Normal Mean Values Research Articles

Weight-specific normal liver stiffness values in children.

Two-dimensional (2-D) shear wave elastography is a commonly used sonographic elastography method for the noninvasive measurement of liver stiffness. There is little liver stiffness data available in the pediatric population and its association with the child's weight is scarce. The principal aim of our study was to determine weight-specific reference liver stiffness values in a pediatric population free of liver disease. In this retrospective single-center study, 2-D shear wave elastography values were recorded in children with no history of liver disease and with a clinically indicated ultrasound examination, between April 2021 and July 2022. Examinations were performed using an Aplio i800 and two Aplio a450 (Canon Medical Systems), with a convex probe (i8CX1 or 8C1 transducers). This population was divided into ten weight groups. We evaluated the relation between weight and liver elasticity values and compared right and left lobe measurements. During the period of the study, 235 children were included. We then excluded 64 patients (weight not available = 13, interquartile range to median ratio (IQR/M) greater than 30% = 51). On the final sample (171 patients, median age 6.5years [0-18], median weight 22.6kg [2.5-80]), stiffness values showed a global significant trend to increase with weight. In each group, there was no significant difference between right and left liver stiffness values. The mean normal liver stiffness value including all children was 5.3 ± 1.1kPa. Liver stiffness in our pediatric sample with no history of liver disease increases with weight. These data may help to distinguish normal from pathological elastography values.

The Δ Anion Gap/Δ Bicarbonate Ratio in Lactic Acidosis: Time for a New Baseline?

The ratio of delta anion gap and delta bicarbonate (ΔAG/ΔHCO3) is used to detect co-existing acid-base disorders in patients with high anion gap metabolic acidosis. The ΔAG/ΔHCO3 ratio of 1.6-1.8:1 in lactic acidosis is derived from limited data using mean normal values for AG and serum HCO3. The objective of this study was to be the first to examine the ΔAG/ΔHCO3 using each patient's individual baseline AG and serum HCO3. This was a retrospective cohort study of adult ICU patients with sepsis. Lab data from simultaneously drawn chemistry panel, including anion gap and serum lactate on admission to the ICU was obtained. Baseline AG, HCO3 and albumin measurements were obtained 1-24 months prior to ICU admission. The ΔAG/ΔHCO3 was calculated using an albumin-corrected anion gap and each patient's individual baseline AG and serum HCO3. 344 patients were included. 128 patients had normal serum lactate levels (≤1.9 mmol/L) and 216 patients had elevated serum lactate levels (>1.9 mmol/L). ΔAG/ΔHCO3 was calculated for the 216 patients who had elevated serum lactate levels (>1.9 mmol/L). The mean ΔAG/ΔHCO3 for all patients with elevated serum lactate levels was 1.20 (SD 1.50). The mean ΔAG/ΔHCO3 calculated using an albumin-corrected anion gap and each patient's individual baseline AG and serum HCO3 was 1.20. The ΔAG/ΔHCO3 reported in prior literature which used mean normal AG and serum HCO3 was 1.6-1.8, highlighting that use of mean normal values affects the calculation of the ΔAG/ΔHCO3 and subsequent conclusions about underlying pathophysiology. The use of these mean normal values can result in misdiagnosis of complex acid-base disorders and inappropriate treatment. Our analysis indicates that the elevated ΔAG/ΔHCO3 is likely due to unmeasured anions contributing to an elevation in AG.

Continued harmonization of the international normalized ratio across a large laboratory network: Evidence of sustained low interlaboratory variation and bias after a change in instrumentation.

Our objective was to maintain low interlaboratory variation and bias in international normalized ratio (INR) results following a network change in instrumentation and reagents, using a process of ongoing standardization and harmonization. Network-wide standardization to new common instrument and reagent platforms followed by network-wide application of a simple novel process of verification of international sensitive index and mean normal prothrombin time values for each new lot of prothrombin time (PT) reagent that does not require use of World Health Organization reference thromboplastin or INR calibration/certified plasma. The network transitioned from mechanical hemostasis detection instruments with associated PT reagent (Diagnostica Stago; NeoPTimal) to optical detection (ACL TOPs) with associated PT reagent (Werfen; RecombiPlasTin 2G). Comparing 3 years of data for each situation, the network (n=27 laboratories) maintained low INR variability and bias relative to general mechanical and optical groups and other laboratories. Harmonized support for patient management of vitamin K antagonists such as warfarin was continuously maintained in our geography, with potentially positive implications for other coagulation laboratories and geographies. For the United States in particular, paucity of US Food and Drug Administration-cleared INR certified plasmas potentially compromises INR test accuracy; our novel approach may provide workable alternatives for other laboratories/networks.

