BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pa...BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.展开更多
Diabetes mellitus significantly increases the risk of cardiovascular disease and heart failure in patients.Independent of hypertension and coronary artery disease,diabetes is associated with a specific cardiomyopathy,...Diabetes mellitus significantly increases the risk of cardiovascular disease and heart failure in patients.Independent of hypertension and coronary artery disease,diabetes is associated with a specific cardiomyopathy,known as diabetic cardiomyopathy(DCM).Four decades of research in experimental animal models and advances in clinical imaging techniques suggest that DCM is a progressive disease,beginning early after the onset of type 1 and type 2 diabetes,ahead of left ventricular remodeling and overt diastolic dysfunction.Although the molecular pathogenesis of early DCM still remains largely unclear,activation of protein kinase C appears to be central in driving the oxidative stress dependent and independent pathways in the development of contractile dysfunction.Multiple subcellular alterations to the cardiomyocyte are now being highlighted as critical events in the early changes to the rate of force development,relaxation and stability under pathophysiological stresses.These changes include perturbed calcium handling,suppressed activity of aerobic energy producing enzymes,altered transcriptional and posttranslational modification of membrane and sarcomeric cytoskeletal proteins,reduced actin-myosin cross-bridge cycling and dynamics,and changed myofilament calcium sensitivity.In this review,we will present and discuss novel aspects of the molecular pathogenesis of early DCM,with a special focus on the sarcomeric contractile apparatus.展开更多
Background:Cerebrospinal fluid(CSF)-diversion procedures have traditionally been the standard of treatment for patients with medically refractive idiopathic intracranial hypertension(IIH).However,dural venous sinus st...Background:Cerebrospinal fluid(CSF)-diversion procedures have traditionally been the standard of treatment for patients with medically refractive idiopathic intracranial hypertension(IIH).However,dural venous sinus stent(VSS)placement has been described as a safe and effective procedure for the management of medically refractive IIH.We performed a meta-analysis comparing outcomes and complications of CSF-diversion procedures,VSS and optic nerve sheath fenestration(ONSF)for the treatment of medically refractive IIH.Methods:Electronic searches were performed using six databases from 1988 to January 2017.Data was extracted and meta-analysed from the identified studies.Results:From 55 pooled studies,there were 538 CSF-diversion cases,224 dural venous stent placements,and 872 ONSF procedures.Similar improvements were found in terms of postoperative headaches(CSF vs.VSS vs.ONSF:84%vs.78%vs.62%,P=0.223),papilledema(CSF vs.VSS vs.ONSF:71%vs.86%vs.77%,P=0.192),whilst visual acuity changes favored venous stenting(CSF vs.VSS vs.ONSF:55%vs.69%vs.44%,P=0.037).There was a significantly lower rate of subsequent procedures with venous stent placement(CSF vs.VSS vs.ONSF:37%vs.13%vs.18%,P<0.001),but other complication rates were similar(CSF vs.VSS vs.ONSF:13%vs.8%vs.14%,P=0.28).Subgroup analysis of lumbar-peritoneal vs.ventriculoperitoneal shunts found no differences in symptom improvements,complications and subsequent procedure rates.Conclusions:Our findings suggest that dural venous sinus stenting may be a viable alternative to traditional surgical interventions in patients who are refractory to medical treatment.展开更多
This article is a call to action to address escalating threats to scientific progress that affect academic researchers across the globe.These threats include public mistrust of science,challenges in translating academ...This article is a call to action to address escalating threats to scientific progress that affect academic researchers across the globe.These threats include public mistrust of science,challenges in translating academic research to end-user applications,a disconnect between academics and policymakers,emerging barriers to international collaboration,and a reliance on conventional metrics to evaluate academic performance.This article presents various calls to action informed by exemplary approaches across the globe that serve as frameworks to drive beneficial transformation for researchers,academic institutions,and society.展开更多
A 50 year old Asian born man presented with Cryptococcal meningitis due to Cryptococcus gattii.His CSF had no cells but abundant cryptococcal yeast on microscopy.A fluid level could be seen between the yeast and the C...A 50 year old Asian born man presented with Cryptococcal meningitis due to Cryptococcus gattii.His CSF had no cells but abundant cryptococcal yeast on microscopy.A fluid level could be seen between the yeast and the CSF on MRI.展开更多
A 60-year-old immunocompetent woman was diagnosed with meningococcemia and presumed meningitis after presenting with altered consciousness,headache,neck stiffness,and a purpuric rash.She had some atypical features for...A 60-year-old immunocompetent woman was diagnosed with meningococcemia and presumed meningitis after presenting with altered consciousness,headache,neck stiffness,and a purpuric rash.She had some atypical features for meningitis including nystagmus and dizziness,which persisted beyond a standard course of 7 days of intravenous ceftriaxone.Computed tomography brain and fundoscopy were normal.Magnetic resonance imaging(MRI)brain revealed pyogenic ventriculitis and ependymal enhancement.Antimicrobials were not extended due to clinical and biochemical improvement.The patient had close neurological monitoring as an inpatient and following discharge until recovery.Follow-up MRI brain after 3 months was normal.Pyogenic ventriculitis is described rarely in the literature as a complication of bacterial meningitis in adults,particularly secondary to Neisseria meningitidis.Optimal antibiotic regimen and duration are not well-established.It should be considered in patients not improving as per expected trajectory,including those with atypical neurology.If not recognized early,it can lead to hydrocephalus and death.展开更多
文摘BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.
