Risultati per: Il ruolo dell’imaging nel sanguinamento gastrointestinale: linea guida

In Italia oltre 100mila con patologie rare non diagnosticate

Primario al Gemelli, autore di molti studi scientifici

Objective
To investigate the relationship between eosinophil (EOS) and CT imaging, we quantitatively evaluated the bronchial wall thickening, emphysema index (EI) and pulmonary vascular parameters in patients with chronic obstructive pulmonary disease (COPD) based on different EOS levels.

Design
Retrospective observational study.

Setting
A tertiary hospital in China.

Participants
448 patients with COPD from January 2020 to January 2023.

Main outcome measures
Laboratory data, chest CT and pulmonary function based on different EOS levels:

Our review highlights the potential for the use of AI algorithms applied to retina images, particularly CFP, to screen, predict, or diagnose the various microvascular and macrovascular complications of diabetes. However, we identified few studies with longitudinal data and a paucity of randomized control trials, reflecting a gap between the development of AI algorithms and real-world implementation and translational studies.

I riconoscimenti del Premio Omar dalla stampa all’online, i video ed i podcast

‘Fare rete per accompagnare il cambiamento che è iniziato’

Esperto, il 40% di chi chiede consiglio soffre di emicrania

Sip, ‘il focus deve spostarsi dal peso alla salute’

Introduction
Postsurgical hypoparathyroidism (PoSH) is an iatrogenic condition that occurs as a complication of several different procedures with thyroid surgery being the most common. PoSH has significant short- and long-term morbidities. The volume of thyroid surgery is increasing, and PoSH is therefore likely to increase. Some studies have shown promising results using near-infrared fluorescence (NIRF) imaging in reducing the risk of PoSH which has the potential to significantly reduce morbidity and costs associated with monitoring and treatment.

Methods and analysis
NIFTy is an unblinded, parallel group, multicentre, seamless phase II/III randomised controlled trial in patients undergoing total or completion thyroidectomy. The trial incorporates a process evaluation (IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up framework) 2a) to inform the trial protocol, a phase II (IDEAL 2b) analysis using a surrogate primary outcome of 1 day transient hypocalcaemia to determine early futility and phase III (IDEAL 3) assessment of the primary outcome of PoSH at 6 months after surgery. 454 participants will be randomised on a 1:1 basis to evaluate thyroid surgery with NIRF and indocyanine green against standard thyroid surgery in reducing PoSH at 6 months after surgery, with the phase II analysis occurring once data are available for 200 participants. Analysis in both phases will be using multilevel logistic regression incorporating random effects with respect to surgeon and adjusting for minimisation factors. Phase III secondary outcomes include protracted hypoparathyroidism, hypercalcaemia, complications, length of stay, readmissions and patient reported quality of life using the Short Form 36 Health Survey Questionnaire and Hypoparathyroid Patient Questionnaire instruments.

Ethics and dissemination
NIFTy is funded by National Institute for Health and Care Research Efficacy and Mechanism Evaluation Programme (Grant Ref: 17/11/27) and approved by a Research Ethics Committee (reference: 21/WA/0375) and Health Research Authority (HRA). Trial results will be disseminated through conference presentations, peer-reviewed publication and through relevant patient groups.

Trial registration number
ISRCTN59074092.

Stroke, Volume 56, Issue Suppl_1, Page AWP185-AWP185, February 1, 2025. Introduction:Branch atheromatous disease involving the lenticulostriate artery (LSA) is strongly associated with early neurological deterioration. We aimed to investigate whether an apparent thalamostriate vein (TSV) or brush sign on susceptibility-weighted imaging (SWI) can predict infarct growth.Methods:Consecutive patients with the small subcortical infarction of the LSA presenting within 24 h of onset were retrospectively evaluated. MRI, including SWI, was performed on admission and within 1 week of admission. An apparent TSV was defined as a difference in the diameter of the TSV between the right and left sides on SWI upon admission. Infarct growth was defined as an increase in infarct size on axial or coronal diffusion-weighted imaging from 1 point.Results:Of the 76 patients (median age, 76 [67.25–82] years, 48 male) with the small subcortical infarction of the LSA, 22 (median age, 75.5 [64.75–82.5] years, 13 male) presented with an apparent TSV and/or brush sign. On univariable logistic analysis, only the presence of apparent TSV and/or brush sign (OR, 3.12; 95% CI, 1.11–8.73;p=0.03) was associated with infarct growth. In multivariable logistic regression analysis, age (OR, 1.07; 95% CI, 1.01–1.14;p=0.02) and infarct growth (OR, 4.46; 95% CI, 1.37–14.54;p=0.01) were independently associated with progressive paralysis.Conclusion:An apparent TSV or brush sign could indicate infarct growth in cases of the small subcortical infarction of the LSA.

