Podcasts about prognostic value

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Prognostic Value of Pericoronary Fat Attenuation Index on Computed Tomography for Hospitalization for Heart Failure.

Incremental Prognostic Value Of Calcium Detection On The Lipid-rich Plaque Vulnerability: Development And Validation Of An Artificial Intelligence Algorithm For Coronary Calcium Detection With Clinica

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Sex Differences in the Prognostic Value of Circulating Biomarkers in Patients Presenting With Acute Chest Pain

Commentary by Dr. Jian'an Wang.

In this September 17, 2024 JACC issue, Dr. Zhi Jian Zhang and colleagues unveil a groundbreaking study on pulmonary arterial hypertension (PAH) that identifies plasma IgG fucosylation and glycan traits as promising prognostic markers. This research not only enhances survival predictions beyond current models but also opens intriguing possibilities for future therapeutic targets in PAH.

Abdullah Al-Abcha, MD, social media editor of JACC: Cardiovascular Interventions, and Jun Jiang, MD, discuss a recently published original research paper on a study that aimed to evaluate the prognostic impact of coronary microvascular function in patients with NSTEMI, as determined by angio-IMR.

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Editor's Summary by Mary McGrae McDermott, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the June 11, 2024, issue.

Commentary by Dr. Valentin Fuster

2024 SCCM Congress: Tuesday Special Guests: Karen Berger, PharmD, FASHP, FCCM, BCCCP, BCPS Melanie Smith Condeni, PharmD, FCCM, BCPS, BCCCP Julie Farrar, PharmD, BCCCP Lama Nazer, PharmD, BCPS Joanna Stollings, PharmD, FCCP, FCCM, BCPS, BCCCP Andy Webb, PharmD, BCCCP 03:05: Star Research Presentation: “Effect of Antipsychotics on Agitation in ICU Delirium: Secondary Analysis of a Randomized Trial” featuring Joanna Stollings 10:43: Star Research Presentations: “Procalcitonin and Antimicrobial Utilization in Critically Ill Cancer Patients with Sepsis (PRO-CAN)” & “Diagnostic and Prognostic Value of Procalcitonin in Critically Ill Cancer Patients with Sepsis” featuring Lama Nazer 25:32: Clinical Pharmacy and Pharmacology (CPP) Year in Review presenter and moderator roundtable discussion featuring Karen Berger, Melanie Smith Condeni, Julie Farrar, and Andy Webb 2024 SCCM Congress website: https://congress2024.sccm.org PharmacyToDose.com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

BUFFALO, NY- January 23, 2024 – A new #research paper was #published in Aging (listed by MEDLINE/PubMed as "Aging (Albany NY)" and "Aging-US" by Web of Science) Volume 16, Issue 1, entitled, “Systematic analysis of the prognostic value and immunological function of LTBR in human cancer.” Lymphotoxin beta receptor (LTBR) is a positive T cell proliferation regulator gene. It is closely associated with the tumor immune microenvironment. However, its role in cancer and immunotherapy is unclear. In this new study, researchers Yinteng Wu, Shijian Zhao, Wenliang Guo, Ying Liu, Marìa Del Mar Requena Mullor, Raquel Alarcòn Rodrìguez, and Ruqiong Wei from The First Affiliated Hospital of Guangxi Medical University, The Eighth Affiliated Hospital of Guangxi Medical University and University of Almerìa analyzed the expression level and prognostic value of LTBR in clinical stages, immune subtypes, and molecular subtypes. The correlation between LTBR and immune regulatory genes, immune checkpoint genes, and RNA modification genes was then analyzed. Correlations between LTBR and immune cells, scores, cancer-related functional status, tumor stemness index, mismatch repair (MMR) genes, and DNA methyltransferase were also analyzed. In addition, the team analyzed the role of LTBR in DNA methylation, mutational status, tumor mutation burden (TMB), and microsatellite instability (MSI). Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA) were used to explore the role of LTBR in pan-cancer. Finally, the drugs associated with LTBR were analyzed. “In this work, we looked into the expression of LTBR at multiple levels.” The expression of LTBR was confirmed using quantitative real-time PCR and Western blot. LTBR is significantly overexpressed in most cancers and is associated with low patient survival. In addition, LTBR expression was strongly correlated with immune cells, score, cancer-related functional status, tumor stemness index, MMR genes, DNA methyltransferase, DNA methylation, mutational status, TMB, and MSI. Enrichment analysis revealed that LTBR was associated with apoptosis, necroptosis, and immune-related pathways. Finally, multiple drugs targeting LTBR were identified. LTBR is overexpressed in several tumors and is associated with a poor prognosis. It is related to immune-related genes and immune cell infiltration. “Notably, we identified LTBR as a potential target for cancer immunotherapy and a marker of immune infiltration and poor prognosis. This study offers new possibilities for the diagnosis and treatment of cancer patients, instilling hope for improved outcomes.” DOI - https://doi.org/10.18632/aging.205356 Corresponding author - Ruqiong Wei - ruqiongwei@sr.gxmu.edu.cn Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts About Aging-US Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

The treatment and management of patients with multiple myeloma is continually evolving, giving rise to novel prognostic tools and therapeutic... The post Unanswered questions regarding the sequencing of BCMA therapies, the prognostic value of CTCs & the growing role of quadruplets appeared first on VJHemOnc.