Lung T1 MRI assessments in children with mild cystic fibrosis lung disease.

Lung T1 MRI is a potential method to assess cystic fibrosis (CF)lung disease that is safe, quick, and widely available, but there are no data in children with mild CF lung disease. Assess the ability of lung T1 MRI to detect abnormalities in children with mild CF lung disease. We performed T1 MRI, multiple breath washout (MBW),chest computed tomography (CT),and spirometry in a cohort of 45 children with mild CF lung disease (6-11 years of age). Despite mean normal ppFEV1 values, the majority of children with CF in this study exhibited mild lung disease evident in lung clearance index (LCI)measured by MBW, chest CT Brody scores, and percent normal lung perfusion (%NLP)measured by T1 MRI. The %NLP correlated with chest CT Brody scores, as did LCI, but %NLP and LCI did not correlate with each other. Analysis of the Brody subscores showed that %NLP and LCI largely correlated with different Brody subscores. T1 MRI can detect mild CF lung disease in children and correlates with chest CT findings. The %NLPfrom T1 MRI and LCI correlate with different chest CT Brody subscores, suggesting they provide complementary information about CF lung disease.

The Effect of I-131 Treatment on Complete Blood Count

Radioactive iodine-131 (RAI) treatment may cause suppression in the bone marrow. In this study, hemoglobin levels, leukocyte, thrombocyte, and lymphocyte counts will be compared before total thyroidectomy and 6 months after RAI treatment. 97 patients (76 females, 21 males) with a diagnosis of well-differentiated thyroid cancer who had undergone total thyroidectomy and received 50-200 mCi RAI treatment were included in the study. Hemoglobin levels, leukocyte, thrombocyte, and lymphocyte counts of the patients in the last month before the treatment and in the sixth month after the treatment were compared retrospectively. When the whole patients were analyzed, hemoglobin levels, leukocyte, thrombocyte, and lymphocyte counts in pretreatment were statistically lower than after-treatment values. While hemoglobin levels of female patients were similar before and after treatment, lymphocyte, thrombocyte, and leukocyte counts were statistically lower before treatment. Hemoglobin levels, leukocyte,and thrombocyte counts were similar before and after treatment, while lymphocytes decreased significantly after RAI treatment. Thyroid cancer patients who received 50-200 mCi RAI treatment after total thyroidectomy, have bone marrow suppression but are still in normal mean value ranges. This mild bone marrow suppression is more prominent in female patients than in male patients.

ИССЛЕДОВАНИЕ МИКРОЦИРКУЛЯЦИИ КРОВИ В УСЛОВИЯХ НЕВЕСОМОСТИ С ПОМОЩЬЮ ПОРТАТИВНЫХ ЛАЗЕРНЫХ ДОПЛЕРОВСКИХ ФЛОУМЕТРОВ

The paper reports the results of blood microcirculation studies in microgravity using portable laser analyzer LAZMAPF. Two cosmonauts (C-1 and C-2) performed pre-launch and in-flight (9 days) 8-minute sessions with the use of 2 portable flowmeters symmetrically attached to the temporal skin, palmer sides of distal phalanxes III, forearm superficies and planter surfaces of toe distal phalanxes I. In C-1, mean perfusion rate in toes decreased more than in half due to blood redistribution toward the upper body on the first two days in orbit and then, by way of adaptation, regained normal mean values. In C-2, compression of the proximal regions of lower extremities to induce blood deposition caused high-amplitude NO-dependent oscillations at about 1/min. On the background of adaptation during flight days 2–3, high-amplitude endothelial vasomotions in C-1 (one oscillation every 3–4 minutes) can be associated with an endothelial hyperpolarizing factor. In whole, on flight days 2–3 adaptation of the microcirculation system, particularly pronounced in the temporal and planter tissues, was characterized by a significant reduction of perfusion and increased vascular tone. Baseline prelaunch values were regained by flight day 6. For the first time, a research technique was proposed under microgravity conditions and data were obtained on the state of blood microcirculation of astronauts during the period of acute adaptation to microgravity conditions and readaptation after flight completion.

