OBJECTIVES: To assess the diagnostic performance and interobserver agreement of CT pulmonary angiography (CTPA) in the detection of chronic thromboembolic pulmonary hypertension (CTEPH) and its features among radiologists of different levels of experience. MATERIALS AND METHODS: In this retrospective, single-center, single-blinded study, three radiologists with different levels of experience in CT imaging (R1:15 years, R2:6 years, and R3:3 years) evaluated CTPA of 51 patients ultimately diagnosed with CTEPH (European Society of Cardiology guidelines) and 49 patients without CTEPH in random order to assess the presence of CTEPH, its features in the pulmonary artery tree, proximal level of involvement, bronchial artery hypertrophy, mosaic perfusion, and right heart overload. RESULTS: CTPAs of 51 patients with CTEPH (median age, 66 years (IQR 56-72), 28 men) and 49 patients without CTEPH (median age, 65 years (IQR 50-74), 25 men) were evaluated. The sensitivity and specificity for the detection of CTEPH was 100% (all radiologists) and 100% (R1), 96% (R2), and 96% (R3) with almost perfect agreement (κ = 0.95). The sensitivity and specificity for detecting CTEPH by mosaic perfusion would be 89% (95%CI 83-93%) and 81% (74-87%). The level of pulmonary artery involvement was reported with moderate agreement (κ = 0.54, 95%CI 0.40-0.65). Substantial agreement was found in the evaluation of mosaic attenuation (κ = 0.75, 95%CI 0.64-0.84), right heart overload (κ = 0.68, 95%CI 0.56-0.79), and bronchial artery hypertrophy (0.71, 95%CI 0.59-0.82) which were the best predictors of CTEPH (p < 0.0001). CONCLUSIONS: CTPA has high sensitivity and specificity in detecting CTEPH and almost perfect agreement among radiologists of different levels of expertise. CLINICAL RELEVANCE: CT pulmonary angiography can be used as a first-line imaging modality in patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH) even when interpreted by non-CTEPH experts. KEY POINTS: • CT pulmonary angiography has high sensitivity and specificity in detecting chronic thromboembolic pulmonary hypertension (CTEPH) and almost perfect interobserver agreement among radiologists of different levels of expertise. • Substantial agreement exists in the assessment of mosaic attenuation, right heart overload, and bronchial artery hypertrophy, which are the best predictors of CTEPH.
- MeSH
- angiografie metody MeSH
- chronická nemoc MeSH
- hypertrofie MeSH
- jednoduchá slepá metoda MeSH
- lidé středního věku MeSH
- lidé MeSH
- plicní embolie * komplikace diagnostické zobrazování MeSH
- plicní hypertenze * komplikace diagnostické zobrazování MeSH
- počítačová rentgenová tomografie metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Neurological damage remains the leading cause of death in cardiac arrest victims with early neuroprognostication being the cornerstone of the decision-making process to continue or discontinue advanced treatments. In this study, we aimed to find markers of favorable and unfavorable outcome on early brain computed tomography (CT) in patients after prolonged out-of-hospital cardiac arrest (OHCA) treated both by conventional and extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: In a secondary analysis of the Prague OHCA study, patients who underwent brain CT within 36 hours after cardiac arrest were identified. Qualitative findings (brain edema, hemorrhage) and quantitative measurements [attenuation of grey matter structures and grey-to-white matter attenuation ratio (GWR)] between patients with cerebral performance category (CPC) of 1-2 (favorable outcome) and 3-5 (unfavorable outcome) within 180 days after the event were compared. RESULTS: In 45 eligible patients, intracranial edema (n=16, 50%) was present in patients with CPC 3-5 only (n=32, 71%). Attenuation of brain structures and GWR did not differ between patients with favorable and unfavorable outcomes. However, the GWR in the caudate and putamen of most CPC 1-2 patients was within a narrow range of values (1.18 to 1.30 and 1.20 to 1.33) that separated patients with CPC 1-2 from CPC 3-5 with a sensitivity of 78% and 66% a specificity of 85% and 100%, and area under the curve (AUC) of 0.86 (P=0.0001) and 0.77 (P=0.0053), respectively. Patients treated by ECPR had lower attenuation in the centrum semiovale (28.3±2.7) compared to those who were not (31.0±2.8, P=0.003). The most common causes of death in CPC 3-5 patients were brain death in 13 (41%) patients, multiorgan failure in 12 (38%), and cardiac rearrest in 4 (13%). CONCLUSIONS: Both decreased and increased grey-to-white matter differentiation in the putamen and caudate on early non-contrast brain CT after prolonged OHCA indicate poor neurological outcome within 180 days after cardiac arrest.
- Publikační typ
- časopisecké články MeSH
Tarzální a karpální koalice jsou vývojové vady, které jsou i přes svou četnost v populaci značně poddiagnostikované. Mohou vést k bolesti, poruchám hybnosti končetiny a jejímu vadnému držení, což může být pro pacienta důvod návštěvy lékaře. Naším úkolem je při hodnocení vyšetření na tyto anomálie myslet a znát jejich obraz. Na prostém snímku je pro tarzální koalice typický tzv. "obraz písmene C" nebo "příznak nosu mravenečníka" - ty však nemusejí být u všech pacientů plně vyjádřeny. V těchto případech musíme doplnit CT nebo MR vyšetření. Ve stati dokumentujeme typické nálezy kazuistikami z našeho pracoviště.
