doi: 10.1016/j.apmr.2007.06.778. PMID: 18226650. TRACTION APPLIED IN THE PRONE POSITION USING THE VAX-D FOR 8 WEEKS WAS ASSOCIATED WITH IMPROVEMENTS IN PAIN INTENSITY AND RMDQ SCORES AT DISCHARGE, AND AT 30 AND 180 DAYS AFTER DISCHARGE IN A SAMPLE OF PATIENTS WITH ACTIVITY-LIMITING LBP. CAUSAL RELATIONSHIPS BETWEEN THESE OUTCOMES AND THE INTERVENTION SHOULD NOT BE MADE UNTIL FURTHER STUDY IS PERFORMED USING RANDOMIZED COMPARISON GROUPS.   REAL-TIME MR IMAGING WHILE PERFORMING TRACTION IS POSSIBLE. Mitchell UH, Beattie PF, Bowden J, Larson R, Wang H. Age-related differences in the response of the L5-S1 intervertebral disc to spinal traction. Musculoskelet Sci Pract. 2017 Oct;31:1-8. doi: 10.1016/j.msksp.2017.06.004. Epub 2017 Jun 9. PMID: 28624722. TO DETERMINE DIFFERENCES IN THE APPARENT DIFFUSION COEFFICIENT (ADC) OBTAINED WITH LUMBAR DIFFUSION-WEIGHTED IMAGING (DWI) OF THE L5-S1 IVD BEFORE, AND DURING, THE APPLICATION OF LUMBAR TRACTION STATIC TRACTION WAS ASSOCIATED WITH AN INCREASE IN DIFFUSION OF WATER WITHIN THE L5-S1 IVDS OF MIDDLE-AGE INDIVIDUALS, BUT NOT IN YOUNG ADULTS, SUGGESTING AGE-RELATED DIFFERENCES IN THE DIFFUSION RESPONSE. FURTHER STUDY IS NEEDED TO ASSESS THE RELATIONSHIP BETWEEN THESE FINDINGS AND THE SYMPTOMS OF BACK PAIN. HIGHLIGHTS: STATIC TRACTION IS ASSOCIATED WITH AN INCREASE IN ADC IN OLDER DISCS, NOT YOUNGER. INVERSE RELATIONSHIP BETWEEN BASELINE ADC AND PERCENT INCREASE WITH TRACTION. FINDINGS SUGGEST PRESENCE OF AGE-RELATED CHANGES IN THE RATE OF DIFFUSION RESPONSE.   SAAL, JEFFREY A., MD; SAAL, JOEL S., MD Nonoperative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy: An Outcome Study, Spine: April 1989 - Volume 14 - Issue 4 - p 431-437 64 PATIENTS WITH LUMBAR HERNIATED NUCLEUS PULPOSUS WITHOUT SIGNIFICANT STENOSIS WERE TREATED NON SURGICALLY. 90% GOOD OR EXCELLENT OUTCOME WITH A 92% RETURN TO WORK RATE. FOR THE SUBGROUPS WITH EXTRUDED DISCS AND SECOND OPINIONS, 87% AND 83% HAD GOOD OR EXCELLENT OUTCOMES, RESPECTIVELY, ALL (100%) OF WHOM RETURNED TO WORK. SICK LEAVE TIME FOR THESE SUBGROUPS WAS 2.9 MONTHS (+/- 1.4 MONTHS) AND 3.4 MONTHS (+/- 1.7 MONTHS), RESPECTIVELY. THESE RESULTS COMPARED FAVORABLY WITH PREVIOUSLY PUBLISHED SURGICAL STUDIES. FOUR OF SIX PATIENTS WHO REQUIRED SURGERY WERE FOUND TO HAVE STENOSIS AT OPERATION.   Sari H, Akarirmak U, Karacan I, Akman H. Computed tomographic evaluation of lumbar spinal structures during traction. Physiother Theory Pract. 2005 Jan-Mar;21(1):3-11. PMID: 16385939. DURING TRACTION OF INDIVIDUALS WITH ACUTE LDH THERE WAS A REDUCTION OF THE SIZE OF THE HERNIATION, INCREASED SPACE WITHIN THE SPINAL CANAL, WIDENING OF THE NEURAL FORAMINA, AND DECREASED THICKNESS OF THE PSOAS MUSCLE.   Park WM, Kim K, Kim YH. Biomechanical analysis of two-step traction therapy in the lumbar spine. Man Ther. 2014 Dec;19(6):527-33. doi: 10.1016/j.math.2014.05.004. Epub 2014 May 22. PMID: 24913413. A COMBINATION OF GLOBAL AXIAL TRACTION AND LOCAL DECOMPRESSION WOULD BE HELPFUL FOR REDUCING TENSILE STRESS ON THE FIBERS OF THE ANNULUS FIBROSUS AND LIGAMENTS, AND INTRADISCAL PRESSURE IN TRACTION THERAPY. THIS STUDY COULD BE USED TO DEVELOP A SAFER AND MORE EFFECTIVE TYPE OF TRACTION THERAPY   Chow DHK, Yuen EMK, Xiao L, Leung MCP. Mechanical effects of traction on lumbar intervertebral discs: A magnetic resonance imaging study. Musculoskelet Sci Pract. 2017 Jun;29:78-83. doi: 10.1016/j.msksp.2017.03.007. Epub 2017 Mar 20. PMID: 28347933. HORIZONTAL TRACTION WAS EVIDENTLY EFFECTIVE IN INCREASING THE DISC HEIGHT OF LOWER LUMBAR LEVELS, PARTICULARLY IN THE POSTERIOR REGIONS OF THE DISCS. FURTHER EVIDENCE OF THE EFFECTS OF TRACTION OF DIFFERENT MODES, MAGNITUDES, AND DURATIONS ON THE CHANGE IN DISC HEIGHT IS REQUIRED FOR PROPER CONTROL OF TRACTION APPLIED TO SPECIFIC DISC LEVELS. HIGHLIGHTS: MECHANICAL EFFECTS OF TRACTION ON LUMBAR DISCS WAS EVALUATED USING MRI. HORIZONTAL TRACTION USING 42% OF BODY WEIGHT WAS ASSOCIATED WITH AN INCREASED DISC HEIGHT OF LOWER LUMBAR DISCS. HORIZONTAL TRACTION ALSO RESULTED IN REDUCED LORDOSIS AND CHANGE IN TILT ANGLE. THE EFFECTS WERE MORE PROMINENT AT THE POSTERIOR DISCAL REGIONS.   Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. PMID: 28192789. a  systematic  review  of  randomized, controlled  trials  and  systematic  reviews  published  through  April 2015  on  noninvasive  pharmacologic  and  nonpharmacologic treatments  for  low  back  pain.  Updated  searches  were  performed through  November  2016. Recommendation  1: Given  that  most  patients  with  acute  or subacute  low  back  pain  improve  over  time  regardless  of  treat-ment,  clinicians  and  patients  should  select  nonpharmacologic treatment  with  superficial  heat  (moderate-quality  evidence),  massage,  acupuncture,  or  spinal  manipulation  (low-quality  evidence). If  pharmacologic  treatment  is  desired,  clinicians  and  patients should  select  nonsteroidal  anti-inflammatory  drugs  or  skeletal muscle  relaxants  (moderate-quality  evidence).  (Grade:  strong recommendation) Recommendation  2: For  patients  with  chronic  low  back  pain, clinicians  and  patients  should  initially  select  nonpharmacologic treatment  with  exercise,  multidisciplinary  rehabilitation,  acupuncture,  mindfulness-based  stress  reduction  (moderate-quality  evidence),  tai  chi,  yoga,  motor  control  exercise,  progressive relaxation,  electromyography  biofeedback,  low-level  laser therapy,  operant  therapy,  cognitive  behavioral  therapy,  or  spinal manipulation  (low-quality  evidence).  (Grade:  strong recommendation) Recommendation  3: In  patients  with  chronic  low  back  pain  who have  had  an  inadequate  response  to  nonpharmacologic  therapy, clinicians  and  patients  should  consider  pharmacologic  treatment with  nonsteroidal  anti-inflammatory  drugs  as  first-line  therapy,  or tramadol  or  duloxetine  as  second-line  therapy.  Clinicians  should only  consider  opioids  as  an  option  in  patients  who  have  failed  the aforementioned  treatments  and  only  if  the  potential  benefits  out-weigh  the  risks  for  individual  patients  and  after  a  discussion  of known  risks  and  realistic  benefits  with  patients.  (Grade:  weak  recommendation,  moderate-quality  evidence) Low  back  pain  is  one  of  the  most  common  reasons for  physician  visits  in  the  United  States.  Most  Americans  have  experienced  low  back  pain,  and  approximately  one  quarter  of  U.S.  adults  reported  having  low back  pain  lasting  at  least  1  day  in  the  past  3  months  (1).Low  back  pain  is  associated  with  high  costs,  including those  related  to  health  care  and  indirect  costs  from missed  work  or  reduced  productivity  (2).  The  total  costs attributable  to  low  back  pain  in  the  United  States  were estimated  at  $100  billion  in  2006,  two  thirds  of  which were  indirect  costs  of  lost  wages  and  productivity  (3).Low  back  pain  is  frequently  classified  and  treated on  the  basis  of  symptom  duration,  potential  cause, presence  or  absence  of  radicular  symptoms,  and  corresponding  anatomical  or  radiographic  abnormalities. Acute  back  pain  is  defined  as  lasting  less  than  4  week   Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166(7):493-505. doi: 10.7326/M16-2459. Epub 2017 Feb 14. PMID: 28192793. Background: A  2007  American  College  of  Physicians  guideline addressed  nonpharmacologic  treatment  options  for  low  back pain. The  current  evidence  on  non-pharmacologic  therapies  for  acute  or  chronic  nonradicular  or  ra-dicular  low  back  pain from  MEDLINE  (January  2008  through  February 2016),  Cochrane  Central  Register  of  Controlled  Trials,  CochraneDatabase  of  Systematic  Reviews,  and  reference  lists. Evidence  continues  to  support  the  effectiveness  of  exercise,  psychological  therapies,  multidisciplinary  rehabilitation,  spinal  manipulation,  massage,  and  acupuncture  for  chronic  low  back  pain. Funding  Source:Agency  for  Healthcare  Research  and Quality.  (PROSPERO:  CRD42014014735)Ann  Intern  Med.2017;166:xxx-xxx.  doi:10.7326/M16-2459Annals.org the  American  College  of  Physicians  (ACP)and  American  Pain  Society  (APS)  recommended  spinal manipulation  as  a  treatment  option  for  acute  low  back pain  and  several  nonpharmacologic  therapies  for  sub-acute  or  chronic  low  back  pain.    Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, Andersen MØ, Fournier G, Højgaard B, Jensen MB, Jensen LD, Karbo T, Kirkeskov L, Melbye M, Morsel-Carlsen L, Nordsteen J, Palsson TS, Rasti Z, Silbye PF, Steiness MZ, Tarp S, Vaagholt M. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018 Jan;27(1):60-75. doi: 10.1007/s00586-017-5099-2. Epub 2017 Apr 20. PMID: 28429142. Purpose: To summarise recommendations about 20 non-surgical interventions for recent onset ( If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.   Krekoukias G1, Gelalis ID1,2, Xenakis T1, Gioftsos G3, Dimitriadis Z4, Sakellari V3. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. MANUAL THERAPY SPINAL MOBILIZATION IS PREFERABLE TO CONVENTIONAL PHYSIOTHERAPY IN ORDER TO REDUCE THE PAIN INTENSITY AND DISABILITY IN SUBJECTS WITH CHRONIC LBP AND ASSOCIATED DISK DEGENERATION. THE FINDINGS OF THIS STUDY MAY LEAD TO THE ESTABLISHMENT OF SPINAL MOBILIZATION AS ONE OF THE MOST PREFERABLE APPROACHES FOR THE MANAGEMENT OF LBP DUE TO DISK DEGENERATION.   REFERENCES FOR 25% RELIEF PAPER BY WIRTH ET AL Wirth B1, Riner F1, Peterson C1, Humphreys BK1, Farshad M2, Becker S3, Schweinhardt P1. An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment. Chiropr Man Therap. 2019 Feb 5;27:6. doi: 10.1186/s12998-018-0225-8. eCollection 2019. Refs on minimal clinical improvement determination: Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158. doi: 10.1016/S0304-3959(01)00349-9. [PubMed] [CrossRef] Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, et al. Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain. Spine (Phila Pa 1976) 2007;32:2915–2920. doi: 10.1097/BRS.0b013e31815b75ae. [PubMed] [CrossRef] Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8:283–291. doi: 10.1016/j.ejpain.2003.09.004. [PubMed] [CrossRef] Robinson-Papp J, George MC, Dorfman D, Simpson DM. Barriers to chronic pain measurement: a qualitative study of patient perspectives.Pain Med. 2015;16:1256–1264. doi: 10.1111/pme.12717. [PMC free article] [PubMed] [CrossRef] Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33:90–94. doi: 10.1097/BRS.0b013e31815e3a10. [PubMed] [CrossRef]   Chung TS1, Yang HE, Ahn SJ, Park JH. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction. Radiology 2015 Jan 22:141400. CONTINUOUS TRACTION ON HERNIATED LUMBAR DISKS AND SURROUNDING STRUCTURES RESULTED IN CHANGE IN DISK SHAPE, DISK REDUCTION WITH OPENING IN THE INTERVERTEBRAL DISK, REDUCTION OF HERNIATED DISK VOLUME, SEPARATION OF THE DISK AND ADJOINING NERVE ROOT, AND WIDENING OF THE FACET JOINT.    Wong A, Parent E, Dhillon S, Prasad N, Kawchuk G: Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls? Spine: 01 September 2015 - Volume 40 - Issue 17 - p 1329–1337  doi: 10.1097/BRS.0000000000000981 PARTICIPANTS WITH LBP AND ASYMPTOMATIC CONTROLS ATTENDED 3 SESSIONS FOR 7 DAYS. ON SESSIONS 1 AND 2, PARTICIPANTS WITH LBP RECEIVED SMT (+LBP/+SMT, N = 32) WHEREAS ASYMPTOMATIC CONTROLS DID NOT (−LBP/−SMT, N = 57). IN THESE SESSIONS, SPINAL STIFFNESS AND MULTIFIDUS THICKNESS RATIOS WERE OBTAINED BEFORE AND AFTER SMT AND ON DAY 7. RESULTS. AFTER THE FIRST SMT, SMT RESPONDERS DISPLAYED STATISTICALLY SIGNIFICANT DECREASES IN SPINAL STIFFNESS AND INCREASES IN MULTIFIDUS THICKNESS RATIO SUSTAINED FOR MORE THAN 7 DAYS; THESE FINDINGS WERE NOT OBSERVED IN OTHER GROUPS. SIMILARLY, ONLY SMT RESPONDERS DISPLAYED SIGNIFICANT POST-SMT IMPROVEMENT IN APPARENT DIFFUSION COEFFICIENTS.     Wong AYL1,2, Parent EC3, Dhillon SS4, Prasad N5, Samartzis D6, Kawchuk GN3. Differential patient responses to spinal manipulative therapy and their relation to spinal degeneration and post-treatment changes in disc diffusion. Eur  Spine J. 2019 Jan 2. doi: 10.1007/s00586-018-5851-2. NON-SPECIFIC LOW BACK PAIN PATIENTS WHO RESPOND WITH >30% RELIEF SHOW HIGHER APPARENT DIFFUSION COEFFICIENT DISC DIFFUSION OF WATER THAN NON POSITIVE RESPONDERS. MRI WAS PERFORMED BEFORE AND AFTER SMT ON DAY 1 OF CARE. OSWESTRY DISABILITY TEST WAS ALSO USED.     Beattie PF, Butts R, Donley JW, Liuzzo DM. The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1. Orthop Sports Phys Ther. 2013 Nov 21. Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC. STUDY TO DETERMINE DIFFERENCES IN THE CHANGES IN DIFFUSION OF WATER WITHIN THE LUMBAR INTERVERTEBRAL DISCS BETWEEN THOSE SUBJECTS WITH LOW BACK PAIN (LBP) WHO DID, AND DID NOT, REPORT A WITHIN-SESSION REDUCTION IN PAIN INTENSITY FOLLOWING A SINGLE TREATMENT OF SPINAL MANIPULATIVE THERAPY (SMT) WAS DONE. CHANGES IN THE DIFFUSION OF WATER WITHIN THE LUMBAR INTERVERTEBRAL DISCS AT THE L1-2, L2-3, AND L5-1 LEVELS APPEAR TO BE RELATED TO DIFFERENCES IN WITHIN-SESSION PAIN REPORTS FOLLOWING A SINGLE TREATMENT OF SPINAL MANIPULATIVE THERAPY. PARTICIPANTS UNDERWENT T2- AND DIFFUSION-WEIGHTED LUMBAR MAGNETIC RESONANCE IMAGING SCANS IMMEDIATELY BEFORE, AND AFTER, RECEIVING A SINGLE TREATMENT OF SMTJ     Kuo, Ya-Wen PhD; Hsu, Yu-Chun MS; Chuang, I-Ting MS; Chao, Pen-Hsiu Grace PhD; Wang, Jaw-Lin PhD Spinal Traction Promotes Molecular Transportation in a Simulated Degenerative Intervertebral Disc Model. Spine: April 20th, 2014 - Volume 39 - Issue 9 - p E550 Traction biomechanics studied in the porcine model biomechanical benefits include disc height recovery, foramen enlargement, and intradiscal pressure reduction. 48 thoracic discs were dissected from 8 porcine spines and then divided into 3 groups: intact, degraded without traction, and degraded with traction. From Day 4 to Day 6, half of the degraded discs received a 30 min traction treatment per day (traction force: 20 kg, loading: unloading = 30 sec: 10 sec). Traction treatment is effective in enhancing nutrition supply and promoting disc cell proliferation of the degraded discs.  