In this episode, Dr Dante Yeh is joined by Gabriel Brat, MD, FACS, MPH and Jayson Marwaha, MD, MBI, from Beth Israel Deaconess Medical Center, Boston, MA. They discuss their recent study, which compared the predictive utility of preoperative surgeon intuition and surgical risk calculators and found that, while preoperative surgeon intuition alone is an independent predictor of patient outcomes, traditional risk calculators are more robust predictors of postoperative complication.   Disclosure Information: Drs Brat and Marwaha have nothing to disclose. Dr Yeh receives author royalties from UpToDate, advisory panel/training honoraria from Takeda Pharmaceuticals, and advisory panel honoraria from Baxter, Eli Lilly, and Fresenius Kabi.   To earn 0.25 AMA PRA Category 1 Credits™ for this episode of the JACS Operative Word Podcast, click here to register for the course and complete the evaluation. Listeners can earn CME credit for this podcast for up to 2 years after the original air date.   Learn more about the Journal of the American College of Surgeons, a monthly peer-reviewed journal publishing original contributions on all aspects of surgery, including scientific articles, collective reviews, experimental investigations, and more.   #JACSOperativeWord

Welcome to another episode of Medmastery's Cardiology Digest! Today, we're diving into three fascinating studies that have stirred up a bit of chatter in the medical world. So grab your coffee and let's delve right in!   STUDY #1: First, we dig into a study that issues a wake-up call about the potential accuracy of home blood pressure measurements. A dash of detective work is required here that could be the key to solving the mystery of some blood pressure anomalies. Cue suspenseful music! Picone DS et al. Availability, cost, and consumer ratings of popular nonvalidated vs validated blood pressure–measuring devices sold online in 10 countries. JAMA 2023 May 2; 329:1514. (https://doi.org/10.1001/jama.2023.2661)   STUDY #2: Our second study takes a close look at 24-hour ambulatory blood pressure measurement and its prognostic value. It's a robust study, but doesn't shy away from addressing some thorny issues surrounding the use of ambulatory monitoring in the U.S. Does this comprehensive blood pressure monitoring lead to better clinical outcomes? This is sure to spark some debate! Staplin N et al. Relationship between clinic and ambulatory blood pressure and mortality: An observational cohort study in 59 124 patients. Lancet 2023 May 5; [e-pub]. (https://doi.org/10.1016/S0140-6736(23)00733-X)   STUDY #3: Lastly, we explore a paper that evaluates whether apixaban, a commonly prescribed oral anticoagulant, had a higher rate of thromboembolic events than warfarin when given to patients with On-X mechanical aortic valves. Tune in as we explore the implications of this eye-opening research!. Wang TY et al. Apixaban or warfarin in patients with an On-X mechanical aortic valve. NEJM Evid 2023 May 6; [e-pub]. (https://doi.org/10.1056/EVIDoa2300067)   Join us for this informative overview of contemporary research, as we break down complex medical concepts into digestible nuggets of knowledge, suitable for both medical students and healthcare professionals eager to keep up-to-date in cardiology. For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.  

Commentary by Dr. Candice Silversides

Commentary by Dr. Julie Rosenthal

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care.Louise leads this conversation with commentary carrying over from last week's discussion on FibroScan as an essential test. Her hope remains that FibroScan be utilized in the early screening process, noting that many patients with poor liver health are still captured much too late in the process. She agrees with the consensus that, while imperfect, FIB-4 currently has the potential to improve patient capture rates. Mazen follows up with a comment on the nature of PPV being highly subjective to both test accuracy and patient population.Ian suggests that some of the preceding conversation anchors performance of these tests to biopsy. Interested in moving beyond biopsy, he points out presentations which compare outcomes of patients according to either biopsy or associated noninvasive tests. The first paper he notes is titled Prognostic Value of Non-Invasive Tests in Patients with NAFLD. This study looks at outcomes for 1,700 patients with various non-invasive tests and demonstrates the value of each in predicting outcomes. Ian explains the conclusion is that NITs should be accepted as surrogate tests for clinical trials. He then looks at a presentation by Samer Gawrieh which correlates VCTE values with progression to cirrhosis and clinical events. He believes this to be the direction in which the field should move.Mazen agrees with the idea that as data accumulates around NITs, we can better understand how longitudinal changes impact outcomes. He then briefly describes other presentations and posters at this meeting that address similar topics. His final comments describe the FDA's interest in NITs: how do we give meaning to improvements in the efficacy of NITS and how do these improvements translate into better outcomes.

The 19th International Myeloma Society (IMS) Annual Meeting was held in Los Angeles, CA, and brought together experts in the field,... The post Highlights from IMS 2022: managing high-risk & frail patients with myeloma and the prognostic value of MRD appeared first on VJHemOnc.

The 19th International Myeloma Society (IMS) Annual Meeting was held in Los Angeles, CA, and brought together experts in the field,... The post Highlights from IMS 2022: managing high-risk & frail patients with myeloma and the prognostic value of MRD appeared first on VJHemOnc.

Commentary by Dr. Chang-Wook Nam

*PCT: Prokalsitonin; MASCC: Multinational Association of Supportive Care in Cancer Nötropenik ateş, hematopoetik kanserler veya kanser için kemoterapötik rejimler alan hastalar ile ilişkili en yaygın ve ciddi komplikasyondur. Nötropenik ateş, nötropenik bir hasta bulaşıcı bir patojenle karşılaştığında ortaya çıkar. Bu bağışıklığı baskılanmış durumda, hastalar enfeksiyonlardan korunmak için gereken bağışıklıklarını kaybederler veya hastaların bağışıklıkları zayıflar. Kemoterapi ve radyasyon tedavisi gören hastaların yaklaşık %1'i bu komplikasyonu yaşar.​1​ Nötropenik ateşin epidemiyolojisi, tanısı, tedavisi için Prof. Dr. Nurettin Özgür Doğan Hocamızın editörlüğünde, Doç. Dr. Elif Yaka Hocamız tarafından yazılmış olan Nötropenik Ateş yazısını okumanızı tavsiye ederim. Tanım Nötropenik ateş tanımı, mutlak nötrofil sayısının 500'ün altında olduğu veya 48 saat içinde