Tarsal and carpal coalitions are developmental anomalies of bone differentiation. Despite being relatively common in general population, they tend to be underdiagnosed. These conditions may lead to pain and stiffness in the affected extremity and incorrect posture that require medical attention. The radiologist is supposed to be aware of these conditions and their appearance. On plain radiographs, calcaneo-navicular coalition may be recognized by the "C - sign" or the "anteater nose sign" - but these may not be fully expressed. In such cases, CT or MRI may be advised. The article is supplemented by case studies from our institution.
Ještě před 15 lety to byla látka mezi veřejností téměř neznámá, dnes je o ní napsáno mnoho odborných článků a v povědomí široké veřejnosti je známá jako zabiják narkomanů. Její chemický název je N-(1-(2-fenylethyl)-4-piperidinyl)-N fenylpropanamid a zkráceně se jí říká fentanyl. Kvůli její dlouholeté regulaci se kromě ní stále častěji objevují nové deriváty fentanylu tzv. „The Fentalogs“.
Detailed study of the period before schizophrenic relapse when early warning signs (EWS) are present is crucial to effective pre-emptive strategies. To investigate the temporal properties of EWS self-reported weekly via a telemedicine system. EWS history was obtained for 61 relapses resulting in hospitalization involving 51 patients with schizophrenia. Up to 20 weeks of EWS history per case were evaluated using a non-parametric bootstrap test and generalized mixed-effects model to test the significance and homogeneity of the findings. A statistically significant increase in EWS sum score was detectable 5 weeks before hospitalization. However, analysis of EWS dynamics revealed a gradual, monotonic increase in EWS score across during the 8 weeks before a relapse. The findings-in contrast to earlier studies-suggest that relapse is preceded by a lengthy period during which pathophysiological processes unfold; these changes are reflected in subjective EWS.
- MeSH
- chronická nemoc MeSH
- dospělí MeSH
- lidé MeSH
- prodromální symptomy MeSH
- průzkumy a dotazníky MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- schizofrenie (psychologie) * MeSH
- schizofrenie diagnóza prevence a kontrola MeSH
- sekundární prevence MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE: To evaluate the effectiveness of the Information Technology-Aided Program of Re lapse Prevention in Schizophrenia (ITAREPS). METHODS: Relapse-prone outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n=75) or control group (n=71). In the active arm, according to the protocol, investigators were prompted to increase the antipsychotic dose upon occurrence of a pharmacological inter vention requiring event (PIRE) detected by ITAREPS. RESULTS: Intention-to-treat (ITT) analysis found no between-group difference in the hospitalization-free survival rate at 12 months. However, the trial suffered from high non-adherence of investigators in the active group, with no antipsychotic dose increase in 61% of PIREs. Furthermore, Cox regression analysis showed a 11-fold increased risk of hospitalization in the absence of pharmacological intervention following a PIRE (hazard ratio [HR]=10.8; 95% confidence interval [CI] 1.4-80.0; p=0.002). Therefore, a post-hoc as-treated analysis was performed, which demonstrated a nine-fold reduction in the risk of hospitalization in ITAREPS Algorithm-Adherers (IAAs, n=25) compared with the ITAREPS Non-interventional group (INIs, n=70; Kaplan-Meier survival analysis, HR=0.11, 95% CI 0.05-0.28, p=0.009; number needed to treat [NNT]=4, 95% CI 3-10). A significant difference in favor of the IAA group was seen in the number of inpatient days (p<0.05) and costs (p<0.05). CONCLUSION: Future ITAREPS trials should target the underlying mechanisms that cause low investigator adherence to the program. Trial registration: Clinical Trials NCT00712660.
- MeSH
- adherence pacienta MeSH
- analýza podle původního léčebného záměru MeSH
- analýza přežití MeSH
- časná diagnóza MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- průzkumy a dotazníky MeSH
- psychotické poruchy diagnóza rehabilitace MeSH
- recidiva MeSH
- schizofrenie diagnóza rehabilitace MeSH
- sekundární prevence MeSH
- telemedicína metody MeSH
- znovupřijetí pacienta statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
This paper presents an adaBoost approach for schizophrenia relapse prediction. The data for the adaBoost are extracted from patients answers to Early Warning Signs questionnaires sent regularly via mobile phone messages. The performance of the adaBoost algorithm is confronted with current ITAREPS system with sensitivity 0.65 and specificity 0.73. AdaBoost has the same sensitivity 0.65 but higher specificity 0.84 and is then ready to became the part of the ITAREPS care program.
- MeSH
- adherence pacienta MeSH
- algoritmy MeSH
- časové faktory MeSH
- chování MeSH
- diagnóza počítačová metody MeSH
- hospitalizace MeSH
- konzultace na dálku metody MeSH
- lidé MeSH
- posílání textových zpráv MeSH
- recidiva MeSH
- rozvoj plánování metody MeSH
- schizofrenie (psychologie) MeSH
- schizofrenie diagnóza prevence a kontrola MeSH
- software MeSH
- systémy pro podporu klinického rozhodování MeSH
- telemedicína metody MeSH
- znovupřijetí pacienta MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- antidota terapeutické užití MeSH
- chemické bojové látky dějiny otrava toxicita MeSH
- cholinesterasové inhibitory MeSH
- lidé MeSH
- neurotoxické syndromy etiologie MeSH
- organofosfáty MeSH
- organofosforové sloučeniny aplikace a dávkování škodlivé účinky toxicita MeSH
- ozbrojené síly MeSH
- první pomoc metody MeSH
- Check Tag
- lidé MeSH
