Andrew Appis

Bio: Andrew Appis is an academic researcher from Rush University Medical Center. The author has contributed to research in topics: Asymptomatic & Myocardial perfusion imaging. The author has an hindex of 5, co-authored 8 publications receiving 161 citations.

Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications.

Abstract: Ultrasound contrast agents (UCAs) are currently used throughout the world in both clinical and research settings. The concept of contrast-enhanced ultrasound imaging originated in the late 1960s, and the first commercially available agents were initially developed in the 1980s. Today's microbubbles are designed for greater utility and are used for both approved and off-label indications. In October 2007, the US Food and Drug Administration (FDA) imposed additional product label warnings that included serious cardiopulmonary reactions, several new disease-state contraindications, and a mandated 30 min post-procedure monitoring period for the agents Optison and Definity. These additional warnings were prompted by reports of cardiopulmonary reactions that were temporally related but were not clearly attributable to these UCAs. Subsequent published reports over the following months established not only the safety but also the improved efficacy of clinical ultrasound applications with UCAs. The FDA consequently updated the product labeling in June 2008 and reduced contraindications, although it continued to monitor select patients. In addition, a post-marketing program was proposed to the sponsors for a series of safety studies to further assess the risk of UCAs. Then in October 2011, the FDA leadership further downgraded the warnings after hearing the results of the post-marketing data, which revealed continued safety and improved efficacy. The present review focuses on the use of UCAs in today's clinical practice, including the approved indications, a variety of off-label uses, and the most recent data, which affirms the safety and efficacy of UCAs.

Impact of Appropriate Use on the Estimated Radiation Risk to Men and Women Undergoing Radionuclide Myocardial Perfusion Imaging

Abstract: Background: The impact of appropriate use criteria (AUC) for myocardial perfusion imaging (MPI) with single-photon emission computed tomography on the estimated lifetime attributable risk (LAR) of cancer is unknown. Methods: A cohort of 1,511 consecutive patients who underwent clinically-indicated 99mTc-setamibi MPI were categorized into appropriate/uncertain (n = 823) vs. inappropriate (n = 688) use groups according to the 2009 AUC, and were prospectively followed for 27±10 months. Logistic regression models were used to determine the annualized probability of major adverse cardiac events (MACE) of cardiac death or myocardial infarction and the probability of revascularization within 6 months of MPI, accounting for significant predictors. We determined LAR for each subject on the basis of accepted risk-estimates. We calculated MPI’s benefit-to-risk ratios, defined by the annualized predicted MACE-to-LAR ratio and the predicted 6-month revascularization-to-LAR ratio. Results: During follow-up, there were 22 MACE and 29 six-month revascularizations. The administered radioactivity and effective radiation doses absorbed were similar between the study groups. Patients with inappropriate MPI had significantly higher LAR (median 0.08% vs. 0.06%,P<0.001), lower predicted MACE-to-LAR ratio (median 1.5 vs. 4.3,P< 0.001), and lower predicted 6-month revascularization-to-LAR ratio (median 5.4 vs. 15.5,P<0.001). Women had higher LAR (median 0.08% vs. 0.07%,P<0.001) and lower predicted MACE-to-LAR ratio (median 1.9 vs. 3.3,P<0.001) and 6-month revascularization-to-LAR ratio (median 4.4 vs. 17.5,P<0.001). However, appropriate/uncertain use negated the difference between men and women in LAR (P = 0.94) and the predicted MACE-to-LAR ratio (P = 0.97). Conclusion: Inappropriate MPI use is associated with excess cancer risk and lower MPI’s benefit-to-risk ratio. Appropriate/uncertain use neutralizes the gender gap in LAR with MPI.

人唾液天疱疮抗原的纯化

Abstract: 1. Place animal in induction chamber and anesthetize the mouse and ensure sedation. 2. Once the animal is sedated, move it to a nose cone for hair removal using cream. Only apply cream to the area of the chest that will be utilized for imaging. Once the hair is removed, wipe area with wet gauze to ensure all hair is removed. 3. Move the animal to the imaging platform and tape its paws to the ECG lead plates and insert rectal probe. Body temperature should be maintained at 36-37°C. During imaging, reduce anesthesia to maintain proper heart rate. If the animal shows signs of being awake, use a higher concentration of anesthetic.

Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update.

Abstract: Thomas R. Porter, MD, FASE (Chair), Sharon L. Mulvagh, MD, FASE (Co-Chair), Sahar S. Abdelmoneim, MBBCH, MSc, MS, FASE, Harald Becher, MD, PhD, J. Todd Belcik, BS, ACS, RDCS, FASE, Michelle Bierig, MPH, ACS, RDCS, FASE, Jonathan Choy, MD, MBA, FASE, Nicola Gaibazzi, MD, PhD, Linda D. Gillam, MD, MPH, FASE, Rajesh Janardhanan, MD, MRCP, FASE, Shelby Kutty, MD, PhD, MHCM, FASE, Howard Leong-Poi, MD, FASE, Jonathan R. Lindner, MD, FASE, Michael L. Main, MD, FASE, Wilson Mathias, Jr., MD, Margaret M. Park, BS, ACS, RDCS, RVT, FASE, Roxy Senior, MD, DM, and Flordeliza Villanueva, MD, Omaha, Nebraska; Rochester, Minnesota; Edmonton, Alberta, Canada; Portland, Oregon; Fort Myers, Florida; Parma, Italy; Morristown, New Jersey; Tucson, Arizona; Toronto, Ontario, Canada; Kansas City, Missouri; S~ ao Paulo, Brazil; Cleveland, Ohio; London, United Kingdom; and Pittsburgh, Pennsylvania

Evolution of contrast agents for ultrasound imaging and ultrasound-mediated drug delivery

Abstract: Ultrasound is one of the most frequently used diagnostic methods. It is a non-invasive, comparably inexpensive imaging method with a broad spectrum of applications, which can be increased even more by using bubbles as contrast agents. There are various different types of bubbles: filled with different gases, composed of soft- or hard-shell materials, and ranging in size from nano- to micrometers. These intravascular contrast agents enable functional analyses, e.g. to acquire organ perfusion in real-time. Molecular analyses are achieved by coupling specific ligands to the bubbles’ shell, which bind to marker molecules in the area of interest. Bubbles can also be loaded with or attached to drugs, peptides or genes and can be destroyed by ultrasound pulses to locally release the entrapped agent. Recent studies show that ultrasound contrast agents are also valuable tools in hyperthermia-induced ablation therapy of tumors, or can increase cellular uptake of locally released drugs by enhancing membrane permeability. This review summarizes important steps in the development of ultrasound contrast agents and introduces the current clinical applications of contrast-enhanced ultrasound. Additionally, an overview of the recent developments in ultrasound probe design for functional and molecular diagnosis as well as for drug delivery is given.

How to perform Contrast-Enhanced Ultrasound (CEUS).

Abstract: “How to perform contrast-enhanced ultrasound (CEUS)” provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients