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Patient-reported outcomes during pelvic radiation therapy: A secondary analysis on sexual function from NRG-RTOG 1203
No full textPurpose:NRG-RTOG 1203 reported that intensity-modulated radiation therapy (IMRT) reduced patient-reported GI toxicities in patients with cervical/endometrial cancer receiving postoperative RT, compared with 3-dimensional conformal radiation therapy (3DRT). We conducted a secondary analysis of patient-reported sexual function (PR-SF) among treatment groups to identify factors associated with sexual dysfunction.
Methods and materials:Patients on NRG-RTOG 1203 were randomly assigned to 3DRT versus IMRT and completed Patient-Reported Outcomes (PRO)-Common Terminology Criteria for Adverse Events (CTCAE) and FACT-Cx surveys at baseline, week 5 of RT, and at 4-6 weeks, 1 year, and 3 years after RT. Patient responses to FACT-Cx sexual function questions were analyzed. The between-arm frequency and severity of responses and their comparison with PRO-CTCAE GI toxicity were tested using chi-square tests. A repeated-measures logistic regression model was used to determine the impact of clinical and treatment factors on PR-SF.
Results:Two hundred thirty-six patients completed PR-SF questions; 125 (53%) received 3DRT and 111 (47%) IMRT. There were no significant differences in PR-SF between groups ( P \u3e .05). After RT, responses to I am afraid to have sex and I am interested in sex significantly improved over time ( P = .007 and P = .03, respectively). At 1 year after RT, women with interference from abdominal pain were more bothered by odor from the vagina versus women with no interference of abdominal pain (5% v 0%, P = .006). Additionally, at 1 year after RT, women with no severity of abdominal pain or no interference from abdominal pain liked their body appearance more versus women with at least some abdominal pain or some interference from abdominal pain (34% v 13%, P = .003 and 32% v 6%, P = .001, respectively).
Conclusion:PR-SF was similar between treatment groups. After RT, fear of sex declined and interest in sex improved over time. Women with GI toxicity after RT completion are at risk for worse sexual function
Stress-induced changes in immune signatures in ME/CFS patients determined by transcriptome analysis
No full textMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, complex multi-organ illness characterized by unexplained debilitating fatigue and post-exertional malaise (PEM). We evaluated transcriptomic changes in peripheral blood mononuclear cells (PBMC) of ME/CFS patients undergoing an exercise challenge and explored the transcriptomic response to exercise and recovery in PBMC of ME/CFS patients, as compared to healthy controls using RNA sequencing technology. As transcriptomic changes in ME/CFS patients are still in the phase of discovery, analysis of data has to be stringent, and the most important results have to be validated by a different technology, such as real-time PCR or NanoString
Blue in the face: Unraveling a hypoxic mystery
No full textInitial History/Presentation: A 5-year-old recently immigrated male with history of asthma and prior admissions for hypoxia presented to the emergency department for left ear pain. He was noted to have central cyanosis and hypoxia which was attributed to asthma exacerbation and treated with albuterol, steroids, and supplemental oxygen. He was also treated with antibiotics for left acute otitis media. The patient was admitted due to hypoxia requiring supplemental oxygen.
Physical Exam: The patient appeared well-developed and in no acute distress. He was mildly tachycardic but other vital signs were normal. His left tympanic membrane showed erythema and serous fluid. He had normal respiratory effort and clear auscultation of lungs, saturating 88-89% on room air and 90-91% on 1.5 liters of nasal cannula. His skin was noted to be blue-grey colored diffusely.
Diagnostic Evaluation: His respiratory viral panel returned positive for human metapneumovirus and enterovirus/rhinovirus. His complete blood count, complete metabolic panel, and procalcitonin were all within normal limits. His hemoglobin electrophoresis was normal. A G6PD level was mildly high at 17 .2 U/g Hb. The patient’s methemoglobin levels were elevated on blood gas and serum testing at 13.6% and 9.8% respectively. His cytochrome B5 reductase level was low at 3.2%.
Diagnosis/Treatment: The patient’s hypoxia and cyanosis were initially attributed to asthma exacerbation, but further evaluation was pursued due to persistent symptoms in the absence of respiratory distress. Furthermore, increases in nasal cannula flow rate did not improve the patient’s cyanosis or hypoxia . Additional laboratory workup revealed an elevated methemoglobin level, which combined with cytochrome B5 reductase deficiency confirmed the diagnosis of congenital methemoglobinemia. Upon identifying the cause of his persistent hypoxia, his oxygen saturation goals were modified to avoid unnecessary interventions based on inaccurate readings, and he was weaned to room air.
