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Zhang SJ, Wang LT, Li X. Postpulmonary embolism syndrome: what should we focus on? J Thromb Haemost 2024; 22:362-364. [PMID: 38309812 DOI: 10.1016/j.jtha.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 02/05/2024]
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Liang XL, Su YD, Li XB, Fu YB, Ma R, Yang R, Wu HL, Li Y. Risk factors and prognosis of malignant peritoneal mesothelioma with paraneoplastic syndrome. World J Surg Oncol 2024; 22:29. [PMID: 38267958 PMCID: PMC10809535 DOI: 10.1186/s12957-024-03312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare and highly aggressive tumor. Its clinical manifestations are diverse, and the symptoms are not specific. Some patients will develop paraneoplastic syndrome (PS) during the disease course. This study aims to analyze the risk factors of PS in patients with MPM and their impacts on prognosis. METHODS The clinical data of MPM patients who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) at our center from June 2015 to May 2023 were retrospectively analyzed. MPM patients were divided into PS group and non-PS group according to the diagnostic criteria. Univariate and multivariate analyses were performed to explore the risk factors of PS in MPM patients, and to analyze the impact of PS on prognosis. RESULTS There were 146 MPM patients in this study, including 60 patients (41.1%) with PS and 86 patients (58.9%) without PS. The highest incidence of PS was thrombocytosis (33.6%), followed by neoplastic fever (9.6%). Univariate analysis revealed 8 factors (P < 0.05) with statistically significant differences between the two groups: prior surgical scores, targeted therapy history, Karnofsky performance status score, preoperative carbohydrate antigen (CA) 125 level, vascular tumor embolus, peritoneal cancer index, completeness of cytoreduction (CC) score and intraoperative ascites. Multivariate analysis identified 3 independent factors associated with PS: preoperative CA 125 level, vascular tumor embolus, and CC score. Survival analysis demonstrated that MPM patients with PS had worse prognosis, although PS was not an independent prognostic factor. CONCLUSIONS PS is not rare in patients with MPM, and is independently associated with preoperative CA 125 level, vascular tumor embolus and CC score. PS often indicates advanced disease and poor prognosis.
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Li Z, Luo D, Ibrahim MM, Hou E, Wang C. Adaptive strategies to freeze-thaw cycles in branch hydraulics of tree species coexisting in a temperate forest. PLANT PHYSIOLOGY AND BIOCHEMISTRY : PPB 2024; 206:108223. [PMID: 38043252 DOI: 10.1016/j.plaphy.2023.108223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/04/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
Freeze-thaw cycles (FTCs) limit the distribution and survival of temperate tree species. Tree species with different wood types coexist in temperate forests and are subjected to the same FTCs. It is essential to understand how these trees differentially cope with xylem hydraulic failure induced by FTCs in the field. The branch hydraulic traits and nonstructural carbohydrate concentration of six coexisting tree species in a temperate forest were measured from mid-winter to early spring when the FTCs occurred from January to April. The percentage loss of hydraulic conductivity (PLC) was lower, and the water potential inducing a 50% loss of hydraulic conductivity (P50) was more negative in tracheid trees than in ring- and diffuse-porous trees, suggesting tracheid trees with narrow tracheid diameters showed less vulnerable to embolism and provided a lower degree of hydraulic failure during FTCs (stronger resistance). Ring-porous trees always showed lower hydraulic conductivity and higher PLC and P50, and these traits did not change during FTCs, suggesting that they might lose the hydraulic functions in winter and abandon the last year xylem. The P50 in diffuse-porous increased after several FTCs (frost fatigue), but that in tracheid species continued to increase (or even decrease) until the end of FTCs (69 cycles), suggesting that tracheid trees were less sensitive to frost fatigue than diffuse-porous trees. Soluble sugar concentration in deciduous trees negatively correlated with PLC at the end of FTCs, indicating that the effect of soluble sugar on refilling embolism occurred in early spring. While the soluble sugar concentration of deciduous trees decreased, that of two evergreen tracheid trees gradually increased, possibly due to the winter photosynthesis of evergreen leaves. Our results suggest temperate trees adopt different strategies to cope with the same FTCs. These findings enrich the understanding of plant hydraulics and carbon physiology in winter and provide insights into the response of different species coexisting in temperate forests under climate change.
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Kyriakoulis I, Adamou A, Stamatiou I, Chlorogiannis DD, Kardoutsos I, Koukousaki D, Ntaios G. Efficacy and safety of direct oral anticoagulants vs vitamin K antagonists in patients with atrial fibrillation and end-stage renal disease on hemodialysis: A systematic review and meta-analysis. Eur J Intern Med 2024; 119:45-52. [PMID: 37648582 DOI: 10.1016/j.ejim.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The prevalence of atrial fibrillation (AF) in individuals with end-stage renal disease (ESRD) on chronic hemodialysis is increasing. The optimal anticoagulant choice in this population is unclear since these patients were excluded from the pivotal randomized controlled trials (RCTs) of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in the general AF population. We aimed to assess the efficacy and safety of DOACs vs. VKAs in patients with AF and ESRD on chronic hemodialysis through a systematic review and meta-analysis of all available evidence. PATIENTS/METHODS We performed a systematic search in MEDLINE and Scopus for RCTs or observational studies of patients with AF and ESRD on chronic hemodialysis who were treated with DOACs or VKAs. The outcomes of interest included ischemic stroke, the composite of ischemic stroke or systemic embolism, major bleeding, gastrointestinal bleeding, minor bleeding events and all-cause mortality. RESULTS Among 397 studies identified from the literature search, six studies (three RCTs and three observational studies) were included in the meta-analysis. Compared with VKA-treated patients, those treated with DOACs had similar risk of ischemic stroke (RR:0.76, 95% CI:0.41-1.41), ischemic stroke or systemic embolism (RR:0.65, 95% CI:0.38-1.10), major bleeding (RR:0.79, 95% CI:0.49-1.28) and all-cause death (RR:0.79, 95% CI:0.56-1.12). The risk of gastrointestinal bleeding was lower in DOAC- vs VKA-treated patients in three eligible observational studies (RR:0.73, 95% CI: 0.54-0.99, I2 = 79%) but this was not confirmed in two eligible RCTs (RR:0.69, 95% CI: 0.33-1.43, I2 = 0%). CONCLUSIONS Among AF patients with ESRD on chronic hemodialysis, the risk of ischemic stroke, ischemic stroke or systemic embolism, minor bleeding, major bleeding, and all-cause mortality is similar in patients treated with DOACs compared to VKAs. Given that the meta-analysis of RCTs on gastrointestinal bleeding did not confirm the results of the meta-analysis of the observational studies, it cannot be concluded that gastrointestinal bleeding is lower among DOAC-treated patients. PROTOCOL REGISTRATION PROSPERO CRD42023391966.
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Embersics C, Bannasch D, Batcher K, Boudreau EC, Church M, Miller A, Platt S, Koehler J, Olby N, Rossmeisl J, Rissi D, Grahn R, Donner J, Dickinson PJ. Association of the FGF4L2 retrogene with fibrocartilaginous embolic myelopathy in dogs. J Vet Intern Med 2024; 38:258-267. [PMID: 37916855 PMCID: PMC10800192 DOI: 10.1111/jvim.16925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Fibrocartilaginous embolic myelopathy (FCE) is a well-documented condition in dogs although rarely reported in chondrodystrophic breeds. Genetic associations have not been defined. OBJECTIVES Define the association of the chondrodystrophy-associated FGF4L2 retrogene with histopathologically confirmed cases of FCE. ANIMALS Ninety-eight dogs with a histopathologic diagnosis of FCE. METHODS Retrospective multicenter study. Dogs were genotyped for the FGF4L2 and FGF4L1 retrogenes using DNA extracted from formalin-fixed, paraffin-embedded tissue. Associations between breed, FCE and retrogene status were investigated with reference to a hospital population and known breed and general population allele frequencies. RESULTS FGF4L2 genotype was defined in 89 FCE cases. Fibrocartilaginous embolic myelopathy was present in 22 dogs from FGF4L2-segregating breeds with allele frequencies of ≥5%; however, all dogs were wild type. Two Labrador retrievers with FCE carried FGF4L2 alleles. Frequency of the FGF4L2 allele was significantly (P < .001) and negatively associated with FCE relative to predicted hospital-population dogs. FCE was overrepresented in Boxer, Great Dane, Yorkshire Terrier, Bernese Mountain Dog, Miniature Schnauzer, Rottweiler, and Shetland Sheepdog breeds. CONCLUSIONS AND CLINICAL IMPORTANCE Study data based on genotypically and histopathologically defined cases support the historical observation that FCE is uncommon in chondrodystrophic dog breeds. FGF4 plays an important role in angiogenesis and vascular integrity; anatomical studies comparing chondrodystrophic and non-chondrodystrophic dogs might provide insight into the pathogenesis of FCE.