The morphological peculiarities of the maxillo-facial region in children with cleft lips and palate

Considerable variation in malocclusion was found in children with cleft lip and palate. Class III malocclusionwere found more frequently due to congenital factors, such as maxillo-mandibular growth potential as well as the severity of the defect.Material and methods. In this study, 15 cephalometric x-rays were analyzed according to the methods proposed by McNamara, Tweed, Roth-Jarabak and Steiner, and 30 cephalometric parameters were calculated for each patient with complete unilateral cleft (so many on the left and so many on the right). The data obtained from the measurements are presented in the tables corresponding to each method. Results. Maxillary and mandibular length (Cond-A, Cond-Gn) statistically significantly reduced compared to normal mean values. The threshold of significance registered for these indices demonstrates significant deviations of the previous height of the face was statistically significantly reduced by the value p<0.01 compared to the normal values (Sna-Me). The posterior vertical skeletal deficit is confirmed by the reduced value of the Hp parameter (posterior height, p<0.01), which compared to Ha, reveals a type of posterior facial rotation. The enlarged lower anterior face is demonstrated by the increased value of the anterior height index, (Sna-Me) which registered an average deviation of 6.57 mm and an increased Ha/Hp ratio (p<0.01). Conclusions. In the result of the analysis of the cephalometric analysis of the x-rays according to the McNamara, Roth-Jarabak, TweedMerriefield and Steiner methods, it was found that the cranio-facial morphology in children with unilateral cleft lips and palate was different from normal values due to the lack of growth of the facial part of the cranium both in sagittal and vertical planes.

Ultrasonographic Evaluation of Normal Liver, Spleen, and Kidney Dimensions in a Healthy Turkish Community of Over 18 Years Old.

The dimensions of the liver, spleen, and kidneys either change in primary diseases related to these organs or in secondary diseases that indirectly affect them, such as diseases of the cardiovascular system. Therefore, we aimed to investigate the normal dimensions of the liver, kidneys, and spleen and their correlations with body mass index in healthy Turkish adults. A total of 1,918 adults older than 18 years of age underwent ultrasonographic (USG) examinations. Participants' age, sex, height, weight, BMI, liver, spleen, and kidney dimensions, biochemistry and haemogram results were recorded. The relationships between organ measurements and these parameters were examined. A total of 1,918 patients participated in the study. Of these, 987 (51.5%) were female and 931 (48.5%) were male. The mean age of the patients was 40.74± 15.95 years. The liver length (LL) for men was found to be greater than that for women. The effect of the sex factor on the LL value was statistically significant (p = 0.000). The difference between men and women in terms of liver depth (LD) was statistically significant (p=0.004). The difference between BMI groups in terms of splenic length (SL) was not statistically significant (p=0.583). The difference between BMI groups in terms of splenic thickness (ST) was statistically significant (p=0.016). We obtained the mean normal standard values of the liver, spleen, and kidneys in a healthy Turkish adult population. Consequently, values exceeding those in our findings will guide clinicians in the diagnosis of organomegaly and will contribute to filling the gap in this regard.

The evolution of depletion zones beneath mud volcanoes

Depletion zones are the least well understood component of mud volcanic systems. They are generally difficult to image using reflection seismic data, and have only rarely been identified and described in the subsurface. This study documents 277 mapped depletion zones in the western Nile Cone, offshore Egypt, of which the dimensions and stratigraphic characteristics of a sub-set of 86 depletion zones associated with mud volcanoes of early Pliocene to Recent age are recorded. The primary database used is a large (4,300 km2) 3D seismic survey in which depletion zones can be confidently interpreted using a set of simple criteria. The sub-set of 86 depletion zones were selected for morphometric analysis by virtue of the quality of seismic imaging. The depletion zones are characterised by circular to elliptical planforms with a bowl or conical geometry. They exhibit truncational stratal relationships with their parent stratigraphic unit, which in this area is the Mid-Late Miocene aged OM2 unit, and which occurs directly beneath the Messinian Evaporites. This geometry implies a top-down formation mechanism. Their diameters and relief range from is 600 m–3300 m, and 100 m–740 m, respectively, with a modest scaling relationship between diameter and relief. Flank angles of bowls and cones range from 11⁰ to 41⁰, with a crudely normal distribution, with median and mean values of 26⁰. A model for the evolution of depletion zones in the study area is based on two previous models developed for single source layer plumbing systems and invokes mobilisation of the source layer by sediment collapse and shear-induced liquefaction following initial seal failure by hydraulic fracturing of the evaporite seal. This mechanism may be more widely applicable to mud volcano systems than currently appreciated.