Stroke, Volume 56, Issue Suppl_1, Page AWP181-AWP181, February 1, 2025. Background:Timely intervention is crucial for patients with acute ischemic stroke. The RapidAI imaging system (RAPID) was implemented to enhance the speed and efficiency of care delivery. We evaluated the impact of RAPID on various metrics in the patient care pathway.Methods:In this retrospective observational study, we analyzed consecutive patients who presented to our hospital ER with acute ischemic stroke and who were treated with Intravenous Thrombolysis (IVT) or mechanical thrombectomy between December 20, 2014, and April 20, 2024. Patients were divided into pre-RAPID (n =186) and post-RAPID (n =264) groups based on the implementation date of the RAPID system (September 1, 2019). We compared Door to Non-contrast CT (NCCT), Door to CT Angiography (CTA) / Perfusion Imaging, Door to IVT, and Door to Puncture / first pass for thrombectomy, between the two groups using Fisher’s exact test.Results:For Door to CT, no significant difference was observed between pre-RAPID and post-RAPID groups; 74% of patients in the post-RAPID group and 71% in the pre-RAPID group received NCCT within 45 minutes (p= 0.44). Significant improvements were observed in Door to CTA/Perfusion times; 90% of patients received vessel or perfusion imaging within 150 minutes post-RAPID compared to 70% pre-RAPID (p= 0.01), and 87% received imaging within 120 minutes post-RAPID compared to 70% pre-RAPID (p= 0.031). For Door to IVT, 96% of patients received treatment within 120 minutes post-RAPID compared to 82% pre-RAPID (p= 0.015). For thrombectomy, there was a trend toward faster door to puncture post-RAPID; 70% of patients were treated within 150 minutes post-RAPID compared to 62% pre-RAPID (p= 0.36), and 90% were treated within 210 minutes post-RAPID compared to 81% pre-RAPID (p= 0.12). Similarly, a trend toward faster Door to First Pass times was observed post-RAPID, with 88% treated within 240 minutes compared to 80% pre-RAPID (p= 0.20).Conclusions:RapidAI Implementation was associated with significant improvements in key workflow metrics, notably in Door to Vessel/Perfusion Imaging and Door to IVT. These findings suggest that RAPID enhances the efficiency of patient care delivery in acute ischemic stroke. Further studies with larger sample sizes are warranted.

