https://vascular.stanford.edu/content/dam/sm/vascular/documents/endovasc/guidelines/PIIS0741521406022968.pdf

Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)

The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents

TOPICAL REVIEW: Applications of magnetic nanoparticles in biomedicine

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.

Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients

Drug delivery, magnetic resonance and fluorescence imaging, magnetic manipulation, and cell targeting are simultaneously possible using a multifunctional mesoporous silica nanoparticle. Superparamagnetic iron oxide nanocrystals were encapsulated inside mesostructured silica spheres that were labeled with fluorescent dye molecules and coated with hydrophilic groups to prevent aggregation. Water-insoluble anticancer drugs were delivered into human cancer cells; surface conjugation with cancer-specific targeting agents increased the uptake into cancer cells relative to that in non-cancerous fibroblasts. The highly versatile multifunctional nanoparticles could potentially be used for simultaneous imaging and therapeutic applications.

/pdf/multifunctional-inorganic-nanoparticles-for-imaging-32xbo3we7g.pdf

Multifunctional Inorganic Nanoparticles for Imaging, Targeting, and Drug Delivery

Drug delivery, magnetic resonance andfluorescence imaging, magnetic manipulation, and cell targetingaresimultaneouslypossibleusingamultifunctionalmesoporoussilicananoparticleSuperparamagnetic ironoxidenanocrystalswereencapsulatedinsidemesostructuredsilicaspheresthatwerelabeledwithfluorescent dye molecules and coated with hydrophilic groups to prevent aggregation Water-insoluble anticancer drugs were delivered into human cancer cells; surface conjugation with cancer-specific targeting agents increased the uptake into cancer cells relative to that in non-cancerousfibroblasts The highly versatile multifunctional nanoparticles could potentially be used for simultaneous imaging and therapeutic applications

/pdf/multifunctional-inorganic-nanoparticles-for-imaging-3c6uigzz0u.pdf

Multifunctional Inorganic Nanoparticles for Imaging, Targeting, and Drug

Background—Based on the observation that ultrasmall superparamagnetic particles of iron oxides (USPIOs) are phagocytosed by cells of the mononuclear phagocytic system, the purpose of this study was to evaluate their use as a marker of atherosclerosis-associated inflammatory changes in the vessel wall before luminal narrowing is present. Methods and Results—Experiments were conducted on 6 heritable hyperlipidemic and 3 New Zealand White rabbits. 3D MR angiography (MRA) of the thoracic aorta was performed on all rabbits by use of a conventional paramagnetic contrast agent that failed to reveal any abnormalities. One week later, all rabbits except 1 of the hyperlipidemic animals were injected with a USPIO contrast agent (Sinerem, Guerbet) at a dose of 1 mmol Fe/kg. 3D MRA data sets collected over the subsequent 5 days showed increasing signal in the aortic lumen. Whereas the aortic wall of the control rabbits remained smooth and bright, marked susceptibility effects became evident on day 4 within the aortic ...

Magnetic Resonance Imaging of Atherosclerotic Plaque With Ultrasmall Superparamagnetic Particles of Iron Oxide in Hyperlipidemic Rabbits

ContextDeciding on the appropriate therapy for patients with malignant diseases
mandates accurate tumor staging with whole-body coverage. Magnetic resonance
imaging (MRI) and a combined modality including positron emission tomography
(PET) and computed tomography (CT) provide whole-body tumor staging in a single
session.ObjectiveTo determine the staging accuracies of both whole-body PET/CT and whole-body
MRI for different malignant diseases.Design, Setting, and PatientsProspective, blinded, investigator-initiated study of 98 patients (mean
age, 58 years; range, 27-94 years) with various oncological diseases who underwent
back-to-back whole-body glucose analog [18F]-fluorodeoxyglucose–PET/CT
and whole-body MRI for tumor staging. The study was conducted at a university
hospital from December 2001 through October 2002 and had a mean follow-up
of 273 days (range, 75-515 days). The images were evaluated by 2 different,
blinded reader teams. The diagnostic accuracies of the 2 imaging procedures
were compared.Main Outcome MeasuresCorrect classification of the primary tumor, regional lymph nodes, and
distant metastasis (overall TNM stage) using whole-body PET/CT and whole-body
MRI. Secondary outcome measures were accurate assessment of T-stage, N-stage,
and M-stage by the 2 imaging procedures.ResultsOf 98 patients, the overall TNM stage was correctly determined in 75
with PET/CT (77%; 95% confidence interval [CI], 67%-85%) and in 53 with MRI
(54%; 95% CI, 44%-64%) (P<.001). Compared with
MRI, PET/CT had a direct impact on patient management in 12 patients. Results
from MRI changed the therapy regimen in 2 patients compared with PET/CT. Separate
assessment of T-stage (with pathological verification) in 46 patients revealed
PET/CT to be accurate in 37 (80%; 95% CI, 66%-91%) and MRI to be accurate
in 24 (52%; 95% CI, 37%-67%) (P<.001). Of 98 patients,
N-stage was correctly determined in 91 patients with PET/CT (93%; 95% CI,
86%-97%) and in 77 patients with MRI (79%; 95% CI, 69%-86%) (P = .001). Both imaging procedures showed a similar performance in
detecting distant metastases.ConclusionsThe feasibility and diagnostic accuracy of the whole-body staging strategies
of PET/CT and MRI are established. Superior performance in overall TNM staging
suggests the use of [18F]-fluorodeoxyglucose–PET/CT as a possible first-line
modality for whole-body tumor staging.

https://jamanetwork.com/journals/jama/articlepdf/197894/JOC31756.pdf

Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology.

Short- and long-axis cine magnetic resonance (MR) images were obtained with a standard fast low-angle shot, or FLASH, sequence and a first-generation true fast imaging with steady-state precession (FISP) sequence on a 1.5-T MR imager. Contrast-to-noise ratios and volumetric left ventricular measurements were compared for manual and automatic segmentation. True FISP images were associated with significantly (P < .01) higher contrast-to-noise ratios and allowed better detection of the endocardial border. True FISP images were provided with short acquisition times and excellent contrast between the myocardium and the ventricular lumen.

Stefan G. Ruehm

Papers

Multifunctional Inorganic Nanoparticles for Imaging, Targeting, and Drug Delivery

Multifunctional Inorganic Nanoparticles for Imaging, Targeting, and Drug

Magnetic Resonance Imaging of Atherosclerotic Plaque With Ultrasmall Superparamagnetic Particles of Iron Oxide in Hyperlipidemic Rabbits

Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology.

MR evaluation of ventricular function: true fast imaging with steady-state precession versus fast low-angle shot cine MR imaging: feasibility study.