For this week's Feature Discussion, please join authors Igor Klem, Pasquale Santangeli, Mark N.A. Estes III, and Associate Editor Victoria Delgado as they discuss, in a panel forum, the articles: " The Relationship of LVEF and Myocardial Scar to Long-Term Mortality Risk and Mode of Death in Patients with Non-Ischemic Cardiomyopathy," "Prognostic Value of Non-Ischemic Ring-Like Left Ventricular Scar in Patients with Apparently Idiopathic Non-Sustained Ventricular Arrhythmias," and "Cardiac Magnetic Resonance Imaging in Nonischemic Cardiomyopathy: Prediction Without Prevention of Sudden Death." Dr. Carolyn Lam: Welcome to Circulation on the run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate editor, Director of the Pauley Heart Center in Richmond, Virginia. Well Carolyn, this week we've got another sort of double feature with a forum and our focus is going to be on myocardial scar that's observed with late gadolinium enhancement during cardiovascular magnetic resonance and the two author groups we'll be discussing the impact of that scar on the development of ventricular arrhythmias. But before we get to that, how about we grab a cup of coffee and jump into the other articles in the issue? Would you like to go first? Dr. Carolyn Lam: I certainly would. Although I have to say, can't wait for the double feature. I love those, and this is right up your alley too. All right. But first, the first paper I want to talk about provides new randomized trial information regarding the benefits of catheter ablation in atrial fibrillation in patients who also have heart failure. Now, this is a sub-study of the CABANA trial. Dr. Greg Hundley: So Carolyn, remind us a little bit about the CABANA trial first. Dr. Carolyn Lam: I thought you might ask. Well, CABANA randomized 2,204 patients with atrial fibrillation who were 65 years or older or less than 65 with one or more risk factors for stroke at, it was huge at 126 sites, and they were randomized to ablation with pulmonary vein isolation or drug therapy. Now of these, 35% of 778 patients had New York Heart Association Class II or higher at baseline, and really formed the subject of the current paper. Although this sub-study was not specifically designed to evaluate patients with heart failure with preserved ejection fraction, about 91% of the patients with a clinical diagnosis of heart failure participating in CABANA for whom such data on injection fraction were available, really had an ejection fraction of above 40% and fully 79% had an ejection fraction above 50%. So excitingly, this is really majority talking about, have HFpEF. Now, what did they find well in patients with New York heart Association Class II or III heart failure at trial entry, most of whom did not have a reduced ejection fraction. Dr. Carolyn Lam: There was substantial clinical outcome benefits with the ablation over drug therapy with a 36% relative reduction in the primary composite endpoint of death, disabling stroke, serious bleeding or cardiac arrest. Benefits were evident for both all-cause mortality and atrial fibrillation reduction. However, the effects on heart failure hospitalization were small and not significant. Authors also caution that these results should not be viewed as practice changing until they are reproduced in a confirmatory trial of ablation in the same population. And this is beautifully discussed in an editorial by Lynda Rosenfeld and Alan Enriquez from Yale University School of Medicine. Dr. Greg Hundley: Oh, wow. Thanks Carolyn. Well, my first paper comes from the world of basic science and it's from Professor Thomas Braun, from the Max Planck Institute for Heart and Lung Research. So Carolyn, vascular smooth muscle cells show a remarkable phenotypic plasticity allowing acquisition of contractile or synthetic states, but critical information is missing about the physiological signals that promote formation and maintenance of contractile vascular smooth muscle cells in vivo. So BMP-9 and BMP-10 are known to regulate endothelial quiescence after secretion from the liver and right atrium. And these investigators are studied the role of BMP-9 and 10 for controlling formation of contract, all vascular smooth muscle cells. Dr. Carolyn Lam: Greg, talking about vascular smooth muscle cells always reminds me of their role in pulmonary hypertension, am I right? Dr. Greg Hundley: Yes, Carolyn. So these investigators found that in mouse models, BMP-9 and BMP-10 act directly on vascular smooth muscle cells for induction and maintenance of their contractile state, and surprisingly the effects of BMP-9 and 10 in vascular smooth muscle cells are mediated by different combinations of BMP type 1 receptors in a vessel bed specific manner. And therefore, just as you suggest, Carolyn, these results may offer new opportunities to manipulate blood pressure in the pulmonary circulation. Dr. Carolyn Lam: Thank you, Greg. Well, my next paper provides the first proof of principle of gene therapy for complete correction of Type 1 Long QT syndrome. Dr. Greg Hundley: Ah, so tell us a little bit about Type 1 Long QT syndrome, Carolyn. Dr. Carolyn Lam: Okay. Well Type 1 long QT syndrome is caused by loss of function variants in the KCNQ1 and coded potassium channel alpha sub-unit. And that is essential for cardiac repolarization providing the slow delayed rectifier current. Now no current therapies target the molecular cause of this Type 1 long QT syndrome. Well, this study from Dr. Michael Ackerman colleagues from Mayo Clinic Rochester really established a novel dual component suppression and replacement KCNQ1 gene therapy approach for Type 1 long QT syndrome. And it's the type that contains the KCNQ1 short hairpin RNA to suppress endogenous expression and a codeine altered short hairpin RNA immune copy of this KCNQ1 for gene replacement. Dr. Carolyn Lam: So this very novel approach rescued the prolonged action potential duration in inducible pluripotent STEM cell cardiomyocytes derived from four patients with unique Type 1 Long QT syndrome, causative, KCNQ1 variants. So it's super cool. Just go have a look. Dr. Greg Hundley: Well, thanks Carolyn. Dr. Carolyn Lam: I want to also tell you about other things in the mail bag. We have ECG Challenge by Dr. Dai on “Severe Arrhythmia Caused by a Chinese Herbal Liqueur. What's the Diagnosis?” I'm not going to tell you. You have to go see. We have Dr. Karen Sliwa writing a beautiful Joint Opinion paper from the World Heart Federation and American College of Cardiology, American Heart Association, and European Society of Cardiology on "Taking a Stand Against Air Pollution, the Impact on Cardiovascular Disease." Dr. Greg Hundley: Well, thanks Carolyn. So I've got a couple other articles. First Professor Yacoub has a global rounds describing and working towards meeting the challenges of improving cardiovascular health in Egypt. Those are really interesting features to learn about cardiovascular care worldwide. Next there's an In Depth article by Professor Thum entitled, "Therapeutic and Diagnostic Translation of Extracellular Vesicles in Cardiovascular Diseases, Roadmap to the Clinic." And then finally, a Research Letter from Dr. Bottá entitled, "Risk of Coronary Artery Disease Conferred by Low Density Lipoprotein Cholesterol Depends on Apologetic Background." Well, Carolyn, what a great issue and how about now we proceed on to that double feature? Dr. Carolyn Lam: Oh, I can't wait. Thanks Greg. Dr. Greg Hundley: Well, listeners, we are here for a really exciting feature discussion today that's going to focus on imaging, in particular magnetic, resonance imaging, and some new findings in that era and how those findings may pertain to ventricular dysrhythmias. With us today, we have Dr. Igor Klem from Duke University who will be discussing a paper, Dr. Pasquale Santangeli from University of Pennsylvania, our own associate editor, Dr. Victoria Delgado from Leiden and an editorialist, Dr. Mark Estes from UPMC in Pittsburgh. Welcome to all of you. Well, Igor, we're going to start with you. Could you tell us what was the hypothesis for your study and what was