To evaluate residual endoleak and thrombus organisation with shear wave imaging (SWI) after endoleak embolisation through an animal study.This prospective experimental study involved eight dogs with creation of 16 iliac aneurysms and type I endoleak after endovascular aneurysm repair (EVAR). Embolisation agents were injected into the sac to seal endoleak. SWI and colour flow Doppler ultrasound (DUS) were performed at implantation, one week, and one and three months after implantation; for three dogs, SWI and DUS were also performed six months after implantation. Digital subtraction angiography and contrast-enhanced computed tomography were performed at sacrifice. Macroscopic and histopathological analyses were processed to identify regions of interest (ROIs) for endoleak, fresh thrombus, organised thrombus and embolisation agent, where SWI elasticity moduli were compared.At sacrifice, nine aneurysms had residual endoleak, while seven were sealed. Ten had a fresh and 15 had an organised thrombus. SWI was able to detect all endoleaks, including two cases undetected with DUS. Elasticity moduli of 0.2 kPa ± 0.1 kPa (mean ± SD), 9.5 kPa ± 3.3 kPa, 48.1 kPa ± 21.3 kPa and 44.9 kPa ± 23.7 kPa were found in the ROIs positioned in endoleaks, fresh thrombi, organised thrombi and embolisation agent, respectively. Elasticity values of endoleak and fresh thrombus were lower than those of organised thrombi and embolisation agent (p < 0.001). Stiffness of fresh thrombus at one week (8.7 kPa ± 3.6 kPa) increased at three months (30.2 kPa ± 13.8 kPa), indicating thrombus maturation (p < 0.001).In a dog model of iliac EVAR, SWI was able to identify endoleak, thrombus maturation and embolising agents after endoleak embolisation.
Objectives: People with HIV are exposed to a higher risk of coronary artery disease (CAD) compared with the general population. Epicardial fat may play a unique role in promoting coronary atherosclerosis. We measured epicardial fat in participants living with HIV and controls and investigated its association with coronary plaque volume and low attenuation plaque, a marker of plaque vulnerability. Design: This is a cross-sectional study, nested in the Canadian HIV and Aging Cohort Study, a large prospective cohort actively following participants with HIV and controls. Participants with low/intermediate cardiovascular risk without symptoms/history of CAD were invited to undergo cardiac computed tomography (CT). Methods: Volume of epicardial fat, coronary plaque and low attenuation component of the plaque were measured. Association between epicardial fat, coronary plaque volume and low attenuation component was tested using adjusted regression analysis. Results: A total of 169 participants with HIV and 81 controls underwent cardiac CT. Participants with HIV had a greater epicardial fat volume compared with controls ( P = 0.019). In participants with HIV, epicardial fat volume was positively associated with duration of nonnucleoside reverse transcriptase inhibitors (NNRTI) ( β =2.19, P = 0.004). After adjustment for cardiovascular risk factors, epicardial fat volume was positively associated to noncalcified plaque volume [odds ratio (OR) = 1.09, P = 0.028] and to the low-attenuation plaque component portion ( β =0.38, P = 0.026). Conclusion: The association of epicardial fat volume to noncalcified plaque volume and to low attenuation component plaque may suggest a potential mechanism by which epicardial fat could be a silent driver of CAD in the HIV population.
Abstract Background BK polyomavirus virus ( BKP yV) screening and immunosuppression reduction effectively prevent graft loss due to BKP yV‐associated nephropathy ( BKPVAN ) during the first year after transplantation. The aim of our study was to evaluate the impact of this infection during longer follow‐up periods. Methods We reviewed the outcome of our screening and immunosuppression reduction protocol in 305 patients who received a kidney transplant between March 2008 and January 2013. Quantitative BKP yV DNA surveillance in plasma was performed at 1, 2, 3, 6, 9, and 12 months after transplantation. Patients with significant viremia and/or biopsy‐proven BKPVAN were treated with immunosuppression reduction and leflunomide. Results During the first post‐transplant year, 24 patients (7.9%) developed significant viremia at a median time of 95 days, and 18 patients had BKPVAN ; 23 of the 24 (7.5%) were treated according to our protocol (group BKV +); 225 patients (73.8%) did not develop any BK viremia (group BKV −). Allograft function was similar in both groups at 1 month post transplantation ( P =.87), but significantly worse at 1 year in the BKV + group ( P =.002). Thereafter, kidney function stabilized in the BKV + group and no differences in patient and graft survival were seen between the groups after a median follow‐up of 4 years. Conclusions We confirm the early occurrence of BKP yV replication after transplantation and the short‐term decline in renal function. However, early detection of BKP yV replication, prompt diagnosis, and reduction in immunosuppression may offer long‐term benefits for graft function.