Comparison of HbA2 Using High Performance Liquid Chromatography Versus Haemoglobin Capillary Zone Electrophoresis.

Thalassemia is among the most common hereditary disorders in the world. Approximately 5% of the world's population are carriers of hemoglobinopathies, and 2.9% are carriers of beta thalassemia. Haemoglobin A2 (HbA2) constitutes less than 3% of the total hemoglobin (Hb) in adults, and the determination of Hb A2 levels is important to diagnose the beta thalassemia trait(BTT). In some cases, the level of HbA2 is not typically elevated, and some difficulties may arise in making the diagnosis. Cation exchange high-performance liquid chromatography (HPLC) and HbCZE (haemoglobin capillary zone electrophoresis) are considered acceptable methods to diagnose BTT, but these vary in their accuracy and cut-offs. In this study, we attempted to compare HbA2 values using two methods, HPLC and HbCZE, in 536 whole blood samples sent by physician-ordered hemoglobinopathy screening over two years. This included antenatal women, patients with anemia not responding to iron, and cases of familial screening where either a child or a sibling had been diagnosed with hemoglobinopathy or thalassemia. The performance characteristics of both machines were compared for the detection of the 5 most common hemoglobin variants: Hb A, HbF, HbS, Hb C, and HbE. On comparing the HbA2 values, the HPLC showed higher values for HbA2 as compared to HbCZE, while the HbF and HbS measurement agreement was good between both methods. Normal ranges and mean normal values of HbA2 differ between different methods and different manufacturers; hence, each institute using these machines should validate its cutoffs.

Bayesian penalized likelihood PET reconstruction impact on quantitative metrics in diffuse large B-cell lymphoma.

Evaluate the quantitative, subjective (Deauville score [DS]) and reader agreement differences between standard ordered subset expectation maximization (OSEM) and Bayesian penalized likelihood (BPL) positron emission tomography (PET) reconstruction methods. A retrospective review of 104 F-18 fluorodeoxyglucose PET/computed tomography (CT) exams among 52 patients with diffuse large B-cell lymphoma. An unblinded radiologist moderator reviewed both BPL and OSEM PET/CT exams. Four blinded radiologists then reviewed the annotated cases to provide a visual DS for each annotated lesion. Significant (P < .001) differences in BPL and OSEM PET methods were identified with greater standard uptake value (SUV) maximum and SUV mean for BPL. The DS was altered in 25% of cases when BPL and OSEM were reviewed by the same radiologist. Interobserver DS agreement was higher for OSEM (>1 cm lesion = 0.89 and ≤1 cm lesion = 0.84) compared to BPL (>1 cm lesion = 0.85 and ≤1 cm lesion = 0.81). Among the 4 readers, average intraobserver visual DS agreement between OSEM and BPL was 0.67 for lesions >1cm and 0.4 for lesions ≤1 cm. F-18 Fluorodeoxyglucose PET/CT of diffuse large B-cell lymphoma reconstructed with BPL has higher SUV values, altered DSs and reader agreement when compared to OSEM. This report finds volumetric PET measurements such as metabolic tumor volume to be similar between BPL and OSEM PET reconstructions. Efforts such as adoption of European Association Research Ltd accreditation should be made to harmonize PET data with an aim at balancing the need for harmonization and sensitivity for lesion detection.

