Objectives To develop prediction models that better estimate the pretest probability of coronary artery disease in low prevalence populations.Design Retrospective pooled analysis of individual patient data.Setting 18 hospitals in Europe and the United States.Participants Patients with stable chest pain without evidence for previous coronary artery disease, if they were referred for computed tomography (CT) based coronary angiography or catheter based coronary angiography (indicated as low and high prevalence settings, respectively). Main outcome measuresObstructive coronary artery disease (≥50% diameter stenosis in at least one vessel found on catheter based coronary angiography). Multiple imputation accounted for missing predictors and outcomes, exploiting strong correlation between the two angiography procedures. Predictive models included a basic model (age, sex, symptoms, and setting), clinical model (basic model factors and diabetes, hypertension, dyslipidaemia, and smoking), and extended model (clinical model factors and use of the CT based coronary calcium score). We assessed discrimination (c statistic), calibration, and continuous net reclassification improvement by cross validation for the four largest low prevalence datasets separately and the smaller remaining low prevalence datasets combined. ResultsWe included 5677 patients (3283 men, 2394 women), of whom 1634 had obstructive coronary artery disease found on catheter based coronary angiography. All potential predictors were significantly associated with the presence of disease in univariable and multivariable analyses. The clinical model improved the prediction, compared with the basic model (cross validated c statistic improvement from 0.77 to 0.79, net reclassification improvement 35%); the coronary calcium score in the extended model was a major predictor (0.79 to 0.88, 102%). Calibration for low prevalence datasets was satisfactory.Conclusions Updated prediction models including age, sex, symptoms, and cardiovascular risk factors allow for accurate estimation of the pretest probability of coronary artery disease in low prevalence populations. Addition of coronary calcium scores to the prediction models improves the estimates. IntroductionIn the United States, about 10.2 million people have chest pain complaints each year, 1 and more than 1.1 million diagnostic procedures of catheter based coronary angiography are performed on inpatients each year. 2 In a recent report based on the national cardiovascular data registry of the American College of Cardiology, 3 only 41% of patients undergoing elective procedures of catheter based coronary angiographies are diagnosed with obstructive coronary artery disease. The report's authors concluded that better risk stratification was needed, underlined by decision analyses showing that the choice of further diagnostic investigation in patients with chest pain depends primarily on the pretest probability of coronary artery disease. [4][5][6] The American College of Cardiology/American Heart Associatio...

Pretreatment IGF1 levels are important predictors of morbidity and mortality in acromegaly. The full hormonal control of the disease, nowadays reached in the majority of patients with modern management, reduces greatly the disease-related mortality.

Objective: Evidence is limited regarding outcome of patients with ectopic Cushing's syndrome (ECS) due to neuroendocrine tumors (NETs). Design: We assessed the prognostic factors affecting the survival of patients with NETs and ECS. Methods: Retrospective analysis of clinicopathological features, severity of hormonal syndrome, treatments from a large cohort of patients with NETs and ECS collected from 17 Italian centers. Results: Our series included 110 patients, 58.2% female, with mean (±s.d.) age at diagnosis of 49.5 ± 15.9 years. The main sources of ectopic ACTH were bronchial carcinoids (BC) (40.9%), occult tumors (22.7%) and pancreatic (p)NETs (15.5%). Curative surgery was performed in 56.7% (70.2% of BC, 11% of pNETs). Overall survival was significantly higher in BC compared with pNETs and occult tumors (P = 0.033) and in G1-NETs compared with G2 and G3 (P = 0.007). Negative predictive factors for survival were severity of hypercortisolism (P < 0.02), hypokalemia (P = 0.001), diabetes mellitus (P = 0.0146) and distant metastases (P < 0.001). Improved survival was observed in patients who underwent NET removal (P < 0.001). Adrenalectomy improved short-term survival. Clinical Study

Real-time sonoelastography can show plantar fasciitis, increase diagnostic performance of B-mode US, and assist in cases of inconclusive B-mode US findings.

