Relevant bibliographies by topics / Pulmonary embolism

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Academic literature on the topic 'Pulmonary embolism'

Author: Grafiati
Published: 4 June 2021
Last updated: 15 June 2025

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Journal articles on the topic "Pulmonary embolism"

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Nie, Yunqiang, Li Sun, Wei Long, et al. "Clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism." Journal of International Medical Research 49, no. 4 (2021): 030006052110047. http://dx.doi.org/10.1177/03000605211004769.

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Objective To explore the clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism (APE). Methods Sixty-four patients with APE were classified into mixed-type and distal-type pulmonary embolism groups. Their right ventricular systolic pressure (RVSP) and disease duration were recorded, and the diameter of their right ventricles was measured by ultrasound. The computed tomography angiographic clot load was determined as a Mastora score. Results Patients with distal-type pulmonary embolisms had significantly lower RVSPs (44.92 ± 17.04 vs 55.69 ± 17.66 mmHg), and significantly smaller right ventricular diameters (21.08 ± 3.06 vs 23.37 ± 3.48 mm) than those with mixed-type pulmonary embolisms. Additionally, disease duration was significantly longer in patients with distal-type pulmonary embolisms (14.33 ± 11.57 vs 8.10 ± 7.10 days), and they had significantly lower Mastora scores (20.91% ± 18.92% vs 43.96% ± 18.30%) than patients with mixed-type pulmonary embolisms. After treatment, RVSPs decreased significantly in patients with both distal-type and mixed-type pulmonary embolisms. Right ventricle diameters also decreased significantly in patients with mixed-type pulmonary embolisms after treatment. Conclusion Patients with mixed-type pulmonary embolisms are significantly more susceptible to pulmonary hypertension, enlarged right ventricular diameters, and shorter durations of disease than those with distal-type pulmonary embolisms. The distribution of pulmonary artery embolism in APE can provide a clinical reference.
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K, Prabakar, and Dhruvanandan K. "Acute Pulmonary Embolism." JOURNAL OF CLINICAL AND BIOMEDICAL SCIENCES 11, no. 4 (2021): 143–50. http://dx.doi.org/10.58739/jcbs/v11i4.2.

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Hannig, Kjartan Eskjaer, Steen Elkjaer Husted, and Erik Lerkevang Grove. "Cardiac Arrest Caused by Multiple Recurrent Pulmonary Embolism." Case Reports in Medicine 2011 (2011): 1–4. http://dx.doi.org/10.1155/2011/425090.

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Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1) The importance of optimal anticoagulant treatment in the prevention of pulmonary embolism reoccurrence. (2) The benefit of immediate accessibility to echocardiography in the handling of haemodynamically unstable patients with an unknown underlying cause. (3) Thrombolytic treatment should always be considered and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism.
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Carpenter, Nicole. "Massive Pulmonary Embolism and Thrombolytic Therapy: Case Study." Journal of Diagnostic Medical Sonography 33, no. 3 (2017): 232–38. http://dx.doi.org/10.1177/8756479317691271.

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Acute pulmonary embolism is the third most common acute cardiovascular disease, with about 600,000 cases annually in the United States. Pulmonary embolism requires a multimodality diagnosis and immediate treatment. Although computed tomography and ventilation perfusion scans are the most commonly used modalities to diagnose pulmonary embolisms, many supplemental tests are necessary. Treatment options for pulmonary embolism include anticoagulation therapy, thrombolytic therapy, or insertion of an inferior vena cava filter when anticoagulation is contraindicated. The long-term benefits of thrombolytic therapy have made it an increasingly popular option in many institutions. The following case study describes a patient who presented to the hospital with shortness of breath for five months and was found to have extensive pulmonary embolisms upon admission. The patient underwent three days of thrombolytic therapy that significantly reduced his pulmonary arterial pressures and resulted in an almost complete resolution of his pulmonary embolisms.
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Sohns, Jan M., Jan Menke, Leonard Bergau, et al. "Screening of extravascular findings in pulmonary embolism computer tomography: 397 patients with 1950 non-pulmonary artery findings." Vascular 26, no. 1 (2017): 99–110. http://dx.doi.org/10.1177/1708538117724628.

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Objectives The aim of this study was to investigate the possible benefits from computed tomography scans of patients with a suspected pulmonary artery embolism with a focus on relevant extravascular findings. Methods A total of 400 consecutive computed tomography pulmonary angiographies were evaluated. Computed tomography scans were analyzed in detail for the presence of pulmonary artery embolisms, as well as any other findings. Extra-artery discoveries were classified into none-relevant (Group A), intermediate (Group B), or relevant (Group C) findings. Results Aggregated computed tomography pulmonary angiographies detected other diagnosis than pulmonary artery embolism in 236 patients (59%). There were 1950 non-pulmonary artery embolism findings (4.9 per patient; n = 397). In the pulmonary artery embolism group, there were 447 extra-pulmonary artery embolism findings (5.2 per patient; n = 86) and in the non-pulmonary artery embolism group, 1503 findings (4.8 per patient; n = 311). Patients with pulmonary artery embolism had a significantly higher rate of pro-coagulate risk factors ( p < 0.001). Conclusions Computed tomography pulmonary angiographies may help to identify further diagnoses. This study represents a retrospective review of a single center experience for incidental computed tomography findings during pulmonary artery embolism work-up and emphasizes the importance of analyzing the whole field-of-view.
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Umairi, Rashid AL, Khadija AL Adawi, Maryam AL Khoori, Ahmed AL Lawati, and Sachin Jose. "COVID-19-Associated Thrombotic Complication: Is It Pulmonary Embolism or In Situ Thrombosis?" Radiology Research and Practice 2023 (July 3, 2023): 1–4. http://dx.doi.org/10.1155/2023/3844069.

