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Endoscopy Dec 2024
Topics: Humans; Esophageal Achalasia; Myotomy; Natural Orifice Endoscopic Surgery; Mediastinum; Male; Female; Esophagoscopy; Middle Aged
PubMed: 38759961
DOI: 10.1055/a-2308-2823 -
International Journal of Particle... Mar 2024To describe the commissioning of real-time gated proton therapy (RGPT) and the establishment of an appropriate clinical workflow for the treatment of patients.
PURPOSE
To describe the commissioning of real-time gated proton therapy (RGPT) and the establishment of an appropriate clinical workflow for the treatment of patients.
MATERIALS AND METHODS
Hitachi PROBEAT provides pencil beam scanning proton therapy with an advanced onboard imaging system including real-time fluoroscopy. RGPT utilizes a matching score to provide instantaneous system performance feedback and quality control for patient safety. The CIRS Dynamic System combined with a Thorax Phantom or plastic water was utilized to mimic target motion. The OCTAVIUS was utilized to measure end-to-end dosimetric accuracy for a moving target across a range of simulated situations. Using this dosimetric data, the gating threshold was carefully evaluated and selected based on the intended treatment sites and planning techniques. An image-guidance workflow was developed and applied to patient treatment.
RESULTS
Dosimetric data demonstrated that proton plan delivery uncertainty could be within 2 mm for a moving target. The dose delivery to a moving target could pass 3%/3 mm gamma analysis following the commissioning process and application of the clinical workflow detailed in this manuscript. A clinical workflow was established and successfully applied to patient treatment utilizing RGPT. Prostate cancer patients with implanted platinum fiducial markers were treated with RGPT. Their target motion and gating signal data were available for intrafraction motion analysis.
CONCLUSION
Real-time gated proton therapy with the Hitachi System has been fully investigated and commissioned for clinical application. RGPT can provide advanced and reliable real-time image guidance to enhance patient safety and inform important treatment planning parameters, such as planning target volume margins and uncertainty parameters for robust plan optimization. RGPT improved the treatment of patients with prostate cancer in situations where intrafraction motion is more than defined tolerance.
PubMed: 38757076
DOI: 10.1016/j.ijpt.2024.01.001 -
Allergologie Select 2024None.
None.
PubMed: 38756207
DOI: 10.5414/ALX02444E -
Thorax May 2024Social media may influence children and young people's health behaviour, including cigarette and e-cigarette use.
BACKGROUND
Social media may influence children and young people's health behaviour, including cigarette and e-cigarette use.
METHODS
We analysed data from participants aged 10-25 years in the UK Household Longitudinal Study 2015-2021. The amount of social media use reported on a normal weekday was related to current cigarette smoking and e-cigarette use. Generalised estimating equation (GEE) logistic regression models investigated associations of social media use with cigarette smoking and e-cigarette use. Models controlled for possible confounders including age, sex, country of UK, ethnicity, household income and use of cigarette/e-cigarettes by others within the home.
RESULTS
Among 10 808 participants with 27 962 observations, current cigarette smoking was reported by 8.6% of participants for at least one time point, and current e-cigarette use by 2.5% of participants. In adjusted GEE models, more frequent use of social media was associated with greater odds of current cigarette smoking. This was particularly apparent at higher levels of use (eg, adjusted odds ratio (AOR) 3.60, 95% CI 2.61 to 4.96 for ≥7 hours/day vs none). Associations were similar for e-cigarettes (AOR 2.73, 95% CI 1.40 to 5.29 for ≥7 hours/day social media use vs none). There was evidence of dose-response in associations between time spent on social media and both cigarette and e-cigarette use (both p<0.001). Analyses stratified by sex and household income found similar associations for cigarettes; however, for e-cigarettes associations were concentrated among males and those from higher household income groups.
CONCLUSIONS
Social media use is associated with increased risk of cigarette smoking and e-cigarette use. There is a need for greater research on this issue as well as potential policy responses.
PubMed: 38755014
DOI: 10.1136/thorax-2023-220569 -
BMC Cardiovascular Disorders May 2024Primary coronary slow flow (CSF) is defined as delayed opacification of the distal epicardial vasculature during coronary angiography in the absence of relevant coronary...
BACKGROUND
Primary coronary slow flow (CSF) is defined as delayed opacification of the distal epicardial vasculature during coronary angiography in the absence of relevant coronary artery stenoses. Microvascular disease is thought to be the underlying cause of this pathology. Epicardial fat tissue (EFT) is an active endocrine organ directly surrounding the coronary arteries that provides pro-inflammatory factors to the adjacent tissue by paracrine and vasocrine mechanisms. The aim of the present study was to investigate a potential association between EFT and primary CSF and whether EFT can predict the presence of primary CSF.