121 Background: Systemic inflammation has been linked to worse outcome in metastatic prostate cancer. This study analyzes the influence of complete blood count (CBC) on outcome after curative radiotherapy for localized prostate cancer. Methods: We reviewed our institutional database of patients with localized prostate cancer treated with either definitive external beam radiotherapy (EBRT) or brachytherapy from September 2001- June 2014. Data on pre-treatment CBC such as hemoglobin (Hgb), mean corpuscular volume(MCV) and platelet count (PLT) were available in 1,021 pts, neutrophil/lymphocyte ratio (NLR) in 1,015 pts. Univariate and multivariate cox proportional hazards models were used to analyze the influence of complete blood count parameters on overall and recurrence free survival (PSA nadir + 2 ng/mL). A p<0.05 was considered statistically significant. Results: Median follow-up was 44 months. 55 patients had biochemical recurrence and 68 patients died.On univariate analysis, increasing risk of biochemical recurrence was associated with a combination of all known risk factors as defined by the Cancer of the Prostate Risk Assessment (CAPRA) score, but not by age. When adjusting for age (p=0.009), CAPRA remained significant (p=0.0003) but no comorbidity or CBC. On univariate analysis for overall survival, CAPRA (p=0.0001) and neutrophil count (p=0.04, HR1.16, 1.01-1.34) as well as a cardiac history (p=0.009) were associated with increased risk of overall mortality. The first multivariate model was adjusted for age and included the CAPRA, comorbidity and CBC variables: age (p=0.006) and CAPRA (p=0.008) were prognostic, neutrophil count was borderline significant (p=0.056, HR 1.17, 0.99-1.37). In a second multivariate model without adjusting for age, neutrophil count was a significant prognostic factor for overall survival (p=0.032, HR 1.18, 1.01-1.38) as well as the CAPRA (p=0.005, HR 1.18, 1.05-1.33). Conclusions: In this testing cohort, neutrophil count was an independent risk factor for increased overall mortality in patients with localized prostate cancer. The influence of age on this prognostic factor will be further studied. A validation cohort is needed to corroborate these results.
Increasing evidence suggests a close relationship between systemic inflammation and cancer development and progression. The neutrophil to lymphocyte ratio (NLR) has been shown to be an independent prognostic indicator in various advanced and localized cancers. We investigated the influence of markers of systemic inflammation such as leucocyte counts and metabolic co-morbidities on overall survival (OS) after radiotherapy for localized prostate cancer.We conducted a retrospective study of patients with localized prostate cancer treated with definitive external beam radiotherapy or brachytherapy. Univariate and multivariate cox proportional hazards models were used to investigate the influence of the following factors on OS: age, neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR), Cancer of the Prostate Risk Assessment (CAPRA) score as well as comorbidities associated with inflammation such as cardiac history, diabetes and use of a statin. A stepwise selection of variable based on the Akaike information criterion (AIC) was used for multivariate analysis.In total, 1772 pts were included; blood count data was available for 950 pts. Median age was 68 years (44-87). Actuarial 5 years OS and biochemical recurrence-free survival (BRFS) for the 1772 patients were 93% and 95%, respectively, with a median follow-up of 44 months (1-156). On univariate analysis, neutrophil count (p = 0.04), cardiac history (p = 0.008), age (p = 0.001) and CAPRA (p = 0.0002) were associated with OS. Lymphocytes, NLR and comorbidities other than cardiac history were not associated with mortality. On multivariate analysis, neutrophil count (HR = 1.18, 95 % CI: 1.017-1.37, p = 0.028), age (HR = 1.06, 95 % CI: 1.01-1.1, p = 0.008) and CAPRA (HR = 1.16, 95 % CI: 1.03-1.31, p = 0.015) were independent predictors of OS.Neutrophil count, as a possible marker of systemic inflammation, appear to be an independent prognostic factor for overall mortality in localized prostate cancer. A validation cohort is needed to corroborate these results.
To assess the value of mechanical dyssynchrony measured by equilibrium radionuclide angiography (ERNA) in predicting long-term outcome in cardiac resynchronization therapy (CRT) patients. We reviewed 146 ERNA studies performed in heart failure patients between 2001 and 2011 at our institution. Long-term follow-up focused on death from any cause or heart transplantation. Phase images were computed using the first harmonic Fourier transform. Intra-ventricular dyssynchrony was calculated as the delay between the earliest and most delayed 20% of the left ventricular (LV) (IntraV-20/80) and inter-ventricular dyssynchrony as the difference between LV- and right ventricular (RV)-mode phase angles (InterV). Eighty-three patients (57%) were implanted with a CRT device after ERNA. Median follow-up was 35 [21–50] months. Twenty-four events were observed during the first 41 months. Median baseline ERNA dyssynchrony values were 28 [3 to 46] degrees for intraV-20/80 and 9 [−6 to 24] degrees for interV. Comparing survival between CRT and non-CRT patients according to dyssynchrony status, log-rank tests showed no difference in survival in patients with no ERNA dyssynchrony (P = 0.34) while a significant difference was observed in ERNA patients with high level of mechanical dyssynchrony (P = 0.004). ERNA mechanical dyssynchrony could be of value in CRT patient selection.