KEYWORDSPlatelet-rich plasma; Achilles tendon; Patellar tendon; Jumper's knee; Achilles tendinopathy.Abstract Purpose: The efficacy of platelet-rich plasma (PRP) in the treatment and healing of chronic tendinopathy through stimulation of cell proliferation and total collagen production has been demonstrated by both in vitro and in vivo studies. The aim of this study is to evaluate the effectiveness of ultrasound (US)-guided autologous PRP injections in patellar and Achilles tendinopathy. Materials and methods: Autologous PRP was injected under US-guidance into the Achilles and patellar tendons (30 Achilles tendons, 28 patellar tendons) in 48 prospectively selected patients (30 males, 18 females, mean age 38 AE 16 years, range 20e61 years). All patients were previously evaluated according to the Victoria Institute of Sport Assessment (VISA) scale, which assessed pain and activity level, and they all underwent US of the tendon before treatment and at follow-up after 20 days and 6 months. Statistical analysis was performed with Chi-square and Wilcoxon tests. Results: 20 days after PRP injection the patients presented a non-significant improvement of clinical symptoms. At the 6-month follow-up VISA score increased from a mean value of 57 e75.5 (p < .01). US evaluation revealed a reduction of hypoechoic areas in 26 tendons (p < .01) associated with a widespread improvement of fibrillar echotexture of the tendon and reduced hypervascularity at power Doppler. Conclusion: PRP injection in patellar and Achilles tendinopathy results in a significant and lasting improvement of clinical symptoms and leads to recovery of the tendon matrix potentially helping to prevent degenerative lesions. US-guidance allows PRP injection into the tendon with great accuracy. Sommario Scopo: Il plasma ricco di piastrine (PRP), provocando un iperafflusso di citochine nel sito di iniezione si è dimostrato efficace, sia in vitro che in studi clinici in vivo, come promotore della rigenerazione tissutale. Lo scopo di questo studio è quello di valutare l'efficacia dell'iniezione ecoguidata di PRP autologo nel trattamento delle tendinopatie croniche del rotuleo e dell'achilleo. Materiali e metodi: Il PRP autologo è stato iniettato sotto guida ecografica in tendini rotulei e achillei (30 tendini di Achille, 28 tendini rotulei) di 48 pazienti selezionati in modo prospettico (30 maschi, 18 femmine, età media 38 AE 16 anni, range 20e61 anni). Tutti i pazienti erano stati precedentemente valutati mediante questionario Victoria Institute of Sport di valutazione (VISA) in cui si analizza il punteggio del dolore e il livello di attività. È stata poi eseguita una valutazione ecografica dei tendini mirata a valutarne l'ecostruttura e vascolarizzazione. La valutazione statistica dei dati ottenuti è stata eseguita mediante i test del Chi-quadrato e di Wilcoxon. Risultati: Venti giorni dopo l'iniezione di PRP è stato rilevato un miglioramento dei sintomi clinici non significativo. Il punteggio VISA è migliorato da una base di 57 a 75,5 a 6 mesi (p < .01). La v...

mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.

ObjectivesTo compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters.MethodsSeventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced-steady state free precession) SAX sequence for MR, and evaluated using dedicated software.ResultsCT and MR images showed good agreement: LV EF (Ejection Fraction) (52 ± 14% for CT vs. 52 ± 14% for MR; r = 0.73; p > 0.05); RV EF (47 ± 12% for CT vs. 47 ± 12% for MR; r = 0.74; p > 0.05); LV EDV (End Diastolic Volume) (74 ± 21 ml/m² for CT vs. 76 ± 25 ml/m² for MR; r = 0.59; p > 0.05); RV EDV (84 ± 25 ml/m² for CT vs. 80 ± 23 ml/m² for MR; r = 0.58; p > 0.05); LV ESV (End Systolic Volume)(37 ± 19 ml/m² for CT vs. 38 ± 23 ml/m² for MR; r = 0.76; p > 0.05); RV ESV (46 ± 21 ml/m² for CT vs. 43 ± 18 ml/m² for MR; r = 0.70; p > 0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups.ConclusionsCardiac CT provides accurate and reproducible LV and RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR.Key Points• Cardiac-CT is able to provide Left and Right Ventricular function.• Cardiac-CT is accurate as MR for LV and RV volume assessment.• Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-011-2345-6) contains supplementary material, which is available to authorized users.

Object: The aim of this paper is to investigate the use of fully-convolutional neural networks (FCNNs) to segment scar tissue in the left ventricle from cardiac magnetic resonance with late gadolinium enhancement (CMR-LGE) images. Methods: A successful FCNN in the literature (the ENet) was modified and trained to provide scar-tissue segmentation. Two segmentation protocols (Protocol 1 and Protocol 2) were investigated, the latter limiting the scar-segmentation search area to the left ventricular myocardial tissue region. CMR-LGE from 30 patients with ischemicheart disease were retrospectively analyzed, for a total of 250 images, presenting high variability in terms of scar dimension and location. Segmentation results were assessed against manual scar-tissue tracing using one-patient-out cross validation. Results: Protocol 2 outperformed Protocol 1 significantly (p-value < 0.05), with median sensitivity and Dice similarity coefficient equal to 88.07% (inter-quartile range (IQR) = 18.84%) and 71.25% (IQR = 31.82%), respectively. Discussion: Both segmentation protocols were able to detect scar tissues in the CMR-LGE images but higher performance was achieved when limiting the search area to the myocardial region. The findings of this paper represent an encouraging starting point for the use of FCNNs for the automatic segmentation of nonviable scar tissue from CMR-LGE images.