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Comparison of wired and wireless electromagnetic hand motion tracking in central venous access: Are they equivalent enough to cut the cord?
No full textPURPOSE: This study aims to compare a commercially available wired and wireless tracker in motion analysis of interventional radiologists performing simulated ultrasound-guided central venous access.
METHODS AND MATERIAL: Interventional radiologists were asked to volunteer for the study. Participants were asked to place central venous lines on a commercially available, standardized manikin as their needle hand and ultrasound probe motion were recorded using electromagnetic trackers. Each participant performed a total of 10 trials, with 5 trials recorded using a wired tracker and 5 using a wireless tracker. Institution-developed software was used to calculate established motion metrics (path length and number of movements). The motion metrics from the two trackers were compared.
RESULTS: Seven interventional radiologists participated in the study. Path length (wireless vs. wired: 773.1 cm ± 85.7 cm vs. 959.5 cm ± 303.6 cm, p \u3c 0.001) and number of movements (193 ± 52 vs. 231 ± 50.5, p = 0.001) differed significantly between the two trackers; however, the time to complete the procedure (51.8 s ± 14.8 s vs. 49.8 s ± 10.5 s, p = 0.68) was similar across trackers.
CONCLUSION: The motion metrics of the same operators differ significantly between wired and wireless trackers. Accounting for the sampling frame rate and the frame efficiency of the wireless sensors can provide comparable motion data
Early Acne Improvements With Fixed-Combination Topical Therapy: Analysis of the First 4 Weeks of Treatment
No full textBACKGROUND: Acne treatment can take weeks to deliver noticeable improvements, which may diminish patients\u27 perception of treatment effectiveness and undermine treatment adherence. Combination topical treatments that target multiple acne pathophysiological pathways are more efficacious than topical monotherapies, and simplifying combination treatment by delivering multiple active ingredients as fixed combinations may improve adherence.
METHODS: This review provides an overview of efficacy with 4 weeks of treatment in pivotal trials of fixed-combination topical treatments for acne. Outcomes assessed were reductions from baseline in inflammatory (IL) and noninflammatory lesions (NIL) and treatment success (≥2-grade reduction in global acne severity score and clear/almost clear skin).
RESULTS: Data were compiled for 7 acne topicals, comprising fixed combinations of adapalene (ADAP), benzoyl peroxide (BPO), clindamycin phosphate (CLIN), and tretinoin (TRET). At week 4, lesion reductions from baseline ranged from 32 to 54% (IL) and 25 to 45% (NIL), while rates of treatment success ranged from 3 to 12%. Overall, efficacy was greatest with triple-combination CLIN 1.2%/ADAP 0.15%/BPO 3.1% gel (IL: 54-55%; NIL: 43-45%; treatment success: 8-12%), followed by combinations of ADAP/BPO (IL: ~42-48%; NIL: ~38%; treatment success: 4-~7%).
CONCLUSIONS: In clinical trials of topical fixed-combination formulations, triple-combination CLIN 1.2%/ADAP 0.15%/BPO 3.1% gel yielded greater lesion reductions and rates of treatment success after 4 weeks of treatment than dyad combinations. Even greater differences may be expected with real-world world use, as early improvements may bolster treatment adherence and long-term outcomes
Predicting stroke in patients with infective endocarditis: A systematic review and meta-analysis of risk factors
No full textBACKGROUND: Neurological complications in patients with infective endocarditis (IE), such as ischemic and hemorrhagic stroke, are well described; however, predicting which patients are most likely to experience stroke remains uncertain.
AIMS: We conducted a systematic review and meta-analysis to identify the factors associated with the risk of stroke in patients hospitalized with IE.
METHODS: A systematic search of Ovid MEDLINE, EMBASE, and Web of Science up to 27 June 2024 was conducted. Articles evaluating risk of acute ischemic stroke (AIS) or intracranial hemorrhage (ICH) in patients with IE were included. Meta-analysis of odds ratios was feasible for only some predictive factors due to study heterogeneity. Cochrane\u27s Risk of Bias in Non-Randomized Studies of Exposure tool was used for risk-of-bias assessment.
SUMMARY OF REVIEW: Of 3538 studies identified, 35 were included: 9 prospective and 26 retrospective cohort.
