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Coronary Artery Calcification Identified on Lung Cancer Screening CT Scans: A Scoping Review
No full textBACKGROUND: Coronary artery calcification (CAC) can be a significant incidental finding on low-dose CT scans performed for lung cancer screening (LCS). CAC presence and grade hold important diagnostic and preventive value, particularly in patients without previously recognized coronary artery disease.
RESEARCH QUESTION: What is the prevalence of CAC as an incidental finding on LCS CT scans across prior studies?
STUDY DESIGN AND METHODS: A literature review was conducted using the PubMed database to identify studies investigating CAC identified on LCS CT scans. The review included articles published in English from January 2012 through March 2024. The search query used 3 main keywords: CAC, LCS, and incidental finding.
RESULTS: The initial search resulted in 256 abstracts screened for eligibility, resulting in 32 articles included in the final review. CAC presence across included studies varied from 14.8% to 98%. CAC most commonly was reported as mild in grade, among 46.9% of studies. Most studies were conducted among predominantly White male participants. Finally, only 6 articles provided information on downstream interventions for patients with newly detected CAC.
INTERPRETATION: CAC, a predictive risk factor for cardiovascular events and mortality, is a frequently detected incidental finding on LCS CT scans, with substantial variation in presence across studies. Identification of CAC on LCS CT scans could inform clinical decisions to reduce patients\u27 overall cardiovascular risk. These findings underscore the significance of standardizing the documentation and management of CAC in LCS. Finally, future studies should include greater race diversity
Enhancing CT image segmentation accuracy through ensemble loss function optimization
No full textBACKGROUND: In CT-based medical image segmentation, the choice of loss function profoundly impacts the training efficacy of deep neural networks. Traditional loss functions like cross entropy (CE), Dice, Boundary, and TopK each have unique strengths and limitations, often introducing biases when used individually.
PURPOSE: This study aims to enhance segmentation accuracy by optimizing ensemble loss functions, thereby addressing the biases and limitations of single loss functions and their linear combinations.
METHODS: We implemented a comprehensive evaluation of loss function combinations by integrating CE, Dice, Boundary, and TopK loss functions through both loss-level linear combination and model-level ensemble methods. Our approach utilized two state-of-the-art 3D segmentation architectures, Attention U-Net (AttUNet) and SwinUNETR, to test the impact of these methods. The study was conducted on two large CT dataset cohorts: an institutional dataset containing pelvic organ segmentations, and a public dataset consisting of multiple organ segmentations. All the models were trained from scratch with different loss settings, and performance was evaluated using Dice similarity coefficient (DSC), Hausdorff distance (HD), and average surface distance (ASD). In the ensemble approach, both static averaging and learnable dynamic weighting strategies were employed to combine the outputs of models trained with different loss functions.
RESULTS: Extensive experiments revealed the following: (1) the linear combination of loss functions achieved results comparable to those of single loss-driven methods; (2) compared to the best non-ensemble methods, ensemble-based approaches resulted in a 2%-7% increase in DSC scores, along with notable reductions in HD (e.g., a 19.1% reduction for rectum segmentation using SwinUNETR) and ASD (e.g., a 49.0% reduction for prostate segmentation using AttUNet); (3) the learnable ensemble approach with optimized weights produced finer details in predicted masks, as confirmed by qualitative analyses; and (4) the learnable ensemble consistently outperforms the static ensemble across most metrics (DSC, HD, ASD) for both AttUNet and SwinUNETR architectures.
CONCLUSIONS: Our findings support the efficacy of using ensemble models with optimized weights to improve segmentation accuracy, highlighting the potential for broader applications in automated medical image analysis
Artificial Intelligence in Scientific Writing: Balancing Innovation and Efficiency with Integrity: Perspectives and Position Statements of Global Andrology Forum Expert Group
No full textDiagnostic algorithm in men suspected with nonobstructive azoospermia
No full textThis review focuses on the diagnostic algorithm for nonobstructive azoospermia (NOA), a significant male factor contributing to infertility. NOA, characterized by the absence of sperm in the ejaculate, requires a systematic diagnostic approach to identify reversible conditions, genetic factors, and prognosis for achieving pregnancy. The diagnostic pathway involves semen analysis and a comprehensive evaluation for hormonal deficiencies, anatomical abnormalities, and genetic factors. The importance of medical history, physical examination, endocrine evaluation, imaging, and genetic testing is emphasized. This review highlights the significance of differentiating NOA from obstructive azoospermia (OA) and outlines key considerations for effective management, including surgical sperm retrieval and assisted reproductive techniques. Testicular biopsy is discussed as a definitive method to distinguish obstructive cases from nonobstructive cases, providing valuable prognostic information. Overall, a thorough and systematic diagnostic approach is essential for the effective management of men suspected with NOA, offering insights into potential treatment options and reproductive outcomes
Outcomes among patients with coronary bifurcation lesions undergoing Impella-supported high-risk percutaneous coronary intervention
No full textBACKGROUND: Coronary bifurcation lesions (CBL) are associated with lower procedural success, worse postprocedural outcomes, and greater unplanned repeat revascularization. We sought to better understand the impact of Impella support in patients undergoing percutaneous coronary intervention (PCI) of CBLs.