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Sun N, Fan Y, Wu B. Timely identification for long-term impairment: a step further for postpulmonary embolism patients. J Thromb Haemost 2024; 22:50-52. [PMID: 38171701 DOI: 10.1016/j.jtha.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 01/05/2024]
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Vadillo-Martín P, Cueva-Recalde JF, Revilla-Martín P, Lacambra-Blasco I, Ruiz-Arroyo JR. Aortic endocarditis with septic pulmonary embolism as a manifestation of silent congenital heart disease. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2024; 94:97-98. [PMID: 38507320 DOI: 10.24875/acm.23000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/18/2023] [Indexed: 03/22/2024] Open
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Roth-Nebelsick A, Konrad W. Modeling and Analyzing Xylem Vulnerability to Embolism as an Epidemic Process. Methods Mol Biol 2024; 2722:17-34. [PMID: 37897597 DOI: 10.1007/978-1-0716-3477-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
Xylem vulnerability to embolism can be quantified by "vulnerability curves" (VC) that are obtained by subjecting wood samples to increasingly negative water potential and monitoring the progressive loss of hydraulic conductivity. VC are typically sigmoidal, and various approaches are used to fit the experimentally obtained VC data for extracting benchmark data of vulnerability to embolism. In addition to such empirical methods, mechanistic approaches to calculate embolism propagation are epidemic modeling and network theory. Both describe the transmission of "objects" (in this case, the transmission of gas) between interconnected elements. In network theory, a population of interconnected elements is described by graphs in which objects are represented by vertices or nodes and connections between these objections as edges linking the vertices. A graph showing a population of interconnected xylem conduits represents an "individual" wood sample that allows spatial tracking of embolism propagation. In contrast, in epidemic modeling, the transmission dynamics for a population that is subdivided into infection-relevant groups is calculated by an equation system. For this, embolized conduits are considered to be "infected," and the "infection" is the transmission of gas from embolized conduits to their still water-filled neighbors. Both approaches allow for a mechanistic simulation of embolism propagation.
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Tomasella M, Petruzzellis F, Natale S, Tromba G, Nardini A. Detecting and Quantifying Xylem Embolism by Synchrotron-Based X-Ray Micro-CT. Methods Mol Biol 2024; 2722:51-63. [PMID: 37897599 DOI: 10.1007/978-1-0716-3477-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
The vulnerability to xylem embolism is a key trait underlying species-specific drought tolerance of plants, and hence is critical for screening climate-resilient crops and understanding vegetation responses to drought and heat waves. Yet, accurate determination of embolism in plant's xylem is challenging, because most traditional hydraulic techniques are destructive and prone to artefacts. Hence, direct and in vivo synchrotron-based X-ray micro-CT observation of xylem conduits has emerged as a key reference technique for accurate quantification of vulnerability to xylem embolism. Micro-CT is nowadays a fundamental tool for studies of plant hydraulic architecture, and this chapter describes the fundamentals of acquisition and processing of micro-CT images of plant xylem.
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Shang X, Pan L, Xu Y, Guo Y, Yang K, Yang Q, Zhou Z. Effect of endovascular treatment on patients with basilar artery occlusion presenting with different pathologic mechanisms: a systematic review and meta-analysis. J Thromb Thrombolysis 2024; 57:124-131. [PMID: 37605064 DOI: 10.1007/s11239-023-02884-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE This study aimed to summarize the clinical outcomes of endovascular treatment in patients with basilar artery occlusion (BAO) with different pathologic mechanisms. METHODS Two independent reviewers searched PubMed/MEDLINE, Embase and Cochrane Library database up to December 2022, patients with different BAO pathological mechanisms (BAO with in situ atherosclerosis vs. embolism alone without vertebral artery steno-occlusion vs. embolism from tandem vertebral artery steno-occlusion) were collected and analyzed. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) to assess the associations between clinical outcomes and BAO pathological mechanisms. RESULTS A total of 1163 participants from 12 studies were identified. Compared with embolism alone, patients with in situ atherosclerotic BAO had a lower favorable outcome rate (modified Rankin score [mRS] 0-2: 34.5% vs. 41.2%; OR 0.83, 95% CI 0.70-0.98; P = 0.03) and moderate outcome rate (mRS 0-3: 45.8% vs. 55.4%; OR 0.65, 95% CI 0.47-0.90; P = 0.01) at 3 months and a higher risk of mortality (29.9% vs. 27.2%; OR 1.31, 95% CI 0.96-1.79, P = 0.09; adjusted OR 1.46, 95% CI 1.08-1.96). Tandem BAO had a comparable mortality risk to that of in situ atherosclerotic BAO (OR 1.37, 95% CI 0.84-2.22; P = 0.48) or embolism alone (OR 1.44, 95% CI 0.65-3.21; P = 0.43), and there were no significant differences in favorable or moderate outcomes between tandem BAO and each of the other two BAO mechanisms. CONCLUSION Among BAO patients with endovascular treatment, embolism mechanism had better clinical outcomes than in situ atherosclerosis, and atherosclerotic mechanism was associated with a higher mortality at 3 months. RCTs are needed to further confirm clinical outcomes of BAO by different mechanisms.
