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Diabetes Care Nov 2023To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain.
OBJECTIVE
To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain.
RESEARCH DESIGN AND METHODS
This prespecified analysis of the multicenter DISCHARGE trial in 16 European countries was performed in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary end point was a major adverse cardiac event (MACE) (cardiovascular death, nonfatal myocardial infarction, or stroke), and the secondary end point was expanded MACE (including transient ischemic attacks and major procedure-related complications).
RESULTS
Follow-up at a median of 3.5 years was available in 3,541 patients of whom 557 (CT group n = 263 vs. ICA group n = 294) had diabetes and 2,984 (CT group n = 1,536 vs. ICA group n = 1,448) did not. No statistically significant diabetes interaction was found for MACE (P = 0.45), expanded MACE (P = 0.35), or major procedure-related complications (P = 0.49). In both patients with and without diabetes, the rate of MACE did not differ between CT and ICA groups. In patients with diabetes, the expanded MACE end point occurred less frequently in the CT group than in the ICA group (3.8% [10 of 263] vs. 8.2% [24 of 294], hazard ratio [HR] 0.45 [95% CI 0.22-0.95]), as did the major procedure-related complication rate (0.4% [1 of 263] vs. 2.7% [8 of 294], HR 0.30 [95% CI 0.13 - 0.63]).
CONCLUSIONS
In patients with diabetes referred for ICA for the investigation of stable chest pain, a CT-first strategy compared with an ICA-first strategy showed no difference in MACE and may potentially be associated with a lower rate of expanded MACE and major procedure-related complications.
Topics: Humans; Coronary Artery Disease; Coronary Angiography; Tomography, X-Ray Computed; Chest Pain; Diabetes Mellitus; Computed Tomography Angiography; Predictive Value of Tests
PubMed: 37725834
DOI: 10.2337/dc23-0710 -
Bone & Joint Research Apr 2022
PubMed: 35369732
DOI: 10.1302/2046-3758.114.BJR-2021-0593.R1 -
Clinical Drug Investigation Mar 2016Iron deficiency is very common in a number of medical conditions. Ferric carboxymaltose is a new stable iron preparation that can be administered in single infusions... (Meta-Analysis)
Meta-Analysis Review
Efficacy and Safety of Ferric Carboxymaltose and Other Formulations in Iron-Deficient Patients: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials.
BACKGROUND
Iron deficiency is very common in a number of medical conditions. Ferric carboxymaltose is a new stable iron preparation that can be administered in single infusions over short periods of time. The aim of this study was to conduct a systematic review of randomised controlled trials (RCTs) regarding the efficacy and safety of the novel complex compared with other iron formulations. In addition, the feasibility of a network meta-analysis for indirect comparisons was investigated.
METHODS
A systematic literature review was performed for published RCTs on the use of ferric carboxymaltose in iron deficiency between July and October 2014. Indirect comparisons were also addressed using terms referring to competing iron formulations. We further supported the qualitative results of the systematic review by a network meta-analysis that allows pooling the evidence around different intervention outcomes in the absence of trials involving a direct comparison.
RESULTS
The initial search yielded 1027 citations, which was decreased to 21 studies eligible for inclusion in the review. Studies were heterogeneous in the number of patients randomised, iron deficiency-related conditions addressed, trial inclusion criteria, time horizon, treatment dosage and outcomes assessed. Six studies with the same time horizon (i.e. 6 weeks) were included in the network meta-analysis. Considering the differences between final and initial outcome values for each iron formulation, the mean difference of these differences (delta) was estimated for each couple of treatments involving ferric carboxymaltose. Significant improvements in serum ferritin (µg/l) were obtained with ferric carboxymaltose compared to oral iron (delta 172.8; 95 % CI 66.7-234.4) and in haemoglobin (g/dl) with respect to ferric gluconate (delta 0.6; 95 % CI 0.2-0.9), oral iron (delta 0.8; 95 % CI 0.6-0.9) and placebo (delta 2.1; 95 % CI 1.2-3.0).
CONCLUSIONS
All currently available intravenous iron preparations appear to be safe and effective, but ferric carboxymaltose seems to provide a better and quicker correction of haemoglobin and serum ferritin levels in iron-deficient patients.
