Comparison of a Portable and Non-Portable Ultrasound Machine in the Evaluation of Children with Sickle Cell Disease: A Pilot Study

Background: Transcranial color Doppler (TCCD) ultrasound is used to identify children with sickle cell disease (SCD) at high risk of developing stroke. There is anecdotal evidence to suggest that different ultrasound equipment can give different blood flow velocities. The purpose of this study was to compare two different TCCD ultrasound machines. Methods and Results: A flow phantom was used to compare PSV measurements from a Philips IU-22 and Zonare Z-One ultrasound machine. Twenty-five children with SCD (aged between 2 and 16 years) attending the outpatient clinic at St. Mary’s Hospital, Imperial College Healthcare NHS Trust, as part of the NHS Sickle Cell & Thalassaemia (SC&T) screening program were studied. The two ultrasound machines compared the TAMM velocities in the middle cerebral artery and stroke risk categorization. PSV measurements using a flow phantom were underestimated by Philips IU-22 (31%) and Zonare Z-One (53%). TAMM velocities varied considerably between machines, with a poor agreement in stroke risk categorization. As a result, three children identified at increased risk of stroke by Philips IU-22 were not identified by Zonare Z-One. Conclusion: Two ultrasound machines were found to underestimate PSV using a flow phantom. The two ultrasound machines were shown to positively correlate, and this was statistically significant. However, there was variation in the TAMM velocities recorded by the machines which resulted in the different categorization of the stroke risk of a small number of the subjects. This pilot study confirms the feasibility and clinical significance of this investigation.

Thrombolytic Therapy in Pulmonary Thromboembolism

Acute pulmonary thromboembolism (PE) is a common disorder with significant mortality and morbidity. Timely recognition and prompt therapy of this disorder is essential to prevent adverse consequences. Thrombolytic therapy has an important role in the management of high-risk pulmonary embolism patients, where it can be lifesaving. However, the potential clinical benefit of thrombolytic therapy needs to balanced against the risk of major bleeding associated with the use of these agents. Hence patient selection is of paramount importance in determining the success of this therapy. Management strategies in PE are centered around the concept of risk stratification of the cases. In this chapter we briefly discuss the risk categorization of PE cases, followed by a more elaborative discussion of the role of thrombolytic therapy in the management of patients with high risk or intermediate risk PE.

Deep learning for automatic calcium scoring in population based cardiovascular screening

Background High volumes of standardized coronary artery calcium (CAC) scans are generated in screening that need to be scored accurately and efficiently to risk stratify individuals. Purpose To evaluate the performance of deep learning based software for automatic coronary calcium scoring in a screening setting. Methods Participants from the Robinsca trial that underwent low-dose ECG-triggered cardiac CT for calcium scoring were included. CAC was measured with fully automated deep learning prototype and compared to the original manual assessment of the Robinsca trial. Detection rate, positive Agatston score and risk categorization (0–99, 100–399, ≥400) were compared using McNemar test, ICC, and Cohen's kappa. False negative (FN), false positive (FP) rate and diagnostic accuracy were determined for preventive treatment initiation (cut-off ≥100 AU). Results In total, 997 participants were included between December 2015 and June 2016. Median age was 61.0 y (IQR: 11.0) and 54.4% was male. A high agreement for detection was found between deep learning based and manual scoring, κ=0.87 (95% CI 0.85–0.89). Median Agatston score was 58.4 (IQR: 12.3–200.2) and 61.2 (IQR: 13.9–212.9) for deep learning based and manual assessment respectively, ICC was 0.958 (95% CI 0.951–0.964). Reclassification rate was 2.0%, with a very high agreement with κ=0.960 (95% CI: 0.943–0.997), p<0.001. FN rate was 0.7% and FP rate was 0.1% and diagnostic accuracy was 99.2% for initiation of preventive treatment. Conclusion Deep learning based software for automatic CAC scoring can be used in a cardiovascular CT screening setting with high accuracy for risk categorization and initiation of preventive treatment. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Robinsca trial was supported by advanced grant of European Research Council

ALGORITHM FOR EARLY DIAGNOSIS AND PREVENTION OF PROFESSIONAL SENSORINEURAL HEARING LOSS

The aim of the study is to develop an algorithm for early diagnosis and prevention of professional neurosensory hearing elasticity (PNST). A comprehensive audiological survey of 600 miners aged 37 to 58, with 10 to 35 years of experience in noise conditions above the PDU for 7-21 dBA (class 3.1-3.3) was carried out. Based on the studies, an algorithm of early diagnosis and prevention of PNST, consisting of 3 blocks: I - hygienic (assessment of working conditions and risk categorization), II - clinical diagnostic, based on modern audiological methods of hearing research with the selection of diagnostic markers of risk of PNST, III - preventive, including the development of individual hearing preservation programs. The developed algorithm allows in 65-75% of cases to identify changes in the auditory analyzer at the preclinical stage, to clarify the nature and localization of the auditory analyzer, which is important in the development of therapeutic and preventive measures.

The ghost mammals from Mexico and their implications

The species records are key to determine their distribution. In México, there are records located up to more 200 km outside the known range of Ateles geoffroyi, Cryptotis mayensis, Pteronotus davyi and Tlacuatzin sinaloae. Other species were captured in their type locality but have not been recorded again over up to 100 years: Dipodomys gravipes, Oryzomys peninsulae, Peromyscus mekisturus, P. pembertoni, Sorex sclateri, S. stizodon, Tylomys bullaris and T. tumbalensis. This study analyzes these mammalian species records, their information gaps related with their known range, and discusses the likely implications for conservation. A survey of the literature and databases of scientific collections available on the Internet were conducted. A geographic information system was used for the spatial analysis of the records obtained. Records outside the limit of the known range of these species are due to misidentification of specimens, accidental introduction and lack of field corroboration. Some of the species captured only in their type locality can be deemed extinct while others require field and laboratory work. Geographic records of the species are valuable inputs to define the distribution range of species and advance our current knowledge about the Mexican. The use of records with errors or that should no longer be considered have an impact on the risk categorization of species and the development of conservation strategies.

Kidney Failure after Liver Transplantation

One-third of patients with cirrhosis present kidney failure (AKI and CKD). It has multifactorial causes and a harmful effect on morbidity and mortality before and after liver transplantation. Kidney function does not improve in all patients after liver transplantation, and liver transplant recipients are at a high risk of developing chronic kidney disease. The causes of renal dysfunction can be divided into three groups: pre-operative, perioperative and post-operative factors. To date, there is no consensus on the modality to evaluate the risk of chronic kidney disease after liver transplantation, or for its prevention. In this narrative review, we describe the outcome of kidney function after liver transplantation, and the prognostic factors of chronic kidney disease in order to establish a risk categorization for each patient. Furthermore, we discuss therapeutic options to prevent kidney dysfunction in this context, and highlight the indications of combined liver–kidney transplantation.

Omental Solitary Fibrous Tumor: A Rare Tumor at Rare Site

Extrapleural solitary fibrous tumor-hemangiopericytoma is a rare tumor. We present a case of this tumor arising in omentum, which is an extremely rare site. The diagnosis was confirmed by diffuse expression of STAT6 on immunohistochemistry. The tumor was assigned a low-risk category according to recent risk categorization models. The patient was advised close follow-up as the tumor was excised completely. These tumors have the potential for recurrence and metastasis even after surgical excision. However, there are no definitive guidelines for adjuvant treatment due to lack of data.