Discussion/Conclusion: Methemoglobinemia, especially congenital forms due to enzyme deficiencies, can present subtly with hypoxia and cyanosis, often misattributed to other respiratory conditions like asthma. Clues to diagnosis may be refractory hypoxemia or a cyanosis-saturation gap. This case emphasizes the importance of recognizing limitations in standard oxygen saturation monitoring when methemoglobin is elevated. Adjusting the oxygen saturation target range in these patients is critical to avoid overtreatment . Early recognition and genetic testing are essential for confirming congenital methemoglobinemia and guiding long-term care
Case report: Extensive deep vein thrombosis and venous pseudoaneurysm following percutaneous transcatheter tricuspid valve intervention
No full textIntroduction:Transcatheter tricuspid valve intervention (TTVI) has evolved as a less-invasive alternative to surgical treatment of severe tricuspid regurgitation. Although venously delivered valves have been introduced, the risk of venous access site complications is unknown. We present a patient who suffered phlegmasia cerulea dolens post-TTVI.
Case summary:We present an 88-year-old female patient who developed phlegmasia cerulea dolens of the right lower extremity shortly after successful TTVI delivered through the right common femoral vein via a 35F sheath. Ipsilateral transpopliteal venography demonstrated an occlusive thrombus in the right common femoral vein and the incidental finding of an external iliac vein pseudoaneurysm. Endovascular treatment consisting of mechanical thrombectomy followed by adjunctive placement of self-expanding metallic stents resulted in restoration of iliofemoral venous outflow and excellent recovery with resolution of the patient\u27s symptoms.
Conclusions:Surveillance, e.g., duplex ultrasonography, immediately post-TTVI is important to rule out acute thrombosis of the venous access site and other complications associated with a large sheath
Advancing tissue engineering through a portable perfusion and incubation system
No full textPerfusion offers unique benefits to tissue-engineered systems, enhancing oxygen and nutrient transport, which improves tissue formation and growth. In this study, we present a novel and integrated portable perfusion system. Weighing \u3c 10 lbs, the system can maintain continuous flow in a standard incubation environment (37 °C, 5% CO2), effectively functioning as a portable perfusion and tissue culturing system. To characterize the perfusion system\u27s flow parameters, we measured the volumetric flow rate across a range of pressures and found that the system could achieve flow velocities between 1.69 to 4.6 μm/s, which is similar to in vivo interstitial flow. Computational fluid dynamics revealed fully developed laminar flow within the sample-containing region of the perfusion system, helping ensure even fluid and nutrient distribution. To study the system\u27s compatibility with live tissues, bioengineered tissue patches were created and perfused. After 24 h of perfusion, no significant difference in cell viability was observed between the perfused samples and static controls, indicating no adverse effects on cell health. Perfusion also facilitated enhanced spatial organization within tissue patches, reducing the inter-spheroids distance. Furthermore, perfusion strengthened the tissue matrix and reduced the degradation rate of the hydrogel scaffold. Complemented by its ability to provide mobile perfusion and incubation, this novel integrated portable perfusion system holds promise for promoting tissue maturation and advancing tissue bioengineering studies
Abstract P2036: Deciphering the burden: Lead exposure as a major contributor to hypertensive heart disease globally: A global analysis from 1990-2021
No full textUnveiling sub-populations in critical care settings: A real-world data approach in COVID-19
No full textBackground:Disease presentation and progression can vary greatly in heterogeneous diseases, such as COVID-19, with variability in patient outcomes, even within the hospital setting. This variability underscores the need for tailored treatment approaches based on distinct clinical subgroups.
Objectives:This study aimed to identify COVID-19 patient subgroups with unique clinical characteristics using real-world data (RWD) from electronic health records (EHRs) to inform individualized treatment plans.
Materials and methods:A Factor Analysis of Mixed Data (FAMD)-based agglomerative hierarchical clustering approach was employed to analyze the real-world data, enabling the identification of distinct patient subgroups. Statistical tests evaluated cluster differences, and machine learning models classified the identified subgroups.
Results:Three clusters of COVID-19 in patients with unique clinical characteristics were identified. The analysis revealed significant differences in hospital stay durations and survival rates among the clusters, with more severe clinical features correlating with worse prognoses and machine learning classifiers achieving high accuracy in subgroup identification.
Conclusion:By leveraging RWD and advanced clustering techniques, the study provides insights into the heterogeneity of COVID-19 presentations. The findings support the development of classification models that can inform more individualized and effective treatment plans, improving patient outcomes in the future