Topics: Administration, Intravenous; Chemistry, Pharmaceutical; Ferric Compounds; Hemoglobins; Humans; Iron Deficiencies; Maltose; Randomized Controlled Trials as Topic
PubMed: 26692005
DOI: 10.1007/s40261-015-0361-z -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2021Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing...
Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology.
BACKGROUND
Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination and when reporting the results. Therefore, MRI requires higher physician qualification and expertise than any other diagnostic imaging technique in medicine. This holds true for indication, performance of the examination itself, and in particular for image evaluation and writing of the report. In Germany, the radiologist is the only specialist who is systematically educated in all aspects of MRI during medical specialty training and who must document a specified, high number of examinations during this training. However, also non-radiologist physicians are increasingly endeavoring to conduct and bill MRI examinations on their own.
METHOD
In this position statement, the following aspects of quality assurance for MRI examinations and billing by radiologists and non-radiologist physician specialists are examined scientifically: Requirements for specialist physician training, MRI risks and contraindications, radiation protection in the case of non-ionizing radiation, application of MR contrast agents, requirements regarding image quality, significance of image artifacts and incidental findings, image evaluation and reporting, interdisciplinary communication and multiple-eyes principle, and impact on healthcare system costs.
CONCLUSION
The German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists are critical with regard to MRI performance by non-radiologists in the interest of quality standards, patient welfare, and healthcare payers. The 24-month additional qualification in MRI as defined by the physician specialization regulations (Weiterbildungsordnung) through the German state medical associations (Landesärztekammern) is the only competence-based and quality-assured training program for board-certified specialist physicians outside radiology. This has to be required as the minimum standard for performance and reporting of MRI exams. Exclusively unstructured MRI training outside the physician specialization regulations has to be strictly rejected for reasons of patient safety. The performance and reporting of MRI examinations must be reserved for adequately trained and continuously educated specialist physicians.
KEY POINTS
· MR imaging plays an increasing role due to its high diagnostic value and serves as the reference standard in many indications.. · MRI is a complex technique that implies patient risks in case of inappropriare application or lack of expertise.. · In Germany, the radiologist is the only specialist physician that has been systematically trained in all aspects of MRI such as indication, performance, and reporting of examinations in specified, high numbers.. · The only competence-based and quality-assured MRI training program for specialist physicians outside radiology is the 24-month additional qualification as defined by the regulations through the German state medical associations.. · In view of quality-assurance and patient safety, a finalized training program following the physician specialization regulations has to be required for the performance and reporting of MRI examinations..
CITATION FORMAT
· Hunold P, Bucher AM, Sandstede J et al. Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology. Fortschr Röntgenstr 2021; 193: 1050 - 1060.
Topics: Child; Germany; Humans; Magnetic Resonance Imaging; Radiography; Radiologists; Radiology
PubMed: 33831956
DOI: 10.1055/a-1463-3626 -
Journal of the American College of... Oct 2023
Topics: Health Equity
PubMed: 37619799
DOI: 10.1016/j.jacr.2023.06.036 -
Current Problems in Diagnostic Radiology 2021To assess gender balance amongst invited speakers at 2 national radiology conferences over the past decade.
RATIONALE AND OBJECTIVES
To assess gender balance amongst invited speakers at 2 national radiology conferences over the past decade.
MATERIALS AND METHODS
The 2009, 2014, and 2019 Association of University Radiologists (AUR) and American Roentgen Ray Society (ARRS) conference programs were evaluated for the number and gender of invited speakers, as well as various presentation characteristics. Gender balance was stratified across conferences and years.
RESULTS
The final analysis included 1657 invited speakers and 45, 602 minutes of presentation. AUR showed a nonsignificant increase in the percent of presentations by women from 42.2% to 46.5% and in the percent of distinct female presenters from 41.6% to 46.0%. For ARRS, percentage of female presenters varied minimally from 36.1% to 38.2%. In AUR 2009, female presenters spoke on average 5.7min less than men (P= 0.042) and 6.5% of women gave lectures over 30 minutes vs 22.2% of men (P = 0.032). Subsequent AUR and ARRS conferences did not demonstrate presentation length disparities. For AUR, no keynote female speaker was identified. For ARRS, there was no significant difference in percentage of keynote speakers based on gender (P ≥0.516). A disproportionately high percentage of presentations before 8am (44.4%-66.7%) were by women.
