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Clinical Case Reports Jul 2024Cesarean scar pregnancy cases who undergo hysteroscopic suction aspiration could be at higher risk of air emboli due to dilated, low-resistant, high-velocity blood...
Cesarean scar pregnancy cases who undergo hysteroscopic suction aspiration could be at higher risk of air emboli due to dilated, low-resistant, high-velocity blood vessels.
PubMed: 38947538
DOI: 10.1002/ccr3.9060 -
World Journal of Gastroenterology Jun 2024Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases. In some countries, its use is restricted to...
Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases. In some countries, its use is restricted to radiologists, limiting access for other clinicians, such as gastroenterologists. Endoscopic ultrasound, as a novel technique, plays a crucial role in diagnosis and treatment of digestive diseases. However, its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists, leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.
PubMed: 38947285
DOI: 10.3748/wjg.v30.i22.2920 -
World Journal of Gastrointestinal... Jun 2024Glucagon-like peptide receptor agonists (GLP-1RA) are used to treat type 2 diabetes mellitus and, more recently, have garnered attention for their effectiveness in...
Glucagon-like peptide receptor agonists (GLP-1RA) are used to treat type 2 diabetes mellitus and, more recently, have garnered attention for their effectiveness in promoting weight loss. They have been associated with several gastrointestinal adverse effects, including nausea and vomiting. These side effects are presumed to be due to increased residual gastric contents. Given the potential risk of aspiration and based on limited data, the American Society of Anesthesiologists updated the guidelines concerning the preoperative management of patients on GLP-1RA in 2023. They included the duration of mandated cessation of GLP-1RA before sedation and usage of "full stomach" precautions if these medications were not appropriately held before the procedure. This has led to additional challenges, such as extended waiting time, higher costs, and increased risk for patients. In this editorial, we review the current societal guidelines, clinical practice, and future directions regarding the usage of GLP-1RA in patients undergoing an endoscopic procedure.
PubMed: 38946857
DOI: 10.4253/wjge.v16.i6.292 -
The Pan African Medical Journal 2024
PubMed: 38946748
DOI: 10.11604/pamj.2024.48.7.43032 -
Otolaryngology--head and Neck Surgery :... Jul 2024Open partial horizontal laryngectomies (OPHLs) represent a comparable alternative to total laryngectomy and nonsurgical protocols in selected cases. While short-term...
OBJECTIVE
Open partial horizontal laryngectomies (OPHLs) represent a comparable alternative to total laryngectomy and nonsurgical protocols in selected cases. While short-term functional outcomes of OPHLs have been widely investigated, few have focused on the effect of aging on residual laryngeal structures.
STUDY DESIGN
Retrospective cohort study.
SETTING
Tertiary care academic center.
METHODS
Patients who underwent OPHLs after at least 1 year follow-up and optimal functional rehabilitation were included in the study. Swallowing function was assessed according to PAS (Penetration aspiration scale) and Pooling scores. Spectrogram analysis of voice was conducted according to Yanagihara classification and acoustic parameters were also recorded. Subjective questionnaire data about phonation and swallowing were also recorded. Data obtained were compared among patients according to age at time of surgery, evaluation and duration of follow-up.
RESULTS
Ninety-seven patients were enrolled with a mean age at surgery and evaluation of 63 and 70 years old, respectively. Median follow-up length was 5 years. OPHL type II was mostly performed. No significant correlation was observed between most of the analyzed variables and patient's age at the time of surgery and at the time of evaluation. Some acoustic parameters were negatively correlated with follow-up length, while Jitter, NHR (Noise-Harmonic Ratio), and Global grade and Roughness were significantly higher in patients >65 years old.
CONCLUSION
Patients who complete rehabilitation reach equally good results as their younger peers with stability over time. Finally, the effects of aging on residual larynx are of minor entity compared to the nonoperated patients.
LEVEL OF EVIDENCE
Level IV-retrospective cohort study.