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Crea F. The key role of thrombosis: focus on acute coronary syndrome, venous thrombo- embolism, and atrial fibrillation. Eur Heart J 2024; 45:1-4. [PMID: 38160711 DOI: 10.1093/eurheartj/ehad835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
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Bukhari S, Saati A, Abuhalimeh B, Ouma G. Recurrent Aortic Thrombo embolism Associated With TET2 Mutation in Chronic Myelomonocytic Leukemia. J Investig Med High Impact Case Rep 2024; 12:23247096231224366. [PMID: 38214069 PMCID: PMC10787530 DOI: 10.1177/23247096231224366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
Ten-eleven translocation 2 (TET2) plays a pivotal role in epigenetic regulation, cell differentiation, and the inflammatory response. It also mediates the transcriptional regulation for inflammatory cytokines, particularly interleukin-6. While loss-of-function mutation in TET2 has been associated with hematological malignancies, it has been increasingly recognized to cause atherosclerotic disease. The increased atherogenicity is thought to be the result of increased production of pro-inflammatory interleukin-1β cytokines following activation of NLRP3 inflammasomes. We present a unique case of recurrent atherothrombosis in an elderly man who was diagnosed with chronic myelomonocytic leukemia in the setting of TET2 mutation.
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Giannopoulos G, Vassilikos VP. Editorial commentary: Coronary embolism as a cause for acute coronary syndromes: When you hear hoofbeats, it may be wise to sometimes think of zebras. Trends Cardiovasc Med 2024; 34:57-58. [PMID: 35908624 DOI: 10.1016/j.tcm.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
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Zhang XM, Xia Y, Li JT, Shi XQ, Liu LX, Tang M, Tang J, Sun W, Wen ZR, Yi Y. Assessing inter-intraspecific variability of leaf vulnerability to embolism for 10 alpine Rhododendron species growing in Southwestern China. PHYSIOLOGIA PLANTARUM 2024; 176:e14211. [PMID: 38351399 DOI: 10.1111/ppl.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Abstract
Alpine Rhododendron species are prominent constituents and renowned ornamental plants in alpine ecosystems. Consequently, evaluating the genetic variation in embolism resistance within the genus Rhododendron and predicting their adaptability to future climate change is important. Nevertheless, the assessment of embolism resistance in Rhododendron species remains limited. This investigation aimed to examine leaf vulnerability to embolism across ten alpine Rhododendron species, which are frequently employed as ornamental species in Rhododendron forests in Southwest China. The study analyzed the correlation between embolism resistance and various morphological traits, while also conducting water control experiments to evaluate the relationship between embolism resistance and drought resistance. The outcomes indicated pronounced variations in leaf vulnerability to embolism among species, as reflected by the water potential at 50% of embolized pixels (P50 ). Furthermore, the leaf P50 exhibited a significant positive correlation with vessel diameter (D) (R2 = 0.44, P = 0.03) and vessel wall span (b) (R2 = 0.64, P = 0.005), while displaying a significant negative correlation with vessel reinforcement ((t/b)2 ) (R2 = 0.67, P = 0.004). These findings underscore the reliability of selecting species based on embolism vulnerability to preserve the diversity of alpine ecosystems and foster resilience to climate change.