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Objectives. Acute pulmonary embolism is a protentional fatal complication of COVID-19. The aim of this study is to investigate whether pulmonary embolism is due to thrombus migration from the venous circulation to the pulmonary arteries or due to local thrombus formation secondary to local inflammation. This was determined by looking at the distribution of pulmonary embolism in relation to lung parenchymal changes in patients with COVID-19 pneumonia. Methods. Retrospectively, we identified pulmonary computed tomography angiography (CTPA) of patients admitted to the Royal Hospital between November 1st, 2020, and October 31, 2021, with a confirmed diagnosis of COVID-19. The CTPAs were examined for the presence of pulmonary embolism and the distribution of the pulmonary embolism in relation with lung parenchymal changes. Results. A total of 215 patients admitted with COVID-19 pneumonia had CTPA. Out of them, 64 patients had pulmonary embolisms (45 men and 19 women; mean age: 58.4 years with a range of 36–98 years). The prevalence of pulmonary embolism (PE) was 29.8% (64/215). Pulmonary embolism was more frequently seen in the lower lobes. 51 patients had PE within the diseased lung parenchyma and 13 patients had PE within normal lung parenchyma. Conclusion. The strong association between pulmonary artery embolism and lung parenchymal changes in patients admitted with COVID-19 pneumonia suggests local thrombus formation.
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Dhingra, Jitesh. "Pulmonary Embolism: Emergency Physician’s Nightmare." Journal of Medical Science And clinical Research 05, no. 06 (2017): 23590–94. http://dx.doi.org/10.18535/jmscr/v5i6.130.

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Houtzager, Tessa, Ingvar Berg, Thijs Urlings, and Robert Grauss. "Concomitant pulmonary embolism and upper limb ischaemia as a first presentation of a patent foramen ovale." BMJ Case Reports 14, no. 10 (2021): e242351. http://dx.doi.org/10.1136/bcr-2021-242351.

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A 78-year-old female patient presented to the emergency department with syncope and dyspnoea. The left arm appeared to be cold and radial pulse was not palpable. A CT scan of the chest and left arm with intravenous contrast displayed bilateral central pulmonary embolisms in combination with a left subclavian artery embolism and an atrial septal aneurysm. Transthoracic echocardiography identified a patent foramen ovale with right-to-left shunting confirming the diagnosis of paradoxical embolism. The patient was treated with anticoagulants. In a patient presenting with a combination of a pulmonary embolism and a peripheral arterial embolism, the clinician should consider a right-to-left shunt with paradoxical embolism. In line with this, when diagnosing a peripheral arterial embolism, a central venous origin should be considered. Furthermore, when diagnosing a pulmonary embolism or other forms of venous thromboembolism, the clinician should be aware of signs of a peripheral arterial embolism.
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Falkenstern-Ge, Roger, Kim Husemann, and Martin Kohlhäufl. "Late onset of pulmonary cement embolism after a regular vertebroplasy. A clinical documentation." Open Medicine 8, no. 5 (2013): 662–64. http://dx.doi.org/10.2478/s11536-013-0207-0.

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AbstractVertebroplasty is a new minimal-invasive procedure for the treatment of painful vertebral fractures. The risk of a pulmonary embolism ranges from 3.5 to 23% for osteoporotic fractures. However, data about the incidence and treatment strategies of pulmonary cement embolisms (PCE) are limited. We report a case of a patient with symptomatic pulmonary cement embolism after the vertebroplasty. The diagnosis was confirmed by means of CT- scan. In cases of asymptomatic patients with peripheral PCE we recommend no treatment besides clinical follow-up. In our case of symptomatic embolisms, we recommend to proceed according to the guidelines regarding the treatment of thrombotic pulmonary embolisms, which includes initial heparinization and a following 6-month coumarin therapy.
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Gong, Xiaowei, Boyun Yuan, and Yadong Yuan. "Incidence and prognostic value of pulmonary embolism in COVID-19: A systematic review and meta-analysis." PLOS ONE 17, no. 3 (2022): e0263580. http://dx.doi.org/10.1371/journal.pone.0263580.

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Background Pulmonary embolisms are frequently and prognostically in individuals infected by coronavirus disease 2019 (COVID-19); the incidence of pulmonary embolisms is varied across numerous studies. This study aimed to assess the pooled incidence of pulmonary embolic events and the prognostic value of such events in intensive care unit (ICU) admissions of patients with COVID-19. Methods The Cochrane Library, PubMed, and EmBase were systematically searched for eligible studies published on or before October 20, 2021. The pooled incidence of pulmonary embolism was calculated using the random-effects model. Moreover, the prognostic value was assessed by measuring the sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Thirty-six studies involving 10,367 COVID-19 patients were selected for the final meta-analysis. The cumulative incidence of pulmonary embolism in patients with COVID-19 was 21% (95% confidence interval [95%CI]: 18−24%; P<0.001), and the incidence of pulmonary embolism in ICU and non-ICU patients was 26% (95%CI: 22−31%; P<0.001) and 17% (95%CI: 14−20%; P<0.001), respectively. The predictive role of pulmonary embolism in ICU admission was also assessed, and the sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.31 (95%CI: 0.21−0.42), 0.84 (95%CI: 0.75−0.90), 1.88 (95%CI: 1.45−2.45), 0.83 (95%CI: 0.75−0.91), 2.25 (95%CI: 1.64−3.08), and 0.61 (95%CI: 0.57−0.65), respectively. Conclusion This study found that the incidence of pulmonary embolism was relatively high in COVID-19 patients, and the incidence of pulmonary embolism in ICU patients was higher than that in non-ICU patients.
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Dissertations / Theses on the topic "Pulmonary embolism"

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Pereira, Daniel José. "Embolia pulmonar experimental = um modelo quase fatal." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309566.