Aufgrund außerplanmäßiger Ausfälle geplanter Gäste erzählt Schepp etwas von seinen Versuchen, mit allen Mitteln Select-Elemente zu stylen (was nicht gehen sollte, aber trotzdem einigermaßen klappt) un…

Aufgrund außerplanmäßiger Ausfälle geplanter Gäste erzählt Schepp etwas von seinen Versuchen, mit allen Mitteln Select-Elemente zu stylen (was nicht gehen sollte, aber trotzdem einigermaßen klappt) und Peter von seinen Versuchen, Elementen ihre Computed Styles zu entlocken (was trivial sein sollte, aber knifflig ist). Moderiert vom unvergleichlichen Hans! Unser Sponsor tradingtwins sucht einen Frontend-Developer für den […]

This week we're joined by Erin Dunlap, MD. Dr. Dunlap is a current PGY-4 at UTMB. We discuss her path to orthopedics, the challenges she's faced along the way, and her ongoing pursuit of an arthroplasty fellowship. Like, subscribe, comment on the video. We're also on iTunes, Spotify, and any other podcast platform. Links to all of our episodes as well as our platforms can be found at www.orthotalkpod.com References from this episode: CT scan for traumatic knee arthrotomies Konda SR, Davidovitch RI, Egol KA. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J Orthop Trauma. 2013;27(9):498-504. doi:10.1097/BOT.0b013e31828219bc https://pubmed.ncbi.nlm.nih.gov/23287770/

Dr. Rezigh presents a clinical unknown on Virtual Morning Report to CPSolvers, Rabih and Reza. Download CPSolvers App here Patreon website Schema Whiteboard Episode Summary A 75-year-old-woman with multiple chronic medical problems presented with right arm pain, anorexia, and diffuse erythematous nodular plaques. Her work up was notable for an elevated serum lactate and S1Q3T3 pattern on ECG. Computed tomography… Read More »Episode 112: Virtual Morning Report #100 with Rabih, Reza, and Dr. Rezigh – Rash and lactic acidosis

Christoph Koch is the neuroscientist who, along with Francis Crick, initiated modern scientific research into the neuroscience of consciousness in the 1990s. Much of this work was done while he was a professor at the California Institute of Technology and he is now president and chief scientist at the Allen Institute for Consciousness. His books include Consciousness: Confessions of a Romantic Reductionist and most recently The Feeling of Life Itself: Why Consciousness is Widespread but Can't be Computed. Christof also writes the Consciousness Redux column for Scientific American Mind.

Commentary by Dr. Ana Barac

We live in a world dependent on Lithium Ion batteries for the operation of products ranging from mobile phones, laptops, and electric vehicles. The quality of these batteries is essential for the functional reliability of these products, so it is critical that these batteries face the most vigorous inspection process possible. Computed tomography is a leading technology to do Lithium Ion battery inspection. In this podcast, ARC Vice President Craig Resnick interviews two leaders from Waygate Technologies, a Baker Hughes business: Oliver Brunke, Product Management Team Leader and Udo de Vries, Growth and Strategy Leader, to discuss for example, what are the advantages of computed tomography in Lithium Ion battery cell inspection; in which phases of the product lifecycle can computed tomography be applied for batteries, which types of batteries and battery systems can be inspected, at which customer locations can CT be applied for batteries, and what kind of failures can computed tomography detect for Lithium Ion batteries.

My guest today is Dr. Christof Koch, one of the worlds foremost experts on neuroscience and consciousness. Dr. Koch is the Chief Scientist and  President of the Allen Institute for Brain Science. He recently released his latest book, The Feeling of Life Itself – Why Consciousness is Everywhere But Can’t be Computed. It explores new insights and perspectives into human consciousness, as well as ideas surrounding the potential of sentient machines. We explore a wide range of issues surrounding consciousness, what it means, and theories on how it works.   Subscribe to the MIND & MACHINE future-tech newsletter: https://www.mindandmachine.io/newsletter    The Allen Institute: https://bit.ly/2rNVEEj Personal Website: https://christofkoch.com   Book: The Feeling of Life Itself https://mitpress.mit.edu/books/feeling-life-itself __________   MIND & MACHINE features interviews by August Bradley with bold thinkers and leaders in transformational technologies.   Subscribe to the MIND & MACHINE newsletter: https://www.mindandmachine.io/newsletter   MIND & MACHINE Website: https://www.MindAndMachine.io

In this episode from the ACEP-EQUAL series, Drs. Godwin and Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department. Guests: Dr. Steven Godwin, Professor and Chair, Department of Emergency Medicine University of Florida Dr. Richard Shih, Professor of Integrated Medical Science and Program , Charles E Schmidt College of Medicine at Florida Atlantic University Host: Jason Woods, MD www.acep.org/equal References: Perry JJ et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018 Carpenter CR et al. Spontaneous Subarachnoid Hemorrhage. A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016 Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6. Perry JJ. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4277 Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Carstairs SD. Computed tomographic angiography for the evaluation of aneruysmal subarachnoid hemorrhage. Acad Emerg Med. 2006 May;13(5):486-92. Epub 2006 Mar 21. El Khaldi M. et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 200 Feb;112(1):123–137. Menke J et al. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011 Apr;69(4):646-54. doi: 10.1002/ana.22270. Friedman BW et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14; 89(20): 2075–2082. doi: 10.1212/WNL.0000000000004642

In this fascinating discussion of one of the hardest problems in all of science — the hard problem of consciousness, that is, explaining how the feeling or experience of something can arise from neural activity — one of the world’s leading neuroscientists Christof Koch argues that consciousness, more widespread than previously assumed, is the feeling of being alive, not a type of computation or a clever hack. Consciousness is experience. Consciousness is, as his book title states, The Feeling of Life Itself — the feeling of being alive. Shermer and Koch discuss: the Neural Correlates of Consciousness (NCC) where consciousness is located in the brain (or, more precisely, where it is not located) what comas and vegetative states teach us about consciousness what brain injuries and diseases teach us about consciousness what hallucinogens teach us about consciousness what split-brain surgeries teach us about the nature of the self and identity Koch’s experience with psilocybin and what he learned about consciousness Koch’s experience in a flotation tank and what he learned about consciousness why computers as they are currently configured can never create consciousness why mind-uploading cannot copy or continue consciousness Integrated Information Theory of Consciousness Global Workspace Theory of Consciousness why consciousness is not an illusion, and mysterian mysteries. Christof Koch is President and Chief Scientist of the Allen Institute for Brain Science in Seattle, following twenty-seven years as a Professor at the California Institute of Technology. He is the author of Consciousness: Confessions of a Romantic Reductionist (MIT Press), The Quest for Consciousness: A Neurobiological Approach, and other books. Listen to Science Salon via iTunes, Spotify, Google Play Music, Stitcher, iHeartRadio, TuneIn, and Soundcloud. You play a vital part in our commitment to promote science and reason. If you enjoy the Science Salon Podcast, please show your support by making a donation, or by becoming a patron.  

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In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj’s unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you’ve ever wondered how any radiology tool works, this episode is for you. We discuss: Raj’s road from engineering to radiology [7:45]; How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [18:00]; Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [27:45]; Ultrasound: Benefits and limitations, and a special use for the heart [40:45]; Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity’ and ‘specificity’ [51:15]; Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [1:03:45]; Brain aneurysms: Using MRI to find them and save lives [1:23:45]; Raj’s unique MRI technology [1:30:00]; The risk of false positives in cancer detection, and how Raj’s MRI can reduce the number of false positives (i.e., increase specificity) [1:43:40]; The unique software Raj created to pair with his MRI machine [1:51:15]; Comparing the radiation exposure of a whole-body PET-CT to Raj’s equipment (DWIBS-MRI) [1:53:40]; How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:55:15]; Why a DW-MRI is still not a perfect test [1:59:00]; The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [2:03:00]; Are there any commercially available scanners that can match the resolution of Raj’s images? [2:06:00]; Machine learning: When and where might machine learning/AI impact the field of radiology? [2:08:40]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

