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LTP occurred at the location of the thinnest margin in nine studies (9/29, 31%). Time for registration and analysis was heterogeneously reported, ranging between 5-30 min. Mean target registration error was reported in seven studies (7/29, 24.1%) at 1.62 mm (range 1.20-2.23 mm). Inter-operator reproducibility was high (kappa range 0.686-1). Lysipressin chemical structure Ascites, liver deformation and inconspicuous tumor were major factors of co-registration error.
Available studies present a low level of evidence overall, since most of them are feasibility, retrospective and single-center studies.
Available studies present a low level of evidence overall, since most of them are feasibility, retrospective and single-center studies.Iodinated contrast media (ICM) is an integral part of interventional cardiology procedures however, a proportion of patients have contrast allergy. We report the first TAVR performed with a gadolinium-based contrast agent, gadobutrol (GBCA) in a patient with severe recurrent ICM allergic reactions despite prophylactic treatment.Vascular closure devices (VCDs) are widely used as an alternative to manual compression of femoral puncture sites. In this report, we present a 73-year-old man who developed symptomatic venous stenosis related to VCD after pulmonary vein isolation. We performed percutaneous treatment with balloon angioplasty. This case suggests that balloon angioplasty with proper safety measures can be an option for treating venous stenosis related to VCDs.
The role of endothelial progenitor cells (EPCs) in atherosclerosis progression and neointimal growth after percutaneous coronary intervention (PCI) remains controversial. The purpose of this study was to perform a systematic review and meta-analysis of studies on EPCs in patients who had PCI.
We searched Pubmed, Embase and Cochrane databases and reviewed cited references up to August 31, 2021. Overall, we selected 9 studies, including 4612 patients.
Lower baseline EPC count was associated with a significantly greater occurrence of in-stent restenosis (HR 1.33; 95% CI 0.97-1.82, P = 0.045). As for EPC coating, there was no significant difference in the 1-year occurrence of cardiac death between EPCs-capturing drug-eluting stents (DES) and standard DES (Relative Risk [RR] 1.146; 95% CI 0.666-1.974, P = 0.98), but target lesion revascularization (RR 1.727; 95% CI 1.199-2.487, P = 0.025), and target vessel failure (RR 1.591; 95% CI 1.213-2.088, P = 0.04) were significantly more common with EPCs-capturing DES than with standard DES.
Circulating EPC count might improve risk stratification after PCI, as it is correlated with the occurrence of in-stent restenosis. Currently available EPCs-capturing DES use was associated with an increased risk of 1-year adverse events, mainly driven by an increase in target lesion revascularization and target vessel failure, not cardiac death.
Circulating EPC count might improve risk stratification after PCI, as it is correlated with the occurrence of in-stent restenosis. Currently available EPCs-capturing DES use was associated with an increased risk of 1-year adverse events, mainly driven by an increase in target lesion revascularization and target vessel failure, not cardiac death.
In this study, the authors investigated the ablation success of scar homogenization with combined (epicardial+ endocardial) vs endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up.
Best ablation approach to achieve long-term success rate in VT patients with ICM is not known yet.
Consecutive ICM patients undergoing VT ablation at our center were classified into group 1 endocardial+ epicardial scar homogenization and group 2 endocardial scar homogenization. Patients with previousopen heart surgery were excluded. Epicardial ablation was performed despite being noninducible after endocardial ablation in all group 1 patients. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue >1.5mV and severe scar<0.5mV. Noninducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up every 4months for 5 years with implantable device interrogations.
A rdial substrate was detected in all group 1 patients despite being noninducible after endocardial ablation. Moreover, combined endo-epicardial scar homogenization was associated with a significantly higher success rate at 5 years of follow-up and a substantially lower need for antiarrhythmic drugs after the procedure compared with the endocardial ablation alone.
In Erectile dysfunction (ED) patients, phosphodiesterase type 5 (PDE5) inhibitors are considered as the first-line therapy. However, 30-50% of ED patients fail to follow this therapeutic option because of adverse events, lack of efficacy, or drug costs. Antioxidant supplementation is widely applied in clinical practice and viewed as a potential therapeutic option for ED. Therefore, it is attractive to assess the effect of antioxidants supplementation on ED patients.
To evaluate the effects of antioxidants supplementation on ED.
Published randomized controlled trials of antioxidants in ED were searched in the PubMed, Embase, and Cochrane Library databases from inception to October 3, 2021. Meta-analyses were carried out using a random-effects model. The results were presented as standard mean differences (SMDs) with their 95% confidence intervals (CIs).
Eighteen studies with 1,331 ED patients were included in the study. Compared with placebo, antioxidants alone treatment showed a statistical increase iXXXXX-XXX.