Ultrasound measurement of optic nerve sheath diameter in a healthy adult Colombian population

BackgroundMeasurement of the optic nerve sheath diameter (ONSD) provides a rapid, safe, and easy method for detecting increased intracranial pressure (ICP). However, the normal mean and upper limit values may vary according to sex, age, ethnicity, and ultrasound technique.AimWe aimed to obtain the mean ONSD in a healthy Colombian adult population and to correlate it with demographic and anthropometric measures.MethodsIn a prospective study using a 10–13 MHz linear ultrasound probe, eye transverse diameter (ETD) and ONSD in the transverse (ONSD-TP) and sagittal planes (ONSD-SP) were measured in healthy adult volunteers in Bogota, Colombia.ResultsA total of 100 healthy subjects were included, with a mean age of 26,7 ± 8,3 years and 62 women. The mean ETD, ONSD-TP and ONSD-SP was 23.11 mm (95% confidence interval (CI): 22.90 mm-23.32 mm), 3.96 mm (95% CI: 3.85 mm-4.07 mm) and 4.0 mm (95% CI: 3.90 mm-4.11 mm), respectively. The ONSD in both planes ranged from 2.35 mm to 5.20 mm. There was a significant correlation between ONSD-SP and ONSD-TP (p < 0.0001) but no correlation between the ocular measures and demographic or anthropometric variables (p > 0.05). The intraclass correlation between the eyes was statistically significant.ConclusionOur study shows that ultrasound-measured ONSD in healthy adults in Colombia is similar to that found worldwide. An ONSD of 5.5 mm may be considered the upper limit for healthy adults in Colombia. ONSD can be measured in either plane; there is a good correlation between the two eyes; and ONSD is not modified by demographic or anthropometric characteristics.

Effect of Antidiabetic Drugs on Blood Coagulation in Diabetic Patients

Background-Diabetes mellitus (DM) is a common endocrine disorder. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are basic haematological indices to screen the coagulation status. Due to persistent hyperglycemia, glycation of proteins involved in clotting mechanism takes place which reduces their availability, thus affecting the clotting capacity. Method- An analytical observational study was conducted on 180 subjects by measuring their PT and aPTT, to observe the effect of antidiabetic drugs on blood coagulation and to compare these indices between treated and untreated diabetics. Results- A significant elevation of PT and aPTT in untreated diabetics when compared to controls was seen (PT (p&lt;0.001); aPTT (p&lt;0.05)). The effect of antidiabetic drugs showed normal mean values of PT and aPTT in treated group (p&gt;0.05). Conclusion- the study revealed that significant elevation of PT and aPTT in untreated DM than non diabetic controls may be interpreted as tendency to bleed while effect of anti diabetic drugs shows normal mean values of PT and aPTT in treated group. This suggests that antidiabetic drugs either in combination or monotherapy may normalize PT and aPTT by reducing glycation of hemoglobin. Therefore, routine examinations of PT and aPTT are important to assess coagulation impairment in diabetes mellitus so as to prevent cardiovascular disease.

Estimation of Stature from Arm Span: A Prospective Study Among Medical Students of Rangpur Medical College

Background: Arm span is one of the most reliable body parameters for predicting the stature of an individual. It is useful in an age-related loss in stature and in identifying individuals with disproportionate growth abnormalities and skeletal dysplasia.&#x0D; Objectives: The present study was undertaken to determine whether there is any correlation between stature and arm span and estimate stature from arm span by using multiplication factor and assess the effectiveness of the above estimation by comparing the ‘estimated’ values with the measured values.&#x0D; Methods: This is a cross-sectional analytical study done in the Department of Anatomy, Rangpur Medical College, Rangpur, from January to December 2018 on purposively selected 700 medical students (350 male and 350 female). Arm span along with their stature was measured directly from the subjects by using an anthropometric technique by a measuring tape. Multiplication factors were estimated for estimating stature and comparison were made between measured and estimated stature using paired “t” test.&#x0D; Results: The mean normal value of arm span was 170.48±7.38 cm in males and 156.13±5.98 cm in females and the stature was 168.93±0.06 cm in males and 156.23±0.05 cm in females. The multiplication factor was estimated for the same hand measurements with the stature. A significant positive correlation was found in the case of arm span with stature.&#x0D; Conclusion: Arm span is a valid measure of stature for both adult males and females.&#x0D; J Rang Med Col. September 2022; Vol. 7, No. 2:47-51

Establishing Normal Range of Fetal Pulmonary Artery and Fetal Aortic Diameter in 18-26 Weeks of Gestation in Pakistani Population