Paul Wang:         Welcome to the monthly podcast, On the Beat, for Circulation: Arrhythmia and Electrophysiology. I'm Dr. Paul Wang, editor-in-chief, with some of the key highlights from this month's issue.                                 In our first study, Filip Plesinger and associates examined whether a computerized analysis of the body surface 12-lead ECG can be used to measure the ventricular electrical activation delay as a predictor of heart failure or death following resynchronization therapy in a MADIT-CRT trial.                                 The authors found that left bundle branch block patients with baseline ventricular electrical activation delay less than 31.2 milliseconds had a 35% risk of MADIT-CRT endpoints, while patients with ventricular electrical activation delay greater than or equal to 31.2 milliseconds had a 14% risk, P value of less than 0.001.                                 The hazard ratio for predicting primary endpoints in patients with low ventricular electrical activation delay was 2.34 with a P value of less than 0.01. However, ventricular electrical activation delay was not predicted in patients with right bundle branch block or IVCD.                                 In our next study, Karl-Heinz Kuck and associates examined the predictors of long-term clinical outcomes after catheter ablation of atrial fibrillation in 750 patients in the FIRE AND ICE Trial. Using propensity score stratification methods to count for differences in baseline characteristics between sexes, the authors found that female sex with a hazard ratio of 1.37, P equals 0.01, and prior direct current cardioversion with a hazard ratio of 1.40, P equals 0.013 were independently associated with atrial fibrillation recurrence.                                 Female sex with hazard ratio of 1.36, P value of 0.035 and hypertension with a hazard ratio of 1.48, P value of 0.013 independently predicted cardiovascular rehospitalization. A longer history of atrial fibrillation with a hazard ratio of 1.03, P value of 0.039 increased the rate of repeat ablation.                                 After propensity score adjustment, women continued to have higher rates of primary efficacy failure with adjusted hazard ratio of 1.51, P less than 0.05 and cardiovascular rehospitalization with a hazard ratio of 1.40, P less than 0.05.                                 In the next study, Laura Bear and associates examined the reliability of inverse electrocardiographic mapping of cardiac electrical activity from recorded body surface potentials. In five anesthetized closed-chest pigs, torso and ventricular epicardial potentials were recorded simultaneously during sinus rhythm, epicardial, and endocardial ventricular pacing. Two approaches, coupled finite/boundary element methods and a meshless approach based on the method of fundamental solutions, were compared.                                 The authors found that inverse mapping underestimated epicardial potentials more than twofold, P less than 0.0001. Mean correlation coefficients for reconstructed epicardial potential distributions ranged from 0.60 to 0.64 across all methods. Epicardial electrograms were recovered with reasonable fidelity at approximately 50% of the sites, but variation was substantial.                                 General activation spread was reproduced with a mean correlation coefficient of 0.72 to 0.78 for activation time maps with spatio-temporal smoothing. Epicardial foci were identified with a mean location error approximately 16 millimeters. Inverse mapping with method of fundamental solutions was better than coupled finite/boundary element methods.                                 The authors concluded that spatio-temporal variability of recovered electrograms may limit the resolution, with implications for accuracy of arrhythmia localization.                                 In the next study, Pejman Raeisi-Giglou and colleagues examined the incidence of pulmonary vein stenosis in 10,368 patients undergoing atrial fibrillation ablation from 2000 to 2015. Computed tomography scans were performed three to six months after the procedures. Severe pulmonary vein stenosis was observed in 52 patients, or 0.5%. The left superior pulmonary vein represented 51% of all severely stenosed veins.                                 Percutaneous interventions were performed in 43 patients, and complications occurred in five, including three pulmonary vein ruptures, one stroke and one phrenic injury. Over a median follow-up of 25 months, 41, or 79%, of patients remained arrhythmia-free.                                  In our next paper, Koichi Nagashima and associates compared hot balloon ablation and cryoballoon ablation in a 165 consecutive patients who underwent initial atrial fibrillation catheter ablation. Of the 165 patients, 74 propensity score-matched patients equally divided between hot balloon ablation and cryoballoon ablation were studied.                                 Patients' characteristics included age, sex, body mass index, atrial fibrillation subtype, CHA2DS2-VASc score, and left atrial dimension were similar between the two groups. 52% of the hot balloon ablation patients required touch-up with radiofrequency ablation for residual/dormant pulmonary vein conduction versus 24% of the cryoballoon ablation patients with a P value of 0.02.                                 The anterior aspect of the left superior pulmonary vein was the site in 41% of the touch-ups after hot balloon versus the inferior aspect of the inferior pulmonary veins in 22% of the touch-ups after cryoballoon ablation. Hot balloon lesions were smaller with an area of 23.8 centimeters squared compared to cryoballoon ablation lesions having an area of 33.5 centimeters squared with a P value of 0.0007. Within 12 months, both methods had an AF recurrence of 16%.                                 In our next paper, Mildred Opondo and associates randomized 61 patients, mean age 52 years, to either 10 months of high intensity exercise or yoga. The authors found that left atrial volume, Vo2 max, and left ventricular end-diastolic volume increased in the exercise group with no change in the control with a P value of less than 0.0001.                                 The authors did not find significant changes in atrial electrical activity and hypothesized that a longer duration training may be required to induce electrical changes.                                 In our next paper, because there's evidence that the distal part of the ligament of Marshall might be a sympathetic conduit between the left stellate ganglion and the ventricles, Shan Liu and associates randomly divided 29 dogs into a sham ablation group, a ligament of Marshall ablation group, and a left stellate ganglion ablation group. Ablation was performed before occlusion of the left anterior coronary artery.                                 Ligament of Marshall ablation attenuated blood pressure elevation induced by left stellate ganglion stimulation. Both ligament of Marshall ablation and left stellate ganglion ablation similarly prolonged ventricular refractory period and reduced the incidence of ventricular arrhythmias compared with sham ablation.                                 In our next study, Smith and Tester and associates examined the heterologous functional validation studies of putative long-QT syndrome subtype 2, LQT2, associated variants. Genetic testing of 292 sudden infant death syndrome cases identified nine KCNH2 variants, while some of the channels associated the variants can lead to accelerated deactivation and activation gating. Other current levels were similar to wild-type.                                 The authors examined the electronic health records of patients who were genotype positive for these particular sudden infant death syndrome–linked KCNH2 variants and found all of them had a median heart rate–corrected QT intervals less than 480 milliseconds and none had been diagnosed with long-QT syndrome or suffered cardiac arrest.                                 Simulating the impact of dysfunctional gating variants using computational models of the human ventricular action potential predicted that they have little impact on action potential duration. The authors concluded that these rare Kv11.1 missense variants are not long-QT2 causative variants and, therefore, do not represent the pathogenic substrate for sudden infant death syndrome in the variant-positive infants.                                 In our next study, Tina Baykaner and associates performed a systematic literature review and meta-analysis to determine outcomes from ablation of atrial fibrillation drivers in addition to pulmonary vein isolation or as a stand-alone procedure. The authors found 17 studies with a cohort size of 3,294 patients.                                 Atrial fibrillation driver ablation, when added to a pulmonary vein ablation or a stand-alone procedure compared the controls, produced an odds ratio of 3.1 with a P value of 0.02 for freedom from atrial fibrillation and an odds ratio of 1.8 with a P value of less 0.01 for freedom of all arrhythmias in four controlled studies.                                 Adding atrial fibrillation driver ablation to pulmonary vein ablation resulted in a freedom from atrial fibrillation of 72.5%, P value of less than 0.01 and a freedom from all arrhythmias of 57.8% with a P value less than 0.01. Atrial fibrillation termination was 40.5% and predicted favorable outcome from ablation with a P value of less than 0.05. Large multicenter randomized trials are needed to precisely define the benefits of adding driver ablation to a pulmonary vein isolation.                                 In our next study, Hidekazu Kondo and associates found that the adverse atrial remodeling, including atrial inflammation, lipidosis and fibrosis, were induced in both wild-type and Interleukin-10 knockout mice by high fat diet, but the effects were exaggerated in the Interleukin-10 knockout mice. Vulnerability to atrial fibrillation was also significantly enhanced by the high fat diet.                                 The total amount of epicardial and pericardial adipose tissue volume was increased with high fat diet. Proinflammatory and profibrotic cytokines of epicardial and pericardial adipose tissue were also upregulated. In contrast, the protein level of adiponectin was downregulated by the high fat diet. Systemic Interleukin-10 administration markedly ameliorated the high fat diet induced obesity-caused left atrial remodeling and vulnerability to atrial fibrillation.                                 The authors concluded that Interleukin-10 treatment may limit the progression of atrial fibrillation occurring in the setting of a high fat diet.                                 In our next paper, Garcia and Campbell and associates demonstrated the ability to deliver amiodarone epicardially over a sustained period of time. The authors demonstrated in a pig model of atrial fibrillation that an amiodarone containing polyethylene glycol-based hydrogel placed directly on the atrial myocardium in a minimally invasive catheter procedure significantly reduced the duration of sustained atrial fibrillation at 21 and 28 days. The authors found that inducibility of atrial fibrillation was also reduced.                                 In our final paper, Htet Khine and associates examined the effect of spaceflight on the changes in atrial structure, supraventricular beats, and atrial electrophysiology, and to determine whether spaceflight could increase the risk of atrial fibrillation.                                 The authors found that, in 13 that in astronauts, the left atrial volume transiently increased after six months in space without changing atrial function. Right atrial size remained unchanged, while one astronaut had a very large increase in supraventricular ectopic beats, none developed atrial fibrillation. The P-wave amplitude duration did not change over time, but RMS 20 decreased on all fight days except landing day.                                 That's it for this month. Thanks for listening to On the Beat. We hope that you'll find the journal to be the go-to place for everyone interested in the field. See you next month.  

In this episode, Adam talks to Chris Fritz about common mistakes people make when designing Vue.js applications, and better ways to solve the same problems. Topics include: Why global state is better than an event bus Why and how to avoid using this.$parent Custom events vs. callback props When to use watchers and when you don't need to Why you should prefer computed properties over methods Inline templates vs. scoped slots Using components to share code instead of mixins or directives Sponsors: Rollbar, sign up at https://rollbar.com/fullstackradio to try their Bootstrap Plan free for 90 days Codeship, check out how they performed in Forrester's latest Continuous Integration Tools report Links: Advanced Vue Component Design, Adam's upcoming course Chris on GitHub Chris on Patreon "7 Secret Patterns Vue Consultants Don't Want You To Know", Chris' recent presentation "Methods, Computed, and Watchers in Vue.js" by Sarah Drasner PortalVue, library for rendering elements outside of their parent component vue-enterprise-boilerplate

Yes! I am Andrew Christopher Buelt and in this all abbreviation and intial podcast I break down some recent studies that might are of interst. First, is HPV testing alone good enough? Should you do a stress test or a Computed tomography angiography for suspected coronary artery disease. In BPH can we stop any medications or must we continue alpha-blockers and 5a-reductase inhibitors for life?