your study population in study design? Dr. Igor Klem: Yes. Good morning, Greg and thanks for the invitation. We wanted to know if you have a patient who you diagnosed with non ischemic cardiomyopathy based on clinical grounds and you refer him for a cardiac MRI study with contrast, what is the additional information that you get from the MRI study? And so we wanted to compare, and that's primarily related to the findings on scar imaging with late gadolinium enhancement. And we wanted to compare that to one of the most robust clinical parameters in cardiology, which is left ventricular ejection fraction, and in particular using a cutoff of 35%, which somehow in our clinical management has sort of as established as a break point for many clinical decisions. Dr. Igor Klem: And so we created a registry among three centers of patients who undergo a cardiac MRI study, where we found an LVEF of less than 50% and we followed them for a number of outcomes. One is all caused death. And then we wanted to separate a little bit the events into those who have cardiac mortality to look at a little epidemiology because in those patients, we have two major adverse events: one as heart failure related mortality. One is arrhythmia related mortality. Dr. Greg Hundley: And how many subjects did you include? Dr. Igor Klem: We included about a thousand patients from three centers and coming to the major findings of our study, we found that both left ventricular ejection fraction, as we know, is a robust marker of all cause mortality and cardiac death. And so it was the presence of myocardial scar on cardiac MRI. But the major difference was in relation to the arrhythmic events. We founded left ventricular ejection fraction in particular, when we use the 35% cutoff actually had very little predictive power to inform us who is at risk of arrhythmic events. In contrast, there was a very strong and robust relationship or multiple statistical methods to stratify patients who are at risk for sudden cardiac death, appropriate ICD shock, as well as arrhythmic cardiac death. Dr. Greg Hundley: Very good. Well, Pasquale understand you also performed a research study utilizing cardiovascular magnetic resonance. Could you describe for us your hypothesis as well as what was your population and your study design? Dr. Pasquale Santangeli: Thank you, Greg. And of course, thanks to the editor for the interest in our paper. I need to thank also the first call authors Daniele Muser and Gaetano Nucifora for putting together a registry of 70 institutions throughout the U.S., Europe, and Japan and the our hypothesis came from a clinical need. We do know that patients with idiopathic ventricular re we ask, which includes not sustain a weakness like PVCs or non-sustained VT. Very few of them, but there is a group of them that have a higher risk of ending malignant and up comes in terms of your ethnic events over follow-up. And prior studies have shown that by doing an MRI and showings and the detecting scar related announcement, there is an increase with how we make events of a follow-up. However, if you do look at those studies late, an answer's been reported in up to 70% of these patients, which you never view is a highly practical way of re-stratifying these patients, because you have a risk factor that is present 70% of those, then it's hard to use it for clinical decision-making. Dr. Pasquale Santangeli: So in this registry, which you put it again at 686 patients with panel data idiopathic, not sustained ventricular arrhythmias, which were defined by a normal WBC gene status, a normal echocardiogram and a normal stress test. We looked at whether there is a specific pattern of late announcement. So how basically I believe lands, and it looks on the MRI, they may predict better or outcomes over follow-up. And again, we use a composite and Pauline the full cost mortality, but associated cardiac arrest due to ventricular fibrillation or a hemodynamically unstable BP, or in a subgroup of patients that underwent ICD therapy. We also looked at, I approve SED shocks. Dr. Pasquale Santangeli: The groups were divided in three different categories. The first one, which is a larger group of 85% of patients and no late announcement. The second group, the one with late announcement, which represents the remaining 50% of 15% of patients, we divided it into a ring light pattern, which was defined as that word says, as a ring like distribution of the lead announcement in the mid-market segments, which involves a three consecutive continuous segments in a short axis view. It looks like really at least half the ring or three-quarters of the ring. Dr. Pasquale Santangeli: And the other group is the one that had the leader announcement without a ring light pattern. And it's interesting that the third and the latest announcement was not that similar between the ring light and the one without ring light late announcement. What we did find though for our follow-up the patient with a ring light pattern, a significantly higher rate of the primary composite endpoint, which happened in the median follow-up about 61 months so it was quite long. And the composite outcome occurred in 50% of patients in the ring light group versus 19% in the no ring light a positive announcement group and a 0.3%. So really, really rare in patients. So then concluded that of course, late announcement does provide some information in general, particularly the type of announcement that increases the risk significantly. Probably although this has to be confirmed prospective fashion patient with a ring light pattern may benefit from other forms of interventions, including potentially defibrillator therapy in a prophylactic fashion. Dr. Greg Hundley: Very nice. So now listeners, we're going to turn to our associate editor. One of the imaging experts here at Circulation, Dr. Victoria Delgado. Victoria, you see a lot of papers come across your desk and as an imaging expert, what attracted you to these two papers? And what do you think are their significance? Dr. Victoria Delgado: Thank you, Greg. I think that these two papers are important because right now, if we follow the clinical guidelines, we decide implantation. For example, of an ICD based on the ejection fraction, and we see that in many patients based on ejection fraction, they may not benefit ever from an ICD because they don't have arrhythmias. What other patients who do not meet the criteria often injection fraction below 35%. They may have still arrhythmias. So the article by Igor highlights the relevance of the amount of burden of late government Huntsman with CMR, in patients with non ischemic cardiomyopathy, which are sometimes very challenging patients on how to decide when we implant an ICD or not. We need sometimes to base the decision on genetics. Dr. Victoria Delgado: If we have an on the other hand, the paper of Pasquale, these were patients with normal echocardiogram. So what patient, having arrhythmias where we don't see on echocardiogram, that is the first imaging technique that we usually use to evaluate these patients. We don't see anything, but CMR can give us more information in terms of structural abnormalities and particularly not only the burden of scar, but also the pattern of the scar. And we have seen in other studies that for example, not only for ICD implantation, but for ventricular tachycardia ablation. The characteristics of that scar and some areas where these are short of panel that can be targeted for that ventricular tachycardia ablation can lead to much more precise treatment if you want of these patients. Dr. Greg Hundley: Thank you, Victoria. So it sounds like listeners we're hearing late gadolinium enhancement, regardless of EF could be forecasting, future arrhythmic events. And then also the pattern of late gadolinium enhancement, where contiguous segments in a ring-like fashion may also offer additional prognostic information. Well, now we're going to turn to our editorialists and as you know, listeners at Circulation, we'll bring in an editorialist to really help put things together and uniquely