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Aims: Atrial contractile dysfunction contributes to worse prognosis in hypertensive heart disease (HHD), but the role of cardiomyocyte dysfunction in atrial remodelling in HHD is not well understood. We investigated and compared cellular mechanisms of left (LA) and right atrial (RA) contractile dysfunction in pigs with HHD. Methods and results: In vivo electrophysiological and magnetic resonance imaging studies were performed in control and pigs treated with 11‐deoxycorticosterone acetate (DOCA)/high‐salt/glucose diet (12 weeks) to induce HHD. HHD leads to significant atrial remodelling and loss of contractile function in LA and a similar trend in RA (magnetic resonance imaging). Atrial remodelling was associated with a higher inducibility of atrial fibrillation but unrelated to changes in atrial refractory period or fibrosis (histology). Reduced atrial function in DOCA pigs was related to reduced contraction amplitude of isolated LA (already at baseline) and RA myocytes (at higher frequencies) due to reduced intracellular Ca release (Fura 2‐AM, field stimulation). However, Ca regulation differed in LA and RA cardiomyocytes: LA cardiomyocytes showed reduced sarcoplasmic reticulum (SR) [Ca], whereas in RA, SR [Ca] was unchanged and SR Ca2+‐ATPase activity was increased. Sodium–calcium exchanger (NCX) activity was not significantly altered. We used ORM‐10103 (3 μM), a specific NCX inhibitor to improve Ca availability in LA and RA cardiomyocytes from DOCA pigs. Partial inhibition of NCX increased Ca2+ transient amplitude and SR Ca in LA, but not RA cells. Conclusions: In this large animal model of HHD, atrial remodelling in sinus rhythm in vivo was related to differential LA and RA cardiomyocyte dysfunction and Ca signalling. Selective acute inhibition of NCX improved Ca release in diseased LA cardiomyocytes, suggesting a potential therapeutic approach to improve atrial inotropy in HHD. [ABSTRACT FROM AUTHOR]

Objectives The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA). Methods Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0–32) and power Doppler (0–14, range global ultrasound score 0–140)], and radiographs were evaluated for enthesophytes and erosions (score range 0–56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression. Results We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P  =0.005), had shorter disease duration (9.7 vs 17.9 years, P =0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P =0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P <0.05). The multivariate regression analysis revealed that 48.6% of the variance of the X-ray score at 12-months follow-up (RegcoeffB = 0.827, P =0.000) could be explained by the baseline US enthesophyte score. Conclusion Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses. [ABSTRACT FROM AUTHOR]

• Radiographic image interpretation with computed tomography texture analysis of the lung in human subjects revealed significant differences between inflammatory and malignant lung lesions. • Significant differences between distinct types of lung neoplasms could be demonstrated using CT texture analysis. • The application of a Hounsfield-Unit threshold for lesion segmentation had a substantial impact on the results of CT texture analysis. To investigate whether CT texture analysis allows differentiation between adenocarcinomas, squamous cell carcinomas, carcinoids, small cell lung cancers and organizing pneumonia and between carcinomas and neuroendocrine tumors. This retrospective study included patients 133 patients (30 patients with organizing pneumonia, 30 patients with adenocarcinoma, 30 patients with squamous cell carcinoma, 23 patients with small cell lung cancer, 20 patients with carcinoid), who underwent CT-guided biopsy of the lung and had a corresponding histopathologic diagnosis. Pulmonary lesions were segmented in consensus by two radiologists with and without a threshold of −50HU in three dimensions. Groupwise comparisons were performed to assess for differences between all five above-listed entities and between carcinomas and neuroendocrine tumors. Pairwise comparisons of the five entities revealed 53 statistically significant texture features when using no HU-threshold and 6 statistically significant features with a threshold of −50HU. The largest AUC (0.818 [95%CI 0.706–0.930]) was found for the feature wavelet-HHH_glszm_SmallAreaEmphasis for discrimination of carcinoid from the other entities when using no HU-threshold. In differentiating neuroendocrine tumors from carcinomas, 173 parameters proved statistically significant when using no HU threshold versus 52 parameters when using a −50HU-threshold. The largest AUC (0.810 [95%CI 0.728–0,893]) was found for the parameter original_glcm_Correlation for discrimination of neuroendocrine tumors from carcinomas when using no HU-threshold. CT texture analysis revealed features that differed significantly between malignant pulmonary lesions and organizing pneumonia and between carcinomas and neuroendocrine tumors of the lung. Applying a HU-threshold for segmentation substantially influenced the results of texture analysis. [ABSTRACT FROM AUTHOR]