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Orientador: Heitor Moreno Junior<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-19T02:49:22Z (GMT). No. of bitstreams: 1 Pereira_DanielJose_M.pdf: 8289618 bytes, checksum: f81b30485257dfeb1919e76b99cecc7d (MD5) Previous issue date: 2011<br>Resumo: Introdução: estudos experimentais de embolia pulmonar (EP) são habitualmente realizados sob ventilação mecânica. Como a maioria dos pacientes com suspeita de EP adentra os Serviços de Emergência em respiração espontânea e em ar ambiente, estudos que medissem as variáveis hemodinâmicas, gasométricas e capnográficas, nestas condições, em muito contribuiriam para compreensão mais específica das alterações cardiopulmonares e gasométricas na fase aguda da doença. Observa-se que faltam na literatura estudos experimentais que avaliem animais em tais condições. Objetivo: o objetivo do presente estudo foi submeter à EP animais sob ventilação espontânea e sem oxigênio suplementar. A EP por coágulos autólogos foi induzida em seis porcos e os registros cardiorrespiratórios e gasométricos foram realizados no pré e pós-EP. O valor da pressão média de artéria pulmonar (PMAP) "quase fatal" foi previamente determinada. Resultados: a presença de choque obstrutivo agudo pôde ser evidenciada pelo aumento da PMAP (de 17,8±3,5 para 41,7±3,3mmHg) (P<0,0001) e pela queda do débito cardíaco (de 4,9±1,0 para 2,7±1,0L/min) (P<0,003). Consequentemente, a presença de acidose metabólica pode ser constatada (de 2,4±0,6 para 5,7±1,8mmol/L) (P<0,0001). Observou-se ainda a presença de hipoxemia (de 73,5±12,7 para 40,3±4,6mmHg) (P<0,0001), porém, a PaCO2 não variou (de 44,9±4,4 para 48,2±6,0mmHg) (NS). Houve expressivos aumentos, tanto para P(a-et)CO2 (de 4,8±2,8 para 37,2±5,8mmHg) quanto para a P(A-a)O2 (de 8,2±8,9 para 37,2±10,3mmHg) (P<0,0001). Como tentativa de compensação à acidose metabólica, evidenciou-se significativo aumento do volume minuto alveolar total (de 4,0±0,9 para 10,6±2,9L/min) (P<0,0001). Conclusão: neste modelo, a PMAP quase fatal foi de 2 a 2,5 vezes a PMAP basal e as variáveis capnográficas, associadas a gasometria arterial e venosa, mostraram-se eficazes em discriminar um quadro obstrutivo agudo<br>Abstract: Introduction: Experimental studies on pulmonary embolism (PE) are usually performed under mechanical ventilation. Most patients with suspicion of PE enter the Emergency Services in spontaneous breathing and environmental air. Thus, under these conditions, measurements of hemodynamic, gasometric and capnographic variables contribute largely to a more specific comprehension of cardiopulmonary and gasometric alterations in the acute phase of the disease. Studies which evaluated animals under conditions are lacking. Objective: This study aimed to submit animals under spontaneous ventilation and without supplemental oxygen to PE. PE was induced in six pigs using autologous blood clots, and cardiorespiratory and gasometric records were performed before and after PE. The values of "near fatal" mean pulmonary arterial pressure (MPAP) were previously determined. Results: The presence of obstructive shock could be evidenced by increased MPAP (from 17.8±3.5 to 41.7±3.3mmHg) (p<0.0001) and decreased cardiac output (from 4.9±1.0 to 2.7±1.0L/min) (p<0.003). Consequently, metabolic acidosis occurred (Lac art)(from 2.4±0.6 to 5.7±1.8mmol/L) (p<0.0001). It was observed hypoxemia (from 73.5±12.7 to 40.3±4.6mmHg) (p<0.0001); however, PaCO2 did not vary (from 44.9±4.4 to 48.2±6.0mmHg) (NS). There were significant increases in both P(a-et)CO2 (from 4.8±2.8 to 37.2±5.8mmHg) and P(A-a)O2 (from 8.2±8.9 to 37.2±10.3mmHg) (p<0.0001). There was also a significant increase in the total alveolar minute volume (from 4.0±0.9 to 10.6±2.9L/min) (p<0.0001). Conclusion: In this model, the near fatal MPAP was from 2 to 2.5 times the basal MPAP; and the capnographic variables, associated with arterial and venous gasometry, showed effective in discriminating an acute obstructive profile<br>Mestrado<br>Farmacologia<br>Mestre em Farmacologia
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Cheriex, Emile C. "Cardiological aspects of pulmonary embolism." Maastricht : Maastricht : Universiteit Maastricht ; University Library, Maastricht University [Host], 1997. http://arno.unimaas.nl/show.cgi?fid=6274.

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Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133529.

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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis<br>Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich
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Schellong, Sebastian M., and Benjamin A. Schmidt. "New Therapeutic Approaches in Pulmonary Embolism." Karger, 2003. https://tud.qucosa.de/id/qucosa%3A27512.

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Pulmonary embolism as a part of venous thromboembolic disease has a broad spectrum of clinical presentations from minimal disease to life-threatening right heart failure. Therapy has to be guided by the risk associated with the individual clinical state of the patient. As long as hemodynamics are entirely stable, anticoagulation is given in order to prevent early or late recurrence, thereby allowing for endogeneous thrombolysis and recovery. In hemodynamically instable patients, i.e. patients under cardiopulmonary resuscitation or in shock, there is the need for a rapid reduction of thrombus mass in order to restore right ventricular function. Systemic thrombolysis is the most feasible modality to reduce the thrombus burden of the pulmonary circulation in the short term. For hemodynamically stable patients with right ventricular dysfunction as assessed by echocardiography, there is still some controversy as to whether thrombolysis improves the long-term outcome. At the least, thrombolysis may positively modify the short-term course of acute disease in patients with an extremely low risk of bleeding. When the acute phase has been overcome, secondary prophylaxis with vitamin K antagonists has to be given. The duration of secondary prophylaxis requires an individual assessment of both the risk of recurrence and the risk of bleeding. In the near future, new anticoagulant drugs such as direct thrombin and factor Xa inhibitors will offer new treatment modalities for the acute phase as well as for secondary prophylaxis.<br>Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Commeree, Ashlee N. "Prediction of pulmonary embolism in children." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12077.