Paul Wang:         Welcome to the monthly podcast On The Beat for Circulation, Arrhythmia and Electrophysiology. I'm Dr. Paul Wang, editor-in-chief, with some of the key highlights from this month's issue. We'll also hear from Dr. Suraj Kapa, reporting on new research from the latest journals in the field.                                 In our first article, Elyar Ghafoori and associates examined the ability of late gadolinium enhancement MRI done immediately after ablation to predict edema and chronically even size. In a canine model, the authors created ventricular radiofrequency ablation lesions. All animals underwent MRI immediately after ablation. After one, two, four and eight weeks, edema and microvascular obstruction MVO, in enhanced volumes were identified in MRI. Immediately after contrast administration, the microvascular obstruction region was 3.2 times larger than the chronic lesion volume size in acute MRI. The authors found that microvascular obstruction region on acute late gadolinium enhancement images acquired 26 minutes after contrast administration most accurately predicts chronic lesion volume.                                 In the next article, Elad Anter and associates characterized the atrial substrate in patients with paroxysmal atrial fibrillation and obstructive sleep apnea. The authors examined 86 patients with paroxysmal atrial fibrillation, 43 with moderate obstructive sleep apnea and 43 without obstructive sleep apnea. The right atrial and left atrial voltage distribution conduction velocities in electrogram characteristics were examined. The authors found that patients with obstructive sleep apnea had lower atrial voltage amplitude, slower conduction velocities, and higher prevalence of electrogram fractionation. Most commonly, the left atrial septum was an area of atrial abnormality while at baseline the pulmonary veins with the most frequent triggers for atrial fibrillation in both groups after pulmonary vein isolation in patients with obstructive sleep apnea had an increased incidence of extrapulmonary vein triggers, 41.8% versus 11.6%, p=0.003. The one year arrhythmia-free survival are similar between patients with and without obstructive sleep apnea, 83.7% and 81.4%, respectively.                                 In comparison, control patients with paroxysmal atrial fibrillation and obstructive sleep apnea who underwent pulmonary vein isolation alone without ablation of extrapulmonary vein triggers had an increased risk of arrhythmia recurrence, 83.7% versus 64.0%, p=0.03, suggesting that ablation of these triggers resulted in improved arrhythmia-free survival. A randomized trial would be needed to prove this relationship.                                 In the next article, Iolanda Feola and associates demonstrated that optogenetics may be used to induce and locally target a rotor in atrial monolayers. The authors used neonatal rat atrial cardiomyocyte monolayers expressing a depolarizing light-gated ion channel, calcium-translocating channelrhodopsin. These monolayers were subjected to patterned illumination to induce the single, stable, and centralized rotor by optical S1-S2 cross-field stimulation. Next, the core region of these rotors was specifically and precisely targeted by light to induce local conduction blocks of circular or linear shapes. Conduction blocks crossing the core region, but not reaching an unexcitable boundary, did not lead to termination. Instead, electrical waves started to propagate along the circumference of block. If, however, core-spanning lines of block reached at least one unexcitable boundary, reentrant activity was consistently terminated by wave collision, suggesting that this may be a key mechanism for rotor elimination.                                 In our next study, Adam Barnett and associates used data from the outcomes registry for better informed treatment of atrial fibrillation ORBIT-AF to determine how frequently patients receive care that was concordant with 11 recommendations of the 2014 AHA, ACC, HRS A-fib guidelines pertaining to antithrombotic therapy rate control in anti-arrhythmic medications. The authors also analyzed the association between guideline concordant care and clinical outcomes at both the patient's level and center level. The authors study 9,570 patients with the median A 275, median CHA2DS2-VASc score of 4. A total of 62.5% or 5,5977 patients received care that was concordant with all guideline recommendations for which they were eligible. Rates of guideline concordant care was higher in patients treated with providers, with greater specialization in arrhythmias; 60.0%, 62.4%, 67.0% for primary care physicians, cardiologists and electrophysiologist, respectively; p less than 0.001. During a median of 30 months of follow up, patients treated with guideline concordant care had a higher risk of bleeding hospitalization; hazard ratio, 1.21. Similar risk of death, stroke, major bleeding can all cause hospitalization.                                 In our next article, Hui-Chen Han and associates conducted electronic search of PubMed and Embase for English scientific literature articles to characterize the clinical presentation, procedural characteristics, diagnostic investigations and treatment outcomes of all reported cases of atrioesophageal fistula. Out of 588 references, 120 cases of atrioesophageal fistula were identified. Clinical presentation occurred between 0 and 60 days postablation with a median of 21 days. The most common presentations were fever 73%, neurological 72%, gastrointestinal 41%, and cardiac 40% symptoms. Computed tomography of the chest was the commonest mode of diagnosis, 68% although six cases required repeat testing. Overall mortality was 55%. In conclusion, the authors reported that atrioesophageal fistula complicating atrial fibrillation is associated with a very high mortality 55% with significantly reduced mortality in patients undergoing surgical repair 33% compared to endoscopic treatment 65%, and conservative management 97%. Odds ratio adjusted 24.9; p less than 0.01 compared to surgery. Neurological symptoms adjusted odd ratio 16.0. In GI bleed, adjusted odds ratio 4.2, were the best predictors of mortality.                                 In the next article, Wei Ma and associates reported that the site origin of left posterior fascicular ventricular tachycardia may be predicted using 12-lead EC morphology in the HIS-ventricular or H-V interval. The authors studied 41 patients who underwent successful catheter ablation of left posterior fascicular ventricular tachycardia. The location of the site of origin was separated into proximal, middle, and distal groups with H-V being greater than zero milliseconds in the proximal group, H-V zero to minus 15 milliseconds in the middle group, and H-V less than negative 15 milliseconds in the distal group. The earliest presystolic potential ratio that is PP-QRS interval during VT divided by the H-V interval during sinus rhythm was statistically significantly different between the three groups, 0.59, 0.45 and 0.31, respectively. In addition, the QRS ratio in the proximal group 114 milliseconds was significant nearer compared to the middle group 128 milliseconds and the distal group 140 milliseconds. The QRS duration in the ratio R to S in leads V6 and lead-1 could predict a proximal or distal origin of left posterior fascicular ventricular tachycardia with high sensitivity and specificity.                                 In our next article, Niv Ad and associates examined the safety and success of on-pump minimally invasive stand-alone Cox-Maze 3/4 procedure via right mini-thoracotomy in 133 patients with nonparoxysmal atrial fibrillation five years after surgery. The mean follow-up was 65 months in a patient population with a mean age of 57.3 years, mean left atrial size of 4.9 centimeters, mean AF duration of 51 months and 78% with longstanding persistent atrial fibrillation. All procedures were performed with no conversion to mid-sternotomy. No renal failure, strokes or operative mortality in less than 30 days. They reported a TIA in one patient, re-operation for bleeding in two patients, and median length of stay in four days. At five years, 73% of patients were in sinus rhythm off anti-arrhythmic drugs following a single intervention.                                 In the next article, Richard Soto-Becerra and associates reported that unipolar endocardial electro-anatomic mapping may be used to identify scar epicardially in chagasic cardiomyopathy. In 19 sick patients, a total of 8,494 epicardial and 6,331 endocardial voltage signals in 314 epicardial and endocardial match pairs of points were analyzed. Basolateral left ventricular scar involvement was observed in 18 out of 19 patients. Bipolar epicardial and endocardial voltages within scar were low, 0.4 and 0.54 millivolts, respectively in confluent indicating a dense transmural scarring process. The endocardial unipolar voltage value with the newly proposed less than of equal to four-millivolt cutoff predicted the presence and extent of epicardial bipolar scar, p less than 0.001.                                 In our next article, Bing Yang and associates reported the results of the stable SR study, which is a multicenter clinical trial of 229 symptomatic nonparoxysmal atrial fibrillation patients random-eyed one-to-one to two ablation strategies. In the stable SR group following pulmonary vein isolation, cavotricuspid isthmus ablation in conversion to sinus rhythm left atrial high density mapping was performed. Areas of low voltage and complex electrogram were further homogenized and eliminated, respectively. Dechanneling was done if necessary. In the step-wise group, additional linear lesions and defragmentation were performed. The primary endpoint was freedom of documented atrial tachyarrhythmias lasting 30 seconds or more after a single ablation procedure without anti-arrhythmic medications at 18 months. At 18 months, success according to intention-to-treat analysis was similar in the two arms with 74.0 success in the stable SR group and 71.5% success in the step-wise group; p=0.3. However, shorter procedure time reduced fluoroscopic time after pulmonary vein isolation and shorter energy delivery time were observed in the stable SR group compared to the step-wise group.                                 In the final paper, Alan Sugrue and associates studied the performance of a morphological T-wave analysis program in defining breakthrough long QT syndrome arrhythmic risk beyond the QTc value. The author studied 246 genetically confirmed LQT1 patients and 161 LQT2 patients with a mean follow-up of 6.4 years. A total of 23 patients experienced more than one breakthrough cardiac arrhythmic event with 5 and 10-year event rates of 4% and 7%. Two independent predictors of future long Qt syndrome-associated cardiac events were identified from the surface ECG using a proprietary novel T-wave analysis program. The authors found that the most predictive features included the left slope of T-wave in V6, hazard ratio of 0.40, and T-wave center of gravity X-axis in lead-1, hazard ratio 1.9, C statistic of 0.77. When added to QTc, discrimination improved from 0.68 for QTc alone to 0.78. Genotype analysis showed weaker association between these T-wave variables in LQT1 triggered events while these features were stronger in patients with LQT2 and significantly outperformed the QTc interval.                                 That's it for this month, but keep listening. Suraj Kapa will be surveying all journals for the latest topics of interest in our field. Remember to download the podcast On the Beat. Take it away, Suraj. Suraj Kapa:          Thank you, Paul. This month, we will again focus on hard-hitting articles from across the electrophysiological literature. I am Suraj Kapa and we're particularly focusing on articles published in October 2017.                                 The first article we will focus on is within the realm of atrial fibrillation specifically related to anticoagulation. In Journal of the American Heart Association in Volume 6, Issue 10, Lin, et al. sought to develop a prediction model for time in therapeutic range in older adults taking vitamin K antagonists. As we know, time in therapeutic range is critical for management of patients on vitamin K antagonists. As poor time in therapeutic range either due to subtherapeutic or supratherapeutic INRs, can lead to increased bleeding or thromboembolic risk. While novel oral anticoagulants have improved care of patients requiring anticoagulation, many patients either due to cost or due to other factors are unable to take the novel oral anticoagulants and thus must be maintained on vitamin K antagonists. In this study, Lin, et al. Used well-over 2,500 patients to create training and validation sets and thereby create two models for estimating time in therapeutic range. Through this, they created a simple model term PROSPER consisting of seven variables including pneumonia, renal dysfunction, prior bleeding, hospital stay more than seven days, pain medication use, lack of access to structured anticoagulation services, and treatment with antibiotics.                                 Using this, they showed that they can predict time in therapeutic range greater than 70% as well as thromboembolic and bleeding outcomes better than other existing time in therapeutic range scoring systems, such as the same TT2R2 score. The reason these scores are important are both to help patients understand when they may be at risk for not maintaining a time in therapeutic range and to assist them in identification of the right anticoagulant methodology or strategy. Also, perhaps to prospectively consider if we can identify patients who may require more intensive monitoring or structured therapy strategies. However, one must also consider that for scores like this, utilization is always critical. In other words, continuous validation of the scoring system must be done in order to make sure it's applicable across populations and across different groups of people in different communities.                                 Next, within the realm of anticoagulation and atrial fibrillation, we'll review the article by Chang, et al. published in JAMA in Volume 318, Issue 13 entitled Association Between Use of Non-Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding Non-Valvular Atrial Fibrillation. With any new drug that comes out, there's always the possibility of various medication interactions. The source of these medication interactions might be variable. They might include direct effects of other medications on systems by which the primary drug is metabolized. Also, might be due to synergistic effects of medications that might be unpredictable or effects on different aspects of systems the drugs are trying to treat. Thus oftentimes, larger population studies are required before one can appreciate drug interactions that might exist. This is particularly true with novel oral anticoagulant drugs. Part of the promise of the novel oral anticoagulants was that because of the extensive medication interactions associating vitamin K antagonists, the availability of the drug perhaps with fewer medication interactions resulting in alteration and bleeding or thromboembolic tendency will be very important.                                 In this important paper, Chang, et al. reviewed the effect of other medications on major bleeding events in patients on non-vitamin K oral anticoagulants such as dabigatran, apixaban, and rivaroxaban. Amongst over 91,000 patients, they noted that the concurrent use of amiodarone, fluconazole,  rifampin, and phenytoin compared with the novel oral anticoagulant alone was associated with a significant increase many times by odds ratio of 100 in risk of major bleeding. Several drugs including atorvastatin, digoxin, erythromycin or clarithromycin when used concurrently with NOACs interestingly were associated with the reduced risk of bleeding without elevating thromboembolic risk. The recent advent of NOACs in clinical use especially in patients who might be taking other medications always need to be considered in the context of how the other medications might affect the bleeding or thromboembolic risk. One of the key findings in this publication is the potential interaction with amiodarone and how concurrent use of amiodarone may increase the risk of major bleeding. Because of the general lack of tools to monitor the effects of NOACs on bleeding risk in patients, one needs to consider these population studies and whether or not there might be synergistic effects between medications going forward.                                 Unfortunately, we cannot adopt guidelines purely based on this data as to whether or not a dose adjustment should occur or whether or not the medication can be used at all. However, it does highlight the care that should be taken when using many of these drugs in conjunction with NOACs.                                 Finally within the realm of anticoagulation and atrial fibrillation, we'll review the article by Cannon, et al. in The New England Journal of Medicine entitled Dual Antithrombotic Therapy with the Dabigatran After PCI in Atrial Fibrillation. In this study, Cannon, et al. sought to systematically review the role of a warfarin strategy post-PCI versus dabigatran strategy post-PCI. They randomized patients to use of a combination of warfarin, aspirin, and a P2Y12 inhibitors such as clopidogrel post-PCI versus using dabigatran plus a P2Y12 inhibitor. They demonstrated that dual therapy approach with dabigatran resulted in significantly lower bleeding events than the triple antithrombotic/antiplatelet therapy group. There was no difference in adverse events including thromboembolism, unplanned revascularization or death between the groups. These findings were irrespective of whether patients were on 110 mg of dabigatran or 150 mg of dabigatran. These findings suggest that a dual therapy approach in the post-PCI setting with the NOACs as the dabigatran and the P2Y12 inhibitors such as clopidogrel lowers bleeding risk without increasing risk of major adverse events including thromboembolism or stent thrombosis after PCI.                                 However, it should be noted that one major criticisms of this trial is that the incremental bleeding risk conferred by aspirin could not be accounted for in the triple therapy cohort as aspirin was not used in the dual therapy cohorts. Thus, one cannot necessarily say whether the same finding would have been noted in a warfarin plus P2Y12 inhibitor versus dabigatran plus P2Y12 inhibitor especially given recent evidence suggesting no incremental benefit of aspirin particularly for thromboembolic risk associated with atrial fibrillation. However, the critical element of these findings is that a strategy excluding aspirin where dabigatran plus the P2Y12 inhibitor are used post-PCI might be actually safe.                                 Changing gears, we will next focus on an article within the realm of cardiac mapping and ablation in atrial fibrillation. This was published in the Journal of the American College of Cardiology in Volume 70, Issue 16 by Prabhu, et al. entitled Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study. In this study, Prabhu, et al. studied in the multicenter randomized clinical trial the effect of catheter ablation for atrial fibrillation in the setting of left ventricular systolic dysfunction versus medical rate control. They looked at the change in ejection fraction over a follow-up of six months. A total of 68 patients were randomized in the study. They demonstrated an absolute improvement in EF by 18% in the ablation group versus 4% in the rate control group, with also a greater rate of EF normalization with ablation. In fact, over 50% of patients had EF normalization after ablation whereas only about 9% had a good medical rate control.                                 Furthermore, the improvements in EF correlated with the absence of late gadolinium enhancement on MRI and in the medical rate control group an average heart rate less than 90 beats per minute was achieved across the population randomized this approach. These findings are somewhat contrary to other studies that suggested that a rate versus a rhythm control approach were not really much different in patients with reduced left ventricular systolic function. These challenges are paradigm by suggesting that in fact successful restoration of normal rhythm in patients postablation can actually confer improvement in ejection fraction in some patients even when rate controlled. The success rates that should be noted in this study were similar to those published in most existing literature with about 56% of patients without further atrial fibrillation after a single ablation off medications and a success rate of 75% after a single ablation on medications. While the number of patients included are small and thus may be difficult to challenge the paradigm that was created, the rate versus rhythm control are equivalent in patients with reduced systolic function.                                 This finding should raise awareness that it is quite possible that there might actually be benefits in restoring normal rhythm by modern approaches in patients with reduced systolic function.                                 Moving on, still within the realm of atrial fibrillation, however, we'll next review the article by Aronsson, et al. in Europace Volume 19, Issue 10 entitled Designing an Optimal Screening Program for Unknown Atrial Fibrillation: A Cost-Effectiveness Analysis. More and more with an understanding that atrial fibrillation is essentially of epidemic proportions, but many patients tend to be asymptomatic and yet having an elevated stroke risk. People are focusing on how do we screen these populations in a manner that is both cost-effective as well as strategic. Aronsson, et al. tried to use computer simulation modeling to determine what the optimal age was to initiate screening for atrial fibrillation. They ran more than two billion different design screening programs that could be implemented at different age ranges and using data from published scientific literature. They tested these various screening programs. They demonstrated that the screening starting at the age of 75 was associated with the relatively low cost per gained quality adjusted life year. The overall cost at this level was 4,800 euros across the population for quality adjusted life year gained across that population.                                 The relevance of this publication while simulation model lies in highlighting the importance of considering what programs can we actually achieve in the modern day to better identify patients with atrial fibrillation who are not yet identified. Across the literature and in recent clinical meetings, there's a number of articles that are being published regarding the role of different strategies in identifying the asymptomatic, not yet diagnosed atrial fibrillation patients. This study presents an initial foray into systematizing programs that might be applied to recognition of these patients.                                 Along a similar course, we'll also review an article by Reiffel, et al. in JAMA Cardiology Volume 2, Issue 10 entitled Incidence of Previously Undiagnosed Atrial Fibrillation using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study. In this study, Reiffel, et al. Reviewed the incidence of atrial fibrillation identified using implantable loop recorders in those with a high risk of stroke nearly a CHADS2 score of 3 or greater, but had not been previously diagnosed. It should be noted that while these patients have never been diagnosed with atrial fibrillation, 90% had nonspecific symptoms such as fatigue, dyspnea or palpitations, then theory could be attributed to atrial fibrillation. A total of 385 patients received monitors. They noted that by 30 months of monitoring, about 40% of patients have been identified as having atrial fibrillation that had not been diagnosed. If patients were only monitored for the first 30 days, however, the incident rate of atrial fibrillation in terms of new diagnosis was only 6%. In fact, the median time from device insertion to first episode of atrial fibrillation was almost four months at about 123 days.                                 In line with the previous discussed study by Arosson, et al., this study notes the importance of consideration of how we monitor patients at risk for stroke. The issue at hand is when we do screening, what is enough. The strategies used to identify atrial fibrillation of patients raised from advising on twice daily poll checks, which when done by the patient regularly might allow for identification of atrial fibrillation if they do it well to doing a single ECG, to doing a 24-hour Holter, to doing a 30-day monitor, to doing things like implantable loop recorders. However, this study by Reiffel, et al. suggests the a 30-day continuous monitor is truly insufficient if there is a high concern for atrial fibrillation. Thus with the goals to identify atrial fibrillation on high-risk patients or whether a significant clinical suspicion, one should always consider longer term monitoring by this study.                                 