Congenital heart diseases constitute almost 0.8 to 1.2% of newborn illnesses globally however unfortunately 64% of them remained undiagnosed on conventional anamoly scan which uses four chamber view for cardiac evaluation. In developed countries, other than routine anomaly scan, the three vessel view(3VV) has been added to look for any potential outflow tract anomalies which increased the sensitivity of screening CHD however this view is not routinely used in our clinical practice due to lack of expertise and less awareness regarding the importance of this view . We aimed to establish normal reference values of fetal pulmonary and fetal aorta diameter value using 3VV so that its routine use can increase diagnostic accuracy of anamoly scan in our population. Methodology: This is a non probability convenient study investigating healthy pregnant females between 18-26weeks of gestation conducted from 04-02-2022 to 04-08-2022. After formal ethical approval, 56 patients were included in the study. After achieving 3VV,fetal pulmonary artery and fetal aorta diameter were evaluated and mean values were calculated for each gestational week. Results: The mean age of pregnant females included is 27.3 + 4.4 years (range 20 -37 years). The pulmonary artery diameter ranged from 2.3mm at 18 week of gestation to 3.6mm at 26 week of gestation. Fetal PAD is observed to correlate linearly (r=0.887) with gestational age and linear regression equation derived as PAD= (-0.52) +0.15(GA). Mean fetal aortic diameter was calculated ranged from 1.5mm at 18 week of gestation to 1.6mm at 26week of gestation. Fetal aorta diameter correlation with gestational was found to be 0.164 showing weak correlation along with insignificant regression analysis hence the regression equation cannot be formulated for fetal aorta. Conclusion: Normal mean values of fetal pulmonary artery and fetal aorta from 18-26weeks of gestation were calculated. Linear relationship was found between pulmonary artery diameter and gestational age. However weak correlation noted between fetal aorta diameter and gestational age was noted. Keywords: Fetal pulmonary artery; fetal aorta; anamoly scan; three vessel view(3VV); normal range.

Anthropometric aspects used to treat fractures of the naso-orbito-ethmoido-maxillary (NOEM) complex in cases of facial trauma

Abstract BACKGROUND. Fractures of the naso-orbito-ethmoido-maxillary (NOEM) complex are frequently acquired post-traumatic lesions, with both aesthetic and functional consequences, if the diagnosis is not promptly established and the surgical correction is delayed. OBJECTIVES. This study was conducted in order to facilitate the diagnosis of NOEM complex fractures by using anthropometric measures. The aim was to obtain normal mean values of the evaluated parameters from a lot of healthy volunteers. MATERIAL AND METHODS. The measurements were conducted on patient-specific three-dimensional models obtained from processing the CT scan images and building further stereolithographic models. 64 Caucasian patients were enrolled, with ages between 19 and 93 years, both female and male volunteers, without previous surgical history of the middle floor of the face. Measurements were performed between certain craniometric points (Nasion, Dacryon, Infraorbital foramen, Rhinion and Frontomalare orbitale) and a database was created. RESULTS. Although some expected variation arised, we have obtained normal-considered intervals for each of the defined and measured segments between the mentioned craniometric points. We find these measurements useful especially for elaborating a presurgical plan for the best outcome. CONCLUSION. Simple measurements could orient a fast diagnosis, could help establish a surgical plan, an optimal surgical timing by combining clinical and imaging data.

Outpatient register of patients who have suffered a myocardial infarction (REGATA): prospective follow-up data and outcomes.