CONCLUSION: Our study has identified factors which are associated with increased stroke risk in IE and may help physicians predict risk. While echocardiographic and neuroimaging findings may be particularly informative, underlying comorbidities and various laboratory values may also contribute to predicting IE-associated strokes
Facet joint distance measurement using digital tomosynthesis while standing
No full textThe zygapophyseal (facet) joint plays a critical role in load transmission and stability of the spine, and facet degeneration is a common consequence of aging and osteoarthritis. The ability to accurately measure facet space is important, as decreased facet space is associated with facet degeneration and lower back pain. Although grading systems exist for assessing facet joint space narrowing, static imaging fails to characterize changes in the facet gap under load that play a role in segmental stability. Current methods for estimating the dynamic behavior of the facet joint are either inaccurate, radiation costly, or clinically impractical. In the current study, we demonstrate the feasibility of a novel method for 3D measurement of facet joint space using digital tomosynthesis (DTS) imaging in supine and standing positions. Facet gap measurements were found to be strongly correlated with (r to 0.98) and accurate (\u3c 20 µm error for median facet gap) relative to microcomputed tomography reference values. In a pilot in vivo demonstration with seven participants, the effect of physiological loading was detectable, with median facet joint space being larger in standing as compared to supine images (p \u3c 0.0001). The presented approach may be useful in directly characterizing changes in the facet joint relevant to segmental stability that are not readily assessed via current clinical imaging methods
Precision surgery for hepatocellular carcinoma
No full textHepatocellular carcinoma arises in the setting of cirrhosis in most cases, requiring multidisciplinary input to define resectability. In this regard, more precise surgical management considers patient factors and anatomical states, including resection margins, tumour biology, and perioperative therapy. Together with advances in surgical techniques, this integrated approach has resulted in considerable improvements in patient morbidity and oncological outcomes. Despite this, recurrence rates in hepatocellular carcinoma remain high. As the systemic treatment landscape in hepatocellular carcinoma continues to evolve and locoregional options are increasingly used, we review current and future opportunities to individualise the surgical management of patients with hepatocellular carcinoma
Clinical and Imaging Predictors of False-Positive and False-Negative Results in Prostate Multiparametric MRI Using PI-RADS Version 2
No full textPurpose: To evaluate predictors of false-positive (FP) and false-negative (FN) results for prostate cancer at prostate multiparametric MRI (mpMRI) using the Prostate Imaging and Reporting Data System version 2 (PI-RADS v2).
Materials and Methods: This was a single-center retrospective cohort study of 2548 consecutive patients who underwent prostate mpMRI examinations (October 2016-July 2022) containing zero or one PI-RADS v2 category 3-5 lesions. Prostate mpMRI examinations were interpreted by 13 radiologists. FP results were defined as prospective PI-RADS v2 score of 3 or higher but benign or grade group 1 prostate cancer at subsequent combined targeted and systematic biopsy. FN results were defined as prospective PI-RADS v2 score 2 or lower but grade group 2 or higher prostate cancer at subsequent combined targeted and systematic biopsy. Predictors of FP and FN results were assessed by logistic regression.
Results: Among the 2548 patients (mean age, 65.7 years ± 7.6 [SD]; all male) analyzed, 52.0% (831 of 1597) had FP results and 15.8% (150 of 951) had FN results at mpMRI. FP results were more likely for younger patients (odds ratio [OR], 0.95/y; P \u3c .001), smaller lesions (OR, 0.62/mm; P \u3c .001), transition zone lesions (OR, 1.74 vs peripheral zone; P = .006), and patients with low prostate-specific antigen (PSA) density (OR, 0.55 per 0.1 ng/mL(2) increase; P \u3c .001). FN results were more likely for older patients (OR, 1.03/y; P = .01) and patients with high PSA density (OR, 2.05 per 0.1 ng/mL(2) increase; P \u3c .001).
Conclusion: PSA density and patient age independently predicted FP and FN results for detection of prostate cancer at mpMRI using PI-RADS v2. These factors are not part of the PI-RADS v2 algorithm and may inform mpMRI interpretation to improve prostate cancer diagnosis. Keywords: MR Imaging, Prostate, PI-RADS, Prostate MRI, Prostate Cancer (©)RSNA, 2025
Impromptu SVC Caval Implantation During Tricuspid Transcatheter Valve-in-Ring
No full textAn 84-year-old man with a history of tricuspid valve regurgitation after repair with an incomplete annuloplasty band presented with worsening tricuspid regurgitation. He underwent a transcatheter valve-in-ring procedure, which was complicated by proximal valve embolization. The procedure was salvaged by performing an ad hoc caval implantation, followed by an additional valve implantation within the tricuspid band, with an excellent result
The Beck Procedure Revisited: Percutaneous Approach to Myocardial Perfusion Through the Coronary Sinus
No full textBACKGROUND: Many patients live with angina following treatment when all available therapies have failed. Providing retrograde arterial myocardial perfusion using the coronary venous system was performed. The first previously reported percutaneous method might have limited application.