here today, we have Dr. Mark Estes, who is really not an imager per se, but like many of us uses the information from imaging to make clinical decisions. Mark, how do you see this late gadolinium enhancement as perhaps a new consideration for placement of devices? Dr. N.A. Mark Estes: Greg, that's one of the key questions. There's no doubt, not only based on these two studies, which extend our prior information about LGE and patients with valid and non ischemic cardiomyopathies that scar burden is important in predicting not only total mortality, but arrhythmic events. All of the criteria that were used in the original ICD studies, which include the definite, the Skuid half Danish and made it our it trials use only ejection fraction and functional status, no imaging. These are legacy trials. Now, many of them, a decade or more older. And the treatment of advanced heart failure has progressed to the point that the total mortality is dramatically lower than it was at the time of these studies. In some instances down to 4 or 5% per year. The studies are important in that they identify a subgroup of patients with low ejection fractions, less than 35%, who might qualify for ICDs, who are unlikely to benefit. Dr. N.A. Mark Estes: They also identify a group of patients with preserved ejection fraction greater than 35%, less than 50 in whom the risk of sudden death may be substantial. And it extends prior observations about patchy, mid Meyer, cardio wall fibrosis, subendocardial, subepicardial and important ways. But the key issue here, and it was alluded to with Pasquale's comments about prospective validation, is that when one has a risk stratifier and identifies a high risk population that has to be linked to an unequivocal therapy, it improves survival. And we don't have that link quite yet. Dr. N.A. Mark Estes: Prospective randomized trials are unlikely to be done in the low ejection fraction because they would probably be considered unethical. Given the trials that have shown the benefit you can't randomize to defibrillator versus an implantable loop recorders. I think the future really lies in risk stratification for people with preserved ejection fractions greater than 35%, less than 50 using LG in that patient population. Currently, I think the best information we can give to clinicians is to stick with the AHA guidelines, which is PF less than 35% with dilated, nonischemic class II symptoms who have had optimal medical therapy for at least three months using perhaps in that patient population LGE for shared decision-making in patients about the magnitude of the risk. And I think that's as far as we can go pending future studies, and there is one which we can discuss later on the CMR study at just that preserved ejection fraction LGE randomizing to defibrillator versus ILR. Dr. Greg Hundley: Thank you, Mark. So listeners just really quickly, let's go back to each of our experts and ask them, you know, in 20 seconds, Igor, Pasquale, Victoria, and Mark, what's the next study that needs to be performed in this space? Igor, we'll start with you. Dr. Igor Klem: Well, number one, following on Mark's comment on the less than 35% population, I think that it's unlikely that they're randomized clinical trial is ethical in this population, but we may consider a wealth of registry data by now that shows that there is a subgroup of patients who have a lower risk or lower benefit from an ICD. I think in the preserved ejection fraction above 35%, maybe up to 45%, 50%. That's an interesting study that's coming up. Maybe there's more trials that can provide us that robust information that we need today in order to change the guidelines to risk stratify, not based on the LVF, but on the presence of scar or maybe subgroups of scar. Dr. Greg Hundley: Pasquale? Dr. Pasquale Santangeli: Yes. So I think of course, one of the major studies is the one already alluded by this, which is a prospective study that links as specific therapy like ICD or even additional risk factors like we've been using program's stimulation some of these patients to further risk for the five to see what they can benefit. Dr. Pasquale Santangeli: Based another one that I think is important for the study that we did is a mechanistic more study to understand why the ring light pattern was there, as opposed to other patterns. We do believe we think that some of these patients may have an initial form of lb dominant arrhythmogenic paramount. There wasn't really a detective before and ran. Now, if we actually extending our study and have a registry to try to screen also the family members or patients with ring light pattern to understand whether there is a familiar component to it, because really we do not see this type of pattern that commonly and it'd been associated with lb dominant. Magnetic kind of alpha in some others, small studies. Dr. Pasquale Santangeli: So that's the other part to dig in a little bit more into the field type for these patients to understand why one pattern versus another happens and whether that gets main to, to explain why there's a higher risk in one population versus another. Dr. Greg Hundley: Victoria. Dr. Victoria Delgado: Yeah. Following what has been said. I think that from the imaging point of view, we are always criticizing in a way that we increase the burden or the cost of healthcare. But I think that these studies or any randomized study where MRI or echo is used in order to design a therapy and show the value of using that imaging technique to optimize the health care costs is important. So I will not add much on which sort of populations, but probably patients within non ischemic cardiomyopathy with preserved ejection fraction that do not fulfill the recent scores, for example, in hypertrophic cardiomyopathy to be implanted with an ICD. But probably if we see a lot of scar on a AGE where specific patterns that can help to decide which are the patients that have benefited from an ICD implantation, for example. Dr. Greg Hundley: Thank you. And finally Mark. Dr. N.A. Mark Estes: But I think all the major points have been hit here. And unfortunately we have a bit of a dilemma. And that dilemma is that these legacy trials for ICDs, which selected based on low ejection fraction and functional class II were done at a time when contemporary heart failure treatment was not as good as it currently is pharmacologically. And it's been reflected with a lower total mortality. When the mortality in this patient population gets down to the 4 and 5% per year, it's unlikely that any intervention for prevention of sudden death is going to impact on that total mortality. Dr. N.A. Mark Estes: So I do think that the registries hold a lot of promise, giving us insights into the subgroup of patients that previously would have been selected for defibrillators who may not have as much benefit or who may benefit the most. And I think that they will play an important part in perhaps refining the risk stratification with greater sensitivity and specificity in the patient population, less than 35%. I think the CMR guide trial is going to be a critical trial and looking at ICDs in the patient population between 35 and 50%, but we need to be mindful of one thing. And that in the Danish trial, they get a sub study looking at about 240 patients using LGE. And they found that ICD in patients with LGE that was positive, did not make a difference in survival or total mortality. So again, we need to get the data. I think the best clinical practice has come out of the best clinical evidence. You'll clearly be limitations to what we can do, but I think in the future, we'll have much better data to make these judgment calls. Dr. Greg Hundley: Very good. Well listeners, we want to thank our panelists, Dr. Igor Clem, Pasquale, Santangeli, Victoria Delgado, and Dr. Mark Estes for this wonderful discussion related to magnetic resonance imaging, late gadolinium enhancement, and how it may be useful in identifying those at risk for future arrhythmic events. On behalf of both Carolyn and myself, want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021.  