基金The research funding from the International Synchrotron Access Program(AS/IA133)of the Australian Synchrotron(to Pearson JT)A Grant-in-Aid for Scientific Research(#E056,26670413)from the Ministry of Education,Culture,Sports,Sciences and Technology of Japan(to Shirai M)
文摘Diabetes mellitus significantly increases the risk of cardiovascular disease and heart failure in patients.Independent of hypertension and coronary artery disease,diabetes is associated with a specific cardiomyopathy,known as diabetic cardiomyopathy(DCM).Four decades of research in experimental animal models and advances in clinical imaging techniques suggest that DCM is a progressive disease,beginning early after the onset of type 1 and type 2 diabetes,ahead of left ventricular remodeling and overt diastolic dysfunction.Although the molecular pathogenesis of early DCM still remains largely unclear,activation of protein kinase C appears to be central in driving the oxidative stress dependent and independent pathways in the development of contractile dysfunction.Multiple subcellular alterations to the cardiomyocyte are now being highlighted as critical events in the early changes to the rate of force development,relaxation and stability under pathophysiological stresses.These changes include perturbed calcium handling,suppressed activity of aerobic energy producing enzymes,altered transcriptional and posttranslational modification of membrane and sarcomeric cytoskeletal proteins,reduced actin-myosin cross-bridge cycling and dynamics,and changed myofilament calcium sensitivity.In this review,we will present and discuss novel aspects of the molecular pathogenesis of early DCM,with a special focus on the sarcomeric contractile apparatus.
文摘Background:Cerebrospinal fluid(CSF)-diversion procedures have traditionally been the standard of treatment for patients with medically refractive idiopathic intracranial hypertension(IIH).However,dural venous sinus stent(VSS)placement has been described as a safe and effective procedure for the management of medically refractive IIH.We performed a meta-analysis comparing outcomes and complications of CSF-diversion procedures,VSS and optic nerve sheath fenestration(ONSF)for the treatment of medically refractive IIH.Methods:Electronic searches were performed using six databases from 1988 to January 2017.Data was extracted and meta-analysed from the identified studies.Results:From 55 pooled studies,there were 538 CSF-diversion cases,224 dural venous stent placements,and 872 ONSF procedures.Similar improvements were found in terms of postoperative headaches(CSF vs.VSS vs.ONSF:84%vs.78%vs.62%,P=0.223),papilledema(CSF vs.VSS vs.ONSF:71%vs.86%vs.77%,P=0.192),whilst visual acuity changes favored venous stenting(CSF vs.VSS vs.ONSF:55%vs.69%vs.44%,P=0.037).There was a significantly lower rate of subsequent procedures with venous stent placement(CSF vs.VSS vs.ONSF:37%vs.13%vs.18%,P<0.001),but other complication rates were similar(CSF vs.VSS vs.ONSF:13%vs.8%vs.14%,P=0.28).Subgroup analysis of lumbar-peritoneal vs.ventriculoperitoneal shunts found no differences in symptom improvements,complications and subsequent procedure rates.Conclusions:Our findings suggest that dural venous sinus stenting may be a viable alternative to traditional surgical interventions in patients who are refractory to medical treatment.
基金funded by the Academy of Medical Sciences(UK)under award number SBF007\100176(R.Z.J.)UK Research and Innovation under award number MR/X032914/1(R.Z.J.)the Swiss National Science Foundation under award number PR00P3_185742(D.L.).
文摘This article is a call to action to address escalating threats to scientific progress that affect academic researchers across the globe.These threats include public mistrust of science,challenges in translating academic research to end-user applications,a disconnect between academics and policymakers,emerging barriers to international collaboration,and a reliance on conventional metrics to evaluate academic performance.This article presents various calls to action informed by exemplary approaches across the globe that serve as frameworks to drive beneficial transformation for researchers,academic institutions,and society.
文摘A 50 year old Asian born man presented with Cryptococcal meningitis due to Cryptococcus gattii.His CSF had no cells but abundant cryptococcal yeast on microscopy.A fluid level could be seen between the yeast and the CSF on MRI.
文摘A 60-year-old immunocompetent woman was diagnosed with meningococcemia and presumed meningitis after presenting with altered consciousness,headache,neck stiffness,and a purpuric rash.She had some atypical features for meningitis including nystagmus and dizziness,which persisted beyond a standard course of 7 days of intravenous ceftriaxone.Computed tomography brain and fundoscopy were normal.Magnetic resonance imaging(MRI)brain revealed pyogenic ventriculitis and ependymal enhancement.Antimicrobials were not extended due to clinical and biochemical improvement.The patient had close neurological monitoring as an inpatient and following discharge until recovery.Follow-up MRI brain after 3 months was normal.Pyogenic ventriculitis is described rarely in the literature as a complication of bacterial meningitis in adults,particularly secondary to Neisseria meningitidis.Optimal antibiotic regimen and duration are not well-established.It should be considered in patients not improving as per expected trajectory,including those with atypical neurology.If not recognized early,it can lead to hydrocephalus and death.