Finally, within the realm of atrial fibrillation, we'll review the article by Tilz, et al. published in Europace Volume 19, Issue 10 on left atrial appendage occluder implantation in Europe, indications anticoagulation post-implantation, results of the European Heart Rhythm Association survey. Currently, there's a high level of utilization of left atrial appendage occlusion for patients with atrial fibrillation who cannot otherwise be on a novel oral anticoagulants in Europe. Tilz, et al. performed a survey of providers performing these procedures. They found that about 52% of those centers performing left atrial appendage occlusion had electrophysiologist performing it as opposed to the remainder using interventional cardiologists. The most common indication for implantation was in those with high risk for stroke and with absolute contraindication to oral anticoagulation or history of bleeding. However, was most interesting from their study was that there was a very wide ranging practice in management after implantation in terms of use of antiplatelets for anticoagulants with 41% prescribing no therapy after implantation. There is even greater variability in therapies for patients who are found to have a thrombus after left atrial appendage occlusion ranging from no therapy to surgery.                                 These findings highlight the difficulty in managing practice patterns with novel technologist and in particular with left atrial appendage occlusion. The highly heterogeneous practice pattern found here suggests that large-scale population outcomes will be difficult to understand unless we understand the individual practice variation that is occurring such as considering what medications patients were prescribed on in the post-implant period or how patients were included in terms of whether or not they met the standard criteria. Furthermore, when a complication occurs such a thrombus septal left atrial appendage occlusion one might suspect that the implications of different strategies such as not doing any therapy all the way to routinely doing surgery tumor to clot should be considered.                                 Next, we will move on to the realm of ICDs, pacemakers, and CRT. First, reviewing the article by Pokorney, et al. published in Circulation in Volume 136, Issue 15 entitled Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. In this study, Pokorney, et al. reviewed these two different approaches in abandoned leads amongst 6,859 patients. They found that extraction was associated with the lower risk of device infection, but there was no association between difference in mortality, need for future lead revision, or need for future extraction. This involved patients in the Medicare age group, but extraction patients of note, tended to be younger with fewer comorbidities, more often female and had a shorter lead dwell time. While they're statistically different, however, the actual number of years by which patients tended to be younger or to have a shorter lead dwell time was only a year.                                 The fact is that it is always hard to know what to do with an abandoned lead. Having more leads in the vascular system might lead to venous stenosis or might lead to patients having future problems when they need an extraction because of infection, or might make it harder to manipulate this in the vascular space. Thus whether extracting abandoned leads as opposed to just capping them and leaving there needs to be considered when taking any patient in for a lead revision or a lead addition for other reasons. These findings suggest that extraction confer similar mortality risk but lower long-term infection risk than capping them. However, it should be noted this is retrospective data set and given the extraction patients already were younger and had their leads for relatively shorter durations with your comorbidities, they might have reflected to healthier population anyway. However, these data are suggestive and highly the need for further study into whether a more aggressive approach with abandoned lead should be considered. Without randomized data, it will not be for certain.                                 Next, also within the realm of lead extraction, we'll review the article by Bongiorni, et al. published in the European Heart Journal in Volume 38, Issue 40 entitled The European Lead Extraction Controlled Study: A European Heart Rhythm Association Registry of Transvenous Lead Extraction Outcomes. This prospect of registry on lead extraction the largest to dates, Bongiorni, et al. reviewed safety and complications in addition to relationship to the type of center. They noted that the overall hospital major complication rate was 1.7% with mortality rate of 0.5% associated with lead extraction. The most common complication was actually pericardial synthesis, need for a chest tube or need for surgical repair. Overall, success rates for lead extraction in terms of complete removal of all lead components was 97%. However, it should be noted the overall complication rate and success rates were better in high-volume centers than low-volume centers. These findings are consistent with prior data published by [Desmott 35:22] and others, suggesting that more experience associates with better outcomes in lead extraction. However, these data represent the largest prospective registry on lead extraction and confirm the safety and efficacy of overall current practices.                                 These better data on modern lead extraction may help facilitate discussions with patients regarding actual outcomes and also decisions on whether or not extraction should be engaged in individual practices.                                 Next, we'll review the article by Aro, et al. in the realm of sudden death cardiac arrest entitled Electrical Risk Score Beyond Left Ventricular Ejection Fraction: Prediction of Sudden Cardiac Death in the Oregon Sudden Unexpected Death Study in the Atherosclerosis Risk and Communities Study, published in the European Heart Journal in Volume 38, Issue 40. In this study, Aro, et al. reviewed what features beyond ejection fraction could predict sudden death in community cohorts. They specifically focus on the electrocardiogram and demonstrated an electrocardiogram risk score based on the presence or absence of a number of features related to heart rate, left ventricular hypertrophy, QRS transition zone, QTc, and others. They found that amongst those patients with a left ventricular ejection fraction greater than 35%, the presence of four more of these ECG abnormalities confer an odd ratio of sudden death of 26.1. The importance of this article is highlighting how more complex considerations of clinical risk might help in further adjudication of sudden death in poorly characterized cohorts.                                 While most studies have concluded that addition of a variety of additional features such a T-wave alternans do not really confer incremental benefit beyond the ejection fraction in adjudicating sudden death risk and in helping decision making regarding ICD implantation. The fact is that more complex analyses that might exist in more nonlinear approaches or consider more advanced features, the ECG and combination, might confer some benefit in poorly characterized populations such as those with moderately reduced ejection fraction between 35 and 50. We know that while those with an ejection fraction less than 35% is a population have a higher risk within that population, the majority of patients who suddenly die do not have an EF less than 35%. Thus, identifying patients without an EF less than 35% who might be at risk is important. This study by Aro, et al. indicates one potential option to help discriminate patients who might not fit within normal categories for sudden death adjudication and did not fit neatly within the trials. However, prospect of evaluation of application of scoring systems either this one or others that may come in the future will be critical.                                 Changing realms yet again, we'll focus on cellular electrophysiology on an article by Kofron, et al. entitled Gq-Activated Fibroblasts Induce Cardiomyocyte Action Potential Prolongation and Automaticity in a Three-Dimensional Microtissue Environment, published in The American Journal of Physiology, Heart and Circulatory Physiology in Volume 313, Issue 4. In this publication, Kofron, et al. demonstrated that in this three-dimensional microtissue model, fibroblasts cause effects on the normal action potential in the surrounding environment leading to proarrhythmogenic automaticity. This model effectively demonstrated the activation of this fibroblast alone taken out of context by other triggers such as abnormalities of innervation, et cetera, could probably contribute to arrhythmogenicity into these hearts. It is well recognized in other studies that fibroblasts don't just cause proarrhythmic effects because of myocardial disarray. In fact, they can have paracrine effects on surrounding cells. This study by Kofron, et al. further highlights those potential effects. The presence of fibroblast amidst cardiomyocytes do not cause proarrhythmic tendency purely by shift in myocardial conduction direction, but also results from the effects of fibroblast once activated on these running cardiomyocytes action potentials of cells.                                 This study is suggesting specifically proarrhythmogenic arrhythmogenicity related to automaticity in those cardiomyocytes that are adjacent to fibroblast, highlights potential future targets for therapies and also highlights potential mechanisms by which arrhythmias might occurrence population.                                 Changing gears, we next look at genetic channelopathies in one article within the realm of Brugada syndrome and the second article within the realm of predicting QT interval. First, Hernandez-Ojeda, et al. published an article in The Journal of the American College of Cardiology Volume 70, Issue 16 entitled Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators: Long-Term Follow-Up. Amongst the 104 patients with long-term follow-up nearly greater than nine years on average, they noted a rate of appropriate therapy was very common especially in secondary prevention patients, however, was as much as 9% in otherwise asymptomatic patients. Appropriate ICD therapies, however, especially amongst asymptomatic patients were exclusively in those spontaneous type I Brugada ECG patterns and inducible ventricular arrhythmias, or those obviously the secondary prevention devices who have prior spontaneous ventricular arrhythmias. However, what is more interesting is that more than 20% of patients had some ICD-related complication. Furthermore, the overall incidence of inappropriate shocks was 8.7%, nearly the same rate as appropriate ICD therapies in the primary prevention population. These findings highlight that there is in fact a reasonable incidence of ventricular arrhythmic events needing ICD therapy even in asymptomatic Brugada patients.                                 However, I think the most striking finding is the high incidence of device-related complications of a follow-up, which highlights the need for considered selection and adequate device programming to avoid inappropriate ICD shocks and finally the need for regular follow-up of these relatively young patients receiving ICDs who might be more prone to complication with the long-term.                                 Changing gears, we'll next review an article by Rosenberg, et al. published in Circulation Genetics in Volume 10, Issue 5 entitled Validation of Polygenic Scores for QT Interval in Clinical Populations. Using more extensive genomic analyses, Rosenberg, et al. used populations and real-world cohorts including 2,915 individuals of European ancestry and 366 individuals of African ancestry. They demonstrated that clinical variables could account for about 9 to 10% of variation in QTc in Europeans and 12 to 18% in African ancestry individuals. However, interestingly, polygenic scores provided incremental explanation of a QTc variation but only in individuals of European ancestry. The reason we find this article interesting is the importance of understanding how much genetics can actually tell us and how what it can tell us might vary between difference, individuals of different backgrounds thus how we apply findings from one study to any other study. In the area of genetic testing, the Holy Grail is fully identifying overall risk scores to tell the patient what they may have without having to rely on clinical studies or other clinical variables. However, we do know that there is both an environmental component as well as the genetic components.                                 This study by Rosenberg highlights the importance of potentially considering both. The issue with the article, however, is the fact that while there was clear benefit of the polygenic score in patients of European ancestry, the African ancestry patients reflect the much smaller population almost one-eighth that of the patients included of European ancestry. Also, European versus African ancestry tend to be very broad-based terms. Whether or not there is greater polygenic variation within those of African ancestry as compared to those Europeans ancestry is relatively unclear. Thus while this study should be taken with grain of salt, it should also be considered in the context of providing a foray into seeing how polygenic scores could augment or understanding of how question intervals might vary in a population of people and might be identified immigrant patients.                                 Moving to the realm of ventricular arrhythmias, we'll first review the article by Siontis, et al. published in Heart Rhythm Volume 14, Issue 10 entitled Association of Preprocedural Cardiac Magnetic Resonance Imaging with Outcomes of Ventricular Tachycardia Ablation in Patients with Idiopathic Dilated Cardiomyopathy. In this study, Siontis, et al. tried to identify whether or not use of preprocedural MRI had any impact on overall procedural outcomes. They compared in a more modern practice where they are routinely obtaining cardiac MRI versus prior practice where they do not routinely obtain preprocedural MRI for ablation in patients with idiopathic dilated cardiomyopathy. They demonstrated that moderate use of preprocedural MRIs was associated with significantly greater procedural success mainly 63% in the modern approach versus 24% previously. The importance of the study why is in trying to understand what the actual value of preprocedural cardiac MRI is when patients are undergoing VT ablation particularly with non-ischemic cardiomyopathy. VT ablation outcomes are notoriously even harder to predict in non-ischemic cardiomyopathy cohorts than ischemic cardiomyopathy cohorts. Improved procedural experience, however, or different technologies may also alter long-term outcomes.                                 Thus, because the populations were not randomized and rather retrospective with a discrete change in practice that occurred temporally and just did not vary in terms of utilization over the course of periods of time when success rates might not have been affected just by incremental procedural success is difficult. However, these data suggest that future studies into the incremental role of MRI for VT ablation are needed to determine its utility.                                 Next, we'll review an article by Ho, et al. published in The Journal of Cardiovascular Electrophysiology in Volume 28, Issue 10 entitled ECG Variation During Ventricular Fibrillation Than Focal Sources Due to Wavebreak, Secondary Rotors, and Meander. Ho, et al. in this publication reviewed the role of rotors and focal sources in ventricular fibrillation. They attempted VF induction of 31 patients and use the combination of surface ECG and biventricular basket catheters to create face mask. They showed there's three differences between those with ventricular fibrillation that was mediate by rotors and those with ventricular fibrillation mediated by focal sources. Specifically those with rotor-based VF had greater voltage variation, which they demonstrated zero wavebreak, secondary rotor formation and rotor meander. One of the most critical findings of this study is the fact that a one-size-fits-all approach to consideration of the mechanism of fibrillation is likely unreasonable in most patients. They discriminate between rotor-based ventricular fibrillation and focal source-based ventricular fibrillation and highlighted there are discrete features that differentiate the two populations.                                 While this should be considered an initial foray into understanding these patients, clinical and computational size will be important into understand how we can discriminate mechanisms of complex arrhythmias between patients to help understand, which patients might most benefit from a specific ablation approach or therapeutic decision. This might also apply to atrial fibrillation where multiple mechanisms may coexist in the same patient for the pathogenesis of the arrhythmia.                                 Finally, we'll review an animal model by Patterson, et al. published in The Journal of Cardiovascular Electrophysiology in Volume 28, Issue 10 entitled Slow Conduction Through an Arc of Block: A Basis for Arrhythmia Formation Postmyocardial Infarction. In this study performed in the University of Oklahoma, Patterson, et al. reviewed a novel basis for arrhythmia formation after MI in an animal model. Amongst 108 anesthetized dogs, they demonstrated the delay potentials may decrement over shorter pacing cycle lengths leading to potential premature ventricular beat initiation after sufficient delay of the second potential. Thus, they demonstrated that there is a Wenckebach-like patterns of delayed activation specifically within this arc of conduction block associated with the region infarcted. These findings suggest that even across line of apparent conduction block there may be a potential for premature beat formation due to very slow conduction and thus a novel mechanism of PVC formation following myocardial infarction. Furthermore, it might highlight the mechanism by which to induce PVCs in this patient population                                 Just because there is conduction block the region of baseline mapping further provocative maneuvers to initiate or to discriminate where there might be very slow conduction might be critical to elicit arrhythmia in some patients.                                 Next, within the realm of syncope. We focus on article by Baron-Esquivias, et al. published in The Journal of American College of Cardiology Volume 70, Issue 14 entitled Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope: The SPAIN Study. In this randomized double blind control study, Baron-Esquivias, et al. study the value of closed loop stimulation in the specific cohort of patients with cardio-inhibitory vasovagal syncope above 40 years of age. They demonstrated amongst 46 patients the closed loops stimulation was associated with the more than 50% reduction in syncopal spells in nearly three quarters of patients. However, it should be noted that up to 9% of patients continue to have syncope in your consistent frequency to prior. However, it should also be noted that sham cohort 46% of patients continue to have syncope while only a quarter were relieved. Syncope is one of the most challenging diagnosis to manage in electrophysiologic practice. This is both due to the heterogeneity of manifestation of syncope in terms of cause as well as the lack of many therapies that affect some of the autonomic features that mediate syncope. Largely, vasovagal syncope can be strategized into cardio-inhibitory and vasodilatory groups.                                 Generally, pacing will be more effective in theory for those more of a cardio-inhibitory than a vasodilatory component thus certainly patients can have both and thus that might be only partial attenuation of syncopal events by fixing the cardio-inhibitory by pacing but not the vasodilatory, which often requires medications. In this study, the use of closed loops stimulation seems to offer significant benefit in the specific population with cardio-inhibitory vasovagal syncope in age greater than 40 years. However, care should be taken not to necessarily apply these findings to patients not within this age group or within this diagnosis group.                                 Next within the realm of electrocardiography, we'll review an article by Yasin, et al. published in The Journal of Electrocardiology Volume 50, Issue 5 entitled Noninvasive Blood Potassium Measurement Using Signal-Processed, Single-Lead ECG Acquired from a Handheld Smartphone. Yasin, et al. reviewed the ability to determine changes in potassium level using the ECG. They demonstrated amongst 22 patients undergoing hemodialysis in whom estimation models could then be trained. The mean absolute error of ambulatory follow-up between the potassium estimated off of a single lead handheld smartphone-enabled ECG in the actual blood potassium was 0.38 milliequivalents per liter or a difference of 9% of the average potassium level. These findings suggest that in terms of clinical robustness a single lead smartphone-enabled handheld base ECG might be sufficient to estimate ambulatory potassium levels in patients who might be at high risk especially of hyperkalemia. The fact is that electrolytes and other abnormalities of a body homeostasis may be reflected in the ECG. However, whether the ECG may in turn be used to finally determine changes in characteristics such as electrolytes levels has not been very well described.                                 Previous work by the same group has suggested that the 12-lead ECG may be utilized to determine find potassium changes in patients undergoing hemodialysis. These findings while in small number of patients in this particular article highlights that ambulatory technologies such as the one they used here might in fact be utilized to discriminate potassium levels in patients who might be at risk of variations of potassium levels that can sometimes be life-threatening. Further validation will be required in larger populations, but this initial foray might create a paradigm for use of the ECG in ways beyond just looking for arrhythmias.                                 The final article we'll review is by Calzolari, et al. published in The Journal of American College of Cardiology, Clinical Electrophysiology in Volume 3, Issue 10 entitled In Vitro Validation of the Lesion Size Index to Predict Lesion Width and Depth After Irrigated Radiofrequency Ablation in a Porcine Model. In this paper published in the special of JACCEP focused on biophysics of ablation, Calzolari, et al. reviewed in vitro validation of lesion size indexing using radiofrequency ablation. Specifically, they reviewed the novel measure that incorporates not just contact force, power and time, but also impedance into predicting lesion quality. They noted that while lesion with in depth did not correlate with power or contact force alone, it did with either the lesion size indexing tool that they created and also with the force-time integral. However, the lesion size indexing where impedance was included was incrementally better than force-time integral. The truth is that improved prediction model lesion size inadequacy are critical during radiofrequency ablation.                                 Predicting lesion formation might help physicians know whether or not they have done adequate intervention at the time of application. They demonstrated incorporating impedance along with contact force, power, and time. The predictive value of their lesion indexing approach was quite good. However, further validation in association with an outcome is necessary to look at the incremental value. It also should be noted that this lesion size indexing tool did not necessarily predict steam pop formation, which is more often associated with power.                                 I appreciate everyone's attention to this key and hard-hitting articles that we have just focused on from this past month of cardiac electrophysiology across the literature. Thanks for listening. Now back to Paul. Paul Wang:         Thanks Suraj. You did a terrific job surveying all journals for the latest articles on topics of interest in our field. There's none an easier way to stay in touch with the latest advances. These summaries and a list of major articles in our field each month could be downloaded from Circulation, Arrhythmia, Electrophysiology website. We hope you'll find the journal to be the go-to place for everyone interested in the field. See you next month.    

