Podcasts about gbcas

Dr. Howard Rowley joins Bill and Kristan for a discussion of the history of GBCAs and the introduction of the newest agent; gadopiclenol Accreditation Coming Soon This MR iCast episode is supported by Bracco Diagnostics Inc. through an unrestricted educational grant.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.08.21.255802v1?rss=1 Authors: Poublanc, J., Sobczyk, O., Shafi, R., Uludag, K., Wood, J., Vu, C., Dharmakumar, R., Fisher, J. A., Mikulis, D. J. Abstract: BACKGROUND: The paramagnetic properties of deoxyhemoglobin shorten T2* as do gadolinium based contrast agents. Induction of abrupt changes in arterial deoxyhemoglobin concentration ([dOHb]) can mimic the action of intra-vascular boluses of gadolinium based contrast agents (GBCAs) used for perfusion imaging. AIM: To demonstrate the feasibility of rapidly changing pulmonary venous hemoglobin saturation for generating boluses of blood with altered T2* properties for measuring flow metrics in the systemic circulation. METHODS: A gas blender with a sequential gas delivery breathing circuit and software enabling prospective arterial blood gas targeting was used to implement rapid lung changes in the partial pressure of blood oxygen (PaO2) while maintaining isocapnea. Lung PaO2 was initially lowered to induce a low baseline deoxyhemoglobin concentration [dOHb]. PaO2 was then rapidly raised to normal for 10 seconds and then rapidly lowered to the initial low baseline creating a oxyhemoglobin (OHb) bolus. R2* changes were measured using blood oxygenation dependent (BOLD) MRI signal changes in large arteries and veins as well as in the microcirculation. This enabled generation of the following maps: bolus arrival time delay (TD) cerebral blood volume (CBV), mean transit time (MTT) and cerebral blood flow (CBF). RESULTS: BOLD signal in the middle cerebral artery showed a sharp increase during the OHb bolus transit indicating minimal dispersion confirming effective rapid modulation of pulmonary venous PO2 with reasonable cortical contrast-to-noise ratio of 3. Signals sorted by amplitude of signal changes and arrival times enabled the visualization of major arteries and veins. Contrast to noise ratio was adequate for a single gas challenge to provide most of the contrast, little improved by averaging over the remaining set of challenges. Values of the flow metrics derived from the perfusion maps were within normal ranges from published literature values. CONCLUSION: Non-invasive induction of abrupt changes in OHb saturation can function as a novel non-invasive vascular contrast agent for use in perfusion imaging. Copy rights belong to original authors. Visit the link for more info

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757311?widget=personalizedcontent&previousarticle=2757307 Prior authorization requirements increased from 8% to approximately 24% of covered drugs on Medicare Part D plans between 2007 and 2019. Solutions- First, focus prior authorization on its intended purpose. Health plans should eliminate prior authorization requirements for medications that have very low final denial rates… this should only be for people that are outliers protect continuity of patient care. For patients who are stable with chronic treatment, insurers should offer protections to minimize disruptions and inefficiencies—get a drug forever shouldn’t need to go off the drug or switch insurance than try a new drug on their formulary when you have already failed it on the other insurance Third, promote transparency, efficiency, and fairness. Technology exists to enable prescribers to view the formulary status, prior authorization requirements, and cost sharing for medications and alternatives in electronic health records (EHRs https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2757311?widget=personalizedcontent&previousarticle=2757307 FDA updated its gadolinium warning in 2010, specifying that 3 agents (gadopentetate dimeglumine, gadodiamide, and gadoversetamide)- the FDA stated that other GBCAs could be used cautiously under certain circumstances We needed a solution so BOOM newer agents, termed group II agents (gadobenate dimeglumine, gadobutrol, gadoteridol, and gadoterate meglumine), In this study – almost 5k pts. stage 4 and 5 CKD receiving group II GBCAs, including patients undergoing dialysis. They report a 0% pooled incidence of unconfounded NSF https://www.bmj.com/content/368/bmj.l6669 Sticking to a healthy lifestyle including not smoking, not being overweight, and exercising regularly, is associated with a longer life expectancy at age 50 free of major diseases such as cancer, cardiovascular diseases, and diabetes, The number of extra disease-free years is around 7.6 for men and 10 for women, compared with participants with no low risk lifestyle factors. https://jamanetwork.com/journals/jama/article-abstract/2758598 prostate cancer and diet Time to progression did not differ significantly between the groups (unadjusted hazard ratio, 0.96 [95 percent confidence interval, 0.75 to 1.24]; adjusted hazard ratio, 0.97 [95 percent confidence interval, 0.76 to 1.25]). For the intervention and control groups, the 24-month Kaplan-Meier progression-free percentages were 43.5 and 41.4 percent, respectively (difference, 2.1 percent; 95 percent confidence interval, −8.1 to 12.2 percent). https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2759737?guestAccessKey=dc41fd4e-5c0c-46bb-9353-ceca16f96b25&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=020320 just read the summary- These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. SUMMARY This study revealed approximately 3% to 7% higher relative risks and less than 2% higher absolute risks of incident CVD and all-cause mortality over the 30 years of follow-up. People who consume more servings per week would have greater risks. Why they are wrong and the big problem Furthermore, risks of CVD and mortality are determined by a range of factors, including but not limited to genetic predisposition, demographic factors, socioeconomic status, weight, lifestyle factors (eg, smoking, sleep, physical activity, and diet), and the built environment Overall looked at 6 studies total- large heterogeneity- people could eat all sorts or amounts of meat Food preparation methods were not consistently and universally assessed across the cohorts in this study. Therefore, separating fried chicken from poultry intake was not possible They used questionnaires- we know people lie to be healthier on questionnaires Only baseline diet data was analyzed from the 6 studies in this cohort. – 19 years of follow up but only used one questionnaire for each study!!!!!!!!!!!!!!!!!!!!!! only 1 dietary measurement was used—

