Nationwide changes in radiation oncology travel and location of care before and during the COVID-19 pandemic

Purpose@#Patients with cancer are particularly vulnerable to coronavirus disease (COVID). Transportation barriers made travel to obtain medical care more difficult during the pandemic. Whether these factors led to changes in the distance traveled for radiotherapy and the coordinated location of radiation treatment is unknown. @*Materials and Methods@#We analyzed patients across 60 cancer sites in the National Cancer Database from 2018 to 2020. Demographic and clinical variables were analyzed for changes in distance traveled for radiotherapy. We designated the facilities in the 99th percentile or above in terms of the proportion of patients who traveled more than 200 miles as “destination facilities.” We defined “coordinated care” as undergoing radiotherapy at the same facility where the cancer was diagnosed. @*Results@#We evaluated 1,151,954 patients. There was a greater than 1% decrease in the proportion of patients treated in the Mid-Atlantic States. Mean distance traveled from place of residence to radiation treatment decreased from 28.6 to 25.9 miles, and the proportion traveling greater than 50 miles decreased from 7.7% to 7.1%. At “destination facilities,” the proportion traveling more than 200 miles decreased from 29.3% in 2018 to 24% in 2020. In comparison, at the other hospitals, the proportion traveling more than 200 miles decreased from 1.07% to 0.97%. In 2020, residing in a rural area resulted in a lower odds of having coordinated care (multivariable odds ratio = 0.89; 95% confidence interval, 0.83–0.95). @*Conclusion@#The first year of the COVID pandemic measurably impacted the location of U.S. radiation therapy treatment.

Citrate does not Change Viscoelastic Haemostatic Assays after Cardiopulmonary Bypass

Context:Viscoelastic hemostatic assays (VHA) are commonly used to identify specific cellular and humoral causes for bleeding in cardiac surgery patients. Cardiopulmonary bypass (CPB) alterations to coagulation are observable on VHA. Citrated VHA can approximate fresh whole blood VHA when kaolin is used as the activator in healthy volunteers. Some have suggested that noncitrated blood is more optimal than citrated blood for point?of?care analysis in some populations. Aims: To determine if storage of blood samples in citrate after CPB alters kaolin activated VHA results. Settings and Design: This was a prospective observational cohort study at a single tertiary care teaching hospital. Methods and Material: Blood samples were subjected to VHA immediately after collection and compared to samples drawn at the same time and stored in citrate for 30, 90, and 150 min prior to kaolin activated VHA both before and after CPB. Statistical Analysis Used: VHA results were compared using paired T?tests and Bland–Altman analysis. Results: Maximum clot strength and time to clot initiation were not considerably different before or after CPB using paired T?tests or Bland– Altman Analysis. Conclusions: Citrated samples appear to be a clinically reliable substitute for fresh samples for maximum clot strength and time to VHA clot initiation after CPB. Concerns about the role of citrate in altering the validity of the VHA samples in the cardiac surgery population seem unfounded.

Efeitos do alinhamento justo e similaridade de rostos no reconhecimento de pessoas / Effects of a fair lineup and face similarity similarity in eyewitness identification / Efectos de la alineación justa y similitud facial en el reconocimiento de personas

Um falso reconhecimento de uma pessoa pode levar à condenação de um inocente. Um método efetivo de diminuir o falso reconhecimento é por meio do alinhamento, procedimento no qual o suspeito é apresentado em conjunto com outras pessoas - fillers (não suspeitos similares ao suspeito). Em um experimento foi comparado o desempenho de testemunhas em alinhamentos nos quais fillers apresentavam moderada ou alta similaridade em relação ao suspeito. Independentemente do grau de similaridade, suspeitos foram identificados com maior frequência que suspeitos inocentes e do que fillers, e fillers foram reconhecidos em maior frequência do que suspeitos inocentes. A similaridade entre fillers e suspeito não teve efeito na probabilidade de reconhecimento do suspeito, seja ele culpado ou inocente. Os resultados são discutidos à luz de teorias acerca do efeito de similaridade de fillers e implicações dos resultados para o sistema de justiça brasileiro (AU).