You are listening to Bark & Wag 15 Minute Vet Talk and I am your host Polly ReQua. Today we are talking with Dr. Susan McMillan, owner of Vet to Pet Mobile Veterinary Service in Burlington, Vermont to shed light on distemper. Canine Distemper in Dogs Canine distemper is a contagious and serious viral illness with no known cure. The disease affects dogs, and certain species of wildlife, such as raccoons, wolves, foxes, and skunks. The common house pet, the ferret, is also a carrier of this virus. Canine distemper belongs to the Morbillivirus class of viruses, and is a relative of the measles virus, which affects humans, the Rinderpest virus that affects cattle, and the Phocine virus that causes seal distemper. All are members of the Paramyxoviridae family. Young, unvaccinated puppies and non-immunized older dogs tend to be more susceptible to the disease.   Symptoms and Types of Distemper in Dogs   The virus, which is spread through the air and by direct or indirect (i.e. utensils, bedding) contact with an infected animal, initially attacks a dog’s tonsils and lymph nodes and replicates itself there for about one week. It then attacks the respiratory, urogenital, gastrointestinal, and nervous systems.   In the initial stages of Canine Distemper, the major symptoms include high fever (≥103.5 ° F, or 39.7° C), reddened eyes, and a watery discharge from the nose and eyes. An infected dog will become lethargic and tired, and will usually become anorexic. Persistent coughing, vomiting, and diarrhea may also occur. In the later stages of the disease, the virus starts attacking the other systems of the dog’s body, particularly the nervous system. The brain and spinal cord are affected and the dog may start having fits, seizures, paralysis, and attacks of hysteria.   Canine distemper is sometimes also called “hard pad disease” because certain strains of the virus can cause an abnormal enlargement or thickening of the pads of an animal’s feet. In dogs or animals with weak immune systems, death may result two to five weeks after the initial infection.   Causes of Distemper in Dogs   The disease can be acquired from improperly attenuated vaccines, though this occurs rather rarely. Bacterial infections of the respiratory or gastrointestinal systems may also increase an animal’s vulnerability to the disease. Non-immunized dogs that come into any kind of contact with an infected animal carry a particularly high risk of contracting the disease.   Diagnosis of Canine Distemper in Dogs   Canine distemper is diagnosed with biochemical tests and urine analysis, which may also reveal a reduced number of lymphocytes, the white blood cells that function in the immune system in the initial stages of the disease (lymphopenia). A serology test may identify positive antibodies, but this test cannot distinguish between vaccination antibodies and an exposure to a virulent virus. Viral antigens may be detected in urine sediment or vaginal imprints. Haired skin, nasal mucous, and the footpad epithelium may be tested for antibodies as well. Radiographs can only be used to determine whether an infected animal has contracted pneumonia. Computed tomography (CT) and magnetic resonance imaging (MRI) scans can be used to examine the brain for any lesions that may have developed.   Treatment for Distemper in Dogs   Unfortunately, there is no cure for canine distemper. Treatment for the disease, therefore, is heavily focused on alleviating the symptoms. If the animal has become anorexic or has diarrhea, intravenous supportive fluids may be given. Discharge from the eyes and nose must be cleaned away regularly. Antibiotics may be prescribed to control the symptoms caused by a secondary bacterial infection, and phenobarbitals and potassium bromide may be needed to control convulsions and seizures. There are no antiviral drugs that are effective in treating the disease.   Living and Management for Canine Distemper   In the more acute stages of canine distemper, it is necessary to monitor for development of pneumonia or dehydration from diarrhea. The central nervous system (CNS) must also be monitored because seizures and other neural disturbances may occur. A dog's chances for surviving canine distemper will depend on the strain of the virus and the strength of the dog’s immune system. Recovery is entirely possible, although seizures and other fatal disturbances to the CNS may occur two to three months after recovery. Fully recovered dogs do not spread or carry the virus.   Prevention of Distemper in Dogs   The best prevention for canine distemper is routine vaccinations and immediate isolation of infected animals. Special care must be taken to protect new-born pups from exposure, since they are especially susceptible to the disease.  This episode is sponsored by BarkBox. Please use vettalk to receive one month free when you join for six months.