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Thesis (M.A.)--Boston University<br>Background: Pulmonary embolism (PE) is a rare condition associated with high morbidity and mortality in children. The diagnosis of PE in children is challenging, considering the often non-specific clinical signs and symptoms associated with this condition. Computed tomography with pulmonary angiography (CTPA) is currently the diagnostic gold standard, but carries the risk of radiation-induced malignancy. For these reasons, the optimal diagnostic management strategy for the care of children with suspected PE in the emergency department (ED) setting is undefined. Objectives: We sought to describe associated clinical signs and symptoms and developed a clinical decision rule for the evaluation of children with suspected PE in the ED setting. In addition, we evaluated the Modified Wells Criteria and PERC (Pulmonary Embolism Rule-out Criteria) Rule by applying these established adult clinical decision rules against our population of children diagnosed with PE. Methods: We conducted a retrospective cohort study of children less than 21 years of age undergoing diagnostic imaging for evaluation of PE from 2000 to 2012. We included children who received either a CTPA or ventilation-perfusion (V/Q) scanning for the evaluation of suspected PE. PE was defined by evidence of an occlusion in a pulmonary blood vessel or intermediate to high probability of PE reported in the diagnostic study results of the CTPA or V/Q scan, respectively. We additionally required the use of anticoagulant therapy to establish the diagnosis of PE. Results: Among 152 patients who presented to an ED setting, the prevalence of PE was 16.4%. The most frequent presenting symptoms in children with PE were chest pain (76%) and shortness of breath (44%), while the most common risk factors were presence of a CVC (16%), prolonged immobility (20%), and recent surgery (24%). The current use of oral contraceptive pill (P value = 0.010), abnormal lung exam (P value = 0.021), and oxygen saturation level (P value = 0.003) were all significant findings that were more likely to be present in patients with PE. Conclusion: Our results describe a high risk population of children evaluated for PE presenting to an ED setting. We identified several historical, clinical, and physical exam findings that are independently associated with diagnosis of PE, such as current use of OCPs, abnormal lung exam, and oxygen saturation level. Next steps will be to use our descriptive analysis to develop a clinical decision rule for the evaluation and diagnosis of PE in children in an ED setting.
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Fortuna, Geisa Maria Xaud Peixoto. "Participação da metaloproteinase 9 da matriz extracelular nas alterações hemodinamicas apos embolia pulmonar aguda." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310015.

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Orientador: Jose Eduardo Tanus dos Santos<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas<br>Made available in DSpace on 2018-08-10T14:15:06Z (GMT). No. of bitstreams: 1 Fortuna_GeisaMariaXaudPeixoto_M.pdf: 4179855 bytes, checksum: c2a44e33b1985187232d501fdd1ac3b0 (MD5) Previous issue date: 2007<br>Resumo: Metaloproteinases modulam a contratilidade vascular e podem afetar a hipertensão pulmonar que ocorre na embolia pulmonar induzida (EPA). Nós examinamos os efeitos da administração de doxiciclina ( um inibidor das metaloproteinases) em cães anestesiados e submetidos à EPA. Métodos: 5 cães no grupo sham receberam somente salina. EPA foi induzida por injeção intravenosa de microesferas em quantidade suficiente para aumentar a pressão média arterial pulmonar (PMAP) em 20 mmHg e cães do grupo embolia receberam salina (grupo embolia, N=8) ou doxiciclina (10 mg/Kg, i.v.) 5 ou 30 minutos após EPA (grupos embolia + doxi 5 e embolia + doxi 30, N=9 e 8, respectivamente). Avaliação hemodinâmica foi feita no momento basal e de 5 a 120 minutos após EPA. Zimografia da MMP-2 e da MMP-9 foi feita nas amostras de plasma. Resultado: nenhuma mudança hemodinâmica foi observada no grupo sham. Embolização aumentou a PMAP em 218+/-16% e índice de resistência vascular pulmonar (IRVP) em 289+/-42% no grupo embolia (ambos p<0,05). Doxicilina aumentou o índice cardíaco (IC) em 24+/-5% e reduziu o IRVP em 23+/-4% 120 minutos após EPA no grupo embolia+doxi 30. Em acréscimo, doxi reduziu PMAP e IRVP 30 minutos após EPA com efeito máximo após 120 (25+/-4% de redução na PMAP e 33+/-6% de redução no IRVP, ambos <0,05) no grupo embolia+doxi 5. Os níveis plasmáticos de pró-MMP-9 e MMP-9 elevaram-se somente no grupo embolia e MMP-2 permaneceu inalterada. Conclusão: nosso estudo mostra que doxiciclina atenua a hipertensão pulmonar na EPA induzida e indica que, MMP-9 tem um papel na hipertensão pulmonar da EPA induzida. MMP-9 pode ser um alvo farmacológico na EPA<br>Abstract: Matrix metalloproteinases (MMPs) modulate vascular contractility and may affect acute pulmonary embolism (APE)-induced pulmonary hypertension. We examined the effects of the administration of doxycycline (a MMP inhibitor) following APE in anesthetized dogs. Methods: Sham operated dogs (N=5) received only saline. APE was induced by intravenous injections of microspheres in amounts to increase mean pulmonary artery pressure (MPAP) by 20 mmHg, and embolized dogs received saline (Emb group, N=8), or doxycycline (10 mg/kg, i.v.) 5 or 30 min of APE (Emb + Doxy 5 and Emb + Doxy 30 groups, N=9 and 8, respectively). Hemodynamic evaluation was performed at baseline and 5-120 after APE. Gelatin zymography of MMP-2 and MMP-9 from plasma samples was performed. Results: No significant hemodynamic changes were found in Sham animals. Embolization increased MPAP by 218±16% and the pulmonary vascular resistance index (PVRI) by 289±42% in Emb group (both P<0.05). Doxycyline increased the cardiac index by 24±5% and reduced PVRI by 23±4% 120 min of APE in Doxy 30 + Emb group. In addition, doxycyline reduced MPAP and PVRI 30 min after APE with maximum effects seen 120 min after APE (25 ± 4% decrease in MPAP and 33 ± 6% decrease in PVRI; both P<0.05) in Doxy + 5 group. Plasma pro-MMP-9 and MMP-9 levels increased only in Emb group and MMP-2 remained unaltered. Conclusions: Our study shows that doxycycline attenuates APE-induced pulmonary hypertension, and indicates that MMP-9 has a role in APE-induced pulmonary hypertension. MMP-9 may be a pharmacological target in APE<br>Mestrado<br>Mestre em Farmacologia
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Sanson, Bernd-Jan. "Risks of thrombophilia and diagnostics of pulmonary embolism." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2000. http://dare.uva.nl/document/83894.

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Wong, Christopher Chi-Yuen. "Identifying Novel Predictors of Mortality in Patients Hospitalized with Acute Pulmonary Embolism." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18933.