Faulty witness identification can lead to the conviction of an innocent person. An effective method to reduce misidentification is using a lineup, a procedure in which the suspect is presented among "fillers" (non-suspects similar to the suspect). In an experiment, we compared the responses of eyewitnesses in lineups where fillers had moderate or high similarity to the suspect. Regardless of the degree of similarity, guilty suspects were identified more often than innocent suspects and fillers, and fillers were identified more often than innocent suspects. The similarity between fillers and suspect did not affect the probability of suspect recognition, whether the suspect was guilty or innocent. The results are discussed in the light of theories about the similarity effect of fillers, and implications for the Brazilian justice system (AU).

Un reconocimiento falso de una persona puede conducir a la condena de un inocente. Un método eficaz para reducir el reconocimiento falso es la alineación, un procedimiento en el que el sospechoso se presenta junto con otras personas - fillers (no sospechosos similares al sospechoso). En un experimento se compara el rendimiento de los testigos en alineaciones en las que los fillers tenían una similitud moderada o alta con el sospechoso. Los resultados mostraron que, independientemente del grado de similitud, en una alineación justa, los sospechosos culpables son más propensos a ser identificados que los inocentes y que los fillers, y cuando el sospechoso es inocente, los fillers tienen más probabilidades de ser reconocidos. La similitud entre filler y sospechoso no tuvo efecto sobre la probabilidad de reconocimiento del sospechoso, tanto si era culpable o inocente. Los resultados se discuten a la luz de las teorías sobre el efecto de similitud de los rellenos y las implicaciones de los resultados para el sistema judicial brasileño (AU).

ASpirin and Plavix Following Coronary Artery Bypass Grafting (ASAP-CABG): A Randomized, Double-Blind, Placebo-Controlled Pilot Trial.

Background: Vein graft thrombosis is the leading cause of acute graft failure within the first post-operative month. Several studies have shown the benefit of post-operative dual anti-platelet therapy (DAPT) in preventing acute graft thrombosis. The purpose of this study was to determine whether peri-operative initiation of DAPT will improve short and intermediate term graft patency. Methods: This was a randomized, double-blind, placebo controlled trial of 20 patients undergoing CABG to compare DAPT versus aspirin monotherapy. The primary outcome was post-operative graft patency at 2 and 52 weeks determined by <50% bypass graft stenosis by cardiac computed tomography angiography (CCTA). The secondary outcomes were (1) major adverse cardiovascular events (MACE), defined as myocardial infarction, thrombotic events, and angina, and (2) safety end-points defined as TIMI major and minor bleeding events. Results: The study population consisted predominately of men (19/20 patients). At 2 weeks, all LIMA grafts were patent although vein graft patency for the DAPT group was only 83.3% (20/24) compared to 89.5% (17/19) for placebo (p=0.597). At 52 weeks, the patency rate in the placebo group was 52.6% (10/19) as compared to a patency of 71.4% (15/24) in the dual anti-platelet therapy arm (p=0.244). Conclusion: The addition of clopidogrel to aspirin post-bypass surgery did not significantly improve venous graft patency at 2 weeks but trended toward higher graft patency at 52 weeks.

Three Dimensional Quantitative Coronary Angiography Can Detect Reliably Ischemic Coronary Lesions Based on Fractional Flow Reserve

Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 +/- 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm2, %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

Utility of Per Vessel Coronary Artery Calcium (CAC) Score in Symptomatic Patients Undergoing Coronary Computed Tomography in Predicting Major Adverse Cardiovascular Events: Single Center Experience and Literature Review.

Background: Atherosclerotic vascular disease remains a significant etiology of morbidity and mortality in the United States. Coronary artery calcium (CAC) is associated with increased stroke incidence and coronary atherosclerotic burden. Uncertainty remains regarding how best to interpret non-zero CAC scores, particularly in symptomatic patients. Methods: A review of the first 1122 patients who underwent coronary CT angiography (CCTA) with CAC scoring from January 2005 until July 2012 was performed. Patients were dichotomized into 2 groups, zero CAC score and non-zero CAC score. Non-zero CAC patients were further subdivided based on the specific coronary artery containing calcium. Rates of major adverse cardiovascular events (MACE) defined as all-cause mortality, non-fatal myocardial infarction (MI), ischemic stroke, and late revascularization (>90 days following CCTA) were evaluated in each group. Results: 505 patients (63% male, mean age 60 ± 11) with non-zero CAC scores were analyzed over a six year period with resultant median follow up period of 22 months (IQR25,75 13-34 months). Major adverse cardiovascular events were observed in 11 patients. Receiver-operator curve (ROC) analysis on each coronary segment showed significance with the presence of left main (LM) CAC (AUC 0.752, p=0.004). Conclusions: The presence of CAC at any value in the LM in this case series appears to predispose patients to increased rates of MACE.