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Goldsweig AM, Deng Y, Yao X, Desai NR, Cohen DJ, Aronow HD, Messé S, Ross JS, Lansky AJ, Savitz ST. Approval, Evidence, and "Off-Label" Device Utilization: The Patent Foramen Ovale Closure Story. Circ Cardiovasc Qual Outcomes 2024; 17:e010200. [PMID: 38189127 PMCID: PMC10844981 DOI: 10.1161/circoutcomes.123.010200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/27/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Following regulatory approval, medical devices may be used "off-label." Patent foramen ovale (PFO) closure is indicated to reduce recurrent stroke but has been proposed for other indications, including migraine, transient ischemic attack, and diving decompression illness. We sought to evaluate PFO closure rates and indications relative to the timing of regulatory approval and publication of key randomized trials. METHODS We performed a retrospective cohort study using the OptumLabs Data Warehouse of US commercial insurance enrollees from 2006 to 2019. We quantified PFO closure among individuals with ≥2 years of preprocedure coverage to establish indications, classified hierarchically as stroke/systemic embolism, migraine, transient ischemia attack, or other. RESULTS We identified 5315 patients undergoing PFO closure (51.8% female, 29.2%≥60 years old), which increased from 4.75 per 100 000 person-years in 2006 to 6.60 per 100 000 person-years in 2019. Patients aged ≥60 years accounted for 29.2% of closures. Procedure volumes corresponded weakly with supportive clinical publications and device approval. Among patients with PFO closure, 58.6% underwent closure for stroke/systemic embolism, 10.2% for transient ischemia attack, 8.8% for migraine, and 22.4% for other indications; 17.6% of patients had atrial fibrillation at baseline; and 11.9% developed atrial fibrillation postprocedure. Those aged ≥60 years and male were less likely to undergo closure for migraine than stroke/systemic embolism. CONCLUSIONS From 2006 to 2019, PFO closure use was consistently low and corresponded weakly with clinical trial publications and regulatory status. Nearly half of patients underwent PFO closure for indications unapproved by the Food and Drug Administration. Regulators and payers should coordinate mechanisms to promote utilization for approved indications to ensure patient safety and should facilitate clinical trials for other possible indications.
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Sanghvi J, Bamshad D, Galla N, Bai H, Garcia-Reyes K, Fischman A. Fluoroscopy Time and Radiation Dose Using Liquid Embolic (n-butyl-2-cyanoacrylate) versus Microspheres for Prostatic Artery Embolization. J Vasc Interv Radiol 2024; 35:147-151.e1. [PMID: 37758023 DOI: 10.1016/j.jvir.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
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Rana MA, Yoon S, Dallan LAP, Tashtish N, Attizzani GF, Rashid I, Rajagopalan S, Arruda M, Filby SJ. Midterm follow-up after computed tomography angiography planned left atrial appendage closure. Catheter Cardiovasc Interv 2024; 103:129-136. [PMID: 37786977 DOI: 10.1002/ccd.30843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/25/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND While studies have shown the advantages of computed tomography angiography (CTA) over transesophageal echocardiography (TEE) in left atrial appendage closure (LAAC) preprocedural planning for WATCHMAN™ legacy and FLX devices, there has been no reported long-term data for this approach. OBJECTIVES We sought to evaluate long-term outcomes using CTA-based preprocedural planning for LAAC using the WATCHMAN™ device. METHODS A prospective analysis of 231 consecutive patients who underwent LAAC in a single, large academic hospital in the United States was conducted over a 5-year period. CTA-guided preprocedural planning was performed in all. Procedural success, adverse events, length of procedure, number of devices used, and length of stay were evaluated. Rates of death, cerebral embolism, systemic embolism, and major and minor bleeding were recorded. Adjusted predicted stroke and major bleeding rates were derived from CHA2DS2-Vasc and HAS-BLED scores, respectively. RESULTS From January 26, 2017, to November 23, 2021, 231 patients underwent LAAC with CTA preprocedural planning by two operating physicians. The mean age of patients was 76.5 ± 8.4. 59.7% of patients were male. Mean CHA2DS2VASc and HAS-BLED scores were 4.5 ± 1.4 and 3.9 ± 0.9, respectively. All procedures were performed with intracardiac echo (100%). The procedural success rate was 99.1%. The CTA sizing strategy accurately predicted the implant size in 93.5% of patients. Mean number of devices used was 1.10 ± 0.3. Peri-procedural complication rate was 2.2%. 6 patients were lost to follow-up. Mean follow-up was 608.94 days with a total of 377.04 patient years. Median follow-up period of 368 days (interquartile range: 209-1067 days). There were 51 deaths from all causes (13.52 per 100 patient-years), 10 cases of cerebral embolism (2.65 per 100 patient-years), 2 cases of systemic embolism (0.53 per 100 patient-years), 17 cases of major bleeding (4.50 per 100 patient-years), and 31 cases of minor bleeding (8.2 per 100 patient-years). All-cause mortality at 1, 2, and 3 years was 12.7%, 20.9%, and 29.2%, respectively. CV event rates at 1, 2, and 3 years were 2.1%, 6.6%, and 10.5%, respectively. CONCLUSIONS CTA-based preprocedural planning is accurate in predicting device size for LAAC and associated with excellent clinical outcomes at 5 years.