Commentary by Dr. Valentin Fuster

I shouldn’t have to tell you that traumatic brain injury is a major cause of morbidity and mortality. I shouldn’t have to. But I will. And it is. In severe cases of head injury, there can be delayed and irreversible deterioration in the nervous system for which there is no treatment and the prognosis is grim. This week on the program, Dr. Monisha Kumar (University of Pennsylvania) discusses the worst of the worst of these scenarios, what to look out for, and expert recommendations on what to do when it happens. Produced by James E. Siegler and Monisha Kumar. Music courtesy of Rui, Swelling, Unheard Music Concepts, Jahzzar, Ian Southerland, and TRG Banks. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. Journal of neurology, neurosurgery, and psychiatry. 1956;19:163-85. Adams JH, Graham DI, Murray LS and Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Annals of neurology. 1982;12:557-63. Povlishock JT, Becker DP, Cheng CL and Vaughan GW. Axonal change in minor head injury. J Neuropathol Exp Neurol. 1983;42:225-42. Gentry LR. Imaging of closed head injury. Radiology. 1994;191:1-17. Meythaler JM, Peduzzi JD, Eleftheriou E and Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil. 2001;82:1461-71. Arfanakis K, Haughton VM, Carew JD, Rogers BP, Dempsey RJ and Meyerand ME. Diffusion tensor MR imaging in diffuse axonal injury. AJNR American journal of neuroradiology. 2002;23:794-802. Scheid R, Preul C, Gruber O, Wiggins C and von Cramon DY. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3 T. AJNR American journal of neuroradiology. 2003;24:1049-56. DeKosky ST, Ikonomovic MD and Gandy S. Traumatic brain injury--football, warfare, and long-term effects. The New England journal of medicine. 2010;363:1293-6. Johnson VE, Stewart W and Smith DH. Widespread tau and amyloid-beta pathology many years after a single traumatic brain injury in humans. Brain Pathol. 2012;22:142-9. Schrag M and Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2014;23:2489-2497. Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, Moore L, Zarychanski R, Douville V, Fergusson D and Turgeon AF. The Prognostic Value of MRI in Moderate and Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Critical care medicine. 2017;45:e1280-e1288. Izzy S, Mazwi NL, Martinez S, Spencer CA, Klein JP, Parikh G, Glenn MB, Greenberg SM, Greer DM, Wu O and Edlow BL. Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal. Neurocritical care. 2017;27:199-207. van Eijck MM, Schoonman GG, van der Naalt J, de Vries J and Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj. 2018;32:395-402.

Podcast Contents 00:00-9:55- Introduction by David A. Bluemke, MD, PhD, Editor of Radiology.   09:45- 17:27– Radiogenomic Analysis of Breast Cancer by Linking MRI Phenotypes with Tumor Gene Expression. Bismeijer et al. Radiology 2020; 296:277–287. [Full Text]   17:28- 26:23– Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction. Leng and Ge et al. Radiology 2020; 296:299–309. . [Full Text]    26:24- 32:39 - Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis. Walker et al. Radiology 2020; 296:312–321. [Full Text]    32:40- 38:47– Distal Femoral Cortical Irregularity at Knee MRI: Increased Prevalence in Youth Competitive Alpine Skiers. Stern et al. Radiology 2020; 296:411–419. [Full Text]   38:04-38:47– Conclusion by David A. Bluemke, MD, PhD, Editor of Radiology