Temporal Trends in Radiation Exposure and Utilization of Coronary CT Angiography, SPECT, and Invasive Coronary Angiography.

Background: The use of noninvasive medical imaging has increased over the past decade at a cost of significant lifetime radiation exposure to study subjects. We report the implementation of radiation dose reduction methods and associated reduction in ionizing radiation exposure with Coronary Computed Tomography Angiography (CCTA) over time. Methods: Radiation doses and total number of studies performed were evaluated constantly from January 2010 to September 2012 for CCTA (N=2613), as well as Single photon emission computed tomography (SPECT, N=8060) part of an ongoing effort to minimize radiation exposure. Analysis of variance was used to evaluate the radiation exposure reduction among modalities. We compared CCTA radiation doses in the era of retrospective protocols coupled with dose modulation (40%-80%phase) using Siemens® 64-slice Dual Source technology, with prospective scanning on the same equipment, as well as radiation doses on the newer Siemens® Flash Equipment and the implementation of nursing/technologist aggressively driven protocol for heart rate control and image acquisition independent of imaging provider presence during acquisition. Results: The radiation dose reduction with implementation of multiple measures of radiation reduction to include physician independent-technician driven CCTA protocol resulted in a reduction from mean of 9.85±5.96 (median 8.8mSv) to mean of 3.00±2.53(median 2.1mSv) (p<0.0001). CCTA radiation dose has decreased by 69.2% since January of 2010 while SPECT radiation dose remained constant at 14mSv (p<0.0001). Conclusion: Continued advances in software and hardware technology, combined with “physician independent-technician driven” CCTA protocol have drastically reduced radiation dosing in CCTA to annual background radiation exposure, while maximizing the benefit of the study and without sacrificing patient safety.

The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry / 예방의학회지

OBJECTIVES: This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. METHODS: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. RESULTS: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for beta-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. CONCLUSIONS: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

Meibography a review of techniques and technologie

Meibomian glands play a significant role in tear production by contributing lipids to the superficial tear film. Dysfunction of the meibomian glands destabilizes tears resulting in evaporative dry eye. Historically, the meibomian glands were assessed in an ex vivo fashion through histologic studies. However, innovations in ocular imaging have advanced significantly in recent decades to include meibography. Meibography is an imaging study developed 35 years ago exclusively for the purpose of observing the morphology of meibomian glands in vivo.4'5 In this review of meibography, we briefly describe the etiology of meibomian gland dysfunction and then discuss various meibography techniques, technologies, and methods of image analysis. We close with a review of the literature, crediting various studies for the significant contributions made toward our current understanding of the meibomian glands

Efecto del dantroleno sódico sobre la concentración de Ca2+ mioplásmico en porcinos susceptibles a hipertermia maligna / Effect of sodium dantrolene on myoplasmic Ca2+ concentration in malign hypertermia in susceptible pigs

Se estudió la [Ca2+]i en reposo, y sus modificaciones por acción del dantroleno sódico en cerdos susceptibles a HM, bajo anestesia con N2O-halotano-pancurinio. A un Vm en reposo de -85 ñ 1 mV la [Ca2+]i fue de 0.41 (ñ 0.01) micronM. Dosis de dantroleno de 0,5 mg/Kg redujeron la [Ca2+]i pero no impidieron la ocurrencia del síndrome de HM. Este fue prevenido por dosis de 1 mg/Kg parcialmente y 2,5 mg/øg totalmente; en ambos casos sin afectar el potencial de membrana (Vm) en reposo, de la fibra musuclar. Se sugiere que el nivel crítico de [Ca2]i en este animal; sobre el cual se desencadena el episodio es de 0,19-0,2 micronM. y el mal funcionamiento de la homeostasis del Ca2+ está relacionado al síndrome