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West AG, Bloy ST, Skelton RP, Midgley JJ. Hydraulic segmentation explains differences in loss of branch conductance caused by fire. TREE PHYSIOLOGY 2023; 43:2121-2130. [PMID: 37672220 PMCID: PMC10714316 DOI: 10.1093/treephys/tpad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/07/2023]
Abstract
The hydraulic death hypothesis suggests that fires kill trees by damaging the plant's hydraulic continuum in addition to stem cambium. A corollary to this hypothesis is that plants that survive fires possess 'pyrohydraulic' traits that prevent heat-induced embolism formation in the xylem and aid post-fire survival. We examine whether hydraulic segmentation within stem xylem may act as such a trait. To do so, we measured the percentage loss of conductance (PLC) and vulnerability to embolism axially along segments of branches exposed to heat plumes in two differing species, fire-tolerant Eucalyptus cladocalyx F. Muell and fire-sensitive Kiggelaria africana L., testing model predictions that fire-tolerant species would exhibit higher degrees of hydraulic segmentation (greater PLC in the distal parts of the branch than the basal) than fire-intolerant species (similar PLC between segments). Following exposure to a heat plume, K. africana suffered between 73 and 84% loss of conductance in all branch segments, whereas E. cladocalyx had 73% loss of conductance in whole branches, including the distal tips, falling to 29% in the most basal part of the branch. There was no evidence for differences in resistance segmentation between the species, and there was limited evidence for differences in distal vulnerability to embolism across the branches. Hydraulic segmentation in E. cladocalyx may enable it to resprout effectively post-fire with a functional hydraulic system. The lack of hydraulic segmentation in K. africana reveals the need to understand possible trade-offs associated with hydraulic segmentation in long-lived woody species with respect to drought and fire.
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Wei Y, Chen YJ, Siddiq Z, Zhang JL, Zhang SB, Jansen S, Cao KF. Hydraulic traits and photosynthesis are coordinated with trunk sapwood capacitance in tropical tree species. TREE PHYSIOLOGY 2023; 43:2109-2120. [PMID: 37672225 DOI: 10.1093/treephys/tpad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023]
Abstract
Water stored in trunk sapwood is vital for the canopy to maintain its physiological function under high transpiration demands. Little is known regarding the anatomical properties that contribute to the hydraulic capacitance of tree trunks and whether trunk capacitance is correlated with the hydraulic and gas exchange traits of canopy branches. We examined sapwood capacitance, xylem anatomical characteristics of tree trunks, embolism resistance, the minimal xylem water potential of canopy branches, leaf photosynthesis and stomatal conductance in 22 species from a tropical seasonal rainforest and savanna. The results showed that the mean trunk sapwood capacitance did not differ between the two biomes. Capacitance was closely related to the fiber lumen fraction and fiber wall reinforcement and not to the axial and ray parenchyma fractions. Additionally, it was positively correlated with the theoretical hydraulic conductivity of a trunk and the specific hydraulic conductivity of branches, and showed a trade-off with branch embolism resistance. Species with a high trunk sapwood capacitance maintained less negative canopy water potentials in the dry season, but higher leaf photosynthetic rates and stomatal conductance in the wet season. This study provides a functional link among trunk sapwood capacitance, xylem anatomy, canopy hydraulics and photosynthesis in tropical trees.