Episode 15: In this episode, Angie Gust goes over information from nutrition experts in relation to the coronavirus. One such expert, Dr. T. Colin Campbell posed the question, "Does a whole food, plant-based diet – known to prevent, and even reverse a broad range of chronic degenerative diseases – act in a similar way to minimize viral diseases?” Based on his studies with the hepatitis B virus, he says that a whole food plant based diet might offer an important path to fight the coronavirus pandemic. The important UN climate meeting, COP 26, that was supposed to convene this November, will take place between Nov 1 and 12, 2021.   References Akhtar, A.  Our Symphony With Animals ~ On Health, Empathy & Our Shared Destiny With Animals. Pegasus Books, NY, 2019. Borenstein, S. May 19, 2020. World carbon pollution falls 17% during pandemic peak. US News and World Report. https://www.usnews.com/news/business/articles/2020-05-19/study-world-carbon-pollution-falls-17-during-pandemic-peak Campbell, TC. Apr 27, 2020.The Path to Recovery through Nutrition: Our Most Important Defense Against COVID-19. https://plantpurecommunities.org/the-path-to-recovery/ Campbell, T. C., Chen, J., Liu, C., Li, J. & Parpia, B. Non-association of aflatoxin with primary liver cancer in a cross-sectional ecologic survey in the People’s Republic of China. Cancer Res. 50, 6882-6893 (1990). Campbell, T. C., and Howard Jacobson. Whole: Rethinking the Science of Nutrition. BenBella Books. 2014. Campbell, T. C. & Campbell, T. M. I. The China Study, startling implications for diet, weight loss and long-term health. pp. 184-187, 2006. Campbell, T. C., Chen, J., Liu, C., Li, J. & Parpia, B. Non-association of aflatoxin with primary liver cancer in a cross-sectional ecologic survey in the People’s Republic of China. Cancer Res. 50, 6882-6893 (1990). Campbell, T. C. Nutrition renaissance and public health policy. J. Nutr. Biology 3(1), 124-138 (2017). J Nutr Biol. 2017;3(1):124-138. doi:10.1080/01635581.2017.1339094 (2017). Campbell, T. C. The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health. 2016. Print. CDC. 2020. COVID-19 Forecasts. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html#anchor_1587397564229 Chen, J., Campbell, T. C., Li, B. & Peto, R. Diet, life-style and mortality in mainland China and Taiwan. A study of the characteristics of 85 Chinese counties. (Harvard University, 1998). Chen, J., Campbell, T. C., Li, B. & Peto, R. Diet, life-style and mortality in mainland China and Taiwan. A study of the characteristics of 85 Chinese counties. (Harvard University, 1998). Ferris, D. May 14, 2020. How lockdowns boost renewables and harm coal. , E&E News reporter Energywire. https://www.eenews.net/stories/1063130269 Hickman, M. 2009. Study claims meat creates half of all greenhouse gases. Independent. https://www.independent.co.uk/environment/climate-change/study-claims-meat-creates-half-of-all-greenhouse-gases-1812909.html Goodland, R and Anhang, J. 2009. Livestock and climate change: What is the key actors in climate change are...cows, pigs and chickens? World Watch. https://awellfedworld.org/wp-content/uploads/Livestock-Climate-Change-Anhang-Goodland.pdf Le Quéré, C., Jackson, R.B., Jones, M.W. et al. Temporary reduction in daily global CO2 emissions during the COVID-19 forced confinement. Nat. Clim. Chang. (2020). https://doi.org/10.1038/s41558-020-0797-x Pollan, M.  June, 2020. “The Sickness in Our Food Supply”. The New York Review of Books. https://www.nybooks.com/articles/2020/06/11/covid-19-sickness-food-supply/ Rowling, M.Vulnerable nations say delayed summit should not mean delayed climate actionThomson Reuters Foundation. https://news.trust.org/item/20200529132518-m7487/?utm_campaign=trending&utm_medium=trendingWebWidget&utm_source=detailPage&utm_content=link2 Shikha G. et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019, COVID-NET, 14 States, March 1–30, 2020,” Morbidity and Mortality Weekly Report, Vol. 69, No. 15 (April 17, 2020).  Singhal, T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020 Apr;87(4):281-286. doi: 10.1007/s12098-020-03263-6. Epub 2020 Mar 13. Slisco, A. 5/7/2020. Elizabeth Warren and Cory Booker Join Forces on Bill to Ban Most Factory Farming by 2040. Newsweek. https://www.newsweek.com/elizabeth-warren-cory-booker-join-forces-bill-ban-most-factory-farming-2040-1502699 Woodend, D. May 15, 2020. Are we ready to “Meat the Future?”TheTyee.ca. https://thetyee.ca/Culture/2020/05/15/Ready-Meat-Future/ Xiaomin Luo et al. Prognostic Value of C-Reactive Protein in Patients with COVID-19,” medRxiv, March 23, 2020. The study has not yet been peer-reviewed.   

EJVES Editor's Choice

Commentary by Dr. Valentin Fuster

Dr. Karen G. Hirsch discusses her paper entitled, "Neurology Journal: Prognostic Value of Diffusion-Weighted MRI for Post-Cardiac Arrest Coma".  

Commentary by Dr. Valentin Fuster

Commentary by Dr. Valentin Fuster

This is a podcast summary by Dr. Jason Lee, on behalf of his colleagues, on the article entitled, "Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD".

This is a podcast summary by Dr. Jason Lee, on behalf of his colleagues, on the article entitled, "Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD".

Commentary by Dr. Valentin Fuster

We investigate the claim that a subjective assessment is an accurate way to measure functional capacity. We also explore whether self-reported ability to climb two flights of stairs is the best subjective method to assess functional capacity and whether exercise tolerance greater than or equal to 4 metabolic equivalents predicts the risk of perioperative complications in any major non-cardiac surgery. Our guests today are Dr. Elisa Walsh and Dr. Laurie Shapiro of the Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Wijeysundera et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018; 391: p2631-2640. Fleisher et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130: e278-e333. Hlatky et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989 Sep 15;64(10):651-4. Wang et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med. 2004;350(7):655. Kistrop et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609. Struthers et al. The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent ‘pancardiac’ target organ damage. European Heart Journal, Volume 28, Issue 14, July 2007, Pages 1678–1682 Carliner et al. Routine preoperative exercise testing patients undergoing major noncardiac surgery. Am J Cardiol 1985;56;51-58. Sgura et al. Supine exercise capacity identifies patients at low risk for perioperative cardiovascular events and predicts long-term survival. Am J Medicin 2000; 108. Kistorp et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293(13):1609. Reilly et al. Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med. 1999 Oct 11;159(18):2185-92. Melon et al. Validated questionnaire vs physicians' judgment to estimate preoperative exercise capacity. JAMA Intern Med. 2014 Sep;174(9):1507-8. Weinstein et al. Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing. Anesthesiol Res Pract. 2018; 2018: 5912726. Ryding et al. Prognostic Value of Brain Natriuretic Peptide in Noncardiac Surgery: A Meta-analysis. Anesthesiology. 8 2009, Vol.111, 311-319. Wright et al. Examining Risk: A Systematic Review of Perioperative Cardiac Risk Prediction Indices. Mayo Clin Proc. 2019. Wiklund RA, Stein HD, Rosenbaum SH. Activities of daily living and cardiovascular complications following elective, noncardiac surgery. Yale J Biol Med 2001; 74: 75–87 Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-   Glover MC, Leon AS. 2011 Compendium of Physical Activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 2011;43(8):1575-1581. --

