1,720,986 research outputs found
A retrospective cohort study comparing a novel, spherical, resorbable particle against five established embolic agents for uterine fibroid embolisation
No full textAIM: To evaluate the effectiveness of a novel, resorbable, spherical embolic agent compared with other established agents, by studying percentage fibroid infarction (the best indicator of long-term symptom improvement) in patients undergoing uterine fibroid embolisation (UFE). MATERIALS AND METHODS: This retrospective cohort study examined six different embolic agents used for fibroid embolisation, including a new gelatin-based, fully resorbable, spherical agent. The primary effectiveness outcomes were magnetic resonance imaging (MRI)-determined dominant fibroid infarct percentage (DF%) and all fibroid percentage infarct (AF%) at 3 months post-embolisation. MRI-determined uterine artery patency rate was the secondary outcome. Chi-squared test (χ
2), relative risk (RR) calculation (primary outcomes), and analysis of variance (ANOVA) (secondary outcome) were the statistical tests employed. RESULTS: One hundred and twenty patients were treated with six embolic agents (20 consecutive patients per group, overall mean age 44.8±6.4, initial uterine volume 570±472 ml, dominant fibroid volume 249±324 ml). Fibroid infarctrates were similar between the cohorts with no significant difference between the new gelatin-based resorbable particle and other embolics in either DF% (χ
2=3.92, p=0.56) or AF% (χ
2=2.83, p=0.73). Complete DF% RR=1.07 (0.90–1.27) and AF% RR=1.09 (0.85–1.41) suggest non-inferiority of the resorbable particle (d=0.67, p<0.05). A favourable uterine artery patency rate was demonstrated for the resorbable particle compared with gelatin slurry (82.5% versus 27.5%, p<0.001 after Bonferroni adjustment). CONCLUSIONS: This new gelatin-based, fully resorbable particle is an effective embolic agent for fibroid embolisation and achieves an infarct rate non-inferior to established embolics.
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Uterine Fibroid Embolization (UFE) with optisphere: A prospective study of a new, spherical, resorbable embolic agent
No full textINTRODUCTION: Optisphere (Teleflex, Wayne, PA, USA, currently distributed by Medtronic, Minneapolis, MN, USA) is a new, resorbable, calibrated spherical embolic agent. We aimed to evaluate its clinical safety and effectiveness for fibroid embolization through a prospective case series.METHOD: This prospective case series studied patients treated with fibroid embolization using Optisphere between July 2017 and June 2018. The primary outcomes were device-related adverse event assessments and MRI-determined percentage infarct of the dominant fibroid (DF %) and infarct of all fibroids (AF %) at 3 months post-embolization. Secondary outcomes included symptom improvement with the validated Uterine Fibroid Symptom Score and Quality of Life questionnaire (UFS-SS and UFS-QOL) at 3 months and 12 months post-embolization. Statistical analysis was through the Wilcoxon signed-rank test for nonparametric paired data.RESULTS: Twenty-three consecutive patients were treated with Optisphere (median age 44.0, uterine volume 484.0 ml, dominant fibroid volume 167.0 ml). The complete dominant fibroid infarction (DF %) rate was 91.3% (21/23 patients), and the complete all fibroid infarction rate (AF %) was 82.6% (19/23). No adverse device-related safety events were encountered. Significant improvement was demonstrated in 3-month UFS-SS (56 vs 19, p < 0.0001), UFS-QOL (40 vs 88, p = 0.0008), uterine volume (484 ml vs 246 ml, p < 0.0001) and dominant fibroid volume (167 vs 64 ml, p < 0.0001). Symptomatic improvement continued to 12 months (UFS-SS 56 vs 11, p = 0.0008, UFS-QOL 40 vs 98.7, p = 0.0008).CONCLUSION: Optisphere is an effective embolic agent for fibroid embolization with good symptomatic response and percentage fibroid infarct.</p
Proactive inhibition is marked by differences in the pattern of motor cortex activity during movement preparation and execution