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Keunen RWM, Daal SM, Romers GJ, Hoohenkerk GJF, van Kampen PM, Suyker WJL. Diagnostic Accuracy of an Algorithm for Discriminating Presumed Solid and Gaseous Microembolic Signals During Transcranial Doppler Examinations. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2483-2488. [PMID: 37709563 DOI: 10.1016/j.ultrasmedbio.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The aim of the work described here was to assess the diagnostic accuracy of a new algorithm (SGA-a) for time-domain analysis of transcranial Doppler audio signals to discriminate presumed solid and gaseous microembolic signals and artifacts (SGAs). METHODS SGA-a was validated by human experts in an artifact cohort of 20 patients subjected to a 1-h transcranial Doppler exam before cardiac surgery (cohort 1). Emboli were validated in a cohort of 10 patients after aortic valve replacement in a 4-h monitoring period (cohort 2). The SGA misclassification rate was estimated by testing SGA-a on artifact-free test files of solid and gaseous emboli. RESULTS In cohort 1 (n = 24,429), artifacts were classified with an accuracy of 94.5%. In cohort 2 (n = 12,328), the accuracy in discriminating solid/gaseous emboli from artifacts was 85.6%. The 95% limits of agreement for, respectively, the numbers of presumed solids and gaseous emboli, artifacts and microembolic signals of undetermined origin were [-10, 10], [-14, 7] and [-9, 16], and the intra-class correction coefficients were 0.99, 0.99 and 0.99, respectively. The rate of misclassification of solid test files was 2%, and the rate of misclassification of gaseous test files was 12%. CONCLUSION SGA-a can detect presumed solid and gaseous microembolic signals and differentiate them from artifacts. SGA-a could be of value when both solid and gaseous emboli may jeopardize brain function such as seen during cardiac valve and/or aortic arch replacement procedures.
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Chekmeyan M, Baccei SJ, Garwood ER. Cross-Check QA: A Quality Assurance Workflow to Prevent Missed Diagnoses by Alerting Inadvertent Discordance Between the Radiologist and Artificial Intelligence in the Interpretation of High-Acuity CT Scans. J Am Coll Radiol 2023; 20:1225-1230. [PMID: 37423347 DOI: 10.1016/j.jacr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The aim of this study was to implement and evaluate a quality assurance (QA) workflow that leverages natural language processing to rapidly resolve inadvertent discordance between radiologists and an artificial intelligence (AI) decision support system (DSS) in the interpretation of high-acuity CT studies when the radiologist does not engage with AI DSS output. METHODS All consecutive high-acuity adult CT examinations performed in a health system between March 1, 2020, and September 20, 2022, were interpreted alongside an AI DSS (Aidoc) for intracranial hemorrhage, cervical spine fracture, and pulmonary embolus. CT studies were flagged for this QA workflow if they met three criteria: (1) negative results by radiologist report, (2) a high probability of positive results by the AI DSS, and (3) unviewed AI DSS output. In these cases, an automated e-mail notification was sent to our quality team. If discordance was confirmed on secondary review-an initially missed diagnosis-addendum and communication documentation was performed. RESULTS Of 111,674 high-acuity CT examinations interpreted alongside the AI DSS over this 2.5-year time period, the frequency of missed diagnoses (intracranial hemorrhage, pulmonary embolus, and cervical spine fracture) uncovered by this workflow was 0.02% (n = 26). Of 12,412 CT studies prioritized as depicting positive findings by the AI DSS, 0.4% (n = 46) were discordant, unengaged, and flagged for QA. Among these discordant cases, 57% (26 of 46) were determined to be true positives. Addendum and communication documentation was performed within 24 hours of the initial report signing in 85% of these cases. CONCLUSIONS Inadvertent discordance between radiologists and the AI DSS occurred in a small number of cases. This QA workflow leveraged natural language processing to rapidly detect, notify, and resolve these discrepancies and prevent potential missed diagnoses.
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Yoshihara S, Matsunaga M, Yaegashi T, Nozue S, Naito M. Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease Due to Coronary Embolism Clarified by Cardiac Computed Tomography. Circ Cardiovasc Imaging 2023; 16:e016033. [PMID: 38031844 DOI: 10.1161/circimaging.123.016033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
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Pereira L, Kaack L, Guan X, Silva LDM, Miranda MT, Pires GS, Ribeiro RV, Schenk HJ, Jansen S. Angiosperms follow a convex trade-off to optimize hydraulic safety and efficiency. THE NEW PHYTOLOGIST 2023; 240:1788-1801. [PMID: 37691289 DOI: 10.1111/nph.19253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023]
Abstract
Intervessel pits are considered to function as valves that avoid embolism spreading and optimize efficient transport of xylem sap across neighbouring vessels. Hydraulic transport between vessels would therefore follow a safety-efficiency trade-off, which is directly related to the total intervessel pit area (Ap ), inversely related to the pit membrane thickness (TPM ) and driven by a pressure difference. To test this hypothesis, we modelled the relative transport rate of gas (ka ) and water (Q) at the intervessel pit level for 23 angiosperm species and correlated these parameters with the water potential at which 50% of embolism occurs (Ψ50 ). We also measured ka for 10 species using pneumatic measurements. The pressure difference across adjacent vessels and estimated values of ka and Q were related to Ψ50 , following a convex safety-efficiency trade-off based on modelled and experimental data. Minor changes in TPM and Ap exponentially affected the pressure difference and flow, respectively. Our results provide clear evidence that a xylem safety-efficiency trade-off is not linear, but convex due to flow across intervessel pit membranes, which represent mesoporous media within microporous conduits. Moreover, the convex nature of long-distance xylem transport may contribute to an adjustable fluid balance of plants, depending on environmental conditions.