METHODS
Between 2016 and 2017, n = 88 patients with high-grade aortic stenosis who were planned for transcatheter aortic valve implantation (TAVI) were included in this retrospective study. EFT volume was measured by pre-TAVI computed tomography (CT) using dedicated software. The presence of primary CSF was defined based on the TIMI frame count from the pre-TAVI coronary angiograms.
RESULTS
Thirty-nine of 88 TAVI patients had CSF (44.3%). EFT volume was markedly higher in patients with CSF (142 ml [IQR 107-180] vs. 113 ml [IQR 89-147]; p = 0.009) and was strongly associated with the presence of CSF (OR 1.012 [95%CI 1.002-1.021]; p = 0.014). After adjustment, EFT volume was still an independent predictor of CSF (OR 1.016 [95%CI 1.004-1.026]; p = 0.009).
CONCLUSION
Primary CSF was independently associated with increased EFT volume. Further studies are needed to validate this finding and elucidate whether a causal relationship exists.
Topics: Humans; Aortic Valve Stenosis; Female; Male; Retrospective Studies; Pericardium; Transcatheter Aortic Valve Replacement; Aged; Coronary Angiography; Severity of Illness Index; Adipose Tissue; Aged, 80 and over; Predictive Value of Tests; Coronary Circulation; Risk Factors; Treatment Outcome; Aortic Valve; Computed Tomography Angiography; Coronary Vessels; Epicardial Adipose Tissue
PubMed: 38750455
DOI: 10.1186/s12872-024-03927-7 -
Jornal Brasileiro de Pneumologia :... May 2024
Topics: Humans; Mediastinum; Lymph Nodes; Brazil; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Male; Middle Aged; Cryosurgery
PubMed: 38747813
DOI: 10.36416/1806-3756/e20230315 -
International Journal of Nursing... Dec 2023Thoracic ultrasound is a valuable tool that helps diagnose cardiopulmonary disorders and guide management in intensive care unit patients. Intensive care unit nurses...
BACKGROUND
Thoracic ultrasound is a valuable tool that helps diagnose cardiopulmonary disorders and guide management in intensive care unit patients. Intensive care unit nurses were trained to perform thoracic ultrasound examinations, after which they were named 'UltraNurses' for clinical recognizability. UltraNurses demonstrated rapid learning trajectories, but the impact on clinical-decision making remained unknown. The aim of this study was to investigate the effects of UltraNurse ultrasound on clinical management.
METHODS
This was a prospective observational single center study within a mixed medical and surgical intensive care unit. All adult patients with an indication for UltraNurse thoracic ultrasound were included. The study consisted of three steps: pre- and post- data collection, with the ultrasound examination conducted in-between these two steps. The examination consisted of a standardized ultrasound protocol aimed at the lungs and cardiac output. Primary outcome was what percentage of ultrasounds led to a change of management. Secondary outcomes included: percentage of changes executed within first 8 hours, frequency of pathology found, percentage of diagnosis change, and frequency of UltraNurse ultrasounds per shift.
RESULTS
A total of 102 ultrasound examinations were performed in 65 patients (89% mechanically-ventilated). Ultrasound examinations suggested changes of management in 26% of cases, of which 96% were executed within 8 hours. Most changes were within the nursing scope (56%), specifically: 44% of examinations changed fluid management. UltraNurse ultrasound detected pathology in 97% of cases. In 7% of cases, the diagnosis was changed, sometimes leading to life-saving interventions. UltraNurses performed one thoracic ultrasound examination per four shifts.
CONCLUSION
In adult intensive care unit patients, UltraNurse thoracic ultrasound led to a change of management in more than a quarter of the cases, of which almost all were executed within the first 8 hours.
STUDY REGISTRATION
Netherlands Trial Registration NL9047, VUmc 2020.011 (prospectively registered on: 13-11-2020).
PubMed: 38746565
DOI: 10.1016/j.ijnsa.2023.100135 -
Cardiovascular Ultrasound May 2024Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the coronary microcirculation, which may be diagnosed using invasive...
BACKGROUND
Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the coronary microcirculation, which may be diagnosed using invasive coronary physiology. CMD is responsible for impaired diastolic cardiac function. It has recently been suggested that left atrial strain (LASr) represents a highly sensitive tool for detecting cardiac diastolic function abnormalities. Accordingly, the aim of this study was to investigate the relationship between CMD and LASr.
METHODS
Consecutively enrolled patients with non-obstructed coronary arteries (NOCA) underwent CMD and LASr evaluation by invasive thermodilution and noninvasive echocardiography, respectively.
RESULTS
Forty-two (42) patients were included, out of which 26 presented with CMD. There were no significant differences between CMD-positive and negative patients in terms of clinical and echocardiographic characteristics. LASr was significantly reduced in patients with CMD (24.6% ± 6.1 vs. 30.3 ± 7.8%, p = 0.01). A moderate correlation was observed between coronary flow reserve and LAsr (r = 0.47, p = 0.002). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LASr (OR = 0.88, 95%CI 0.78-0.99.135, p = 0.04). A LASr cut-off of 25.5% enabled an optimal classification of patients with or without CMD.