Full text linkSuccessful human behaviour relies on the ability to flexibly alter movements depending on the context in which they are made. One such context-dependent modulation is proactive inhibition, a type of behavioural inhibition used when anticipating the need to stop or change movements. We investigated how the motor cortex might prepare and execute movements made under different contexts. We used transcranial magnetic stimulation (TMS) in different coil orientations (PA: postero-anterior and AP: antero-posterior flowing currents) and pulse widths (120 μs and 30 μs) to probe the excitability of different inputs to corticospinal neurons whilst participants performed two reaction time tasks: a simple reaction time task and a stop-signal task requiring proactive inhibition. We took inspiration from state space models to assess whether the pattern of motor cortex activity changed due to proactive inhibition (PA and AP neuronal circuits represent the x and y axes of a state space upon which motor cortex activity unfolds during motor preparation and execution). We found that the rise in motor cortex excitability was delayed when proactive inhibition was required. State space visualisations showed altered patterns of motor cortex activity (combined PA120 and AP30 activity) during proactive inhibition, despite adjusting for reaction time. Overall, we show that the pattern of neural activity generated by the motor cortex during movement preparation and execution is dependent upon the context under which the movement is to be made
Liver-predominant metastatic uveal melanoma treated with melphalan percutaneous hepatic perfusion
No full textMid-term results of the prospective LUMI-PAE study: propensity-matched analysis of 1-year follow-up data
No full textProstatic Artery Embolization (PAE) and Transurethral Resection of the Prostate (TURP) have a differential impact on Lower Urinary Tract Symptoms (LUTS): Retrospective Analysis of the Multicentre UK-ROPE (UK Register of Prostate Embolization) Study
No full textPURPOSE: To compare the relative IPSS (International Prostate Symptom Score) improvement in storage and voiding symptoms between prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP).METHOD: Retrospective analysis of the UK-ROPE (UK Register of Prostate Embolization) multicentre database was conducted with inclusion of all patients with full IPSS questionnaire score data. The voiding and storage subscore improvement was compared between interventions. Student's t-test (paired and unpaired) and ANOVA (Analysis of variance) were used to identify significant differences between the groups.RESULTS: 146 patients (121 PAE, 25 TURP) were included in the analysis. Storage symptoms were more frequently the most severe symptom ('storage' in 75 patients vs 'voiding' in 17 patients). Between groups, no significant difference was seen in raw storage subscore improvement (TURP 4.9 vs PAE 4.2; p = 0.34) or voiding subscore improvement (TURP 8.4 vs PAE 6.7; p = 0.1). ANOVA demonstrated a greater proportionate reduction (relative to total IPSS) towards voiding symptoms in the TURP group (27.3% TURP vs 9.9% PAE, p = 0.001).CONCLUSION: Although both TURP and PAE improve voiding symptoms more than storage, a significantly larger proportion of total symptom reduction is due to voiding in the TURP cohort, with PAE providing a more balanced improvement between voiding and storage.</p
The Impact on Anti-Mullerian Hormone (AMH), uterine fibroid size and uterine artery patency following Uterine Fibroid Embolization (UFE) with a resorbable embolic agent
No full textThe effect of Uterine Fibroid Embolization on fertility and ovarian reserve remains uncertain. We assessed the impact of a new resorbable, spherical particle (Gelbead) on concentration of Anti-Mullerian (AMH) hormone, fibroid volume and uterine artery patency. This prospective cohort study recruited consecutive patients from July 2017 to June 2018. Serum AMH, fibroid and uterine volume, UFS-QOL (uterine fibroid score-quality of life) scores were measured prior to and at 1 month and/or 3 months post embolization. Twenty-four participants were enrolled (median age 44 years, uterine volume 484 cm
3, initial dominant fibroid volume 167 cm
3). One patient was lost to follow-up. AMH (median ± SD) immediately prior to embolization was 3.2 ± 13.7 pmol/L. At 1-month postembolization, AMH was 4.1 ± 8.6 pmol/L and at 3 months 4.4 ± 8.6 pmol/L. We found no significant difference in AMH levels between baseline and at 1 month (p = 0.58) or baseline and 3 months (p = 0.17). The median dominant uterine fibroid volume decreased (167 to 64 cm
3, p < 0.001). At 3 months post-embolization, 17/23 patients had patent uterine arteries bilaterally (73.9%). UFE with Gel-bead did not significantly affect AMH at 3 months post embolization, whilst maintaining a high rate of uterine artery patency.