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Background Acute pulmonary embolism (PE) carries a high burden of mortality and morbidity. PE remains the third leading cause of cardiovascular mortality and carries a substantial economic burden which is driven by the costs of hospitalization. Low-risk PE is safely managed as an outpatient, thus accurate assessment of prognosis is an important part of the management of patients presenting to hospital with PE. Current guidelines recommend the use of clinical risk scores such as the Pulmonary Embolism Severity Index (PESI) or its simplified version (sPESI).There remains scope for refining these risk scores by identifying and incorporating novel predictors of mortality in patients presenting with acute PE. Aims and Methods The aim of this thesis was to identify novel prognostic predictors of mortality by utilizing data from a large contemporary database of patients presenting to a tertiary-referral centre with a primary confirmed diagnosis of PE between 2000 and 2012. Three specific predictors of outcome in patients with acute PE were examined as part of this thesis: 1) the presence of chest pain at presentation with acute PE; 2) the presence of an underlying coagulopathy, indicated by an elevated international normalized ratio (INR), in non-anticoagulated patients presenting with acute PE; and, 3) the administration of a red blood cell (RBC) transfusion during hospital stay in patients admitted to hospital with acute PE. Results In the first part of the thesis examining the prognostic impact of chest pain, 1306 patients were included in the analysis. There were 771 (59%) patients with chest pain at presentation; these patients were younger and had fewer comorbidities compared to patients without chest pain. Multivariable models showed chest pain to be a significant independent predictor of decreased mortality. The addition of chest pain to an established multivariable prognostic model incorporating sPESI led to a significant improvement in net reclassification and reduced the risk of mortality. In the second part of the thesis examining the effect of an elevated admission INR in patients not on anticoagulation, 1039 patients were included in the analysis. There were 94 patients (9%) with an elevated admission INR in the absence of anticoagulant use, and these patients were found to have significantly higher mortality. An elevated admission INR was found to be an independent predictor of mortality; the addition of this variable to a multivariable prognostic model led to significant improvements in both net reclassification and the model’s C statistic. In the third part of the thesis examining the effect of RBC transfusion during the index hospital admission on outcome, 1376 patients were included in the analysis. After adjusting for anaemia and other variables, RBC transfusion independently increased the risk of mortality by three-fold at one month and two-fold at six months. Conclusions Accurate prognostic models can help reduce the frequency of hospitalization in patients with low-risk PE and can better predict outcome consequences of treatment options. We have identified chest pain and elevated baseline INR as two novel and accessible variables that may improve risk stratification on presentation with acute PE. The use of RBC transfusion predicts, and could itself be a cause of increased mortality after acute PE.
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Ebrahimdoost, Yousef. "Computer aided detection of pulmonary embolism (PE) in CTA images." Thesis, Kingston University, 2012. http://eprints.kingston.ac.uk/24027/.

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Pulmonary embolism (PE) is an obstruction within the pulmonary arterial tree and in the majority of cases arises from a thrombosis that has travelled to the lungs via the venous system. Pulmonary embolism (PE) is a fatal condition which affects all age groups and is the third most common cause of death in the US. Computed tomographic angiography (CTA) imaging has recently emerged as an accurate method in the diagnosis of pulmonary embolism. Each CTA scan contains hundreds of CT images, so the accuracy and efficiency of interpreting such a large image data set is complicated due to various PE look-alikes and human factors such as attention span and eye fatigue. Moreover, manual reading and interpreting a large number of slices is time consuming and it is difficult to find all the pulmonary embolisms (PE) in a data set. Consequently, it is highly desirable to have a computer aided detection (CAD) system to assist radiologists in detecting and characterizing emboli in an accurate, efficient and reproducible manner. A computer aided detection (CAD) system for detection of pulmonary embolism is proposed in CTA images. Our approach is performed in three stages: firstly the pulmonary artery tree is extracted in the region of the lung and heart in order to reduce the search area (PE occurs inside the pulmonary artery) and aims to reduce the false detection rate. The pulmonary artery is separated from the surrounding organs by analyzing the second derivative of the Hessian matrix and then a hybrid method based on region growing and a new customized level set is used to extract the pulmonary artery (PA). In the level set implementation algorithm, a new stopping criterion is applied, a consideration often neglected in many level set implementations. In the second stage, pulmonary embolism candidates are detected inside the segmented pulmonary artery, by an analysis of three dimensional features inside the segmented artery. PE detection in the pulmonary artery is implemented using five detectors. Each detector responds to different properties of PE. In the third stage, filtering is used to exclude false positive detections associated with the partial volume effect on the artery boundary, flow void, lymphoid tissue, noise and motion artifacts. Soft tissue between the bronchial wall and the pulmonary artery is a common cause of false positive detection in CAD systems. A new feature, based on location is used to reduce false positives caused by soft tissue. The method was tested on 55 data scans (20 training data scans and 35 additional data scans for evaluation containing a total of 195 emboli). The system provided a segmentation of the PA up to the 6th division, which includes the sub-segmental level. Resulting performance gave 94% detection sensitivity with an average 4.1 false positive detections per scan. We demonstrated that the proposed CAD system can improve the performance of a radiologist, detecting 19 (11 %) extra PE which were not annotated by the radiologist.
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Bilal, Jawad, Irbaz B. Riaz, Jennifer L. Hill, and Tirdad T. Zangeneh. "Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!" LIPPINCOTT WILLIAMS & WILKINS, 2016. http://hdl.handle.net/10150/620829.

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Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.
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Books on the topic "Pulmonary embolism"

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Herzog, Eyal, ed. Pulmonary Embolism. Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-87090-4.

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Nakano, Takeshi, and Samuel Z. Goldhaber, eds. Pulmonary Embolism. Springer Japan, 1999. http://dx.doi.org/10.1007/978-4-431-66893-0.

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Rivera-Lebron, Belinda, and Gustavo A. Heresi, eds. Pulmonary Embolism. Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-51736-6.

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Stein, Paul D., ed. Pulmonary Embolism. Blackwell Publishing, 2007. http://dx.doi.org/10.1002/9780470692042.

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Stein, Paul D. Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.