Aim To determine the factors that influence the long-term prognosis in patients after myocardial infarction (MI) as a part of the prospective REGistry of pATients after myocArdial infarction (REGATA).Material and methods In 2012-2013, 481 post-myocardial infarction patients were included into the REGATA registry; 247 (51.4 %) were men, median age 72 [62; 78] years. The median duration of prospective follow-up after the inclusion into the registry was 6.1 [4.0-6.6] years. Data were obtained for 474 (98.5 %) patients. Statistical analysis was performed with the Microsoft Excel 2010, StatsoftStatistica10.0 software and partially manually by formulas. Methods of descriptive statistics were used. For quantitative variables with normal distribution, mean values and standard deviations were calculated; intergroup differences were evaluated with Student's t-test. Differences between groups of survived and deceased patients were evaluated with a nonparametric method using the Pearson's chi-squared test with a Yates's correction, and the Fisher's exact test. When the frequency of absent data for the studied variable exceeded 20 %, this variable was not included into the analysis. The 6-year survival was analyzed by the Kaplan-Meier method. Fatal outcomes were analyzed with the Cox proportional hazards regression model. Differences were considered significant at p&lt;0.05.Results During the follow-up period, there were 200 (41.6 %) cases of all-cause death and 123 (25.6 %) cases of cardiovascular death; 39 (8.1 %) of patients had acute cerebrovascular disease (ACVD) and 36 (7.5 %) had recurrent myocardial infarction. The median time from the inclusion into the registry to death was 3.4 [1.6; 5.1] years. A higher risk of all-cause death was significantly associated with factors of age (one-year relative risk, RR, 1.03; 95 % confidence interval, CI, 1.02-1.05; р&lt;0.001), III-IV functional class angina (RR, 1.76; 95 % CI, 1.22-2.53; p=0.003), history of ACVD (RR, 2.12; 95 % CI, 1.50-2.98; p&lt;0.001), atrial fibrillation (AF) (RR, 1.52; 95 % CI, 1.10-2.12; р=0.01), diabetes mellitus (DM) (RR, 1.53; 95 % CI, 1.11-2.10; p=0.009), chronic obstructive pulmonary disease (COPD) (RR, 1.77; 95 % CI, 1.20-2.62; p=0.004), and reduced hemoglobin (RR, 2.09; 95 % CI, 1.31-3.33; p=0.002). A lower risk of death was associated with administration of antiplatelets (RR, 0.57; 95 % CI, 0.37-0.89; p=0.01), angiotensin-converting enzyme (ACE) inhibitors /angiotensin II receptor blockers (ARB) (RR, 0.51; 95 % CI, 0.33-0.78; p=0.002), and statins (RR, 0.48; 95 % CI, 0.34-0.67; p&lt;0.001). A higher risk of nonfatal stroke during the follow-up was significantly associated with age (one-year RR, 1.05; 95 % CI, 1.01-1.09; р=0.02), history of ACVD (RR, 2.74; 95 % CI, 1.33-5.63; p=0.006), and DM (RR, 2.43; 95 % CI, 1.17-5.06; p=0.02), and a higher risk of nonfatal stroke was significantly associated with a history of ACVD (RR, 1.70; 95 % CI, 1.44-2.01; p&lt;0.001), DM (RR, 2.33; 95 % CI, 1.13-4.84; p=0.02), and COPD (RR, 2.47; 95 % CI, 1.02-6.00; p=0.06).Conclusion In the outpatient REGATA registry that included patients with MI at any previous time, the death rate for 6 years of follow-up was 41.6 %. In 61.5 % of cases, death was caused by cardiovascular diseases. In clinical practice in long-term, a higher risk of unfavorable outcome was associated with old age, III-IV functional class angina, a history of ACVD, AF, DM, and COPD while a lower risk was associated with the administration of antiplatelets, ACE inhibitors/ARB, and statins.

Hematotoxicity and Nephrotoxicity in Prostate Cancer Patients Undergoing Radioligand Therapy with [177Lu]Lu-PSMA I&T.

Simple SummaryRadioligand therapy (RLT) with prostate-specific membrane antigen (PSMA)-directed agents has shown remarkable results in patients with advanced prostate cancer. Our objective was to provide data on the side effect profile of PSMA-directed RLT using the therapeutic radiotracer [177Lu]Lu-PSMA I&T. We evaluated patients with castration-resistant metastatic prostate cancer treated with at least three cycles of [177Lu]Lu-PSMA I&T. A substantial fraction of the patients already had impaired renal function and/or reduced white blood cell counts at baseline, but the degree of nephrotoxicity or hematotoxicity under RLT was low. No severe toxicities occurred under RLT.(1) Background: Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) has shown remarkable results in patients with advanced prostate cancer. We aimed to evaluate the toxicity profile of the PSMA ligand [177Lu]Lu-PSMA I&T. (2) Methods: 49 patients with metastatic, castration-resistant prostate cancer treated with at least three cycles of [177Lu]Lu-PSMA I&T were evaluated. Prior to and after RLT, we compared leukocytes, hemoglobin, platelet counts, and renal functional parameters (creatinine, eGFR, n = 49; [99mTc]-MAG3-derived tubular extraction rate (TER), n = 42). Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and KDIGO Society. To identify predictive factors, we used Spearman’s rank correlation coefficient. (3) Results: A substantial fraction of the patients already showed impaired renal function and reduced leukocyte counts at baseline. Under RLT, 11/49 (22%) patients presented with nephrotoxicity CTCAE I or II according to creatinine, but 33/49 (67%) according to eGFR. Only 5/42 (13%) showed reduced TER, defined as <70% of the age-adjusted mean normal values. Of all renal functional parameters, absolute changes of only 2% were recorded. CTCAE-based re-categorization was infrequent, with creatinine worsening from I to II in 2/49 (4.1%; GFR, 1/49 (2%)). Similar results were recorded for KDIGO (G2 to G3a, 1/49 (2%); G3a to G3b, 2/49 (4.1%)). After three cycles, follow-up eGFR correlated negatively with age (r = −0.40, p = 0.005) and the eGFR change with Gleason score (r = −0.35, p < 0.05) at baseline. Leukocytopenia CTCAE II occurred only in 1/49 (2%) (CTCAE I, 20/49 (41%)) and CTCAE I thrombocytopenia in 7/49 (14%), with an absolute decrease of 15.2% and 16.6% for leukocyte and platelet counts. Anemia CTCAE II occurred in 10/49 (20%) (CTCAE I, 36/49 (73%)) with a decrease in hemoglobin of 4.7%. (4) Conclusions: After PSMA-targeted therapy using [177Lu]Lu-PSMA I&T, no severe (CTCAE III/IV) toxicities occurred, thereby demonstrating that serious adverse renal or hematological events are unlikely to be a frequent phenomenon with this agent.

