Ultrasound guided port implantation via the IJV results in low periprocedural complication rates.

AimsCoronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography. Methods and resultsSeparate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen’s kappa 0.82, 95% confidence interval 0.74–0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients.ConclusionIn patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information.Trial registration numberNCT02813473.

Superparamagnetic iron oxide nanoparticles (SPIONs) are commonly used in magnetic resonance imaging (MRI), but their fast phagocytosis makes them less than ideal for this application. To circumvent the lymphocyte-macrophage system, we encapsulated SPIONs into red blood cells (RBCs). For loading, the RBC's membrane was opened by swelling under hypoosmotic conditions and subsequently resealed. In this work, we demonstrate that SPIONs can be loaded into RBCs in a concentration sufficient to obtain strong contrast enhancement in MRI.

Cross-sectional imaging such as CT and ultrasound have rapidly developed a central role in diagnostic medicine. However, cross-sectional anatomy has lagged behind in its incorporation into medical school education, often leaving students without even a basic understanding of these images. At Hannover Medical School, we have successfully combined hands-on ultrasound workshops performed by medical students on other students with our anatomy course. This interactive component of our anatomy courses improves our students' understanding of clinical anatomy and introduces them to ultrasound imaging.