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1925-, Morpurgo M., ed. Pulmonary embolism. M. Dekker, 1994.

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Stein, Paul D. Pulmonary embolism. 3rd ed. John Wiley & Sons Inc., 2016.

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Diehl, Jean-Luc. Embolie pulmonaire. Elsevier, 2005.

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Geibel, A., H. Just, W. Kasper, and S. Konstantinides, eds. Acute Pulmonary Embolism. Steinkopff, 2000. http://dx.doi.org/10.1007/978-3-642-51190-5.

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Gan, Huili. Pulmonary embolism and pulmonary thromboendarterectomy. Nova Science, 2010.

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Book chapters on the topic "Pulmonary embolism"

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Kallianos, Kimberly. "Pulmonary Vascular Disease." In IDKD Springer Series. Springer Nature Switzerland, 2025. https://doi.org/10.1007/978-3-031-83872-9_7.

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Abstract Familiarity with the CT features of pulmonary vascular disease, including pulmonary embolism and pulmonary hypertension, is essential to ensure diagnostic accuracy. Acute and chronic pulmonary emboli have characteristic imaging findings; however, the diagnosis of pulmonary embolism can be challenging due to the high prevalence of image artifacts. Foreign materials may also embolize within the pulmonary arterial system. While relatively uncommon, pulmonary hypertension is disorder where accurate interpretation of CT imaging features is of critical importance. The World Health Organization (WHO) has defined a classification scheme with five groups of pulmonary hypertension patients. Characteristic lung parenchymal findings, in addition to pulmonary arterial abnormalities, are useful in distinguishing the etiology of pulmonary hypertension and in determining the most appropriate management.
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"Paradoxical embolism." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch24.

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"Pulmonary embolectomy." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch121.

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Robinson, Terry, and Jane Scullion. "Pulmonary embolism." In Oxford Handbook of Respiratory Nursing. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198831815.003.0019.

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A pulmonary embolism (PE) is a clinically significant obstruction occurring in part of or the entire pulmonary vascular tree. The most common cause is a thrombus from a distant site such as the leg. Most pulmonary emboli originate from detached portions of venous thrombi that have formed in the deep veins of the lower limbs. Other sites where they form include the right side of the heart and the pelvis. Non-thrombotic emboli, mainly fat, air, and amniotic fluid, may also occur but these are rarer. This chapter provides an overview of incidence and aetiology, and tabulates the risk factors for PE. The clinical features and assessment are covered, and six different investigations are explained. Management—anticoagulants, thrombolysis, and high-flow oxygen—are also included, along with nurse involvement at different points of PE.
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Konstantinides, Stavros, Marcin Kurzyna, and Adam Torbicki. "Pulmonary embolism." In The ESC Textbook of Intensive and Acute Cardiovascular Care, edited by Marco Tubaro, Pascal Vranckx, Eric Bonnefoy-Cudraz, Susanna Price, and Christiaan Vrints. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198849346.003.0064.

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Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results of other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
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"Introduction." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch0.

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"Pulmonary embolism and deep venous thrombosis at autopsy." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch1.

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"Venous thromboembolic disease in the four seasons." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch10.

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"Diagnosis of pulmonary embolism in the coronary care unit." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch100.

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"Silent pulmonary embolism with deep venous thrombosis." In Pulmonary Embolism. John Wiley & Sons, Ltd, 2016. http://dx.doi.org/10.1002/9781119039112.ch101.

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Conference papers on the topic "Pulmonary embolism"

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Bouassida, Imen, Amina Abdelkbir, Hazem Zribi, et al. "Hydatid pulmonary embolism." In ERS International Congress 2020 abstracts. European Respiratory Society, 2020. http://dx.doi.org/10.1183/13993003.congress-2020.3458.

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Yasir, M., and M. Ehtesham. "Pulmonary Cement Embolism." In American Thoracic Society 2024 International Conference, May 17-22, 2024 - San Diego, CA. American Thoracic Society, 2024. http://dx.doi.org/10.1164/ajrccm-conference.2024.209.1_meetingabstracts.a2243.

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Huisman, M. V., H. R. Buller, J. W. ten Cate, E. A. van Royen, and J. Vreeken. "SILENT PULMONARY EMBOLISM IN PATIENTS WITH DEEP VEIN THROMBOSIS." In XIth International Congress on Thrombosis and Haemostasis. Schattauer GmbH, 1987. http://dx.doi.org/10.1055/s-0038-1642890.

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In patients presenting with clinically suspected deep vein thrombosis symptomatic pulmonary embolism is rarely apparent. To assess the prevalence of asymptomatic pulmonary embolism in outpatients with proven deep vein thrombosis, perfusion ventilation lungscans were performed in 101 consecutive patients at the first day of treatment and after one week of therapy. Fifty-one percent of these patients had a high probability lung-scan at the start of treatment. In control patients (n=44) without deep venous thrombosis but referred through the same filter, the prevalence of high-proba-bility scans was only 5%. After one week of anticoagulant treatment complete to partial improvement was observed in 55% of the patients while in another 24% of the patients the scan remained normal.It is concluded that lungscan detected asymptomatic pulmonary embolism occurs frequently in patients presenting with symptomatic deep venous thrombosis and that the majority of these emboli resolve within one week of anticoagulant treatment.
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Osler, B., D. Yee, R. Cangemi, and J. M. Aliotta. "Amniotic Fluid Embolism Complicated by Pulmonary Embolism." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a7020.

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Hernandez Borge, Jacinto, Pilar Cordero Montero, María Teresa Gómez Vizcaino, et al. "Cancer after pulmonary embolism." In ERS International Congress 2017 abstracts. European Respiratory Society, 2017. http://dx.doi.org/10.1183/1393003.congress-2017.pa2351.

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Alashram, R., C. Dass, M. Kumaran, et al. "Acute Pulmonary Embolism Causes Pulmonary Artery Enlargement." In American Thoracic Society 2020 International Conference, May 15-20, 2020 - Philadelphia, PA. American Thoracic Society, 2020. http://dx.doi.org/10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2015.

