OBJECTIVES The current study evaluates the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (CCO), and TAG with exclusion of calcified coronary segments (ExC) over coronary computed tomography angiogram (CTA) alone using fractional flow reserve (FFR) as the gold standard. BACKGROUND TAG is defined as the contrast opacification gradient along the length of a coronary artery on a coronary CTA. Preliminary data suggest that TAG provides additional functional information. Interpretation of TAG is hampered by multiple heartbeat acquisition algorithms and coronary calcifications. Two correction models have been proposed based on either dephasing of contrast delivery by relating coronary density to corresponding descending aortic opacification (TAG-CCO) or excluding calcified coronary segments (TAG-ExC). METHODS Eighty-five patients with intermediate probability of coronary artery disease were prospectively included. All patients underwent step-and-shoot 256-slice coronary CTA. TAG, TAG-CCO, and TAG-ExC analyses were performed followed by invasive coronary angiography in conjunction with FFR measurements of all major coronary branches. RESULTS Thirty-four patients (40%) were diagnosed with hemodynamically-significant coronary artery disease (i.e., FFR ≤0.80). On a per-vessel basis (n = 253), 59 lesions (23%) were graded as hemodynamically significant, and the diagnostic accuracy of coronary CTA (diameter stenosis ≥50%) was 95%, 75%, 98%, and 54% for sensitivity, specificity, negative predictive value, and positive predictive value, respectively. TAG and TAG-ExC did not discriminate between vessels with or without hemodynamically significant lesions (−13.5 ± 17.1 HU [Hounsfield units] × 10 mm−1 vs. −11.6 ± 13.3 HU × 10 mm−1, p = 0.36; and 13.1 ± 15.9 HU × 10 mm−1 vs. −11.4 ± 11.7 HU × 10 mm−1, p = 0.77, respectively). TAG-CCO was lower in vessels with a hemodynamically-significant lesion (−0.050 ± 0.051 10 mm−1 vs. −0.036 ± 0.034 10 mm−1, p = 0.03) and TAG-ExC resulted in a slight improvement of the net reclassification index (0.021, p < 0.05). CONCLUSIONS TAG did not provide incremental diagnostic value over 256-slice coronary CTA alone in assessing the hemodynamic consequences of a coronary stenosis. Correction for temporal nonuniformity of contrast delivery or exclusion of calcified coronary segments slightly enhanced the results.

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The synthesis and characterization of a series of macroporous, strong basic anion exchangers (SBAEs), with an average pore radius higher than 50 nm, and the evaluation of their sorption properties for uranyl chlorocomplexes from HCl solutions are reported. Finely divided macroporous styrene–divinylbenzene (S–DVB) copolymers with a narrow distribution of beads sizes, diameters within the range of 90–200 μm, were prepared for this purpose with 2‐ethyl‐1‐hexanol as a porogen, at a high dilution of monomers (D ≥ 0.55 mL/mL). Chloromethyl groups were introduced with (CH2O)n/Me3SiCl as a chloromethylation agent in the presence of a Lewis acid as a catalyst (TiCl4, SnCl4, and FeCl3) in CHCl3 as a reaction medium. SnCl4 and FeCl3 gave comparable chloromethylation degrees in the same reaction conditions. TiCl4 was not efficient as a catalyst in the chloromethylation with this reagent. Diethyl‐2‐hydroxyethylamine was used as a tertiary amine to prepare SBAEs. Structural and morphological characteristics were determined after every functionalization step of the macroporous network. Both the chloromethylation, in the presence of FeCl3 as a catalyst, and the amination reactions determined a significant decrease of the pore volume, in the whole range of the nominal crosslinking degree, comparative with the starting copolymer. The specific surface area and the average pore radius varied in a different way as a function of the nominal crosslinking degree. Thus, the specific surface area increased and the average pore radius decreased after chloromethylation and amination for copolymers with a DVB content lower than 10 wt %. Small decreases of the specific surface area and the average pore radius were observed after chloromethylation and amination reactions for copolymers with a DVB content higher than 10 wt %. SBAEs were also characterized by thermogravimetric analysis and sorption capacity for uranyl chlorocomplexes. © 2004 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 42: 2451–2461, 2004

Background Chronic hepatitis E represents an emerging challenge in organ transplantation, as there are currently no established treatment options for patients who fail to clear hepatitis E virus (HEV) following reduction of immunosuppressive therapy and/or treatment with ribavirin. Sofosbuvir has shown antiviral activity against HEV in vitro but clinical utility in vivo is unknown. Case presentation We describe a 57-year-old liver transplant recipient with decompensated graft cirrhosis due to chronic hepatitis E. Reduction of immunosuppressive treatment as well ribavirin alone for 4 months did not result in viral clearance. Add-on of sofosbuvir for 6 months was associated with HEV RNA becoming undetectable in plasma. However, sustained viral clearance could not be achieved. Conclusions Sofosbuvir may have some antiviral activity against HEV when added to ribavirin. However, this did not suffice to yield sustained viral clearance. Our well-characterized observation emphasizes the need for new treatment options to cure chronic hepatitis E in the setting of organ transplantation.

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