In this edition of the EVJ podcast, Dee Pollard discusses their paper, entitled ‘Assessment of horse owners’ ability to recognise equine laminitis: A cross-sectional study of 93 veterinary diagnosed cases in Great Britain’ and James Carmalt discusses their paper ‘The association between oral examination findings and computed tomographic appearance of the equine temporomandibular joint’.

Dr. Fein is joined by Dr. Daniel Dilling to discuss the topic of cystic lung disease and the paper "Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective

This is Special English. I&`&m Ryan Price in Beijing. Here is the news.China plans to launch another lunar probe at the end of November.The mission will mark China&`&s first automated moon surface sampling and moon take-off, as well as China&`&s first unmanned docking in a lunar orbit around 400,000 kilometers from earth. It will also see China&`&s first return flight in a speed close to second cosmic velocity.With a weight of 8 tonnes, the lunar probe has four parts, namely, an orbiter, a returner, an ascender and a lander. The whole process goes like this. The lander collects moon samples and transfers them into the ascender. The ascender then takes off from the moon, in a journey to dock with the orbiter which is traveling around the moon with the returner. After loading the samples, the returner heads back to earth. It separates from the orbiter before landing on the earth.This is Special English.The number of births in China reached 17 million last year, the largest annual growth since 2000, thanks to the adoption of the second-child policy early last year.According to the top health authority, at least 45 percent of the newborns were not the only child in the family last year, compared to 30 percent in 2013. In some places, mostly large cities in eastern China, more than 50 percent of the newborns were a second child. The authority attributes the increase to the one-year-old universal second-child policy. A baby boom triggered by the new policy will continue in the next two years. It is expected that by 2020, the number of births will climb to 20 million each year. The health authority plans to add 140,000 more maternity health workers in the coming years.Top decision-makers intensified efforts in late 2013 to adjust the family control policies that were in place for three decades. The old policies allowed most couples to have just one child. The policy change aims to address major demographic challenges including an aging population and a looming labor shortage.You&`&re listening to Special English. I&`&m Ryan Price in Beijing. A Chinese language exam is likely to be introduced in Russian schools from next year. According to a national-level education department in Russia, there is a plan to introduce the Chinese language test to the Basic State Exam next year and to the Unified State Exam in 2020.Russia&`&s Basic State Exam is a series of obligatory examinations for ninth grade students and the Unified State Exam for 11th grade students necessary to qualify for university education.Takers of the two exams currently have a choice of English, German, French and Spanish as part of the exam&`&s foreign language component.The Chinese language is taught in 120 educational institutions across Russia. The total number of student learners exceeds 17,000.This is Special English. China has released a short list of eight names for the country&`&s first Mars spacecraft, which is scheduled to launch by 2020.The eight names were the top ones chosen from over 14,500 entries by people worldwide. The names are mandarin phrases, with top scorers meaning "phoenix" and "Mars" in English.China plans to launch its first Mars spacecraft by 2020, which will orbit, land and explore the Red Planet.Selection work started in August last year. The eight finals were decided via online polls and a jury review.The final choice will be announced around Space Day, on April 24. You&`&re listening to Special English. I&`&m Ryan Price in Beijing. The week-long Spring Festival holiday witnessed 400 million passenger trips in China, up 2 percent year on year.Between Jan. 27 and Feb. 2, the number of road trips totaled 330 million, a slight increase from last year. Train trips reached 52 million with an annual increase of 9 percent.A total of around 3 billion trips are expected to be made during this year&`&s Spring Festival travel rush between Jan. 13 and Feb. 21. The lunar New Year is seen as the biggest human migration on earth.The average distance traveled was 260 kilometers per person; and around 90 percent of the trips were within a range of 500 kilometers. Around 90 percent of the trips are made for family reunions.The Guangzhou South Railway Station was the most used transportation hub during the migration, followed by Shanghai Hongqiao Railway Station and Beijing West Railway Station. All the three spots are seated in major cities with significant populations of migrant workers. This is Special English.China has seen an increase of so-called empty-nest youth, or young people who live alone, which experts believe is a cause for public concern.The National Bureau of Statistics reveals that 13 percent of households were inhabited by one person in 2015. The figure in 2008 was 8 percent. The Xinhua News Agency reports that specifically, of this "empty-nest" population, young people are especially common. The term "empty-nest" used to refer to elderly people living alone after their children are grown up and out of the home.A report on "empty-nest youth" found that this group tends to feel lonelier than their peers, and their personal lives are largely kept within their rented apartments. As they typically live far from work to seek cheaper rent, these young people spend hours commuting, leaving them exhausted in the evenings.Even so, this population chooses to live in big cities, attracted by opportunities for a better career. Some 21 percent of the group have no savings or are slightly in debt.Experts say the emergence of empty-nest youth is a result of imbalanced social and economic development between big cities and smaller towns. It is also a natural result of China&`&s ongoing urbanization.Still, the experts warned that the growing size of this group could bring more problems, affecting the population&`&s psychology and marital aspirations. Some recommended that the youth get in engaged in community activities.You&`&re listening to Special English. I&`&m Ryan Price in Beijing. You can access the program by logging on to newsplusradio.cn. You can also find us on our Apple Podcast. If you have any comments or suggestions, please let us know by e-mailing us at mansuyingyu@cri.com.cn. That&`&s mansuyingyu@cri.com.cn. Now the news continues.Super Bowl advertisers are treading carefully this year to avoid alienating customers as a divisive political climate takes some of the buzz away from what is usually the biggest spectacle on TV.Ad critic Barbara Lippert says that while "people need an escape", like the Super Bowl, this year&`&s matchup on the field feels "so much less important than what&`&s going on politically."To get the attention back, some advertisers are turning to nostalgia, celebrities and marketing stunts. P&G is sexing up Mr. Clean, Honda is featuring nine celebrities and Snickers is running a live ad.Others are touching on social issues, without being too blunt about it. Budweiser won the pre-game buzz with sweeping cinematic ad showcasing founder Adolphus Busch&`&s 1857 immigration from Germany to St. Louis. Although it has been in the works since May, the ad felt topical, as it was released online just days after President Donald Trump&`&s travel ban against people from seven Muslim-majority countries. The ad got more than 8 million views on YouTube in just four days.This is Special English.U.S. President Donald Trump says movie star Arnold Schwarzenegger "tried hard" to make "Celebrity Apprentice" a success, but has failed.In an early morning Twitter post recently, the president kept alive a theme he brought up a day earlier during his first appearance at the National Prayer Breakfast.Trump, who once hosted the NBC reality TV show, took a pot shot there at Schwarzenegger, the current host and former California governor, over a ratings nosedive for the show.Trump said in his tweet that Schwarzenegger did a bad job as Governor of California and even worse on the Apprentice, but at least he tried hard.Schwarzenegger responded quickly to the remarks in a video on his verified Twitter account, suggesting that he and Donald Trump switch jobs. His response to the dig from Trump came later in the day in the form of a tweeted link to a 2006 article from the Los Angeles Daily News reporting that he, then the governor, had released his tax records. Trump, as a candidate and now as president, has refused to release his own tax records.Schwarzenegger had no further comment beyond the linked article, but his representative said the article "speaks for itself".You&`&re listening to Special English. I&`&m Ryan Price in Beijing. Nordstrom says it will stop selling Ivanka Trump clothing and accessories, creating some questions about the future of the brand elsewhere.The Seattle-based department store chain said the decision was based on the sales performance of the first daughter&`&s brand. Neiman Marcus may be the next one to pull back on the label, as the branded jewelry is nowhere to be seen on the upscale retailer&`&s website as of Friday.Nordstrom said in a statement emailed to The Associated Press that it makes buying decisions based on performance; and they have got thousands of brands, more than 2,000 offered on the site alone. Reviewing their merit and making edits is part of the regular rhythm of Nordstrom&`&s business.The move by Nordstrom comes amid a social media campaign called "Grab Your Wallet", urging a boycott of stores that stock Ivanka Trump or Donald Trump products.Ivanka Trump announced earlier this month that she would take a leave of absence from her clothing and accessories business as well as the Trump organization.This is Special English.Norwegian zoologists have found around 30 plastic bags and other plastic waste in the stomach of a beaked whale that had beached on a southwestern Norway coast.The visibly sick, 2-ton goose-beaked whale has been euthanized.One zoologist from Bergen University says the whale&`&s stomach was full of plastic, adding that its intestine "had no food, only some remnants of a squid&`&s head in addition to a thin fat layer".The scientists say the non-biodegradable waste was "probably the reason" why the whale repeatedly beached in shallow waters off Sotra, an island west of Bergen, 200 kilometers northwest of the capital of Oslo.It size, around 6 meters, showed that the whale was an adult.The United Nations estimates that 8 million tons of plastic trash is dumped into the world&`&s oceans each year.This is Special English.Fossils of a newly discovered otter species dating back around 6 million years have been found in southwest China&`&s Yunnan Province.The well-preserved fossil has an almost complete cranium and mandible and a partial skeleton.The otter weighed around 50 kilograms, around the same as a wolf, and measured up to two meters in length, almost double the size of a modern otter.Computed tomography restoration of the skull revealed a combination of otter-like and badger-like skulls and tooth characteristics.One scientist at the Natural History Museum of Los Angeles County says the species belonged to an extinct group of otters in East Asia.Otters are semi-aquatic predators. Modern otters have worldwide distribution, but their fossil record is poor.The new species outlined the migration paths of otters moving from Southeast Asia to China. It can help scientists better understand the evolution of the animals. This is the end of this edition of Special English. To freshen up your memory, I&`&m going to read one of the news items again at normal speed. Please listen carefully.This is the end of today&`&s program. I&`&m Ryan Price in Beijing, and I hope you can join us every day, to learn English and learn about the world.

This week's BrainWaves episode features a case of a middle-aged woman with progressive headache and cranial neuropathies. The diagnosis of aseptic meningitis is made and a differential diagnosis is illustrated. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health identifying information. REFERENCES 1. Nigrovic LE. Aseptic meningitis. Handbook of clinical neurology. 2013;112:1153-6. 2. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB and Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. The New England journal of medicine. 2004;351:1849-59. 3. Hasbun R, Abrahams J, Jekel J and Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. The New England journal of medicine. 2001;345:1727-33. 4. Lee BE, Chawla R, Langley JM, Forgie SE, Al-Hosni M, Baerg K, Husain E, Strong J, Robinson JL, Allen U, Law BJ, Dobson S and Davies HD. Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of aseptic meningitis. BMC Infect Dis. 2006;6:68. 5. Negrini B, Kelleher KJ and Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics. 2000;105:316-9. 6. Logan SA and MacMahon E. Viral meningitis. Bmj. 2008;336:36-40. 7. Ginsberg L and Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008;8:348-61. 8. Jolles S, Sewell WA and Leighton C. Drug-induced aseptic meningitis: diagnosis and management. Drug Saf. 2000;22:215-26. 9. Chamberlain MC and Glantz M. Myelomatous meningitis. Cancer. 2008;112:1562-7. 10. Nieuwenhuizen L and Biesma DH. Central nervous system myelomatosis: review of the literature. Eur J Haematol. 2008;80:1-9. 11. Sobol U and Stiff P. Neurologic aspects of plasma cell disorders. Handbook of clinical neurology. 2014;120:1083-99.

Det är ganska exakt ett år sedan Drupal 8 släpptes och även om väldigt många moduler finns i stabila versioner och en hel del följer med Drupal Core så saknas en del ganska vanliga moduler. Vi diskuterar vad vi saknar och vad vi stött på som vi önskar kunde finnas. Länkar till moduler, webbplatser och tjänster vi pratade om i detta avsnitt: Inledning TFA Field collection Feeds SMTP Views Bulk Operations Rules Flag A plan for media management in Drupal 8 Maillog Reroute e-mail Pardot Prepopulate Computed field Automatic Entity Label Auto nodetitle CLI - command line interface Drupal console Eftersnack Doctor Strange SPF Truesize

What is radioactivity? Where are you from? Send us a postcard! Strange Attractor, c/ PO Box 9, Fitzroy, VIC 3065, Australia What is radioactivity? Including alpha, beta & gamma decay, half-life, background radiation & health effects (Physics.org) Types of radioactivity (Andy Darvill's Science Site) The difference between radioactivity & radiation (The Conversation) Cool chart that shows radiation doses for all sorts of things...including sleeping next to someone & eating a banana (xkcd) Alpha, beta & gamma penetration (HyperPhysics, Georgia State University) Alpha, beta & gamma penetration (BBC, GCSE) Radioactive elements can 'decay' into other elements — here's the crazy decay chain for uranium-238 (Wikipedia) There are 29 radioactive elements on Earth & thousands more radioactive isotopes (Wikipedia) Some examples of radioactive isotopes or 'radionuclides' (Wikipedia) Some 'nuclides' are stable, but most are radioactive & decay — here's a list of >900 with half-lives from 50 million years (Wikipedia) The number 20 is a 'score' in ye olde talk (Wikipedia) What is uranium? (Jefferson Lab) What is plutonium? (Jefferson Lab) What is an alpha particle? (Physics Department, Idaho State University) During alpha decay, alpha particles (helium nuclei) are released from a radioactive atom's nucleus (Wikipedia) The crazy strong nuclear forces involved (HyperPhysics, Georgia State University) Conservation of energy — it can neither be lost nor gained (Encyclopaedia Britannica) Energy equals mass: e=mc^2 & all that malarky (livescience) Alpha particles are the least harmful in that they are large & can be easily stopped by e.g. paper; however, if ingested they're super dangerous (HyperPhysics, Georgia State University) Radioactive elements are inherently unstable (Reference) Sometimes you have to wait a loooooong time for a radioactive element to spit out a particle, like 4.5 billion years (Wikipedia) Everything is radioactive in the periodic table from 83 (bismuth) onwards (Wikipedia) Why is radioactive decay random & spontaneous? (I'm a scientist get me out of here) Schrödinger's cat (IFL Science) What is polonium? (Jefferson Lab) What is alchemy? (livescience) What is an isotope? (HyperPhysics, Georgia State University) What is an isotope? (The Conversation) Fact or fiction?: Lead can be turned into gold (Scientific American) It sounds like isotopes can indeed have too few neutrons, as well as too many (The Naked Scientists) What is a beta particle? (Idaho State University) Beta radioactivity (HyperPhysics, Georgia State University) An electron is ~1,800 times smaller than a proton (Jefferson Lab) What is a gamma ray? (Idaho State University) Gamma rays consist of high-energy photons (Wikipedia) Gamma radioactivity (HyperPhysics, Georgia State University) Ionising radiation "carries enough energy to free electrons from atoms or molecules, thereby ionising them" (Wikipedia) How radiation sickness works (Science, How Stuff Works) Too much ionising radiation is bad...but humans have evolved to be able to cope with a certain amount of background radiation (World Nuclear Association) Natural background radiation (Australian Nuclear Science and Technology Association) Bananas are a bit radioactive because they contain potassium: The banana equivalent dose (Wikipedia) Still cleaning up: 30 years after the Chernobyl disaster (The Atlantic) Flying and health: Cosmic radiation exposure for casual flyers and aircrew (Australian Radiation Protection and Nuclear Safety Agency) Health threats for astronauts from cosmic rays (Wikipedia) How does lead absorb radiation like x-rays and gamma rays? (The Naked Scientists) How do x-rays work? (Wonderopolis) Radiation therapy employs x-rays, gamma rays & charged particles to kill cancer cells (National Cancer Institute) The 'gamma knife' delivers precise beams of radiation to diseased brain tissue or tumour from a large number of directions (Imaginis) Magnetic resonance imaging (MRI) scans don't use radiation (National Institute of Biomedical Imaging and Bioengineering) Computed tomography (CT) scans use ionising radiation (National Institute of Biomedical Imaging and Bioengineering) Positron emission tomography (PET) scans use radiopharmaceuticals (National Institute of Biomedical Imaging and Bioengineering) Alexander Litvinenko: Profile of murdered Russian spy — the guy who drank tea with polonium-210 in it (BBC News) Want some polonium-209? It'll set you back USD$3,200 per microcurie (Jefferson Lab) Sydney's Lucas Heights reactor to ramp up nuclear medicine production to meet world demand (ABC News) Synchrotrons are extremely powerful sources of x-rays (European Synchrotron Radiation Facility) The Australian synchrotron is in Clayton (Australian Synchrotron) Ikea Springvale How does a nuclear power station work? (Explain That Stuff!) A discussion about whether Mark Watney from 'The Martian' had a high cancer risk after heating up his little car with a radioactive source (Quora) How to protect astronauts from space radiation on Mars (NASA) Radioactive waste management (World Nuclear Association) Nuclear agencies are searching for the signs, language & solutions that will warn our descendants to stay away (FT Magazine) Cockroaches have an exoskeleton so they probably wouldn't know what a skull & cross bones are (Wikipedia) Thaw could release Cold War-era radioactive waste buried under Greenland's ice (ABC News) Greeland is an autonomous country within the Danish realm (Wikipedia) Nuclear power in space (Wikipedia) How do nuclear submarines work? (Science, How Stuff Works) The nuclear submarine that can remain underwater for 25 years (Wired) 'Letters of last resort' are written by all new UK Prime Ministers, with instructions to submarine commanding officers on what to do if a nuclear strike wipes out the Government (Wikipedia) Billionaires are buying submarines (The Daily Mail UK) Can nuclear waste be neutralised by bacteria? (Engineering.com) Iggy Pop is indeed alive & currently 69 (IggyPop.com) Nirvana David Bowie Ziggy Stardust (Wikipedia) Billy Joel Kim Wilde Atomic clocks & cesium...not radioactive even though they sound like it (HyperPhysics, Georgia State University) Atomic clocks (Wikipedia) Microwaves are not radioactive (Cancer Research UK) Mobile phones are not radioactive — they emit electromagnetic radiation, which is very different, & they also don't emit enough energy to break the molecular bonds inside cells (Scientific American) Mobile phones are not radioactive (Skeptic) Here's the patch you stick on your phone that apparently saves you from the evil 'radiation' — decide for yourself (cellsafe) Ionising (bad one) vs non-ionising radiation (Australian Radiation Protection and Nuclear Safety Agency) UV light is ionising radiation & can break chemical bonds in cells (livescience) Suffering endures for 'Radium Girls' who painted watches in the '20s (Hartford Web Publishing) The Bachelor, Australia (Channel Ten) Corrections An exact description of how the Americium-241 in smoke detectors works (Wikipedia) Bismuth's half-life is estimated to be more than a billion times the age of the universe (Wikipedia) Billy Idol isn't chubbsy at all...sorry Billy, you still got it (BillyIdol.net) The metre was originally defined as one ten-millionth of the distance from the equator (not Paris) to the North Pole (Wikipedia) One of the main dreams of alchemy was to turn lead (atomic number 82) into gold (atomic number 79), which would have meant losing protons, not gaining (livescience) Cheeky review? (If we may be so bold) It'd be amazing if you gave us a short review...it'll make us easier to find in iTunes: Click here for instructions. You're the best! We owe you a free hug and/or a glass of wine from our cellar