The Food and Drug Administration (FDA) is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder can cause a rare but very serious reaction that excessively activates the body's infection-fighting immune system. This can cause severe inflammation throughout the body and lead to hospitalization and death, especially if the reaction is not diagnosed and treated quickly. A link to the full communication detailing specific information for health care professionals and a list of FDA-approved GBCAs can be found at www.fda.gov/Drugs/DrugSafety Released 4/25/2018

The Food and Drug Administration (FDA) is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder can cause a rare but very serious reaction that excessively activates the body’s infection-fighting immune system. This can cause severe inflammation throughout the body and lead to hospitalization and death, especially if the reaction is not diagnosed and treated quickly. A link to the full communication detailing specific information for health care professionals and a list of FDA-approved GBCAs can be found at www.fda.gov/Drugs/DrugSafety Released 4/25/2018

The Food and Drug Administration (FDA) is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder can cause a rare but very serious reaction that excessively activates the body’s infection-fighting immune system. This can cause severe inflammation throughout the body and lead to hospitalization and death, especially if the reaction is not diagnosed and treated quickly. A link to the full communication detailing specific information for health care professionals and a list of FDA-approved GBCAs can be found at www.fda.gov/Drugs/DrugSafety Released 4/25/2018

The FDA announced that it is requiring a new class warning and other safety measures for all gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (or MRI) concerning gadolinium remaining in patients’ bodies, including the brain, for months to years after receiving these drugs. Report side effects involving GBCAs to FDA’s MedWatch program at www.fda.gov/medwatch. A link to the full communication detailing specific information for health care professionals and a list of FDA approved GBCAs can be found at www.fda.gov/DrugSafety. Released 12/19/2017

Listen to an audio podcast of the December 19, 2017 FDA Drug Safety Communication "FDA warns that gadolinium-based contrast agents (GBCAs) are retained in the body; requires new class warnings". This is an update to the FDA Drug Safety Communication: FDA identifies no harmful effects to date with br

Listen to an audio podcast of the May 22, 2017 FDA Drug Safety Communication. FDA announced that to date a review has not identified adverse health effects from gadolinium retained in the brain after the use of gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI); review to

Purpose: The purpose of this study was the intraindividual comparison of a 1.0 M and two 0.5 M gadolinium-based contrast agents (GBCA) using equimolar dosing in dynamic and static magnetic resonance angiography (MRA) of the supra-aortic vessels. Materials and Methods: In this institutional review board-approved study, a total of 20 healthy volunteers (mean +/- SD age, 29 +/- 6 years) underwent 3 consecutive supra-aortic MRA examinations on a 3.0 T magnetic resonance system. The order of GBCA (Gadobutrol, Gadobenate dimeglumine, and Gadoterate meglumine) was randomized with a minimum interval of 48 hours between the examinations. Before each examination and 45 minutes after each examination, circulatory parameters were recorded. Total GBCA dose per MRA examination was 0.1 mmol/kg with a 0.03 mmol/kg and 0.07 mmol/kg split for dynamic and static MRA, respectively, injected at a rate of 2 mL/s. Two blinded readers qualitatively assessed static MRA data sets independently using pairwise rankings (superior, inferior, and equal). In addition, quantitative analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) evaluation as well as vessel sharpness analysis of static MRA using an in-house-developed semiautomated tool. Dynamic MRA was evaluated for maximal SNR. Statistical analysis was performed using the Cohen kappa, the Wilcoxon rank sum tests, and mixed effects models. Results: No significant differences of hemodynamic parameters were observed. In static MRA, Gadobutrol was rated superior to Gadoterate meglumine (P < 0.05) and equal to Gadobenate dimeglumine (P = 0.06) with good to excellent reader agreement (kappa, 0.66-0.83). In static MRA, SNR was significantly higher using 1.0 M Gadobutrol as compared with either 0.5 M agent (P < 0.05 and P < 0.05) and CNR was significantly higher as compared with Gadoterate meglumine (P < 0.05), whereas CNR values of Gadobutrol data sets were not significantly different as compared with Gadobenate dimeglumine (P = 0.13). Differences in CNR between Gadobenate dimeglumine and Gadoterate meglumine were not significant (P = 0.78). Differences in vessel sharpness between the different GBCAs were also not significant (P > 0.05). Maximal SNR in dynamic MRA using Gadobutrol was significantly higher than both comparators at the level of the proximal and distal internal carotid artery (P < 0.05 and P < 0.05; P < 0.05 and P < 0.05). Conclusions: At equimolar doses, 1.0 M Gadobutrol demonstrates higher SNR/CNR than do Gadobenate dimeglumine and Gadoterate meglumine, with superior image quality as compared with Gadoterate meglumine for dynamic and static carotid MRA. Despite the shortened bolus with Gadobutrol, no blurring of vessel edges was observed.