METHODS: We used data from the cVAD PROTECT III study (NCT04136392), an FDA-audited, single-arm study of patients undergoing high-risk PCI with Impella support, to examine the outcomes of patients undergoing PCI of CBLs. Patients with a Medina classification of 1.1.1, 1.0.1, or 0.1.1 were considered to have a true CBL, and were compared to patients with nontrue CBLs and/or no CBLs. The primary outcome was the rate of CEC-adjudicated major adverse cardiac and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) at 90 days. Cox proportional hazards regression models were adjusted for age, sex, left main disease, and triple vessel disease.
RESULTS: Of 1,044 patients, 523 had at least one true CBL treated. Baseline characteristics were comparable between groups except for age which was higher in patients with CBLs. Patients with CBLs had a significantly higher pre-PCI SYNTAX scores and number of treated lesions, more left main disease and triple vessel disease, and longer procedure duration. There was no difference in post-PCI SYNTAX score, PCI-related complications, or failure to achieve angiographic success. After adjustment for potential confounders, patients with CBLs had similar rates of 90-day MACCE.
CONCLUSIONS: While patients with CBLs undergoing Impella-supported high-risk PCI had higher complexity, there were similar rates of PCI-related complications and 90-day MACCE.
TRIAL REGISTRATION: Trial Name: The Global cVAD Study (cVAD), ClinicalTrial.gov Identifier: NCT04136392, URL:https://clinicaltrials.gov/ct2/show/NCT04136392?term=cvad&draw=2&rank=2
The Beta-Blocker Pharmacogenetic Puzzle: More Pieces of Evidence for Pharmacodynamic Candidate Variants
No full textPrevious pharmacogenetic findings for beta-blocker pharmacodynamic candidate genes (ADRB1, ADRB2, ADRA2C, GRK4, and GRK5) have been inconsistent. Therefore, the purpose of this study was to determine whether interactions of pharmacodynamic variants with beta-blocker exposure significantly associated with survival in patients with heart failure with reduced ejection (HFrEF). The 893 patients were 51% self-reported African American and 49% self-reported White race, 36% female, and 240 died (27%) over a median follow-up of 2.8 years. The primary outcome was all-cause mortality. Using Cox proportional hazards models with time-varying beta-blocker exposure and adjusted for clinical risk factors and ancestry, interactions of ADRB1 Arg389Gly, ADRB1 Ser49-Arg389Gly haplotype, ADRA2C Del(322-325), and GRK4 Ala486Val with beta-blocker exposure were significant before correction for multiple comparisons (p \u3c 0.1), but only GRK4 Ala486Val remained significant in African Americans after correction for multiple comparisons using the adaptive Hochberg method (p = 0.022). Beta-blocker exposure only associated with a significant reduction in the risk of mortality in the African American HFrEF patients with the GRK4 Ala486/Ala486 genotype (HR = 0.44; 95% CI = 0.20-0.96; p = 0.04). In conclusion, the interaction of GRK4 Ala486Val with beta-blocker exposure significantly associated with survival in African American HFrEF patients. Larger sample sizes or meta-analyses are needed to have more statistical power to better assess beta-blocker pharmacogenetic interactions for ADRB1 Arg389Gly, ADRB1 Ser49-Arg389Gly haplotype, and ADRA2C Del(322-325) in the future
Redo or Redon\u27t? Mitral valve reoperation vs. first-time surgery outcomes: A nationwide study
No full textPercutaneous Paravalvular Leak Closure of the EVOQUE Transcatheter Tricuspid Valve Replacement System
No full text•Transcatheter closure of paravalvular leak of the EVOQUE valve is feasible and can be done from a transfemoral or transjugular approach.•Preoperative cardiac computed tomography is useful to characterize the location and size of the paravalvular leak defects.•The mechanisms of late paravalvular leak are unclear, but the progressive right ventricular dilatation and ellipsoid deformation of the tricuspid annulus may contribute to the development of leaks in the septal and lateral positions
First-in-Human Percutaneous Transseptal Retrieval of Embolized Transcatheter Valve in the Left Ventricle: The RETRIEVE Trial
No full textManaging Commissural Mitral Valve Regurgitation Following Transcatheter Mitral Valve Repair Using the Amplatzer Occluder Device
No full textMitral regurgitation (MR) is a common valvular abnormality in patients in the Western world. Treatment options include surgery and edge-to-edge repair of the mitral valve leaflets using the MitraClip device. However, MR may recur, and MitraClip can be unsuccessful, posing a challenging management dilemma. We present a case involving a 74-year-old male patient who originally presented due to severe symptomatic MR. The patient originally underwent successful intervention with a MitraClip. However, the patient reported recurrent dyspnea with little effort approximately six months after the index procedure. A repeat 3D transesophageal echocardiogram revealed severe recurrent MR at the medial commissure with an eccentric jet, similar to findings from prior studies. Due to the medial location of the defect, limited space to steer an additional clip, and high surgical risk, the patient was not a suitable candidate for surgical intervention or repeat MitraClip (Abbott Vascular, Santa Clara, CA) placement. The severe recurrent commissural MR was successfully managed using an Amplatzer Patent Foramen Ovale Occluder device (St. Jude Medical, Minneapolis, MN) in an off-label fashion