CONCLUSION
Patients with NOCA and CMD had a significantly reduced LASr compared with patients without CMD, suggesting the early impairment of diastolic function in these patients.
Topics: Humans; Male; Female; Microcirculation; Middle Aged; Coronary Circulation; Heart Atria; Echocardiography; Coronary Vessels; Coronary Artery Disease; Aged; Atrial Function, Left; Thermodilution; Diastole
PubMed: 38745211
DOI: 10.1186/s12947-024-00324-0 -
International Journal of Chronic... 2024There is an assumption that because EBLVR requires less use of hospital resources, offsetting the higher cost of endobronchial valves, it should therefore be the... (Comparative Study)
Comparative Study
Bronchoscopic Lung Volume Reduction as the Treatment of Choice versus Robotic-Assisted Lung Volume Reduction Surgery in Similar Patients with Emphysema - An Initial Experience of the Benefits and Complications.
OBJECTIVE
There is an assumption that because EBLVR requires less use of hospital resources, offsetting the higher cost of endobronchial valves, it should therefore be the treatment of choice wherever possible. We have tested this hypothesis in a retrospective analysis of the two in similar groups of patients.
METHODS
In a 4-year experience, we performed 177 consecutive LVR procedures: 83 patients underwent Robot Assisted Thoracoscopic (RATS) LVRS and 94 EBLVR. EBLVR was intentionally precluded by evidence of incomplete fissure integrity or intra-operative assessment of collateral ventilation. Unilateral RATS LVRS was performed in these cases together with those with unsuitable targets for EBLVR.
RESULTS
EBLVR was uncomplicated in 37 (39%) cases; complicated by post-procedure spontaneous pneumothorax (SP) in 28(30%) and required revision in 29 (31%). In the LVRS group, 7 (8%) patients were readmitted with treatment-related complications, but no revisional procedure was needed. When compared with uncomplicated EBLVR, LVRS had a significantly longer operating time: 85 (14-82) vs 40 (15-151) minutes (p<0.001) and hospital stay: 7.5 (2-80) vs 2 (1-14) days (p<0.01). However, LVRS had a similar total operating time to both EBLVR requiring revision: 78 (38-292) minutes and hospital stay to EBLVR complicated by pneumothorax of 11.5 (6.5-24.25) days. Use of critical care was significantly longer in RATS group, and it was also significantly longer in EBV with SP group than in uncomplicated EBV group.
CONCLUSION
Endobronchial LVR does use less hospital resources than RATS LVRS in comparable groups if the recovery is uncomplicated. However, this advantage is lost if one includes the resources needed for the treatment of complications and revisional procedures. Any decision to favour EBLVR over LVRS should not be based on the assumption of a smoother, faster perioperative course.
Topics: Humans; Retrospective Studies; Pneumonectomy; Male; Middle Aged; Bronchoscopy; Pulmonary Emphysema; Aged; Female; Treatment Outcome; Robotic Surgical Procedures; Time Factors; Lung; Length of Stay; Postoperative Complications; Operative Time; Risk Factors; Pneumothorax; Clinical Decision-Making; Patient Readmission
PubMed: 38741941
DOI: 10.2147/COPD.S442380 -
International Journal of Infectious... May 2024Monitoring tools that could provide quick predictions of tuberculosis (TB) treatment outcomes are urgently needed. Here, we assessed whether the evolution of selected...
OBJECTIVES
Monitoring tools that could provide quick predictions of tuberculosis (TB) treatment outcomes are urgently needed. Here, we assessed whether the evolution of selected biomarkers of innate immunity may help monitoring TB treatment response within 2 weeks of treatment initiation.
METHODS
ANRS12394-LILAC-TB was a proof-of concept prospective study: HIV-negative and HIV-infected adults with a rifampicin-susceptible TB, documented by a positive Xpert MTB/RIF test, were enrolled in Cambodia and Côte d'Ivoire. Plasma concentrations of IL-1Ra, IP-10 and sCD163 were measured by commercial ELISA kits. A Wilcoxon test for paired data was used for longitudinal comparisons.
RESULTS
55 patients were enrolled (women: 31%, median age: 37 years; median CD4 count in the 10/13 HIV-infected participants: 53 cells/mm). Overall, 83% were considered in TB treatment success. Compared to baseline, IL-1Ra plasma levels significantly decreased as soon as Week (W)1, independently of HIV status (-71% in HIV-positive vs. -33% in HIV-negative; p<0.001). IP-10 plasma levels significantly decreased at W1 and W2 compared to baseline (p<0.0001), but that decrease was less marked in HIV-infected participants.
CONCLUSION
Our findings suggest that measuring IL-1Ra plasma levels with a standard ELISA technique at baseline then one week after TB treatment onset could help clinicians to quickly assess TB treatment response.
PubMed: 38740279
DOI: 10.1016/j.ijid.2024.107096