EARLY REPORT SUMMARY: We present a first-in-human successful, reproducible, and widely applicable percutaneous procedure using a noncovered coronary stent to connect the left circumflex (LCX) to the coronary sinus (CS) in a patient with previous placement of a CS Reducer.
DISCUSSION AND NOVELTY: Unlike the previous report, our procedure shows for the first time that placement of a noncovered stent between the proximal LCX and the CS did not result in bleeding while effectively relieving the angina. Using a noncovered stent to create a bypass to the CS makes the procedure applicable to more patients with lifestyle-limiting angina.
TAKE-HOME MESSAGE: Using the noncovered stent from the LCX to the CS to provide myocardial perfusion might be feasible and safe
Autologous cell harvesting device provides repigmentation and improves quality-of-life for patients with stable vitiligo lesions in a large and diverse patient population
No full textINTRODUCTION: The mental health burden associated with vitiligo can significantly impact patients\u27 quality-of-life. Although successful for repigmentation of stable vitiligo, adoption of surgical melanocyte transplantation remains limited due to time and skilled-expertise requirements. A cell harvesting device prepares autologous skin cell suspension (ASCS) at point of care, simplifying the process.
OBJECTIVE: To confirm early and favorable repigmentation response and evaluate health-related quality-of-life changes following ASCS treatment of stable vitiligo.
METHODS: In this large (N = 107), prospective, multicenter study, vitiligo lesions were laser-ablated and received ASCS treatment followed by at-home phototherapy.
RESULTS: All Fitzpatrick skin types and major vitiligo subtypes were represented. Excellent repigmentation response (≥80%) was observed by week 4. By week-24, all lesions demonstrated improvement; 67% achieved \u3e50% repigmentation, 42% achieved ≥80% repigmentation, and 8% achieved complete repigmentation. Vitiligo Noticeability Scale response was attained by 27.7% of lesions; 72.3% of patients reported treatment satisfaction. Significant improvement from baseline in Vitiligo Quality-of-Life Instrument (P \u3c .05) was observed at week-24.
LIMITATIONS: No control.
CONCLUSIONS: The cell harvesting device provides a simplified, more accessible technique for melanocyte transplantation. ASCS is highly effective for repigmentation of stable vitiligo lesions, with positive patient-reported outcomes and improvement in quality-of-life, as demonstrated in this large, diverse population
Autologous skin cell suspension plus phototherapy in stable vitiligo: findings from a US economic model
No full textINTRODUCTION: A cell harvesting device for preparing non-cultured autologous skin cell suspension (ASCS) at the point-of-care is FDA-approved for repigmentation of stable depigmented vitiligo lesions in patients 18 years and older. The pivotal RSVP trial showed ≥80% repigmentation at Week-24 in 36% of lesions treated with laser ablation, ASCS, and narrowband ultraviolet B phototherapy compared to 0% with phototherapy alone (p = 0.012). The objective of this analysis was to evaluate the potential economic impact of laser ablation plus ASCS with phototherapy versus phototherapy alone for repigmentation of stable vitiligo lesions from a US payer perspective.
METHODS: A 5-year decision-tree model was developed reflecting clinical pathways of adults with stable vitiligo lesions who had an inadequate response to prior topicals and phototherapy. Patients entering the model were treated with ASCS plus phototherapy or phototherapy alone and assessed for treatment response at Weeks-24 and 52 based on the RSVP trial\u27s effectiveness endpoints. Durable response for Year-2 onwards was proxied by melanocyte-keratinocyte transplantation data. Model outcomes included per-patient total and incremental healthcare costs, treatment costs and total costs, cost per-patient per-month (PPPM), and cost per-patient per-year (PPPY). One-way sensitivity analyses assessed model result robustness.
RESULTS: The cumulative total per-patient cost for ASCS plus phototherapy increased from 92,779 between Year-1 and Year-5. Phototherapy alone increased from 101,518 over the same period. Compared to phototherapy alone, ASCS plus phototherapy incurred 8,738 less by Year-5 (-1,748 PPPY). Breakeven occurred between Years 2-3. Results were most sensitive to changes in ASCS response at Weeks-24 and 52 and healthcare costs.
CONCLUSION: Among adults with stable vitiligo with prior inadequate response to topicals or phototherapy, ASCS treatment may lead to lower all-cause direct medical costs over 5 years compared to phototherapy alone