BackgroundSarcoidosis is a chronic multisystem disease of unknown etiology characterized by noncaseating granulomas that most often involves the lungs, but frequently has extrapulmonary manifestations, which might be difficult to treat in individual patients.ObjectiveTo review different disease manifestations, focusing on extrapulmonary organ systems, and to provide treatment options for refractory cases.Materials and methodsWe performed a literature search using Medline and Google Scholar for individual or combined keywords of “sarcoidosis, extrapulmonary, treatment, kidney, neurosarcoidosis, cardiovascular, gastrointestinal, transplantation, musculoskeletal, rheumatology, arthritis, and skin”. Peer-reviewed articles, including review articles, clinical trials, observational trials, and case reports that were published in English were included. References from retrieved articles were also manually searched for relevant articles.Results and conclusionIsolated involvement of a single organ or organ system is rare in sarcoidosis, and thus all patients must be thoroughly evaluated for additional disease manifestations. Cardiac sarcoidosis and neurosarcoidosis may be life-threatening. Clinicians need to assess patients comprehensively using clinical, laboratory, imaging, and histopathological data to recommend competently the best and least toxic treatment option for the individual patient.
Purpose
Myocardial tissue stiffness plays an important role in cardiac function. A non-invasive quantitative imaging technique capable of measuring myocardial stiffness could aid in disease diagnosis, therapy monitoring, and disease prognostic strategies. We recently developed a high frequency cardiac magnetic resonance elastography (MRE) technique capable of making non-invasive stiffness measurements. Hence our objective was to evaluate if cardiac Magnetic Resonance Elastography (MRE) can measure increased stiffness in patients with cardiac amyloidosis.
Materials and Methods
16 volunteers and 22 patients with cardiac amyloidosis were enrolled in this study, after IRB approval and obtaining formal written consent. All subjects were imaged head first in the supine position in a 1.5-Tesla closed-bore MR imager (Optima MR450W; GE Healthcare, Milwaukee, WI, USA). 3D MRE was performed using 5 mm isotropic resolution oblique short-axis slices and a vibration frequency of 140Hz to obtain global quantitative in vivo left ventricular stiffness measurements. The median stiffness was compared between the two cohorts. An octahedral shear strain signal-to-noise ratio (OSS-SNR) threshold of 1.17 was used to exclude exams with insufficient motion amplitude.
Results
Five volunteers and 6 patients had to be excluded from the study because they fell below the 1.17 OSS-SNR threshold. The myocardial stiffness of cardiac amyloid patients (median: 11.4 kPa, min: 9.2, max: 15.7) was significantly higher (p = 0.0008) than normal controls (median: 8.2 kPa, min: 7.2, max: 11.8).
Conclusions
This study demonstrates the feasibility of 3D high-frequency cardiac MRE as a contrast-agent-free diagnostic imaging technique for cardiac amyloidosis.
A baumannii and AGS 13TU possessed similar quinolone resistance associated with amino acid substitutions in GyrA and ParC. Further study with more strains is needed to determine whether a single Ser83Leu substitution in GyrA was associated with a high level of quinolone MIC only in A baumannii, but not in AGS 13TU.
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