Normal and Range Value Evaluations Using Heart Risk View-Function Based on the Japanese Societyof Nuclear Medicine Working Group Database.

Background: Gated myocardial perfusion single-photon emission computed tomography (SPECT) has been used to non-invasively evaluate the left ventricular (LV) volume and function. This study aimed to measure the normal and range values for heart risk view-function (HRV-F) software using the Japanese Society of Nuclear Medicine Working Group (JSNM-WG) normal database and clarify the characteristics of the normal database. Methods:We used 206 myocardial perfusion short-axis images from the normal database. Ejection fraction (EF), end-systolic volume (ESV), end-diastolic volume (EDV), peak filling rate (PFR), 1/3 mean filling rate (MFR), time to PFR (TTPF), and TTPF divided by RR interval (TPFR/RR) were calculated. Phase parameters of 95% histogram bandwidth and standard deviation were also computed using the phase analysis. The relationships among phase parameters, LV volumes, and body surface area (BSA) were evaluated in the age group of ≤65 years. Results: Higher EF was observed in females than in males (p<0.0001). EDV and ESV were significantly higher in males than in females (p<0.0001). Additionally, PFR and 1/3 MFR significantly differed between sexes (p≤0.075). Phase parameters were higher in males than in females, and higher at stress than at rest. All diastolic parameters showed no significant differences between sexes in any age group, whereas differences have remained in phase values. Phase parameters were weakly correlated with EDV (r=0.31), ESV (r=0.43), and BSA (r=0.27), respectively. Conclusions: Mean normal and range values of the normal database were determined using the HRV-F software. The normal and range values can help diagnose gated SPECT data in patients with cardiac diseases.

Cine phase-contrast magnetic resonance imaging evaluation of cerebrospinal fluid flow dynamics in healthy pediatric subjects.

ObjectiveTo evaluate cerebrospinal fluid dynamics, using cine phase-contrast magnetic resonance imaging (cine-PC MRI), in healthy pediatric subjects, determining the normal flow values in this population, as well as identifying differences related to age, sex, and body surface area.Materials and MethodsThis was a descriptive cross-sectional study involving 32 healthy children and adolescents, in whom the flow of cerebrospinal fluid through the cerebral aqueduct was evaluated quantitatively with cine-PC MRI. We used specialized software to analyze the images obtained with cine-PC MRI, drawing a region of interest on the aqueduct. A flow-time curve was obtained, as were automated measurements of the various parameters.ResultsThe following normal (mean) values were obtained: net flow, 1.10 ± 0.99 mL/m; stroke volume, 12.2 ± 10.1 µL/cycle; mean velocity, 0.72 ± 1.00 cm/s; peak systolic velocity, 5.28 ± 2.30 cm/s; peak diastolic velocity, 4.51 ± 1.77 cm/s. These values were not affected by age or sex. In addition, body surface area was not found to correlate significantly with mean velocity or stroke volume.ConclusionIn children and adolescents, the basic cerebrospinal fluid flow parameters, as determined by cine-PC MRI, appear to be independent of age and sex.