Stroke, Volume 56, Issue Suppl_1, Page AWP184-AWP184, February 1, 2025. Objective:High calcium (Ca), low phosphate(P), and Ca-P product (CPP) levels are associated with cardiovascular disease and coronary artery atherosclerosis in patients with chronic kidney disease. However, whether this relationship persists in individuals with carotid artery atherosclerosis of acute ischemic stroke is unknown. We investigated the association of serum Ca, P, and CPP to carotid artery atherosclerotic plaque assessed by high-resolution MR vessel wall imaging in acute ischemic stroke patients.Methods:A total of 251 ischemic stroke participants with carotid artery atherosclerosis (mean age 68 years old, male 80.1%) were consecutively included in a comprehensive stroke center. Serum Ca, and P were obtained from blood tests after admission, and carotid artery plaque characteristics including plaque burden and vulnerability were evaluated using high-resolution MR vessel wall imaging, then the association between serum Ca, P, CPP, and atherosclerosis plaque characteristics was analyzed in multi-variate linear or logistic regression analysis； Finally, the consistency was also explored in different subgroups.Results:The mean±SD of serum Ca and P in this population is 2.26±0.11 and 1.16±0.19 individually. Serum P and CPP were associated with carotid artery plaque burden, presented as maximum wall thickness (max WT), wall area, and lipid-rich necrotic core (LRNC), in univariate analysis, with β=-0.205，95% CI (-0.348,-0.061), β=-0.258，95% CI (-0.405,-0.113), OR=0.182, 95% CI (0.034,0.975) for P, and β=-0.203，95% (-0.346,-0.059), β=-0.221，95% CI (-0.366,-0.074), OR=0.466, 95% CI (0.237,0.915) for CPP, respectively. In multivariate regression analysis, after further correction of age, sex in model 1 and cardiovascular risk factors in model 2, P level is associated with wall area independently, β=-0.211, 95% CI (-0.367, -0.052), while CPP is associated with wall area marginally, with β=-0.147, 95%CI (-0.300, 0.008) in model 1, and β=-0.157, 95%(-0.314, 0.004) in model 2. In subgroup analysis, the independent relationship between P and wall area can still be consistent in age＞65 years (β=-0.222, 95%CI [-0.400, -0.011]), male (β=-0.219， 95%CI [-0.446,-0.045], and hypertension (β=-0.314， 95%CI [-0.513, -0.130] subgroups.Conclusion:Lower serum P was associated with increased carotid artery plaque burden presented with wall area, and this relationship could differ in different age, sex, and hypertension subgroups.

Stroke, Volume 56, Issue Suppl_1, Page AWP195-AWP195, February 1, 2025. Introduction:Randomized clinical trials evaluating the effects of endovascular treatment (EVT) for medium vessel occlusion (MeVO) are ongoing. However, it remains unclear how clinicians determine the indication for EVT in MeVO cases in real-world practiceHypothesis:We hypothesize that in actual clinical practice, there is a threshold of clinical symptoms and perfusion imaging findings that guide the decision to intervene with EVT for MeVO.Methods:We conducted a single-center retrospective registry from April 2019 to April 2024, enrolling consecutive patients with acute ischemic stroke due to MeVO. We compared the outcomes of MeVO patients who received EVT with those who received medical treatment (MT). The primary outcome was defined as a good functional outcome, indicated by a modified Rankin scale score of 0-2 at 90 days post-stroke onset. Secondary outcomes included exploring the optimal thresholds for EVT intervention in real-world clinical practice, based on clinical symptoms indicated by the National Institutes of Health Stroke Scale and perfusion imaging using RAPID software.Results:We analyzed 162 patients (EVT, n = 102; MT, n = 60). The mean age was 80 years, with 53.7% being men. Recombinant tissue plasminogen activator was used more frequently in the EVT group (42.2% vs. 18.3%). The median NIHSS was higher in the EVT group (median [interquartile range, IQR]; 13 [6–19] vs. 7 [2–14]). In terms of perfusion imaging, there was no significant difference between the two groups in CBF < 30% (median [IQR]; 4 [0–17] vs. 4 [0–22]). However, the median T max > 6 sec and mismatch volume were significantly higher in the EVT group (median [IQR]; 44 [27–82] vs. 28 [6–49] and 35 [21–55] vs. 12 [2–28], respectively). The primary outcome was not significantly different between the EVT and MT groups (41 [40.2%] vs. 25 [41.7%]; adjusted odds ratio [aOR]: 1.10 [95% CI: 0.42–2.89]). Receiver-operating characteristic analyses showed that the areas under the curves for NIHSS, CBF < 30%, T max > 6 sec, and mismatch volume were 0.64, 0.49, 0.68, and 0.74, respectively. Mismatch volume had the best discriminatory power with respect to EVT intervention, with a threshold of 20 ml.Conclusions:A mismatch volume of ≥ 20 ml may be a useful criterion for determining EVT intervention in MeVO cases in real-world practice.