Background: In patients with pulmonary hypertension (PH), duration of vortical blood flow along the main pulmonary artery enables estimation of the mean pulmonary arterial pressure (mPAP) non-invasively. It remains to date not known, if this method is applicable in patients with pulmonary arterial hypertension (PAH) and abnormal aortic-to-pulmonary shunting. Case presentation: The present case analyzes the effect of a patent ductus arteriosus (PDA) on pulmonary artery flow patterns in PAH (mPAP from right heart catheterization, 75 mmHg). PH-associated vortical blood flow, which is typically observed rotating in a clockwise direction when viewed in right ventricular outflow tract orientation, was found nested in PDA left-to-right shunting. Even though rotating counter-clockwise, duration of vortical flow translated into correct non-invasive mPAP estimate. Conclusions: This case indicates that PH-associated vortex rotation is not restricted to clockwise direction, and that vortex-based estimation of elevated mPAP might also be feasible in patients with PAH and PDA. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (SSc) is an intractable autoimmune disease characterized by vasculopathy and organ fibrosis. Autologous hematopoietic stem cell transplantation (AHSCT) should be considered for the treatment of selected patients with rapid progressive SSc at high risk of organ failure. It, however, remains elusive whether immunosuppressive therapies such as rituximab (RTX) are still necessary for such patients after AHSCT, especially in those with bad outcomes. In the present report, a 43-year-old man with diffuse cutaneous SSc received AHSCT. Despite AHSCT, SSc further progressed with progressive symptomatic heart failure with newly developed concomitant mitral and tricuspid valve insufficiency, thus the patient started on RTX 8 months after AHSCT. Shortly after initiation of RTX, clinical symptoms and organ functions ameliorated subsequently. Heart valve regurgitations were reversible after initiation of RTX treatment. Currently, the patient remains in a stable condition with significant improvement of clinical symptoms and organ functions. Reporting about therapies after AHSCT in SSc is a very important issue, as randomized controlled trials are lacking, and therefore this report adds to evidence that RTX can be considered as a treatment option in patients with SSc that do not respond to AHSCT. [ABSTRACT FROM AUTHOR]

Purpose: To assess correlations of lean body weight (LBW) calculated with various formulas, total body weight (TBW), body height (BH), body mass index (BMI), body surface area (BSA) and fat-free mass (FFM) with vascular and parenchymal enhancement in multiphasic CT of the liver.Method: Thirty consecutive patients underwent multiphasic CT of the liver using constant iodine dose and flow rate. Contrast enhancement of aorta, portal vein and liver was calculated by measuring mean vascular and parenchymal attenuation in pre-contrast and post-contrast phases. Correlations of TBW, BH, BMI, BSA, FFM, and LBW (calculated with formulas of Boer, Hume, James and Green&Duffull) with enhancement were tested using Spearman's correlation coefficient. The method of Fieller et al. was used to calculate 95 % confidence intervals. A p-value ≤ 0.05 was considered statistically significant.Results: Aortal enhancement correlated strongly with TBW, BSA, LBWBoer and LBWHume and moderately with BH, BMI, FFM, LBWJames and LBWGreen&Duffull. Liver enhancement in the late arterial phase correlated moderately with TBW, FFM, LBWBoer, LBWHume and LBWGreen&Duffull and weakly with BSA. Liver enhancement in the portal venous phase correlated strongly with TBW, BSA, FFM, LBWBoer, LBWHume and LBWGreen&Duffull, whereby overlap of the 95 % CI graphs demonstrated that the differences in the correlation coefficients were not statistically significant. Liver enhancement in the delayed phase correlated moderately with BH but did not correlate significantly with any other parameter.Conclusion: Regardless of the form used for calculation, LBW did not correlate statistically significantly stronger than TBW with vascular or parenchymal enhancement of the liver. [ABSTRACT FROM AUTHOR]