PubMed: 38946680
DOI: 10.1002/ohn.863 -
Journal of Materials Chemistry. B Jul 2024Water-soluble graphene quantum dots (GQDs) have recently exhibited considerable potential for diverse biomedical applications owing to their exceptional optical and... (Review)
Review
Water-soluble graphene quantum dots (GQDs) have recently exhibited considerable potential for diverse biomedical applications owing to their exceptional optical and chemical properties. However, the pronounced heterogeneity in the composition, size, and morphology of GQDs poses challenges for a comprehensive understanding of the intricate correlation between their structural attributes and functional properties. This variability also introduces complexities in scaling the production processes and addressing safety considerations. Light and sound have firmly established their role in clinical applications as pivotal energy sources for minimally invasive therapeutic interventions. Given the limited penetration depth of light, photodynamic therapy (PDT) predominantly targets superficial conditions such as dermatological disorders, head and neck malignancies, ocular ailments, and early-stage esophageal cancer. Conversely, ultrasound-based sonodynamic therapy (SDT) capitalizes on its superior ability to propagate and focus ultrasound within biological tissues, enabling a diverse range of therapeutic applications, including the management of gliomas, breast cancer, hematological tumors, and modulation of the blood-brain barrier (BBB). Considering the advancements in theranostic and precision therapies, reevaluating these conventional energy sources and their associated sensitizers is imperative. This review introduces three prevalent treatment modalities that harness light and sound stimuli: PDT, SDT, and a synergistic approach that integrates PDT and SDT. This study delineated the therapeutic dynamics and contemporary designs of sensitizers tailored to these modalities. By exploring the historical context of the field and elucidating the latest design strategies, this review underscores the pivotal role of GQDs in propelling the evolution of PDT and SDT. This aspires to stimulate researchers to develop "multimodal" therapies integrating both light and sound stimuli.
PubMed: 38946657
DOI: 10.1039/d4tb00767k -
Neurointervention Jul 2024The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical...
PURPOSE
The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical features and initial results of a novel reperfusion catheter (REDTM 62) used for frontline aspiration thrombectomy of M2 occlusions in acute ischemic stroke patients. Appropriate aspiration catheters are crucial for a successful ADAPT maneuver; however, the selection of catheters suitable for smaller-sized vessels is scarce compared to the ones for large vessel occlusions.
MATERIALS AND METHODS
All patients treated with ADAPT using REDTM 62 as the frontline treatment approach for acute M2 occlusions between December 2022 and February 2024 were retrospectively enrolled. Demographic data, procedural timings and safety, recanalization rates, and outcome data were recorded.
RESULTS
Twenty patients with a median admission National Institutes of Health Stroke Scale (NIHSS) score of 8 were identified. Successful revascularization (DMVO-thrombolysis in cerebral infarction [TICI]≥2b) with REDTM 62 aspiration thrombectomy was obtained in 65.0% (13/20) of cases. The first pass effect was 45.0% (9/20). In 2 cases, the REDTM 62 did not reach the clot due to marked distal vessel tortuosity. Stent retrievers were additionally used in 9 cases and led to an overall DMVO-TICI 2c/3 of 90.0% (18/20). Mean procedural time was 48 minutes. No complications directly related to ADAPT occurred. In-hospital mortality rate was 20.0% (4/20). The median discharge NIHSS score was 2.5. A good functional outcome at discharge (modified Rankin scale 0-2) was achieved in 55.0% (11/20) of cases.
CONCLUSION
Our initial experiences with the novel REDTM 62 reperfusion catheter for treatment of M2 occlusions is in line with published data. ADAPT using this catheter may be considered as a safe and effective first-line treatment option. Further studies are warranted to validate the initial results.
PubMed: 38946131
DOI: 10.5469/neuroint.2024.00171 -
Cytopathology : Official Journal of the... Jun 2024The American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) is a widely used method for the management of adult thyroid nodules. However, its...
OBJECTIVE
The American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) is a widely used method for the management of adult thyroid nodules. However, its use in paediatric patients is controversial because adult fine needle aspiration biopsy (FNAB) recommendations may lead to delayed diagnoses of cancer in children. The objectives of this study were to evaluate the performance of TI-RADS in paediatric thyroid nodules and to tailor FNAB recommendations for children.