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Laughlin DC, Siefert A, Fleri JR, Tumber-Dávila SJ, Hammond WM, Sabatini FM, Damasceno G, Aubin I, Field R, Hatim MZ, Jansen S, Lenoir J, Lens F, McCarthy JK, Niinemets Ü, Phillips OL, Attorre F, Bergeron Y, Bruun HH, Byun C, Ćušterevska R, Dengler J, De Sanctis M, Dolezal J, Jiménez-Alfaro B, Hérault B, Homeier J, Kattge J, Meir P, Mencuccini M, Noroozi J, Nowak A, Peñuelas J, Schmidt M, Škvorc Ž, Sultana F, Ugarte RM, Bruelheide H. Rooting depth and xylem vulnerability are independent woody plant traits jointly selected by aridity, seasonality, and water table depth. THE NEW PHYTOLOGIST 2023; 240:1774-1787. [PMID: 37743552 DOI: 10.1111/nph.19276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
Evolutionary radiations of woody taxa within arid environments were made possible by multiple trait innovations including deep roots and embolism-resistant xylem, but little is known about how these traits have coevolved across the phylogeny of woody plants or how they jointly influence the distribution of species. We synthesized global trait and vegetation plot datasets to examine how rooting depth and xylem vulnerability across 188 woody plant species interact with aridity, precipitation seasonality, and water table depth to influence species occurrence probabilities across all biomes. Xylem resistance to embolism and rooting depth are independent woody plant traits that do not exhibit an interspecific trade-off. Resistant xylem and deep roots increase occurrence probabilities in arid, seasonal climates over deep water tables. Resistant xylem and shallow roots increase occurrence probabilities in arid, nonseasonal climates over deep water tables. Vulnerable xylem and deep roots increase occurrence probabilities in arid, nonseasonal climates over shallow water tables. Lastly, vulnerable xylem and shallow roots increase occurrence probabilities in humid climates. Each combination of trait values optimizes occurrence probabilities in unique environmental conditions. Responses of deeply rooted vegetation may be buffered if evaporative demand changes faster than water table depth under climate change.
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Paligi SS, Link RM, Isasa E, Bittencourt P, Cabral JS, Jansen S, Oliveira RS, Pereira L, Schuldt B. Assessing the agreement between the pneumatic and the flow-centrifuge method for estimating xylem safety in temperate diffuse-porous tree species. PLANT BIOLOGY (STUTTGART, GERMANY) 2023; 25:1171-1185. [PMID: 37703535 DOI: 10.1111/plb.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/06/2023] [Indexed: 09/15/2023]
Abstract
The increasing frequency of global change-type droughts has created a need for fast, accurate and widely applicable techniques for estimating xylem embolism resistance to improve forecasts of future forest changes. We used data from 12 diffuse-porous temperate tree species covering a wide range of xylem safety to compare the pneumatic and flow-centrifuge method, two rapid methods used for constructing xylem vulnerability curves. We evaluated the agreement between parameters estimated with both methods and the sensitivity of pneumatic measurements to the duration of air discharge (AD) measurements. There was close agreement between xylem water potentials at 50% air discharged (PAD), estimated with the Pneumatron, and 50% loss of hydraulic conductivity (PLC), estimated with the flow-centrifuge method (mean signed deviation: 0.12 MPa, Pearson correlation: 0.96 after 15 s of gas extraction). However, the relationship between the estimated slopes was more variable, resulting in lower agreement in the xylem water potential at 12% and 88% PAD/PLC. The agreement between the two methods was not affected by species-specific vessel length distributions. All pneumatic parameters were sensitive to AD time. Overall agreement was highest at relatively short AD times, with an optimum at 16 s. Our results highlight the value of the Pneumatron as an easy and reliable tool to estimate 50% embolism thresholds for a wide range of diffuse-porous temperate angiosperms. Further, our study provides a set of useful metrics for methodological comparisons of vulnerability curves in terms of systematic and random deviations, as well as overall agreement.
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