BACKGROUND AND PURPOSE: Currently, the characteristics of carotid plaques are considered important factors for identifying subjects at high risk of stroke. This study aimed to test the hypothesis that carotid plaque composition assessed by CTA is associated with an increased risk of future major adverse cardiovascular events among asymptomatic subjects with moderate-to-severe carotid artery stenosis. MATERIALS AND METHODS:This single-center, retrospective cohort study included 194 carotid plaques from 176 asymptomatic subjects with moderate-to-severe carotid artery stenosis. The association of CTA-determined plaque composition with the risk of subsequent adverse cardiovascular events was analyzed.RESULTS: During a median follow-up of 41 months, the adverse cardiovascular event incidence among 194 carotid plaques was 19.6%. There were significant differences in plaque Hounsfield units (P , .001) and spotty calcium presence (P , .001) between carotid plaques from subjects with and without subsequent adverse cardiovascular events. Multivariable analysis revealed carotid plaque Hounsfield unit density (P , .001) and spotty calcium (P , .001) as independent predictors of subsequent adverse cardiovascular events. In association with moderate carotid artery stenosis, the plaque Hounsfield unit values were significantly lower among carotid plaques from subjects who experienced subsequent adverse cardiovascular events (P ¼ .002), strokes (P ¼ .01), and cardiovascular deaths (P ¼ .04); the presence of spotty calcium was significantly associated with the occurrence of adverse cardiovascular events (P ¼ .001), acute coronary syndrome (P ¼ .01), and cardiovascular death (P ¼ .04).CONCLUSIONS: Carotid plaque Hounsfield unit density and spotty calcium were independent predictors of a greater risk of adverse cardiovascular event occurrence. ABBREVIATIONS: ACS ¼ acute coronary syndrome; CAS ¼ carotid artery stenosis; DUS ¼ Doppler ultrasound; HR ¼ hazard ratio; IQR ¼ interquartile range; MACE ¼ major adverse cardiovascular event

Low body mass index (BMI) is a risk factor for nutcracker syndrome (NCS). We evaluated the BMI and symptoms of patients having NCS. Methods: This was a retrospective study of patients who were diagnosed with NCS between 2010 and 2015. The diagnosis was based on computed tomography, ultrasound, magnetic resonance venography, or intravascular ultrasonography findings. The BMI of these patients was compared with the BMI of an equal number of controls selected from our departmental database and matched for sex and age. Results: A total of 30 patients were included in this study. There were 22 female patients (73.3%) and 8 males (26.7%) with a median age of 38.5 years (interquartile range [IQR], 26.75∼56.25 years). The median age of female patients was 42.0 years (IQR, 32.75∼57 years) and that of male patients was 25.5 years (IQR, 19.25∼48.75 years). The mean BMI was 20.2±2.7 kg/m 2 (range, 13.6∼25.1 kg/m 2 ). The mean BMI of female patients was 20.5±2.7 kg/m 2 and that of male patients was 19.7±3.0 kg/m 2 (p=.482). The mean BMI of the matched cohort was 22.08±3.5 kg/m 2 (p=.022). The most common symptom was gross hematuria (18 patients, 60.0%). The other symptoms included abdominal pain (17, 56.7%), flank pain (9, 30.0%), pelvic symptoms including heaviness, fullness, and dysuria (6, 20.0%), and back pain (1, 3.3%). Conclusion:The BMI of patients with NCS was significantly lower than that of the controls. NCS was more common in women, and the most common symptom was gross hematuria.

The author's trauma center implemented Mobile Trauma Units (MTU), which are ground transportation automobiles constructed with advanced medical equipment, in an attempt to improve the survival rate of severe trauma patients. The purpose of this study was to examine the efficacy of MTU as a means of inter-hospital transfer of patients in urban environments. Methods: Patients with an injury severity score (ISS) of 16 or more were enrolled in this study. The participants must also be patients who were transferred with the MTU in the 18 months between January 2017 and June 2018. To assess the survival probability, the revised trauma score (RTS), trauma and injury severity score (TRISS), and w-score were used as the outcome indices. Results: Forty-four (86.3%) of the severe trauma patients with an ISS of 16 or more were male and 7 (13.7%) were female. The number of patients from the territory were 32 (62.7%), and patients from the others were 19 (37.3%). All the patients received their injury from blunt force trauma. The average time of from the scene of the accident to the trauma center was 176 minutes. In 13 deaths, 10 (76.9%) of the RTS values were below 4 points. Among the 51 patients, TRISS was more than 0.5 in 32 patients (62.7%). The w-score was 13.25 and the actual survival rate of a patient was 74.50%. Conclusion: Ground transportation automobiles that use MTU for severe trauma patients in urban areas are more economically beneficial and more efficient. The survival rate while using MTU was also shown to be higher than that of medical helicopter transfers.