METHODS
Consecutive surgically resected paediatric thyroid nodules from two tertiary care centres between 2003 and 2021 were reviewed. Ultrasounds were blindly scored by radiologists according to TI-RADS. Management recommendations based on TI-RADS were evaluated. Various modelling methodologies were used to determine the optimal cutoff for FNAB in children.
RESULTS
Of the 96 patients, 79 (82%) were female and the median age at surgery was 16.1 years. Fifty (52%) nodules were malignant on surgical pathology. The area under the receiver operating characteristic curve of TI-RADS for predicting malignancy was 0.78. Adult TI-RADS recommendations would have resulted in 4% of cancerous nodules being lost to follow-up. Modifications to TI-RADS (FNAB of all TR3 nodules ≥1.5 cm, FNAB of TR4 and TR5 nodules ≥0.5 cm, surveillance of nodules ≥1 cm, consider surgery for nodules >4 cm) reduced this missed malignancy rate to 0%.
CONCLUSIONS
TI-RADS can risk-stratify paediatric thyroid nodules. However, the system requires modifications to reduce the missed malignancy rate in paediatric thyroid nodules. Our data suggest that lower size thresholds for FNAB are warranted in children.
PubMed: 38946029
DOI: 10.1111/cyt.13414 -
Laboratory Investigation; a Journal of... Jun 2024The glycosaminoglycan hyaluronan (HA) plays an important role in tumor progression. However, its biological and clinical significance in papillary thyroid cancer (PTC)...
The glycosaminoglycan hyaluronan (HA) plays an important role in tumor progression. However, its biological and clinical significance in papillary thyroid cancer (PTC) remains unknown. Immunohistochemistry was performed to examine HA expression in tissues from PTC patients. Two PTC cell lines were treated with HA synthesized inhibitor against HA production to assess its function. Serum HA levels from 107 PTC patients, 30 Hashimoto thyroiditis, and 45 normal controls (NC) were measured by chemiluminescence immunoassay. HA levels in FNA washouts obtained from thyroid nodules and lymph nodes (LNs) were measured by chemiluminescence immunoassay. Area under the curve (AUC) were computed to evaluate HA`s clinical value. HA was highly expressed in PTC. Reducing HA production significantly inhibited PTC cell proliferation and invasion. Importantly, serum HA levels in PTC were significantly higher than in NCs and Hashimoto thyroiditis and allowed distinguishing of thyroid cancers from NCs with high accuracy (AUC=0.782). Moreover, elevated serum HA levels in PTC correlate with LN metastasis. HA levels in fine needle aspiration (FNA) washouts from PTC patients were significantly higher than in benign controls, with a high AUC value (0.8644) for distinguishing PTC from benign controls. Furthermore, HA levels in FNA washouts from metastatic LN were significantly higher than in non-metastatic LN, with a high AUC value (0.8007) for distinguishing metastatic LNs from non-metastatic LNs. HA in serum and FNA washout exhibited a potential significance for PTC diagnosis and indicator for LN metastasis in patients with PTC.
PubMed: 38945481
DOI: 10.1016/j.labinv.2024.102104 -
Journal of Vascular and Interventional... Jun 2024Retransplantation has been the primary treatment for Hepatic artery thrombosis (HAT) in Orthotopic Liver Transplant (OLT) patients; however, due to scarcity of grafts,...
Retransplantation has been the primary treatment for Hepatic artery thrombosis (HAT) in Orthotopic Liver Transplant (OLT) patients; however, due to scarcity of grafts, endovascular revascularization via mechanical thrombectomy offers an alternative to re-transplantation should it provide similar long term benefits. A series of 8 patients with hepatic artery thrombectomies across 10 procedures (1 Early HAT and 9 Late HAT) utilizing stent-retriever and/or suction catheter was collected. All had technically successful restoration of flow with stent placement of the anastomotic stenosis in 8 cases. Two patients required re-intervention for HAT at 18 and 701 days post-primary intervention, with the first expiring from liver failure but with a patent hepatic artery on explant. One case had a procedural related adverse event, hepatic artery dissection, SIR AE classification of 2. Technical success was achieved in all procedures, demonstrating promise in effectively treating HAT in OLT patients.
PubMed: 38945294
DOI: 10.1016/j.jvir.2024.06.024