CONCLUSION
Female representation was greater than among the overall radiology workforce, highlighting a role of national societies in promoting female radiologists. Nonetheless, such representation is confounded by disproportionate underrepresentation in visibility of invited talks. While improvement in some presentation measures were observed, continued efforts are warranted to promote equal opportunities for female radiologists at national conferences.
Topics: Female; Humans; Male; Radiologists; Radiology; Societies, Medical; United States; Workforce
PubMed: 32553673
DOI: 10.1067/j.cpradiol.2020.05.002 -
Biomedicines Jan 2022Tau proteins are known to be mainly involved in regulation of microtubule dynamics. Besides this function, which is critical for axonal transport and signal... (Review)
Review
Tau proteins are known to be mainly involved in regulation of microtubule dynamics. Besides this function, which is critical for axonal transport and signal transduction, tau proteins also have other roles in neurons. Moreover, tau proteins are turned into aggregates and consequently trigger many neurodegenerative diseases termed tauopathies, of which Alzheimer's disease (AD) is the figurehead. Such pathological aggregation processes are critical for the onset of these diseases. Among the various causes of tau protein pathogenicity, abnormal tau mRNA metabolism, expression and dysregulation of tau post-translational modifications are critical steps. Moreover, the relevance of tau function to general mRNA metabolism has been highlighted recently in tauopathies. In this review, we mainly focus on how mRNA metabolism impacts the onset and development of tauopathies. Thus, we intend to portray how mRNA metabolism of, or mediated by, tau is associated with neurodegenerative diseases.
PubMed: 35203451
DOI: 10.3390/biomedicines10020241 -
Biochemical and Biophysical Research... Dec 2022Continuous and imaginative technological developments are leading to a massive accumulation of various types of data in all areas of biological research. As a result,... (Review)
Review
Continuous and imaginative technological developments are leading to a massive accumulation of various types of data in all areas of biological research. As a result, the central importance of databases is increasing. Databases related to biology must not only be structured using controlled vocabularies, but also be fully integrated into the whole biological domain. To achieve this goal, they must be systematically grounded in biological evolution and exploit the available tools of evolutionary systematics to contribute to our understanding of life processes.
Topics: Forests; Biological Evolution; Databases, Factual
PubMed: 36344159
DOI: 10.1016/j.bbrc.2022.09.030 -
Biochimie Feb 2024Translation initiation consists in the assembly of the small and large ribosomal subunits on the start codon. This important step directly modulates the general proteome... (Review)
Review
Translation initiation consists in the assembly of the small and large ribosomal subunits on the start codon. This important step directly modulates the general proteome in living cells. Recently, genome wide studies revealed unexpected translation initiation events from unsuspected novel open reading frames resulting in the synthesis of a so-called 'dark proteome'. Indeed, the identification of the start codon by the translation machinery is a critical step that defines the translational landscape of the cell. Therefore, translation initiation is a highly regulated process in all organisms. In this review, we focus on the various cis- and trans-acting factors that rule the regulation of translation initiation in eukaryotes. Recent discoveries have shown that the guidance of the translation machinery for the choice of the start codon require sophisticated molecular mechanisms. In particular, the 5'UTR and the coding sequences contain cis-acting elements that trigger the use of AUG codons but also non-AUG codons to initiate protein synthesis. The use of these alternative start codons is also largely influenced by numerous trans-acting elements that drive selective mRNA translation in response to environmental changes.
Topics: Codon, Initiator; Eukaryota; Trans-Activators; RNA, Messenger; Proteome; Peptide Chain Initiation, Translational; Codon; Protein Biosynthesis; Open Reading Frames; 5' Untranslated Regions
PubMed: 37741547
DOI: 10.1016/j.biochi.2023.09.017 -
Journal of the American College of... Jan 2022Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of... (Review)
Review
INTRODUCTION
Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology.
METHODS
We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
RESULTS
The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis.
DISCUSSION
We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.
Topics: Healthcare Disparities; Publications; Radiography; Radiology
PubMed: 35033297
DOI: 10.1016/j.jacr.2021.08.024