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Uppal, Amit, David Steiger, Dina Abi-Fadel, et al. "Pulmonary Embolism Severity Index In Patients With Acute Pulmonary Embolism After Orthopedic Surgery." In American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans. American Thoracic Society, 2010. http://dx.doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a1928.

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Wig, R., F. P. Rischard, H. Gudi, K. Yaddanapudi, and M. Insel. "The Association of Acute Pulmonary Embolism Severity With Subsequent Post-Pulmonary Embolism Dyspnea." In American Thoracic Society 2024 International Conference, May 17-22, 2024 - San Diego, CA. American Thoracic Society, 2024. http://dx.doi.org/10.1164/ajrccm-conference.2024.209.1_meetingabstracts.a2167.

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Mani, RK, P. Pandey, D. Nama, et al. "Pulmonary Embolism in Indian Patients." In American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California. American Thoracic Society, 2009. http://dx.doi.org/10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a3287.

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Londono, A., J. Bell, and E. Bondarsky. "Metastatic Chondrosarcoma Mimicking Pulmonary Embolism." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a2309.

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Reports on the topic "Pulmonary embolism"

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Xu, Xiujuan, Jianbiao Meng, Rongchen Dai, and Conghua Ji. Risk factors for pulmonary embolism in ICU patients: a systematic review and meta analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2021. http://dx.doi.org/10.37766/inplasy2021.5.0105.

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Glover, Tia, Leslie Asplund, and Tracy McClinton. Pulmonary Embolism Response Team in Acute Care Settings: A scoping Review of the Evidence. University of Tennessee Health Science Center, 2025. https://doi.org/10.21007/con.dnp.2025.0126.

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Yu, Miao, Chuan-Hua Yang, and Deng-Chao Wang. Systematic Review and Meta-Analysis of Magnetic Resonance Imaging in the Diagnosis of Pulmonary Embolism. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2024. http://dx.doi.org/10.37766/inplasy2024.7.0060.

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Lin, Jia-Ling, I.-Yen Chen, and Po-Kai Yang. Comparison of the clinical efficacy and safety of standard and ultrasound-assisted thrombolysis for pulmonary embolism. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.4.0082.

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Jimenez, David, Behnood Bikdeli, Victor Tapson, et al. Systematic review of prognostic scores and individual predictor variables for short-term mortality after acute pulmonary embolism. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2025. https://doi.org/10.37766/inplasy2025.6.0031.

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Ye, Liao. Prognostic Value of Red blood cell distribution width in Patients with Acute Pulmonary Embolism: A protocol for systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2021. http://dx.doi.org/10.37766/inplasy2021.3.0036.

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hou, xianbing, dandan chen, tongfei cheng, et al. Bleeding risk of anticoagulant therapy in patients with advanced cancer in palliative care settings：a protocol for systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, 2022. http://dx.doi.org/10.37766/inplasy2022.4.0064.

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Review question / Objective: The systematic review aim to provide synthesised and appraised evidence to assess the bleeding risk of anticoagulant therapy in patients with advanced cancer in palliative care settings. Condition being studied: Cancer is a recognized risk factor for venous thromboembolism (VTE). The main forms of thromboembolic disease include pulmonary embolism (PE) and deep vein thrombosis (DVT). Given their diagnosis and often poor physical status, patients with advanced cancer are at particularly high risk of developing VTE, resulting in reduced activity levels or even immobility. The exact incidence and prevalence of VTE in the population of cancer patients receiving hospice or palliative care has not been well investigated and few reports are available. Clinical studies have not yet determined whether such patients benefit from anticoagulant therapy and whether there is an increased risk of bleeding and death.
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Saldanha, Ian J., Wangnan Cao, Justin M. Broyles, et al. Breast Reconstruction After Mastectomy: A Systematic Review and Meta-Analysis. Agency for Healthcare Research and Quality (AHRQ), 2021. http://dx.doi.org/10.23970/ahrqepccer245.

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Objectives. This systematic review evaluates breast reconstruction options for women after mastectomy for breast cancer (or breast cancer prophylaxis). We addressed six Key Questions (KQs): (1) implant-based reconstruction (IBR) versus autologous reconstruction (AR), (2) timing of IBR and AR in relation to chemotherapy and radiation therapy, (3) comparisons of implant materials, (4) comparisons of anatomic planes for IBR, (5) use versus nonuse of human acellular dermal matrices (ADMs) during IBR, and (6) comparisons of AR flap types. Data sources and review methods. We searched Medline®, Embase®, Cochrane CENTRAL, CINAHL®, and ClinicalTrials.gov from inception to March 23, 2021, to identify comparative and single group studies. We extracted study data into the Systematic Review Data Repository Plus (SRDR+). We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. The protocol was registered in PROSPERO (registration number CRD42020193183). Results. We found 8 randomized controlled trials, 83 nonrandomized comparative studies, and 69 single group studies. Risk of bias was moderate to high for most studies. KQ1: Compared with IBR, AR is probably associated with clinically better patient satisfaction with breasts and sexual well-being but comparable general quality of life and psychosocial well-being (moderate SoE, all outcomes). AR probably poses a greater risk of deep vein thrombosis or pulmonary embolism (moderate SoE), but IBR probably poses a greater risk of reconstructive failure in the long term (1.5 to 4 years) (moderate SoE) and may pose a greater risk of breast seroma (low SoE). KQ 2: Conducting IBR either before or after radiation therapy may result in comparable physical well-being, psychosocial well-being, sexual well-being, and patient satisfaction with breasts (all low SoE), and probably results in comparable risks of implant failure/loss or need for explant surgery (moderate SoE). We found no evidence addressing timing of IBR or AR in relation to chemotherapy or timing of AR in relation to radiation therapy. KQ 3: Silicone and saline implants may result in clinically comparable patient satisfaction with breasts (low SoE). There is insufficient evidence regarding double lumen implants. KQ 4: Whether the implant is placed in the prepectoral or total submuscular plane may not be associated with risk of infections that are not explicitly implant related (low SoE). There is insufficient evidence addressing the comparisons between prepectoral and partial submuscular and between partial and total submuscular planes. KQ 5: The evidence is inconsistent regarding whether human ADM use during IBR impacts physical well-being, psychosocial well-being, or satisfaction with breasts. However, ADM use probably increases the risk of implant failure/loss or need for explant surgery (moderate SoE) and may increase the risk of infections not explicitly implant related (low SoE). Whether or not ADM is used probably is associated with comparable risks of seroma and unplanned repeat surgeries for revision (moderate SoE for both), and possibly necrosis (low SoE). KQ 6: AR with either transverse rectus abdominis (TRAM) or deep inferior epigastric perforator (DIEP) flaps may result in comparable patient satisfaction with breasts (low SoE), but TRAM flaps probably increase the risk of harms to the area of flap harvest (moderate SoE). AR with either DIEP or latissimus dorsi flaps may result in comparable patient satisfaction with breasts (low SoE), but there is insufficient evidence regarding thromboembolic events and no evidence regarding other surgical complications. Conclusion. Evidence regarding surgical breast reconstruction options is largely insufficient or of only low or moderate SoE. New high-quality research is needed, especially for timing of IBR and AR in relation to chemotherapy and radiation therapy, for comparisons of implant materials, and for comparisons of anatomic planes of implant placement.
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99mTc SPECT-CT, Consensus QIBA Profile. Chair Yuni Dewaraja and Robert Miyaoka. Radiological Society of North America (RSNA)/Quantitative Imaging Biomarkers Alliance (QIBA), 2019. https://doi.org/10.1148/qiba/20191021.