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Technical and imaging outcomes from the UK registry of prostate artery embolization (UK-ROPE) study: Focusing on predictors of clinical success
No full textINTRODUCTION: The UK Registry of Prostate Artery Embolization (UK-ROPE) was a prospective, multicentre study comparing PAE against surgical therapies for symptomatic benign prostatic hyperplasia (BPH). A wealth of data was collected supplementary to the main study outcomes which provide a snapshot of UK PAE practice. We aimed to interpret these data in the hope of providing insight into factors which affect clinical outcome and radiation dose.METHODS: 216 patients (mean age 66, mean IPSS 21.3) undergoing PAE at 20 British centres from July 2014 to January 2016 were prospectively followed up to 12 months with retrospective analysis of the data. Technical outcome was evaluated based on procedural and fluoroscopy times, skin dose and dose area product (DAP). Clinical outcome was evaluated through collection of Qmax, IPSS reduction and prostate volume reduction. Multiple analysis of variance (MANOVA) was used to assess the significance of various patients and procedural factors on clinical outcome and patient dose.RESULTS: Significant predictors of technical outcome which affected patient skin dose included severity of CTA-detected atheroma (p < 0.001), the practitioner (p < 0.001) and use of protective coil embolization (p = 0.019). Predictors of clinical outcome included initial prostate size (dichotomized into groups > 80 ml and = <80 ml, d = 1, p = 0.0138), embolic agent (spherical particles < 300 nm performed best, p = 0.01) and number of arteries embolized (IPSS reduction of 32.9% in unilateral PAE versus 54.4% for bilateral PAE, p = 0.026).CONCLUSION: We have identified several important factors which are associated with improved clinical outcome and increased patient dose which we hope will facilitate optimal patient selection and encourage improved embolization technique.</p
A machine learning approach using stone volume to predict stone-free status at ureteroscopy
No full textIntroduction: To develop a predictive model incorporating stone volume along with other clinical and radiological factors to predict stone-free (SF) status at ureteroscopy (URS). Material and methods: Retrospective analysis of patients undergoing URS for kidney stone disease at our institution from 2012 to 2021. SF status was defined as stone fragments < 2 mm at the end of the procedure confirmed endoscopically and no evidence of stone fragments > 2 mm at XR KUB or US KUB at 3 months follow up. We specifically included all non-SF patients to optimise our algorithm for identifying instances with residual stone burden. SF patients were also randomly sampled over the same time period to ensure a more balanced dataset for ML prediction. Stone volumes were measured using preprocedural CT and combined with 19 other clinical and radiological factors. A bagged trees machine learning model with cross-validation was used for this analysis. Results: 330 patients were included (SF: n = 276, not SF: n = 54, mean age 59.5 ± 16.1 years). A fivefold cross validated RUSboosted trees model has an accuracy of 74.5% and AUC of 0.82. The model sensitivity and specificity were 75% and 72.2% respectively. Variable importance analysis identified total stone volume (17.7% of total importance), operation time (14.3%), age (12.9%) and stone composition (10.9%) as important factors in predicting non-SF patients. Single and cumulative stone size which are commonly used in current practice to guide management, only represented 9.4% and 4.7% of total importance, respectively. Conclusion: Machine learning can be used to predict patients that will be SF at the time of URS. Total stone volume appears to be more important than stone size in predicting SF status. Our findings could be used to optimise patient counselling and highlight an increasing role of stone volume to guide endourological practice and future guidelines.</p
Transarterial embolization for mitigation of severe hypoglycemia in 2 patients with primary pancreatic insulinoma
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