How do you approach the child who may be altered?   Altered mental status in children can be subtle.  Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction. In the altered child, anchoring bias is your biggest enemy.  Keep your mind open to the possibilities, and be ready to change it, when new information becomes available. For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke). Try this for altered children: remember that they need their VITAMINS! V – Vascular (e.g. arteriovenous malformation, systemic vasculitis) I – Infection (e.g. meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. environmental, medications, contaminated breast milk) A – Accident/abuse (e.g. non-accidental trauma, sequelae of previous trauma) M – Metabolic (e.g. hypoglycemia, DKA, thyroid disorders) I – Intussusception (e.g. the somnolent variant of intussusception, with lethargy) N – Neoplasm (e.g. sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. seizure and its variable presentation, especially subclinical status epilepticus)   Case One: Sleepy Toddler 16-month-old who chewed on his grandmother's clonidine patch Clonidine is an alpha-2 agonist with many therapeutic indications including hypertension, alcohol withdrawal, smoking cessation, perimenopausal symptoms.  In children specifically, clonidine is prescribed for attention deficit hyperactivity disorder, spasticity due to cerebral palsy and other neurologic disorders, and Tourette’s syndrome. The classic clonidine toxidrome is altered mental status, miosis, hypotension, bradycardia, and bradypnea.  Clonidine is on the infamous list of “one pill can kill”. Treatment is primarily supportive, with careful serial examinations of the airway, and strict hemodynamic monitoring. Naloxone can partially counteract the endogenous opioids that are released with clonidine's pharmacodynamics. Start with the usual naloxone dose of 0.01 mg/kg, up to the typical adult starting dose is 0.4 mg. In clonidine overdose, however, you may need to increase the naloxone dose (incomplete and variable activity) up to 0.1 mg/kg.  Titrate to hemodynamic stability and spontaneous respirations, not full reversal of all CNS effects.   Case Two: In Bed All Day A 7-year-old with fever, vomiting, body aches, sick contacts.  Altered on exam. Should you get a CT before LP? If you were going to perform CT regardless, then do it. Adult guidelines: age over 60, immunocompromised state, history of central nervous system disease, seizure within one week before presentation, abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, facial palsy, arm drift, leg drift, and abnormal language. Children: if altered, and your differential diagnosis is broad (especially if you may suspect tumor, bleed, obvious abscess). Influenza is often overlooked as a potential cause of altered mental status.  Many authors report a broad array of neurological manifestations associated with influenza, such as altered mental status, seizures, cranial nerve abnormalities, hallucinations, abnormal behavior, and persistent irritability.  All of this is due to a hypercytokinemic state, not a primary CNS infection.   Case Three: Terrible Teenager 14-year-old brought in for "not listening" and "acting crazy"; non-complaint on medications for systemic lupus erythematosus (SLE). SLE is rare in children under 5. When school-age children present with SLE, they typically have more systemic signs and symptoms.  Teenagers present like adults.  All young people have a larger disease burden with lupus, since they have many more years to develop complications. Lupus cerebritis: high-dose corticosteroids, and possibly IV immunoglobulin.  Many will need therapeutic plasma exchange (TPE), a type of plasmapheresis.   Summary In altered mental status, keep your differential diagnosis open Pursue multiple possibilities until you are able to discard them Be ready to change your mind completely with new information Make sure your altered child gets his VITAMINS (Vascular, Infectious, Toxins, Accident/Abuse, Metabolic, Intussusception, Neoplasm, Stroke)   References Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984; 101:692. Fujita K, Nagase H, Nakagawa T et al. Non-convulsive seizures in children with infection-related altered mental status. Pediatrics International. 2015; 57(4):659–664. Gallagher J, Luck RP, Del Vecchio M. Altered mental status – a state of confusion. Paediatr Child Health. 2010 May-Jun; 15(5): 263–265. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001; 345(24):1727-33. Oliver WJ, Shope TC, Kuhns LR. Fatal Lumbar Puncture: Fact Versus Fiction—An Approach to a Clinical Dilemma. Pediatrics. 2003; 112(3) Schwartz J et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue. Journal of Clinical Apheresis. 2013; 28:145–284. Zorc JJ. A lethargic infant: Ingestion or deception? Pediatr Ann 2000; 29: 104–107   This post and podcast are dedicated to Teresa Chan, HBSc, BEd, MD, MS, FRCPC for her boundless passion for and support of #FOAMed, for her innovation in education, and for her dedication to making you and me better clinicians and educators.  Thank you, T-Chan. Altered Mental Status Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP  

Deeter, tecto and shrop talk about normalization vs. denormalization of data in MongoDB and using the maximum:computed-fields package to keep data denormalized and updated across collections.

Discussion between Dr. Diane Strollo and Dr. Alan Fein

In this podcast, Ricardo talks about the danger of performing multiple tasks without understanding the implications. He explains that we must always consider the residual time between tasks and the real time (or Takt Time) of each task. The Takt Time concept, according to the www.businessdictionary.com, is an adjustable time unit used in lean production to synchronize the rate of production with the rate of demand. Computed by dividing available production by the number of items to be produced, takt time provides a precise rhythm to run an entire process sequence that maximizes efficiency whereas minimizing wastes. Although popularized by the Japanese, takt time is a German term which refers to rhythm or beat of music.

Echinoderms are characterised by a mineralised skeleton, specialised water vascular system and five-fold symmetry. It is this unusual body plane symmetry that gives the starfish its star-shape. None of these features, however, are possessed by the closest living relatives of echinoderms – the hemichordates. Palaeontology offers a unique perspective into the early evolution of echinoderms, revealing that echinoderm characteristics were acquired in a step-wise fashion from a bilaterally symmetrical ancestor. We speak to Dr Imran Rahman, a postdoctoral researcher at the University of Bristol, about the early evolution of echinoderms, from worms to stars.

Craig Hore gives a great case based discussion of on trauma and CTA of the neck and thorax, all in under 15 minutes. This talk was recorded at BCC4.

Interview with Pim A. de Jong, MD, PhD, author of Identification of Chronic Obstructive Pulmonary Disease in Lung Cancer Screening Computed Tomographic Scans

Lecture 20: Carmichael discusses three main ways of obtaining medical imaging data: CT (Computed Tomography) scans, MRIs (Magnetic Resonance Imaging) and PET (Positron Emission Tomography)

Chertock, A (North Carolina State) Tuesday 05 October 2010, 14:00-14:45

Background: Intravascular lymphoma (IVL) is an uncommon disease characterized by atypical lymphoid cells growing inside the lumina of small vessels. The diversity of clinical presentation due to possible involvement of multiple organs often complicates its diagnosis. Case Report: Here, we report on a case of IVL with rapidly progressive dementia and Coombs-negative hemolytic anemia. Interestingly, the erythrocytes exhibited a decreased osmotic resistance. Bone marrow histopathology revealed increased erythropoiesis and, finally, a small monoclonal B lymphocyte population. Cerebral magnetic resonance imaging (MRI) demonstrated few micro-bleedings. Computed tomography (CT) showed bilateral ground-glass opacity of the lungs. Within a few days, the patient developed respiratory failure and died. On post-mortem examination, intravascular large B-cell lymphoma with almost complete infiltration of the brain and lungs was diagnosed. Conclusion: IVL should be considered early in situations of unexplained neuropsychiatric disease along with markedly elevated levels of lactic dehydrogenase, anemia, and hemolysis.

Dr. Don Rockey discusses current perspectives and future directions of computed tomographic (CT) colonography

Computed tomography (CT) and magnetic resonance imaging (MRI) were used to study the anatomy of clinically and radiographically normal carpal joints in 12 large-breed dogs that were euthanatised for medical reasons. Preparations made by sectioning the carpal joints from these same dogs were used as controls. Computed tomographic and magnetic resonance images were taken in transverse, sagittal and dorsal planes. The computed tomographic examination focused on the depiction of the ligaments, muscles and tendons of the carpal joint using a soft tissue window. Reconstruction algorithms of a medium-sized kernel proved to be applicable. Window settings with a centre of between 50 and 110 HU and a width of 200 to 300 HU provided the best soft tissue contrast in the carpal region. A single-slice helical third generation CT scanner was used together with software that allowed a multi-planar reconstruction of the transverse slices in sagittal and dorsal planes. A low-field open magnetic resonance unit (0.2 T) was used for MRI. T1 and T2 weighted images with different sequences and different slice thickness were obtained in the transverse, sagittal and dorsal planes. T1 weighted spin echo sequences (TR: 640 ms, TE: 26 ms, slice thickness: 3 mm) provided good quality images. Upon completion of the imaging modalities, the joints were sectioned and anatomical preparations were made. These included cryostat sections and permanent transparent slice plastinations. There was a good correlation between the anatomical structures of the frozen sections and those of the slice plastinations. The computed tomographic and magnetic resonance images and the anatomical sections were compared. Viewing the computed tomographic and magnetic resonance images on a monitor using a navigation system offered more advantages than conventional viewing of single images. Projection of the chosen image together with the corresponding images in the other two planes allowed faster and more precise identification of the anatomic structures than viewing single images alone. The superimposition-free depiction of computed tomographic and magnetic resonance images allowed good visualisation of ligaments, tendons and muscles of the carpal region. Compared to muscles, the tendons and ligaments appeared slightly hyperdense on computed tomographic images and markedly hypointense on magnetic resonance images. The palmar flexor tendons, the strong palmar ligaments and the collateral ligaments could be identified on images generated by CT and MRI. Magnetic resonance imaging was superior to CT for visualisation of the extensor tendons and the weaker dorsal ligaments. Most of the extensor tendons and many of the smaller ligaments and tendons could be seen via MRI. Clear differentiation of the medial collateral ligament and the tendon of the long abductor muscle of the first digit (musculus abductor digiti I longus) was not possible with either CT or MRI. As well, the lateral collateral ligament could not be clearly differentiated from surrounding tissue. The medial and lateral accessory metacarpal ligaments could be depicted on both computed tomographic and magnetic resonance images. The palmar fibrocartilage could also be visualised; on computed tomographic images, it was slightly hyperdense with an irregular border and with MRI, it had a low and irregular signal and could be better differentiated. The ligaments that are situated palmar to the antebrachiocarpal joint space could be seen better on magnetic resonance images than on computed tomographic images. The short digital muscles could be visualised with both imaging modalities, but could not be differentiated from each other. Individual carpal bones could be easily distinguished from each other on magnetic resonance images. On computed tomographic images, these bones could not be differentiated well using a soft tissue window, but could be clearly distinguished using a bone window. Some of the large nerves and vessels could be seen on magnetic resonance images; however, reliable identification of these structures was not possible. Contrast studies are required for identification of individual vessels. Synovial bursae and tendon sheaths were barely recognisable on magnetic resonance images and could not be identified on computed tomographic images. Magnetic resonance imaging was superior to CT for identification of all soft tissue structures of the canine carpus. Therefore, soft tissue injuries of that joint should be evaluated using MRI rather than CT.

Computed tomography was performed in 9 male patients with a diagnosis of opiate dependence and in 9 age-matched psychiatric controls (neurotic depression). Patients with a history or diagnosis of another substance dependence (alcohol, cocaine, cannabis) were excluded from the study. The volumes of internal and external components of cerebrospinal fluid (CSF) were measured with a point-counting stereological method. Analysis of variance with age as a covariate revealed a significant enlargement of external and external CSF spaces in male patients with opiate dependence. There was no significant correlation between the length of opiate dependence and the volumes of internal and external CSF spaces. The present results suggest that opiate dependence is associated with structural brain alterations. However, the relationship between opiate dependence and structural brain changes is complex and still not well understood.

It has been suggested that the distribution of the subchondral bone density may be regarded as the expression of the long-term effective stress in a joint, and previous results indicate the regularity of the distribution of subchondral bone density as a function of the passing demands made upon a joint. Computed tomography-osteoabsorptiometry has been developed to visualize the area distribution of subchondral mineralization in the major joints in vivo. The purpose of this study was to display the distribution of subchondral bone density in the acetabular cup of patients of different ages. Computer tomography data files of hip joints of 27 patients (18–89 years) were used. Density ranges, image analysis, and area presentation of the distribution of subchondral mineralization are presented. The maximal subchondral mineralization in young persons is found both in the ventral and dorsal part of the acetabular roof. In older people, however, the densest areas are most often found at the zenith of the acetabulum. These morphological results could be well explained by the experimental results of other authors who found a joint incongruity in young persons with contact areas in the ventral and dorsal part of the acetabulum. With advancing age a decrease in incongruence is found, leading to an increased stress in the dome, i.e. in the area where degenerative changes are often found.