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The quantification of 99mTc labeled biomarkers can add unique value in many different settings, ranging from clinical trials of investigation new drugs to the treatment of individual patients with marketed therapeutics. For example, goals of precision medicine include using companion radiopharmaceutical diagnostics as just-in-time, predictive biomarkers for selecting patients to receive targeted treatments, customizing doses of internally administered radiotherapeutics, and assessing responses to treatment. This Profile describes quantitative outcome measures that represent proxies of target concentration or target mass in topographically specific volumes of interest (VOIs). These outcome measures are usually expressed as the percent injected dose (i.e., radioactivity) per mL of tissue (%ID/mL), a standard uptake value ratio (SUVr), or a target-to-background ratio (TBR). In this profile, targeting is not limited to any single mechanism of action. Targeting can be based on interaction with a cell surface protein, an intracellular complex after diffusion, protein-mediated transport, endocytosis, or mechanical trapping in a capillary bed, as in the case of transarterial administration of embolic microspheres. Regardless, the profile focuses on quantification in well-defined volumes of interest. Technetium-99m based dopamine transporter imaging agents, such as TRODAT, are nearly direct links with some aspects of the predecessor profile on 123I-ioflupane for neurodegenerative disorders. (See www.qibawiki.rsna.org ) Cancer is often a base case of convenience for new material in this profile, but the intent is to create methods that can be useful in other therapeutic areas where the diseases are characterized by spatially-limited anatomical volumes, such as lung segments, or multifocal aggregations of targets, such as white blood cell surface receptors on pulmonary nodules in patients with sarcoidosis. Neoplastic masses that can be measured with x-ray computed tomography (CT) or magnetic resonance imaging (MRI) are the starting point. However, the intent is to create a profile that can be extrapolated to diseases in other therapeutic areas that are also associated with focal, or multi-focal pathology, such as pulmonary granulomatous diseases of autoimmune or infectious etiology, non-oncological diseases of organs such as polycystic kidney disease, and the like. The criteria for measurability are based on the current resolution of most SPECT-CT systems in clinical practice, and are independent of criteria for measurability in other contexts. For this SPECT profile, conformance requires that a “small” VOI must be greater than 30 mL to be measurable. It is understood that much smaller VOIs can sometimes exhibit high conspicuity on SPECT, but these use cases are beyond the scope of this profile and will not be tested for conformance in this version. It is left to individual stakeholders to show the extent to which they can achieve conformance when measuring VOIs less than 30 mL. The detection of smaller changes during clinical trials of large groups can be achieved by referring to the QIBA companion guidance on powering trials. The Claims (Section 2) asserts that compliance with the specifications described in this Profile will produce cross sectional estimates of the concentration of radioactivity [kBq/mL] in a volume of interest (VOI) or a target-to-background ratio (TBR) within a defined confidence interval (CI), and distinguish true biological change from system variance (i.e., measurement error) in individual patients or clinical trials of many patients who will be studied longitudinally with 99mTc SPECT agents. Both claims are founded on observations that target density varies between patients with the same disease as well as within patients with multi-focal disease. The Activities (Section 3) describes the requirements that are placed on the Actors who need to achieve the Claim. Section 3 specifies what the actors must do in order to estimate the amount of radioactivity in a volume of interest, expressed in kBq/mL (ideal) or as a TBR (acceptable) within a 95% CI surrounding the true value. Measurands such as %ID/mL are targets for nonclinical studies in animal models that use terminal sacrifice to establish ground truth for imaging studies. TBRs can be precarious, as the assumptions that depend on the physiology of the background regions matching the volume of interest can be hard to accept sometimes. It is up to each individual stakeholder to qualify the background regions used in their own use case. This profile qualifies only a few in some very limited contexts as examples. The Assessment Procedures (Section 4) for evaluating specific requirements are defined as needed. The requirements are focused on achieving sufficient accuracy and avoiding unnecessary variability of the measurements. The clinical performance target is to achieve a 95% confidence interval for concentration in units of kBq/mL (kilobequerels per milliliter) or %ID/mL (percent injected dose per milliliter) or TBR with both a reproducibility and a repeatability of +/- 8% within a single individual under zero-biological-change conditions. This document is intended to help clinicians basing decisions on these biomarkers, imaging staffs generating measurements of these biomarkers, vendors who are developing related products, purchasers of such products, and investigators designing trials. Note that this document only states requirements to achieve the claims, not “requirements on standard of care” nor compliance with any particular protocol for treating participants in clinical trial settings. Conformance to this Profile is secondary to properly caring for patients or adhering to the requirements of a protocol. QIBA Profiles addressing other imaging biomarkers using CT, MRI, PET and Ultrasound can be found at www.qibawiki.rsna.org.
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Rapid blood test helps exclude pulmonary embolism for low risk patients. National Institute for Health Research, 2016. http://dx.doi.org/10.3310/signal-000320.

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