Commentary by Dr. Valentin Fuster http://traffic.libsyn.com/jaccaudio/JACC7420_fustersummary_01.mp3

Interview with Paaladinesh Thavendiranathan, MD, MSc, FRCPC, FASE, author of Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis

Interview with Paaladinesh Thavendiranathan, MD, MSc, FRCPC, FASE, author of Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis

Commentary by Dr. Valentin Fuster

Interview with Jeroen J. Bax, MD, PhD, author of Association of Left Ventricular Global Longitudinal Strain With Asymptomatic Severe Aortic Stenosis: Natural Course and Prognostic Value, and James D. Thomas, author of Moving Past Ejection Fraction in Timing of Aortic Stenosis Intervention

Interview with Jeroen J. Bax, MD, PhD, author of Association of Left Ventricular Global Longitudinal Strain With Asymptomatic Severe Aortic Stenosis: Natural Course and Prognostic Value, and James D. Thomas, author of Moving Past Ejection Fraction in Timing of Aortic Stenosis Intervention

Commentary by Dr. Valentin Fuster

Prof Saiag talks to ecancertv at EADO 2015 about the prognostic value of BRAFV600 mutations in American Joint Committee on Cancer (AJCC) stage 3 cutaneous melanoma patients in the MelanCohort prospective cohort.

Commentary by Dr. Valentin Fuster

Prof Michael Baumann - University Hospital Carl Gustav Carus, Dresden, Germany Prof Schrappe talks to ecancertv at ECC 2015 about the final results of the prospective DDFMISO-trial validating hypoxia-specific PET imaging during radiochemotherapy for local control of locally advanced head-and-neck cancer.

Veterinary Pathology podcast editor Leah Schutt discusses the the article, "Prognostic Value of Histologic Grading for Feline Mammary Carcinoma: A Retrospective Survival Analysis" with Dr. Simko, one of the authors of the study.   To view this article, click here.

This podcast provides a commentary on the association of braf mutation and thyroid cancer showing an increase risk of recurrence in patients with thyroid cancer that harbor this mutation.

Background Selective Internal Radiation Therapy (SIRT) is a new and effective locoregional anticancer therapy for colorectal cancer patients with liver metastases. Markers for prediction of therapy response and prognosis are needed for the individual management of those patients undergoing SIRT. Methods Blood samples were prospectively and consecutively taken from 49 colorectal cancer patients with extensive hepatic metastases before, three, six, 24 and 48 h after SIRT to analyze the concentrations of nucleosomes and further laboratory parameters, and to compare them with the response to therapy regularly determined 3 months after therapy and with overall survival. Results Circulating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), C-reactive protein (CRP) and various liver markers increased already 24 h after SIRT. Pretherapeutical levels of CYFRA 21-1, CEA, cancer antigen 19-9 (CA 19-9), asparate-aminotransferase (AST) and lactate dehydrogenase (LDH) as well as 24 h values of nucleosomes were significantly higher in patients suffering from disease progression (N = 35) than in non-progressive patients (N = 14). Concerning overall survival, CEA, CA 19-9, CYFRA 21-1, CRP, LDH, AST, choline esterase (CHE), gamma-glutamyl-transferase, alkaline phosphatase, and amylase (all 0 h, 24 h) and nucleosomes (24 h) were found to be prognostic relevant markers in univariate analyses. In multivariate Cox-Regression analysis, the best prognostic model was obtained for the combination of CRP and AST. When 24 h values were additionally included, nucleosomes (24 h) further improved the existing model. Conclusion Panels of biochemical markers are helpful to stratify pretherapeutically colorectal cancer patients for SIR-therapy and to early estimate the response to SIR-therapy.

Background: Increased ventilatory response has been shown to have a high prognostic value in patients with chronic heart failure. Our aim was therefore to determine the ventilatory efficiency in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension by cardiopulmonary exercise testing (CPET) identifying PH-patients with increased risk for death within 24 months after evaluation. Methods: 116 patients (age: 64 +/- 1 years) with a mean pulmonary arterial pressure of 35 +/- 1 mmHg underwent CPET and right heart catheterization. During a follow-up of 24 months, we compared the initial characteristics of survivors (n = 87) with nonsurvivors (n = 29). Results: Significant differences (p = 55 mmHg a 2.9-fold, and with Ve/VCO2 slope >= 60 a 5.8-fold increased risk of mortality in the next 24 months. Conclusions: Our results demonstrate that abnormalities in exercise ventilation powerfully predict outcomes in PH. Consideration should be given to add clinical guidelines to reflect the prognostic importance of ventilatory efficiency parameters in addition to peak VO2.

Prognostic Value of Normal Adenosin-Stress Cardiac Magnetic Resonance Imaging

Background: Eradication of Pseudomonas aeruginosa in patients with cystic fibrosis (CF) is possible if initiated early in the course of colonisation. To detect P aeruginosa as early as possible is therefore a major goal. This study was undertaken to validate a commercialised test for the detection of serum Pseudomonas antibodies in patients with CF.Methods: A representative cross sectional analysis of serum antibodies against three Pseudomonas antigens (alkaline protease, elastase, and exotoxin A) was performed in 183 patients with CF of mean age 16.7 years and FEV1 85.9% predicted. The results were correlated with microbiological results from the previous 2 years to calculate sensitivity, specificity, positive and negative predictive values. The following 2 years were assessed to determine prognostic predictive values.Results: A combination of all three tested antibodies yielded the best results with a sensitivity of 86%, specificity of 96%, and a positive predictive value of 97%. These values were higher if only patients in whom sputum cultures were available were considered (n = 76, sensitivity 95%, specificity 100%, positive predictive value 100%). The prognostic positive predictive value was high in intermittently infected patients (83%) but low in patients free of infection (33%), whereas the prognostic negative predictive value was high in patients free of infection (78%) and low in intermittently infected patients (58%).Conclusions: Regular determination of serum antibodies may be useful in CF patients with negative or intermittent but not with positive P aeruginosa status. A rise in antibody titres indicates probable infection and eradication treatment may be initiated even in the absence of microbiological detection of P aeruginosa.