This study found that the effect of antioxidant alone treatment on ED may be limited. However, antioxidant compound treatment, as well as combination of PDE5 inhibitors and antioxidants, were associated with improved ED, and can be considered as an accessary therapeutic option for ED. Su L, Yang Z, Qu H, et al. Effect of Antioxidants Supplementation on Erectile Dysfunction A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sex Med Rev 2021;XXXXX-XXX.
The Cancer and Aging Reflections for Elders Expressive Writing Intervention (CARE-Express) was developed to enhance coping and minimize psychological distress in older adults with cancer. The aim of the current study is to evaluate the feasibility and initial efficacy of CARE-Express.
Seventy-one distressed older adults (≥70) with cancer were assigned to CARE-Express (n = 41) or the Enhanced Social Work Control (ESWC) arm (n = 30). Participants completed five telephone sessions over seven weeks and were assessed on psychosocial variables at baseline, post-intervention, and four months post study enrollment. Feasibility was assessed by examining rates of eligibility, acceptance, retention, assessment, and fidelity. Initial efficacy was evaluated using standardized effect sizes.
Adequate rates of acceptance (29%), eligibility (66%), retention (90%), assessment (70% at post-intervention, 63% at four month follow-up), and fidelity (97%) were observed. At post-intervention, participants receiving CARE-Express reported less depression compared to ESWC (d = 0.69, p = 0.01) and lower demoralization (d = 0.50, p = 0.06). A small/moderate effect was demonstrated for increased total spirituality scores (d = 0.41, p = 0.07), meaning/peace (d = 0.32, p = 0.20) and faith (d = 0.35, p = 0.07). The CARE-Express group reported greater reductions in behavioral disengagement (d = 0.44, p = 0.06), while ESWC demonstrated a small effect for active coping (d = 0.21, p = 0.31). At four months, differential effects of CARE-Express had attenuated, though small/moderate, effects in favor of CARE-Express remained.
Results support the feasibility of CARE-Express and its potential positive impact on psychological well-being.
Registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT00984321 on September 25, 2009.
Registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT00984321 on September 25, 2009.
Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFR
) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFR
is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFR
in patients with de novo three-vessel disease and/or left main CAD.
This is a post-hoc sub-analysis of the international, multicenter, and randomized SYNTAX III REVOLUTION trial, in which both invasive coronary angiography and coronary computed tomography angiography were prospectively obtained prior to the heart team discussion. QFR was performed in an independent core laboratory and compared with FFR
analyzed by HeartFlow™. The correlation and agreement between QFR and FFR
were assessed per vessel. Furthermore, independent factors of diagnostic discordance between QFR and FFR
were evaluated.
Out of 223 patients, 40 patients were excluded from this analysis due to the unavailability of FFR
and/or QFR, and a total of 469 vessels (183 patients) were analyzed. There was a strong correlation between QFR and FFR
(R=0.759; p<0.001), and the Bland-Altman analysis demonstrated a mean difference of -0.005 and a standard deviation of 0.116. An independent predictor of diagnostic concordance between QFR and FFR
was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174-0.894; P=0.026).
In patients with complex CAD, QFR and FFR
were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFR
.
In patients with complex CAD, QFR and FFRCT were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFRCT.Academic detailing is a medical education outreach service that typically features in-person individualized discussion of therapeutic decisions. The onset of the coronavirus disease 2019 (COVID-19) pandemic compelled many existing academic detailing services to switch to providing their services virtually. This format switch brought opportunities and challenges to detailing programs across North America. Technology enabled programs to continue, but adaptations were necessary, including communication style changes enabling automated booking and optimizing support materials for a virtual environment. Specifically, communication decisions, including when to screen share and strategies to encourage 2-way communication must be addressed to maintain the advantage of a discussion format. As pandemic limitations resolve and academic detailing services move forward, it is important to consider advantages and challenges of virtual academic detailing and how pandemic work will inform future approaches to academic detailing that may blend in-person and virtual outreach.
Best Case/Worst Case (BC/WC) is a communication tool designed to promote shared decision-making for high-risk procedures near the end of life. This study aimed to increase scalability of a BC/WC training program and measure its impact on surgeon confidence in and perceived importance of the methodology.
A prospective cohort pre-post study; December 2018 to January 2019.
Multi-center tertiary care teaching hospital.
Forty-eight resident surgeons from general surgery and otolaryngology.
Learners were 24 to 37 years old with 52% in post graduate year 1 to 2. Although learners encountered high-stakes communication (HSC) frequently (3.6 [0.7] on 5-point Likert scale), most reported no HSC training in medical school (74.5%) or residency (87.5%). BC/WC training was accomplished with an instructor to learner ratio of 1-to-5.3. After training, learner confidence improved on all measured communication skills on a 5-point scale (e.g., exploring patient's values increased from 3.6 [0.8] to 4.1 [0.6], p = <0.
